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Post-Holiday Depression

Presents have been unwrapped; cookies cooked and consumed, memories of joy on faces remain in your phone. But now that the festivities are over and it’s time to start taking down the lights, are you feeling down? It’s no surprise that the decrease in celebration and excitement can certainly affect moods, causing disappointment or even sadness. “It’s not an uncommon phenomenon, so if you are feeling that way, you are not alone,” says Martha Nelson, CHAS Health Behavioral Health Provider.

 

Causes:

  • Busyness – It’s a crazy hectic time of year. You just finished having so many people to get the perfect present for, the perfect meals, and attended too many functions. It’s such a wonderful time, but also, exhausting. Coming down from the busyness and hype is tough.
  • Family – Family is the best! Family is the worst! All kinds of feelings come up during the holiday season and it can certainly take an emotional toll. Do you have family members that are stressful to be around? “Hope for the best, prepare for the worst,” most definitely applies here. Even the most incredible families can cause some levels of exhaustion.
  • Memories – Holidays bring past memories, and often a sense of nostalgia for good times that have passed and loved ones that may be gone.
  • Fatigue – Fatigue is a common contributing factor for holiday depression. It can be a packed time of year, with normal routines and exercise out the window. Additionally, it’s cold outside (and so warm under the blankets). No wonder you can feel fatigued. It’s the time of year I personally put off a lot of things in exchange for sleeping in or going to sleep early.
  • Sugar and food – So many good treats! So many good foods! During this time of year, there is so much to eat, drink, and be merry with. It’s easy to go overboard, throw your routine out the window, and over eat (or under eat if you swap eating something good in order to splurge on a dessert). The amounts of blood sugar spikes can lead you feeling crabby, hungry and a little bit sad.

 

Ideas to help cope with post-holiday depression:

  • Take what you enjoyed during the holidays and continue it throughout the year. If you enjoyed spending time with friends and family, invite them over soon for a meal, play some games, or watch a movie.
  • Have fun! Go to a movie, see a play, go to the Museum of Arts and Culture, ski or do some tubing at Mt. Spokane.
  • Start or continue your exercise routine. Sometimes exercise goes out the window during the holidays (sometimes it goes out the window well before the holidays too). But, now is a perfect time to re-start or get in to a new routine. Include a buddy so you have company and someone you look forward to hanging out with and to hold each other accountable.
  • If you’ve gained weight, don’t worry about it. There were a lot of good treats around. No regrets. It doesn’t mean you are weak, worthless, or irresponsible, it means there were some awesome cookies around…gotta live a little. Right? However, it’s never too late to get back on track with a healthy eating plan.
  • Plan something each week to look forward to.
  • Take care of yourself, including eating well (don’t confuse this with not eating), exercising and getting enough sleep. Have a good attitude as well; it’s easily to slip in to negative notions.
  • If the post-holiday blues hang on for too long, consider reaching out to a behavioral health specialist. Seasonal affective disorder is a legit issue that many people deal with. As we roll in to 2017, remember to make the resolution to highlight health and happiness.

By Matt Grebe and Martha Nelson

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Contraception Options

Women use contraception for many reasons, but the primary reason is to prevent pregnancy.  There are many options for contraception and some options are more effective than others.  Choosing the right method for YOU can be confusing at first, but a conversation with your midwife or provider can help.

 

Natural Family Planning/Fertility Awareness:

1 in 4 women will be pregnant within a year using this method.  The sad, tired, worn out joke goes:  What do you call couples that practice Natural Family Planning?  Answer: Parents.

 

Natural Family Planning involves a commitment to learning about your cycle, reading your body signals daily, and a commitment by both partners to practice abstinence during your fertile periods.  This method can be highly successful for motivated partners.

 

Barrier Methods: 1 in 4 women will be pregnant within a year using this method, but you can purchase these over the counter without a prescription from a provider.

