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01 TAKECONTROLOFPAIN–WITHOUTOPIOIDS

03 Q&A:BEATINGBACKPAIN

04 LASERSKINTREATMENT–NOW’STHETIME

06 THEPORTLANDCLINICACCESSGUIDE

07 CLASSES:MANAGINGCHRONICPAIN

08 BUILDBETTERBROWN-BAGLUNCHES

09 RECIPE:PEANUTSESAMENOODLES

01 CONTINUEDONPAGE02

OxyContin,Percocet,Vicodinandotheropioidpainkillers,whenusedcorrectly,

canhelppeoplegetthroughshort-termacutepain,suchassurgery.But

wenowknowthatthesedrugsposeseriousriskswhenusedlongtermfor

chronicpain.Inadditiontotheveryhighriskofaddictionandfataloverdose,

theycancauseorworsendepression,sleepproblems,heartdiseaseandlow

testosterone.Ontopofallthat,inacruelirony,theyactuallymakemanypeople

moresensitivetopain,andlessabletofunctionwellintheirdailylives.

Fortunately,wehavesaferoptions.Non-opioidmedicines,physicaltherapyand

cognitivebehavioraltherapyarethreeapproaches,oftenusedincombination,

thatcanbeveryeffectiveforpeoplewithpersistentpain.Whiletheyrequire

morecommitmentthansimplytakingapainpill,theydoabetterjobof

addressingtherootofthepainandhelpingyouregaincontrolofyourlife.

Non-opioid medicines

Severalmedicinesareavailablethatarejustaseffectiveasopioidsinreducing

chronicpain,butwithouttheaddictivenatureofopioids.Someexamples:

• NSAIDs(nonsteroidalanti-inflammatories—e.g.,aspirin,ibuprofen)reduce

bothpainandinflammation.They’reavailableoverthecounter,inprescription

strength,andintopicalcreamsthatcanreducestomachirritation.

• Tylenolreducespain,butnotinflammation.It’seasieronthestomachthan

NSAIDs,butcorrectdosingisimportanttoavoidliverdamage.

• Anticonvulsants(e.g.,Gabapentin)canrelievenervepainfromshingles.

• SNRIs(serotoninandnorepinephrinereuptakeinhibitors—e.g.,Cymbalta,

Effexor)areanewclassofantidepressantsthatalsorelievechronicpain—

especiallynervepainandfibromyalgia.

•Triciclicantidepressants,anolderclassofantidepressants,alsocantreatpain.

Manypeoplefindthattakingacombinationofthesetoaddressseveraldifferent

painpathwayscanbringsignificantrelief.

Take Control of Pain — Without OpioidsA PHARMACIST, A PHYSICAL THERAPIST AND A PSYCHOLOGIST OFFER HELP

ALEX BULOCHNIK, PHARM.D. (DOWN-TOWN), LEIGH REECE, DPT (SOUTH AND TIGARD), AND MICHAEL SHRIFTER, PSY.D. (SOUTH) SHARE THEIR ADVICE.

02

Physical therapy

Ifyouhavepainwithmovement,whetheritstartedwithaninjuryordeveloped

gradually,physicaltherapymaybeagoodoptionforyou.Physicaltherapists

focusonhelpingyoumovebetterwithlesspain.Theymayusehands-on

techniquestodecreasetissueirritationandimproverangeofmotion.Butthe

mosteffectivetreatmentsarethestretchingandstrengtheningexercisesthat

theycanteachyoutodoforyourself.

Byworkingone-on-onewithaphysicaltherapist,you’llgainabetter

understandingofwhyyouhavepain,howyourbodyiscapableofmoving,

andhowtokeepitmoving.You’llalsoincreaseyourstrength,flexibilityand

toleranceformovement,whichcanreduceoreveneliminateyourneedforpain

medication.Learnmoreatmoveforwardpt.comandtamethebeast.org.

Cognitive behavioral therapy

Peopledon’tautomaticallythinkofpsychotherapyasatreatmentforpain.

Butpainhasbothphysicalandemotionalcomponents,andimprovingyour

emotionalwell-beingcanreduceyourpain.Specifically,cognitivebehavioral

therapycanhelpyougaincontroloveryourpaininthreeways:

• Byvalidatingyourexperienceofpainanditsimpactonyourlife

• Through“behavioralactivationinterventions,”whichteachyouwaystofeel

safemovingyourbodymore,withoutoverdoingit

• Through“cognitiverestructuring,”orchangingyourautomaticthoughtsfrom

patternsofconstantcatastrophe,soyoucantellanewstoryaboutyourlife

Take a positive step forward today

Ifyoulivewithpain,weencourageyoutotakeonesmall,positivestep

foryourselfbyattendingourfree,one-hourpainmanagementclass—see

page7fordetails.Yourhealthcareteamisheretohelpyouexplorethebest

approachestogainingcontroloveryourpain.Letushelp.

