by Guest | Mar 12, 2025 | Being Well, Featured, Uncategorized
We each deserve to spend the last months, weeks, days, and hours of our lives in an environment that makes us feel empowered, human, and whole. But doing so requires frank conversations about death, which many of us struggle to have, even with ourselves. According to a 2018 national survey by the Conversation Project, only 32% of people have discussed their wishes for end-of-life care, even though 92% believe it’s important to have those discussions.
When we do manage to have those discussions, the systems around death and dying are complex and often exhausting to navigate, meaning many people who are terminally ill or dying end up with unmet needs, even when their support system is doing everything they can.
Those situations are where a death doula—also called an end-of-life doula—can be helpful to have.
What is a death doula?
A death doula is a companion and guide through the end-of-life process. Their primary client is the dying person, though they also work with other members of the family, community, or care teams. Many death doulas take on small caseloads, allowing them to meet with clients more often and for longer sessions than care providers with intense caseloads or family caregivers with multiple responsibilities may be able to.
Death doulas provide six areas of support:
- Presence: Acting as a nurturing, calming companion.
- Emotional support: Being there for patients to talk to, being the person who doesn’t shy away from talking about death.
- Information sharing. Educating on relevant topics as needed.
- Proactive guidance. Anticipating patient needs and planning accordingly.
- Resources connection: Referring out to appropriate providers and community resources.
- Comfort measures: Using non-medical means to ease physical discomfort.
- Logistical support: Including household help, coordinating community care, etc.
Why might you work with a death doula?
Since wants and needs at the end of our life are as unique as each of us, there are many reasons why you might engage a death doula. Common ones include:
- You want the assistance of a compassionate guide when having those difficult conversations about death and end-of-life planning with yourself, or with someone else.
- You’re unsure how to start planning your end-of-life care and want help navigating the process.
- You have a limited support system and want a companion through your final months, weeks, or days.
- You want more companionship, emotional support, comfort measures, or logistical support than hospice, caregivers, or the other members of your care team have the capacity to provide.
- You want someone to help plan and/or participate in your vigil.
- You have knowledge, stories, etc. you want to pass on and need help with legacy planning/projects, which have been shown to increase patient and caregiver wellbeing.
- You want help planning your deathbed ecosystem; where you pass away, who is present, what the room looks, sounds, and smells like. You have every right to cultivate a deathbed ecosystem that brings you comfort, peace, even joy.
- You’re nowhere near death but you want to be on the safe side by planning proactively.
How to choose a death doula
Currently, death doula work is not heavily regulated. Organizations like the National End-of-Life Doula Association and the Internation End-of-Life Doula Association offer certifications in order to lend a degree of consistency and accountability for doulas. But certification isn’t legally required for someone to advertise as one.
When contacting a death doula, you can ask if they’re certified, and by who, and what training they’ve undergone; in Oregon, the Peaceful Prescence Project is commonly used and well-regarded. You can also familiarize yourself with the death doula scope of practice; that way, you can identify if a death doula is offering services outside their capacity to provide.
It can help to spend time thinking about what death doula services you want, as the exact services offered can vary between providers. Knowing what matters most to you in your end-of-life care makes it easier to find a death doula who’s a good fit.
You can find more advice on selecting a death doula at NEDA. If you decide to work with a death doula, you can use the NEDA “Find a Doula” directory or this state-by-state directory to find one near you.
Written by contributor Sam Wall, LMSW NEDA-Proficient, and trained in death doulaship through the Peaceful Presence Project. You can visit Sam’s website for more information here: https://morningstardeathdoula.com/about/
by Michelle | Jan 31, 2025 | Being Well, Eat Well, Featured, Uncategorized
Did you know simple mealtime routines can set children up for success? Providing nutritious foods that nourish a child’s physical and mental development is important; however, predictable mealtime patterns can be equally, if not more, important. Safe, consistent and nurturing care are critical for the development of a young child’s nervous system. These factors contribute to a child’s ability to make sense of the world and the degree to which they feel a sense of agency or control over their place in the world. Early childhood experiences shape how their bodies and minds will react to adversity in the future. Parents and caregivers can use mealtimes to reinforce safety and shared expectations with children as a way to build resilience.
