Celilo Turns 3

Living Well WithOsteoarthritis

When YouCan’t Snooze,You Lose

MID-COLUMBIA MEDICAL CENTER S p r i n g 2 0 0 4w w w. m c m c . n e t

Celilo Turns 3

Living Well WithOsteoarthritis

When YouCan’t Snooze,You Lose

Not long ago, we passed an important anniver-sary at Mid-Columbia Medical Center. Feb. 18

marked the third year of operation for Celilo Centerfor cancer care.

It hardly seems possible that it was three yearsago that we opened the region’s first cancer centerand, for the first time, gave Mid-Columbia residentsaccess to local radiation therapy services and a widerange of other cancer-related programs. On the otherhand, when you consider the number of patientswho have been served over that time, it hardly seems possible Celilo hasn’t been around longer.

In three years, 650 cancer patients have been treated at Celilo with the most advancedradiation therapy treatments available, intensity modulated radiation therapy. More than9,000 patients have received other cancer therapies at Celilo or been seen by one of thevisiting physicians housed in the facility. Last year, Celilo’s services were expanded greatly withthe addition of a new medical oncologist, Samuel Taylor, M.D.

Of course, we knew there was a need for a comprehensive cancer center in this region, buteven we have been surprised that the need was so profound. It has been one of the greatrewards of my job to see Celilo embraced so completely by the communities we serve and, inturn, to see Celilo and its amazing staff have such a profound and positive impact on the livesof so many.

In this issue of Well Aware, you can read about a very special honor given to Celilo, theSpirit of Caring Award. It’s a testament to the spirit, compassion and talent of the Celilo staff toearn this distinction in such a short amount of time. I congratulate all of them, as well as themany patients they have served, for making Celilo such a truly unique place.

This issue is full of interesting stories and helpful information. Read on to learn about thetwo new physicians we’ve recruited to the area to care for our communities’ children. You canalso read about what a powerful tool meditation can be to calm a hectic life, and how manypeople are using weight training to ward off the effects of aging. There’s a very informativequestion-and-answer session about sleep disorders with Dr. Paul Cardosi, helpful sleep tips andmuch more.

I hope you enjoy the issue and have a wonderful spring.

Sincerely,

Duane FrancisPresident/CEO

Celilo Turns 3

On the Cover: Corliss March practicesT’ai Chi on the labyrinth outside Celilo.

Inside ScoopIt is Our Mission. . .

To lead and act as a catalyst in promoting health for all people.

To recognize the individual as a wholehuman being with different needs that must

be enthusiastically met.

To communicate a vision of health, art,education, technology and a center for

healing which will continually upgrade thequality of life in the community environment

in which we live.

To empower people to become partners intheir health care.

Mid-Columbia Medical Center is a not-for-profithealthcare organization offering comprehensive

services to the Mid-Columbia Region, and is governed by a volunteer Board of Trustees:

Robert L.R. BaileyJorge BarraganPamela ClausenDuane Francis

Gretchen KimseyRobert A. Staver, M.D.

Wallace Wolf, Jr., D.V.M.

WellAware is published byMid-Columbia Medical Center

1700 East 19th Street The Dalles, OR 97058

(541) 296-7545

All rights reserved. No information may be reprinted without the written consent of MCMC.

Living Well With OsteoarthritisHip replacement surgery helps Florence Sheldon over-come the pain of osteoarthritis.

Spring 2004

Photo Credits:All photos by Mount Burns

except pages 2 and 14 by Susan Garrett Crowley.

Oops, I did it Again!Dr. Steve McLennon debunks the myths aboutmeditation.

MCMC, Celilo HonoredA pair of national awards recognize the hospitaland its cancer care center’s whole-personapproach to care.

Information to Sleep onRead a Q & A with our sleep specialist, test yoursleep IQ and learn some tips to help you sleepbetter.

Beware the SupersizeFast-food restaurants are helping create an oversized America.

New Kid Docs on the BlockTwo new pediatricians expand healthcare servicesfor children at Columbia Hills Family Medicine.

Add a Little Class to Your LifeMCMC educators plan an active spring.

Healthy Recipes

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Seven years ago, a random detour at a roadsiderest stop in California changed Florence Sheldon’s

life. Forever.Already on crutches, nursing a broken ankle,

Florence skidded on a slippery restroom floor and wentdown -- hard. She twisted her right leg underneath herduring the fall, splintering the bone. It never did healproperly, and Florence began noticing pain in both hipsshortly thereafter.

At the time, she didn’t think to question her physi-

cian’s diagnosis of “severe osteoporosis.” At five feettall and just shy of 100 pounds, the 60-something coordinator of Mid-Columbia Medical Center’s Seniorityprogram fit to a T the profile of an osteoporosis candidate. It wasn’t until about a year ago thatFlorence learned she was battling an entirely differentfoe -- osteoarthritis.

Orthopedic surgeon Gregory Stanley, M.D., brokethe news to Florence in April 2003. At some point dur-ing her medical history, he informed her, Florence had

After hip replacement surgery, Florence Sheldonis pain-free and ready to take on her greatgrandchildren.

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Living WithOsteoarthritis

By Erin Johnson

been subjected to a steroid, which appeared to haveaccelerated the deterioration of the right hip joint.Coupled with the wear and tear associated with herinjury, the trauma to the joint warranted a partial hipreplacement.

Unfortunately, the operation did not solve all ofFlorence’s problems. There was still the left hip to contend with. After months of continued pain, Florenceopted for total replacement of the joint last October.

She’s glad she did.“I’ve been nearly pain-free since my recovery,” she

reflects.In her estimation, Florence’s surgeon is the cream

of the crop. “I just think the world of Dr. Stanley. He’svery open and approachable, and he’s excellent atwhat he does.”

Florence was off work for six weeks, despiteattempts to convince her doctor of her speedy recovery.“He knew what I needed,” she admits. “Some doctorswould have let me go back to the office sooner, but thatwasn’t in my best interest, and Dr. Stanley knew that.He wasn’t influenced when I cried, telling him I wantedto go back to work. He just handed me a tissue.”

Several months later, after 12 weeks of physicaltherapy and faithful adherence to an ongoing exerciseplan, Florence is indeed back at work, doing what sheloves best -- helping senior citizens within MCMC’sservice area navigate the sometimes confusing world ofinsurance coverage. She’s thrilled to be giving back,once again to the organization that, in essence, gaveher her former life back.

“I received nothing but the best care at MCMC,”Florence recalls, “from my surgeon, to the nurses, tothe dietary staff who went out of their way to makesure I had my specially prepared latté every day. Howcould I not get well with so much encouragement andlove?”

Osteoarthritis, commonly referred to as degenera-tive joint disease, is caused by the wear and tear onjoints over time.

“I have seen a lot of osteoarthritis in our commu-nity,” says Dr. Stanley, who is in practice at CascadeOrthopedics in The Dalles. “It’s age-related, so this issomething that everyone will have to deal with atsome point in their lives. That’s why I feel it’s important

that we understand the process.”Osteoarthritis commonly strikes in one’s golden

years, although since it is directly related to wear andtear on the joints, it can affect young adults as well.

