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Pediatric Tips For Summer

As the school days wind down and the thought of summer vacation draws closer, it’s important to have a game plan ready to stay healthy this summer. The warmer months are a wonderful opportunity to explore, play and learn outdoors. We’ve prepared a few tips to help you navigate your children’s health this summer:


June:

Camp brings a ton of kids together for fun, learning, and outdoor time. Make sure you have your needed vaccines ready prior to first day of camp. Vaccinations can help protect against diseases and conditions that pose higher risks in a camp setting. And if your child brings something home with them then the whole family may be at risk. Tetanus, pertussis (whooping cough), meningitis, hepatitis a are typically recommended by camps.

July:

If your child hasn’t gotten their annual wellness check, summer is a great time to get this taken care of. Kids are out of school and schedules are a bit more free. At this exam, make sure to get any required vaccinations, asthma checks, epi pens, sports physicals, etc. for the upcoming school year.

August:

It’ll be that time to start thinking about getting back to school already before we know it. While your child is getting prepared for school, it’s also time for you to get prepared. Make sure your school immunization forms and medical records are complete prior to first day of school. In addition, make sure all medications/ADHD  or other plans are prepared for the upcoming school year.

Water safety:

Water-related activities are popular, especially with access to such amazing lakes, rivers, and public swimming pools. Make sure your child has gotten in to swimming lessons to protect young children from drowning. Many area pools offer courses that are surprisingly affordable.

Beat the heat and sun:

Cover up and use sunscreen every time you and your child go outside to prevent burns. During especially hot months, dress light, schedule outdoor activities outside of the hottest times of day, morning and evening. Stay cool with cool showers or baths. Never leave infants, children, or pets in a parked car – even if the windows are cracked open.

Wear a helmet:

Always protect your noggin while you are on a bike, skateboard, or other personal wheeled transportation. This goes for parents too, be a great example to your children – plus, you never know when an unexpected bump in the road may come from.

Don’t forget the 5-2-1-0 rule:

5 – Try to eat at least 5 fruits, roots, & vegetables a day.

2 – Watch less than 2 hours of screen time.

1 – Play more! Get at least 1 hour of physical activity per day.

0 – Try to cut down sugary drinks to 0. Sugary drinks have little health benefit and a lot of empty calories.

We hope you have a wonderful summer this year! Take the time to build lasting family memories, get outdoors and have fun!

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Oral Cancer – what you need to know

April is here, bringing warm wet weather, Easter egg hunts, and dreams of May flowers.  But April is an important month in other ways, as it is oral cancer awareness month.  That means that now is a great time to learn a little more about the signs, symptoms and causes of this disease.  Maybe not something we all want to talk or think about, but very important. According to the American Academy of Oral and Maxillofacial Surgeons, oral and pharyngeal cancer kills nearly one person every hour of every day of the year. 

Oral and pharyngeal cancer is located in the oral cavity, nose, pharynx, voice box trachea and esophagus.  The mortality rate is higher than other cancers because typically it is not detected early.  The prognosis for patients who have oral cancers is much higher the earlier it is detected.   Oral cancer can be broken into two categories, non-HPV related oral cancers and HPV related oral cancers.

The most common cause of non-HPV related oral cancers are excessive alcohol and tobacco use.  In particular, the combination of smoking and heavy alcohol use increases the risk of oral cancer by 15 times, according to the NIH.  Men are at higher risk than women, as well as those age 55 or older.   Exposure to sunlight can increase the risk of oral cancers of the lip (so don’t forget your sunblock!)

Signs and symptoms of oral cancer caused by tobacco usage and/or excessive alcohol usage may include one or more of the following and are persistent in nature (meaning they do not resolve on their own and linger beyond two weeks:

  • Any sore or ulceration that does not heal within 14 days.
  • A red, white, or black discoloration of the soft tissues of the mouth.
  • Any abnormality that bleeds easily when touched.
  • A lump or hard spot in the tissue, often on the lateral border of the tongue or underneath the tongue.
  • Tissue raised above the area that surrounds it; a growth.
  • A sore under a denture, which even after adjustment of the denture that does not heal.
  • A lump or thickening that develops in the mouth.
  • A painless, firm, fixated lump felt on the outside of the neck that has been there for at least two weeks.

HPV related oral cancers differ slightly form non-HPV cancers.  HPV is the human papilloma virus.  According to the CDC, up to 8-0% of Americans with have an HPV infection during their lifetime, but the great majority (99%) will not develop cancer as their immune system will clear the virus.  Men are affected more than women (approximately 4:1), particularly white, non-smoking men between the ages of 35-55.  The HPV vaccine protects against cancers caused by the virus.  Your child can and should be vaccinated as early as 11 or 12.  The vaccine is recommended for young women through age 26 and young men through age 21.

