October 25, 2009
Well, my daughter has influenza A, and there is really only one strain of influenza A in the public right now, H1N1. I want to document for everyone what I have done for Ila because it seems that many of us will get this flu before immunizations are available to the general public.
Friday night, 7pm – started with her lying on the couch, which she never does, and she said her body was hurting and cold. Took her temperature and it was 101.5. She looked flushed and sweaty. I also noted a dry, tight cough but no problems breathing. Gave her children’s ibuprofen and put her to bed. When I took her temperature 1 hour later, it had increased to 102, so I gave her Tylenol, and let her sleep with me. She slept 10 hours straight.
Saturday – She woke up shivering and sweaty. Fever was 102, and the dry cough is difficult for her to control. She did not complain about sore throat. Her nose was congested with occasional clear drainage. I gave her ibuprofen every 6 hours which kept the fever decreased to 100.5. She stayed on the couch all day, and I told her we would go to the clinic tomorrow if she woke up with a fever. She had a nice hot bath, which she said helped her feel better. I gave her some Triaminic night time medicine before bed for the cough.
Sunday – She woke up with 102.5 degree fever. I gave her some ibuprofen and within an hour the fever was down to 99.5. She told me that the dry cough kept her up all night. Took her to the clinic and the rapid flu test was positive for influenza A. The rest of her exam is normal. It is interesting that her cough increases with the fever and goes away when the fever is under control. I started her on Tamiflu, mostly because that is what I would do for everybody else (it is hard to be objective with your own kids and she was doing so well that I almost did not give it to her). She is on the couch now watching an old Looney Tunes Halloween special. She is eating, drinking and acting quite normal; just her energy level is decreased.
So we have quarantined her to the house and are hoping no one in the family gets this from her (I had the vaccine for health care workers 10 days ago, so I should be OK). The moral of the story: this is the flu, and like any other flu virus, you need to take care of yourself and protect others from getting it.
1. Push fluids – this can be ice chips, popsicles, jello – anything clear that turns into liquid. Dehydration is one of the reasons patients are admitted to the hospital with the flu.
2. Control the fever – use baths, cold drinks, ibuprofen and/or Tylenol.
3. Watch for respiratory symptoms – if you or your family member has a cough that develops into chest pressure/congestion, wheezing or difficulty taking a deep breath, they need medical evaluation immediately to check for pneumonia.
4. Stay home! If you want to get a flu test and Tamiflu, please email me.
Stay tuned for up-to-date information about the H1N1 vaccine – there will likely be widespread availability of the vaccine in November.
Thursday, November 12, 2009
September 2009 Email/Homepage
September 2009 Updates
First of all, thank you, thank you, and thank you! It was a wonderful summer with some 3 day mini vacations and more time with my family and friends. My children remember who I am and I am enjoying the practice of medicine again. The winter will be interesting because there will be some days where I have very few open appointments. Just email Michele or me for availabilities, and we will find a place for you and your family.
Due to the winter getting busier, I will be seasonally opening up some Wednesday afternoons. This means that from September to May, I will open up the online schedule for appointments on the Wednesdays I am in the clinic. If there are no appointments available and you need to be seen on Wednesday, email or call and we can make some arrangements to get you in. Also, please verify the date of the visit whenever you make an online appointment, as AppointmentQuest will find the first available 15 minute slot and it may not be on the day you want to see me.
Flu Shots
If you had to pick one year to get a flu shot, this is the one. It would help me out a lot if everybody received a shot or FluMist nasal spray, then if you get sick I know it is not that type of flu. Adults and kids over 12 years can get the vaccine through most grocery stores. I will only have vaccine for children less than 12 years old.
The first shipment of H1N1 flu vaccine will be delivered to the Health Departments for high-risk patients in October, and it will be available through some pharmacies for in November, as the mass vaccinations start. I will not be a H1N1 vaccine clinic, but I will keep the website updated on where you can get the vaccine, if you wish. The closest Health Department Immunization Clinic is Renton Public Health Center, 3001 NE 4th St.