 

Diaphragm:  The only diaphragm on the market currently is the Caya.  It is a one-size fits all diaphragm that can be purchased over the counter at pharmacies.  Coupled with a spermicide, it can be effective if used properly.  This is a great option if you do not wish to become pregnant, do not want an implant inside your body, and are willing to use the Caya every time you have sex.

 

Condoms:  This method has the benefit of protecting against sexually transmitted infections.  Your partner must be willing to use the condom every time you have sex.  The downside is that they can break, leak, slip, or just not be used.

 

Hormonal contraception options: About 1 in 15 women will become pregnant within a year using these methods.  All of these methods require a prescription by a provider, but there is legislation in some states to make some of these methods available in the pharmacy without a provider visit.

 

Pills:  The tradition birth control pills contain two hormones, estrogen and progesterone.  The Mini Pill contains only progesterone.  They do have a slight increased risk of blood clots, so your provider will investigate your medical history and ask questions related to migraines, heart disease, blood clotting disorders, seizures, and other medical complications.  The pills are very effective if taken every day, but missing even one pill can cause you to ovulate and place you at risk of pregnancy.

 

Patch: If you choose the patch, you place a new patch on your skin every week for three weeks.  The fourth week you do not wear a patch and you get your period.  The hormones in the patch are both estrogen and progesterone.  If you are overweight, the hormones might not work as effectively for you due to absorption issues through the skin.

 

Ring:  The NuvaRing is a soft plastic ring that you can place in the vagina for three weeks.  The hormones estrogen and progesterone slowly absorb into your body.  The fourth week, you remove it and have your period.  Some women love the convenience and some women report being able to feel the ring in the vagina.

 

Depo Shot:  The hormonal method of birth control that has the greatest documented side effects is the Depo shot.  It is an injection of high dose progesterone that you get every 3 months.  For the first 3-6 months you can have very irregular spotting and bleeding, but usually after the 2nd or 3rd dose, your periods go away.  It can take 18-24 months for your fertility to return after you stop the Depo shots.  Major side effects include depression and weight gain.

 

Long Acting Reversible Contraception (LARC): <1 in 100 will get pregnant using these methods.  They are as effective as tying your tubes but completely reversible.

Nexplanon:  The Nexplanon is a small plastic rod that is inserted into your arm.  It stays there for 3 years, slowly releasing progesterone every day to keep you from ovulating.  The side effects can include unpredictable spotting, headaches, increase appetite, and depression.  After about one year, many women report that their periods have stopped, but they will return when the Nexplanon is removed.

 

IUD:  There are two forms of IntraUterine Devices: the Mirena and the Paragard.  Both are inserted into the uterus and act primarily against sperm to prevent pregnancy.  The Mirena lasts for 5 years, releases a small amount of progesterone to thin the lining of the uterus, and many women report lighter or no periods while using the Mirena.  The Paragard lasts for 10 years, contains no hormone, but your periods might be heavier with heavier cramping.  Both of these must be placed by a trained provider.

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Holiday Blues

Many people can experience feelings of anxiety or depression during the holiday season. People who already live with a mental health condition should take extra care to tend to their overall health and wellness during this time.  Extra stress, unrealistic expectations or even sentimental memories that accompany the season can be a catalyst for the holiday blues. Some can be at risk for feelings of loneliness, sadness, fatigue, tension and a sense of loss.  A lot of seasonal factors can trigger the holiday blues such as, less sunlight, changes in your diet or routine, alcohol at parties, over-commercialization or the inability to be with friends or family. These are all factors that can seriously affect your mood.

Via nami.org

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Press Release: More Services for Moscow!

 

Spokane, WA. December 5, 2016 – Palouse residents will soon have increased access to dental services thanks to the upcoming expansion of Latah Community Health, a CHAS Health clinic in Moscow, Idaho. This service builds on the already comprehensive services of the clinic including medical, behavioral health, and pharmacy; and expands dental from 1 operatory to multiple chairs.