Signs and symptoms of HPV related oral cancer may include:

  • Hoarseness or sore throat that does not resolve.
  • A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks.
  • Constant coughing that does not resolve.
  • Difficulty swallowing; a sensation that food is getting caught in your throat.
  • An earache on one side (unilateral) that persists for more than a few days.

In addition to preventing, identifying and treating diseases of the dentition and periodontium, one of the most important jobs your dental team does is screen for oral cancer.  This includes both an extra oral assessment of the head and neck region as well as a thorough assessment of the oral cavity including the lips, tongue, tongue, cheeks, tonsils and throat.  If you have noticed a lesion that you are concerned about, make sure to let your dental team know.  

There is always more to learn about Oral Cancer.  Check it all out at the Oral Cancer Foundation’s web site.

By Dr. Warder, Dental Director

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What you need to know about Juuling (and other electronic cigarettes)!

Juuling has quickly become very popular in our high schools, colleges, and even middle schools.  While electronic cigarettes were created to help people quit smoking, in young people they are actually becoming the introduction to tobacco use.  Here are some key things to know:

Safer does not equal safe.  Yes there are no studies linking e-cigarettes to cancer.  Just because e-cigarettes are safer than traditional cigarettes does not mean they are safe.  They still contain many chemicals that we know are airway irritants and carcinogens.  They contain nicotine.   We have no long term studies of the safety of e-cigarettes.

Nicotine is addictive. The Juul pods contain the same amount of nicotine as a pack of cigarettes.    Some e-cigarettes juice is even stronger.  Studies have shown e-cigarette fluid that claims to be nicotine free often contains nicotine.  We also know nicotine affects the developing brain leading to difficulties with attention, learning, impulse control, and mood.

Teens are the target of advertisement. Juul, the most common e-cigarette used among teenagers, began advertising on Youtube, Instagram, and Twitter.  There is a huge social media presence of Juul and Juul is starting to show up in TV shows and movies.  #doitforJuul is a common hashtag that people use to show them using a Juul.  This affects teens, even if they do not realize.

People vape a variety of substances. On youtube you can find videos of people using a variety of fluids including caffeine, alcohol, and Marijuana. Anytime someone is breathing in a substance, it is likely to irritate the airwyas.  There have even been cases of people dying after vaping synthetic cannabinoid.

Juul use is increasing tobacco use among teens. Starting in the 1990s there was a steady decline in tobacco use among teenagers, reaching as low as 12% of all teenagers ever using tobacco.  With the advent of Juul, as many as 35% of teenagers admit to using nicotine containing products.  Unfortunately, many of these Juul users go on to smoke traditional cigarettes.

Juul and other ecigarette companies create fruit flavored fluids that appeal to young users.  Juul can be easily concealed and has become a trend among high school students.  Our teens are getting addicted to nicotine and we must do our best to prevent this!

By Dr. Ashlee Mickelson

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Nurse Practitioner Residency Program Receives Accreditation

The CHAS Health Nurse Practitioner Residency Program has received accreditations from the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC). The NNPRFTC serves as a national accrediting organization, focused on consistently upholding the principles of excellence in accreditation and clinical training while fostering innovation and leadership in healthcare. Accreditation shows the commitment of CHAS Health to provide the highest levels of rigorous clinical training for postgraduate trainees and the same high level of conduct in business practices.
The CHAS Health Nurse Practitioner Residency Clinic opened in August 2017, to help train the next generation of Nurse Practitioners beyond their stand-alone education. The clinic is designed for fully licensed and credentialed ARNPs seeking to perfect their knowledge, skills, and abilities in a real world primary care setting. The program has expanded healthcare access to patients, while advancing the education of new nurse practitioners. The clinic has three long-term CHAS Health providers onsite, who provide guidance for three fully licensed ARNP Residents during the 13 month program.
Through accreditation, CHAS will be able to further develop our program through self-evaluation; identification of strengths and weaknesses; on-going refinement of the curriculum; and program enhancements to meet changing practice environments. For our patients and communities, accreditation is beneficial because it promotes the health, safety and welfare of society by fostering the development of competent health professionals, some of whom we hope to retain.
This is trailblazing work, as less than 10 programs are accredited nationally and CHAS Health was the first to successfully receive pre-accreditation prior to full accreditation.
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5 Things You Can Do To Prepare for Bloomsday!

  1. Get started on a running or walking program

There are endless options out there to improve your endurance when preparing for a long distance run or walk, so find one that best caters to your needs and goals. Interval training is a great way to get your heart rate up and give your body the boost it needs to keep running during steady periods of time. If you plan on walking, it’s a good idea to get into a weekly or even daily walking routine to prepare your muscles and joints for the 7 mile trek through Spokane streets—it’s also a great excuse to do some sightseeing as the weather begins to warm up!