“Every injury you sustain predisposes you to anearlier onset of this disease,” Dr. Stanley points out.“It’s important to remember that you’ve only got oneset of wheels, so to speak. Take care of yourself now to minimize your chances of going through jointreplacement surgery at a later date.”

However, the fact that you endured a particularlyharsh wipeout on the slopes last season doesn’t necessarily qualify you as a contender for future surgery. “It’s a pattern of behavior, not a single event,”says Dr. Stanley. “If you’re into longevity, pay closeattention to the way you live. Make logical decisionsabout the activities you choose to engage in, and consider your risk factors for serious injury.”

Perhaps you lived life on the edge during youryounger years, and your joints are paying the pricetoday. Don’t ignore it. “It’s important not to shrug offhow much it hurts. Do not just assume that pain is anormal part of growing older,” Dr. Stanley says.

“See your physician and get an appropriate diagnosis. If it is osteoarthritis and we catch it earlyenough, there are things that can be done short of surgery.”

And there are more options now than ever when itcomes to therapy, Dr. Stanley points out. From dietarymodification to pain medication to activity restriction,and all the way to surgical intervention, the realm ofarthritis treatment has widened considerably in thepast several decades.

“It’s important to keep tabs on what your treatment options are,” he says. “As a patient, it’s yourresponsibility to keep your finger on the pulse of yourown health.”

As for Florence, she’s committed to keeping her finger on that pulse -- for life. At her tender age, she’sgot plenty of living left to do.

“This spring, for the first time in seven years, I’mgoing to be able to play with my great-grandchildren,”she says, laughing.

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“It’s important not to shrug off how much it hurts. Do not justassume that pain is a normal part of growing older.”

Around the Center for Mind and Body Medicine, we are sometimes hesitant to use the “M” word . . .

meditation. It’s a self-conscious attempt (on our part) toavoid offending those relatively few people who hearother M words when meditation is mentioned. Wordslike malarkey, mumbo-jumbo, mysterious, mind-control,mystical and merit-less, to name a few.That’s O.K. Those arejust misperceptionsthat can be clarifiedwith a little informa-tion.

Meditation issimply directed concentration.That’s all. It involvesfocusing our atten-tion on our breathing (often thefocus for relaxation and stress reductiontechniques), bodily sensations, a meaningful word,phrase or prayer,thoughts, emotions orany other object of ourchoosing.

The practice ofmeditation can take usout of the mind, withits preoccupation withthe past and future,into the realm of pres-ent moment experience . . . the here and now, which iswhere life is actually happening.

Medical research over the past 30-plus years hasdemonstrated the physical, mental and emotional effectsof meditation practice and a number of practical healthbenefits. It can help ease the stress and pain of chronicillnesses such as cancer, heart disease, AIDS and chronicpain syndromes such as fibromyalgia, irritable bowel syn-drome and migraine headaches. Blood pressure can bebrought into better control and symptoms of anxiety,

depression and insomnia may be lessened. Meditation ismoving into the medical mainstream as a viable additionto other medical therapies.

How does it work? We don’t really know for sure, buta recent high-tech study has shed some light on what isoccurring in the brains of meditators, which may help

explain why this low-tech approach can be so powerful.The research was conducted by Dr. Richard

Davidson, director of the Laboratory for AffectiveNeuroscience at the University of Wisconsin atMadison and Dr. John Kabat-Zinn, founder of thehighly respected Stress Reduction and RelaxationProgram at the University of Massachusetts School

of Medicine.Earlier researchby Dr. Davidsonusing functionalMRI brain imag-ing (this givesdetailed picturesof the brain inaction) andadvanced EEGtechniques (which

measures electrical activity inthe brain, or “brain waves”)

identified “set points” for goodmoods vs. bad moods in groups of individ-uals. Those prone to depression, anxietyand negative moods consistently showedmore activity in the right prefrontal area of

the brain, whereas happier, generally more contentedpeople demonstrated more activity in the left prefrontalarea. The “set point” for mood had been thought to begenetically determined and relatively fixed and stablethroughout a person’s life. This new study has changedall that.

The researchers randomly assigned stressed-outbiotechnology workers to two groups. One group of 25people participated in eight, weekly, three-hour classes in

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OOPS!I Did It Again - I Used the ‘M’Word

By Stephen McLennon, MD

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On the Whole Grains-Heart Disease Link

Lowering your risk for cardiovas-cular disease may be as simple

as making a sandwich on whole-grainbread. That’s what scientist foundwhen they surveyed a group of nearly3,600 elderly men and women onhow much fiber they consumed frombreads, cereals, fruits and vegetablesand then tracked their incidence ofcardiovascular disease for more thaneight years.

People who consumed 4.6 gramsof fiber a day from breads and cereals— equivalent to two slices of whole-grain bread — had a 14 percentreduction in risk for cardiovasculardisease compared to people who atethe least amount of fiber from thosefoods. People who consumed 6.3grams of fiber a day from grains low-ered their risk by 21 percent.

Whole grains always have morefiber than refined. Other whole-grainoptions, besides breads and cereals,include brown rice and barley.

Managing Dry Skin

Aging and years of sun exposure reduce the capacity of your skin

to moisturize itself, so your skinbecomes even drier when humidity islower in the winter and in dry cli-mates. To help combat dry skin anditchiness try these tips:

• Avoid harsh soaps, which are drying to the skin. Instead use mild or glycerinsoaps.

• Seal moisture into your skin by applying a moistur-izing cream or bath oil to your skin immediately after

bathing, while your skin is still damp

• Make your bath water warm rather than very hot. Hot water worsens dry skin.

• Watch the temperature of your shower water. Most people use hotter water for showers than they do for tub bathing. Experts use tothink frequent bathing was drying to skin. Now they recommend daily soaking for 10 minutes in water no warmer than about 90 F. You can also use a bath oil in your tub if your skin is extra dry. Be careful when using bath oil as they maketubs slippery.

• Pat your skin dry after your bath. Never rub. And leave your skin a bit moist.

Physical Health andMental Well-being

Studies suggest regular exercisecan help lessen depression by

lowering the release of stress hor-mones and increasing serotonin. Itmay also increase a natural stimulantin the body called phenylethylamine,or PEA. Exercise also stimulatesappetite and helps regulate sleep,both of which can be a problem indepression. And it can offer people aneeded sense of control. Relaxationtechniques like meditation and yogaalso appear to lower stress hormones,calming anxiety.

HealthcareNOTESmindful meditation and yoga.Mindfulness encourages an attitudeof non-judgmental acceptance ofwhatever comes to one’s awareness.In addition to the class, they prac-ticed at home for 45-minutes to anhour per day, six days a week.

The other group did not receivemeditation training until after thestudy was completed. At the end ofthe study, the meditation groupshowed a significant shift of brainactivity to the left, along with report-ing more positive moods in general.They also, as a group, showed astronger antibody response to a flushot, suggesting an immune systemboosting effect. The control groupshowed none of these changes.