The book, Hungry for Love, by Registered Dietician Charlie Slaughter describes how establishing set mealtimes with consistent, shared expectations between caregiver and child strengthens bonds of trust and feelings of safety. Even if parents have not had this modeled for them in their own lives, they can adopt these simple practices within their own family environment. The earlier children are exposed to established routines, the better. If children are older, it can be more challenging to shift family norms. As with any effort to change habits, it’s best to make small changes over time and to be patient with progress.
Following are some research-backed strategies to consider:
Eat Together: Establish and maintain consistent mealtimes in a designated location. Ideally this is the dining or meal preparation area, to be associated with eating together as a family as often as possible. Even if it is only a few nights a week, setting this pattern creates expectations that spending time being nourished together is a priority. Let’s face it. We need to eat to survive. And we need each other to survive. There aren’t many better ways to instill a sense of safety and security in children than to prioritize eating meals together in a calm and supportive setting. Our family rule was that food could only be eaten in the “hard floors” part of the house. Since we had carpet in the living room, this meant meals and snacks had to be consumed in the kitchen or dining area. Yes, it kept my house a lot cleaner but the main idea was to focus on food and family. This also helped limit snacking so the kids were hungry for mealtimes.
Foster Connection: Families are busy. It’s okay to have boxed macaroni and cheese with fish sticks or even take and bake pizza for dinner sometimes. What’s important is to establish spending time together as the priority. Eating around the television or using cell phones during meals signals the importance of sources other than the child and they will get that message loud and clear. Instead, use meal times as a safe, welcoming environment to discuss everyday events, feelings and challenges. Our family used “high,low, middle” as a mealtime conversation starter. “Tell us your high and your low from today and something interesting that happened.” Asking kids open-ended questions helps parents learn more about their child’s perspective and it helps the child develop crucial skills of self-awareness and empathy.
Set Clear but Compassionate Expectations – and stick to them: Introduce choices to build a sense of agency or control while also setting clear expectations. “Would you like green beans or broccoli?” The message here is that we are going to eat healthy vegetables but you can choose which one. Families can fall into patterns where mealtimes become a power play. “You WILL eat your vegetables!” This is a great way to train a child to avoid vegetables for the rest of their life. It can take multiple introductions of certain foods before kids form a positive association. Find ways to empower children to try new things. We had a rule that each child had to eat at least as many bites of their vegetables as they were old. If you were three, you ate three green beans. It was a crazy idea that actually worked really well for us in getting our kids to try new foods.
Many people grow up as members of the “clean plate” club; where the expectation is that every morsel of food on the plate has to be consumed. This can set children up for disordered eating patterns later on. Consider using divided plates to help children learn portion control and let them dish up servings for themselves when they are old enough. This helps develop mindful eating patterns where portion sizes are driven by hunger and satiety cues rather than mere habit. Welcoming, safe mealtimes also support kids eating more slowly which will help them recognize those cues.
Last but not least, set consistent expectations around dessert. Rather than establishing a pattern that every meal ends in dessert, consider having fruit or no dessert after dinner most nights of the week and designate one or two nights a week for special treats. According to the American Heart Association, it is estimated that Americans consume 2 to 3 times the recommended daily allowance of sugar. That adds up to about 60 pounds – the equivalent of six, 10-pound bowling balls – every year. Setting family norms around sugar consumption is critical for lifelong health. Our family eliminated candy early on as a way to reduce artificial ingredients in our kids’ diets. We allowed chocolates as small treats and designated Friday as “ice cream night.” To make it even more special, it was the one exception to eating in the living room.
Mealtimes are more than just opportunities to nourish our bodies—they are powerful moments to nurture our children’s emotional and psychological well-being. By establishing predictable routines, fostering connection, and setting compassionate yet clear expectations, we can create a safe and supportive environment that helps children feel secure, understood, and empowered. These simple yet impactful strategies not only contribute to healthier eating habits but also build resilience, emotional regulation, and a sense of belonging.
AUTHOR: Michelle Jenck, Adventist Health Tillamook Director of Community Well-Being
by Guest | Dec 28, 2024 | Being Well, Featured, Uncategorized
With the introduction of hormone therapy in the 1960s, women flocked to their doctors to treat their menopause symptoms. The therapy was groundbreaking and provided relief for millions of women. The treatment grew in popularity until the early 2000s. The use of hormones abruptly dropped after a women’s health study raised serious concerns over risks. With few other options available, the fallout from the study left an entire generation of healthcare providers struggling to treat women in their menopausal years. This gaping hole in women’s health is now getting addressed with more education, research, and a look back at that sentinel study that stopped it all.
