home - the portland clinic · 2018. 7. 9. · created date: 3/2/2016 10:51:21 am
TRANSCRIPT
SP16
The Portland C
linic Quarterly
a health
upd
ate for o
ur patien
ts
01 GAINCONTROLOVERCHRONICPAIN
03 Q&A:GETTINGBACKINTHEGAME
04 NEWS:44TOPDOCTORSANDNURSES
06 THEPORTLANDCLINICACCESSGUIDE
07 CLASSES:CONTROLDIABETESANDPREDIABETES
08 NUTRITION:SIXSHIFTSTOENJOYMOREVEGGIES
09 GROCERYBAG:THEPERFECT100-CALORIESNACK
01
Gain Control Over Chronic PainGOOD SELF-CARE CAN REDUCE PAIN AND LIFT EMOTIONAL WELL-BEING
CONTINUEDONPAGE02
Painismorethanaphysicalproblem;itcanhaveamajorimpactonemotional
well-being.Peopleinpain—whetheracuteorchronic—candevelop
depression,anxietyandotheremotionalstruggleswhenpainaffectstheir
abilitytofunctionandtheirqualityoflife.Inaddition,peoplewhosufferfrom
anxietyordepressionoftenexperiencepainmoreintensely.Thiscanturnintoa
viciouscycle.
Improvingemotionalwell-being,ontheotherhand,canhelppeoplereduce
pain,andreducingpaincanimproveemotionalwell-being—amuchmore
positivecycle.Severalstrategiescanhelpyousetthiscycleintomotion.
Oneofthemostimportantobjectivesinpainmanagementistodevelop“self-
efficacy”—thatis,theabilitytofeelthatyouhavesomecontroloveryourpain.
Developingself-efficacybeginswithgoodself-care.Thefollowingself-care
strategiescanhelpyoubegintotakecontrol,andultimatelyreduceyourpain.
Pace yourself
Tryingtocopewithcontinuouspaincanbeexhausting;it’simportanttofind
therightcombinationofactivityandrest.Over-doingitcanincreasepain,but
socanunder-doingit.Forexample,stayinginbedtoolongcausesstiffness,
whichincreasesinflammation,whichmakespainworse.
Movingyourbodyincreasesbloodflow,reducesinflammationandhelpsreduce
theintensityofpain.Gentleyoga,wateraerobics,walkingandtaichimayhelp.
Besuretoassessyourpainlevelregularlyandadjustyouractivityaccordingly.
Ifdailytaskssuchasshowering,cookingandhouseholdchoresaggravateyour
pain,prioritizetaskswiththeunderstandingthatnotallofthemhavetobe
doneeveryday.Doasmuchasyou’reablewhileacknowledgingyourlimits.
Eat to nourish your body
Eatingnutritiousfoodplaysanimportantroleinpainmanagement.Bothunder-
eatingandover-eatingcanworsenpain.Somespecificfoodsalsomayaffect
BY MICHAEL SHRIFTER, PSY.D., CLINICAL PSYCHOLOGIST, THE PORTLAND CLINIC – SOUTH
02
yourpain,energyorstiffness.Keepingafooddiarymayhelpyouidentify
eatingpatternsthatmakeyoufeelbetterorworse.
Prioritize sleep
Inanotherviciouscycle,paincanmakeitdifficulttosleep,andpoorsleepcan
makeithardertomanagepain.Tosleepbetter,trytomaintainaconsistent
bedtimeandwaketime,limitdaytimenapping,minimizecaffeineandalcohol,
reducescreentime(TV,computers,etc.)intheevening,createarelaxingsleep
environment,andfindamorecomfortablepositionthateasesyourpaininbed.
Try new coping strategies
• Progressivemusclerelaxation:tensingandrelaxingindividualmusclesina
sequence—forexample,fromyourtoestoyourneck—canreducepain
causedbymuscleguardingandtension.
• Bellybreathing:shiftingfromshallow,upper-chestbreathingtodeeper
breathsthatfillyourbellyandlungscanhelpyoufeelcalmandlessanxious.
• Mindfulness:thispowerfulmentalskillcanhelpyoudwelllessonpastlosses
andfutureworriesandmoreonthepresentmomentandwhatyoucando,
rightnow,tobeproactiveaboutreducingpain.