Reflection, contemplation, still-ness, mindfulness — these are mere-ly aspects of being human. Judgingor fearing the “M” word is unneces-sary. In fact, it might be hazardousto our health and well-being to do so.

Here are a few suggestionsfor those interested in explor-ing meditation further:

• Take a class in breath work.• Take a class in “moving medita-tion” such as T’ai Chi, yoga or drum-ming (you can’t drum and think atthe same time).• Read a book: “Wherever you Go,There You Are, MindfulnessMeditation in Daily Life,” by Dr. JohnKabat-Zinn. “The Miracle ofMindfulness,” by Thich Nhat Hahn.• Check out a tape: www.mindful-nesstapes.com, or some of the tapesby The Center for Mind and BodyMedicine staff.

Dr. McLennon is medical director ofthe Center for Mind and BodyMedicine at MCMC.

NOTES

MCMC Award A First ForHealthcareOrganizations

Mid-Columbia Medical Centerhas earned the distinction

of becoming the first healthcareorganization ever to be honoredwith the prestigious Expy Award.

The Expy is presented annuallyto 10 organizations that exemplifythe principles and practices promoted in the best-selling book,The Experience Economy: Work isTheatre, and Every Business is aStage. Written by Joe Pine and JimGilmore, the book explores theemergence of an economic environ-ment in which more and more corporations are striving to providesomething beyond just good serviceto their customers.

“Just as the Industrial Economysupplanted the Agrarian Economyand was, in turn, supplanted by theService Economy, we are now

shifting to an Experience Economy,”they write. “The developed world’spredominant economic offering isnow becoming experiences – memorable events that engage eachcustomer in an inherently personalway.”

MCMC was honored for its long-standing efforts to personalize,humanize and demystify the health-care experience for its patients andtheir families. Since 1991, the hospital has undergone a dramatictransformation from a typical hospital, providing traditionalhealthcare services, to a unique center of whole-person healing.

Rather than simply treating itspatients medical conditions andaddressing only their physical needs,MCMC has developed an array ofunique programs designed to promote whole-person healing. Fromits unique, home-like architecture toits promotion of education, familyinvolvement, mind-body healing concepts, complementary therapiesand more, MCMC has gained aninternational reputation as a healthcare innovator.

“We’re honored to win the Expy Award because it is one morevalidation of our ongoing efforts tochange the way people experiencehospitals,” says MCMC presidentand CEO Duane Francis. “Peoplewho come to us for care aren’t justtreated and sent home. They haveaccess to an array of professionals,programs and tools that address thespectrum of their needs – physical,emotional, intellectual, social andspiritual. They aren’t just treatedhere, they participate in a healingexperience.”

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MCMC, Celilo Honored“We’re honored towin the EXPYAward because it isone more validationof our ongoingefforts to changethe way peopleexperience hospitals.”

- Duane FrancisMCMC President/CEO

Celilo HonoredWith CovetedPlanetreeAward

Celilo Center for cancer care atMid-Columbia Medical Center

has been honored nationally withthe Spirit of Caring Award from thePlanetree Alliance. The award wascreated to recognize healthcareproviders who have demonstratedextraordinary efforts to promotepatient-centered care.

Planetree is a holistic,patient-focused model of healthcarethat encourages a healing approachthat considers patients’ and theirfamilies’ mental, emotional, spiritualand social concerns as well as theirphysical needs. The Spirit of Caringaward recognizes members of thePlanetree Alliance that have demon-strated an appreciation for the interrelated functioning of body,mind and spirit in illness and recovery.

That philosophy has since 1991guided a dramatic transformation atMCMC and led to the developmentof its one-of-a-kind cancer center,Celilo.

At Celilo, cancer patientsthroughout the region have accessto the most advanced technologyavailable as well as a host of complementary therapies designedto address their unique and complexneeds.

The array of healing tools available to Celilo patients, as wellas their family members, includesstress management programs,massage therapy, yoga, meditation

and T’ai Chi classes, guided imageryexercises, relaxation programs,nutrition counseling and acupuncture.

Even the physical environmentof Celilo was designed to promotehealing. The centerpiece of the building’s exterior is a beautifulwater and rock sculpture. Whenviewed from the inside, through thelobby’s dramatic two-story windows,the rocks reveal a series ofpetraglyphs, replicas of ancientdrawings made by the area’s earlyNative American inhabitants.

Celilo also features a spa area,where patients and family memberscan relax before or after treatment,meditation garden, on-site resourcelibrary and comfortable chemothera-py suite with sweeping views of thesurrounding hills and ColumbiaRiver.

“In Celilo, we have broughttogether all that we have learnedover the years about caring for people as humans with a diverse setof needs, not just patients with amedical condition,” says MCMCPresident and CEO Duane Francis.

“Our goal was to create analmost sacred space where patients,many of whom are facing thebiggest challenge of their lives,immediately feel comfortable andsecure. We believe Celilo is proofthat state-of-the-art medicine andthe healing arts can beautifully, andeffectively, co-exist in a modernmedical setting.”

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“In Celilo, we havebrought together allthat we havelearned over theyears about caringfor people ashumans with adiverse set ofneeds.”

- Duane FrancisMCMC President/CEO

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From Naps to Night Terrors:

Children’sSleepAn informative Q & A withPaul Cardosi, M.D., sleep studies specialist at MCMC’sCenter for Sleep Medicine

We all know how precious a good night’s sleepcan be. If you are a parent, you want your

children to sleep well for their own health – as well asyour own!

Sleep problems in both adults and children are morecommon than previously thought. The AmericanAcademy of Pediatrics now recommends that all childrenbe assessed during their well-child check-ups for thepresence of snoring and related problems. Some chil-dren may have chronic sleep difficulties, and many areactually going through their days sleep-deprived.

In some cases, the problems can be related to sleephabits; other cases may have a medical cause related tobreathing or the neurological controls that regulatesleep and waking. Some problems can be expected toimprove without significant intervention, while in othercases specific treatment may be necessary.

Read on for information to help your kids (and you)get a better night’s sleep.

Q. What is the relationshipbetween sleep disorders and ADD (attention deficit disorder)?

Dr. Cardosi: Sleep disorders that fragmentand disrupt the regenerative process of sleep can leavethe brain unable to work at optimal capacity. Attention,vigilance and behavioral control can suffer. Often thesesymptoms can be labeled as consistent with attentiondeficit disorder. There are likely a variety of types of prob-lems that are labeled ADD, so it is important to recognizethat chronic, poor sleep can be one of these problems.

Q. How can I tell if my child is sleep deprived? How much sleep do kids need?

Dr. Cardosi: Sleep needs change as yourchild grows. Newborns sleep about 18 hours a day andalmost half of that is REM or dream sleep! The sleepneed decreases with age but, even during the adoles-cent years, children generally need about 10 hours ofsleep a day. Symptoms of sleep deprivation in childrencan be very subtle. Sleepy children can act “hyper” andhave difficulty concentrating. They may be apt to fallasleep while riding in the car or in class, or during quiet,unstimulating activities.

