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A Chiari malformation occurs when brain tissue extends outside of the skull and into the spinal cord. The cerebellum is a lower part of the brain that controls balance, coordination, and muscle movement. Normally, the cerebellum sits above an opening in the skull where the spinal cord passes through, called the foramen magnum. When part of the cerebellum extends below the foramen magnum and into the upper spinal canal, a Chiara malformation is present. There are several different types of Chiari malformations that are classified by the severity of the disorder and the part of the brain that is affected.

Causes and risk factors

  • Most often caused by structural defects in the brain and spinal cord that occur during fetal development
  • Excessive draining of spinal fluid due to traumatic injury, disease or infection
  • May be hereditary

Symptoms

Many people with Chiari malformation have no signs or symptoms and don’t require treatment. However, depending on the severity of the condition, there are some common symptoms:

  • Headaches, especially after coughing, sneezing or straining
  • Severe neck pain
  • Dizziness and balance problems
  • Blurred or double vision
  • Difficulty swallowing, which may cause gagging, choking or vomiting
  • Sleep apnea
  • Loss of sensation or tingling in the hands and arms
  • Developmental delays

Treatment

Treatment for Chiari malformation depends on the severity of the condition and symptoms. If no symptoms are present, your doctor will likely recommend no further treatment beyond monitoring with regular examinations. If headaches are the main symptoms, medications may be prescribed by your doctor. When more serious symptoms are present, surgery is usually necessary to relieve pressure on the spinal cord.

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Cerebral palsy affects approximately two of every 1,000 live births in the United States. This condition is usually the result of damage or abnormalities to the brain that occur before, during or shortly after birth. Cerebral palsy affects the parts of the brain that are involved with movement and coordination, and a child’s ability to control his or her muscles.

Cerebral palsy causes and risk factors

It is difficult to determine how damage or abnormalities to the brain are caused. Before a child is born, the brain is extremely sensitive to damage from maternal infections and toxins, as well as exposure to drugs or alcohol. A lack of oxygen during birth has also been linked to the development of cerebral palsy in some cases. After birth, infection, lack of oxygen and head injuries can all be contributing factors. Children born prematurely may be at a greater risk for developing cerebral palsy.

Symptoms

In most cases, cerebral palsy begins before a child is born, but this condition can also present itself at birth or during the early years of life. The physical disabilities resulting from cerebral palsy can be mild, moderate or severe, depending on which part and how much of the brain has been damaged. Early symptoms of cerebral palsy include:

  • Delayed milestones like learning to roll over, sit up, crawl or walk
  • Exaggerated reflexes
  • Involuntary movement
  • Stiffness or floppiness in the limbs

Treatment

There is no cure for cerebral palsy, but treatment for the symptoms is available. Treatment such as physical therapy, occupational therapy, speech therapy, medication or braces can help children significantly improve their functional capabilities. The condition will not worsen as children get older, but it is important to start treatment as soon as possible for the best results. In some cases, a pediatric neurosurgeon can do a surgical procedure to help manage the spasticity that can be associated with cerebral palsy.

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Bursitis is a condition caused by inflammation of one or both of the fluid-filled cushioning sacs between the rotator cuff and part of the shoulder blade (acromion). This condition often occurs with rotator cuff tendinitis.

Causes and risk factors

  • Excessive use
  • Long periods of pressure on joint (leaning on elbows)
  • Gout
  • Trauma
  • Rheumatoid arthritis

Symptoms

The many tissues of the shoulder become inflamed and painful with this condition. The shoulder area may have stiffness, swelling, and/or redness. Daily activities such as washing your hair and getting dressed may become painful.

Treatment

Bursitis is usually treated without surgery. Many people experience relief with lifestyle changes such as:

  • Activity modification
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Crutches/walking cane
  • Physical therapy
  • Steroid injection

In some cases surgery is required to repair torn tissues. A comprehensive examination from an orthopedic surgeon is required to find the causes of your shoulder pain and treat it appropriately.

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Together, the brain and spinal cord make up the central nervous system (CNS). The brain controls thought, memory, movement, speech, vision, hearing and more. The spinal cord is responsible for carrying messages between the brain and the rest of the body. A brain or spinal cord tumor is a mass formed by an abnormal growth of cells in the tissues of the brain or spinal cord. Tumors that begin in the CNS are known as primary tumors, while tumors that begin in another part of the body and travel to the CNS are known as secondary tumors. It is important to distinguish the difference between benign and malignant tumors. Benign tumors are non-cancerous and do not spread to nearby tissues or other distant areas. Malignant tumors are cancerous, and can spread to tissues throughout the body.

