Monthly Matters:

• Thanks to our Corporate & Community Partners
• GreenField Welcomes our Newest Health Coordinators
• GreenField's Sustainability Team
• Stop Smoking: Information for You or a Friend
• Health Habits for the Summer
• False Advertising: Energy Drinks and VitaminWater
• Family Matters: Medications used to Treat Asthma in Children
• Office Notes

GreenField Health’s Health Matters

May 2009

Thanks to our Corporate & Community Partners

We would like to extend our thanks to our corporate partners. Bake Ellis Asset Management, LLC provides annual fees for their clients. Kryptiq Corporation and Stahancyk, Kent, Johnson & Hook, PC both cover the GreenField Health annual fee for their employees. These organizations recognize the value of convenient care and great access for their clients and employees and are applauded for their forward thinking. They enjoy a corporate discount off of their annual fees, which we would like to extend to other businesses in the community. If you are interested in more information for your business, please contact Kim.Walgraeve@GreenFieldHealth.com

We would also like to welcome our two new community partners, the Hollywood Barber Shop and Yuen Lui Photography; both are business neighbors of our NE Broadway clinic. They are partnering with us to get the word out to the community about GreenField Health. Yuen Lui Studios has graciously agreed to offer our GreenField patients a discount on photography services at their location on NE Broadway. Their special package includes a $19.95 sitting fee with one free 8x10 photo. Plus, a 20% discount on any additional prints you order. Feel free to call them to arrange for your sitting - simply tell them you are a GreenField Health patient to enjoy your discount. They can be reached at: 503.288.0404.

GreenField Welcomes our Newest Health Coordinators

Marsha Box, MA, is supporting Dr. Charles Kilo and Dr. Meena Mital. Before joining GreenField, she was a medical assistant at the Kaiser Permanente Beaverton Medical Office where she worked in their family practice, internal medicine, pediatrics, and urgent care areas. She has a three-year-old daughter and a 13-month-old son. She has been married to her husband for seven years. They often take long drives around Oregon and love visiting the Seattle area.

Danika Pellicano, NCMA, is working with Dr. Paula Koeller and her patients. She is currently working on her associate degree in Allied Health. She has been a medical assistant for 16 years and has worked in occupational medicine, urgent care, dermatology, obstetrics and gynecology, allergy and asthma, and internal medicine. For the past 6 years, she has also enjoyed teaching part-time at Pioneer Pacific College in their Medical Assisting program. She and her husband have two sons and two grandchildren. She loves to cook and watch movies. She also enjoys taking family trips to the beach.

Alisyn Shaw, CMA, is working with Dr. Elizabeth Hays and her patients. She has worked in healthcare for over 10 years. She has worked in primary care, diabetic and nutrition care, neurology, and she even worked as an optician for 7 years. She is married and has one “high- maintenance cat.” She loves to go to the movies and to local events such as the Portland Rose Festival and the Star Light Parade. She is also an enthusiastic Portland Trailblazers fan.

GreenField’s Sustainability Team

At GreenField, our commitment to the environment has always been important to us, and we have had a Sustainability Team at GreenField for several years now. We thought that you’d like to know what we’ve been doing on behalf of a cleaner environment. We:

• Keep lights off at off hours and when our exam rooms are not in use

• Compost food scraps, coffee grounds, paper towels and other items

• Use glass or compostable cups for coffee and water

• Use e-faxes and other electronic means of communication to reduce paper use

• Promote alternative transportation days for our team

• Provide a carafe of half and half instead of disposable plastic creamer cups

• Recycle paper, plastic and a whole lot more

• Sponsor community clean-up work days and volunteer our time

• Turn off computers for the night

• Have programmed our HVAC at NE Broadway to use less energy at night and on the weekends

• Have a partnership with an eco dry cleaning service

• Use eco friendly and recycled materials in our newest NE Broadway clinic

• Reuse paper for scrap paper

• Use sustainable building materials when building out new clinic sites

• Have a number of staff who often bike to work

• Drive a Prius (well, two of our team members so far!)

• Drive a Honda Civic Hybrid (well, one of our team members so far!)

Stop Smoking: Information for You or a Friend

Everyone knows that cigarette smoking is one of the most harmful--not to mention expensive--health habits. We realize that most smokers would prefer not to be smoking, but stopping is hard. However, resources are available for those who choose to stop, and with assistance, many people are successful at kicking the habit.

Instead of going into the medications and techniques for smoking cessation in this issue of Health Matters, we would like to refer you and have you refer others to the very successful Oregon Tobacco Quit line which is very effective, and best of all, it is available to anyone for free. If you are a smoker, we really encourage you to call, even if you are not currently ready to stop. If you are not a smoker but have a relative, friend, or colleague who is, please feel free to refer them as well. They will be better off because you took the time. The phone number is 1-800-QUIT-NOW (1-800-784-8669) and their website is www.oregon.gov/DHS/ph/tobacco/oregonquitline.shtml.

