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Tips to beat the winter blues

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KVH Contributor*
Auren O'Connell 
Auren O’Connell, DNP, PMHNP
KVH Family Medicine – Cle Elum

Beat the winter blues
Snow Covered Tree — Image by © Royalty-Free/Corbis

Winter solstice is fast approaching, and it already feels like winter across Kittitas County. December 22 will mark winter and the darkest day of 2018, as we are at the farthest point from the sun in the northern hemisphere. In the new year, we will slowly regain our light until the longest day of light during summer solstice on June 21, 2019.  

The seasons are marked by cycles of cold and heat, darkness and light. Some of us are more susceptible to these cycles, especially during the winter, when there is less light. Symptoms of seasonal affective disorder (SAD) are most common during the winter months, but can occur with any season change. “Winter blues” often refers to the symptoms of SAD, which can be decreased energy, difficulty with focus and concentration, social withdrawal, sleeping problems, and changes in appetite. Many of us will commonly experience some elements of SAD during the winter months.

All of us can benefit from a wellness plan and interventions designed to alleviate symptoms of “Winter blues.” Here are some tips to keep your mood, energy, and motivation steady during the winter:

Stay active: Exercise is vital to our brain power and mood. It is preferable to dedicate 30-minute time blocks to exercise at least three times per week, but even a 10-minute walk during lunch in the daylight can be helpful.

Get outside: There is no substitute for natural sunlight and fresh air. If you are able, try to get outside daily.

Light therapy: Light boxes can be helpful on overcast winter days, and dawn simulators can be the missing link in getting out of bed on time during dark mornings. (There are numerous consumer light therapy products on the market that may or may not be helpful, but it is vital to consult a healthcare professional if you are seeking such products for treatment of SAD or depression .)

Stay social: Try to maintain regular social engagements at least a few times each week. This may be going for a walk with a friend, attending a community event, or simply eating a meal with someone with no distractions. Whatever it is, try to keep it regular.

If you feel stuck, or when symptoms interfere with daily activities and relationships, it is vital to get help from a qualified health professional; seeking help and advice from your primary care provider is a good first step.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

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.

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.

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.”