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A history of GNP care

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GNP Care

Familiar ground: GNP Jean Yoder, in the main conference room at KVH’s Radio Hill Facility. The room was once a dining area for assisted living residents at Royal Vista, where Yoder made weekly rounds. (Thumbnail photo: Radio Hill exterior.)

Jean Yoder has been a local fixture in senior patient care for the past 23 years.

“I’ve always liked working with elderly people,” says Yoder, who first ventured into the world of healthcare as a young candy striper, bringing meals and other items to patients in their hospital rooms. Years later, Yoder found her calling as a Geriatric Nurse Provider (GNP), bringing medical care to patients in their homes.

Yoder’s was the first class of GNPs at the University of Washington. “We learned from them and they learned on us,” she laughs. Then, after working with geriatricians in the Seattle area, Yoder learned about a program in Ellensburg led by then-director of Home Care and Hospice Carol Detweiler.

A fellow UW GNP graduate, Detweiler’s vision was to bring medical care delivery out of the traditional patient care setting and into the community, particularly for the frail elderly. It was a vision Yoder shared. “We wanted to make care available for those who couldn’t access it,” she recalls, “whether they were physically frail, struggled with dementia, or had other issues that made it difficult to get in and out of the home for medical visits.”

Soon, the program was underway with Yoder as the sole practitioner.

Yoder’s territory included Royal Vista (a skilled nursing facility) and Kittitas Valley Health and Rehabilitation. Every week, she spent two days at each location, and was on daytime call for both. Nights and weekends were covered by patients’ primary care physicians.

From the outset, the program included a collaborative practice with physicians in the community, starting with Drs. Wise, Schmitt and Anderson in Cle Elum, later expanding to Ellensburg and physicians such as Dr. Solberg, who was struck by the increased level of care his patients were receiving under the GNP program. “He and I made monthly rounds together in the skilled nursing facilities for years,” says Yoder.

The steady presence of a GNP helped fill the care gap for patients and their physicians, whose schedules didn’t often allow for regular visits to these facilities. “We could be on-site, evaluate an individual, see where their code status was, talk to family, talk to staff, and get a plan in place to set up and provide care.”

“We were very busy,” she recalls. “With up to 65 patients in each facility, there’s a lot that goes on from one day to the next.”

Covering the community.

Soon, a second GNP was hired, and Yoder began spending a day each week seeing assisted living patients at Mountain View Meadows (now Meadows Place), and eventually Hearthstone.

“It’s not quite as intense as a skilled nursing facility,” says Yoder. “We focus on treating patients in their environment, keeping them healthy and hopefully away from the E.R.”

The GNP team worked with staff to prevent or treat conditions like urinary tract infections, pneumonias, skin tears, cellulitis, etc. With so many variables, says Yoder, “you never knew what your day would be like.”

Another major shift occurred when GNP Anna Collins entered the picture, joining forces with Yoder to divide up days and locations, increasing overall coverage. Collins took on Meadows Place, while Yoder continued at Hearthstone. “We added on Dry Creek (now Pacifica). And in the middle of all that, we started doing home visits.”

According to Yoder, GNP home visits serve those “who fall through the cracks, in the sense that they have many medical problems, but don’t qualify for the Medicare A Home Program” which covers services from KVH Home Health.

Thankfully, Medicare does allow nurse practitioners to do home visits. “It used to be called a doctor’s home visit,” explains Yoder. “We go through the physician to get a home visit, evaluate the patient and, with the patient’s permission, set up a care plan.”

Once they’ve established care with a patient in their home, GNPs make monthly visits unless a change in health brings them by sooner. “If there’s a spell of illness, or an issue like a wound needing frequent dressing changes, or someone is really fragile and needs more attention and services, we work with a physician to bring in Home Health.”

Taking on the trends.

One big change Yoder’s seen during her time as a GNP is the amount of medications taken by seniors. “It used to be that five medications was remarkable. Now, we have people on 15 or 20,” she says. “We look at the whole picture to see how it’s all working, and focus on comfort while getting rid of unnecessary medications and testing.”

Another trend Yoder sees is a faster discharge from hospitals. “Even if a patient rehabs in a skilled nursing facility, what happens once they get home?” The GNP program will soon begin making home visits after patients are discharged. “You can see when you walk into the environment, what’s working, or isn’t, and what we need to do. It involves quite a bit of detective work.”

The next chapter.