Paul Cardosi, M.D.

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Q. What causes sleepwalking?

Dr. Cardosi: Sleepwalking tends to occur inchildren about age 4 or 5. Generally, it improves as theyapproach the teen years. Sleepwalking occurs when thebrain has the ability to be partially asleep and awake atthe same time. Sometimes the sleepwalking activity isfairly benign and uncomplicated, consisting of walkingaround the room with a blank expression and mum-bling, for example. For others, the behavior can be quitecomplex. Some people have driven cars in their sleep!Unlike adults, children have a very high proportion ofdeep sleep, which seems to allow this admixture ofsleeping and waking state to occur more easily.

Q. What would cause a child to have difficulty staying awake during the day?

Dr. Cardosi: Difficulty staying awake duringthe day can result from a number of different problems.In general, any problem that prevents adequate sleep,either in amount or quality, will cause sleepiness. If youdon’t sleep enough hours, you will be sleepy. Somesleep disorders, such as sleep apnea, cause frequentbrief disturbances in sleep that go generally unnoticedexcept by monitoring of the brainwaves. These distur-bances can degrade the quality of the sleep so that eveneight or 10 hours of such sleep is not restorative and,consequently, a state of sleep deprivation exists.Frequent limb movements at night is another potentialcause of disrupted sleep.

Other sleep disorders that result in excessive daytimesleepiness include narcolepsy, the symptoms of whichinclude the irresistible need to sleep during the day,episodes of muscular weakness that occur with strongemotion, episodes of dream-like imagery while awake,and paralysis-like feelings upon waking up or going tosleep. Other disorders result from a failure of the brain’sarousal mechanisms to fully stimulate wakefulness.Medications and other illnesses such as depression canalso contribute to sleepiness.

Q. Why won’t my child go to sleep or wake up on time?

Dr. Cardosi: This is most frequently due to scheduling issues and habits but is a major problemfor many parents, especially for parents of teenagedchildren, whose brains seem to direct them to stay upuntil all hours of the night. Research shows that this is not far from the truth! There are steps to be takenthat can help.

Q. Should I be concerned about my child’s snoring?

Dr. Cardosi: Maybe. About 10 percent ofchildren snore occasionally or more often. One or 2 per-cent of children snore enough to cause compromises inthe quality of their sleep so that it adversely impactstheir sleep and, thus, their waking period. Such childrengenerally show the signs of restless sleep and daytimesleepiness I’ve previously described. Evaluation by aphysician and, if appropriate, evaluation of their sleepwith an overnight sleep study can distinguish between“benign” snoring and a more serious problem.

Most adults know what it feels like to be grumpy, con-trary and not at our best from lack of sleep. If our kidsoften feel this way, we owe it to them to find solutionsto this problem.

To learn more about naps, sleep schedules,night terrors, snoring and how sleep is relat-ed to behavior disorders in children, be sureto attend Dr. Cardosi’s free lecture onTuesday, March 9.

Call 541-296-8444 for completeinformation and to pre-register.

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By Luke Habberstad

When You Can’tSnooze, You Lose

Do you find it hard to get out ofbed in the morning? When you

wake up, do you feel irritable orstressed? Do you often feel tiredduring the day?

If you are having trouble sleep-ing or are feeling sleepy much of thetime, you may have a sleep disorder.These days, there are treatments formost sleep ailments, but the firststep is recognizing that a problemexists.

If you suspect you have a sleepproblem, try our sleep-inducing tips(next page) and keep a sleep journal.If problems continue, discuss yoursleep diary with your doctor, as theremay be an underlying cause and youwill want to be properly diagnosed.Your doctor will help treat the problem or may refer you to theSleep Center at Mid-ColumbiaMedical Center, which is accreditedby the American Academy of SleepMedicine.

Test Your Sleep IQThink you know everything there is to know about sleep? Probablynot; few of us do. In a 1999 nation-wide survey, 83 percent of adultAmericans failed the National SleepFoundation’s Sleep IQ Test. Find outyour sleep IQ by answering the Trueor False questions below:

1. During sleep, your brain rests.2.You cannot learn to function

normallywith oneor twofewerhours ofsleep a night than you need.

3. Resting in bed with your eyesclosed cannot satisfy your body’sneed for sleep.

4. Snoring is not harmful as long as itdoesn’t disturb others or wake you up.

5. Everyone dreams every night.

Answers:1. False. While your body rests,your brain doesn’t. An active brainduring sleep prepares us for alertnessand peak functioning the next day.

2. True. The need for sleep is biological. While children need moresleep than adults, how much sleepany individual needs is geneticallydetermined. Most adults need eighthours of sleep to function at theirbest. How do you determine whatyou need? Sleep until you wake onyour own -- without an alarm clock.Feel rested? That’s your sleep need.You can teach yourself to sleep lessbut not to need less sleep.

3. True. Sleep is as necessary tohealth as food and water, and rest is no substitute for sleep. As notedabove, sleep is an active processneeded for health and alertness.When you don’t get the sleep you

need, your body builds up a sleepdebt. Sooner or later, this debt mustbe paid -- with sleep. If you drivewhen you’re sleepy, you place yourself and others at risk becausedrowsy drivers can fall asleep at thewheel with little or no warning.Sleepiness contributes to driver inattention, which is related to 1 million crashes each year!

4. False. Snoring may indicate thepresence of a potentially life-threat-ening sleep disorder called sleepapnea. People with sleep apneasnore loudly and arouse repeatedlyduring the night, gasping for breath.These repeated awakenings lead tosevere daytime sleepiness, whichraises the risk for accidents and heartproblems. Yet 95 percent of thosewith sleep apnea remain unawarethat they have a serious disorder. Thegood news: With treatment, patientscan improve their sleep and alertnessand reduce their risk for accidentsand health problems. Physicians andsleep specialists should be consulted.

5. True. Though many people failto remember their dreams, dreamingdoes occur for every person, everynight. Dreams are most vivid duringREM, or rapid eye movement, sleep.

Read the statements below. Answertrue or false for each one. If you

answer true more than twice, you maywant to discuss your sleep problem withyour doctor.

1. I feel sleepy during the day, even when I get a good night’s sleep.

2. I get very irritable when I can’t sleep.

3. I often wake up at night and have trouble falling back to sleep.

4. It usually takes me a long time to fall asleep.

5. I often wake up very early and can’t fall back to sleep.

6. I usually feel achy and stiff when I wake up in the morning.

7. I often seem to wake up because of dreams.

8. I sometimes wake up gasping for breath.

9. My bed partner says my snoring keeps her/him from sleeping.

10. I’ve fallen asleep driving.

10 Sleep Tips to Help YouAvoid Counting SheepThe following 10 tips can help youachieve sleep and the benefits it provides.

1. Keep a regular sleep schedule. Oursleep-wake cycle is regulated by a “circa-dian clock” in our brain and the body’sneed to balance both sleep time andwake time. That is also why it is impor-tant to keep a regular bedtime and wake-time, even on the weekends when thereis the temptation to sleep in.

