Kittitas Valley

Beat the heat: Diabetic safety

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

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.

Talking about racism to children

Contributor: Dr. Elise Herman, KVH Pediatrics

Racism is front and center now, and parents may wonder how to have important conversations with their child about diversity, equality, and discrimination. It helps to keep your discussion age-appropriate, share your feelings and listen to your child.

Under age 5 years – Studies have revealed that even infants notice different skin tones and preschool kids have been shown to view those who look like themselves more positively, so addressing racism early is important. Kids relate easily to the concept of fairness so it can simply be explained as treating someone unfairly based on how they look. Young kids may ask about why people’s skin colors are different. Explain simply that darker skin has more of the pigment melanin in it and that no skin color is ‘better’ than another. Celebrate human diversity by noting that “we are all human but can have lots of differences, too, making everyone special!”. Encourage your young child’s appreciation for diversity by reading books and playing with toys featuring people of different races.

6-11 years old – At this age, children are more aware of current events based on what they have heard and seen from adults, other kids and on the news or in social media. Ask your child about what they know and what questions they have. Kids this age understand empathy so discussing how it would feel to be judged unfairly can be helpful. Children of all ethnicities can be assured that people world-wide are upset about racism and are working to make things better.

12 and older – Kids this age are often very informed and have developed their own opinions about issues such as racism and protests. Discussing the news and current events and how it affects them opens the door to a deeper conversation. The same concepts of fairness and empathy apply, but now taking action may be a logical next step. It may be sharing something on social media, reading more about the history of oppressed peoples or attending an event.

All kids benefit from social experiences with a variety of people. Cooking food and listening to music of different cultures broadens our horizons. It is alright to let your child know that you are upset or sad about what is happening, but you also need to assure your child that they are safe in what can be a frightening time. This conversation will look different for families of color where the issue hits a lot closer to home than for whites.

As always, what we do and say speaks volumes to our children. It is vital that as parents we confront our own prejudices and biases and work to be more open and understanding. Let your kids see you speaking out against racism, embracing diversity and calling for justice for all people.

Safe behavior as restrictions ease

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.

Coronavirus: a local story

Click here to be directed to our COVID information site.

Dr. Jie Casey took one look at his 67-year-old patient and asked her if she was feeling okay. “She’s been sick for a couple of weeks,” her husband interjected. So Dr. Casey sat on the exam table and began to ask the couple questions, learning that in addition to her symptoms the couple had had direct contact with someone who had already tested positive. Casey had them mask up. “It quickly became clear that my patient was high risk for COVID,” he says.

Using a Public Health questionnaire, Casey reviewed the patient’s information with County Health Officer and KVH colleague Dr. Mark Larson. “He said that absolutely, she needs to be tested,” says Casey, who contacted KVH Hospital to order a BioFire (respiratory lab panel), and chest x-ray.

“I want you to go directly to the hospital with your masks on,” directed Casey. “They’re going to take an x-ray and a swab or two. And then you’re going to go straight home until you hear from me or Dr. Larson.” The couple agreed. Casey then demonstrated proper hand washing techniques, including use of a paper towel when turning the sink on and off. He then asked them to do the same, washing their hands appropriately before leaving the room and closing the door with their elbow.

As soon as they left, the exam room was locked down until it could be cleaned. And Casey moved on to the next patient.

“Essential medical personnel are expected to work unless they’re symptomatic,” Casey explains, emphasizing that, even if he had contracted the virus during the visit, he would not have been contagious when continuing to see patients. Saturday morning, Larson called with news that the patient test was ‘positive.’ Casey was asked to self-quarantine until more details were available. Also under quarantine, the couple are monitored daily by the Public Health Department, who has communicated with all of their direct contacts.

“I already had the week off for a CME (continuing medical education) event,” says Casey, who was tested, nixing his travel plans and now self-quarantined at home. Casey regularly reports in with KVH Quality Director Mandee Olsen, and checks his own temperature. Olsen keeps track of his vitals as part of the process.

When Casey received his test results, they were ‘negative.’ Following current public health policy, he’ll return to patient care after 14 days as a precaution.

While the coronavirus is nothing to be flippant about, healthcare workers are trained to handle these kinds of cases as part of their medical routine. “Dr. Casey did everything perfectly,” confirms Larson, who continues to keep his colleague updated by phone. “I told him he couldn’t have done a single thing better than he did.”

KVH Board Represents the Community

Four years ago, I was elected to serve on the Board of Commissioners for Hospital District 1. As KVH’s governing body, the Board sets the organization’s strategic direction, ensures that it offers high-quality services, and maintains its financial viability. As President of the Board, part of my job is to make people aware of what we have been doing.

In 2016, the Board hired a CEO that shares our vision for KVH. Instead of cutting services to protect the bottom line, we have developed new services to meet the demand in the community and keep care local. As a result of priorities set by the Board, KVH now has an outpatient pharmacy, Workplace Health, expanded physical therapy, integrated behavioral health, dermatology, wound care, an “ouchless” ER, and digital mammography. For the first time in many years, KVH clinics are accepting new patients, and for the first time ever, we are offering pediatric services.

KVH has expanded its footprint to include the Radio Hill Annex and the Medical Arts Center (MAC). For several years, KVH planned to build a new medical office building. After the election in 2016, the new Board changed direction. Our decision to purchase the MAC gives us more space at a cheaper cost, and without disrupting the existing neighborhood south of the hospital. Renovations are incorporating design ideas that were developed during brainstorming sessions for the original building. The MAC will open in early 2020, and it will be a state-of-the-art facility in which we can deliver excellent patient care and form partnerships to offer even more services to Kittitas County. It will also help us to recruit providers so that we can better meet the needs of the community in the future.

When I was elected to the Board, one of my priorities was to open lines of communication with the community. We regularly have Coffee with a Commissioner, where people can tell Board members what’s on their minds. Community members now serve on the Quality Improvement Council, the Finance Committee, and, of course, the KVH Foundation Board. We have also recently created a Patient & Family Advisory Council, where several county residents will have input on hospital operations.

There are other notable achievements behind the scenes, including the implementation of a new electronic health records system, several successful state audits, and award-winning quality improvement. All these efforts are guided by the strategic plan, which we developed in 2017 and which defines our work in terms of four key strategies: access, community engagement, partnership & collaboration, and financial sustainability. We will be revisiting the strategic plan in 2020.

Earlier this year, I attended the American Hospital Association annual meeting, and people there were concerned about the challenges facing healthcare providers, especially in rural areas. Many independent hospitals throughout the country are either closing or being absorbed into larger systems. Despite these national trends, KVH has maintained its independence and its financial stability. Even though District 1 has the lowest levy rate of any public hospital district in the state, we are the envy of many other Washington hospitals, some of which are struggling.

Ultimately, KVH’s success is due to the dedication of its many employees: the doctors, nurses, pharmacists, technicians, dieticians, housekeepers, receptionists, and administrators who do amazing work every day. From the patient perspective, the Board is probably invisible, and it should be. Rest assured that the other Board members and I are doing our best to represent the community, to make sure that KVH is a great place to work for its employees and your first choice for high-quality healthcare.

Matt Altman is President of the KVH Board of Commissioners and a professor at Central Washington University.

More than medical care: Sexual Assault Nurse Examiners

Stop sexual harassment and violence against women, rape and sexual abuse concept, STOP gesture with hand, Stop drugs, human rights violations, human trafficking, Copy space.

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.

Online SANE training

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