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Adolescent Suicide on the Rise in Spokane

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A recent article in the Spokesman Review states, “Five teen suicides this school year – including three in the past month – have jolted the community. It’s the highest number in the history of Spokane Public Schools, prompting parents, students and community members to ask what they can do to help.”

As a Pediatrician here at CHAS I have noticed since mid –March an increased number of teenagers coming into my office for significant suicidal concerns with several reporting that they don’t feel safe going home from the clinic. This is very alarming and hard to manage if our Mental Health Staff has a full schedule. Periodically, the only option we may have available is to ask the family to go to the Sacred Heart Children’s Hospital Emergency Room for safety and to get prompt access to a mental health professional or other services.

Another article from the Inlander just three years ago, covers this local topic as well. They report, “experts say the region needs to start talking about the problem. Spokane has a rate of suicide higher than the state average. It’s the city’s second-leading cause of death for people ages 10-24.” Suicide isn’t just an issue for Spokane, but the entire Inland Northwest. Coeur d’Alene has the highest suicide rate in Idaho, and Idaho consistently has one of the highest rates in the nation, according to a report by Suicide Prevention Action Network of Idaho.

Both articles go on to discuss the need to work on being open and frank with all adolescents. As a medical care team we need to remember to do annual mental health screenings for all teenagers and the PHQ (Patient Health Questionnaire) is a validated test and a reasonable way to open the conversation with any teenagers in your office. The biggest obstacle is getting over the awkwardness of discussing this topic which is hard for many individuals to do. Teenagers tend to be more open and honest when they feel you are open with them and showing them that you actually care about their personal story.

Scientifically we know the adolescent brain works differently than the adult brain as teenagers seem to be pre-programmed to take greater risks and have less inhibition of impulse behaviors. This makes them appear to live more in their current emotions and less in their analytical/reasoning brain where adults tend to spend more of their time. This can lead to behavior that seems uncharacteristic and reckless to others but does not seem strange or out of the ordinary to teens in my office when they bring up the topic.

To try and keep this commentary to a minimum, I have provided links to both of the recent articles which I feel are informative for our community. They do go on to provide resources which I have attached below.

What Causes Suicide?

According to the National Alliance on Mental Illness (NAMI), “90 percent of youth suicide victims have at least one major psychiatric disorder, although younger adolescent suicide victims have lower rates of psychopathology.” Overall, NAMI asserts that 90 percent of people who complete suicide could have been treated for a mental or substance-abuse disorder.

Suicide Prevention Meetings

Prevent Suicide Spokane is hosting a meeting about what can be done in the community to help. The event is 1 to 3 p.m. Friday at Spokane Regional Health District, 1101 W College Ave. For more information contact Sabrina Votava at (509)475-7334 or sabrina@yspp.org.

Prevention Resources

First Call for Help Crisis Hotline: 509-838-4428

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

suicidepreventionlifeline.org

LGBTQ Crisis Hotline: 1-866-4-U-TREVOR

American Foundation for Suicide Prevention: afsp.org

QPR Institute: qprinstitute.com

Youth Suicide Prevention Program: yspp.org

Some Warning Signs

  • Talking or writing about death, dying or suicide when these actions are out of the ordinary for the person
  • Acting reckless or engaging in risky activities — seemingly without thinking
  • Increasing alcohol or drug use
  • Withdrawing from friends, family and society
  • Feeling anxious or agitated, being unable to sleep, or sleeping all the time
  • Experiencing dramatic mood changes
  • Changes in eating and sleeping habits
  • Unusual neglect of personal appearance
  • Marked personality changes
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • SOURCES: National Suicide Prevention Lifeline (suicidepreventionlifeline.org); National Alliance on Mental Illness (nami.org)

By Dan Moorman, Physician

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Love Them. Protect Them. Immunize Them.

Community Health Association of Spokane Valley Clinic With it being National Infant Immunization Week (NIIW), it is a great time to make sure we are promoting, encouraging, educating and reminding parents to have their children immunized. If infants are not immunized the consequences can be severe and in some cases the preventable diseases can even be fatal. It’s easy for us to believe that these preventable diseases are a thing of the past but, as we have seen with the recent cases of measles and pertussis in our community, these diseases still exist.