2. Avoid caffeine. Caffeine is a stimulant,which means it can produce an alertingeffect. Caffeine products, such as coffee,tea, colas and chocolate, remain in thebody on average from three to five hours,but they can affect some people up to 12

hours later. Even if you do not thinkcaffeine affects you, it may be dis-rupting and changing the quality ofyour sleep. Avoiding caffeine withinsix to eight hours of going to bedcan help improve sleep quality.

3. Avoid nicotine. Nicotine is also a stimulant. Smoking before bed makes itmore difficult to fall asleep. When smok-ers go to sleep, they experience with-drawal symptoms from nicotine, whichalso cause sleep problems. Nicotine cancause difficulty falling asleep, problemswaking in the morning, and may alsocause nightmares. Difficulty sleeping isjust one more reason to quit smoking.

4. Avoid alcohol. Although many peoplethink of alcohol as a sleep aid because ofits sedating effect, it actually disruptssleep, causing nighttime awakenings.Consuming alcohol leads to a night ofless restful sleep..5. Don’t eat or drink too much close tobedtime. Eating or drinking too muchmay make you less comfortable whensettling down for bed. It is best to avoida heavy meal too close to bedtime. Also,spicy foods may cause heartburn, whichleads to difficulty falling asleep and dis-comfort during the night. Try to restrictfluids close to bedtime to prevent night-time awakenings to go to the bathroom,though some people find milk or herbal,non-caffeinated teas to be soothing anda helpful part of a bedtime routine.

6. Exercise at the right time promotessleep. In general, exercising regularlymakes it easier to fall asleep and contributes to sounder sleep. However,exercising sporadically or right beforegoing to bed will make falling asleepmore difficult. In addition to making usmore alert, our body temperature risesduring exercise, and takes as much as six

hours to begin to drop. A cooler bodytemperature provides a signal that it istime to sleep. Finish your exercise at leastthree hours before bedtime.

7. Use relaxing bedtime rituals. A relax-ing, routine activity right before bedtime conducted away from bright lights sendsa signal to your body that it is almosttime to go to sleep and will make it easi-er to fall asleep. If you are unable toavoid tension and stress, it may be help-ful to learn relaxation therapy from oneof the specialists at MCMC’s Center forMind & Body Medicine.

8. Create a sleep-promoting environment.Design your sleep environment to estab-lish the conditions you need for sleep --cool, quiet, dark, comfortable and free ofinterruptions. Also make your bedroomreflective of the value you place on sleep.

9. Associate your bed with sleep and sexonly. Use your bed only for sleep and sexto strengthen the association between bedand sleep. If you associate a particularactivity or item with anxiety about sleep-ing, omit it from your bedtime routine.

10. Limit sleep time in bed. If you do notfall asleep within 15 to 20 minutes ofgoing to bed and turning out the lights, itis best to get out of bed and do anotherrelaxing activity until you are feelingsleepy again. If anxiety about somethingyou need to do prevents you from sleep-ing, it is sometimes helpful to jot downnotes in a “worry” or “to do” book. Napduring the day only when needed to maintain alertness, and plan on napping20 to 30 minutes.

11

Sleep QuizzzSleep Quizzz

If Americans keep putting on thepounds at the current rate, almost

everyone is going to be overweightby 2035 and obese by 2100, saysJohn Foreyt, director of the NutritionResearch Clinic at Houston’s BaylorCollege.

Nearly one quarter of Americanadults are obese and more than halfof American adults are overweight.

So what’s the difference betweenoverweight and obese?” The termsoverweight and obesity are nowmore commonly measured using aBody Mass Index or BMI. Overweightis defined as a BMI between 25 and29.9 and obesity is defined as 30 orgreater.

As a person’s weight creepsupward on the BMI table, so does the risk for many diseases. There are 280,000 adult deaths per yearattributed to obesity. Even a

moderate weight excess (10 to 20pounds) increases this risk particularlyin the age group of 30 to 64.

The rate of heart disease isincreased for those who have a BMIover 25, and high blood pressure is twice as common in adults who are obese. A weight gain of 11 to 18 pounds increases the risk for developing type 2 diabetes as well as pre-diabetes. Obesity increasesrisk for certain types of cancers suchas breast cancer (1.5 times the risk),colon (1.4 times the risk) and uterine (five times the risk), as well as gallbladder, prostate and kidney cancers.

Other health problems associatedwith obesity are sleep apnea,gallbladder disease, asthma andarthritis, not to mention the generaldecline in quality of life and limitedmobility.

Americans spend about $33 billion annually on weight loss products and services; however, that doesn’t seem to be the answer. Sowhere do we turn? What’s theanswer?

Starting with the basic andproven suggestions for good health isthe simplest solution. That’s right —physical activity. Any activity is beneficial but working up to 30 min-utes a day, five times a week is anexcellent goal to work toward.

Eat breakfast in the morning, andnot just because you mom said so.It really is helpful in weight manage-ment. Focus on increasing intake offruits and vegetables to five a day.And lastly, while eating is a socialand pleasurable activity, rememberthat food is truly intended for nourishment and survival.

Pumping Ironto Stay Young.By Stacey Romney, P.T.

Want to hold off or reversebone loss? Prevent falls?

Jumpstart your metabolism?Improve your posture? Protect yourjoints? Decrease your risk for dia-betes and, along the way, tone up foryour next high school reunion? Thendrop the remote control and pick upsome dumbbells. Strength trainingcould be what your exercise programis missing.

Although all individuals age atthe same rate — one day at a time —

the SupersizeBewareBy Tracy Dugick, R.D.

12

Mammograms find between 85 percent and 90 percent of breast cancers. Most people affected

by breast cancer have no family history of the disease.What’s more, they often have no risk factors other than

being an older female. Fact is, aboutone in eight women will developbreast cancer over the course of herlifetime.

The good news is that a mammogram, together with otherscreening methods such as monthlybreast self-examinations and a year-ly physical examination of thebreasts by a health-care profession-

al, usually can detect breast cancer in its earliest stage.When the disease is caught before it has invaded sur-rounding healthy tissue, the five-year survival rate isgreater than 95 percent.

Unfortunately, only six in 10 breast cancers are

discovered at this stage. That’s why it is vital to workwith your physician to make sure screenings happenearly enough and as often as needed. For most women,mammograms are recommended every one to two yearsbetween ages 40 and 50 and yearly after age 50.

Ask your doctor for a schedule that is right for you.

National Cancer Institute recommendationsfor screening mammograms:

• Women in their 40s and older should have mammograms every one to two years.

• Women who are at higher than average risk of breast cancer should talk with their healthcare providers about whether to have mammograms before age 40 and how often to have them.

To schedule your mammogram callA Woman’s Place at 298-4000.

the passage of time affects each person uniquely. Certainly, someaspects of the aging process are outof our control, but studies show thatstrength training benefits all agegroups and positively affects healthand vitality as we age.

While maximum muscle strengthis generally achieved between theages of 25 and 35, significantincreases in strength can occur infrail 80 and 90 year olds. In oneoften-quoted study involving nursinghome residents ranging in age from86 to 96, participants averaged a174 percent improvement instrength after just eight weeks oftraining.