Q&A: Beating Back Pain BY TOM STARBARD, D.O. , MANUAL MEDICINE

03

Q: I OVERDID IT IN THE YARD. NOW MY BACK IS KILLING ME. WHAT CAN I DO?

Aslongasthepainisn’textending

intoyourlegsandyou’renothaving

problemsemptyingyourbladderor

bowel,trygentlehometreatment.

Icepackscanreduceinflammation

andhelpnumbthenerves.Aheating

padcanrelievemilderpain.Ifyou’re

notsure,stickwithice.Eitherway,

gentlestretchingcanhelp,too.

Q: SHOULD I REST IN BED UNTIL MY BACK STOPS HURTING?

Prolongedbedrestisnotagood

idea.Yourbodyneedsmovementto

stimulatebloodflow,whichishelpful

forbackpain.Ifyourpainissevereor

shootingdownyourlegs,youshould

getitcheckedout.Otherwise,trythe

tipsabove.AbathwithEpsomsalts

couldhelp,too.

Q: HOW CAN MY DOCTOR HELP?

Yourdoctorcancheckformore

seriousproblemsandreferyou

fortreatmentIfyourpainissevere

orself-careisn’thelping.Ifyour

conditionisn’tserious,yourdoctor

canofferreassuranceandcancoach

youonhomecare.Sometimes,back

issuesjusttaketimetogetbetter.

Q: WHAT ARE THE BEST WAYS TO AVOID BACK TROUBLE?

Thesearemytopthree:

1. Exercise regularly. Movingyour

bodyrelievesstress,keepsoff

extrapoundsthatcanmakeback

problemsworse,andkeepsyour

wholemusculoskeletalsystemintop

shape.Doavarietyofactivitiesand

movementstoexerciseallareasof

yourbodyandback.

2. Maintain good posture.Slouching

orhunchingforwardputsstresson

yourback.Ifyouworkatadesk,

mixupyoursittingarrangements

throughouttheday,switchingfrom

achairtoayogaballtostanding.If

youhaveaccesstoasit-standdesk,

that’sagreatwaytoavoidstayingin

thesamepositionalldaylong.

3. Use proper body mechanics. Lift

withyourlegs,notyourback,and

don’ttwistyourbackwhilelifting.

Q: WHAT STRETCHES AND EXERCISES CAN I DO TO STRENGTHEN MY BACK?

Core-strengtheningexercisescan

beveryhelpful.Visitourwebsite

foranillustratedpageofLower-

BackStretchesandStrengthening

Exercises.

Q: CAN YOGA HELP WITH STUBBORN BACK PAIN?

Yes!WeAmericansdon’tstretch

enough,andtightmusclescan

getverypainful.Yogaandother

stretchingexercises(taichi,qigong,

pilates)helpreducemuscletension

andimprovebloodflow,whichis

greatforyourwholebody.

OSTEOPATHICPHYSICIANTOMSTARBARD,

D.O.,HASBEENNAMEDA“TOPDOC”BY

PORTLANDMONTHLYFORFIVEYEARS

RUNNING.HEPRACTICESINOUR

NORTHEASTANDTIGARDOFFICES.

News BriefsWHAT’S NEW AT THE PORTLAND CLINIC

04

INTRODUCING TWO NEW PHYSICIANS

Young Choi, M.D., gastroenterology,nowseespatientsinour

DowntownandTigardoffices.DuringhisearlyyearsinAustin,

Texas,hewasinspiredbyhisphysicianfather.“Fromhim,I

learnedthatbeingaphysicianwasnotanoccupation,buta

calling,”hesays.“Ialwaysadmiredmyfatherbecomingan

advocateforhispatients.”Dr.Choiearnedhismedicaldegree

fromtheUniversityofIllinoisCollegeofMedicine.Priorto

joiningThePortlandClinic,hewasthechiefofgastroenterology

attheSkagitValleyRegionalClinicatMt.Vernon,Wash.

Diana Umene, M.D., internal medicine,recentlyjoinedour

Downtownteam.ShegrewupinCaliforniaandmovedto

PortlandforhermedicaltrainingatOregonHealth&Science

University.“Ienjoybeingapatientadvocate,activelistener

andeducator,asitisatthecoreofmaintainingalong-lasting

andtrustingrelationship,”shesays.“IhopetobuildsuchapracticehereatThe

PortlandClinic.”Dr.UmeneisfluentinJapanese.