CHAS offers immunizations through the Vaccines for Children’s program. The program is federally funded and provides vaccinations for children through the age of 18 at no cost.

Infant immunization protects from vaccine-preventable diseases throughout their life and offers protection against the 14 diseases below:

Hepatitis A – A virus that causes liver infection.

Hepatitis B – A virus that causes liver infection. In some cases, Hepatitis B remains in the liver for life and can lead to further complications including liver cancer.

Diphtheria– A potentially fatal condition in which the airways can become blocked, restricting breathing. Also associated with heart problems and paralysis of throat muscles needed for swallowing.

Hib Disease (Haemophilus Influenzae Type b) – A serious disease which can cause meningitis and pneumonia.

Pertussis (whooping cough) – A potentially fatal bacteria that is very contagious with symptoms including persistent violent coughing and choking which can last for weeks. It is particularly worrisome in infants and young children.

Pneumococcal Disease – A potentially fatal bacterial infection which can cause pneumonia.

Polio – A viral infection with possible symptoms of fever, pain, sore throat, head ache and in some cases paralysis and death.

Influenza (flu) – A bacteria that can cause respiratory complications and can result in hospitalization or death. Infants, young children, pregnant women, and the elderly are at higher risk of complications related to influenza.

Measles -A potentially fatal disease caused by a virus whose symptoms include cough, fever and rash. In severe cases, measles can cause brain damage, pneumonia, and seizures.

Mumps – A virus that causes headaches, fever, pain and swelling in the salivary glands.

Rotavirus – A virus that causes severe diarrhea and vomiting which usually lasts days. Complications can include severe dehydration and possible hospitalization.

Rubella (German Measles) – A virus with of fever, rash and swollen glands. A pregnant woman with rubella is at greater risk of miscarriage and her baby may have physical defects including loss of sight or hearing and heart problems.

Tetanus (Lockjaw) – A condition caused by bacteria, which affects the muscles, causing them to spasm. A person may experience headaches, increased blood pressure, elevated body temperature and muscle pain. The jaw muscles may spasm causing the jaw to ‘lock’.

Varicella (Chickenpox) – A highly contagious virus whose symptoms cause blister-like rash, sever itching, fever. Can cause severe complications that can lead to hospitalization.

So let’s do our part in making sure that parents and caregivers are educated on the importance of vaccinating and protecting their children against vaccine-preventable diseases.

References:

www.cdc.gov

www.immunize.org

 

-By Shereen Martin, Medical Support Supervisor

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Meet your provider: Deena Solomon

CHAS Dr. Solomon

I recently sat down with Perry St. Clinic’s pediatrician, Deena Solomon to get to know a little bit more about what makes her so great to work with.

Tell us about yourself…

My name is Deena Solomon, Pediatrician at the new Perry St. clinic! I am originally from New York, I grew up in Staten Island, went to medical school in Tel Aviv University in Israel, and did my residency in the pediatric department at King’s County hospital and University Medical center of Brooklyn, New York. After that, I worked as a pediatrician for 3 years in an outpatient clinic Staten Island Hospital. We moved to Spokane 6 years ago and have been a stay at home mom up until I started working at CHAS, about 6 months ago.

What initially drew you to Pediatrics vs any other branch of medicine?

CHILDREN! I love kids, I think that kids are extremely honest, which makes them so fun to work with. They always tell the truth the way they see it, and I always appreciate that about them.

Do you have children yourself?

I have 3 kids, a 7 year old son, and 2 daughters, 5 and 4 years old.

Do you have any special connection to the Perry District?

I live on the South Hill and I frequently visit the Perry District. I am excited to be in a place close to where my kids are attending school, I’m familiar with District 81 schools, sports available at those schools, parks to play at nearby, and things to do in nearby. I’m excited to relate to families in Perry and to be more conversational about what’s going on in their neighborhood. I’m especially excited to start building more relationships with families in the area.

When you aren’t taking care of kids, what are you doing?

