St. Charles Bend drive-through COVID-19 test site closing Friday, March 4 

With the Oregon National Guard scheduled to stand down its operations at St. Charles facilities over the next two weeks, St. Charles Bend is planning to close its drive-through COVID-19 test site on Friday, March 4. 

Patients who need a COVID-19 test after that date and meet St. Charles’ testing criteria will be encouraged to schedule an appointment at www.stcharleshealthcare.org/COVIDtesting or another test site. To see all available options, visit COVID-19 Testing in Oregon (egov.com).

People who should seek testing from a health care provider include those who:

• Are 65 or older
• Have a chronic health condition such as obesity, diabetes, chronic kidney disease or any other condition that puts them at increased risk of severe disease, or they are pregnant 
• Have moderate or severe illness needing medical evaluation
• Live in a group setting such as a nursing home
• Work in agriculture, food service or an educational setting like a preschool and at-home testing is not available

People who may not need to seek testing from a health care provider include those who:

• Have had close contact with a family member with COVID-19. In this scenario, household members should assume they have COVID-19 and isolate. The exception is if any household members are considered high risk and would benefit from treatment.
• Are mildly ill and do not meet conditions above
• Have tested positive with an at-home kit. Another confirmatory test is not needed. Likewise, symptomatic people with a negative test within three to five days of illness onset do not need a confirmatory test.
• Have had COVID-19 and want to return to work or school. Individuals should be able to return after completing their isolation or quarantine as described at www.deschutes.org/covidinfo    

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

Grand Rounds - Feb. 25, 2022
"Sepsis Update & Treatments"

Speaker: Presented by Clinton Coil, MD. Associate Clinical Professor of Emergency Medicine, Associate Medical Director for Quality and Safety, LA County Harbor-UCLA Medical Center.

Objectives

1. Follow current guidelines and evidence-based practice in sepsis management.
2. Recognize and diagnose sepsis in a timely and efficient manner.
3. Utilize new treatment modalities to aggressively treat the sepsis patient.
4. Prioritize treatment for septic patients effectively.
5. Determine when and how to use procalcitonin (PCT).
6. Identify high-risk patient groups, such as the elderly and immune-compromised patients.

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].

What is a spinal fusion?

Spinal fusion is a surgical procedure that involves permanently joining vertebrae together and fusing them into a single bone. It is usually recommended when your surgeon can pinpoint the source of your back pain. By eliminating the motion in the spine that causes pain, this procedure relieves symptoms of many back conditions including spinal stenosis, spondylolisthesis, degenerative disk disease, and others.

All spinal fusions use some type of bone material, called a bone graft, to stimulate bone healing and help fill in the space left after a disk is removed. The bone is usually taken from your hip area, but can be taken from a donor as well. After the bone graft is placed, your neurosurgeon will use metal screws, plates, and rods to stabilize the spine and promote healing of the fusion.

What is a lumbar transformal epidural steroid injection?

A lumbar transformal epidural steroid injection is a non-surgical procedure that treats pain and can also serve as a diagnostic tool. Conditions typically treated include pinched nerve/radiculopathy, sciatica, herniated discs or spinal stenosis. Your doctor injects a combination of anesthetic and steroid medications adjacent to the inflamed/painful nerve. Come patients experience significant pain relief after just one steroid injection. However, some patients get no pain relief or only short term relief.

Bulging, slipped or herniated discs can occur due to arthritis, trauma or aging and are a common cause of severe back pain when a nerve is compressed. When conservative treatment options like physical therapy, medication and rest do not relieve low back pain, your neurosurgeon may recommend microdiscectomy. It is a minimally invasive surgical procedure which allows for removal of only a portion of the damaged lumbar disc, enlarging the spinal canal, and alleviating the low back pain symptoms. This is typically done on an outpatient basis and patients can go home the same day.

A laminectomy is a surgical procedure typically performed on patients with spinal stenosis that suffer from chronic back pain. A laminectomy makes the spinal canal larger, reducing pressure on the spinal nerves. The bony arch at the back of the spine that covers the spinal canal (lamina) is removed at the site of nerve irritation. Your neurosurgeon will also remove any bone spurs from around the nerves, reducing irritation and inflammation they have caused. It may be necessary to remove part of the facet joints or part of the discs as well.

As we age, bone strength decreases and can cause fractures in the spine called vertebral compression fractures. A vertebral compression fracture occurs when too much pressure is placed on a weakened vertebrae, and the front of it cracks and loses height. They can result from a fall or doing everyday things such as reaching, coughing, or sneezing. In many cases, people get better with conservative treatment such as rest, medication, or a brace. If you are suffering from severe back pain from a recent fracture that is not responding to non-surgical treatment, your doctor may recommend kyphoplasty. This minimally-invasive procedure repairs a vertebral compression fracture. It helps restore the spine’s natural shape and some patients experience rapid pain relief after the procedure.