So, although declines instrength are associated with aging, asimple strength training program(like the one below), followed twicea week for 30 minutes, could possi-bly improve the amount of inde-pendence and function you willenjoy as an older adult.

1. Perform a minimum of eight to 10 exercises that train the majormuscle groups.2. Perform one set of eight to 12repetitions to the point of volitional fatigue. In other words,experiment with the amount ofweight (starting with a light weight)until you find a weight that fatiguesyour muscles between eight and 12

reps. (If you would feel like pumpingout 10 more after already perform-ing 12 reps then the weight is tooeasy.)

3. Perform exercises at least twodays per week. Studies show thatmore frequent training may elicitslightly stronger strength gains butadditional improvement is relativelysmall.

4. Perform exercises in the maxi-mum range of motion that does notcause pain or discomfort.Maintain a normal breathing pattern.

One ineight

womenwill

developbreastcancer

Mammogram?Do I Really Need a

13

Located on 12th and Dry Hollow,in the remodeled facility for-

merly occupied by Kirk’s Market, thenew Columbia Hills Family Medicine(formerly The Dalles Clinic) has inrecent months welcomed into itsfold Drs. Michele Beaman andCorinda Hankins.

Though she graduated from theUniversity of Michigan MedicalSchool, Dr. Beaman is no stranger tothe area. In fact, it was during herschooling that she and her husband,both avid windsurfers, were intro-duced to the Gorge. It was love atfirst sight.

“We had two weeks off togeth-er every year and we would drivenonstop from Ann Arbor to HoodRiver,” Dr. Beaman recalls.

The couple dreamed of living

and practicing in the Gorge. Aftercompleting a residency, internshipand fellowship at the University ofMichigan, Dr. Beaman and her hus-band headed to California, whereshe completed a second pediatricfellowship with the Children’sHospital of Oakland.

Seven years ago, the pediatri-cian and her husband, an orthopedicspecialist, moved to Portland, spend-ing their summers in Hood River.Last fall they made Hood River theirpermanent address.

At Columbia Hills FamilyMedicine Dr. Beaman joined a groupof physicians that included fellowpediatrician and newcomer CorindaHankins, M.D., who relocated to thearea from Illinois last summer.

Prior to joining the ColumbiaHills staff, Dr. Hankins complet-

ed one year of a pediatric pulmonaryfellowship at the Children’sMemorial Hospital in Chicago. Sheand her husband, an emergencyphysician, make their home in HoodRiver.

Dr. Hankins earned her medicaldegree in 1999 from IndianaUniversity School of Medicine, thenwent on to pursue a pediatric resi-dency at the University of Arizona.As a fourth-year medical student,she spent two months in anexchange program at Moi UniversityHospital in Eldoret, Kenya. This expe-rience with “bare-bones medicine”made her grateful to live and work

in the United States, where the high-est level of medical technology isalways at her fingertips.

“It was a heart-wrenchingexperience,” she recalls. “AsAmericans, we take a lot for granted. I saw so many children suf-fering with diseases that have longsince been eradicated here. We werepracticing true medicine at the mostbasic level.”

Dr. Hankins says she is excitedto add, with Dr. Beaman, the special-ty of pediatrics to Columbia Hills’family health offerings.

“I expect this is going to be areally great relationship,” she says.“Mid-Columbia Medical Center andthe other family physicians haveworked hard to bring us out hereand help us get established. I enjoybeing part of this community, and Iappreciate the opportunity to helpbring pediatrics to the Gorge.”

Columbia Hills Family Medicine’scall group will be available 24 hoursa day, seven days a week. Eachmember of the medical staff, includ-ing pediatricians and family practicephysicians, will take call on designat-ed evenings and weekends, to besure children get the care they needfrom an experienced medical profes-sional – even if it is in the middle ofthe night.

Dr. Michele Beaman and Dr.Corinda Hankins can be reached at541-296-9151.

Michele Beaman, M.D.

Corinda Hankins, M.D.

New Kid Docs on the BlockWith the addition of two pediatricians to thestaff of Columbia Hills Family Medicine, thefuture is looking even healthier for childrenin the Mid-Columbia region.

14

www.mcmc.net

Mid-Columbia Medical Centerjust got a makeover on the

World Wide Web. The hospital recentlyintroduced its new and improved Website - www.mcmc.net - which offersvisitors easy access to a wealth ofinformation about hospital services andhealth in general.

The site now offers extensivephysician-reviewed content and a substantial library of healthcare information to help visitors learn moreabout health-related topics. In addition,mcmc.net includes a variety of usefulfeatures, such as online employmentopportunities and application informa-tion, a calendar of events, lectures andclasses, online patient pre-registration,and a real-time, searchable physiciandirectory.

“Our goal is to bring accurate andcomprehensive healthcare informationto consumers via our Web Site,” saidMCMC President and CEO DuaneFrancis. “With our new on-line services,we will be able to deliver personalized

health information and remain in touch with patients and consumers before and after they visit one of our facilities.”

The new site will be updated frequently to ensure that visitors arereceiving the most accurate and timelyinformation about MCMC programsand services, said Yvonne Arbogast,MCMC’s public relations director.

“Most people visit hospital andhealthcare Web sites when they need current health information orassistance with their healthcare needs.We understand that the success of anygood Web site is largely dependent onhaving the most current informationpossible,” Arbogast said.

Future site enhancements include:online billing, electronic newsletters,healthy recipes and easier access forthe community’s Latino population.

For more information on Mid-Columbia Medical Center, pleasevisit www.mcmc.net.

MCMC Launches Next-Generation Web Site

What you’ll findonline atwww.mcmc.net:

• Comprehensive encyclope-dia of health information

• Information about MCMC programs and services

• Physician directory for MCMC primary care providers and specialists

• Online pre-registration form

• Step-by-step explanation ofsurgeries and procedures

• MCMC’s virtual nursery

• Directions, maps and other visitor information

• Employment opportunities at MCMC

• Center for Mind & Body Medicine programs and services

• MCMC news

• Health mini-quizzes

• Information about MCMC’s Health Foundation / Funds /Philanthropy

www.mcmc.net offers visitors easyaccess to a wealth of information abouthospital services and health in general.

15

Center for

Mind & Body Medicine

Add a Little Classto Your Life

16

Upcoming Programs

Upcoming education programs from theCenter for Mind & Body Medicine* Mid-Columbia Medical Center. Pre-registrationrequired; please call 296-7202 to registerunless otherwise indicated.

Fitness Programs and ClassesIndividual Fitness ConsultMeet with our ACE-certified fitnessexpert and develop a fitness programthat is right for you. The consult includesbody fat, flexibility and strength testingand a personalized fitness plan.• By appointment only.• $50

Physical Therapy Consult forTherapeutic Exercise AssessmentAn individual consult with a physicaltherapist for evaluation and exercisetherapy plan. This consult is intended forpeople with a muscular-skeletal issueand/or limited mobility. A physician refer-ral is required for insurance coverage.