HOW DOES YOUR DOCTOR RATE?

Wonderinghowotherpatientsrateyourdoctor?Nowyoucanfindout.Just

visittheportlandclinic.comandpluginyourdoctor’snameinthesearchwindow

atthetop.Whenyourdoctor’sbiocomesup,scrolldowntoseeratingsand

commentsfromotherpatients.

Allcommentsandratingscomefromourpatientsurveys.Notalldoctors

haveratingsyet—basedonindustrystandards,werequireaminimumof30

completedpatientsurveysbeforewepostanaverageratingforaphysician.

Overtime,aswereceivemoresurveys,thenumberofratedphysicianswill

increase.Learnmoreaboutourdoctorreviews.Andkeepyoureyesopenfor

thosesurveys!

CONSIDERING LASER SKIN TREATMENT? NOW’S THE TIME

Fallmeansit’stimetopackawayourshortsandtocoverupwithlongpantsand,

sigh,jackets.Butbeforeyoucoverupcompletely,takeagoodlookatyourskin.

Ifyouseesignsofsundamage,brownspotsorotherblemishes,fallisalsothe

perfecttimetobooklaserskintreatments.

Ourdermatologistsuselaserstotreatsundamageaswellasagespots,rosacea,

brokenbloodvessels,wrinklesandacnescars.Manyofthesetreatmentscan’tbe

doneinthesummer,whenyourskinisexposedtosunlightmoreoften.Soifyou

thinknow’sthetime,giveourdermatologistsacall.Learnmore.

GivingNEWS FROM THE PORTLAND CLINIC FOUNDATION

05

WE GAVE $40,000 TO 17 LOCAL NONPROFITS, AND YOU HELPED!

ThePortlandClinicFoundationrecentlyawarded$40,000ingrantsto

17Portland-areanonprofitorganizations.Heartfeltthankstoeveryonewho

contributed!Pleasejoinusincelebratingour2018grantrecipients:

• FamilyJusticeCenterofWashingtonCountyworkstoendthecycleof

domesticviolencebyprovidingcomprehensiveservicestosurvivors.

• PathfindersNetworkmentorsandsupportsjustice-system-impactedchildren,

individualsandfamilies.

• VillagesNWconnectselderswithvolunteerswhohelpthemtoliveand

ageindependently.

• Children’sBookBankgivesbookstolow-incomechildrentoimproveliteracy

andeducationaloutcomes;ourgrantprovidedbooksfor75children.

• HollywoodSeniorCenteroffersprogramsandservicestoseniorsandim-

proveswellnessthroughevidence-informedexerciseandmovementclasses.

• CoalitionofCommunitiesofColorfundsresearchintotheinequitiesaffecting

communitiesofcolorinordertoinformlong-termchangeinitiatives.

• TraumaInterventionProgramofPortland/Vancouver,Inc.,providesemer-

gencysupport,throughavolunteernetwork,topeopleincrisis.

• Voz:Workers’RightsEducationProjectempowers,informsandprovidessafe

employmentforvulnerabledayworkers.

• ASSISThelpsdisabledpeopleexperiencinghomelessnessorlivinginpoverty

toattainSocialSecuritybenefitsandlong-termstability.

• Bienestar,Inc.,provideshousing,hope,services,stabilityandempowerment

forthewell-beingofworkingfamiliesandseniors.

• TheJessieF.RichardsonFoundationworkstoimproveconditionsfor

vulnerableolderadultsandrunsTheTiesThatBind,asupportnetworkfor

grandparentsraisingtheirgrandchildrenthroughfostercare/adoption.

• MiracleTheatreGroup(Milagro)supportstheaterproductionsthatbuildun-

derstanding,creativityandcommunityamongLatinoandgeneralaudiences.

• PawsAssistingVeteransprovidessupportdogsforveteranswithPTSD.

• WilliamTempleHousesupportspeopleinneedwithemergencyassistance

(food,supplies,shelter,referrals),mentalhealthcounselingandspiritualcare.

• EcologyinClassroomsandOutdoorssupportshands-onecologicalandout-

doorlearningopportunitiesforlow-incomeelementaryschoolstudents.

• NorthbyNortheastCommunityHealthCenterprovidesculturallyspecific

careforlow-incomeAfricanAmericancommunities.

• TheLivingRoomoffersasafehavenforLGBTQyouthsinClackamasCounty.

Formoreinformation,pleasevisittheportlandclinic.com/foundation.

06

SCHEDULING/ PHYSICIAN REFERRAL503-223-3113

AFTER HOURSFORURGENTNEEDSWHENOUR

CLINICSARECLOSED,CALLOUR

ON-CALLPHYSICIAN:503-221-0161.

