Flu shots are now available for all GreenField patients and their families. We have
scheduled flu shot clinics on the following dates at our Barnes Road location:  

Saturday, October 18           10:00 am – 2:00 pm

Saturday, November 8         10:00 am – 2:00 pm 

Many insurance companies do not cover the cost of flu shots so it is frequently an out-of-pocket expense. If you are a GreenField patient, we will bill your insurance and collect a
co-payment if you have one, since it is a large part of the total cost of the immunization. Please plan to pay your co-payment by check or credit card on the day you visit the clinic. 

We are also happy to vaccinate family members even if they are not patients at GreenField. For friends and family members who are not GreenField patients, we will not be able to bill insurance, but we are happy to provide the shots for a $40 payment at the time of service.
We would greatly appreciate it if you could please pay by check or credit card. 

In addition to the flu shot clinics, you can also come to our Barnes Road or NE Broadway locations at any time for the vaccine. You don’t need to schedule a visit, but if you’d like to assure the quickest service, please call ahead and schedule a time with one of our Health Coordinators.  

If you have any severe allergies, please talk to your physician before having the vaccine. It
is also important to note that children under the age of 8 who have never had the vaccine
will need two doses separated by at least one month. Your GreenField physician can
discuss this with you further if you are planning on vaccinating your child.  

The best time to get the flu vaccine is in October and November, but vaccination in
December or later can still be beneficial. If you get one elsewhere – for instance at work
or the local grocery store – please let us know so that we can record this in your chart.  

We last discussed the problems with prostate cancer screening in 2005. Prostate cancer
is the most common non-skin cancer, and the second leading cause of cancer death in
men. While prostate cancer screening is essentially a community standard in Portland,
and while we do it routinely at GreenField, it remains very difficult to demonstrate the
benefits of prostate cancer screening while the harms – both psychological and clinical –
are much clearer.  

The US Preventive Services Task Force recently published a major summary of the
existing data in a highly respected medical journal. We will summarize their article here,
and readdress the issue of prostate cancer screening.  

The US Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care. It is known that the measurement of the prostate-specific antigen (PSA) in the blood can find prostate cancer before symptoms develop. Abnormal PSA levels require prostate biopsy to see whether cancer is actually present.  

The problem is that it is not known whether treating prostate cancer before symptoms develop helps patients. Most prostate cancer grows very slowly, and many men with prostate cancer die of something else before the prostate cancer causes a problem. Thus, the early detection of prostate cancer with the PSA test and biopsy in those without symptoms puts men at risk for unnecessary worry and side effects of treatment. Both surgery and radiation therapy, the most common treatments for prostate cancer, can cause problems with sexual function and bowel and bladder incontinence. 

The USPSTF performed a very thorough review of published research to assess the benefits and harms of screening for prostate cancer. Importantly, their review and their recommendations apply to men at average risk for prostate cancer and not to men at high risk, such as those with a father or brother with prostate cancer. The conclusions from their review are as follows: 

-        Good evidence indicates that PSA testing can find prostate cancer.

-        For men younger than 75, no good-quality evidence shows that finding prostate cancer by screening rather than waiting until symptoms develop leads to fewer men dying of the disease.

-        For men age 75 or older, the benefits of finding prostate cancer by screening are small to none.

-        Good evidence indicates that treatment of prostate cancer found by screening can cause harms such as sexual dysfunction, bowel and bladder incontinence, and even death. Other harms from screening include pain from prostate biopsy and worry about test results. 

Based on this data, for men younger than 75, the USPSTF does not recommend either for or against routine screening for prostate cancer by using PSA testing. Before screening, men should understand the potential benefits and harms of early treatment.  

For men age 75 or older, the USPSTF recommends that doctors and patients do not routinely screen for prostate cancer because the harms are likely to outweigh the benefits.  

The Pros and Cons of Screening

It seems intuitive that doctors would want to find cancer in their patients at the earliest stage possible. Unfortunately, in the case of prostate cancer, the situation is not so simple. There are a number of arguments for and against prostate cancer screening. 

Arguments for screening

·        Even though many men with prostate cancer have the non-aggressive form and do not die of the disease, the cancer is common and a substantial number of men die from it every year, while many more have complications from advanced disease.

·        For men with the form of aggressive prostate cancer, the best chance for curing it is by finding it at an early stage through screening and then treating it with surgery or radiation.

·        We should detect prostate cancer early because the five-year survival for men who have prostate cancer confined to the prostate gland is nearly 100 percent, but it drops to 30 percent for men whose cancer has spread to other areas of the body.

·        The available screening tests are not perfect, but they are easy to perform.

·        Mortality due to prostate cancer has declined in recent years. It is possible that screening programs are partially responsible for this decline, although we cannot be certain. 

Arguments against screening

·        Despite the arguments for screening, there is little evidence that screening and treatment help men live longer or avoid the complications of advanced prostate cancer. No well-performed studies have determined that prostate cancer screening in the general population saves lives.

·        Men face significant risks from being diagnosed and treated for prostate cancer when a high percentage of those cancers would never have caused problems.