Health Habits for the Summer

Spring is well underway and summer is fast approaching. We recommend that everyone find a way to make exercise a part of their daily routine. Here are some tips to exercise success:

1. Remember that exercise and weight management are both important, but exercise by itself is very important and has sustained positive effects, even if you don’t lose weight.

2. Develop a habit of exercise. This means that just like eating meals every day and doing other daily routines, exercise would preferably become a part of that daily routine, from 5-6 days per week.

3. Build exercise into your schedule – to be a successful exerciser, exercise (and health) has to fit clearly in your schedule on most days. It is as important if not more so than most of the things that you do during the day, although we understand how easy it is to allow work and other aspects of life to get in the way of exercise. We encourage you to make exercise a high priority.

4. Push yourself. People often times have the problem of being too hard on themselves psychologically and not hard enough on themselves physically. Physical exercise is a very effective approach to managing psychological stress and depression. So set yourself a pretty good target such as walking a marathon and go for it.

False Advertising: Energy Drinks and VitaminWater

This spring, Coca-Cola was served a class action lawsuit filed for false advertising on its VitaminWater beverages by the Center for Science in the Public Interest (CSPI). Coke markets VitaminWater as a healthful drink by labeling its several flavors with such health buzz words as "defense," "rescue," "energy," and "endurance", terms that are deceptive and unsubstantiated. Like so many other products on the over-the-counter market these days, Coke makes a wide range of dramatic claims including that its drinks variously reduce the risk of chronic disease, reduce the risk of eye disease, promote healthy joints, and support optimal immune function. None of this is true.

According to CSPI nutritionists, the 33 grams of sugar in each bottle of VitaminWater promote obesity, diabetes, and other health problems and like regular multivitamins, the small amount of vitamins included in these drinks have no demonstrated beneficial effect.

VitaminWater's website, marketing materials, and labels claim that it is healthy, claiming, for example, that "balance cran-grapefruit" has "bioactive components" to promote "healthy, pain-free functioning of joints, structural integrity of joints and bones" and that the nutrients in “power-c dragonfruit" "enable the body to exert physical power by contributing to the structural integrity of the musculoskeletal system."

VitaminWater contains between zero and one percent juice, despite names such as "endurance peach mango" and "focus kiwi strawberry," and "xxx blueberry pomegranate acai," among others. A press release for the "xxx" drink claims its antioxidants makes the drinker "last longer" in unspecified ways.

Coke has previously acknowledged that its products can promote obesity and other health problems. The company appears to have acquired VitaminWater's parent company, Glaceau, in 2007 as they thought that they could use marketing and false advertising to fool the public and based on their sales, they have been successful. CSPI litigation director Steve Gardner has stated that "VitaminWater is Coke's attempt to dress up soda in a physician's white coat. Underneath, it’s still sugar water, albeit sugar water that costs about ten bucks a gallon."

CSPI and several state Attorneys General successfully sued Anheuser-Busch and settled with MillerCoors on the short lived alcohol energy drinks that they were both producing. While an alcoholic energy drink may seem like an odd concept, good marketers can sell just about anything to an uninformed public. These drinks contain alcohol along with caffeine and other stimulant additives not officially approved for use in such drinks.

Dubbed "alcospeed," Sparks by MillerCoors has more alcohol than beer. No studies are available to support the safety of consuming those stimulants and alcohol together—but according to CSPI, research indicates that young consumers of these type of drinks are more likely to binge drink, become injured, ride with an intoxicated driver, or be taken advantage of sexually than drinkers of conventional alcoholic drinks.

After the lawsuit was filed, state Attorneys General reached agreement with MillerCoors to stop selling alcoholic beverages with stimulants nationwide. MillerCoors has thus joined Anheuser-Busch in removing alcospeed beverages, and the risks are much reduced.

We remain impressed at what marketers will push on an unsuspecting and perhaps ill-informed public. These examples demonstrate that just because something is on the shelves of a local grocery story and made to look inviting by using word like energy, vitamins, health, or otherwise doesn’t mean anything about the true effects of those products. Many more of those products so prevalent at the grocery check out line may end up with the same fate of false advertising since so many of them make health claims that go far beyond any scientific evidence of their effect.

We recommend that you make smart consumer choices and avoid such products and teach your children to avoid them. Sodas, energy drinks, bottled water, vitamin or other health drinks are all generally bad health concepts.

Family Matters: Medications used to treat Asthma in Children

In last month's Health Matters we reviewed the topic of asthma in children. This month we will look at medications that can be used to treat asthma.

