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.












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.



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


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


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


National Health Center Week 2016: Open Houses

CHAS Health is celebrating National Health Center week with a series of open houses! Whether it’s our remodel at the Denny Murphy clinic or our dental expansion at our Cheney Health Center, we have some exciting updates to share with you. Meet our staff, take a tour, enjoy some refreshments, and learn more about what our clinics have to offer.






The Climacteric, The Change of Life, or my favorite:

MANopause.  That’s right, fella’s, back away slowly…

Throughout a woman’s life, hormones are constantly shifting and changing, rising, and falling, performing an intricate dance.  When the ovaries reach the end of their lifespan, on average around the age of 50, they no longer produce the hormones estrogen and progesterone.  For some women this happens suddenly and they are thrust into distressing symptoms such as irregular periods, heavy  bleeding, hot flashes, night sweats, vaginal dryness and pain with sex, low sex drive, anxiety, irritability, and even depression.  Perimenopause, the years before the official diagnosis of menopause, can last 10 years or more.  When you have not had a period for an entire year, we can officially say you are in menopause.

One of the most common distressing symptoms are called “hot flashes”. Hot flashes begin as a sudden sensation of heat centered on the upper chest and face that rapidly becomes generalized.  The sensation of heat lasts from two to four minutes, is often associated with profuse perspiration and occasionally palpitations, and is sometimes followed by chills, shivering, and a feeling of anxiety.  Hot flashes may range from less than one each day to as many as one per hour during the day and night.  On average, symptoms last 5 years but 30% of women have symptoms for 10 years and 9% of women have symptoms for 20 years

Modern medicine can offer relief from distressing symptoms, but there is no “cure” for this very natural life process.  As with any medication, there are risks and benefits.  A discussion with your provider can help you decide if medication or hormone replacement therapy is right for you.

Thankfully, there are many things you can do to manage symptoms at home.  These suggestions are basic recommendations for self-care:

For the management of hot flashes and night sweats:

  1. Lower the room temperature
  2. Use fans
  3. Dress in layers that can be easily shed
  4. Wear a base layer that wicks moisture away from your skin.
  5. Avoid spicy food, hot drinks, alcohol, stress
  6. Weight Loss

To keep your mood and emotions steady:

  1. Daily Exercise
  2. Daily Yoga or other mindful meditation and relaxation

For vaginal dryness and pain with sex:

  1. Use a vaginal moisturizer three times a week.
  2. Use lubrication for sex.
  3. Sorry, we have no great medical solution for libido


To protect your bones, support your immune system, and promote sleep:

  1. 1200mg of Calcium
  2. 400mg Magnesium
  3. 2000IU Vitamin D daily.

Calcium is only absorbed 500mg at a time so taking a supplement twice a day with meals, in addition to at least one serving of dairy or other calcium fortified food daily will supply what you need. The Vitamin D helps your body absorb the calcium and it activates it in your muscle and bone cells so it can work for you.  Magnesium and Vitamin D help with mood and a healthy immune system, too.

For more information on perimenopause and menopause, you can explore the following:

The Wisdom of Menopause, by Christiane Northrup, M.D.



-Kirstin Johnson, Certified Nurse Midwife


Pokémon Go, For Your Health?

If you’ve seen an increased number of people walking and biking around town with their phones glued to their faces, there’s a strong chance they are searching for a Charmander, Snorlax, or one of the other 151 Pokémon varieties. Of course we’re talking about Pokémon Go, the latest interactive app to blow up your Facebook and Twitter feed. The coolest part of the app (aside from finding a Squirtle in your backyard), is it’s actually helping people to get outside and exercise more.

Released last week, Pokémon Go is an interactive game that uses your phone’s GPS, camera,  and clock to detect where and when you are in the game and make Pokémon “appear” around using augmented reality. The Pokemon that the players catch can be powered up and used to take over or train at local gyms (usually monuments, churches, other public spaces). Different types of creatures appear as you move around your city, with the variety changing as you move from block to block. You’re literally chasing Pokémon around your city, which is making this game a huge hit and an excellent addition to your exercise regimen.

Many people using the app have seen significant increases in their steps since they began playing.

In addition, some Pokémon Go players are seeing mental health benefits. Simply by getting outside and taking a short walk (sometimes with friends) players are helping themselves to battle anxiety and depression. The game can be played solo or with a group of friends/strangers.

Tumblr user Ari is one of them. She has anxiety and depression and for the past three years has avoided leaving the house unless absolutely necessary.

“I have struggled with motivation and energy since I was 9, when I developed severe depression. After that, when I was 15, I developed CPTSD [complex post-traumatic stress disorder] from an abusive relationship that left me completely socially phobic, and starting then I was barely able to leave my house for fear of seeing people.

“But as soon as I got Pokemon Go I was able to leave the house, and I walked outside for hours and suddenly found myself enjoying it. I had the instant rush of dopamine whenever I caught a Pokémon, and I wanted to keep going. Then today and yesterday I purposely put myself in social situations, going to the mall, just to play. And best of all I enjoyed it.