Seek support
Chronicpaincanmakeyoufeelisolatedandmisunderstood,whichcompounds
emotionaldistress.It’simportanttostayconnectedtofamilymembersand
friendswhoaregenuinelyinvestedinyourwell-being.Considerjoiningapain-
managementpeer-supportgrouptoconnectwithpeoplewhounderstandyour
experienceofpain.Apsychotherapistalsocanhelpyoubroadenyourcoping
skills,gainsomecontroloverpainandemotionaldistressandbuildself-efficacy.
ManyofthetipsI’vesharedcomefromtheexcellentbook,Master Your Pain: A
Comprehensive Science-Based Method to Help You Live Well with Chronic Pain,
byJillB.Fancher.Ihighlyrecommendit.
03
Q&A: Getting Back in the Game after an InjurySTEVEN NAKANO, PHYSICAL THERAPIST
Q: HOW ACTIVE SHOULD I BE AFTER AN INJURY?
Painthatcomesonsuddenlyand
limitsyouractivityshouldbelooked
atbyyourhealthcareprovider.With
minorinjuries,however,manyofus
liketotakeawait-and-seeapproach.
AftertryingRICE(rest,ice,compres-
sion,elevation)forsprainsand
strains,however,thenextstepmay
beunclear.Shouldyoukeepresting,
orjustactnormallyandignorethe
pain?Theanswerliessomewherein
between—wecallit“activerest.”
Getyourbodymovingassoonas
it’scomfortable—thatmaymean
puttingupwithalittlediscomfort,
butnomorethana3onapainscale
of1-10.Withactiverest,thegoalisto
findtherightamountofactivitythat
yourbodywilltolerateasitheals,so
youractivitylevelcanprogressalong
withyourhealing.
Ifyoucan’tfindacomfortablelevel
ofactivitywhenusingtheinjured
jointormuscle,chooseactivitiesthat
don’tinvolvethatarea.Ifithurtsyour
ankletostand,forexample,thensit
andusehandweights.Ifyourhand
hurts,walkmore.
Q: I’M AFRAID TO BE MORE ACTIVE BECAUSE I’M AFRAID IT WILL CAUSE MORE PAIN. HOW CAN I GET PAST THAT?
Understandinghowpainworkscan
help.Whenyourbrainperceivesa
physicalthreat(aninjurytoyourknee,
forexample),itsendsyouamessage
—pain—tostopyoufromdoing
anythingthatmightcausefurther
damage.Asyou’veseen,itworks—
thepainstopsyoufromdoingany
moreofthatactivity.Unfortunately,
yourfearofreceivingmorepain
messagesisoftenenoughtostop
youfromactivitiesthatmightactually
helpyourknee.
Togetpastthat,youcansend
messagesbacktoyourbraintolower
theperceivedthreatlevel.Oneway
istoexerciseatalevelthatkeeps
painlowandtolerable.Anotherway
istoreduceyouroverallstresslevel.
Massage,topicalrubs,meditation—
essentially,anythingthatfeelsgood
anddoesn’tsignificantlyincreasethe
threattoyourinjurycaninfluence
yourbraintobackawayfromthepain
trigger.Someofthetipsforchronic
painonpages1-2alsomayhelp.
Q: WHAT IF THE JOINT STARTS TO FEEL UNCOMFORTABLE?
Asyouprogressivelyincreaseyour
activity,youmayrunintophysical
limitationssuchasjointtightness,
tinglingorweakness.Fearofdoing
damageorofdoingthe“wrongthing”
mayalsostopyourprogress.Youcan
stretch,massageandexerciseyour
waythroughsomeofthesebarriers.
Ifpainincreases,slowdownandtake
iteasyforabit,butthengetright
backatit.Ifsomethingisstopping
youfrommovingforward,thenitmay
betimetogetsomehelp.Aphysical
therapistcanhelpyousafelymove
pastthebarriersandgetbackinto
gameform.
STEVENNAKANO,MSPT,SEESPATIENTSAT
OURBEAVERTONANDEASTLOCATIONS
ANDISTHEPORTLANDCLINIC’SDIRECTOR
OFREHABILITATIONSERVICES.
News BriefsWHAT’S NEW AT THE PORTLAND CLINIC
04
CONGRATULATIONS TO OUR 44 “TOP DOCS AND NURSES!”
InJanuary,PortlandMonthlynamed40ofThePortlandClinic’sdoctorsand
fourofournursepractitionersamongits“TopDocsandNursesof2016.”We
thankeachofthemfortheirhardworkandexcellentservice.