Before the procedure, you are anesthetized. The physician guides a needle through the skin of your back and into your fractured vertebrae. A special x-ray device called a fluoroscope helps the physician position the needle. A balloon device is placed into the vertebrae through the needle. The physician inflates this balloon to expand the fractured bone. When the balloon is deflated, it leaves a cavity in the middle of the vertebral body. Once the balloon is removed, the physician injects bone cement through the needle. This cement fills the cavity and hardens inside the vertebral body, stabilizing the fracture.

What is a facet joint injection?

The facet joints, found on both sides of the back of the spine, can become irritated and painful. A facet joint injection may help diagnose the source of a patient’s pain, or may be used to relieve pain and inflammation.

What is radiofrequency ablation?

Radiofrequency ablation (RFA) is a procedure used to provide longer term back pain relief than that provided by simple injections or nerve blocks. This procedure is also called radiofrequency neurotomy or radiofrequency rhizotomy. It can treat pain that doesn’t respond to medications or to physical therapy. By selectively destroying nerves that carry pain impulses, the painful structure can be effectively denervated and the pain reduced or eliminated for anywhere from a few months to up to 12 months.

Radiofrequency waves are electromagnetic waves which travel at the speed of light, or 186,000 miles per second (300,000 km/s). Radiofrequency Energy is a type of heat energy that is created by a special generator at very high or super high frequencies. With the use of this specialized generator, heat energy is created and delivered with precision to target nerves that carry pain impulses. The resulting “lesion” involves a spherical area of tissue destruction at the tip of the RF needle that can include pain-carrying nerves.

Once a structure has been determined to be a pain generator, its nerve supply is targeted for interruption. A small insulated needle or RF cannula is positioned next to these nerves with fluoroscopic guidance (live video X-Ray). Your doctor knows where to place the RF cannula because he is an expert in anatomy. The shaft of this cannula except for the last 5 to 10 mm is covered with a protective insulation so that the electric current only passes into the surrounding tissues from the very tip of the cannula. When the cannula appears to be in good position, the doctor may perform a test and release a small amount of electric current through the needle tip at two different frequencies. This test helps to confirm that the cannula tip is in close proximity to the target nerve and that it is not near any other nerve. After a successful test confirms good cannula tip position, a local anesthetic is injected to numb the area. The RF generator is then used to heat the cannula tip for up to 90 seconds, and thus the target nerve is destroyed.

There are a multitude of chronic pain conditions that respond well to this treatment. Chronic spinal pain, including spinal arthritis (spondylosis), post-traumatic pain (whiplash), pain after spine surgery, and other spinal pain conditions are those most commonly treated with RFL. Other conditions that are known to respond well to RFL include some neuropathic pain conditions like Complex Regional Pain Syndrome, (CRPS or RSD), peripheral nerve entrapment syndromes, and other assorted chronic pain conditions. A patient’s candidacy for RFL is usually determined by the performance of a Diagnostic Nerve Block. This procedure will help to confirm whether a patient’s pain improves just for the duration of the local anesthetic (or not). Patients who have little to no pain relief after a diagnostic nerve block are not candidates for a neurodestructive procedure like RF Lesioning.

Is this procedure painful? 

This procedure can be moderately painful, it ranges from mild to severe, but typically severe pain is for a minute or less. Patients are often given mild intravenous sedation during the procedure, but sedation is not absolutely required. Deep sedation is not a safe alternative and is therefore not offered for RFA procedures. It is quite common for neck or back pain to increase for a few days or longer after before it starts to improve.

What should I do to prepare for my procedure?

If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you are receiving IV sedation, follow the instructions from your doctor or nurse on limiting food and beverages before the procedure. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure. If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.

What should I do after my procedure?

Following discharge home, you should plan on simple rest and relaxation. If you have pain at the needle puncture sites, icing this area should be helpful. If you receive intravenous sedation, you should not drive a car until the next day. Patients are generally advised to go home and not return to work after this type of procedure. Some patients do return to work the next day.

Could there be side effects or complications?

Your physician will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed.

Can this procedure be repeated if my pain returns?

It is possible for the treated nerve(s) to regenerate, which could lead to recurrent pain. However, this procedure is repeatable for nerve regeneration if it worked the first time around.

What are epidural steroid injections?

Conditions such as herniated discs and spinal stenosis can compress nerves, causing severe pain and inflammation. An epidural steroid injection may reduce inflammation and provide back pain relief, while avoiding the need for surgery to fix the problem.

The procedure is performed with the patient lying down. A region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle. Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel. A contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves. Then the anti-inflammatory steroid is injected and absorbed by the inflamed nerves to decrease swelling and relieve pressure. Some patients may need only one injection, but it may take two or three injections to provide significant pain relief. 

As one of the most commonly used non-invasive and conservative treatments for a variety of cervical spine issues, the injections are known to provide comfort for more than half of those who use them, and they can be safely repeated if pain returns or if therapy needs to progress a bit farther for the best outcome.