Last month, the GNP office relocated to KVH’s newly remodeled Radio Hill facility – formerly known as Royal Vista, the place where Jean first began her GNP rounds in Kittitas County.

Now that things have come full circle, Yoder is set to retire. “I’ve let go of a lot of things already,” she says, as the GNP team has grown to include practitioners Nenna Nzeocha, Marquetta Washington, and Mary Nouwens. “It’s great to have them here. They want to do this work, and they’re not frightened by the scope and intensity of it.” And while she’s ready to focus on family and home remodeling, there are things Yoder will deeply miss – especially her working relationship with Anna Collins. “We’ve enjoyed each other and we communicate well together. We worked hard!,” she laughs.

Yoder is confident that the GNP program, under the visionary direction of KVH Chief Medical Officer Dr. Kevin Martin, is positioned to continue a pattern of growth in caring for patients throughout the county. Yoder’s optimism rests on a legacy shaped by years of faithful service.

“Nurse practitioners make a difference for patients, family, and staff,” she says. “I really believe that.”

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

When wounds need help to heal

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Mary Nouwens

Long before she helped launch KVH Wound Care, Mary Nouwens grew up on a ranch. Among her favorite things to do was to help her father treat injured or sick cattle.

“I like science,” she grins, “and I believe people have a God-given bent to what they like.”

As an adult, she moved from cows to sheep when her children were small. She enjoyed treating the sheep when they needed medical attention. But once her kids were grown, Nouwens’ dreams of becoming a veterinarian shifted. “I wanted to serve people,” she says.

And off to nursing school she went.

Nouwens went on to earn a Master’s of Science in Nursing from Washington State University. She joined the provider team at Community Health of Central Washington. “It was a wonderful experience,” says Nouwens, who had no intention of leaving the clinic – until KVH moved forward with plans for a wound care service at KVH Hospital.

In August 2018, KVH Wound Care launched with Nouwens on board. She wasn’t surprised when things took off quickly and didn’t slow down: “Before this service started, the closest one was in Yakima.”

What is Wound Care?

While people treat their own superficial wounds with a bandaid and some antibacterial ointment, the treatment of chronic wounds (which take more than two weeks to heal) requires a skilled team with a focused treatment program.

“We see such a variety,” says Nouwens, including post-surgical wounds and diabetic foot ulcers. Patients visit Wound Care over a period of several weeks to months depending on outpatient treatment.

“When a wound becomes chronic, the makeup of the wound changes,” says Nouwens. “There’s an increase in white blood cells call neutrophils which try to clean up the wound and fight any bacteria that would want to colonize there. That keeps the wound in an inflammatory state.”

Often, the work of the wound care team is to take an inflamed wound back to its original condition through a clearing and cleaning process. The team then uses a variety of tools to accelerate healing. “We have so many specialized tools,” says Nouwens. “Alginates and collagens, special hydrofiber foams, wound vacs, and more.”

Each patient visit lasts about 30 minutes, giving staff time to talk with patients about managing their conditions as (for example) the patient’s dressing is changed. Wound Care stocks a variety of materials on wound care and prevention. “We try to provide education every time.”

Jim Gallagher

Beyond the bandages.

Nutrition is a frequent topic of wound care education, especially for patients dealing with complications from diseases like diabetes. “Nutrition is critical,” agrees Jim Gallagher, Director of Food & Nutrition Services at KVH Hospital. “It can reduce inflammation and also provide the necessary elements to produce new tissue for wound healing.”

Wound Care refers patients to Gallagher for nutritional services. Recently, “a patient got her dressings changed while we hung out for about half an hour and talked nutrition,” recalls Gallagher. “I want people to leave with a plan, so they know what they’re going to eat, and what they’re going to do. We pencil out a menu they can use.”

Based on individual patient needs, Gallagher often assigns more targeted therapies including certain vitamins, minerals, and amino acid supplements that can aid in healing. But for some patients there is also an underlying behavioral issue to address.

When it comes to diabetes, “some people just need to get ‘lean and mean,’” says Gallagher. “Others need to make sure they protect their feet, and take precautions to avoid wounds because they can they can be difficult to heal.”

“I’ve seen patients with Type 2 diabetes lose 40, 60, 80 pounds, and their diabetes disappeared completely,” says Gallagher. “Others had the symptoms disappear, but still needed to maintain preventative practices. Even elderly patients with Type 1 diabetes, if they eat right, stay active, and take their insulin when they should, may show very little ill effects from the disease.”

