Cle Elum

Let’s talk about vaping

Contributor: Chelsea Newman, PA-C, KVH Family Medicine – Cle Elum

The news has recently been inundated with stories of a mysterious illness affecting those who use vaping products. The illness has led to serious lung disease and death in several previously healthy individuals. The CDC and FDA are currently investigating these vaping-linked illnesses and as of October 8, 2019 there are more than 1,299 lung injury reports and 26 confirmed deaths in the US linked to vaping products. Many of these cases involve vaping products containing nicotine and THC, the principle psychoactive ingredient of cannabis. Symptoms of the illness include coughing, shortness of breath, chest pain, fever, nausea, vomiting and diarrhea. Currently, no specific ingredient or chemical has been identified as the cause of the lung disease but all those affected have used vaping products.

Rates of vaping have been on the rise for several years and the most rapid increase has been with teenagers. Among the current vaping associated epidemic, more than 1/3 of reported lung injuries are in those 18 and younger. The 2018 National Youth Tobacco Survey found alarming increases in e-cigarette use among middle and high school aged students and 68% of kids using e-cigarettes are using flavored vape products. Manufacturers of these devices are directly appealing to children with flavors like bubble gum, cotton candy and watermelon. Devices are also made to resemble USB drives in order to discretely use without notice and deceive parents and teachers. Most e-cigarette and vapes contain nicotine, an extremely addictive substance that only reinforces the desire to smoke or vape. Nicotine also has a host of negative health impacts in the body and can alter the development of the maturing adolescent brain.

So what can be done? How can we as healthcare providers, teachers, parents, family members and friends help discourage vaping and e-cigarette use among those that we care about?

One strategy is to talk about it. Don’t assume the sweet, 14-year-old volleyball player sitting in front of you wouldn’t do that kind of thing. Kids are impressionable and easily swayed by peer pressure. Whether you are talking with your patient, student, child or friend, don’t be afraid to ask about vaping use. Be non-judgmental and give advice out of concern. Learn about the variety of vaping products and delivery systems available so that you can recognize them.

We should also be talking with adults who vape. Vaping has been touted as a smoking cessation aid for some but there are significant health risks associated with continued use of nicotine and with so called nicotine-free vape. There are several carcinogens in the agents used to aerosolize the vapor. Also, kids with parents that vape are more likely to think it is safe or acceptable.

Another strategy to curb use is to make these products less appealing and less available. Earlier this month, the Washington State Board of Health passed emergency legislation to ban the sale of all flavored vape products. This legislation lasts only until February 2020 and will be up for renewal. While it helps to address some current safety concerns, it is also a strategy to curb adolescent use and to make these products less appealing and less available while investigators look for the cause of this vaping epidemic.

If you or someone you know is vaping and would like to quit, there are abundant resources to help. Washington also has several resources including counseling with a smoking cessation coach at 1-800-QUIT-NOW or www.quitline.com. There is also a new free app called 2Morrow cessation with a customized quit plan with lessons, daily messages and reminders and access to a live coach. Healthcare providers are on the front line of treating nicotine addiction and a great resource for behavioral and medical strategies to help abstain. Please contact your local health care provider or health department for more help on smoking cessation.

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

Collaborative Care

KVH Contributor*

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

In a medical emergency or when you are not feeling well, one word often comes to mind, “doctor”. According to Merriam-Webster, “The word doctor comes from the Latin word for ‘teacher,’ itself from docere, meaning ‘to teach.'” 

Patient education and teaching are not my first expectation when I seek medical care. “Give me something to feel better” or “make me better” is often on my mind.

Thankfully, many medical conditions are easily treatable and only require brief treatment or interventions. Other conditions are not so simple, requiring occasional follow-up and/or chronic management.

As a society we are living longer, and as we age we are more vulnerable to chronic conditions and mismanagement thereof. If managing our health condition didn’t seem like enough, then comes the cost and coordination of various visits, all of which can snowball and seem overwhelming. 

As a whole, healthcare and funding are transitioning from volume-based (fee for service) to value-based (fee for value). Within this paradigm shift, evidence-based practice models of team-based collaborative care are being deployed, most targeting chronic conditions and/or mental health problems.

There are many terms being tossed around: integrated, medical home, collaborative care, chronic care management, etc. All these terms are important, but all emphasize patient-centered, collaborative, and team-based interventions.

At the core of these models is an emphasis on teaching and collaboration by all members of the care team, including the patient, who teaches the care team about his/her own strengths, needs, and preferences.

The primary care provider is the head coach on the team and is empowered to deliver comprehensive and connected healthcare through a shared treatment plan with measurement-based targets. Nurses and/or care managers help to coordinate the treatment plan, offer self-management support, and answer questions by phone and in person visits.

All of this equates to more value and resources for both the patient and the team.

Quality and collaboration are core values of Kittitas Valley Healthcare. In my experience as a psychiatric nurse practitioner, whole health and value-based healthcare is at the core of what drives both leadership and providers within Kittitas Valley Healthcare. Fortunately, reimbursement models with payers are emerging which will allow for expansion of value-based healthcare that emphasizes quality evidence-based interventions, care coordination support, and collaboration for patients who need it most.

Your primary care provider may approach you about participation in our new chronic care management program or our collaborative behavioral healthcare program, which will be launching in the future. I plan to share more on collaborative behavioral healthcare at a later date, but these are my thoughts on value-based healthcare and collaboration as a whole. 

*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.

Tips to beat the winter blues

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.