(Laughs) When I’m not taking care of kids at CHAS, I’m taking care of my own kids at home! So, lots of outside play time. Right now, it’s all about basketball. My two oldest are involved playing at the YMCA, so most weekends are spent practicing and playing in games. But, now that the weather is getting good, it’s also going to be more about riding bikes and being out at the playgrounds. It’s basically all kids all the time.

What do you listen to get you excited for the day?

I listen to comedy talk shows, but I also enjoy quiet drives to work, since I’m always around kids at work and at home. The 10-15 minute car ride on the way here is the best way to get me prepped for the day.

What do patients/co-workers like about you?

I am pretty easy to speak to, and I think I am a good listener and people appreciate that about me. Especially parents with concerns about their children.

What’s the best advice you’ve ever received?

That’s a really easy one, one of my mentors during my rotations was a big inspiration to me, he always made a point of reminding me, “less is more when it comes to pediatrics.” When there is a question of whether you should do an invasive test, intervention, blood test or x-ray, it’s usually best to avoid it. Typically best for kids not to go through the trauma of excessive testing. He always said a children’s place is at home, if there is any way you can get a kid at home vs. in the emergency room or in the hospital for an extended time, that’s where they should be.

Doc McStuffins or Jake and the Neverland Pirates?

I love Doc McStuffins! The show promotes all the values I would want to promote in my own kids. They show that both male and female roles aren’t predetermined and you can do anything you put your mind to! I also appreciate the diversity of the show…plus she’s a doctor!

What makes you unique?

I think my life experience, growing up in New York, my parents emigrating from Eastern Europe, living in Israel, traveling a ton in my life, and marrying someone with a very different background than my own (because my husband is Middle Eastern). My take on everything is a little unique because of all the different experiences and backgrounds influencing my life and it gives me a unique perspective.

What do you enjoy most about working at CHAS?

I really like that everyone is really working towards the mission of CHAS, (The mission of CHAS is to improve the overall health of the communities we serve by expanding access to quality health and wellness services), and it’s really been a pleasure for me to see that everybody I have met has a really positive outlook on what they are doing and working towards that mission. I love the fact that CHAS has been around for 20 years and we are making a big difference in our community and we are continuing to expand to all areas of our community. I’m really happy to be part of that.

Deena can’t wait for the Perry St. opening on March 23rd!

 

By Matt Grebe

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Multiple Sclerosis Awareness Month

Did you know March is National MS Education and Awareness Month? Multiple sclerosis affects more than 2.5 million people worldwide and is an unpredictable disease.  I recently sat down with CHAS’ chief Medical Director, Bill Lockwood to learn more about MS and how it affects the body.

What is MS?

A disease which affects mostly young adults – beginning at ages 20-40 and involves the brain and spinal cord. The underlying cause is a patient’s own immune system destroying the “myelin sheath” or insulation which surrounds nerves in the brain and spinal cord. This affects nerves ability to conduct electric signals as usual.

Who can get it?

It is usually diagnosed in people 18-40 years old and affects women approximately 3 times as much as men. There seems to be some genetic predisposition as it more often affects people of Northern European descent and is more common in family members of MS patients.  There seems to be environmental factors as well since it affects people who live in temperate climates more often than those in very cold or very warm climates.

There is no government mandated reporting requirements so estimates of total incidence may be inaccurate but in 2002 it was estimated that 400,000 people in the US had MS.

Symptoms

The damage to the myelin sheath can affect any nerve in the brain or spinal cord so the symptoms are highly variable and tend to come and go (one of the requirements for diagnosing the disease are symptoms separated by space and time. In other words, two or more discreet episodes affecting different parts of the nervous system at different times, for example, double vision which resolves, followed by arm numbness, which ultimately resolves.

Some of the symptoms include fatigue – the most common symptoms, tingling, visual changes (including double vision) balance problems, nerve pain, swallowing difficulties, trouble walking (due to imbalance or ) leg weakness), constipation, bladder problems (incontinence, or inability to empty), and cognitive (thinking) difficulties.

The symptoms tend to come and go early in the course of the disease but as time goes on, most patients will develop progressive disease, the course is different in every individual who has it.

