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health

KVH Childbirth & Family Education offers free webinar series

HealthNews · Jul 29, 2021 ·

Julie Harwell, RN, BSN is hosting a free webinar series through our Childbirth & Family Education Program at Kittitas Valley Healthcare. The most recent webinar titled “Creating Meaningful Learning Communities: How Covid has helped us to Reimagine Possibilities in Education” details how one local school adapted to the COVID-19 restrictions and found opportunities for resilience and growth in the classroom and our community.

“The Covid-19 Pandemic brought about many changes in the way we as a society approach school. In addition to the challenges, the past year brought many opportunities for us to reflect on education and how we can best support engagement in learning for children. We found great value in more outdoor education, multi-age groups, parent partnerships in learning, and extending the walls of the classroom to include more community places and partners. This year illustrated the great potential we have to provide meaningful learning experiences for our children when families, children, schools and community members work together.”

Webinar presenter Natalia Parker, a founder of and the current Director at Discovery Lab of Ellensburg, has worked with children and families in varying capacities for the past 20 years. After graduating with degrees in Psychology and Infant Mental Health, Natalia worked in various roles educating and supporting caregivers, children and students in grades Kindergarten through Post-Secondary. Currently, in her role at Discovery Lab she works to support meaningful and engaging teaching and learning practices that best support healthy child development. When she isn’t at work she loves to be outside exploring the beautiful area we live in.

Check out our website to learn more about the KVH Childbirth & Family Education Program.

Beat the heat: Diabetic safety

HealthNews · Jul 1, 2021 ·

Photo: Even in summer, foot protection is a priority for people living with diabetes. Skip the sandals and barefoot walks. Keep them covered!

Wear sunscreen. Stay hydrated. Wear light, loose clothing. Anyone who’s lived in Kittitas County for more than a year knows these basics for survival in the summer heat. If you’re diabetic, there’s another concern to add to the list: extreme temperatures can spike your blood sugar levels, and wreak havoc on testing equipment and medication.

Recent findings show that the summer heat drives more people with diabetes to the ER, and more diabetics are hospitalized due to heat illness.

“First of all, be aware of your environment. Watch the forecast. When we’re in for a hot spell, there are some things you can do to prepare for diabetic safety,” advises Nicole Norton, Diabetes & Nutrition Education Coordinator at KVH.

Careful planning of your diet is always important, but even more so in extreme temperatures. Think through any adjustments you need to make. And be diligent in avoiding added sugars. “A lot of folks reach for sugared sodas, sweet teas, and juices when they’re thirsty,” warns Norton. “For someone with diabetes, it’s safest to stick with water.”

Another common mistake is skipping meals. Norton explains, “We’re more active in the summer, and we get distracted, forgetting to eat when we should.” That’s not good in normal conditions, but in the heat of summer, it’s even more dangerous. Be familiar with the early symptoms of low blood sugar, and keep some carbohydrates with you to eat if you need to raise your blood sugar.

Once you put the steps into practice, diabetic safety becomes just another automatic healthy habit.

Medication storage is another concern. While unopened insulin should always be kept in the fridge, storing any medications in the heat can degrade them. “Don’t keep medications in your car,” advises Norton. “In a high temp situation, use an ice pack in an insulated lunch pail.”

More frequent testing is also a good idea. Your diabetes educator can help you with guidelines for an appropriate testing schedule.

It’s easy to forget, but foot problems are common for people with diabetes, and summer is all about bare feet, sandals, and open toed shoes. “Keep your feet covered in well-fitting shoes,” says Norton, “even in warm weather. Check your feet every day, and get treatment right away for any injuries.”

It’s a lot to consider, but, like using sunscreen and staying hydrated, once you put the steps into practice, diabetic safety becomes just another automatic healthy habit. “We all have health limitations of some kind,” says Norton. “With a little preplanning and awareness of their surroundings, people living with diabetes can enjoy themselves in the summer like anyone else.”

Article updated 7/2021. Original post 8/2017.

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

The pandemic & depression in teens

HealthNews · Dec 11, 2020 ·

Contributor: Elise Herman, MD, KVH Pediatrics

We are all dealing in some way with the ravages of COVID-19 – isolation, financial hardships, personal illness or illness of loved ones, changes in education or work. Our kids are also being affected, and teens in particular have been noted to have a significant increase in mental health issues attributable to the pandemic.