Fitness For HealthDesigned for all levels of fitness. Begin ormaintain a personal fitness programusing state-of-the-art equipment with theassistance of a fitness instructor. Attendany combination of times that is conven-ient for your schedule.Mondays, 5:30–11:30 a.m. & 3–7 p.m.Tuesdays, 5:30–10:30 a.m. & 4–7 p.m.Wednesdays, 5:30–8 a.m. & 5–8 p.m.Thursdays, 5:30–10:30 a.m. & 4–7 p.m.Fridays, 5:30–9 a.m. & 4–7 p.m.Saturdays, 7:30–11:30 a.m.• CMBM Exercise Room • $30 per month

T’AI CHI (Yang Style – Short Form)T’ai Chi is an ancient mind/body/spiritdiscipline of relaxed movement. Itinvolves gentle, meditative exercise forindividuals of all ages and fitness levels.Participants will enjoy increased balance,flexibility and coordination and improvedwell being, while reducing stress andassociated pain and fatigue.• Begins Tuesday, March 30• New students: 2 p.m. or 6:30 p.m.• Returning students: 1 p.m. or 5:30 p.m.• $40 per 8-week session

Therapeutic Exercise – An Eight-Week ExperienceThis eight-week class is intended forthose whose chronic pain and/or illnessmakes it difficult to engage in traditionalexercise. Supervised by a physical thera-pist and registered nurse, this programoffers strengthening and stretching exer-cises that will aid in pain managementand reducing stress. A physician referralis required for health insurance coverage.• Call for clinic schedule

Stress Reduction andWellness ServicesHealthy Weight Solutions The Center for Mind & Body Medicineis offering a unique weight loss clinic!Healthy Weight Solutions outpatientprogram is a 10-week progressiveweight loss and wellness clinic that willbe a safe and supportive environmentfor weight loss achievement, stressreduction and disease prevention. Theprogram will focus on a holistic solutionto weight management.The multi-disciplinary team includes adietitian, registered nurse and physician.

The curriculum will include research-based integrative strategies that aresimple, practical and lifelong. Spaceis limited.• Call for clinic dates• Wednesdays 6:30 to 8:30 p.m.

Tea SavvyResearch indicates there are many healthbenefits associated with drinking tea. Inthis class you will learn the art of brew-ing and the healthy advantages teashave to offer. Participants will enjoysampling a variety of hot and iced teas.• Friday, June 11, 10:30–11:30 p.m.• Free

Declutter Your Home,Declutter StressAre you feeling overwhelmed by clutterin your home? Does the clutter impactyour life and cause you stress? Join NylaKent as she guides you on a journey inlearning key principles that will help youto reduce the emotional impact of clutter.• Thursday, June 24, 10–11:30 p.m.• Free

Living Healthy With DiabetesThe Diabetes Self-Management EducationClass is a comprehensive learning experi-ence, which teaches the many differentaspects of diabetes management. It alsoincludes an exercise program designedto meet your individual needs. This six-session course is offered on Mondaysfrom 1 to 3:30 p.m. and we encouragea support person to attend, at no additional fee. We promote patient well-ness and, through education, will helpyou live healthy with diabetes.• Call for class schedule.

Spring 2004

Relaxing With RhythmJoin Dr. Steve McLennon the firstWednesday of every month for relaxationthrough rhythmic drumming. Instrumentsare provided — just bring yourself!Drumming can help you reduce and man-age stress in your everyday life. Learningskills to better handle your stress canhelp improve your quality of life andincrease your sense of well being.• First Wednesday of each month,

6:30–8 p.m.• $30 for 5 sessions,

$50 for 10 sessions or$8 drop-in

Individual Nutrition ConsultsMeet with our registered dietitian forone-on-one coaching. A dietitian providesreliable, objective nutrition informationby separating facts from fads and trans-lating the latest scientific findings intoeasy-to-understand nutrition information.By appointment only.

Massage TherapyMassage therapy is one of the oldestforms of health practice. It has beenused to enhance healing and generalwell being since ancient times. Thistherapy manipulates the skin, musclesand joints for muscle relaxation,improved circulation and stress relief.To schedule an appointment or purchasea gift certificate for a massage, call296-7389 or 296-7202.• Celilo Center• $40 for an hour, $25 for a half-hour

Yoga ClassesYoga – All LevelsUnwind and rejuvenate your mind andbody with yoga stretching, breathingexercises and relaxation. This class isdesigned for all ages and levels of fit-ness. Increase your flexibility, strengthand balance. Instructor: Susan Erikson.• Mondays & Thursdays, 5:30–7 p.m.

Celilo Center.• $30 for 5 sessions

$50 for 10 sessions or$8 drop-in

Yoga – Rise And StretchJoin instructor Susan Erikson for energizing morning yoga.• Wednesdays, 6:30–7:30 a.m.• Celilo Center• $30 for 5 sessions

$50 for 10 sessions or$8 drop-in

Gentle Stretch YogaJoin instructor Susan Erikson for this gentle exercise class, designedespecially for beginners and thosewith limited mobility.• Wednesdays, 8–9 a.m.• Celilo Center• $30 for 5 sessions, $50 for 10 sessions

or $8 drop-in

Flow YogaThis class is geared towards those desir-ing a more vigorous yoga practice. Usingvinyasa flow (moving fluidly from oneasana to another using the breath as afocus) we will increase strength, balanceand flexibility. Those with injuries areinvited to learn how to modify specificallyfor their situation. Yoga experience is preferred but not necessary.Instructor, Jill Kieffer RN Wednesdays, 5:30–7 pm• Celilo Center• $30 for 5 sessions

$50 for 10 sessions or$8 drop-in

Noon YogaJoin Susan Erikson for a 30-minutesession of yoga for working people.Return to your workday feeling energeticand refreshed. Great for beginners.Come in your work clothes.• Thursdays, April 8 through May 13• $4 per session. Drop in, join anytime

Yo-Kids (and Moms and Dads!)This is four-week class for mom and/ordad to do with kids ages 3-5. Each classincludes fun stretching, breathing exercis-es, and even a tiny rest (mostly for theparents!).• 10:00–11:45 am, April 6 through 27• $30• (Parent attendance required)

Prenatal YogaEnjoy your pregnancy and prepare for giving birth with safe, gentle prenatalyoga. Enjoy the company of other mothers-to-be as you stretch, breatheand relax. This class offers a supportive,fun, atmosphere, honoring you duringthis special time.• Thursdays, on-going class.

Start anytime. 4–5 p.m.• $30 for 5 sessions

$50 for 10 sessions or$8 drop-in

Yoga Spring TeaJoin Susan Erikson for a spring morninggentle yoga session. Taste a variety ofteas and unwind and rejuvenate yourmind and body. Light lunch included.• Saturday, May 1, 9 a.m.–noon • Celilo Center• $30 for 5 sessions

$50 for 10 sessions or$8 drop-in

Core ProgramsCall for class dates and times

Living Healthy with Diabetes

Medical Symptom Reduction Clinic

Cardiac Rehabilitation Clinic

Pulmonary Health Services

* Many insurance companies andMedicare will cover all or a portion ofthe clinic fee. We will assist you todetermine your insurance benefits.Physician referral may be required.