Positive changes start with attitude, believes Gallagher. “If you’re thinking about it, realizing you have a problem and you want to do something about it, that’s something we can definitely work with.”

The making of two M.A.s

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“I’d been working at Starbucks for 8 years and 3 months, and it was about 8 years and 3 months too long.”

No disrespect intended to the international coffee giant. Life just had other plans for Alisha Liedtke.

After a stint selling bamboo sheets for Costco across the continental U.S., Liedtke found herself wanting something that kept her closer to home, and to husband Drew, who at the time was getting his Master of Fine Arts from CWU.

“We’d lived in Ellensburg for three years,” Liedtke recalls, “but I’d never been part of the town.”

She was ready for a change.

Photo: Flores and Liedtke take a moment to confer in a clinic exam room.

Liedtke found a local job opening for a scribe in a clinical environment at Kittitas Valley Healthcare. She applied, and was chosen out of more than forty applicants for the position. “I thought it was an established program,” she laughs. “Turns out I was the first one.”

Soon, Liedtke found herself working alongside teammates José Diaz, April Grant, Laurie Rost, and Carrie Barr, laying the groundwork for the program now in place at KVH, where scribes serve in exam rooms alongside patients and providers, handling the computer charting during the visit.

Rightfully proud of what the team accomplished, Liedtke sees the scribe’s role as “helping the provider to focus on patients.” Now, much of the documentation work that added hours to a provider’s already long day rests in the capable hands of scribes.

Six months before Liedtke began her journey at KVH Family Medicine – Ellensburg, Flores became the newest dietary aide in Food and Nutrition Services at KVH Hospital. Unlike Liedtke, the healthcare setting was familiar to Flores. The daughter of an RN, “I’ve always worked in the medical field,” she explains. “I got my CNA (Certified Nurse Assistant) when I was 16.”

She put that degree to good use for the next 16 years, working as a residential trainer for people with disabilities, then at a nursing home.

About a year into her time in the KVH kitchen, Flores underwent surgery. While convalescing, she received a call from Chief Clinic Officer Carrie Barr, asking Flores if she’d be interested in becoming a medical assistant (MA).

It was a tough decision for Flores to make.

“I’ve always wanted to work in a doctor’s office,” she admits, “but I was thinking about my family in the hospital kitchen. I loved working with everyone there. It was comfortable, and I didn’t want to leave them hanging.”

Around the same time, Liedtke got a call of her own. She was summoned to the manager’s office for a private meeting. “I was terrified! What did I do?” she’d wondered. She then learned that KVH was about to launch another program in the clinics, this time an apprenticeship for medical assistants.

They asked me, “Are you interested?”

That one question led to some sleepless nights for Liedtke, who would be facing yet another major transition. Being an MA “is a whole different ballgame,” she says. “And I’d also be leaving a job that really nurtured me into becoming the person I was supposed to be.”

Despite their initial hesitancy, both women ultimately made the courageous decision to move forward into the exciting world of medical assistants.

Things took off quickly once the apprenticeship began. After a one-day orientation, they shadowed with their coaches (certified MAs), who roomed patients, gave immunizations and EKGs, and did documentation and data entry. “By Day 3, we felt comfortable,” recalls Liedtke. “The coaches were still there, but we were ‘driving.’”

Now that the one-year apprenticeship is drawing to a close, Flores and Liedtke both agree they made the right decision.

“I can’t believe how much I love it,” beams Liedtke. “I’m doing things now that in the past I’d only hoped for. I’m living this life I never could have imagined for myself. I get to wake up and put on PJs (scrubs) and go to work and help patients all day. It’s like the greatest job in the world!”

Flores agrees. “It’s never boring.” As a mother of two, Flores is a hit with the clinic’s pediatric patients. Other than her son Colton and daughter Dakotah, “I’ve never worked with children before,” says Flores. She quickly got past that barrier, finding ways to encourage youngsters who often aren’t thrilled about being at the clinic. “No matter how they do, with their parents’ permission, I give them a popsicle and tell them ‘Thanks for being a good kid. You’re a super hero!’”

The two women’s families are also thrilled, with both mothers aspiring even more for their girls. “My mom thinks I should become an RN,” says Flores, who loves her work as an MA and is content to continue in that role. Young Dakotah feels the same way: “‘It’s more of a mom job you’re doing now,’” she recently told Flores. “’I can say I’m proud of you.’” That, along with the clinic’s family-friendly schedule, is as much of a reward as Flores could ever want.