Health Care Reform
No matter what you think about health care reform, change is coming and it is important for us all to use our collective voices and votes. There is a great short film produced by an Emergency Room physician in Portland, OR that presents all sides of this complicated issue. It can be accessed through www.ourailinghealthcare.com. I would encourage you to familiarize yourself with this issue as it will not only dramatically affect us in our lifetime but will have a profound effect on generations to come. Send your opinions to our leaders – links are below.
President Obama -- http://www.whitehouse.gov/contact/
Office of the Surgeon General -- Phone: 301-443-4000/Fax: 301-443-3574
Senator Maria Cantwell -- http://cantwell.senate.gov/contact/ -- phone: 202-224-3441
Senator Patty Murray -- http://murray.senate.gov/email/index.cfm -- phone: 202-224-2621
Washington State Congressmen List -- http://www.house.gov/house/MemberWWW_by_State.shtml#wa
Health Notes
I am frequently asked about what I do to maximize my immune system and prevent illness, since I am exposed to sick people every day. Below is what I do for myself and my kids. We still get sick, but frequency and intensity of our illnesses have been decreased with this regimen. Keep in mind that I do not care if you buy these supplements from me or online; I just want you to have the right stuff. As I have told many of you, I am lucky enough NOT to only sell supplements for a living.
Daily Immune Supplements for Kristina
• Pharmax Liquid Multivitamin, 2 capfuls per day in 2 liters of water.
• Vitamin D 2000-4000iu per day.
• Pharmax HLC probiotics, 1-2 capsules per day.
• Thorne Green tea capsules, 1-2 per day.
• Thorne IM-Encap or Phytogen, 1-2 capsules twice a day
• Xymogen IgG Pure, 1-2 scoops per day.
• Xymogen IgG, 2 capsules twice a day (only if I start to feel sick)
Daily supplements for Ila and Kian (sometimes Kian won’t eat anything I give him)
• Multivitamins (gummy vits from Costco).
• Pharmax Probiotic straws, 1 straw every 2-3 days.
• Xymogen IgG Powder, 1 tsp per day OR 1 tsp twice a day when ill.
• Wise Women Herbals, Herbal CE 1, ½ tsp at night when exposed to illness or ill.
(of note, kids absorb Vitamin D better than adults, so no supplement is recommended)
Daily activity, even a 10 minute walk outside, helps the body to maintain balance and function appropriately. Vigorous activity, such as a hike in the middle of the winter, stimulates “leukocytosis” and increases the white blood cells in the body. And, for the last time, you really are what you eat, and although a twinkie can survive on the shelf, fresh and new, for many years, you cannot. As we age, our body’s response to the fuel we give it is amplified, so eat 5 servings of fruits and veges per day, cut down on simple carbs like sugar and white flour products, and eat lean proteins like chicken, turkey and fish. When possible, choose organic, locally grown food, as it really does make a difference in taste and residual free radicals from chemicals in the body. And it makes you feel good to buy food from your neighbors.
So it is not easy to stay healthy on a daily basis, but it pays off when you don’t have to check out for a week because of illness. I am here for you if you need me!
Kristina
First of all, thank you, thank you, and thank you! It was a wonderful summer with some 3 day mini vacations and more time with my family and friends. My children remember who I am and I am enjoying the practice of medicine again. The winter will be interesting because there will be some days where I have very few open appointments. Just email Michele or me for availabilities, and we will find a place for you and your family.
Due to the winter getting busier, I will be seasonally opening up some Wednesday afternoons. This means that from September to May, I will open up the online schedule for appointments on the Wednesdays I am in the clinic. If there are no appointments available and you need to be seen on Wednesday, email or call and we can make some arrangements to get you in. Also, please verify the date of the visit whenever you make an online appointment, as AppointmentQuest will find the first available 15 minute slot and it may not be on the day you want to see me.