“I think it’s partially because it gives an instant reward. It’s not like going out, having an awful experience, and getting praise after. It’s going out and getting that instant positive affirmation that makes going outside a good experience. I guess most people get that with being social or doing other activities.”


Of course the exercise is a side effect of playing Pokémon Go, which is at its core an incredibly fun way  to try and see if you can “catch ‘em all”. It brings back a sense of nostalgia, childhood wonder, and lets players explore their environment.

Now, if someone can help me find a Pikachu in Spokane, that would be amazing.

-Matt Grebe & Rachael Chambers, CHAS Health Communications Team


Welcome to Summer!


Helmets– Are highly recommended with all wheeled sports. You only have one head and need to protect that brain for many years to come. If you happen to get in a wreck, get help to make sure you don’t have a serious injury.

Swimming– We have so many awesome lakes, rivers, and pools within a short distance which is why it’s important to practice good water safety. Even if you’re a good swimmer, make sure someone is around to watch you.

Sunblock- We recommend you use a sunblock that covers both UVA and UVB; and an SPF of 70 would be best (with the way most people put on sunblock you only get about half the SPF number listed on the bottle). Don’t forget to drink lots of cool water when the heat rises outside or if you’ve been sweating more than usual! Be sure to stay hydrated to keep your body from overheating.

Camp Physicals-Summertime is a great time to go to camp! Ask your parents to call and schedule an annual physical appointment now so you’re ready for all your activities at camp – and get a jump on the next school year.

Summer Treats– What summer is complete without a few sweets? Remember that we don’t get a summer break from brushing our teeth; we have to do it every day. If you haven’t been into the dentist in a while, now is a great time to let your tooth shine. For extra protection, remember we also have fluoride supplements for kids from 6 months old until 16 years old.

Last, but not least, make sure you talk with your parents about expectations for summer, make sure you know your home address, parent’s phone, and who to contact in case of emergency. Have a fun and safe summer!


4 ways to get your bike ready for Summer!









It’s the perfect time of year to take your bike out for a spin! Before you hit the trails, here are some ways to make sure your bike is in tip top shape.

  1. Clean your bike!

Keeping your bike clean will extend its life and the life of all its parts. Take a basic cleaner (bonus points if its biodegradable), a towel, and a toothbrush and clean everything.

  1. Check your brakes.

Stopping your bike is kind of important, so make sure that those brakes are working before you join traffic. Check your brake pads for uneven wear and replace if necessary. When in doubt, bring in your bike to a local shop to be inspected. Better safe than sorry!

  1. Inspect your tires and wheels.

Changing a tire in the middle of your commute isn’t fun, so make sure your tires are in good shape! After you inspect the rims for nicks and other damage, elevate one end of the bike and spin the wheel, making sure that it moves smoothly. Check your tires for cracks, tears, or excessive wear.

  1. Know the rules of the road!

Do you know how to bike in traffic? Make sure you know your hand signals…

  • Left turn: Extend your left arm straight out to your side (horizontally).
  • Right turn: With your elbow bent, hold your arm in an “L” shape. (And alternative but less common, right turn signal is to extend your right arm straight out to your side.)
  • Stop or sudden slow down: With your elbow bent, hold your arm down in an upsode-down “L” shape.

Be sure to ride in the direction of traffic and always wear a helmet! Now go out and have fun!


Kick morning sickness to the curb!

Though there are some fortunate women who do not experience nausea and vomiting during their pregnancy, about 25% of pregnant women will have some mild nausea, and 30% will have nausea and vomiting severe enough to disrupt their daily life.  “Morning sickness” is a common term used to describe these pregnancy symptoms. In most cases, women find it is at its worst when they are about 8-10 weeks along.  Most of the time, the symptoms lessen or dissolve completely by 12-16 weeks.

The first step to treating nausea is to make sure you are eating every 2-3 hours.  Although it may sound counterproductive—as nausea often results in loss of appetite—dehydration and low blood sugar will often worsen symptoms and even increase nausea.

Here are some tips to help curb morning sickness:

  1. Eat small meals every 2-3 hours.
  2. Have a snack before bedtime, one with protein to help keep your blood sugar stable through the night and avoid the early morning blood sugar low.
  3. Suck on a lemon or lime slice.
  4. Try drinking carbonated beverages between meals.
  5. Avoid greasy, fried, spicy, hot, odorous foods.
  6. Drink or eat real, fresh ginger.  Make ginger root tea, add ginger syrup to water, chew ginger gum, or suck on ginger candy. You can even find ginger capsules in a drug store (the dose is 250mg four times a day).
  7. Acupressure bands work for some women by placing pressure on points inside the wrist.

If you have access to the internet, you can take the PUQE test (pronounced “puke” test) – we doctors have a great sense of humor – by visiting www.sosmorningsickness.com. This site also has extensive information on nausea and vomiting and ways to ease the symptoms associated with morning sickness.

MotherRisk also offers a website and a Help Line to answer your questions on nausea, vomiting, and medications in pregnancy. http://www.motherisk.org/women/morningSickness.jsp or 1-800-436-8477.

-Kirstin Johnson, Certified Nurse Midwife

Celebrate the small successes.