** The Center for Mind & Body Medicine(CMBM) classroom and exercise roomare located in Suite 226 of the MedicalCenter Office Plaza, located directlyeast of Mid-Columbia Medical Center.

17

NON-PROFITU.S. Postage

P A I DMID-COLUMBIA

MEDICAL CENTERPermit #161

CURRENT RESIDENT

Eating WellWhat’s for SupperSimple one pan suppersin about half an hourA one-pan meal — Think of it … no stove fullof frying pans to tend, no sink full of dirty utensils. Each dish disguises its simplicity,tasting as if it required slow simmering ormany steps. Add the complements listed andyou’ve got a meal.

Sloppy LasagnaPREP AND COOK TIME: About 40 minutesMakes 4 servings

11/4 pounds uncooked mild orhot Italian turkey sausages

1 onion (about 1/2 lb.), peeled and chopped2 cloves garlic, minced or pressed8 ounces dried lasagna2 cups fat-skimmed chicken broth1 can (about 15 oz.) diced tomatoes1 can (about 8 oz.) tomato sauce1/2 teaspoon dried basil1/2 teaspoon dried oregano1 cup (4 oz.) shredded reduced-fat

mozzarella cheeseChopped parsley

1. Remove and discard sausage casings.2. In a 4- to 5-quart nonstick pan over high heat,

combine sausages, onion, and garlic. With a spoon,break meat into small pieces and stir often untilmixture is browned, about 15 minutes.

3. Meanwhile, break the lasagna into 2- to3-inch pieces.

4. To pan, add broth, 2 cups water, tomatoes (withjuice), tomato sauce, basil, oregano, and lasagna.Boil, stirring often, until pasta is tender to bite,about 15 minutes.

5. Ladle into wide bowls and sprinkle with cheeseand parsley.

Per serving: 597 cal., 30% (180 cal.) from fat; 45 gprotein; 20 g fat (6.4 g sat.); 60 g carbo (4 g fiber);1,629 mg sodium; 86 mg chol.

Potato “Risotto” withSausage and BroccoliPREP AND COOK TIME: About 30 minutesWhile not made with rice, this dish achieves asurprisingly creamy, risotto-like texture withfrozen shredded potatoes.Makes 4 servings

3/4 pound uncooked chicken-apple sausages3 cups (about 1/2 lb.) broccoli florets5 cups frozen hash-brown-cut

(shredded) potatoes 1 onion (1/2 lb.), peeled and finely chopped1 tablespoon chopped fresh sage leaves21/2 cups nonfat milkSalt

1. Discard sausage casings. In a 10- to 12-inch non-stick frying pan over high heat, stir sausages untilbroken up and no longer pink, about 5 minutes.

2. Add broccoli florets; stir until sausages are wellbrowned and broccoli is tender-crisp to bite, 3 to 5minutes more. Pour into a bowl; keep warm.

3. Add potatoes and onion to pan, reduce heat tomedium-high, and stir until onion is limp, 2 to3 minutes.

4. Add sage and milk to pan, and stir just untilpotatoes are tender to bite, 8 to 10 minutes more.

5 Pour potato mixture onto a platter; spoon sausageand broccoli mixture over it. Add salt to taste.

Per serving: 475 cal., 30% (144 cal.) from fat; 26 gprotein; 16 g fat (4.4 g sat.); 62 g carbo (6.5 g fiber);757 mg sodium; 79 mg chol.

Warm Spinach Salad PREP AND COOK TIME: About 30 minutesTo create a Cobb salad, put spinach in individualbowls and group each topping separately on leaves.

Makes 4 servings 1 package (10 oz.) washed spinach leaves1/4 pound turkey bacon, chopped1 cup finely chopped red onion1 package (10 oz.) frozen corn kernels1/2 cup red wine vinegar4 teaspoons sugar1/4 cup crumbled blue cheese2 cups purchased fat-free croutons

1. If desired, stack spinach leaves and cut into1/2-inch-wide strips. Mound spinach equallyonto plates.

2. In a 10- to 12-inch nonstick frying pan over highheat, stir turkey bacon until browned and crisp,about 5 minutes. Spoon equal portions of thebacon over spinach.

3. To pan, add onion, corn, vinegar, and sugar. Stirmixture until onion is limp, 3 to 4 minutes. With aslotted spoon, transfer onion and corn ontospinach, then spoon cooking liquid over salads.

4. Arrange blue cheese equally on salads and addcroutons.

Per serving: 265 cal., 28% (74 cal.) from fat; 12 gprotein; 8.2 g fat (2.7 g sat.); 36 g carbo (3.4 g fiber);721 mg sodium; 27 mg chol.

Tortilla Soup PREP AND COOK TIME: About 20 minutesMakes 4 servings

1 pound boned, skinned chicken breasts2 fresh poblano chilies (also called pasillas;

5 to 6 oz. total)1/2 cup chopped onion8 cups fat-skimmed chicken broth6 corn tortillas (6 in.)About 1/4 cup lime juice

1. Cut into 1-inch chunks.2. Rinse chilies, then trim and discard stems, seeds,

and veins. Cut chilies lengthwise into 1/8- to1/4-inch strips.

3. In a 4- to 5-quart pan over high heat, bring chilies,onion, and broth to a boil. Reduce heat, cover, andsimmer 5 minutes. Add chicken, cover, and simmeruntil meat is no longer pink in center of thickestpart (cut to test), about 4 minutes.

4. Meanwhile, cut tortillas into 1-inch squares.Divide squares equally among wide soup bowls.

5. Ladle soup over tortillas. Add lime juice to taste.Per serving: 299 cal., 7.4% (22 cal.) from fat; 45 gprotein; 2.4 g fat (0.5 g sat.); 23 g carbo (2.7 g fiber);289 mg sodium; 66 mg chol

Easy ComplementsHere is a salad and dessert that echo the point of aone-pan entrée: Less is more. Each takes 10 minutesor less to prepare, and serves four.

Apple SlawCombine 4 cups coleslaw mix, 1 cup chopped apple,1/3 cup nonfat mayonnaise, 1 teaspoon cider vinegar,and hot sauce to taste.Per serving: 75 cal., 6% (4.5 cal.) from fat; 2.4 gprotein; 0.5 g fat (0.1 g sat.); 17 g carbo (1.1 g fiber);172 mg sodium; 0 mg chol.

Chocolate andStrawberry Pavlovas Fill each of 4 purchased baked meringues(31/4 oz. total) with 1/2 cup chocolate frozennonfat yogurt and top each portion with 1/4 cupsliced strawberries and 1 tablespoon nonfatchocolate syrup.Per serving: 251 cal., 8.4% (21 cal.) from fat; 5.3 gprotein; 2.3 g fat (0.1 g sat.); 56 g carbo (1 g fiber);97 mg sodium; 5 mg chol.

1700 E. 19th St., The Dalles, OR 97058