Flu Shots
If you had to pick one year to get a flu shot, this is the one. It would help me out a lot if everybody received a shot or FluMist nasal spray, then if you get sick I know it is not that type of flu. Adults and kids over 12 years can get the vaccine through most grocery stores. I will only have vaccine for children less than 12 years old.
The first shipment of H1N1 flu vaccine will be delivered to the Health Departments for high-risk patients in October, and it will be available through some pharmacies for in November, as the mass vaccinations start. I will not be a H1N1 vaccine clinic, but I will keep the website updated on where you can get the vaccine, if you wish. The closest Health Department Immunization Clinic is Renton Public Health Center, 3001 NE 4th St.
Health Care Reform
No matter what you think about health care reform, change is coming and it is important for us all to use our collective voices and votes. There is a great short film produced by an Emergency Room physician in Portland, OR that presents all sides of this complicated issue. It can be accessed through www.ourailinghealthcare.com. I would encourage you to familiarize yourself with this issue as it will not only dramatically affect us in our lifetime but will have a profound effect on generations to come. Send your opinions to our leaders – links are below.
President Obama -- http://www.whitehouse.gov/contact/
Office of the Surgeon General -- Phone: 301-443-4000/Fax: 301-443-3574
Senator Maria Cantwell -- http://cantwell.senate.gov/contact/ -- phone: 202-224-3441
Senator Patty Murray -- http://murray.senate.gov/email/index.cfm -- phone: 202-224-2621
Washington State Congressmen List -- http://www.house.gov/house/MemberWWW_by_State.shtml#wa
Health Notes
I am frequently asked about what I do to maximize my immune system and prevent illness, since I am exposed to sick people every day. Below is what I do for myself and my kids. We still get sick, but frequency and intensity of our illnesses have been decreased with this regimen. Keep in mind that I do not care if you buy these supplements from me or online; I just want you to have the right stuff. As I have told many of you, I am lucky enough NOT to only sell supplements for a living.
Daily Immune Supplements for Kristina
• Pharmax Liquid Multivitamin, 2 capfuls per day in 2 liters of water.
• Vitamin D 2000-4000iu per day.
• Pharmax HLC probiotics, 1-2 capsules per day.
• Thorne Green tea capsules, 1-2 per day.
• Thorne IM-Encap or Phytogen, 1-2 capsules twice a day
• Xymogen IgG Pure, 1-2 scoops per day.
• Xymogen IgG, 2 capsules twice a day (only if I start to feel sick)
Daily supplements for Ila and Kian (sometimes Kian won’t eat anything I give him)
• Multivitamins (gummy vits from Costco).
• Pharmax Probiotic straws, 1 straw every 2-3 days.
• Xymogen IgG Powder, 1 tsp per day OR 1 tsp twice a day when ill.
• Wise Women Herbals, Herbal CE 1, ½ tsp at night when exposed to illness or ill.
(of note, kids absorb Vitamin D better than adults, so no supplement is recommended)
Daily activity, even a 10 minute walk outside, helps the body to maintain balance and function appropriately. Vigorous activity, such as a hike in the middle of the winter, stimulates “leukocytosis” and increases the white blood cells in the body. And, for the last time, you really are what you eat, and although a twinkie can survive on the shelf, fresh and new, for many years, you cannot. As we age, our body’s response to the fuel we give it is amplified, so eat 5 servings of fruits and veges per day, cut down on simple carbs like sugar and white flour products, and eat lean proteins like chicken, turkey and fish. When possible, choose organic, locally grown food, as it really does make a difference in taste and residual free radicals from chemicals in the body. And it makes you feel good to buy food from your neighbors.
So it is not easy to stay healthy on a daily basis, but it pays off when you don’t have to check out for a week because of illness. I am here for you if you need me!