In the same selfless way that they care for their patients, Flores and Liedtke encourage others to join them in considering an apprenticeship. “If you love the idea of patient care, it’s absolutely the way to go,” says Liedtke. And while program graduates agree to stay with KVH for at least one year, both women find the idea of working elsewhere amusing.

Says Liedtke, “I’m never leaving this place.” Flores nods and smiles gently, “I’d say we’re spoiled.”

Surely, these remarkable ladies’ shared passion for patient care somehow makes us all a little better.

The truth about vaping

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Contributor: Dr. Elise Herman, KVH Pediatrics

Vaping

As parents, we are vigilant about so many things- alcohol, drug use, Internet and technology issues. Here’s one more, and one that can fly under the parental radar. Vaping (using an electronic cigarette to inhale a vapor usually containing nicotine) is increasingly common among youth and has become very popular over the last 5 years. 

Currently, more high school students use e-cigarettes then standard cigarettes. Although often touted as helping smokers quit, there is no evidence to support this, and when used by non-smokers, vaping may lead to nicotine addiction. In fact, youth who vape are more likely to use cigarettes or other tobacco products.

E-cigarette liquid typically includes nicotine (although not always), chemicals to vaporize the liquid (like propylene glycol) additives and flavoring. There are also other potentially harmful ingredients, including ultrafine particles that can be inhaled deep into the lungs, formaldehyde, heavy metals (lead, tin, nickel) and flavorants such as diacetyl, a chemical associated with serious lung disease.

Of course nicotine is the biggest concern with vaping because it is clearly a habit-forming drug that has harmful effects on the heart, lungs, kidneys and more.  Immediate effects include increased blood pressure, heart rate and breathing. It is a stimulant so gives the user a surge of adrenaline as well as dopamine, a brain chemical that affects sensations of pleasure and pain. This increased dopamine makes people feel more contented—easy to see how this could become addictive! Additionally, there is a lot of research showing that nicotine causes cancer.

As e-cigarettes do not actually contain tobacco, use of these has been largely unregulated in the US, but this is changing. Some cities have banned their use wherever smoking is prohibited, and other regulations are in the works. States differ in term of who may buy e-cigarettes. In Washington state, the sale of these devices is prohibited to people age 18 and younger.  Online sites, however, may not ask for proof of age. The use of vapor products is prohibited in schools, on playgrounds, on elevators, etc. in our state as well.

Youth frequently favor an e-cigarette is called “JUUL” (pronounced “jewel”). It is popular because it has sleek, small packaging that resembles a flash drive, all the better to easily carry and use.  Easy to hide in a pocket, easy to use even in a school classroom. It is appealing due to its kid-friendly flavors such as mango and mint.  JUUL is very addictive as it contains twice the concentration of nicotine of other ‘e-cigs’. Each  JUUL pod contains the same amount of nicotine as an entire pack of cigarettes. Because of its ease of use, it is increasingly common on high school and college campuses, and users often share with peers, encouraging non-users to try it. Like JUUL, other e-cigarettes may look like household items- an asthma inhaler, a car key fob, a pen.

In terms of having a conversation with your child about vaping, it is good to approach the subject non-judgmentally and not to lecture.  The topic might come up more naturally if it is response to seeing someone vaping or passing an e-cigarette shop. Acknowledge that you realize it is common, often due to the mistaken idea that it is risk free. Remind your child that his/her brain is still developing and that no tobacco product or nicotine is safe. There is a real risk for people who vape to also use tobacco products. If you do use tobacco yourself, being upfront about the health risks to you and the challenge of quitting is important. Emphasize that you do not want your child to face the same problem.

More information including a tip sheet for parents is available at the websites for the U.S Surgeon General and the American Academy of Pediatrics.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Grilled Fajita Medley

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Fajitas are a staple in our household for an easy week-night dinner. Grilled fajitas take on a whole new twist! Summer is great for throwing things on the grill and having your meal quickly without heating up your house. Try this recipe tonight!