  1. Join a team or get a partner

Exercising with other people can often be a lot more fun than just going by yourself. When we have a reliable teammate or partner to push us, we tend to reach past our own expectations and reach our goals for efficiently. Find someone who is going to give you that push you need and you may just build a lifelong exerciseship.

 

  1. Increase your water intake

It is recommended that the average person drinks between 5-8 eight ounce glasses of water a day. When preparing for the big race, it’s important to consistently drink water throughout the day and get in the habit of drinking water BEFORE you are even thirsty. Though Bloomsday doesn’t take place during a hot month, 7.5 miles often takes a lot of sweat—refuel and recharge.

 

  1. Visit your physician

Though Bloomsday participants run and walk at all levels, it’s a good idea to visit your health care provider before starting a training program to make sure your heath is not at risk. They can also let you know if your finish time goal is reasonable and give you tips for proper training.

 

  1. Start stretching regularly

It is always good to stretch before and after doing any strenuous physical activity, but daily stretching is great at increasing flexibility to prevent future injury. If you don’t have much experience with stretching, taking up a Yoga class or even finding a TV program that teaches stretching, Yoga or Pilates at home could be beneficial to your Bloomsday experience.

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March is National Nutrition Month!

National Nutrition Month (NNM) is celebrated every year during the month of March. It is a nutrition education campaign that focuses on the importance of providing science-based nutrition information to help people with making healthy lifestyle changes. It was created and promoted by the Academy of Nutrition and Dietetics starting in 1973, originally in the form of National Nutrition Week.

Every year, a theme is chosen for NNM. Recent past themes have included, “Go Further with Food”, “Put Your Best Fork Forward”, “Bite Into a Healthy Lifestyle”, and “Savor the Flavor of Eating Right”. The theme this year is a simple one – National Nutrition Month. This year’s focus is back to the core purpose of NNM, which is “to increase the public’s awareness of the importance of good nutrition and position registered dietitian nutritionists as the authorities in nutrition.” The key messages of the 2019 NNM theme are:

  1. Discover the benefits of a healthy eating style.
  2. Choose foods and drinks that are good for your health.
  3. Include a variety of healthful foods from all of the food groups on a regular basis.
  4. Select healthier options when eating away from home.
  5. Be mindful of portion sizes. Eat and drink the amount that’s right for you, as MyPlate encourages us to do.
  6. Keep it simple. Eating right doesn’t have to be complicated.
  7. Make food safety part of your everyday routine.
  8. Help to reduce food waste by considering the foods you have on hand before buying more at the store.
  9. Find activities that you enjoy and be physically active most days of the week.
  10. Consult the nutrition experts. Registered Dietitian Nutritionists can provide sound, easy-to-follow personalized nutrition advice to meet your lifestyle, preferences and health-related needs.

 

As you can see, there is special attention on making the public aware of a most valuable resource for nutrition information…registered dietitians or registered dietitian nutritionists (RD/RDN).

 

What is a RD/RDN?

A RD/RDN is considered to be a food and nutrition expert, armed with a wealth of knowledge to share with those interested in making diet or activity changes to enjoy a more healthy lifestyle.

What is the difference between a dietitian and a nutritionist?

In order to become a RD, a person must complete certain requirements, which include obtaining a degree in a health-related field from an accredited college or university, completing a supervised internship, and pass an examination. The title “nutritionist” is not regulated and anyone with basic background knowledge of nutrition might call themselves a nutritionist. Just remember, every dietitian is a nutritionist, but not every nutritionist is a dietitian.

As part of NNM, we celebrate our RD/RDNs on National RD/RDN Day, which is always the second Wednesday of March. And did you know that CHAS has several dietitians on staff? We are armed and ready to help come alongside you to help you to achieve your health and wellness goals.

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Parenting Through Puberty

I know when my oldest let me know about the changes, I wasn’t ready.  I had prepared my child with what to expect, gotten her some nice books about it that we read together. But, when the time arrived, I thought, “already?”

The changes of puberty are different for every child, but there are some points that help know what’s ahead, just around the corner.

Physical Changes

 

For girls, the changes of puberty start between 8 and 13 years old.  Usually the first sign is breast development.  It commonly takes about two years to get from there to the first menses, or period.  Along the way, development of pubertal hair and a growth spurt usually ensue as well.  When girls start menses, it can be irregular in the first year, but it tends to become more regular with time.