·        The high number of false-positive rectal exams and PSA tests, leads to anxiety and necessitates further testing including possible prostate biopsy which is relatively safe, but does have side effects.

·        The side effects of treatment for early prostate cancers detected by screening are substantial. Surgery and radiation therapy can cause erectile dysfunction and urinary and bowel problems. Many men will suffer significant side effects of surgery and radiation, when the cancer itself would never have been a problem.

Recommendations

The USPSTF and many European cancer societies have not endorsed routine PSA screening, while the American Cancer Society and American Urological Association do recommend screening. This lack of consensus arises from an inability to adequately assess the benefits of screening while recognizing that there are significant risks associated with treatment. 

Clearly, these tests are far from perfect, but those who favor prostate screening should have a yearly rectal exam and PSA, followed by prostate biopsy if either test is positive. Screening typically begins at age 50, although men who have other risk factors such as black men or men with a father or brother who had prostate cancer may want to begin screening at 45. Screening is generally discontinued in men over 75 because such men are unlikely to live long enough to benefit from screening. 

At GreenField, we know that there is no one right answer, although our tendency is toward yearly screening and then careful interpretation of the results. We do know that only you can decide what is best for you and our goal is to discuss these issues with each man and help him make a decision based on his personal preferences.  

The Transformation program at GreenField Health is a lifestyle and weight management program. There have been scores of participants over the three years of its existence and their experience has led to the development of “The Seventeen Habits of Successful Weight-Appropriate People.” Each month in Health Matters, we have been sharing one of these habits with you and discussing its benefits.  

This month we want to discuss the importance of practicing stress reduction techniques daily. Stress is an unavoidable part of life, especially in these times, but our reaction to it and our ability to reduce its harmful effects on our bodies is what can keep us healthier. This is true in terms of typical medical conditions we associate with stress, like headaches, stomach issues, etc. as well as our ability to maintain an appropriate weight and healthy body fat percentage.  

When we are stressed, even a modest amount on a daily basis, the output of the adrenal hormones adrenaline and cortisol are higher than when we are calmer. These hormones encourage fat storage, particularly around our waist. Not only that, they encourage us to eat foods with a quick energy reaction or those high in carbohydrates or sugars. We crave soothing foods the more we are stressed, which are usually high in sugar and fat. 

We can counteract this situation by practicing techniques which lower our bodies’ reactions to stress, thereby decreasing the output of these hormones. Exercise can do this and is an important part of a healthy lifestyle. Yoga, Tai Chi and other meditative movement practices are very effective in relieving stress and are available at affordable rates through community centers and parks and recreation departments. Quieting and relaxing our minds, even for a short time period, can have beneficial effects on our whole body. One resource that can help you find an easy way to incorporate this into your life is “The Relaxation Response” by Herbert Benson, MD. He is a Harvard cardiologist who first wrote this book 30 years ago when he pioneered an easy breathing technique to help his cardiac patients control their blood pressure. It has been used for decades and continues to be a very helpful stress reduction technique.  

So, rather than just reacting to stress, we can respond to it in effective ways to improve our health. There are many things which can lower stress in our lives; it is important to give those a high priority in our schedules so we will make the necessary time for them.  

Whooping Cough, also called pertussis, is a common upper respiratory infection in children, but adults can be affected as well. Pertussis is caused by a highly contagious bacterium called Bordetella pertussis. Pertussis is spread by direct contact with secretions or spray from the cough. It is easily spread from child to child, and adults can pick it up from infected children and pass it on to other children. 

In kids, pertussis infection ranges from very mild and indistinguishable from other colds and respiratory infections to classic whooping cough which can be severe and dangerous. In adults, it generally causes a respiratory infection with symptoms indistinguishable from typical viral upper respiratory infections. It can lead to a prolonged cough in adults.  

Whereas the typical cough from a viral upper respiratory tract infection lasts on average between 2-4 weeks, the cough from pertussis can last 2-3 months. Thus, when someone has a truly prolonged cough lasting more than 3-4 weeks, we start to think about pertussis. Whereas antibiotics are not helpful in the typical viral cold, bronchitis, or upper respiratory tract infection, antibiotics are used to treat pertussis.

Childhood immunization against pertussis started in the 1940s and by 1970, the number of pertussis cases had declined by more than 99%. In 1976 only about 1,000 cases were documented. However, in 2001 the documented pertussis cases increased to about 8,000, and outbreaks continue to occur every 3-4 years. Since pertussis frequently looks like the typical cold, bronchitis, or other upper respiratory infection, we don’t routinely test for it because testing isn’t easy and it is expensive. So these numbers probably represent just the tip of the iceberg in terms of the true prevalence of the infection.  

There are several factors that contribute to the resurgence of pertussis. One is that immunity to pertussis tends to wane over time - you slowly loose immunity. 

What can we do?

Most children already receive the pertussis vaccine along with tetanus and diphtheria in a combined vaccine referred to as DTaP – it is a series of 4 shots over several years. Parents should always assure that their kids receive all of the recommended vaccinations. 