TOLL-FREE FROM SW WASHINGTON 360-693-3532

The Portland Clinic Access GuideFIVE LOCATIONS | 24/7 ACCESS | 503-221-0161

FIND US ON FACEBOOK FACEBOOK.COM/THEPORTLANDCLINIC

FOLLOW US ON TWITTER TWITTER.COM/PORTLANDCLINIC

WATCH US ON YOUTUBE YOUTUBE.COM/THEPORTLANDCLINIC

MAKE APPOINTMENTS ON ZOCDOC THEPORTLANDCLINIC.COM/ZOCDOC

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SOUTH6640SWREDWOODLNPORTLAND,OR97224PHONE|503-620-7358HOURS|M–F7:30A.M.–5P.M.

DOWNTOWN800SW13THAVENUEPORTLAND,OR97205PHONE|503-221-0161HOURS|M–F7:30A.M.–5:30P.M.

NORTHEAST5005NESANDYBLVDPORTLAND,OR97213PHONE|503-233-6940HOURS|M–F7:30A.M.–5P.M.

BEAVERTON15950SWMILLIKANWAYBEAVERTON,OR97003PHONE|503-646-0161HOURS|M–TH7:30A.M.–5P.M.FRI8A.M.–5P.M.

TIGARD9250SWHALLBLVDTIGARD,OR97223PHONE|503-293-0161HOURS|M–F7A.M.–5P.M.URGENT CARE|M–F8A.M.–8P.M.SAT9A.M.–5P.M.

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07

Health Classes & NewsPRE-REGISTRATION IS REQUIRED FOR ALL CLASSES.

MANAGING CHRONIC PAIN – IN PARTNERSHIP WITH REGENCE

SOUTH|WEDNESDAY,OCT.10,2-3P.M.

NORTHEAST|TUESDAY,NOV.13,2-3P.M.

BEAVERTON|WEDNESDAY,DEC.5,5-6P.M.

Wishyoucouldrelylessonmedicationtocontrolchronicpain?Inthisfree

class,taughtbyaphysicaltherapistandabehavioralhealthspecialist,you’ll

learnprovencopingtechniques.Toregister,call503-293-0161ext.4138.

DIABETES: INVITATION TO A HEALTHIER LIFE

SOUTH|WEDNESDAYS,OCT.10-NOV.7,7-9P.M.

Whetheryou’vejustbeendiagnosedwithType2diabetes,oryou’velived

withitforyears,you’lllearnmoreaboutdiabetesself-managementinthis

five-weekclassseries.Aregisterednurseandaregistereddietitian/certified

diabeteseducatorteacheachsessiontohelpyougaintheskills,knowledge

andconfidencetomaintaingoodhealth.Manyhealthplanscoverthecostof

thisseries;askyourinsureraboutcoverage.Toregister,call503-223-3113or

emailRSVP@TPCLLP.COM.Onesupportpersonmayattendwithyou.

CAN THE FLU SHOT GIVE YOU THE FLU?

Westillhearthisquestionalot,andtheanswerisafirm“No,”sayspharmacy

directorAlexBulochnik,Pharm.D.“Thevirusinthevaccineisinactivated,”he

says.“Itdoesn’tcontainanypartofthefluvirusthatcouldbepassedonto

you.”Andjusttobeclear,headds,“Therearenoexceptionstothat.”

Sowhatmightexplainsomeonehavingflu-likesymptoms,suchasalowfever

andmuscleaches,aftergettingthevaccine?“That’sasignthatyourimmune

systemisrespondingtotheforeignvaccineandbuildingadefenseagainstthe

flu,”saysDr.Bulochnik.Thosesymptoms,whentheyhappenatall,aremuch

milderthanacaseoftheflu,andusuallylastonlyadayorso.Afull-blowncase

ofthefluismuchmoresevereandcanlastforaweekormore.

Itispossibletogetthefluaftergettingtheflushot,butit’snottheshotthat

causesit.Youcouldstillgetthefluif:

• Youwereexposedtotheflubeforeyougottheshot,orbeforeyourbody

hadachancetobuildfullimmunitytotheflu(ittakesabouttwoweeks).

• Youwereexposedtoastrainofthefluthatwasn’tcoveredbytheshot.

Eachyear’svaccineisformulatedtoprotectagainsttheflustrainsmost

likelytohit,butnovaccinecanprotectagainsteverypossiblefluvirus.