•StephenMannino,M.D.,dermatology
•CristinaMondragon,M.D.,internal
medicine
•AmyMulcaster,D.O.,gynecology
•KathleenPalm,M.D.,pediatrics
•MichaelParsons,M.D.,cardiology
•JustinPavlovich,M.D.,ear,noseand
throatmedicine
•AmandaPickert,M.D.,dermatology
•BrettRath,M.D.,familymedicine
•MattReed,M.D.,surgery
•LaurenRoberts,M.D.,family
medicine
•JanelleRohrback,M.D.,dermatology
•RobertSandmeier,M.D.,sports
medicine
•JayShah,M.D.,cardiology
•TomStarbard,D.C.,D.O.,manual
medicine
•RebekahTrochmann,M.D.,internal
medicine
•MaryEllenUlmer,M.D.,pediatrics
•EhudZusman,M.D.,urology
Our Portland Monthly Top Nurses:
•MichelleGrove,ANP,diabetes
•MilesHolland,ANP,cardiology
•ChristineOlinghouse,FNP,diabetes
•VickiSwanson,FNP,familymedicine
Our Portland Monthly Top Docs:
•RonAllen,D.O.,ophthalmology
•JohnBarnes,DPM,podiatry
•MarkBates,M.D.,internalmedicine
•EdwardBieniek,M.D.,surgery
•LauraBitts,M.D.,familymedicine
•LauraBledsoe,M.D.,pediatrics
•MichahBrasseur,M.D.,neurology
•PrasannaChandran,M.D.,family
medicine
•JeffreyCleven,M.D.,internal
medicine
•JonathanCrist,M.D.,sports
medicine
•RobertCrouse,M.D.,internal
medicine
•ErtanEsmer,M.D.,ear,noseand
throatmedicine
•AndreGrisham,M.D.,surgery
•JeffreyHal,M.D.,radiology
•TomHirsh,M.D.,radiology
•JansonHolm,DPM,podiatry
•MaryHorrall,M.D.,pediatrics
•MichaelHwang,M.D.,orthopedics
•ChrisHyun,M.D.,gastroenterology
•TerresaJung,M.D.,gynecology
•GaryKim,M.D.,internal
medicine
•MeganMadden,M.D.,neurology
•MonikaMalecha,M.D.,
ophthalmology
WHAT WOULD YOU LIKE TO READ ABOUT IN FUTURE ISSUES OF OUR NEWSLETTER?
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DOWNTOWN SURGERY CENTER EARNS SAFETY ACCREDITATION
ThePortlandClinic’sdowntownsurgerycenterhasdemonstratedits
commitmenttopatientsafetybyearningaccreditationfromtheAmerican
AssociationforAccreditationofAmbulatorySurgeryFacilities.Afterathorough
assessmentofhundredsofpatient-safetycriteria,thecenterwasfoundtobein
100percentcompliancewithallsafetystandards.
INTRODUCING “EDIE,” A NEW PART OF OUR CARE TEAM
Anewmemberofourteamhasbeenworkingquietlybehindthescenes,inlocal
hospitalsandemergencyrooms,toimprovecareforourpatients.EDIE—the
EmergencyDepartmentInformationExchange—letsusknowinrealtimeif
youareadmittedtoahospitalorERinOregonorWashington.Thatgivesyour
primarycareprovideranopportunitytosharepertinentinformation—suchas
yourmedicalhistoryortreatmentsthathaveworkedwellforyouinthepast—
withtheteamthat’sprovidingyourcare.EDIEisagreatadditiontotheteam,
helpingusallworktogethertolookoutforyourbestinterests.
06
The Portland Clinic Access Guide7 LOCATIONS | 24/7 ACCESS | 503-221-0161
PORTLAND SOUTH6640SWREDWOODLNPORTLAND,OR97224PHONE|503-620-7358HOURS|M–F7:30A.M.–5P.M.
PORTLAND DOWNTOWN800SW13THAVENUEPORTLAND,OR97205PHONE|503-221-0161HOURS|M–F8A.M.–5P.M.URGENT CARE|M–F9A.M.–6P.M.
PORTLAND EAST541NE20THAVENUE,SUITE210PORTLAND,OR97232PHONE|503-233-6940HOURS|M–F7:30A.M.–5P.M.
COLUMBIA5847NE122NDAVEPORTLAND,OR97230PHONE|503-256-3401HOURS|M–F7:30A.M.–5P.M.
HILLSBORO256SE2NDAVENUEHILLSBORO,OR97123PHONE|503-648-4171HOURS|M–F8A.M.–5P.M.
BEAVERTON15950SWMILLIKANWAYBEAVERTON,OR97003PHONE|503-646-0161HOURS|M–TH7:30A.M.–5P.M.FRI8A.M.–5P.M.