 Grilled Fajita Medley

Grilled Fajita Medley


Ingredients:
•4 steaks of choice (we used porterhouse and bottom round steaks)
•3 green bell peppers
•4 jalapenos
•8-10 large carrots, cut in half
•2 small red onions
•1 lb of mushrooms
•2 tbs chili powder
•2 tsp cumin
•2 tsp smoked paprika
•2 tsp garlic powder
•1 tsp onion powder
•Salt and pepper to taste
•1 lime, juiced
•1 tbs olive or avocado oil


Directions:
In a small mixing bowl, combine together your seasonings, lime juice, and oil. Mix well! In a large mixing bowl or Ziploc bag, combine your veggies and pour your seasoning mixture into the bag and make sure to coat well. Set aside and prepare your steaks. If you like a lot of flavor, use the same seasonings as your veggies! Looking for something a bit more simple? Season with salt and pepper to taste.
Preheat your grill to medium heat. Once ready, place your veggies (it’s best to put the mushrooms on a skewer) and steaks onto the grill. Flip your vegetable after about 5 mins as well as your steaks. If more time is needed, flip again until you have grill marks on both side and your steak is cooked to desired doneness.
Enjoy for the week with burrito bowl lunches or serve this up for a big family dinner!

Coconut Flour Zucchini Bread

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Looking for a low carb, high-fiber and protein way to enjoy bread? Look no further! We combined coconut flour, farm fresh eggs, and backyard grown zucchini into this delicious bread. Bake this today for a healthy breakfast on-the-go for the morning.

Coconut Flour Zucchini Bread

Ingredients:
•6 large eggs
•1/2 cup oil (we used walnut oil!)
•1 tsp vanilla
•1/3 cup honey
•2 tsp cinnamon
•1 tsp baking powder
•½ tsp baking soda
•Dash of salt
•1 cup grated zucchini, squeezed to drain out the liquid.
•OPTIONAL: 3 tbs protein powder & chocolate chips!

Directions:
Preheat your oven to 375 degrees F. In a large mixing bowl, whisk together your eggs, oil, vanilla and honey until well combined. In a smaller, separate bowl, combine your flour, baking soda, baking powder, cinnamon and salt and mix well. Combine your dry ingredients into the large mixing bowl with your egg mixture. Gently stir until well combined. Fold in your zucchini making sure that you have drained most of the moisture out so not to disturb the structure of the bread. Add in your optional ingredients at this point if you wish. Pour your batter into a well-oiled bread pan and bake for 34-45 minutes or until your bread is firm in the center. Top with honey and enjoy!

More than medical care: Sexual Assault Nurse Examiners

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April is Sexual Assault Awareness Month.

Last week, some 100 forensic nurses from around the country gathered in Washington DC, seeking help with funding for research, education and prevention efforts related to sexual assault. It’s an ongoing battle to represent the needs of patients who rarely speak for themselves.

Here in Kittitas County, we’re nearing the 6-year mark of our local Sexual Assault Nurse Examiner (SANE) program at KVH Hospital. The program involves a collaborative effort between local law enforcement, ASPEN, CWU, and the hospital; in every situation, trained staff are involved from the initial report of assault through the victim’s medical examination.

Ask any SANE and you’ll find a person who cares deeply about the care and treatment of sexual abuse victims. “It’s very emotional,” says Pam Clemons, RN and SANE at KVH Hospital. “One of the most important responsibilities we have is to be objective – but it’s not always easy.”

Objectivity for SANEs is key, because they are not only caring for and treating patients – they’re also collecting evidence. The SANE program is an example of forensic nursing, providing specialized care for victims and perpetrators of intentionally and unintentionally inflicted trauma. Forensic nurses have a specialized knowledge of the legal system and skills in identifying, evaluating and documenting injuries. According to the International Association of Forensic Nursing, after attending to a patient’s immediate medical needs, a forensic nurse often collects evidence, provides medical testimony in court, and consults with legal authorities.

As an emergency room nurse, Clemons was already familiar with helping patients in crisis situations. Then she saw an unmet need in care for sexual assault victims. “I thought, I can do this. I took the training, and the passion I now have grew out of my experiences.”

The nature of emergencies and traumas is unpredictable and unplanned, which means Clemons and other SANE professionals can’t predict how many patients they’ll see in a given month. Clemons says, “For some reason, patients often come in waves. We won’t see any for months, and then have 3 in one weekend.”

Weekends treating multiple sexual assault victims are tough on these examiners. The emotion and empathy, combined with heightened awareness needed not just for physical care, but forensic procedures, can quickly drain a nurse’s energy. But the sense of satisfaction that comes with helping victims can be almost as overwhelming. It’s one reason why Clemons encourages others who are interested to seek out SANE training. “Every time a nurse joins the group, we learn something from them,” she says. “They bring ideas and past experiences that give us a fresh perspective on what we’re doing.”