Teens are experiencing real loss- loss of school activities, sports, and milestones such as homecoming and prom. Spending most of their time with their family can feel suffocating, with no real privacy or independence. Jobs for adolescents used to provide a sense of accomplishment and maturity, but these have largely disappeared.

Social isolation is a big factor in mental health issues related to the pandemic and especially so for teens. Social media and FaceTime may help but do not replace the “passive socialization” that typically would be happening, like having conversations in the classroom, being amongst peers in the halls, or sharing a laugh casually with fellow students or staff. Teen friendships are instrumental in maintaining self-esteem and navigating adolescence, and TikTok and Instagram are inadequate substitutes for in-person relationships.

Sadness is a normal and appropriate response to so much loss, upheaval and uncertainty. So when does ordinary sadness cross the line over to the more worrisome depression (also known as Major Depressive Disorder or MDD)? True depression is more severe, lasts longer, and may involve the loss of usual interest in friends or activities, irritability, changes in sleep, appetite or activity level. Poor self-esteem, decreased concentration and thoughts of suicide and death may also occur. If several of the above changes are noted daily for at least 2 weeks, especially if this change has been rapid, parents need to talk with their teen and take action. Obviously, any suicidal thoughts need to be addressed immediately.

Pick the right time to have a conversation with your child, when there is no time pressure, and you have privacy. Tell them without judgement what you have observed; have they also noticed this? Let them know that you care and are aware this is a hard time in view of the challenges and losses particularly for teens. If you have faced depression and feel comfortable sharing your experience and what helped, this may encourage your teen to open up.

Offer options to help such as counseling or having them talk to their health care provider. Frame the idea of counseling not as “fixing” something that is broken but rather more positively as “strength-building” or “coaching”. Medication can be very effective though this takes an in-depth discussion with your teen’s provider to make sure it is the right step. There are other actions that could be considered a mental health “prescription” such as getting outside regularly, meditation, daily exercise and having a routine schedule for sleeping and eating. And no one needs to hear, read or watch the news 24/7- minimize overconsumption which can add to stress.

If there is concern of suicidal thoughts, secure medications in a locked cabinet and remove any guns and ammunition from your home. This literally can save a life. You can temporarily give guns to a friend, or you can find an out-of-home temporary safe storage facility by looking on-line (google ‘Washington firearm safe storage map’). There are 59 of these (they are businesses or law enforcement agencies) in Washington state.

Empathizing with your teen and sharing your own challenges is important, but we also need to project a sense of strength and optimism that we know things will get better and we will get past this pandemic with all of its difficulties. As adults we must take care of ourselves so we can be there for our family, be it going for a walk, practicing relaxation techniques like yoga or meditation, or even just taking the occasional nap. We also need to do what we can to help- which right now means masking up, social distancing and having a very quiet holiday season.

Don’t put off skin cancer screenings

HealthNews · Nov 16, 2020 ·

Contributor: Dr. Susan Oldenkamp, KVH Dermatology

It seems unusual to be writing about skin cancer in November, but 2020 has been an unusual year! When the COVID-19 epidemic first hit, we advised patients to postpone non-essential visits to the clinic, but now that we have effective safety measures in place at KVH, we have resumed regular skin cancer screenings.

Who should be screened? First, anyone with a family history of malignant melanoma, and those with a large number of atypical moles, should be screened on a regular basis. Second, anyone with a personal history of skin cancer should be screened. In addition, anyone with a history of precancerous lesions, called actinic keratosis, needs to be screened. Regular skin cancer screening helps us catch skin cancers early, when they are the smallest and most easily treated.

Even if you don’t receive regular skin cancer screenings, there are some things you should watch for. A flesh colored, or translucent bump that bleeds and does not heal may be a basal cell carcinoma. A thickened, red, scaly patch which persists, and may bleed, can be a sign of squamous cell carcinoma. These two types of skin cancer, sometimes lumped together and called ‘non-melanoma skin cancer’, almost always occur on chronically sun-exposed skin. They are not usually life threatening, but will continue to get larger until they are removed.