TIGARD9250SWHALLBLVDTIGARD,OR97223PHONE|503-293-0161HOURS|M–F8A.M.–5P.M.URGENT CARE|M–F8A.M.–8P.M.SAT9A.M.–5P.M.
SCHEDULING/ PHYSICIAN REFERRAL503-223-3113
AFTER HOURSFORURGENTNEEDSWHENOUR
CLINICSARECLOSED,CALLOUR
ON-CALLPHYSICIAN:503-221-0161.
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OURDOWNTOWN,BEAVERTON
ANDSOUTHOFFICES.
TOLL-FREE FROM SW WASHINGTON 360-693-3532
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FOLLOW US ON TWITTER TWITTER.COM/PORTLANDCLINIC
WATCH US ON YOUTUBE YOUTUBE.COM/THEPORTLANDCLINIC
07
Health ClassesPRE-REGISTRATION IS REQUIRED.
FORCLASSDETAILS,VISITWWW.THEPORTLANDCLINIC.COM/CLASSES
DIABETES: INVITATION TO A HEALTHIER LIFE
BEAVERTON|WEDNESDAYS,APRIL13–MAY11,4–6P.M.
SOUTH|WEDNESDAYS,MAY25-JUNE22,7-9P.M.
Whetheryou’vejustbeendiagnosedwithType2diabetes,oryou’velivedwith
itforyears,you’lllearnmoreaboutdiabetesself-managementinthisfive-week
series.Aregisterednurseandaregistereddietitian/certifieddiabeteseducator
teacheachsessiontohelpyougaintheskills,knowledgeandconfidenceto
maintaingoodhealth.Manyhealthplanscoverthecostofthisseries;askyour
insurerdirectlyaboutcoveragefor“diabetesself-managementtraining.”To
register,call503-223-3113,[email protected].*
PREDIABETES: MAKING HEALTHY CHANGES TO AVOID DIABETES
EAST|THURSDAYS,MAY5ANDJUNE2,4:30-6P.M.
Areyounewlydiagnosedwithprediabetes?Researchshowsthatpeoplewith
prediabetescanavoiddevelopingdiabetes.Learnhowinthistwo-partclass.
Shareyourstory,bringquestions,andstrategizewithotherparticipants.Each
sessionistaughtbyaregisterednurseordietitian/certifieddiabeteseducator.
Mostinsurancecompaniescoverthecostoftheserieswithyourusualcopay.
Toregister,pleasecall503-233-6940.*
*One support person may attend with you at no added cost.
REGULAR SCREENING PREVENTS COLON CANCER
Thegoodnews:Coloncancerdiagnosesamongpeople50andoverhave
dropped30percentintheU.S.inthelast10years,thankstomorepeople
gettingregularscreenings.
Thebadnews:Wecouldbedoingalotbetter.Eventhoughweknowthat
regularscreeningcanpreventmostcoloncancers,only59percentofpeople
50andoverareuptodateonthesetests.Asaresult,coloncancerisstilloneof
theleadingcausesofcancer-relateddeathsintheUnitedStates.
Upto90percentofcoloncancersbeginasbenigngrowthscalledpolyps.
About25percentofpeoplehavepolypsintheircolonbytheageof50.Ifthese
polypsaren’tremoved,someofthemmayeventuallydevelopintocancer.
Gettingregularscreeningsgivesyouthebestchanceoffindingthesepolypsso
theycanberemovedbeforetheyeverhavethechancetobecomecancerous.
ThePortlandClinicjoinstheAmericanCancerSocietyinitscommitment
toincreasescreeningratestoatleast80percentby2018.Screeningis
recommendedbeginningatage50,orearlierforpeopleathigherriskof
developingcoloncancer.Ifyouare50orover,pleasetalkwithyourdoctor
aboutyourriskandaboutgettingscreened.
08
Food for ThoughtNUTRITION TIPS FROM THE PORTLAND CLINIC DIETITIANS
SIX SHIFTS TO BOOST YOUR VEGETABLE INTAKE
ThenewlyreleasedDietaryGuidelinesforAmericansfocusonmakingshifts
tosubstitutemore-nutritiousfoodsforless-healthychoices.Onekeyshiftisto
choosemorenon-starchyvegetablesinplaceoffoodsthatarehighincalories
andsaturatedfats.Makingthisshiftcouldreduceyourriskofobesity,diabetes,
heartdisease,cancerandotherills.Youknowit,butthequestionis,howtodoit?