Causes and Risk Factors

The cause of most brain and spinal cord tumors is unknown, but there are certain risk factors to be aware of. Risk factors include:

  • Radiation exposure
  • Inherited or genetic conditions such as neurofibromatosis, Tuberous sclerosis, Von Hippel-Lindau disease or Li-Fraumeni syndrome

Symptoms

Signs and symptoms of a brain or spinal cord tumor may occur gradually and get worse over time, or they may happen suddenly. Your child’s symptoms will depend on the location and size of their tumor, and whether it effects the brain or the spinal cord. Common symptoms of a brain or spinal cord symptom include:

  • Headache
  • Nausea or vomiting
  • Changes in vision, hearing or other senses
  • Problems with balance or movement
  • Changes in personality, mood or behavior
  • Seizures
  • Drowsiness or another change in energy levels

It is important to note that many of these symptoms can be caused by other health issues. It is important to meet with your child’s primary care provider to determine the cause.

Treatment

Treatment for brain or spinal cord tumors greatly depends on a variety of factors. Your child’s neurological team will come up with a personalized treatment plan based on their age, the size of their tumor, the location of their tumor and more. Common treatment options include:

  • Radiation therapy
  • Chemotherapy
  • Targeted therapy drugs
  • Surgery

There are several types of procedures that may be performed depending on your child’s tumor. Surgery is typically performed to take a sample of the tumor to learn more about it, to remove or destroy the tumor, or to help prevent or treat symptoms associated with the tumor.

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If your child experiences a traumatic brain or spine injury, they will need to be evaluated by a neurosurgeon who is experienced in pediatric care. Your physician may use a neurological exam, diagnostic imaging, or other test to help diagnose the injury. Depending on the severity of the injury, your child’s treatment may include:

  • Observation and/or monitoring
  • Medication
  • Surgery

Treatment may include emergency care to prevent further damage. Our pediatric neurosurgeons make it a priority to clearly communicate with patients and their families so they can make well informed decisions about brain or spine injuries.

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Children are not just small adults. Their growing bodies require specialized orthopedic care, whether treating a fracture or a complicated medical condition like limb and spinal deformity. The St. Charles Center is committed to providing the highest level of quality pediatric orthopedic, pediatric neurosurgery and concussion care for Central Oregon children.

When your child is hurt, our pediatric orthopedic experts offer a broad range of the most advanced treatments and services ensuring your child gets the best possible care to get them back to what they love doing. When unexpected mishaps happen, our NOWcare walk-in injury clinic is open to provide immediate orthopedic expertise or concussion care.

Shriners Children's Clinic at the St. Charles Center for Orthopedics & Neurosurgery

For patients requiring more specialized care, Shriners Children’s provides pediatric neuromuscular orthopedic care for children up to age 17 two times a month at our Redmond clinic. To schedule an appointment or refer a patient, call 503-221-3422.

Pediatric Orthopedics

  • Bowed Legs and Knocked Knees
  • Brachial Plexus Palsy

  • Cavus Foot

  • Chondromyxoid Fibroma

  • Clubfoot

  • Discoid Meniscus

  • Down Syndrome

  • Flatfoot

  • Hemangioma

  • In-Toeing

  • Juvenile Arthritis

  • Leg Length Discrepancy

  • Marfan Syndrome

  • Muscular Dystrophy

  • Non Ossifying Fibroma

  • Osgood-Schlatter’s Disease

  • Osteochondroma

  • Osteogenesis Imperfecta

  • Out-Toeing

  • Perthes Disease

  • Slipped Capital Femoral Epiphysis (SCFE)

  • Snapping Hip

  • Spica Casts

  • Tarsal Coalitions

  • Unicameral Bone Cyst (UBC)

  • Vertical Talus

Pediatric spine

  • Scoliosis Kyphosis

  • Spondylolysis (Pars Fracture)