CHAS Health will reopen the health center in the new Gritman Medical Center on December 12th. The move will increase the health center facility from 2,500 square feet to 9,800 square feet. All existing services will continue to be provided at the new site, and the additional clinic space will allow for more primary medical and behavioral health care. The new space also allows CHAS Health to expand the dental services that began in October 2016 from a single chair operatory to 6 chairs, one dedicated to hygiene. All services will continue to be available to everyone, regardless of insurance status.

 

“We are excited to have the opportunity to grow in this community,” states Aaron Wilson, CHAS Chief Executive Officer, “Expanding dental services to Moscow-area residents is one step further in ensuring quality healthcare for everyone.”

 

Latah Community Health originally opened in 2013 due to a combination of efforts by the City of Moscow, the League of Women Voters, Gritman Medical Center, and CHAS Health. This was a response to the growing number of requests for social services in the Palouse. The clinic currently serves over 1600 patients in the Moscow area.


About CHAS Health

The mission of CHAS Health is “to improve the overall health of the communities we serve by expanding access to quality health and wellness services”. Check out their website (www.chas.org) to learn more about their available services and facilities. 

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Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

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5 Things to know about open enrollment this year

  1. Open enrollment for the individual marketplace begins on November 1st, 2016 and ends on Jan 31st, 2017. During this time, consumers can select a new plan, renew their existing coverage, or change plans. It’s also a good time to review their application and report any changes in income or household size. The individual marketplaces for Washington and Idaho are the Washington Healthplanfinder (wahealthplanfinder.org) and Your Health Idaho (www.yourhealthidaho.org). Both sites are where individuals can purchase health plans and see if they qualify for free or low-cost health insurance. 
  2. At CHAS Health, all of our Patient Services Coordinators are available to help patients and community members to apply and enroll in Medicaid or Qualified Health Plans. Every CHAS Health PSC is a certified navigator in the Washington Healthplanfinder; the PSCs at Spokane Valley CHAS Health, Spokane Urgent Care – Valley, Lewis and Clark Health Center, and Latah Community Health are also certified Enrollment Counselors for Your Health Idaho. This means that they provide free, unbiased assistance to help consumers understand their options for health coverage to get covered and stay covered. To see a PSC, call 509.444.8200 to schedule an appointment or walk in to any CHAS Health location. For a list of information to bring with you to your appointment, click here. You don’t have to be a patient at CHAS to see one of our Patient Services Coordinators. We welcome everyone!raw
  3. New for 2017! WA Healthplanfinder is offering adult dental plans. One of the biggest disappointments for many Washington consumers over the last few years was the fact that the Qualified Health Plans offered on the WA Healthplanfinder did not provide dental coverage for adults. This year, adults will have the option to purchase an adult or family dental plan from Delta Dental, Dentegra, or Dental Health Services. An adult must purchase a health plan to also purchase a dental plan. Premium tax credits can only be applied to the health plan. Adult dental premiums range from approximately $19-$39 per month.
  4. Washington Healthplanfinder saw lower increases related to average premium and deductible increases from 2016 to 2017 than the national marketplace. Pat MacEwan, CEO of the Washington Health Benefit Exchange, said in a recent news release, “in contrast to much of the country, the Washington individual insurance market is competitive and healthy. Customers in Washington will find a choice of plans and carriers on the Exchange.” The amount of carriers offering health plans in the exchange has helped to create competition and keep prices low. While the national average for the second lowest cost silver plan increased 25%, Washington experienced an average increase of only 8%. Consumers in Washington will continue to have many affordable choices when it comes to choosing the health insurance that fits their individual needs. Read the full news release from Washington Health Benefit Exchange here.
  5. Enrollment in Medicaid programs is open all year, but ‘tis the season for WA Apple Health renewals! There are no open enrollment periods for Medicaid in Washington or Idaho so residents of either state can apply for Medicaid medical coverage at any time during the year. However, in Washington, many Apple Health (Medicaid) members will need to renew their coverage over the next few months. Apple Health renewals can be completed 1) online at wahealthplanfinder.org, 2) by calling WA Healthplanfinder Customer Support Center at 1-855-923-4633, 3) by paper, or 4) by seeing a certified navigator in the community. At CHAS, our Patient Service Coordinators are ready to help you with your Apple Health renewals. To see a PSC at CHAS, call 509-444-8200 to schedule an appointment or walk in to any CHAS Health location.