What is menopause
Natural menopause occurs when a woman or person identified as female at birth has gone 12 months without any period. This defines the end of not just menstruation but also the end of fertility, as the ovaries are no longer functioning as effectively. This decreased function results in less hormone production, primarily the estrogen hormone. An estimated 1.3 million women enter menopause each year, with approximately one-third of their lives spent in menopause. The average age for natural menopause is 51 years. But symptoms may begin up to 10 years before menopause in what is known as perimenopause or the menopause transition.
Surgical menopause involves removing both ovaries with a surgery known as an oophorectomy. The removal of ovaries relates to medical issues, which can occur at any age. The missing ovaries will trigger menopause symptoms due to the lack of hormones they typically produce.
Common Menopause Symptoms
| Hot flashes are the sudden sensation of warmth in the face, neck, or chest with or without sweating |
Night sweats are hot flashes with sweating that occur at night |
| Difficulty sleeping, which may cause daytime fatigue and irritability |
Thinning of bones (osteoporosis), which may cause bones to break more easily |
| The vaginal skin may become thin or dry, causing irritation and painful sex |
Urinary issues such as recurring urinary tract infections (UTIs) and incontinence |
| Mood changes, such as depression or irritability |
Anxiety |
| Joint pain, aches, or stiffness |
Hair loss or thinning |
| Memory or concentration problems, commonly called “brain fog” |
Heart palpitations where your heart beats suddenly become more noticeable |
| Decreased interest in sex |
Tinnitus, a constant ringing in the ears |
| Weight gain |
Increased facial hair |
Types of hormone therapy
Hormone therapy is the use of prescription medications to boost hormone levels in the body. For the treatment of menopause, this therapy replaces the declining estrogen and progesterone. For menopause, this therapy comes in two types.
Systemic therapy. Estrogen and progestin, or similar compounds, are absorbed into the blood and travel throughout the body to treat symptoms. This method is very effective at treating hot flashes. Systemic therapy comes in the form of:
- Oral pills
- Patches placed on the skin
- Gels or sprays placed on the skin
- Ring inserted into the vagina
Low-dose therapy. Also known as vaginal estrogen therapy, this medicine treats just the vaginal area in the form of topical or vaginal creams. Low doses rebuild and moisturize vaginal tissue. Because of the small doses of this therapy, there are fewer risks as only a minimal amount enters the bloodstream.
Concerns about hormones for the treatment of menopause
In 1991, the Women’s Health Initiative (WHI) began a long-term study on women’s health. The study focused on cardiovascular disease, cancer, and osteoporosis-related fractures. In 1998, the study looked at hormone therapy use with both estrogen and the combination of estrogen and progestin. By 2004, researchers had stopped both studies early after finding increased risks of heart disease, stroke, pulmonary embolism, and breast cancer. The halting of the studies made headlines, leading many women to stop using hormones. Women aged 52-65 had the greatest decline as use dropped 88% in this group.
The impact of the WHI study was profound. Few other treatments were well studied. An entire generation of healthcare providers were left lacking information on treating menopause, and women felt this. A survey in 2021 found that 73% of women ages 40-65 were not getting care for their menopause symptoms. An additional 65% said they would not consider hormone therapy.
The benefits of treating symptoms
About 70-80% of women have menopause symptoms negatively affecting their quality of life. Hot flashes are the most reported symptom and can last more than a decade. However, up to 40% of individuals will continue to have symptoms into their 60s, and up to 15% will have hot flashes into their 70s. Hot flashes affect not only physical comfort but also sleep and mood.
The tide is changing with menopause treatments. Since the WHI study, research has shown hormone therapy is safer in younger women. Starting MHT within 10 years of the onset of menopause or before age 60 poses less risk. Hormone therapy is the most effective method of treating vasomotor symptoms like hot flashes. About 80% of women get relief from symptoms within two weeks of starting hormone therapy. There are still risks, and each individual should discuss their personal risk with their healthcare provider. Risks associated with hormone therapy:
- Stroke
- Uterine cancer
- Blood blots
- Breast cancer
For many, the benefits of hormone therapy outweigh the risks.
- Reduced menopause symptoms
- Relief of vaginal discomfort and dryness
- Improved bone health
- Ease symptoms of overactive bladder
- Lower risk of cardiovascular disease
- Reduced risk of developing type 2 diabetes
But hormones aren’t the only treatments. More research backed non-hormonal options are available to treat a variety of symptoms.
