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LSVT is a scientifically researched, high-intensity therapeutic intervention to improve motor coordination and voice production in individuals with Parkinson’s disease and other neurological disorders.

LSVT LOUD Speech Therapy can benefit the patient by:

  • Increasing vocal loudness
  • Improving articulation and speech intelligibility
  • Improving intonation
  • Improving facial expression
  • Creating changes in neural functioning related to voice and speech

Patients attend 16 one-hour sessions of Speech Therapy. One-on-one individualized sessions occur four consecutive days a week for four weeks. Additionally, patients will complete daily homework practice and carryover exercises.

LSVT BIG Physical and Occupational Therapy can help the patient achieve:

  • Faster walking with bigger steps
  • Improved balance
  • Increased trunk rotation
  • Improvements in daily activities (getting out of bed, getting dressed, etc.)
  • Improved standardized motor scores

Patients attend 16 one-hour sessions of combined Physical and Occupational Therapy. One-on-one individualized sessions occur four consecutive days a week for four weeks. Additionally, patients will complete daily homework practice and carryover exercises.

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Grand Rounds - Mar. 19, 2021
"Breast Surgery"

Speaker: Kelly Hewitt, MD, FACS. Medical Oncology, St. Charles Health System

Objectives

  1. Describe biomarkers used to differentiate breast cancer
  2. Understand varying disease presentation in the context of screening
  3. Identify genetic assays and their clinical utility
  4. Understand the benefits of varying orders of therapy (i.e. chemotherapy before or after surgery)

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.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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OFNHP and St. Charles reach agreement, strike to end

The union and the hospital have come to an agreement that ends the strike and ensures that further negotiations will proceed effectively while patient care remains the focus.

BEND, Ore.—On Friday, March 12, technical caregivers who are represented by OFNHP and St. Charles Health System leaders came to an agreement that would end the strike and return therapists, technicians, and technologists to work on Monday, March 15. This agreement ensures the two parties will bargain over several days to secure a contract by March 31, addressing key issues that were discussed at a recent bargaining session. The agreement came together as both parties believe patient care is and should be the top priority, the strike has been distracting and difficult for all involved and it is in everyone’s best interest to return to the table and continue bargaining.

Further updates on ongoing contract negotiations will continue to be shared as upcoming sessions occur. The federal mediator has been very helpful and will continue to guide bargaining sessions through the end of the month. We look forward to building on this partnership to approach our collective challenges with dynamic solutions that will result in a fair contract.

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(NOTE: According to caregivers familiar with his case, there is zero evidence linking Dale Cheney’s medical incident, described below, to the COVID-19 vaccine he received earlier in the day. He just happened to be at the vaccine clinic when the incident occurred.)

Thousands of Central Oregon seniors have gone through the switchbacking vaccine line at the Deschutes County Fair & Expo Center over the past several weeks.

“Most days, it’s pretty uneventful,” said Dr. Matthew Slater, a cardiothoracic surgeon with St. Charles and one of many physicians who have volunteered to provide medical staffing for the fairgrounds COVID-19 vaccine clinic. Their job, typically, is to keep an eye out for people having trouble standing or moving through the line, to answer questions prompted by a pre-shot screening process and to respond when a patient has a reaction to a vaccine.

“That’s 99.9% of what we do there,” Slater said, “and then the rest is true medical emergencies.”

Medical emergencies have been rare so far, but they’re certain to happen, given the sheer number of people expected to be vaccinated at the clinic over the next few months, said Bo Miller, St. Charles’ medical director of provider informatics.

“We want to vaccinate as many people in Central Oregon as possible in the clinic,” he said. “When you have thousands and thousands of people, many of them elderly or with pre-existing conditions, the probability of a serious medical event unrelated to the actual vaccine is very real. We accounted for that and have a system to handle emergencies, no matter how uncommon they are.”

To date, St. Charles has spent around $250,000 on the vaccine clinic, Miller said, stocking medical supplies, upgrading the WiFi, paying for interpretation services and incurring other expenses to ensure patients are as safe as possible during their visit.

“We want people to be confident they can come here, get their shot and go home, and we’re watching out for them every step of the way,” Miller said. “If something goes wrong, we’re as prepared for it as we can be.”

DALE’S STORY

Dale Cheney of Redmond was scheduled to get his second dose of COVID-19 vaccine at 8:30 a.m. on Feb. 18. But he was up and ready to go by 7 a.m.

