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.

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Concussions are a significant concern in youth sports, especially as research uncovers the long-term consequences of head injuries. While much attention has been focused on the physical damage caused by concussions, their psychological effects are equally alarming, particularly in youth athletes who are still in crucial developmental stages. Understanding the psychological effects of concussions on youth athletes is vital for parents, coaches, and educators to protect the well-being of young athletes.

What is a concussion?

A concussion is a type of traumatic brain injury (TBI) caused by a blow or jolt to the head or body, resulting in the brain moving rapidly back and forth. The Centers for Disease Control and Prevention (CDC) define concussions as "a mild TBI that can change the way your brain normally works." Symptoms of concussions can be physical (headaches, dizziness, nausea), cognitive (difficulty concentrating, confusion), or emotional (irritability, mood swings).

The prevalence of concussions in youth sports

According to the CDC, around 1.6 to 3.8 million sports-related concussions occur annually in the U.S. Although all sports carry some risk, contact sports like football, soccer, and hockey have the highest incidence of concussions. A study published in Pediatrics shows that approximately 15% of high school athletes have experienced at least one concussion, with many cases going unreported due to under-recognition or athletes not wanting to miss games.

Psychological effects of concussions

While the physical symptoms of concussions may subside within a few weeks, the psychological effects can be long-lasting and, in some cases, debilitating. These effects are particularly concerning for youth athletes because their brains are still developing, making them more vulnerable to long-term consequences.

1. Mood changes

One of the most common psychological symptoms following a concussion is mood instability. Research from the Journal of Neurosurgery: Pediatrics suggests that concussions can lead to increased anxiety, depression, irritability, and even aggression. This is particularly alarming for adolescents, as they are already navigating hormonal changes and the emotional challenges of growing up. Youth athletes may struggle to understand and cope with these mood swings, potentially leading to withdrawal from social interactions or a decline in academic performance.

2. Cognitive impairments

Concussions can impair cognitive functions such as memory, attention, and problem-solving, which are essential for both sports performance and academic success. A study published in JAMA Pediatrics indicates that cognitive symptoms may last longer in younger athletes, with some experiencing lingering effects for months. This can cause frustration and anxiety, particularly for athletes who feel pressure to return to their sport prematurely or who struggle academically as a result of their injury.

3. Sleep disruptions

Sleep problems are another common post-concussion symptom, and these can have far-reaching psychological effects. Poor sleep can exacerbate mood disorders, increase fatigue, and hinder cognitive recovery. According to the Sleep Medicine Reviews, concussions often lead to insomnia or changes in sleep patterns, which in turn can negatively impact an athlete’s mental health and recovery process.

4. Social isolation and identity issues

For many youth athletes, sports are not just a hobby but a core part of their identity. Being sidelined due to a concussion can cause feelings of isolation and a loss of self-worth. Research from The Clinical Journal of Sports Medicine highlights that athletes who are unable to participate in their sport may experience social withdrawal and depression, especially if they feel disconnected from their teammates. The pressure to return to the game, often reinforced by peers or coaches, can further exacerbate these feelings.

Long-term psychological consequences

The psychological effects of concussions aren’t just short-term concerns. Studies have shown that repeated concussions or improperly managed recovery can lead to chronic issues such as post-concussion syndrome (PCS) or even chronic traumatic encephalopathy (CTE). PCS involves persistent symptoms that last for months or even years, including depression, anxiety, and memory problems. CTE, often associated with athletes in contact sports, is a neurodegenerative disease that can result in severe depression, aggression, and dementia later in life.

Prevention and recovery: what can be done?

Given the potential psychological impacts, it is crucial to prioritize concussion prevention and proper management in youth sports.

1. Education: Parents, coaches, and athletes must be educated about the risks of concussions and the importance of reporting symptoms. Go HERE to learn more about concussions.
2. Strict Return-to-Play Protocols: Athletes should not return to play until they are fully symptom-free and have been cleared by a healthcare professional. The American Academy of Pediatrics emphasizes the importance of following a stepwise return-to-play approach to avoid exacerbating symptoms or increasing the risk of re-injury. Read about our protocols for safe return to play following concussion HERE.
3. Appropriate Medical Coverage: Athletic trainers are health care professionals who are experts in recognizing, evaluating and treating concussions. It is crucial that anywhere youth sports are played, that adequate medical coverage is available to appropriately recognize, evaluate and remove from play suspected concussions. Parents, if your sports league does not have athletic trainers present to cover games ask them why and advocate for the safety of your kids. Learn about our Sports Medicine program HERE.
4. Mental Health Support: Mental health professionals should be involved in concussion management, especially for athletes who experience prolonged psychological symptoms. Early intervention can help mitigate long-term effects and provide athletes with coping strategies.
5. Awareness of Long-Term Risks: While a single concussion can have significant effects, the danger increases with repeated head injuries. Coaches and parents must advocate for a cautious approach, especially in youth sports where long-term brain health should be the priority.

Conclusion

Concussions are more than just a physical injury. The psychological toll they take on youth athletes can be profound and long-lasting. Parents, coaches and health care professionals must be vigilant in recognizing the signs of concussions and ensuring that athletes receive the proper care—not only for their physical recovery but for their mental health as well. By raising awareness and prioritizing safety, we can help protect the mental well-being of the next generation of athletes. 

Sources:

• Centers for Disease Control and Prevention (CDC). “Concussion in Sports.”
• JAMA Pediatrics. “Cognitive Impairments Following Concussions in Youth Athletes.”
• Journal of Neurosurgery: Pediatrics. "Mood Changes After Concussion in Young Athletes."
• Sleep Medicine Reviews. "Sleep Disturbances in Youth Following Concussion."
• Clinical Journal of Sports Medicine. "Social and Psychological Effects of Sports-Related

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.