What’stheupshot?“Gettheshot,”saysDr.Bulochnik.“It’ssafe.Itreduces

yourriskofgettingtheflu,andit’snotjustaboutyou—italsolowersyour

riskofspreadingtheflutoyourfamilyandthepeoplearoundyou.”

08

Food for ThoughtTIPS FROM THE PORTLAND CLINIC PEDIATRICS TEAM

BUILDING A BETTER BROWN-BAG LUNCH

Nowthatschoolisbackinfullswing,we

askedtwoofourresidentexpertsfortheir

adviceonhowtopackalunchthat’sfastand

easy,butstillhealthyandappealingtokids.

HereiswhatourBeavertonpediatricians

MaryEllenUlmer,M.D.(left),andKathleen

Palm,M.D.,hadtosay.

Leverage your leftovers

Makeextradinnertopackforlunch

(seeourrecipeonpage9).Ifchicken,

meatortofuisonthedinnermenu,

makeenoughtouseinsandwiches.

Got milk?

Don’tpacksugarydrinksandjuices.

Waterandlow-fatmilkarethebest

drinksforkids.Chocolatemilkshould

belimitedtoaonce-a-weektreat.

Ifyoudopackfruitjuice,makesure

ithasnoaddedsugar,andkeepin

mindthattheAcademyofPediatrics

recommendsnomorethan4-6

ouncesadayfor4-6yearoldsand

8ouncesmaxforkids7andolder.

Rethink your bag

Insulatedlunchboxesandbagshelp

keephotfoodhotandcoldfood

cold.ConsideraThermosforsoup

orspaghetti,orslipinanicepackto

keepmeatsandmayocold.

Keep it fun

Getthekidsinvolved.Givethem

choicesbetweenhealthyoptions.

Packdipsfortheveggies.Cut

sandwichesinfunnyshapes.Slipa

jokeoranencouragingnoteintotheir

bag.Don’tforgetthelove.

Try for five

Trytoincludethesefivekindsof

foodsinyourchild’slunch:protein,

vegetables,fruit,grainsanddairy.A

well-balancedlunch(andbreakfast!)

helpskidsdotheirbestinschool.

Pack real food

Steerclearofprocessedfoodslike

Lunchables,chips,cookies,candies

andcrackerswithnofiberinthem.

Encourageyourkidstoeatrealfood.

Think outside the sandwich

Sickofsandwiches?Herearesome

ideastokeeplunchtimeinteresting:

•Proteins:meatslicesorrolls;string

cheese;edamame;tuna;smoked

salmonortrout;hummusorblack

beandip;peanutorothernutbutters

•Grains:whole-graincrackersor

bagels;low-sugarcereals(Cheerios,

Life,ShreddedWheat);leftoverrice,

noodlesorwhole-grainwaffles

•Vegetables:cherrytomatoes;pea

pods;carrots;celery;broccoliorcauli-

flowertrees;jicama;roastedseaweed

•Fruits:Anythingfreshandinseasonis

best,butapplesauce,driedfruitand

fruitleathersareOKaslongasthey

don’thaveaddedsugar.

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The Grocery Bag

Make it for dinner, pack leftovers for lunch

Peanutbutternoodlesare

theultimateeasy,kid-friendly

dinner—andkidslovepack-

ingtheleftoversforlunch.

Thisrecipeissuperflexible:

•Swapinanyvegetables

thatyourkidslike.

•Nutallergies?Usesunflower

seedbutterinstead.

•Boostfiberbyusingwhole-

grainorsobanoodles.

•Increaseproteinbyadding

shreddedchickenortofu.

From The Portland Clinic Nutrition Team

Recipe: superhealthykids.com

PEANUT SESAME NOODLES & VEGGIES

• 1/4cuplow-sodiumsoysauce

•2Tbsp.ricevinegar

• 1Tbsp.sesameoil

•3Tbsp.peanutbutter(orsunflowerseed

butterforthosewithpeanutallergies)

• 1Tbsp.honey

• 1tsp.freshgingerroot,peeledandgrated

•2clovesgarlic,peeledandgrated

• 1tsp.Srirachasauceorchilipaste

• 16oz.dryricenoodles(orothernoodles)

•2-3cupschoppedveggies(e.g.,1redbell

pepper,1-1/2carrotsand1greenonion)

• 1/4cuppeanuts(orsunflowerseeds)

Whisktogetherfirst8ingredients.Cook

noodlesaccordingtopackage,leavingslightly

firm.Drainbutdon’trinse.Poursauceover

noodlesandmixtocoat.Stirinveggies.Top

withnuts.Enjoyatroomtemporchilled.

8 servings: 304 cal, 7g fat, 53g carbs, 5g protein,

2g fiber, 4g sugar