“I told him he should go ahead and go if he wanted to,” said Dale’s wife of 63 years, Judy. “So he left, and he had his cane with him because his back always bothers him if he has to stand for a while.”

Judy, 84, didn’t think anything of sending Dale to his appointment on his own. “He was in excellent health,” she said.

Dale, 86, arrived at the fairgrounds to find a line of about 50 people waiting to enter, Judy said, but a man near the front of the line saw his cane and invited him to jump in ahead of him. Once inside, Dale was escorted past the switchback section of the process and taken directly to a vaccination table, where he received his shot, she said.

From there, Dale walked to the respite room and took a seat to wait 15 minutes to make sure he didn’t have a reaction to the vaccine. After about five minutes, he looked up, Judy said, and made a mental note of how long he’d been there.

And that’s when Makena Forestell, a combat medic with the Oregon National Guard and a pediatric medical assistant at Mosaic Medical in Bend, heard Dale’s cane hit the linoleum floor.

“It drew our attention to him as he collapsed,” said Forestell, who was standing just a few dozen feet away. “We ran over to him, and when I saw other people initiating First Aid and blood all over his face, I went to grab gloves and gauze.”

Cheney had suffered a heart attack — unrelated to the vaccine he’d just received — and tumbled forward out of his chair, landing on the floor and breaking his nose. The first people to reach him were Forestell and Tiffani Soliz, a combat medic with the Guard and a medical assistant for Mosaic Medical in Redmond who, according to Forestell, “took charge of the situation immediately” by starting CPR and calling for an automated external defibrillator (AED) when she couldn’t get Cheney’s pulse. Soon, they were joined by paramedics from Redmond Fire & Rescue, as well as Slater, who immediately recognized Cheney’s affliction.

‘HE WAS DYING’

“I’ve seen a lot of dying people, unfortunately, in my career, and he was dying,” Slater said. “He was grey. He was struggling to breathe. He was clearly having what I thought was a cardiac event.”

The group worked to clear Dale’s airway and administered CPR while Forestell attached the AED to his body. After one shock and more CPR, a second shock — combined with a dose of epinephrine — brought Dale back to life, Slater said. He was then transferred to St. Charles Bend for further evaluation and treatment.

A week later, all involved were quick to credit others for the save. Soliz said a sheriff’s deputy did a good job of keeping onlookers away and helping to protect Dale’s privacy. Slater praised the “spectacular” work of the Guardsmen and the Redmond paramedics. Soliz also said the impromptu team worked incredibly well together. “I’ve seen established ER teams that didn’t work together as well as we did,” she said.

“Thankfully, this happened in a place surrounded by doctors, medics, paramedics, EMTs and nurses,” said Forestell. “We were able to get to him quickly and it worked out alright.”

For Judy, her husband’s good fortune started earlier in the day.

“The way it all came together — that he went an hour early, the man who called him to the front of the line — it all led to him being in that chair at that moment,” she said. “Had it been just a minute’s difference, he could’ve fallen while he was walking. He could’ve had it in the car. He could’ve died at home.”

THE SYSTEM WORKED

Besides staffing the clinic with the right people and positioning them effectively, Miller and a group of St. Charles caregivers worked diligently before the clinic opened to make sure the right equipment, the right medications and the right protocols are in place and ready for the most likely medical emergencies. They brought in a fleet of golf carts to transport mobility challenged people from the parking lot to the front door, and they placed wheelchairs strategically throughout the facility. They even closed half the bathrooms to give people less space to roam between their shot and the respite room.

Not all of those factors directly affected Dale Cheney’s incident, but it’s that kind of planning and attention to detail that put him in the right place at the right time and surrounded him with the resources that saved his life.

“It’s never a good day to have a heart attack, but if you’re going to do it, it’s best to do it in front of a system designed to rescue you,” Slater said. “The system is designed to give us the best chance of saving somebody, and this is evidence that it worked.”

EPILOGUE

Dale Cheney was discharged from the hospital a week after his heart attack and had a few days of feeling good at home, said Judy, his wife. But then he stopped eating and started losing strength, and on the first day of March, he went back to the hospital, where he was diagnosed with pneumonia.

He passed away late in the evening on March 5.

Judy is devastated, and she is also grateful to the people who cared for her husband that day at the fairgrounds. She’s thankful that their life-saving efforts gave her a couple more weeks to talk to Dale and take care of him.

She said she has asked God why He saved her husband only to take him a short time later, and she thinks she knows at least part of the answer.