Kristina
June 2009 Email/Homepage
June 2009
Hello to All, and I again extend my appreciation for your understanding in this transition. I would appreciate any feedback about the workings of the clinic – I still won’t hire someone to answer the phone, but you can share with me how much you hate voice mail, and I will listen…
Here is an article about the medical model I am striving to achieve… of note, many of these medical models have a membership fee and I do not plan to do that because you all have been good enough to come in for an appointment when you need me…
http://www.nytimes.com/2009/06/07/health/07health.html?emc=eta1
Everything has slowed down after cold and flu season, so if you have some little things that have been bothering you and have not made time for yourself, there are same day appointments available every week, and I am only booking out about one week for physical appointments.
One unfortunate business decision that I had to make this month was breaking off negotiations with Medicare. FYI – you don’t really negotiate with Medicare; it is more of a “take it or leave it” scenario, so I left it. Nurse practitioners get a 20% pay cut from the regular physician fee, and if you do not implement e-prescribing and a Medicare approved electronic medical record, you get another pay cut. So since I would actually be paying to see Medicare patients, I opted out of the system for 2 years. I am hoping things will change as more and more people appreciate nurse practitioners as an important part of the health care team. Medicare patients will privately contract with me on a fee-for-service basis with a discount for paying at time of service. I am having a meeting for any interested parties (even those close to Medicare enrollment) on Tuesday, June 9th at 5pm.
Now for the fun…
I am having an Open House on July 3rd from 4-9pm. It will correspond with Art Walk in the Village, and there will be art and hopefully some music. All children who are of walking age are welcome to come in at 1pm that day to paint a mural in my hallway. You can paint anything – handprints are accepted! The clinic will be open for walk-in/urgent appointments only from 9am to 1pm. Hope to see you there!
If you cannot make it to this Art Walk, I will have art at the clinic on August 7th and September 4th.
Have a great summer! I know I will!!
Kristina
Hello to All, and I again extend my appreciation for your understanding in this transition. I would appreciate any feedback about the workings of the clinic – I still won’t hire someone to answer the phone, but you can share with me how much you hate voice mail, and I will listen…
Here is an article about the medical model I am striving to achieve… of note, many of these medical models have a membership fee and I do not plan to do that because you all have been good enough to come in for an appointment when you need me…
http://www.nytimes.com/2009/06/07/health/07health.html?emc=eta1
Everything has slowed down after cold and flu season, so if you have some little things that have been bothering you and have not made time for yourself, there are same day appointments available every week, and I am only booking out about one week for physical appointments.
One unfortunate business decision that I had to make this month was breaking off negotiations with Medicare. FYI – you don’t really negotiate with Medicare; it is more of a “take it or leave it” scenario, so I left it. Nurse practitioners get a 20% pay cut from the regular physician fee, and if you do not implement e-prescribing and a Medicare approved electronic medical record, you get another pay cut. So since I would actually be paying to see Medicare patients, I opted out of the system for 2 years. I am hoping things will change as more and more people appreciate nurse practitioners as an important part of the health care team. Medicare patients will privately contract with me on a fee-for-service basis with a discount for paying at time of service. I am having a meeting for any interested parties (even those close to Medicare enrollment) on Tuesday, June 9th at 5pm.
Now for the fun…
I am having an Open House on July 3rd from 4-9pm. It will correspond with Art Walk in the Village, and there will be art and hopefully some music. All children who are of walking age are welcome to come in at 1pm that day to paint a mural in my hallway. You can paint anything – handprints are accepted! The clinic will be open for walk-in/urgent appointments only from 9am to 1pm. Hope to see you there!
If you cannot make it to this Art Walk, I will have art at the clinic on August 7th and September 4th.
Have a great summer! I know I will!!
Kristina
April 2009 Email/Homepage
April 2009
Well, I think we have made it through the worst of a late cold and flu season. Some of you people were really sick! I was able to accommodate most everyone with same day appointments during the busiest time of the year, so I think the clinic is at a good number of patients at this point. I am still not accepting any new patients or prior Issaquah Medical Group patients at this time.