When evaluating a pigmented spot or ‘mole’, look for the ABCDEs. A is for asymmetry, B for irregular borders, C for more than one color, and D for diameter greater than 6mm, the size of a pencil eraser. More recently, E was added, E is for ‘evolving’ or changing. Any pigmented spot that changes should be pointed out to your PCP or dermatologist. You may also hear the term ‘ugly duckling’. This refers to a spot that stands out as different from your other pigmented spots. Melanoma can occur anywhere on the skin. It is a serious type of cancer, and it is important to diagnose and treat it as early as possible.

Although we need to continue to remain vigilant to prevent the spread of COVID, we can and should attend to our other health needs as well, including taking care of our skin.

Public Health: Take Children to Doctor Appointments

HealthNews · May 11, 2020 ·

The Kittitas County Incident Management Team (IMT) and Kittitas County Medical Providers want to remind caregivers to continue to take children in for routine medical visits, which include administration of scheduled vaccine.  The Washington State Department of Health’s data shows a 30% drop in vaccines during the month of March.  According to the Washington State Department of Health (DOH), the number of immunizations given to children dropping during the COIVD-19 pandemic leaves children and communities at risk.

Medical providers are prepared to see patients while preventing the spread of COVID-19.  Please contact your healthcare provider and schedule appointments for your children.  If you have missed a visit, please call and reschedule.

According to the DOH, “We are concerned that children aren’t getting all the vaccines they need to protect them. Slowing or stopping access to immunizations increases the risk that we could see an outbreak of a vaccine-preventable disease. Adding more outbreaks on top of COVID-19 not only would put more people’s health at risk, it also could overload the health care system.”

“If you are concerned about bringing in your child, please contact your healthcare office,” states local provider Dr. Merrill-Steskal.  “Your healthcare provider is happy to discuss with you safety measures in place, so that you are informed prior to coming in for an appointment.”

If you have questions about your health, please contact your healthcare provider or you can call the KVH COVID Clinic at 509-933-8850.  General questions can be answered via the Emergency Operation Center at 509-933-8315 or 509-933-8305 Monday through Friday.  Information is available via the county website and the Kittitas County Public Health Department Facebook page.

Safe behavior as restrictions ease

HealthNews · Apr 29, 2020 ·

Contributor: Dr. Elise Herman, KVH Pediatrics

After what has felt like a very long time “sheltering in place” due to the Coronavirus pandemic, we are on the verge of easing of some restrictions. Whew! The problem is, of course, that if people do not follow the safety rules of social distancing and wearing masks, cases of COVID-19 may spike and force a renewal of restrictions. Adults understand this, but kids may not grasp why getting out more may look very different than ‘way back’ in March when life changed.

For young children, explain that the COVID-19 virus is a germ that can easily go from one person to another even if people don’t know they have it. It can travel in the air up to 6 feet (about the length of 2 grocery carts) if someone coughs or sneezes. To keep all people safe (and especially older people like grandparents), we need to stay at least 6 feet apart from others when we leave our homes. Washing hands and not touching our faces continues to be the routine. Explain that though parents may be going shopping a bit more as businesses open up, kids should still not be along for these trips if possible.

For older children and teens, let them know that they can be part of making the easing of restrictions successful by following the safety guidelines. They will be protecting not only themselves but also their family and community. Limiting the number of new COVID-19 infections helps keep our first responders and healthcare workers safe. Kids can be a good example to others to also ‘play by the rules’.

Ideally everyone should wear a mask when out and about if social distancing cannot be maintained. There are some exceptions, however. Children under the age 2 years should not wear a mask, and if the wearing of a mask causes your child to frequently touch and adjust the mask, it may be better to forego it. Wash hands before and after wearing a mask, and remove it by the ear loops or ties. Some children are afraid of people wearing masks; simply explain that masks make it harder for germs to travel from one person to the other. Kids may be less afraid (and more inclined to wear a mask if needed) if they can put a cloth face covering on a stuffed animal and see photos on-line of other children wearing them.

As the weather improves and access to the outdoors is made easier by changing restrictions, it may be tempting to rush to the park, lake or trailhead. Try to be pro-active to minimize being part of a crowd. Go early or late in the day, find lesser-known spots and if a place looks congested, make a different plan. Explain to your kids that we all have to do our part in protecting others and ourselves. And, as adults, that means leading by example – social distancing, washing our hands frequently and wearing a mask when social distancing is not possible. That said, getting out more will be terrific for our physical and mental health – we just need to do it safely.

