When surgeons remove cancerous tissue during breast cancer surgery, they want to ensure they have removed all the cancer. Surgeons want to see clean margins, which means no cancer cells can be found at the edge of the tissue, suggesting that all the cancer has been removed.

Thanks to two new specially designed machines funded by St. Charles Foundation, checking for margins now takes mere seconds and reduces the time patients need to be under anesthesia during breast cancer surgery by 30 minutes or more. Redmond received its first Trident machine this winter and Bend received a replacement for a Trident machine at the end of its life.

Scott Nelson, director of Imaging services for St. Charles, explains that the change is huge, especially for patients undergoing surgery in Redmond. Previously, once the surgeon removed the tissue, another caregiver would take the tissue in a biohazard bag out of the operating room and run it across the parking lot to Central Oregon Radiology Associates, who would scan it for margins. This process took 30 to 40 minutes – all while the patient remained under anesthesia.

“Now, the Trident can be wheeled into the operating room and the surgeon can see within seconds whether they have all the margins or not. It’s easy to use and it’s a big win for doctors and for patients,” said Nelson.

The Trident machines are designed specifically for breast tissue. They do not emit any radiation and are easy to use, according to Nelson. The funding for the $110,000 machines came specifically from Sara’s Project, a special fund within the Foundation dedicated to breast cancer.

Breast cancer patients benefit because they will spend less time in surgery. Additionally, the time saved allows more surgeries to take place in the operating rooms, which is a benefit to patients and doctors across the region.

“This will have a huge impact on people’s lives,” said Nelson.

Jenny O’Bryan, executive director of the Foundation, said, “Our donors are committed to ensuring St. Charles caregivers have the best technology on hand to support our cancer patients. We are grateful to all the community members who have supported Sara’s Project over the years, as that fund continues to provide support and resources for breast cancer treatment.”

Sara’s Project was created in 1992 to honor Sara Fisher, a local teacher, counselor, volunteer and advocate for women’s health and breast cancer research and treatment. Learn more about the background and efforts of Sara’s Project on the Foundation’s website. 

Members of the public can expect increase in first responder vehicles and personnel at the Prineville facility June 12

St. Charles Prineville will host an emergency preparedness training event in partnership with local law enforcement, Fire/EMS and public health on the evening of June 12. Members of the public can expect to see an increased presence of first responder vehicles and personnel at the hospital and Family Care Clinic June 12 as part of this training exercise.

Due to the training event, the Prineville Urgent Care and Family Care Clinic will close at 5 p.m. June 12. Visitors who come to the hospital after 5 p.m. will be escorted to the room of the patient they wish to visit by hospital staff. During the drill, visitors may experience increased noise and will hear announcements overhead to test internal systems (these announcements will always include the word “drill”).

Emergency Department in Prineville will not be impacted during this drill.

NOTE: The drill is not open to the public or media.

Grand Rounds - June 7, 2024  
"Surgical Site Infections"

Speaker: Clinton Coil, MD, MPH, FACEP. Chief Quality Officer, Associate Medical Director for Quality and Safety, LA County Harbor‐UCLA Medical Center; Assistant Clinical Professor of Medicine, Division of Emergency Medicine, David Geffen School of Medicine at UCLA.

Objectives

1. Define surgical site infection (SSI) and identify risk factors for SSI in general and Pacemaker surgery.
2. Describe the components of prevention bundles to decrease SSI.
3. Review examples of programs that successfully reduced SSI.

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].

Enduring Materials - June 6, 2024
"Psychedelics for PTSD and other Mental Health Disorders"

Speaker: Melissa Brewster, PharmD, BCPS. Director of Pharmacy Services, Mosaic Community Health. 

Objectives

1. Describe the mental conditions, with special emphasis on trauma and PTSD, that may respond to psychedelics.
2. Discuss available and pipeline treatment options with psychedelics, to include dose and method of administration.
3. Understand the limitations of psychedelic treatments and the role of the health care provider to guide patients who seek psychedelics and other non-traditional care for emotional distress.
4. Review treatments available at Mosaic, within Central Oregon, and across the state using the Oregon Health Authority Psilocybin references.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and Mosaic Community Health. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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]. 