Video from the Office for Victims of Crime, US Department of Justice.

Related:
Online SANE training

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

John & Anne Merrill-Steskal

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John & Anne Merrill-Steskal

When John and Anne Merrill-Steskal went looking for a place to call home, who could have guessed the answer lay at the end of a rainbow?

It was June 1993. John, who attended medical school at the University of Kansas, was finishing a residency in family practice at the University of Wisconsin-Madison.

A fellow resident knew Ellensburg. “So I talked to Dr. Bruce Herman who was recruiting for what was then the Valley Clinic (now KVH Family Medicine-Ellensburg),” John says. “We flew out and fell in love with the place immediately.” Their trip included hiking Manastash Ridge with Herman and his wife Dr. Elise Herman.

“There was this huge rainbow at the top of the ridge,” John says. “It was unforgettable. We were both struck by what a beautiful valley it was. It was as if the rainbow was the icing on the cake, confirmation of our impression of Ellensburg and the area in general.”

After all, the Merrill-Steskals had arrived in search of a college town with a good healthcare system, a strong community and easy access to hiking. Nearly a quarter of a century later the only thing that’s changed is a deepening appreciation for the place they call home.

They live at the base of Manastash Ridge on 20 acres they share with two other families. It’s where they raised their son Gabe, an EHS graduate enrolled at Whitman and currently studying piano in Europe. A 12-year-old golden retriever they call Cascade keeps them company.

John, a veteran of 22 years practicing family medicine, also hikes, gardens, does stained glass and makes bread, while Anne, a physical therapist who has worked for Kittitas Valley Healthcare for 16 years and now specializes in vestibular rehabilitation therapy, enjoys spending time with friends and family, landscaping with native plants, hiking and swimming in mountain lakes.

Still in love with their surroundings, they hike the ridge together three days a week. And both say they’ve found fulfilling careers at KVH.

Anne appreciates the opportunities she’s had within the field of physical therapy both to treat diverse conditions and specialize in a variety of areas. In 2013, with KVH support she advanced her education by completing a doctorate in physical therapy.

As for John, “I really like the people at KVH and I believe KVH strives for high quality care. It’s a supportive organization that wants me to be able to do my job,” he says. An instructor for a student he was precepting once asked if he’d ever had a patient encounter that convinced him family medicine had been the right choice for him. “I have those experiences weekly. I love interacting with people,” John says, beaming. “Family medicine is a perfect fit for me and what I love to do.”

And what he loves to do goes far beyond the exam room.

A Passion for Healthy Communication

Convinced that family physicians “need to get out of their clinics and make their voices heard in their communities,” John leads by example sharing what he calls “a passion for behavior that promotes a healthy lifestyle” through social media and technology.

Since June of 2015, he’s hosted Dr. John’s Radio Show which streams at noon on the first Friday of every month on Ellensburg Community Radio. Last March, John launched a monthly blog. It features short, reader-friendly posts on a variety of subjects ranging from the importance of vaccines to a common sense approach to weight loss, his own experience dealing with cancer, the overuse of antibiotics and the benefits of exercise and getting out into nature.

While one-on-one interactions with patients are the cornerstone for his love of being a doctor, he says the radio show and the blog heighten the enjoyment he finds in practicing medicine.

His efforts haven’t gone unnoticed.

This past spring, he was one of two national recipients of the 2016 American Academy of Family Physicians Vaccine Science Fellowships. The fellowships enable recipients to gain expertise in vaccine science and policy. “It ties right into my interest in promoting behaviors that lead to a healthy life,” he says. “Vaccines have prevented disease and saved more lives than any other aspect of medicine.”

Follow Dr. Merrill-Steskal’s blog at espresso3med.wordpress.com.

Heins

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Heins

Carter Hein is just 6 months old, too young to realize that long before the day he was born, his parents were already looking out for him.

Like many first-time parents-to-be, Penny and John Hein experienced a whirlwind of emotions when they learned in November 2011 that they were expecting. This was, after all, uncharted territory for them. Both believed that top-notch prenatal care from a doctor they could count on to personally guide them through the pregnancy was key to ensuring Carter the best possible start in life. Friends recommended Dr. Bruce Herman of KVH Family Medicine – Ellensburg.