Weoffersixsimpleshiftstohelpyoufinallygetseriousaboutyourveggies.
ToseetheDietaryGuidelines,visithealth.gov/dietaryguidelines/2015/guidelines.
it.Lookmorecloselyintheproduce
section—veggiesaregettingmore
andmoreconvenient.
4. Shift cooking methods
Aretherecertainvegetablesthatyou
neverliked?Maybetheproblemwas
thewaytheywerecooked,andnotthe
veggiesthemselves.Giveyour“dislike”
listanothertry,andcookthemtheway
youlike.Roastingmakeseverything
sweeter.Steamingtakesjustafew
minutesforcrisp-tender(notmushy)
results.Asquirtoflemonaddsazesty
finish.Youmightsurpriseyourself.
5. Shift out of your rut
Greensaregood,weknow,butsoare
reds,oranges,yellowsandpurples.If
yourplateisalwaysthesamecolor,
shifttoshoppingforvegetablesin
everycoloroftherainbow.Varietyisn’t
onlythespiceoflife—it’salsothekey
tocoveringallthenutrientbases.
6. Shift your snacks to veggies
Veggiesinsteadofchips?Absolutely.
Buyaweek’sworthofyourfavorite
pre-choppedveggies(orpre-chop
yourown),whipuponeofthedipson
page9,andvoila—veggie“chips”and
dipwhenevertheurgeforacrunchy
snackstrikes.
1. Shift your mindset
Placea2-cupmeasuringcupatthe
centerofyourkitchencounterevery
morning.That’stheminimumamount
ofvegetablesyoushouldeatevery
day.Avisualreminderhelpsyou
makeveggiesapriorityratherthanan
afterthought.Manypeopletakeiteven
further,measuringtheirvegetablesat
eachmealandcheckingoffeachhalf-
cuponacharttomakesuretheymeet
(orbetter,beat)theirminimum.Ifyou
needextrareinforcement,giveitatry.
Once2cupsisahabit,gofor3or4.
2. Shift your timing
Don’twaituntildinnertothinkabout
vegetables—bythen,it’shardtocatch
uponyour2-4cups.Shifttoincluding
vegetablesearlierintheday.Tryan
eggscrambleloadedwithmushrooms,
peppers,anyleftoverveggiesand
somechunkysalsaforbreakfast;a
tacopiledwithcabbage,avocado
andcucumberforlunch,andahot
vegetableandcoolsaladwithdinner.
3. Shift “convenience” foods
Ifyouhavetimetomicrowavea
frozenmeal,youhavetimetopoke
acoupleofholesinabagofpre-
choppedbroccoliandmicrowave
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5
The Grocery BagCREAMY GARLIC-HERB DIP
•1/2cup(4ounces)1/3-less-fatcreamcheese
•1/4cupbuttermilk
•2tablespoonsmincedfreshchives
•1tablespoonmincedfreshparsley
•1teaspoongratedlemonrind
•1/4teaspoonsalt
•1/8teaspoonfreshlygroundblackpepper
•1smallgarlicclove,minced
Blendeverythingwithamixerorfoodprocessor
untilsmooth.Per2-tablespoonserving:55calories,
4.4gfat(2.9gsatfat),2.5gprotein,1.5gcarbs,
195mgsodium.
SMOKED SALMON DIP
•1(8-ounce)tublightcreamcheese
•2tablespoonschoppedfreshdill
•1tablespoonfreshlemonjuice
•4ouncessmokedsalmon,chopped,divided
Blendeverythingbuthalfthesalmoninafood
processoruntilsmooth.Foldinremainingsalmon.
Per2-tablespoonserving:56calories,3.5gfat(2.1
gsatfat),4gprotein,1.4gcarbs,89mgsodium.
The perfect 100-calorie snack
Vegetablesarepackedwith
essentialnutrientsthatour
bodiescraveforgoodhealth.
Yetmostofusstruggletoget
our2cups(minimum)daily.
Maybeit’stimeweshiftedour
thinkingaboutveggiesfroma
“should”toa“want.”
Here’soneeasyway:Trade
inyourchipsforveggiesand
dip.Acupofrawveggies
(yourchoice)andaservingof
eitherofthesedipsdelivers
atasty,crunchysnack,half
yourdailyveggies,oodlesof
nutrientsandjust100calories.
Chipsjustcan’tcompete.
ByThePortlandClinicdietitians.
Recipesfrom Cooking Light.
Dipskeepuptoaweekinthefridge.