  • Spondylolisthesis

Pediatric/Adolescent sports medicine

SHOULDER

  • Shoulder Instability

  • Little League Shoulder

ELBOW

  • Little League Elbow

  • Osteochondritis Dissecans

  • Panner’s Disease

HIP

  • Pelvic Apophyseal Avulsion Fractures

  • Labral Tear

  • Athletic Pubalgia

KNEE

  • ACL Tears

  • Meniscal Tears

  • Patellar Instability

  • Osteochondritis Dissecans

  • Sinding-Larson-Johansson Syndrome

FOOT/ANKLE

  • Ankle Instability

  • Tarsal Coalitions

  • Osteochondritis Dissecans

Trauma

  • Complex Trauma

  • Fracture Care

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At the St. Charles Center, our region’s only pediatric neurosurgeon provides specialized diagnosis and care for infants, children and adolescents facing conditions of the brain, spinal cord and peripheral nerves. Recognizing that neurological diseases in children differ from those in adults, our neurosurgeon combines advanced clinical expertise with compassionate, family‑centered care. We treat a full spectrum of congenital and acquired conditions - including brain and spine trauma, tumors, Chiari malformations, tethered cord, and spina bifida — using minimally invasive techniques whenever possible to promote faster recovery and less pain. 

Our commitment extends beyond single interventions; we foster long‑term relationships, supporting patients and families through growth and developmental milestones. By treating pediatric neurological conditions throughout childhood and adolescence, we ensure continuity of care tailored to each child’s evolving needs. And when immediate attention is needed, our NOWcare clinic offers walk‑in support for concussions and head trauma, ensuring timely treatment right here in Central Oregon.

Neuromuscular disease management and treatment

  • Spina Bifida

Pediatric Neurosurgery

  • Brain and Spine Trauma
  • Brain and Spine Tumors
  • Congenital Spine Conditions 
  • Tethered Cord
  • Chiari Malformations
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Arthroscopic knee surgery is a safe and effective tool for diagnosing and treating knee problems. The word arthroscopy comes from the Greek words, “arthro” (joint) and “skopein” (to look). The term literally means to look within the joint. During the surgery, an orthopedic surgeon makes 2-3 small incisions to insert instruments into the knee joint. These instruments contain a lighting system to illuminate the structures inside the joint and a miniature camera, so the surgeon can visualize and examine the inside of the knee. They can examine the bones, cartilage, and ligaments of the knee and repair or correct various problems or injuries. Some of the more common reasons that knee arthroscopy is done include:

  • Torn meniscus
  • Abnormally formed mensicus
  • Fractures in or near knee joint
  • Repair of torn ligaments, such as ACL, PCL, and MCL
  • Persistent knee pain (for accurate diagnosis, combined with an evaluation, and imaging studies)
  • Removal of inflamed lining (synovium) in the knee
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Dr. Emily Baird works for Bend Anesthesiology Group, but she spends many of her days in St. Charles’ Family Birthing Center, working closely with nurses and doctors to deliver healthy babies.

That’s where she found a group of people to join her on a medical mission trip to the western highlands of Guatemala.

“I had told some of the labor and delivery nurses that I was going on this trip, and I was shocked at the interest,” Baird said. “Since I got back, even more people have said that next time, they want to go.”

In fact, there’s a long history of St. Charles caregivers traveling to Nuevo Progreso, a rural area in the southwest corner of Guatemala where crime rates are high and health care services are scarce. They go to work alongside resident health care workers at Hospital De La Familia, where they provide general medical care and specialized treatment and surgeries for locals, regardless of their ability to pay. (The foundation that organizes the trips also sends teams to provide vision care, maternal health services and care for malnourished children.)

Baird and three registered nurses — Nikki Truhlar, Dana Carmichael and Clarena Rule — from the Bend Family Birthing Center went to Nuevo Progreso in February. Over the course of five days, they provided much-needed treatment to more than 100 people, many of whom traveled long distances to receive care.

“Some come by bus. Some of them walk there. But they come because we are offering free medical care. They don’t have to pay anything,” Baird said. “The amazing thing about these patients is just how incredibly resilient and grateful they are. It’s remarkable to take care of them.”

The medical mission performed multiple medical services, including hysterectomies, hernia repairs, gallbladder removals and resection of uterine polyps. In addition, the group hosted a pregnancy clinic, offering screening ultrasounds and prenatal care in a region where physician-supervised prenatal care is uncommon.

One of goals was to build trust and enhance medical knowledge within the community of Nuevo Progreso.