Because immunity wanes over time, it is recommended that adults be revaccinated, and a new vaccine was made available about 2 years ago for adults. The adult vaccine combines “acellular pertussis” with tetanus and diphtheria and together they are referred to as Tdap – tetanus, diphtheria, acellular pertussis. The pediatric DTaP and the adult Tdap (yes, confusing) contain different quantities of diphtheria and pertussis and they are not interchangeable. 

We recommend that adults get a booster vaccine every 10 years, just like the prior tetanus vaccine. Pregnant women should talk with us before vaccination. The Tdap in adults will protect you against pertussis and keep you from spreading it to others. If you received a “tetanus shot” prior to 2 years ago, you likely received tetanus and diphtheria. If you received a “tetanus” shot in the past 2 years, you likely received the Tdap.  

To get vaccinated at GreenField, an appointment isn’t necessary. You can even get a flu shot at the same time. 

And don’t forget, covering your mouth when you cough or sneeze helps to reduce the spread of viruses or bacteria as does frequent hand washing, especially when you have a cold or upper respiratory infection. 

GreenField strives to provide you the best care possible and that extends to the coordination of care between our practice and others. In order for us to do our job well, it is helpful for us to know when you see other healthcare professionals and to understand their recommendations.  

Please remember to give your GreenField Health doctor's full name, address, and telephone number to other healthcare providers that you see and specifically ask them to communicate with us. For example, if you are seen by a specialist, please make sure that they know that we are your primary care practice and ask them to send their consult notes to us. It helps if you keep one of our business cards with you for this purpose. 

Likewise, if another physician orders blood tests or x-rays for you, please ask the lab or radiology center to send us the results directly as well. It is important that we see them and have them in our records. 

Please do not go to urgent care or the emergency department without calling us first unless it is a very clear emergency. We are available by phone 24/7 and we can help you avoid the majority of ER and urgent care visits and the resulting co-pay. A phone call to us is a lot more efficient and cost-effective than spending your time in an ER. 

If you are seen in an emergency department or urgent care center, we would like to know about it while you are there. Ideally, we'd like a call from the physician taking care of you while you are there, even in the middle of the night and on weekends. We may be able to help out by providing additional information and it allows us to follow up with you after such visits. 

Lastly, if you are ever admitted to any hospital on either an emergency or elective basis, we want to know so that we can help you as much as possible during that time. Don’t assume that they have contacted us because frequently they do not.  

In order to provide you with comprehensive care and to coordinate care appropriately, we need your help. Health care is getting better in terms of information sharing and accessibility, but we still have a long way to go so your diligence in these matters really helps us to help you.  

As we mentioned before, we will be rolling out e-statements within the next couple of months. We will also be introducing email reminders for your visits, if you’ve scheduled them more than a few days in advance. We will continue bringing you these and other conveniences as soon as the technology becomes available.

After nearly five years, we will have an increase in our annual fee effective January 1. As we have capacity to fill at our NE Broadway site, we will offer a discount for patients who wish to transfer their care there, or for new patients who sign up there in the first several months of 2009.  Please watch for an email outlining these changes within the next few weeks.

Don’t forget our Friends and Family CPR classes – offered free of charge to all GreenField patients. This is not a certificate class, but rather a brief version so that you will know what to do in case of emergency. Drs. Todd Canon and Dave Hays teach this course once a month on the first Wednesday evening of each month.  Please call Connie Turner at 503-384-2041 or email her at Connie.Turner@GreenFieldHealth.com to register. 

We are delighted to bring you this monthly edition of Health Matters, and we wish you and your little goblins a Happy Halloween. We hope you’re enjoying our brilliant fall foliage, not to mention that sunshine whenever it peeks through. As always, please call or email us if we can do anything for you. 

Sincerely, 

Your GreenField Team

Amanda Clark, MA, your Health Coordinator (email)               
Angie Ashburn, CMA, your Health Coordinator (email)            
Beth Davis, your Business Office Manager (email)            
Chuck Kilo, MD (email)                                                          
Cindy King, your Benefits Coordinator and Biller (email)            
Connie Turner, MA, your Health Coordinator (email)                  
Cynthia Ferrier, MD (email)                                                     
Dana Lee, MA, your Clinical Supervisor (email)                        
David Hays, MD (email)                                                         
David Shute, MD (email)                                                        
Desi Lowder, CMA, your Health Coordinator (email)
Elizabeth Hays, MD (email)
Jill Arena, your COO (email)
Joel Swartzmiller, your IT Manager (email)
Kim Walgraeve, your Marketing Manager(email)
Kristin Walker, your Program and Executive Assistant (email)
Lea Robinson, your Administrative Assistant (email)
Malcolm McAninch, MD (email)
Maria Soutavong, MA, your Health Coordinator (email)
Meena Mital, MD (email)
Pam Mockenhaupt, CMA, your Health Coordinator and Biller (email)
Paula Koeller, MD (email)
Samantha Charles, your Clinic Administrator (email)
Todd Canon, MD, (email)

GreenField Health at Barnes Road                                                  
9427 SW Barnes Road, Suite 590                                                   
Portland, OR 97225                                                                       

GreenField Health at NE Broadway
2606 NE Broadway, Suite C
Portland, OR 97232

questions, concerns, comments always appreciated:
questions@GreenFieldHealth.com

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