 

Happy Open Enrollment!

 

Julie Becker

Patient Services Administrator

 

Get covered. Stay Covered. Come see a CHAS Patient Services Coordinator today.

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Too sick for school?

Fall is officially here and the school year is in full swing! Unfortunately, this also means we are nearing the peak of cold and flu season. Over the next few months, many parents of ill children will be faced with the decision whether or not to send their child to school. The most important thing for parents to consider when making this decision is if the child will be able to learn and participate in school activities. We also don’t want to unnecessarily expose other children to illness causing germs. However, we all want to minimize missed school and work days for both students and their parents. Below are a few guidelines that can help parents make this often tricky call.

 

 

 

 

 

 

 

 

 

 

Fever

A fever is body’s way of fighting off infection and is the most common reason parents keep their children home from school. The definition of a fever is a temperature of 100.4 or higher, though some schools and daycare centers will have their own rules. The general rule of thumb is to keep your child home until they have been fever free for 24 hours.

 

Upper respiratory Infections

Most children will have several different cold viruses each winter. A child with typical cold symptoms including a runny nose, sore throat, and cough can usually participate in school without any restrictions. Coughs may linger for several weeks after the other symptoms have resolved. It is important to go over the importance of coughing or sneezing into an elbow or a tissue and proper hand washing techniques with your sick child to limit the spread of these germs.

It may be necessary to keep a child home if they have more severe symptoms, such as extreme fatigue, loss of appetite, or anything else that will keep them from learning and participating at school. If a child has influenza (the “flu”), they should be kept home from school until their symptoms have resolved. The flu is similar to a cold but is accompanied by high fevers and body aches. We recommend an annual influenza vaccine to help lower the risk of this illness.

If your child has an ear, sinus, or strep throat infection it is recommended that they stay home from school until at least 24 hours after antibiotic treatment has been started. Conjunctivitis (also known as “pink eye”) can be caused by allergies or a virus, but when it’s caused by bacteria it is very contagious and needs antibiotic treatment before the child returns to school.

 

Vomiting and Diarrhea

Children with vomiting and diarrhea should also be kept home until their symptoms have resolved. If there are no other symptoms, older children with mild diarrhea that are able to use the toilet and wash their hands on their own may go to school if they don’t have any other symptoms.

 

Skin

Most childhood rashes are caused by viruses and most are not cause for concern. Certain rashes, such as chicken pox are more severe and highly contagious. If a rash is accompanied by a fever, the child should not attend school. If you are unsure what is causing a child’s rash, it’s a good idea for them be seen by their healthcare provider to find out what the rash is and any precautions that should be taken.

 

Lice is another common reason for children to miss school. In the past, many schools had a “no nits” policy. Experts now agree that these absences are unnecessary and children can return to school as soon as they have had one lice treatment.
Illnesses are a normal part childhood. We can’t keep our children home for every sniffle and sneeze, but we do want to minimize the spread of germs and make sure that our children go to school ready to learn. If you have any questions about whether or not to send your child to school, talk to your child’s healthcare provider.

Autumn Barbero, Pediatric Nurse Practitioner

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5 Rules for Screen Time.