“The hope was that there could be some education, and that this is something they will continue to do after we’re gone,” Baird said. “It was also a step toward trying to build some trust between the medical community and the patient population.”

When performing surgery, the team worked in a spartan room with three operating tables situated side by side, about 8 feet apart. They supplemented the hospital’s supplies with donated equipment and medications — including a couple thousand dollars worth from St. Charles, Baird said, which helped ensure a safe anesthetic experience for patients.

“Those are medications that I can’t get in Guatemala, but I really wanted to take them down there with me,” she said. “I think the most impressive thing was just how willing everyone I talked to at St. Charles was to help. I didn’t have to plead my case that hard, and just seeing how excited they were to help however they could made me feel really proud.”

For Truhlar, February’s trip was her second time working at Hospital De La Familia. This time, she managed post-anesthesia care for patients and coordinated logistical aspects of surgeries — two very different roles than what she has done for St. Charles for the past 15 years.

“We all kind of rotated around a little bit, which is part of the experience,” she said. “It’s not about going down and finding your niche and focusing on that, but to have the opportunity to experience a lot of other types of nursing, and to be part of a team that can come in and provide quality care for the people there.”

In particular, Truhlar enjoyed working alongside the hospital’s caregivers and augmenting the care they provide for the people of the region.

“I got to see how they do their daily functions and how they manage patient care, and that really allowed me to have an understanding of the hard work they do,” she said. “It’s not just caring for the patients, but also recognizing the people who work there and how much work goes into caring for their own community.”

The trip was a perfect fit for Carmichael, who makes a habit of volunteering in fields that are important to her. Locally, she works with Street Dog Hero, and in Nuevo Progreso, she helped prepare patients for surgery.

“I like traveling. I like medicine. I like being of service. It’s a beautiful country and beautiful people,” she said. “It was just a cool experience in so many different ways, and something like this can kind of reset your priorities, you know? You come away saying, ‘OK, this is why I’m here. This is why I chose this profession.’”

In the evenings, the group engaged in community activities, playing soccer and volleyball with locals and participating in exercise classes. They lived in dorm-style rooms and at the end of the trip, hiked a volcano together. And when they arrived home in Central Oregon, they shared a stronger bond and new perspectives on both the world at large and the work they do every day.

“Trips like this reinforce for me just how happy the people are and how vibrant their lives can be with so little,” Baird said. “I also think it reinforces that it’s such a gift to be able to practice medicine and to be able to help people. And it was very fun to do it with people that I continue to work with now that we’re home.”

Pictured in the left-most image below, clockwise from upper left, are Dana Carmichael, Emily Baird, Nikki Truhlar and Clarena Rule. All photos were taken by Nikki Truhlar.

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At the St. Charles Cancer Center, healing takes many forms. Thanks to Foundation donor support, in addition to traditional medical treatments, cancer patients in Central Oregon also have access to massage and reiki therapy at no cost.

These integrative therapies complement traditional cancer treatments by supporting the whole person. Patients often face anxiety, fatigue and physical side effects like muscle tightness or nerve pain. Reiki and massage offer relief from these symptoms while providing a restorative and calming environment that promotes healing.

These therapies are making a real difference. In 2024 alone, patients received 1,162 massage treatments and 477 reiki sessions, provided by 15 reiki volunteers and licensed massage therapist at the Cancer Center.

“These services are much more than just comfort, they are essential tools in a patient’s healing journey,” said Jane Cook, a cancer patient who received these treatments.

Jane was introduced to the Cancer Center’s integrative services in 2022 during her treatment for lung cancer. She knew these therapies would be vital to her care and has since received reiki and massage regularly, finding both physical relief and emotional strength through these sessions. She says reiki, something she had never tried before, has become a source of emotional and spiritual healing. Massage therapy has helped alleviate the lasting effects of radiation, especially in her head and neck.

“Fighting cancer and healing is not just about the medicine. It’s your mental approach, your physical comfort and feeling like you’re a part of a supportive community. These services help me stay above water and gives me something positive to look forward to,” said Jane.  

Patients like Jane, who find strength, healing and comfort through integrative therapies, are a testament to the powerful impact of your donor support.

The opening of the St. Charles Cancer Center in Redmond in early 2026 will allow us to expand these vital services to even more patients, including those living in our rural communities.

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