When to see a healthcare provider
Menopause treatment is in the spotlight with organizations nationwide. Locally, Oregon Health and Sciences University (OHSU) began offering training on menopause care. The classes are offered statewide to primary care providers and community health partners. With this program, OHSU focuses on reaching healthcare providers located in rural areas, including Tillamook County.
The impact of menopause symptoms cannot be understated. They are disruptive for many women daily, affecting how they feel, work, and relate to others. Perimenopause and menopause symptoms last for a decade or more, yet 1 in 8 adults still avoid talking about menopause. If you have perimenopause or menopause symptoms, talk with your healthcare provider. You can discuss:
- Whether you have reached menopause
- The symptoms you have and how much they affect you
- Your health risks based on your age and general health
- Whether hormone therapy is a good option for you
- Alternative treatment options to hormone therapy
If you need assistance in finding a provider to treat your menopause symptoms, check The Menopause Society’s website for a link to menopause specialists. If you are in the Columbia Pacific CCO, look at their Find a Provider page.
Written by: Leanna Coy, FNP-BC, Freelance Health Writer
References:
Menopause definitions. (2024). The Menopause Society. Retrieved December 2, 2024. https://menopause.org/patient-education/menopause-glossary
Menopause. (2024). Society for Women’s Health Research. Retrieved December 2, 2024. https://swhr.org/health_focus_area/menopause/
Walsh, J. (January 10, 2024). How gaps in research lead to gaps in care for aging women. Harvard Medical School News & Research. https://hms.harvard.edu/news/how-gaps-scientific-data-lead-gaps-care-aging-women#:~:text=Ambrosio%3A%20Menopause%20is%20inextricably%20intertwined,third%20of%20their%20lives%20postmenopausal.
Signs and symptoms of menopause. (March 14, 2023). NHS. https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/signs-and-symptoms-of-menopause/
Hormone Therapy. (2024). The Menopause Society. Retrieved December 2, 2024. https://menopause.org/patient-education/menopause-topics/hormone-therapy#:~:text=What%20Is%20Hormone%20Therapy?,night%20sweats%2C%20and%20sleep%20disturbances.
Kohn, G.E., Rodriguez, K.M., Pastuszak, A.W. The history of estrogen therapy. Sex Med Rev. May 27, 2019. PMID: 31147294
About WHI. (2021). The Women’s Health Initiative. Retrieved December 2, 2024. https://www.whi.org/about-whi
Iyer, T.K., Manson, J.E. Recent trends in menopausal hormone therapy use in the U.S. JAMA Network. September 27, 2024. PMID: 39331374
Elflein, J. Treatment of menopause symptoms among older U.S. women as of 2021. Statista. August 5, 2021. https://www.statista.com/statistics/1255552/treatment-of-menopause-symptoms-among-older-us-women/
The Menopause Society. September 4, 2024. Hormone therapy usage rates still low despite proven benefits. https://menopause.org/press-releases/hormone-therapy-usage-rates-still-low-despite-proven-benefits#:~:text=It’s%20estimated%20that%2070%25%20to,continue%20to%20have%20hot%20flashes.
Yang, J. (November 20, 2023). Share of U.S. adults who avoid talking about menstruation or menopause as of 2022. Statista. https://www.statista.com/statistics/1424427/menstruation-and-menopause-taboo-us/
Solving the mysteries of menopause, one conversation at a time. (October 24, 2024). Oregon Health News Blog. https://covidblog.oregon.gov/solving-the-mysteries-of-menopause-one-conversation-at-a-time/?utm_medium=email&utm_source=govdelivery
by Guest | Oct 11, 2024 | Being Well, Featured, Uncategorized, Work Well
Let’s face it: Whether you’re a single parent, have a supportive co-parent, or are part of a large, supportive family system, parenting well is hard. Kids, no matter how much we love them, don’t come with instruction manuals and often push us to our limits.
We want to bring our best selves to this parenting endeavor; we know how we treat and invest in our children will have lifelong repercussions . . . but sometimes we need a little support.
Engaging your child resourcefully, creatively, and educationally, boosting and encouraging playful curiosity, and celebrating developmental milestones—that’s what our family educators do every day. We believe that parents are their kids’ first and best teachers and we want to equip parents to engage their kiddos with creative, fun learning activities all year long.
