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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

  1. Create a differential diagnosis for back pain in children and teens.
  2. Determine an appropriate work up.
  3. 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.

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].

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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.

Sincerely,
Steve

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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.”

Learn more about St. Charles Gastroenterology on our website.

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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.’”

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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

  1. Learn about the latest vaccine recommendations.
  2. Review the latest status of emerging and returning respiratory viruses.
  3. 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.

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].

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Grand Rounds - November 8, 2024
"Serious Illness Conversations"

Speakers:

  • Katie H. Stowers, DO,FAAHPM. Director of Serious Illness Education; Palliative Care Physician OHSU Center for Ethics in Healthcare.
  • Briana Ketterer MD, MS. Assistant Professor of Medicine, Palliative Care Physician; Education Director of Inpatient Palliative Care; Serious Illness Communication Coach OHSU Center for Ethics in Healthcare.
  • Jared Chiarchiaro, MD, MS. Pulmonary and Critical Care Physician, OHSU Communication Coach, OHSU Center for Ethics in Healthcare.

 

 

Objectives

  1. Appreciate how a person-centered framework for goals of care conversations can improve quality and efficiency.
  2. Recognize the importance of sharing clear medical information to aid in patient understanding.
  3. Feel prepared to recognize and respond to patient emotions.

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].

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Community members throughout Central Oregon are invited to a day of celebration in recognition of Native American, American Indian and Alaskan Native Heritage month at St. Charles Madras on Thursday, Nov. 14. The celebration will include a Native Market with 10 artisan vendors from the Confederated Tribes of Warm Springs, complimentary fry bread tacos and a presentation of the new land acknowledgment and artwork in the hospital’s Galleria. The Native Market is open to the public from 11 a.m. to 3 p.m. and the land acknowledgment presentation will take place at 1:15 p.m.

During the event, St. Charles President and CEO Dr. Steve Gordon will share why a land acknowledgement, which was developed in partnership with members of the Confederated Tribes of Warm Spring, is important to St. Charles and surrounding communities.  

“This acknowledgement is a way for us to pay respects to the original inhabitants and to recognize Indigenous people as the original stewards of the land upon which we reside and work,” Gordon said. “We hope that by sharing this acknowledgment we can aid in emotional healing, invite personal inquiry and reflection, and help set a positive tone for future generations.” 

The presentation will also include Kiksht language speakers from Madras High School and Warm Springs K8 Academy.

The land acknowledgment and accompanying artwork will be on permanent display in the main entrance at St. Charles Madras. In the coming months, the acknowledgment will also be installed at other St. Charles locations. Learn more about St. Charles’ land acknowledgment on our website.

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Grand Rounds - November 1, 2024
"Malnutrition in the Elderly"

Speaker: Lagomarcino Ledesma, MS, RDN, CSO, CLT. Oncology Dietitian, Cancer Resource Center, UCSF Helen Diller Family Comprehensive Cancer Center.

 

 

Objectives

  1. List three consequences of malnutrition.
  2. Name three or more micronutrients that are commonly low in the aging population.
  3. Employ three or more nutritional and supplemental strategies to combat sarcopenia.

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].

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For many of us, it wouldn’t be fall without having a little creative fun with a pumpkin. We bake with them, we decorate our homes with their fun colors and textures, and we put extra thought into carving our neighborhood’s greatest entryway masterpiece. There’s nothing quite as nostalgic as carving pumpkins.

The majority of the 1.5 billion pounds of fresh pumpkin varieties grown in the United States each year are sold for Halloween. Increasing pumpkin sales during the fall months also means an increase in people visiting the emergency room with hand injuries from slicing into a pumpkin. Various injuries can occur when dealing with a pumpkin’s hard flesh and a sharp cutting utensil. The St. Charles Center’s hand surgeons see several injuries from pumpkin carving every year. Most are minor, but the more serious ones that make it to a hand surgeon can involve injury to your tendons or nerves and require surgery.

Common hand injuries from pumpkin carving 

  • Minor cuts or lacerations in the non-dominant hand
  • Stab and puncture wounds in the hand
  • Severed tendons and ligaments
  • Permanent nerve damage in hands and fingers
  • Flexor and extensor tendon injuries
  • Loss of function and motion in the hand

To avoid hand injuries this fall season, here are some recommendations from the American Society for Surgery of the Hand:

Carve in a clean, dry, well-lit area

Wash and thoroughly dry all of the tools that you will use, including: carving tools, knife, cutting surface, and your hands. Any moisture on your tools, hands, or table can cause slipping that can lead to injuries.

Always have adult supervision

All too often, we see adolescent patients with injuries because adults feel the kids are responsible enough to be left on their own. Even though the carving may be going great, it only takes a second for an injury to occur.

Leave the carving to adults

Never let children do the pumpkin carving. Instead, maybe let kids draw a pattern on the pumpkin and have them be responsible for cleaning out the inside pulp and seeds. When the adults do start cutting, they should always cut away from themselves and cut in small, controlled strokes.

Sharper is not better

A sharper knife is not necessarily better, because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it. An injury can occur if your hand is in the wrong place when the knife finally dislodges from the thick skin of the pumpkin. Injuries are also sustained when the knife slips and comes out the other side of the pumpkin where your hand may be holding it steady.

Use a pumpkin carving kit

Special kits are available in stores and include small, serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue.

Help for an injury

Should you cut your finger or hand, bleeding from minor cuts will often stop on its own by applying direct pressure to the wound with a clean cloth. If continuous pressure does not slow or stop the bleeding after 15 minutes, an emergency room or urgent care visit may be required.

While most of the injuries from pumpkin carving may only need stitches, others may need to be seen by a hand specialist, such as a hand surgeon, who can restore the hand’s movement and function.

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