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?

PleaseletusknowwhetheryouwouldliketokeepreceivingThePortlandClinic

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Ifyouhavesentthisformbefore,thereisnoneedtosenditagainunless

youaremakingachangeoryouareofferingfeedbackonthenewsletter.

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.

OPHTHALMOLOGYEYESERVICESAREAVAILABLEIN

OURDOWNTOWN,BEAVERTON

ANDSOUTHOFFICES.

TOLL-FREE FROM SW WASHINGTON 360-693-3532

FIND US ON FACEBOOK FACEBOOK.COM/THEPORTLANDCLINIC

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,orsendanemailtoRSVP@tpcllp.com.*

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.