 

 

 

 

 

 

 

 

 

 

Everyone loves screen time.  Whether it is watching a movie, playing a video game, reading the news, or talking with friends, technology is at the center of all of our lives.  Media and screen time, like most things, should be used in moderation.  While technology use is important in most facets of life today, too much screen time has been linked to obesity, difficulty sleeping, problems in school, aggressive behavior, and bullying.  It is important to help your child find a healthy balance.  A few simple guidelines can help keep screen time in check for you and your family:

  1. Remove all screens from the bedroom. Kids with TVs in the bedroom have been found to watch 1 ½ hours more TV than kids without TVs in the bedroom.  TVs in the bedroom have also been linked to obesity.  Availability of internet and texting in your child’s bedroom gives them unmonitored access to anything on the internet.  Keep all screens (including your own) out of the bedroom.  Try setting up a charging station for all devices in a common area.
  2. Monitor what your children are doing during their screen time! Just like you would ask who they are spending time with on the weekend, ask who they are spending time with on social media.  It is important to teach children what is and is not appropriate to share on social media.  Also, be aware of the websites they are going to and the apps they are using.  Play apps and video games with them!  Then you know what they are doing and if it is appropriate.
  3. Make sure screen time is age appropriate and educational. Not sure if a movie or video game is good for your child? Check out commonsensemedia.org.  This website is run by a nonprofit organization that provides independent ratings for movies, TV shows, video games, and apps.  It provides you with a summary of the game or video and suggested ages for appropriate use.
  4. Limit screen time for everyone in the family. All children should spend no more than 2 hours in front of a screen for non-school purposes.  Think of things you can do as a family that does not involve a screen: go for a walk, play a board game, go to the park, or read a book together.  Any activity that provides family interaction is preferred to screen time!
  5. No screens after dinner. We know that looking at a screen keeps your body from releasing melatonin.  Without melatonin you don’t feel sleepy when bedtime comes.  Sleep is important to help with mood, concentration, and learning.  If sleep is a problem for your child, try a screen fast (by eliminating electronic device use for a few weeks) to see if this helps restore a good sleep pattern.

 

Screen use is here to stay.  Help your child form good, healthy screen habits!

-Ashlee Mickelson, MD Pediatrician

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Birth Plans!

Should I write a Birth Plan?

Many women want to write out a birth plan to clarify the care they hope to receive while they are in labor.  A birth plan can be a short wish list or a long explanation of your circumstance, such as if you are adopting the child out or if there are known anomalies incompatible with life.

Is a Birth Plan required?  No.  The nurses, midwives, and physicians are highly trained professionals who will take care of you to the best of their abilities.  We have not performed routine shaves, enemas, or episiotomies for over 25 years, so you do not need to request that we refrain from these procedures.  We have many tools in our bag of tricks to help your labor progress well and hopefully avoid complications.

In addition, every woman and every labor is different.  It is a good idea for you to relax, let go, and accept the labor that comes to you.  There really is no other choice but to deal with the reality of the moment.  Your care providers will help you.  Honest.  That’s what we have chosen to do for our career.  We want the best outcome for you and your family.

I do recommend that my mammas write up a short, one-page wish list that gives the labor team a frame of reference of what experience you are hoping for in labor and delivery.  It is a good idea to designate one person to speak for you if you are unable to speak for yourself due to an intense labor.  It tells us if you have specific requests, such as dad cutting the umbilical cord or your desire to avoid an epidural or even GIVE ME THE EPIDURAL THE MOMENT I WALK IN THE DOOR!

Bring your birth plan to one of your prenatal visits to discuss with your midwife or physician.  Then when you have a final draft, bring a printed copy for the nurse caring for you in labor and delivery.  That way, your entire team is on board with the plan and works with you!  Remember to keep it short and flexible.

Some ideas of what women specify in a birth plan:

  • Who will be present for the birth?
  • Are you bringing a doula?
  • Will there be siblings present?
  • Do you want mobility or do you want to stay in bed?
  • What activities or positions do you plan to use (walking, birthing ball, standing, tub, squatting, etc)?
  • What is your plan for pain relief (massage, hot packs, position changes, hypnobirthing, Lamaze breathing, jacousi tub, medication)?
  • How do you feel about fetal monitoring?
  • Who will care for the baby?
  • What is your plan to feed your baby?
  • Do you want to wear your own clothing and listen to music?

 

You can always google “birth plans” on the internet for more ideas, remembering to keep your wish list to one page!

-Kirstin Johnson, Certified Nurse Midwife