Did you know that St. Charles has a support group for people with new or established ostomies? The St. Charles Ostomy Support Group (OSG) has been providing ostomates with education, peer-to-peer support, community collaboration, and other resources for more than 13 years. This group meets quarterly, and is open to anyone with a colostomy, ileostomy, urostomy or nephrostomy; family members, spouses and caregivers also attend. Information provided at the meeting includes: 

• educational topics such as peristomal health, travel and recreation tips, and use of products 
• presentations by ostomy product representatives and supply companies, and 
• presentations by ostomates sharing their personal experiences. 

There is always ample time at the end of the meeting for members to share their stories and gain insight from other ostomates. 

The St. Charles OSG is now under the umbrella of the United Ostomy Associations of America (UOAA, ostomy.org), a well-established ostomy organization that provides an amazing amount of support for ostomates, their families and caregivers, and health care professionals. UOAA provides free educational materials (online and print) and information about attending their national conferences. 

If you or someone you know would benefit from this support group, please contact Leah Witmer who will provide you with more information. 

Lower extremity venous disease (LEVD) covers several dysfunctional disorders of the venous system, including the superficial veins, deep veins, and perforating veins. Damage or abnormalities in any part of the venous system can increase sustained pressure within the system. Symptoms of LEVD can include: 

• Aching and heaviness 
• Shallow wound(s) with irregular edges 
• High exudate (drainage) 
• Edema (swelling of the legs) 
• Pain and swelling often relieved by leg elevation 
• Hemosiderin staining (brownish discoloration of lower legs) 

Treatment for LEVD can include exams to evaluate the blood flow in your legs (Ankle Brachial Index, or ABI), topical wound care, and compression therapy. Learn more about the ABI exam and compression therapy. 

At the St. Charles Outpatient clinics, treatment for LEVD often begins with a non-invasive exam called an Ankle Brachial Index (ABI). ABI is an easy test to check the blood flow to your legs and feet. It can be done in 30 minutes by your wound care clinician. 

On the day of your ABI appointment, we will have you lay as flat as possible for 10 minutes. Then your wound care clinician will check the blood pressure in your arms and legs using a manual blood pressure cuff and Doppler, or with an automatic ABI machine. This will feel the same as checking your blood pressure at the doctor’s office except you will be able to hear the sounds (the Doppler is louder than the stethoscope) and we use a gel on your skin where we place the Doppler. We compare the numbers for six different arteries to determine your ABI. This means we will check your blood pressure six times in different places on your arms and legs. 

We will share the final results with you and your doctor so together we can better guide your care. The ABI will be used to determine the safe amount of compression to help your swelling and wound healing. If you have abnormal results, we will refer you for further testing with a vascular surgeon. 

An ABI >1.3 indicates calcified arteries and patient should be referred to vascular surgeon for further assessment 

An ABI of 0.9-1.3 indicates the patient can probably tolerate full compression (30-40mmHg) 

An ABI of 0.5-0.8 indicates lower extremity arterial disease (LEAD); light compression is recommended (20-30mmHg) 

An ABI < 0.5 is indicative of severe ischemia and should be emergently referred to a vascular surgeon to avoid loss of limb 

(Link to Compression Therapy) 

The use of compression to treat LEVD is the gold standard of treatment. Compression assists with improving venous return, reducing edema, reducing the diameter of vessels, and supporting the calf muscle pump. In addition, compression improves healing rates of venous leg ulcers. Options for compression that will be explored with your wound care clinician include multi-layer compression systems, compression socks, and adjustable wraps with Velcro straps. The table below shows different classifications of compression, and the indications for use. 

Lower extremity arterial disease (LEAD) is a progressive disease caused by systemic atherosclerosis, hardening of arteries caused by buildup of fats and cholesterol, combined with inflammation. This leads to stenosis and possible occlusion of the artery. Symptoms of LEAD can include: 

• In early stages, may have no symptoms 
• Red discoloration when legs are down, paleness of legs when elevated 
• Pain that increases with elevation and activity 
• Nocturnal pain (occurs at night) 
• Shiny, taut, and fragile skin; minimal or absent hair on lower extremity 
• ABI <0.9 

Treatment for LEAD is based on vascular test results (Ankle Brachial Index, or ABI). A referral for evaluation by a vascular specialist may also be indicated. Learn more about the ABI exam. 

At the St. Charles Outpatient clinics, treatment for LEAD often begins with a non-invasive exam called an Ankle Brachial Index (ABI). ABI is an easy test to check the blood flow to your legs and feet. It can be done in 30 minutes by your wound care clinician. 