“What happened to him that day was a miracle,” she said. “And we need to tell people about it to let them know that miracles do still happen.”

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A tiny seed is having a big impact on breast cancer care.

In partnership with Central Oregon Radiology Associates (CORA), St. Charles Cancer Center has begun using Magseed—a tiny, iron oxide “seed” that is implanted in a cancerous breast tumor to mark its location for surgery. Equipment needed to use Magseed was purchased with money from Sara's Project, a St. Charles Foundation fund dedicated to easing the challenges of breast cancer for people in Central and Eastern Oregon.

The Magseed is a substantial improvement over the metal wires that were formerly used to guide surgeons to tumors that are otherwise too small to find, said Dr. Kelly Hewitt, a University of California San Francisco fellowship-trained breast surgeon who joined the Cancer Center in October.

“As you can probably imagine, that can be fraught with issues,” said Hewitt, who prior to her fellowship worked as a general surgeon in Newport, Ore.

The thin wires, which usually had to be placed the day of surgery, could sometimes become dislodged when the patient traveled from the radiologist’s office to the hospital, or in the operating room, she said. And because the wires could be unwieldly, they had to be taped to the patient’s breast until she was in the operating room.

“From a system standpoint, it’s also a scheduling nightmare because they have to put the wire in at a certain time and coordinate it with surgery, etc.,” she said.

Placed by a radiologist in the breast tissue, the radiation-free Magseed marker won’t move or break, and can be placed days, weeks and even months ahead of surgery, Hewitt said. During surgery, she waves a wand-like localization device over the breast that guides her to the seed, targeting where the incision needs to be made.

“It really lets me pick my incision based on aesthetics and safety,” Hewitt said. “Sometimes the wire can kind of dictate where you have to go, but with the seed, it gives you more flexibility.”

Hewitt said she has even implanted the Magseed—which is so small it can’t be felt by the patient—in lymph nodes that need to be removed as well.

The only fellowship-trained breast surgeon in Central Oregon, Hewitt said she is excited to be able to use this new technology to improve care for patients.

“It’s all about perfection and doing something that is both oncologically safe—so, getting all of the cancer out—but then also making it look as nice as possible,” she said. “So, having the best aesthetic outcome in combination with the best oncological outcome.”

Heads up: Dr. Kelly Hewitt will present "Breast cancer in 2021: Diagnosis to survivorship" at our next installment of Doc Talks on March 29.

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In recent weeks, media outlets, health care organizations and others around the world have been marking the one-year anniversary of COVID-19’s unwelcome arrival into our lives.

What a year it has been.

When I think back, I cannot remember when or where I first read about this new novel coronavirus, which started in China in late 2019 and spread to the United States in January of 2020.

What I can remember is the day the first presumptive positive case of COVID-19 was confirmed in Central Oregon: March 11, 2020. I remember attending a hastily organized mid-day meeting, where the overriding mood was not one of worry or panic, but of confidence and resolve. We had been preparing for that moment for months, and we knew that while the disease was unpredictable and the future was uncertain, our health system was ready to handle it.

I also remember watching my colleague, Dr. Jeff Absalon, and other local officials speak at a press conference that afternoon. “This,” said Dr. Absalon, St. Charles’ chief physician executive,  “is what we do.”

To be clear, he was not talking about holding press conferences. He was talking about caring for people who are sick.

That is what we do here at St. Charles, every single day. It is our commitment to ourselves, our commitment to each other, our commitment to our communities and our commitment to you.

Of course, there have been tough stretches over the past year. Preparing for and responding to COVID-19 has been a massive operational undertaking for our health system. It has dealt a financial blow to our organization. It has changed the way we do just about everything, from the bedside to the board room and all points between. And it has certainly tested our frontline caregivers and our first responders.

Have there been uneasy moments? Definitely. We are human beings, after all. But again and again over the past year, I have seen our people rise to the challenge, whether that challenge is figuring out how to quadruple a hospital’s patient capacity without expanding its footprint or how to give a dying woman the birthday celebration she deserves, even in isolation. Now, they’re heavily involved — alongside Deschutes, Crook and Jefferson counties and the Oregon National Guard — in the complicated regional effort to end this pandemic by vaccinating as many people as possible as quickly as possible. And they’ve done it all during a time of unprecedented upheaval in both their professional and their personal lives.

I have said it before and I’ll say it again: I feel incredibly proud and fortunate to lead the 4,600 caregivers who make St. Charles Health System such a great place to provide and receive care. Through a year of dizzying ups and downs, they have been a steadying force every step of the way.