One of the things that takes up about 1-2 hours per day is my extra work – emails, refills, referrals, FMLA paperwork, etc. I used to have 4 people on staff that helped with this work, and had to see 8-10 more patients per day to pay them. I get it all done eventually, but let me explain my process a little:
“A” list – all the patients that have gone out of their way to make an appointment. Obviously, when you are in front of me, you have my full attention and resources, and get immediate service.
“B” list –emails, refills, lab results, phone calls. These are usually completed in 48 hours.
“C” list – FMLA paperwork, medical records requests, billing questions, referrals. These are completed in one week unless I am having difficulty accessing information and I will at least give you an update.
None of this is difficult – just takes time. I share this with you because if you urgently need something on the B or C list to be done right away, you need to make an appointment. That is the only way I can guarantee immediate service. I do have part-time help in the morning, but all of the above duties are mine alone. I have the staff busy with many other tasks that make the clinic run. So we will never be answering the phone, but you will get a call back now when you leave a message!
After 3 months in business, I have finally carved out some time to write clinic policies. I really do not like formal policies, but they are an unfortunate necessity to protect against naughty clients. I have attached the policies. Included is the HIPAA policy (required by law and standard at all medical offices) and email policy. It is very important for everyone to read the email policy because, before your next visit, you will be asked to sign that you read and understood the privacy and email policies. Email has worked FABULOUSLY to communicate with patients and I can do 5-6 emails for every phone call, so I want to continue to communicate primarily by email.
There are some additions to the website as well – a page with health links and phone numbers to urgent care centers for those Sundays with sick kids. Please let me know if I can provide any additional information on the website. Thank you for your continuing support!
Kristina Garrido
Well, I think we have made it through the worst of a late cold and flu season. Some of you people were really sick! I was able to accommodate most everyone with same day appointments during the busiest time of the year, so I think the clinic is at a good number of patients at this point. I am still not accepting any new patients or prior Issaquah Medical Group patients at this time.
One of the things that takes up about 1-2 hours per day is my extra work – emails, refills, referrals, FMLA paperwork, etc. I used to have 4 people on staff that helped with this work, and had to see 8-10 more patients per day to pay them. I get it all done eventually, but let me explain my process a little:
“A” list – all the patients that have gone out of their way to make an appointment. Obviously, when you are in front of me, you have my full attention and resources, and get immediate service.
“B” list –emails, refills, lab results, phone calls. These are usually completed in 48 hours.
“C” list – FMLA paperwork, medical records requests, billing questions, referrals. These are completed in one week unless I am having difficulty accessing information and I will at least give you an update.
None of this is difficult – just takes time. I share this with you because if you urgently need something on the B or C list to be done right away, you need to make an appointment. That is the only way I can guarantee immediate service. I do have part-time help in the morning, but all of the above duties are mine alone. I have the staff busy with many other tasks that make the clinic run. So we will never be answering the phone, but you will get a call back now when you leave a message!
After 3 months in business, I have finally carved out some time to write clinic policies. I really do not like formal policies, but they are an unfortunate necessity to protect against naughty clients. I have attached the policies. Included is the HIPAA policy (required by law and standard at all medical offices) and email policy. It is very important for everyone to read the email policy because, before your next visit, you will be asked to sign that you read and understood the privacy and email policies. Email has worked FABULOUSLY to communicate with patients and I can do 5-6 emails for every phone call, so I want to continue to communicate primarily by email.
There are some additions to the website as well – a page with health links and phone numbers to urgent care centers for those Sundays with sick kids. Please let me know if I can provide any additional information on the website. Thank you for your continuing support!
