KVH Family Medicine

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.



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.


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

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.”