There are many factors which can exacerbate or worsen asthma. Cold air, exercise, and inhaled irritants like tobacco smoke can all cause an asthma attack. Many children with asthma also have allergies. Allergens can likewise initiate an attack. One of the first steps of controlling asthma is avoiding these asthma “triggers”. An inhaled medication called cromolyn sodium (Intal) can be used in cases which a person knows that they are going to have a short-term exposure to an allergen. If a child that is allergic to cats was going to be visiting a house with a cat in it, they could take 1-2 puffs of cromolyn and potentially prevent an asthma attack. It works by preventing the allergic cascade that happens with allergy triggers.

The most commonly used class of medications for asthma is bronchodilators. Medications in this class include the short-acting inhaled medications such as albuterol and the long-acting versions such as salmeterol. One of the hallmarks of asthma is bronchoconstriction, or narrowing of the airways, caused by smooth muscle contraction in the walls of the medium-sized airways called bronchi. This happens in response to any of the triggers discussed above. Because the airways are narrowed, children have difficulty breathing and tend to have wheezing, a high-pitched noise caused by turbulent airflow in the airways. The bronchodilators help to relax these smooth muscles so that the airways can open again. They work quickly to relieve the obstruction and patients usually feel an improvement in their breathing quickly after taking 1-2 puffs from one of the short-acting inhalers. The long-acting versions do the same thing but can last up to 12 hours instead of the 3-4 hour duration of the short-acting medications. These medications can either be given through an inhaler or with a nebulizer, a machine that creates a mist out of a liquid solution of the medication that can then be inhaled either through a mouthpiece or by using a mask.

Although the bronchodilators provide rapid relief, they should not be solely relied upon during an asthma exacerbation or for ongoing management of moderate to severe asthma. When patients experience increased asthma symptoms, they develop inflammation in the walls of the bronchi as well as the constriction discussed above. The bronchodilators can relieve the obstruction but they do nothing to treat the inflammation. If the inflammation is not treated, the symptoms will likely persist or worsen.

Steroid medications are most commonly used to treat the inflammation in the airways. Inhaled steroids work by blocking the inflammatory cascade from happening. They do not work immediately, and therefore must be taken on a regular basis regardless of current symptoms in order to assist with control. For severe asthma exacerbations it is sometimes required that a patient receive steroids either by mouth, by injection, or intravenously in order to achieve more rapid control.

Leukotriene receptor antagonists such as monteleukast (Singulair) also work by blocking the inflammatory cascade that happens in response to an asthma trigger. They are sometimes taken in addition to inhaled steroids for children who do not have adequate symptom control on inhaled steroids and bronchodilators.

Inhalers can be tricky to use, especially when trying to use them to give medications to small children. Inhalers should always be used with a spacer or a chamber, which is a device that can hold the medication after it is aerosolized but before it is inhaled. If you use an inhaler without a spacer, much of the medication ends up being sprayed on the back of the throat. For very small children a mask can also be attached to the spacer to allow the child to take normal breaths through the spacer and mask to get the medication into their lungs.

Asthma is a condition which requires self-management on the part of the patient and the family. Patients should always work with their physician to develop individual plans for avoiding triggers, treating acute symptoms, treating more severe attacks, and achieving good long-term control of asthma.

Office Notes

• Please note that we will be closed on Monday, May 25th in observance of Memorial Day. As usual, one of our physicians will be on call and available to you for urgent and emergent needs.

As we begin to see more of the sunshine of our beautiful Northwest springtime, we wish you and yours a happy, healthy season. Thanks, as always, for inviting us along on your healthcare journey.

Sincerely,

Alisyn Shaw, CMA, your Health Coordinator (email)
Beth Davis, your Business Office Manager (email)
Chuck Kilo, MD (email)
Connie Turner, MA, your Health Coordinator (email)
Cynthia Ferrier, MD (email)
Dana Lee, MA, your Clinical Supervisor (email)
Danika Pellicano, NCMA, your Health Coordinator (email)
David Hays, MD (email)
David Shute, MD (email)
Elizabeth Hays, MD (email)
Jill Arena, your COO (email)
Joel Swartzmiller, your IT Manager (email)
Kate Griggs, your Administrative Assistant (email)
Kim Walgraeve, your Marketing Manager (email)
Kristin Walker, your Program and Executive Assistant (email)
Malcolm McAninch, MD (email)
Marsha Box, MA, your Health Coordinator (email)(email)
Meena Mital, MD (email)
Pam Mockenhaupt, CMA, your Health Coordinator and Biller (email)
Paula Koeller, MD (email)
Peter Casey, your Consultant (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

Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.GreenFieldHealth.com

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

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