Diagnosis

The disease is diagnosed by history and physical exam followed by an MRI and blood tests. Sometimes a lumbar puncture (spinal tap) is required. Diagnosis is usually made by a physician who specializes in diseases of the nervous system (“neurologist”). Diagnosing the disease in its early stages allows early administration of “disease modifying drugs) which can slow the course of the disease.

Treatment

Overall care of MS is provided by a care team of physicians, nurses, mental health workers, and physical and occupational therapists. Besides social and physical supports,  there are a number of medications used to treat MS.

There are two main types of medications – disease modifying drugs, and drugs to treat symptoms.

The disease modifying drugs affect the immune system and slow the progression and reduce the number and severity of exacerbations (temporary worsenings) of the disease. There are currently 15 FDA approved disease modifying drugs and at least that many in clinical trials. A total of $870 million has been spent so far in MS research.

There are a number of drugs used to  treat the symptoms of MS (as described above) such as muscle relaxers, bladder relaxers, nerve pain medications, and steroids (used to treat sudden temporary worseinings of the disease).

by Matt Grebe and William Lockwood

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Eating Disorder Awareness

In the United States, 20 million women and 10 million men suffer from an eating disorder at some point in their life. Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health.

February 22-28, 2015 is National Eating Disorders Awareness Week. The goal of National Eating Disorders Awareness Week is to highlight the seriousness of eating disorders and to improve general public understanding of the causes, triggers, and treatments available for eating disorders. Increasing awareness and access to valuable resources can encourage early detection and interventions.

The theme for this years’ National Eating Disorders Awareness Week is “I Had No Idea”. This theme hopes to recognize that early intervention is crucial and spotlight the diversity of those affected by eating disorders (men and women alike of all ages). Early intervention is a key component because it often increases the chances of a full recovery for those who seek professional help.

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The most common eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorders, or other specified eating or feeding disorders. Identifying the early signs or symptoms of an eating disorder can greatly impact the course for recovery. Learn more about the warning signs of eating disorders below.

Anorexia Nervosa

Anorexia nervosa is characterized by self-starvation and extreme weight loss. This deprives the body of important nutrients that it needs for proper functioning. Health consequences from anorexia nervosa may include slow heart rate, low blood pressure, severe dehydration, and fatigue or fainting. Some of the warning signs of anorexia nervosa are:

  • Extreme or dramatic weight loss
  • Overly occupied with weight, calories, and food
  • Severe food restrictions (refuses to eat certain food groups or types of food)
  • Often comments about appearance related to weight  and exhibits anxiety related to weight
  • May develop food rituals (how many bites to eat or chewing each piece a specific number of times)
  • Avoids meal times and situations that involve food
  • Excessive exercise routines
  • Withdrawal from friends, family, and usual activities

Bulimia Nervosa

Bulimia nervosa is characterized by a cycle of binging and compensatory behaviors, such as self-induced vomiting or the use of laxatives. Electrolyte imbalances, tooth decay, esophageal inflammation, and possible gastric rupture are just a few of the health consequences of bulimia nervosa. Some of the warning signs can be:

  • Sudden disappearance of large amounts of food (or finding wrappers or containers from foods)
  • Frequent bathroom trips with or without the smell of vomiting or evidence of laxatives (packaging from laxatives)
  • Excessive exercise routines
  • Swelling of cheeks or jaw area
  • Calluses or scars on hands or knuckles (from self-induced vomiting)
  • Discolored teeth (or stained teeth)
  • Withdrawal from friends, family, and usual activities

Binge Eating Disorder

Binge eating disorder (BED) is characterized by recurrent binge eating without the use of compensatory behaviors. High blood pressure, high cholesterols, diabetes, or musculoskeletal issues are a few of the health consequences of BED. Warning signs of BED may be:

  • Frequent episodes of eating large amounts of food
  • Eating when not hungry
  • Eating to the point of feeling/acting uncomfortable

Other Specified Eating or Feeding Disorders

Other Specified Feeding or Eating Disorder (OSFED), is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder. These can include:

  • Atypical anorexia nervosa (weight is not below normal)
  • Bulimia nervosa with less frequent behaviors
  • Binge-eating disorder(with less frequent occurrences
  • Purging disorder (purging without binge eating)
  • Night eating syndrome

 

If you’re wondering how you can become involved in raising awareness, consider educating yourself about eating disorders. Spreading the truth about eating disorders can help squash the myths and misinformation that hinder early intervention and recovery. Visit the National Eating Disorders Association (nedawareness.org or nationaleatingdisorders.org) for more information.