Sincerely,
Joe

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St. Charles and OFNHP met with federal mediator to continue negotiations on a first-time contract 

Bargaining teams for St. Charles Bend and the Oregon Federation of Nurses and Health Professionals met Wednesday for continued negotiations on a first-time contract. This session included a federal mediator in an effort to move the process forward. 

The parties exchanged proposals through the mediator in confidential sessions. 

“The bargaining teams engaged in some joint sessions throughout the day and the presence of the mediator was very helpful,” said Aaron Adams, president of St. Charles Bend. “We are hopeful we can get back to the table soon for further discussion.” 

The St. Charles bargaining team shared with the OFNHP team that the hospital is eager to get back to the table and resolve the situation, but continues to find it challenging to both bargain and run the hospital during a strike. For this reason, St. Charles has asked the union if its members would be willing to return to work so the hospital can create an environment in which its team could better focus on bargaining.  

“No one wins in a strike – not the health system, not our caregivers, not our patients, not our community,” Adams said. “We want the strike to end so we can get back to the table, resolve the contract and focus all of our energy on the most important work of all – caring for our patients.”

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 4,600 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.

 

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OFNHP continues to be unresponsive

Now on day five of its strike, the Oregon Federation of Nurses and Health Professionals (OFNHP) has neither declined St. Charles Bend’s March 3 supposal nor provided a counter, or otherwise made any attempt to respond to that proposal since the strike began. 

The parties are still scheduled to meet with a federal mediator for the next bargaining session on March 10. In the meantime, operations at St. Charles Bend continue uninterrupted with qualified replacement workers covering shifts throughout the hospital. Surgeries and other procedures are taking place as scheduled. 

“We’ve not received a return to work notice from the union, which is the first step in the process of bringing our caregivers back to work,” said St. Charles Bend President Aaron Adams.  

Two core issues still remain on the table: compensation and union security.   

The teams have agreed upon wages for the first year of the contract. Under this agreement, the average hourly wage for techs in the bargaining unit will be $41.94 per hour. This equates to an annual base salary of $87,000 a year for a full-time equivalent position, not including overtime, premium pay, shift differentials and other benefits. However, wages for years two through five of the contract are still being negotiated. 

The union has also requested a closed shop, meaning all St. Charles technical employees’ jobs would be conditional upon joining the union and paying 1.4% of their base wage in dues or paying agency fees and giving up voting rights. St. Charles has asked for an open shop in order to give its caregivers a choice on whether they are members of the union. 

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 4,600 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.

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At St. Charles Bend, patient care is proceeding as normal

St. Charles Bend technical workers represented by the Oregon Federation of Nurses and Health Professionals (OFNHP) went on strike at 8 a.m. Thursday for an indefinite period of time. Representatives from the hospital and union are scheduled to meet again March 10 with a federal mediator.

“I'm looking forward to getting this situation resolved and welcoming our caregivers back,” said St. Charles Bend President Aaron Adams. “They are missed already.”

St. Charles has engaged with an outside agency to recruit dozens of highly skilled replacement workers who will cover shifts at the hospital for the duration of the strike.

“Each person is thoroughly vetted by the agency and St. Charles to ensure they have the proper qualifications and work experience to competently perform their role,” said Vice President of Human Resources Rebecca Berry. “Additionally, they go through an on-site onboarding process.”

St. Charles scheduled limited surgical procedures for Thursday and today, and some cases were moved to St. Charles Redmond. Now that that the replacement workforce is in place, the hospital anticipates operating normally as of Saturday.

“We are pleased with how well the transition to the replacement workforce went Thursday,” Adams said. “Technicians came from all corners of the country, and from some of the top medical centers. We’re pleased we have been able to mitigate disruptions to our health care services.”

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 4,600 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.

 

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Grand Rounds - Mar. 5, 2021
"Palliative Care"

Speaker: Jennifer Blechman, MD. Hospice & Palliative Care Specialist, Partners In Care

Objectives

  1. Understand the role and value of palliative care in serious illness management
  2. Distinguish between palliative care and hospice
  3. Explain the importance of advance care planningand discuss approaches to help patients, particularlyduring a pandemic
  4. Review options for treatments at end of life includinghospice, withdrawal of life-sustaining therapies, palliative sedation, and medical aid in dying
  5. Identify how patients without decision-makingcapacity can communicate their wishes

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.

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 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

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