Kristina Garrido
January/February 2009 Email/Homepage
Dear Patients and Friends,
What a whirlwind! Any of you who visited in January observed that I was leaving your insurance cards on the copier and forgetting co-pays, but I was open for business! Although I may have seemed a little discombobulated (one of my favorite words), I am SO HAPPY! I wanted to thank you all for your kindness and patience at this time. I have now hired front desk staff (Michele, Blake and Jesse) so things will be a bit smoother at your next visit…
I am still streamlining the process of lab notifications, so if anyone does not receive a result in a timely fashion – I apologize – email and remind me! For those who had trouble finding the place, we have changed the website map in an effort to help others. FYI – I am in Gilman Village, at the southwest end behind Sweet Additions. If you park in the Juniper Street lot at the southwest end, you will see the sign for Grimaldi’s Coffee Shop (the best coffee I’ve had since I lived in Seattle) and I am the “salmon” (pink) building next to them.
A few words about online scheduling…
It is going pretty well, and most are having no trouble. I have closed the enrollment due to overwhelming response (a blessing and a curse!), so if some of your family members have not signed up, they need to email me and I will make them an account. I just needed to put my “finger in the dike” for a bit, and then I can decide what a comfortable patient base is for the clinic.
So, making an appointment… many have emailed me that they are not able to make a same day/15minute appointment. Those appointments open up the day before so that there will be available slots for sick/injured people. If you try to make those appointments the week before, it will not work. My experience has been that if patients are thinking about the appointment a week ahead of time, they will need more than 15 minutes for the appointment. The 30 minute appointments are best for medication checks/refills/complicated disease management, and those can be scheduled months in advance. The software will generate a reminder 48 hours before the appointment so you can re-schedule if needed.
If I am completely out of same day appointments and you are in crisis or very ill, I will find a way to fit you into the schedule. I do show preference to my littlest patients, as they are the ones who get sick very fast and need care right away.
Of the 2-3 thousand patients that I regularly saw at my prior clinic, you all are the 700 patients that felt it was worth it to follow me to Village Family Clinic. You have made my dream come true… and the clinic is a welcoming, gentle place for healing… I am so happy to share it with you!
Kristina
What a whirlwind! Any of you who visited in January observed that I was leaving your insurance cards on the copier and forgetting co-pays, but I was open for business! Although I may have seemed a little discombobulated (one of my favorite words), I am SO HAPPY! I wanted to thank you all for your kindness and patience at this time. I have now hired front desk staff (Michele, Blake and Jesse) so things will be a bit smoother at your next visit…
I am still streamlining the process of lab notifications, so if anyone does not receive a result in a timely fashion – I apologize – email and remind me! For those who had trouble finding the place, we have changed the website map in an effort to help others. FYI – I am in Gilman Village, at the southwest end behind Sweet Additions. If you park in the Juniper Street lot at the southwest end, you will see the sign for Grimaldi’s Coffee Shop (the best coffee I’ve had since I lived in Seattle) and I am the “salmon” (pink) building next to them.
A few words about online scheduling…
It is going pretty well, and most are having no trouble. I have closed the enrollment due to overwhelming response (a blessing and a curse!), so if some of your family members have not signed up, they need to email me and I will make them an account. I just needed to put my “finger in the dike” for a bit, and then I can decide what a comfortable patient base is for the clinic.
So, making an appointment… many have emailed me that they are not able to make a same day/15minute appointment. Those appointments open up the day before so that there will be available slots for sick/injured people. If you try to make those appointments the week before, it will not work. My experience has been that if patients are thinking about the appointment a week ahead of time, they will need more than 15 minutes for the appointment. The 30 minute appointments are best for medication checks/refills/complicated disease management, and those can be scheduled months in advance. The software will generate a reminder 48 hours before the appointment so you can re-schedule if needed.
If I am completely out of same day appointments and you are in crisis or very ill, I will find a way to fit you into the schedule. I do show preference to my littlest patients, as they are the ones who get sick very fast and need care right away.
Of the 2-3 thousand patients that I regularly saw at my prior clinic, you all are the 700 patients that felt it was worth it to follow me to Village Family Clinic. You have made my dream come true… and the clinic is a welcoming, gentle place for healing… I am so happy to share it with you!
Kristina
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