Caring for sensitive skin during COVID-19

HealthNews · Mar 26, 2020 ·

Contributor: Dr. Susan Oldenkamp, KVH Dermatology

While much of our community falls into the non-essential workforce during this period of shelter-in-place, some business such as grocery stores remain open to serve the community. As these essential workers follow guidelines to keep their hands and work surfaces sanitized, those with skin issues are likely seeing flare-ups of their conditions. We asked KVH Dermatologist Susan Oldenkamp to share a quick word of general advice, in case it would bring those hardworking folks some measure of relief.

Unfortunately, some people’s hands just don’t stand up to multiple washings every day. Some things you can do, though, are keeping a tube of a cream such as Cetaphil or Eucerin by where you wash your hands and apply it after every washing. It also helps to apply petrolatum (i.e. Vaseline) to your hands just before you go to sleep at night. If desired you can cover your hands with white cotton gloves or white socks to keep the ointment off your sheets. If you develop cracks in your skin it can help to apply antibiotic ointment, such as bacitracin to the crack and cover it with a bandaid.

It’s not practical at work, but at home you should try to do all your wet work at once and then dry your hands thoroughly and apply your cream.

If these measures aren’t enough, getting a topical corticosteroid cream from your doctor may help.

I’m sure this is a very challenging time for those with sensitive skin, and in fact, nearly everyone will be affected to some extent.

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

Healthy Holiday Eating

HealthNews · Nov 25, 2019 ·

KVH Contributor*
Nicole Norton, MDA, RDN, CDE
KVH Diabetes Education

The holidays are upon us and many of us are preparing for gatherings with friends and family. Although it can be a joyful time of the year to celebrate, a common worry revolves around overindulging on holiday favorites, and the potential for weight gain and elevated blood sugars. While it isn’t necessary to deprive yourself during the holidays or feel guilty about eating sweets, there are several things you can keep in mind to make it through the holidays without going overboard.

One trick to prevent overeating is having a pre-snack before heading to a holiday party. Going on an empty stomach may leave you famished and overeating large quantities of less than ideal foods. Try a combination of complex carbohydrates with protein and healthy fats for a satisfying snack you can feel good about. Examples include an apple with almonds or whole wheat pita chips with hummus.

To avoid excess calories from mindless eating at parties, distance yourself from the food table. It may be easy to continuously eat with the temptation of appetizing food within arm’s reach, so dish up a plate and hold a conversation away from the food. If you find yourself tempted to return to the table often, chew a piece of gum to keep yourself from reaching for the snacks.

While alcohol is common for people to consume during the holidays, it can add several hundred calories on top of the calorie dense foods you may already be eating. Alcoholic beverages can range from 100 to 300 calories, depending on the alcohol and mixers. To reduce your calories, drink a glass of water or flavored seltzer water between drinks.

When it comes time for the big meal, be smart about your choices. Resist the urge to put everything on your plate. Scan the buffet first to check out all of your options so you can decide which items you are most interested in. And remember to pile on the veggies. A general rule for someone with diabetes to follow is to fill half the plate with vegetables. If you aren’t sure what foods will be available at the party, bring a vegetable dish so you know you’ll be able to include vegetables at the meal. Try parmesan mashed cauliflower or garlic roasted green beans.

Even with those additional vegetables, your overall calorie intake may still be higher than usual. Eating your meal slowly and stopping to take a break after finishing can help you allow time for the signal to get to your brain that you are full. Recheck your appetite before continuing to eat.

Continuing to stay active can help as well. Suggest a family walk after the big meal and before bringing out the dessert. Taking a 30 minute walk can burn about 109 calories for a 150 pound person, or 145 calories at 200 pounds; about the amount of calories in a scoop of ice cream or a cookie.

And in the end, remember to focus on more than food during the holidays. Focus on what matters most; spending quality time with friends and family, laughing, sharing stories and creating memories together. Cheers and happy holidays!

Resources: Harvard Health Publishing

Find healthy holiday recipes at diabetesforecast.org

*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.

GNP Care

A history of GNP care

HealthNews · Nov 26, 2018 ·

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.

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