Herman and his nurse, Debbie Perry, are old hands at calming the nerves of expectant parents – and there’s good reason. He delivers about 120 babies a year and has been at the clinic 23 years. She’s got 38 years as a nurse under her belt, 28 of them at the clinic, 13 of them working side-by-side with Herman.

Perry, says Penny, “was nurturing and motherly. As for Herman, “Within ten minutes of meeting Dr. Herman you could tell he really was interested in his patients, that he loved people and cared about them,” John says. “He was warm, personable and informative. Any nervousness we had quickly disappeared.” Herman and Perry both encouraged Penny to call at any time if she had questions or concerns. More than once, Penny did.

Herman, the Heins say, has a talent for making expectant parents feel special. “We learned something new at each visit and he explained things in a way we would understand, outlining our options, recommending what he thought would be best but ultimately let us decide what was the best fit for us,” Penny says. “It was very personal.”

With normal pregnancies, patients meet with Perry and with Herman in the clinic about fourteen times prior to delivery. Regular office visits involve blood pressure monitoring, weight checks, growth measurements, checks of fetal heart tones and checks for sugar and protein in the urine. At certain points, there also are checks for increased risk of congenital abnormalities and gestational diabetes. In addition, Herman sees the patient twice at KVH Hospital for ultrasounds.

Heins

Despite the number of pregnancies handled annually in the practice, Perry says there’s something special about each one. “Pregnancy is such an amazing, incredible process and unique every time,” she says, noting that often something as simple as a touch on the arm or lending an ear helps build connection with patients. And while she helps educate and guide patients, she also learns from them, she says.

By the time Penny entered KVH Hospital last July 30, Penny and John felt well prepared and grateful for prenatal care they say was everything they’d hoped for. The following day, Carter weighed in at solid eight pounds five ounces.

“I couldn’t take my eyes off him,” John says proudly.

Truth is, sometimes he still can’t.

Sydney Skistad

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Sydney Skistad

She’s only 6 years old but Sydney Skistad already knows that you don’t have to get sick to visit the doctor. Sometimes you go to get shots so you won’t get sick. Sometimes you go just to make sure you’re really as well as you’re feeling.

That’s why Sydney, a bright-eyed heartbreaker in the making, visited Dr. Bruce Herman’s office at KVH Family Medicine – Ellensburg for a check up this fall. “It was good,” she says.”He checked my heart. He checked my ears. He checked down my throat – it tickled. He checked everything to make sure it was good. Everything was good!”

And then?

“Then I got a sticker,” Sydney says, flashing a smile as her 3-year-old sister Charlotte – decked out as Rapunzel – dances through the living room of the Skistad home.

Dr. Herman and his staff, as it happens, are no strangers to stickers. Debra Perry, who has spent 27 of her 37 years as a registered nurse at KVH Family Medicine – Ellensburg, has handed out plenty of them. “In our practice alone we use about 1,200 stickers per year, one sticker per shot and a sticker for each child after visits,” she says.

Kids get the exams and the stickers. Perry gets the joy of working with the kids and their families. “Kids teach me something new every time I interact with them and with the people they love,” she says. “I love their honesty. Because I’ve been at the clinic as long as I have it’s been an incredible ride watching them grow up.”

Dr. Herman says well child care begins in the hospital with a newborn exam, hearing screening, screening for genetic diseases and immunization planning. Regular office visits soon follow, the first just a few days after birth, the next a week or so later. Then come exams at two, four, six and sometimes nine months followed by exams at fifteen and twenty-four months. Barring problems, visits are annual after that.

Sydney Skistad

The aim is to follow the infant’s growth and development, catching significant problems as early as possible. Regular well child exams can reveal a wide range of conditions from delays in growth or development to undescended testicles, hernias and hip dislocations or other problems. Along the way, Herman and his staff provide support and guidance for new parents on issues ranging from immunizations to preventing illness.

Denee Skistad, Sydney and Charlotte’s mother, as adept at wielding a thermometer or tackling an upset tummy or earache as any mom, understands why parents sometimes find it difficult to make a well child checkup a priority. But even when a child isn’t sick there’s a certain assurance that comes from a well child checkup, she says.

“It’s tempting not to go because there’s no immediate problem,” Skistad says. “But it’s an opportunity for the doctor to check a child’s health for things that aren’t always obvious. “It’s knowing that there’s not something there that you’re missing or you can’t see. It really is about peace of mind.”