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Talking with baby

Community Health Association of Spokane Valley Clinic

 

Did you know something as simple as talking to your baby can help them be more successful in school?  75% of your baby’s brain development occurs in the first 2 years of life.  You are your baby’s first teacher!  The more words they are exposed to during this time the better.  Simple things like telling your child what you are doing, “Mommy is making your bottle now,” and pointing out things you see, “Look at the big red ball,” help their language develop.  You may be tempted to turn the TV on and let your baby be exposed to language that way.  Unfortunately, studies have shown this actually makes their language development worse.  Instead, turn the tv off and talk directly to your baby throughout the day, making eye contact with them, and giving them a chance to respond.  This helps with language and communication skills that are needed throughout life.

Books and songs are another way to help develop their language skills.  Sing simple songs over and over again, and you will quickly see that they will begin to recognize the song.  Exposing them to books is a great opportunity.  You might find your 6 month old baby has no interest in sitting down and reading a book, but let them explore books.  They will probably start by sticking it in their mouth, but soon they will start looking at the pictures, and before you know it they will have their own favorite book.  Your baby may not want to sit on your lap and read the entire book.  That’s ok!  Flip through the book with them.  Point out different pictures.  Practice animal sounds.  Your baby will enjoy the time spent cuddling with you, while also building a foundation for their developing language and a love for reading.

By Ashlee Mickelson, Physician

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Homeless Quick Facts

Dr. Paul Farmer, cofounder of Partners in Health states, “The idea that some lives matter less is the root of all that is wrong with the world.” We gathered as a group at the homeless memorial as a testament that no lives matter less.

Here are a few dry statistics to ponder, but we all known that human lives are more than a sum of statistics.

  • There were 633,782 people experiencing homelessness on one night in January 2012, this translates to a national homeless rate of 20 per 10,000 people.
  • A majority of the homeless population is comprised of adults (394,379 people).
  • Approximately 38 percent are families with children (239,403 people in 77, 157 households)
  • And 16 percent (99,894 people) are considered chronically homeless, meaning they are living with a disability and staying in shelters or on the streets for long periods of time or repeatedly.
  • On any given night, it is estimated that almost 23,000 people are homeless in Washington State.
  • Nationally, during the past 13 years, there were 1,289 incidents (339 fatal attacks) recorded of what is characterized as hate crimes against the homeless.  These crimes were violent and brutal, including drowning, burning, shooting and stabbing.  These crimes were committed by people who were not homeless themselves.  (National Coalition for the Homeless, 2013)
  • For every age group, homeless persons are three times more likely to die than the general population. Middle-aged homeless men and young homeless women are at particularly increased risk. The average age of death of homeless persons is about 50 years, the age at which Americans commonly died in 1900.2 Today, non-homeless Americans can expect to live to age 78.3
  • Homeless persons die on the streets from exposure to the cold. In the coldest areas, homeless persons with a history of frostbite, immersion foot, or hypothermia have an eightfold risk of dying when compared to matched non-homeless controls.

Gustavo Guttierrez, the liberation theologian and Notre Dame Professor states, “In the final analysis, poverty means death: lack of food and housing, the inability to attend properly to health and education needs, the exploitation of workers, permanent unemployment, the lack of respect for one’s human dignity, and unjust limitations placed on personal freedom in the areas of self-expression, politics, and religion.”

The problems we face are bigger than us as a community, but little actions can accumulate and have a profound effect and as a community we can help alleviate the suffering of our often forgotten and ignored members.

By William Bomberger, PA-C at Denny Murphy Clinic

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CHAS Gets National Recognition for Quality!