Did you know that year-round support from Healthy Families and Early Head Start is available to families in every part of Tillamook County? Here’s what you need to know about our three Child & Family Programs, all housed under Community Action Team:
Healthy Families:
– Register your child within 90 days of birth
– Known for their diaper program
– Regular home visits, frequency of visits based on need
– Healthy Families – Community Action Team (cat-team.org)
Early Head Start:
– Registration accepted year-round, ages 0-3
– Weekly home visits
– Biweekly socializations/play dates
– Educational and literacy focus
– Seamless transition to Head Start (preschool, ages 3-5)
– www.nworheadstart.org
Head Start:
– preschool (drop off/pick up)
– only available to families living in Tillamook proper at this time
– 2 locations: 1100 Miller Ave, Tillamook, OR and 3808 12th Street, Tillamook, OR
– www.nworheadstart.org
We are a resource for you and want to make your parenting journey a little less
overwhelming, so you can offer your kiddo your very best self!
To reach out and ask questions, please contact:
Christina Pfister
Family Advocate for Early Head Start
971-813-9450
cpfister@nworheadstart.org
Written by Christina Pfister, Family Advocate for Early Head Start
Other wellness questions? Email us at info@tillamookcountywellness.org. For more local health and wellness information, visit www.tillamookcountywellness.org or follow Tillamook County Wellness on Facebook and Instagram.
by Guest | Sep 16, 2024 | Being Well, Featured, Why I'm In
“WHY I’M IN …” An interview with Galena Flores, Program Assistant SNAP-Educator with Tillamook County Extension through Oregon State University and Tillamook Family YMCA
What drew you/your organization to partner with Tillamook County Wellness?
My first partnership with Tillamook County Wellness (TCW) was at the YMCA. Having lost my grandfather to diabetes, I became a Lifestyle coach teaching the National Diabetes Prevention Program, which was partnered with Tillamook County Wellness. They promote the program by helping recruit individuals at risk of developing type 2 diabetes. The year-long program taught individuals small lifestyle changes that would have a lasting impact on their health, reducing their chances of getting Type 2 Diabetes.
As my role in the community has changed, I have continued to work with TCW through different avenues and organizations. During my internship at the Tillamook County Community Health Center, I worked with TCW on a Health Literacy campaign that was published on the Tillamook County Wellness Facebook page and other social media platforms.
More recently, with my new role at Tillamook Extension, I have worked closely with TWC on different committees and projects, one of which is the Treasure Your Wellness map currently underway. I am also working with the Access to Physical Activity Committee as we work toward promoting the Salmonberry Trail and events like the bike rodeo and the Four Seasons of Forging events that will be going on in our community throughout the year.
What, if any, changes have you seen come about as a result of this work?
I have seen the prevalence of type 2 diabetes go down in Tillamook, along with the several established walking groups that are throughout the county and much more.
What have you learned from being involved in this work?
This community can do some very meaningful things by bringing different organizations together. I also learned about the Salmonberry Trail, which would be fantastic for our community, along with various other things.
What are your hopes for this work as it relates to you/your organization?
My hope is to empower our community to take control of their health. Through my work with Tillamook Extension, I am providing individuals with the resources and knowledge to be able to make informed decisions about their health. I hope to be able to impact my community with healthy recipes and knowledge about specific ingredients that they might not be sure about. I hope to be able to provide information to people about ways to be more physically active and feel more confident in the kitchen when preparing meals for themselves and their families. I hope to be able to encourage our low-income and underserved population on different ways to take care of themselves, which could be done by teaching them how to prepare nutritious meals with the items they are receiving at the food banks or educating them on different resources there are throughout the community they might not be aware of.
What are your hopes for this work as it relates to changing community health in Tillamook County?
I hope that people will be able to access the resources that my organization and TWC provide. I hope to truly impact our community in a positive way and inspire people to take care of themselves and, if possible, others.
Is there anything else you’d like to share?
TCW truly has its community’s best interest at heart, and many Tillamook County residents do not realize how much they are really affected by this organization. The work that is being done every day to improve this community’s health through different organizations is astonishing. I feel it is a beautiful thing, and we are so lucky to have such a grand coalition in our community.
Other wellness questions? Email us at info@tillamookcountywellness.org. For more local health and wellness information, visit www.tillamookcountywellness.org or follow Tillamook County Wellness on Facebook and Instagram.