For boys, the changes of puberty start between 9 and 14 years of age.  This starts with genitals enlarging, followed by pubertal hair.  Then they will develop increased muscle mass and voice changes, with the start of these averaging at 13 ½ years old. The peak height for boys is usually reached by 17 years old, 2 years past that for girls.

Both girls and boys will have other changes as well, including hair growth, acne, and body odor.  If you have questions or concerns about whether your child’s patterns are normal, it’s important to ask your healthcare provider.

Emotional Changes

 

Along with the physical changes, there are many emotional changes with puberty as well. Adolescent youth begin to become more independent and less interested in having the attention of their parents.  Some will lose their temper more easily and have more mood swings.  It’s important to keep the conversation open with these changes, both physical and emotional.  Being positively and proactively involved in your child life, even when it’s not invited, helps them know you support them when they need it.

Puberty is Starting Earlier

 

Despite the normal ranges of puberty described above, the onset of puberty has gotten earlier over the years. The cause is unclear, but we know several factors can lead to an earlier start.  Trends from lifestyle factors include an earlier start for girls with more sugar intake (independent of weight), also an earlier start for girls with obesity.  There are differences in the start of puberty with different racial background as well, with puberty often occurring earlier in African-American children.


Booklist

 

Some books that may help open the conversation with you and your child include “The Care and Keeping of You: A Body Book for Girls” by Valerie Lee Schafer and “Guy Stuff: the Body Book” by Dr. Cara Natterson.  These are appropriate for kids 8 years old and up according to Common Sense Media, a website with recommendations on books and movies for kids that are age appropriate.


Are My Child’s Changes Normal?

 

If your girl starts showing signs of puberty before 8 years old or your boy before 9, it’s worth bringing up with your provider to discuss further.  Similarly, if your girl has not started these changes by the time she reaches 13 or your boy by 14, that’s a good reason to discuss as well. Your annual well-child visits are a great opportunity for providers to evaluate these development milestones and make sure things are on track. Please make sure to keep up-to-date on these important visits.

Entering into the next stage can be an intimidating phase for parents and kids alike, but it’s all about being there for your child in an open and honest way.

By Dr. Deborah Wiser, Chief Medical Officer

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Southgate Clinic Now Open!

CHAS Health has opened new clinic on Spokane’s upper South Hill to provide comprehensive healthcare services for patients of all ages. The new CHAS Health Southgate Clinic, located at 5620 S. Regal St., Suite 11, offers medical, behavioral health, and pharmacy services under one roof, with a team experienced in family medicine, pediatrics, and women’s healthcare.

 

Pediatric services include acute care, well child exams, immunizations, and sports physicals for children under 18. Women’s health includes annual gynecological exams, pap smears, family planning, birth control, and menopause management. Our midwives and providers also offer complete pregnancy care. Pharmacists work side by side with the providers to assist with medication management. The collaborative approach provides coordinated care for our patients.

 

Patients can schedule an appointment by calling 509.444.8200.

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Healthy Recipes: Instant Pot General Tso’s Chicken Lettuce Wraps

 

Ingredients
2 lbs skinless and boneless chicken breast, cut into bite size pieces
1/4 cup low sodium soy sauce
1 tsp dark soy sauce
2 Tbsp honey
2 Tbsp brown sugar
2 cloves garlic, minced
1 tsp fresh ginger, grated
3 Tbsp rice vinegar
1/4 tsp red pepper flakes
1 Tbsp tomato paste
2 Tbsp hoisin sauce
1 Tbsp cornstarch
1 Tbsp water

Directions
Turn your Instant Pot to the sauté setting. (See your manufacturer’s guide for detailed instructions on how to use your instant pot.)
Add the chicken pieces to the Instant Pot then dump the rest of the ingredients in it, excluding the cornstarch and water. Stir everything well with a spoon.
Close the lid and set the Instant Pot to the Poultry setting and set the timer to 5 minutes.
Once the Instant Pot cycle is complete, wait until the natural release cycle is
finished, about 10 minutes. Follow the manufacturer’s guide for quick release, if in a rush. Carefully unlock and remove the lid from the Instant Pot.
Switch the Instant Pot to the sauté setting (do not put the lid on). Transfer the chicken to a bowl using a slotted spoon.
In a small bowl whisk the cornstarch and water together, then pour over the sauce and stir. Cook for about 2 minutes until the sauce thickens. Add the chicken back to the Instant Pot and turn off your Instant Pot by pressing the cancel button.
Garnish the chicken with sesame seeds and green onions. Serve in lettuce leaves.
Notes:
To make this in the crockpot, add all ingredients except cornstarch and water and cook on low for 4-6 hours.
After cooking, remove the chicken, turn the crockpot to high, add the cornstarch/water mixture and allow to thicken. Add the chicken back in and serve as desired.

By Erica Baty, RD, CDE