On the day of your ABI appointment, we will have you lay as flat as possible for 10 minutes. Then your wound care clinician will check the blood pressure in your arms and legs using a manual blood pressure cuff and Doppler, or with an automatic ABI machine. This will feel the same as checking your blood pressure at the doctor’s office except you will be able to hear the sounds (the Doppler is louder than the stethoscope) and we use a gel on your skin where we place the Doppler. We compare the numbers for six different arteries to determine your ABI. This means we will check your blood pressure six times in different places on your arms and legs. 

We will share the final results with you and your doctor so together we can better guide your care. The ABI will be used to determine the safe amount of compression to help your swelling and wound healing. If you have abnormal results, we will refer you for further testing with a vascular surgeon. 

• An ABI >1.3 indicates calcified arteries and patient should be referred to vascular surgeon for further assessment 

• An ABI of 0.9-1.3 indicates the patient can probably tolerate full compression (30-40mmHg) 

• An ABI of 0.5-0.8 indicates lower extremity arterial disease (LEAD); light compression is recommended (20-30mmHg) 

• An ABI < 0.5 is indicative of severe ischemia and should be emergently referred to a vascular surgeon to avoid loss of limb 

Source:
Wound, Ostomy, and Continence Nurses Society. (2021). Core curriculum: Wound management (2nd ed.). 

Foot and Nail Care now offered at St. Charles Wound Clinics! 

Routine foot and nail care by a Certified Foot and Nail Care Nurse (CFCN) has been shown to reduce pain and injuries in the patient population at risk for limb loss. The patients that benefit from this specialty care include those with diabetes, neuropathy, and lower extremity arterial disease. 

Regular foot care can reduce the risk of foot ulcers and infection, reduce the risk of amputations, increase quality of life, and reduce hospitalizations and the cost of care related to diabetic and neuropathic foot ulceration. 

Services provided by our certified foot and nail care nurse include: 

• Foot assessment and inspection 
• Vascular assessment 
• Management of nails and skin 
• Management of corns and calluses 
• Patient/Caregiver education 
• Referral to specialist (podiatry, vascular, diabetic educator, nutrition, surgical) as needed 

To make an appointment at one of our outpatient wound clinics (Bend, Madras or Prineville), please contact your physician to obtain a referral. 

According to the WOCN Society, in collaboration with the American Society of Colon and Rectal Surgeons, preoperative stoma site selection and ostomy education should be performed for all patients who are undergoing surgery that may involve the creation of a stoma. This statement is supported by numerous evidence-based studies that show fewer postoperative complications when a stoma site is selected pre-operatively. 

The appointment 

A referral to the St. Charles outpatient Wound & Ostomy clinics can be obtained from your primary care physician or the surgeon who will be performing your procedure. The outpatient setting is ideal for this preoperative visit. The hour-long visit provides ample time, with no interruptions, for stoma site marking and education regarding the planned procedure and postoperative expectations. The ostomy nurse can also discuss ostomy resources, including supplies and ostomy support group information. 

Issues that are explored during the preoperative stoma site marking visit include: 

• Surgical considerations and diagnosis
• Physical considerations and limitations, including a protruding abdomen, skin folds, and the presence of scars or other stomas
• Patient considerations and limitations, including vision, manual dexterity, age, occupation, and clothing preferences
• Positioning considerations and limitations, which may include whether a patient uses a wheelchair or has postural issues such as contractures or scoliosis 

Ideally, the stoma site should be placed in an area you can easily see to facilitate self-care. The stoma site selection is completed after the ostomy nurse visualizes your abdomen while you are lying down, sitting, standing, and bending forward. 

Preoperative stoma site marking, along with pre– and postoperative education, has been shown to reduce complications, promote self-care, and improve an ostomate’s quality of life. 

A new cancer center in Redmond 

Located on the corner of NW Kingwood Ave. and NW Canal Blvd. in Redmond, our new cancer center will have a tremendously positive impact on our community, as it will expand access and services to Redmond and surrounding communities, serving 300 or more cancer patients every day. At more than 53,000-square-feet, the new St. Charles Cancer Center in Redmond will be nine times the size of our current facility in Redmond and will provide patients with comprehensive cancer services including radiation oncology, chemotherapy infusion, surgical oncology, expanded support services and much more.