This week the U.S. Health Resources and Services Administration announced quality improvement award funding for Community Health Centers. There are 1,300 health centers across the nation, and CHAS is one of just 57 health centers to be recognized as a “National Quality Leader”. National Quality Leaders are health centers that are the highest performers compared with national standards and benchmarks in key clinical areas. CHAS received the National Quality Leader award for exceeding national clinical benchmarks (Healthy People 2020 objectives and health center national averages) for chronic disease management, preventive care, and perinatal/prenatal care. This is a very prestigious national recognition! Additionally, CHAS was also recognized as a “Clinical Quality Improver” for demonstrating at least a 10 percent improvement in clinical quality measures between 2012 and 2013.

“This funding rewards health centers that have a proven track record in clinical quality improvement, which translates to better patient care, and it allows them to expand and improve their systems and infrastructure to bring the highest quality primary care services to the communities they serve,” said U.S. Health and Human Services Secretary Sylvia M. Burwell.

“These funds reward and support those health centers that have taken steps to achieve the highest levels of clinical quality performance and improvement,” said Health Resources and Services Administration Administrator Mary K. Wakefield, Ph.D., R.N.

One of our core values is commitment to quality improvement, with that commitment, we are psyched to be on this list!  Readthe U.S. Health and Human Services’ national press release here.

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Diabetic-Friendly Recipes: Chocolate Pudding “Cake”

Chocolate Pudding “Cake”

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Try this quick and easy dessert, it’s great to take to a party and everyone will love it.

Prep time: 15 minutes

Serves: 12

Ingredients:

  • 30 graham cracker squares (15 sheets broken in half), divided
  • 1.4 ounce box sugar-free, fat-free instant chocolate pudding mix
  • 1 ½ cups fat-free milk
  • 12 ounces fat-free whipped topping, thawed and divided
  • ¼ cup mini-chocolate chips

Directions:

  1. Arrange 10 graham squares, slightly overlapping, on bottom of 8-inch square pan.
  2. In a large bowl, prepare pudding according to package directions. Cool in refrigerator for 5 minutes.
  3. Fold 6 ounces whipped topping into pudding and incorporate well.
  4. Spread half of the pudding mixture over graham squares in pan; cover with 10 of the remaining graham squares. Repeat layers.
  5. Refrigerate 3 hours or overnight.
  6. Top dessert with remaining 6 ounces light whipped topping. Sprinkle with mini chocolate chips.

Nutrition facts for 1 rectangle (2” x 2 2/3”)

Calories: 165

Carbohydrates: 29g

Protein: 3g

Fat: 3.0g

Sugar: 13g

Dietary fiber: 1g

Sodium: 210mg

by Keri Smith, CDE, registered dietitian at Valley Clinic

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Diabetes-Friendly Recipes: Shrimp Fajitas!

Eating healthy can seem challenging even when a person does not have diabetes. See the recipe below for a diabetic friendly meal.

Shrimp Fajitas

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Serve this dish with jicama sticks and guacamole. You can make this colorful dish even more vibrant by using different color peppers or purple onion.

Prep time: 15 minutes

Serves: 5

Ingredients:

  • Cooking spray
  • 1 pound medium shrimp, peeled and deveined
  • 1 teaspoon canola oil
  • 1 red bell pepper, sliced into thin strips
  • 1 green bell pepper, sliced into thin strips
  • 1 medium onion, sliced into thin strips
  • ¼ cup water
  • ½ tablespoon chili powder
  • ¼ teaspoon cayenne pepper (optional)
  • ¼ teaspoon cumin
  • ½ teaspoon salt (optional)
  • ½ teaspoon ground black pepper
  • 10 corn tortillas

Directions:

  1. Coat a large non-stick skillet with cooking spray.  Cook the shrimp over medium heat for about 2 minutes.  Remove the shrimp from the pan and set aside.
  2. Add the oil to the pan and heat. Add the bell peppers and onions and cook for about 7 minutes or until they begin to brown. Add the shrimp and any juices back to pan.
  3. Add the water and spices, including salt (optional) and pepper. Bring the mixture to a boil; reduce heat and simmer until the water evaporates. Serve the shrimp and peppers in the corn tortillas.

Nutrition facts for 2 fajitas:

Calories: 245

Carbohydrates: 31g

Protein: 24g

Fat: 3.5g

Sugar: 4g

Dietary fiber: 5g

Sodium: 385mg

 

by Keri Smith, CDE, registered dietitian at Valley Clinic