What is a land acknowledgment and why did St. Charles create one?

A land acknowledgment is a way for organizations and entities to to recognize Indigenous people as the original stewards of the land upon which we reside and work. St. Charles is embracing this process in hopes that it can also serve as a tool for emotional healing that can help set a positive tone for future generations. 

St. Charles recognizes that the health system and hospitals occupy land originally inhabited by Indigenous people, who populated this region for thousands of years (sandals found near Fort Rock date back 7,000 years). 

It’s important to recognize that the descendants of the original inhabitants of this land continue to live and thrive in Central Oregon. Members of the Confederated Tribes of Warm Springs are part of the St. Charles community and are valued caregivers, patients and community members. By acknowledging the past and working towards an inclusive future, St. Charles also aims to be a place where Indigenous professionals can be part of a thriving health care system that uses culturally competent practices for all. 

What is the history of the Confederated Tribes of Warm Springs? 

The Jefferson County region has long been a place where food was gathered and collected. Tribes used this area as a hub for travel and commerce before settlers came in the 19th Century and well before the Treaty of 1855 was signed with the Mid-Columbia Tribes.  

The Confederated Tribes of Warm Springs is comprised of three distinct tribes:

Warm Springs: “Treaty Tribe” This includes many Ichishkiin Speaking tribes historically indigenous to the Jefferson/ Wasco/ Gilliam/ Wheeler/ Crook and Deschutes counties, now spoken of as one group.

Wascos: “Treaty Tribe” Re-located Kiksht Speaking tribes (Cascade Mountains to The Dalles) from the lush Columbia River to the arid High Desert.

Paiutes: “Non-Treaty Tribe” Many Numu Speaking tribes historically indigenous to the area from Deschutes County to western Idaho and south to Tonopah, Nevada and west to Yosemite National Park back to Deschutes County. These tribes were brought to the area after defending their territories against colonization, now a diaspora of people.  

See a map of the land ceded in the treaty with the Middle Bands of Oregon, courtesy of Robert Brunoe, tribal member and Secretary-Treasurer-CEO of the Confederated Tribes of Warm Springs

How was this land acknowledgment created?

St. Charles is grateful to all the partners who helped develop and inspire this project. We give special thanks to the following individuals for offering their insights and support. Thank you to members from the Confederated Tribes of Warm Springs, including Robert Brunoe, Tribal Member and Secretary-Treasurer-CEO of the Confederated Tribes of Warm Springs, and Shilo Shaw Tippett, Ph.D., Tribal Member, clinical psychologist with St. Charles and OHSU assistant professor, for helping create text of the land acknowledgment. Thank you to Rain Circle, Tribal Member, Kiksht language intern with the Cultural and Heritage Department with the Confederated Tribes of Warm Springs, for development and creation of content for the webpage. Thank you to the members of the CEO-appointed task force of St. Charles caregivers appointed to help support this effort, including Vanessa Culps, Tribal Member and a St. Charles caregiver. Thank you also to the many Tribal Members and St. Charles caregivers who provided valuable input, insight and support throughout the process. 

Where can the land acknowledgment be found?

Artwork depicting the text of the land acknowledgment can be found in the main entrance of St. Charles Madras. The land acknowledgment is also slated to be displayed at all four St. Charles hospitals and several St. Charles clinic locations throughout the region. 

What additional actions is St. Charles taking to align with this effort?

St. Charles Health System is committed to partnering with members of the Confederated Tribes of Warm Springs on programs that support increased health, wellness, education, understanding and awareness between our communities.

St. Charles Madras partners with spiritual leaders in Warm Springs to participate in beginning and end of life ceremonies in the hospital setting.

St. Charles was grateful for the opportunity to work closely with community partners in Warm Springs to advocate for passage of new state legislation to allow health care organizations to better support patients’ cultural and spiritual beliefs (the legislation passed in July 2023.) St. Charles is honored to be longtime participants in Native Aspirations, a community group with the focus on health and well-being of the Warm Springs community. Our organization is also honored to participate in the Pi-Ume-Sha health fair held in Warm Springs, one of the largest such fairs in the region. In 2022, St. Charles honored the passing of the Wasco Chief by lowering American flags on the hospital campuses. 

Residents who are part of St. Charles' new graduate medical education program (Three Sisters Rural Track Program), will practice medicine at the Indian Health Service Clinic in Warm Springs in addition to serving at St. Charles Madras and other area sites. 

St. Charles Madras hosts a quarterly Patient Family Advisory Council meeting with members from local communities, including Warm Springs. We look to members of the council to consistently help us learn and grow in our cultural competencies as a provider of health care in the Central Oregon region and we look forward to continuing to strengthen our relationships into the future. 

St. Charles Madras has also hosted a Native Market featuring local vendors from the Confederated Tribes of Warm Springs. 

How can individuals learn more about the history, culture and current events related to the Confederated Tribes of Warm Springs and other Indigenous people?

The Tribes host an informative website that includes information on tribal history.

A widespread international campaign is underway to raise awareness about instances of violence against Indigenous people called Missing and Murdered Indigenous Women and Relatives (learn more), and often symbolized by a red hand, often depicted across the mouth of an individual. Learn more by visiting Sovereign Bodies Institute, which has a goal of using “Indigenous traditions data gathering and knowledge transfer to create, disseminate, and put into action research on gender and sexual violence against Indigenous people.” 

Oregon State University hosts an in-depth resource for those interested in learning more about land acknowledgments and related resources. 

The land acknowledgment in Madras includes many symbols – what do they mean?

The border for the land acknowledgment includes symbols of objects, foods, animals and artifacts of importance to the Confederated Tribes of Warm Springs. Pictured are huckleberries, arrowheads, a root-digging tool, a salmon, a black bear and a basket.