Posted in Blog Posts, Featured, Reading Room

A Corona Virus Hotspot

Brandy Wiltermuth is a nurse practitioner who currently gives medical-wellness checks to workers during a COVID-19 outbreak in Yakima County, Wash.

‘I take care of workers in Yakima County, a coronavirus hot spot: ‘The nearest hospital is a few miles away, but most refuse to use it’

Someone picked, packaged and sent those berries off to your local grocery store.

That someone likely works in Washington State’s Yakima County, home to a $1 billion agricultural industry and now also a hot spot for COVID-19 infections. There were more than 6,283 cases as of Monday as the deadly virus works its way out of urban cities and into rural America.

Washington state not only is the nation’s biggest supplier of apples, it also produces 90.5% of red raspberries in the U.S. Fruits make up the biggest share of the state’s roughly $3.4 billion pile of annual agriculture exports.

Coronavirus has raised fears of meat shortages, and Yakima County has become a hot spot for outbreaks among farm workers.

Places like Yakima only rarely make the nightly news. Recently, coronavirus has raised fears of meat shortages and concerns that the food supply will be disrupted, and Yakima County has become a hot spot for outbreaks among farm workers.

That’s why I’m here, three days a week, working 12-hour shifts with my small team, screening workers at a food distribution center for COVID-19. The virus is here. There are roughly 700 employees at the center. I have learned that 18 have tested positive. They work 12- to 14-hour shifts at the 24/7 operation. The center distributes only what can be found at grocery stores, everything from ice cream and cereal to dog food and toilet paper.

Employees are told to come visit our bright blue, mobile breast-cancer screening bus on their breaks, before shifts or after. The setup looks welcoming, with our “waiting room” consisting of properly distanced picnic tables and a white awning to provide a patch of shade. During better times, it might look like a setup for a celebration.

Still, our daily routine often starts out looking like a dog running through a flock of birds: they scatter and spread out when we show up.

Some workers have taken up our offer of a free medical visit. They come, often starting out by asking general questions about various conditions. Trouble sleeping, anxiety, wrist pain or rash. Once in the mobile unit, more barriers come down. More pointed questions, subtle clues or intricate requests that test my ability to rapidly absorb a large amount of information, process it and produce a response.

Our daily routine often starts out looking like a dog running through a flock of birds: they scatter and spread out when we show up.

After all, the workers are on their break. They have 10 minutes. Often times, I ask them to bring me more information and come back tomorrow or next week. When our schedules jibe, they make another appointment.

But a diagnosis and recommendation are as far as I can go. I can reach into my nursing bag of “tricks and cures,” pull out what’s there, but I cannot use my prescriptive power or order required tests. Instead, I write names of over-the counter drugs, creams, drops, devices, tests and websites on a sticky note, also known as the nurse’s prescription pad.

I have seen a lot of rashes or “atopic dermatitis.” I show them my hands. I have it too. It’s likely a reaction to lots of soap, 70-proof sanitizer, disinfectant wipes and gloves. Skin is our body’s largest organ and our first line of defense. It is hard to examine workers sometimes because they are wearing layers. Many work in the freezers. It is now 80 degrees when they come out of the warehouse.

They smile at us with their eyes. Their eyes are so beautiful and bright. I know they are smiling even though they are wearing masks.

They also are worried. Many just want to be checked out. We screen them with questions about their travel or potential exposure to anyone with COVID-19. We ask if they have any symptoms. We take their temperature. We know it doesn’t really change anything. Anyone, after all, could be asymptomatic and still be contagious.

Language may be a barrier preventing more visits, even though our medical staff consists of Spanish-speakers. Also, few want to come after a 14-hour stint. They want to go home and relax. We mostly feel ineffective and wish we could do more, to really make a difference.

Limited access to health care is the one common thread between Yakima and countless other medically under-served areas I’ve served.

I can’t say that I know much about Yakima other than the people I’ve treated in their homes, and now outside of their work.

But limited access to health care is the one common thread between Yakima and the countless other medically under-served areas I’ve served, often traveling to places where people have abundant medical needs, but little access.

In Yakima, the nearest hospital is a few miles away, but most refuse to use it, telling me that care is inadequate and that there is a lack of compassion. They prefer instead to make a 45-minute drive to a larger regional hospital. Most of the people I have treated say they either do not know if they have health insurance, or what it might cover. Many say they don’t utilize health care unless there is an emergency.

Well before COVID-19, in December 2018, I spent my 43rd birthday in a Yakima hotel, my first visit to the area. I came to see Medicare recipients in their homes to perform annual assessments. That’s when I realized my limited Spanish classes really didn’t stick. But I did pick up quite a bit of medical Spanish, after 10 days packed with eight-plus patient visits per day, and a translation service that depleted my smartphone battery following each visit.

I have heard many complaints about physical disabilities, injuries and chronic pain conditions that were the direct results of physical labor. Some had 50 years of hard physical labor under their belt.

I know who the local employers are, but the workers I met do not call their employers by their corporate names. They call their employers “vineyard,” “orchard,” “meat-packing plant,” “nuclear site,” “canning factory,” “paper mill” or “warehouse” or, simply, “the fields.”

Some workers were embarrassed about their living conditions. Most impressive was their desire to make me feel welcome.

I met 70-year-olds still working 12-hour shifts, seven days a week in the fields. I once did an assessment with a Medicare member at his home after work. He was living alone in a basement room with a cot to sleep on, a hot plate and no heat.

Some were embarrassed at times about their living conditions. Most impressive was their genuine curiosity about me and their desire to make me feel comfortable and welcome.

Yet, I am not fully trustworthy either in the eyes of Yakima. Few workers want to tell me about their families, any medical history issues or about their relatives’ health. Even less is said about where their family comes from or where they live now. I can’t blame them. They fear exposing a family member that lacks legal status, a fear that has risen along with Trump administration’s threats to crack down on undocumented immigrants, even though farms and food-distributers often are run on migrant labor.

I don’t press them on it. I always remind them that an acceptable answer is: “I don’t know.”

As cases of coronavirus increase, more families are being exposed. I recently met a young woman in the bathroom of the food-distribution facility. She was clearly upset and had been crying. She looked at me in my scrubs and asked, “How long are you guys gonna be here?” I told her most likely until the end of July. I asked if there was something she wanted to talk about. “Well, I am pregnant. And I am just crying all the time,” she said.

I noticed her belly, even under the thick bibs meant to shield her from the blasting sub-zero freezers during shifts of up to 14 hours. “I’m worried about the coronavirus. What if I get it?” she asked. I recalled my oncology experience: “Don’t give false reassurance, give facts.” I told her that a lot of women all over the world have had babies during the last four months, and that even women with active COVID-19 are giving birth to healthy babies.

Her doctor told her the same thing, she said. I reminded her everyone is scared right now, but also that she has an extra responsibility. I suggested that she come talk with us, even if she’s not sick. “We can make a plan for being as healthy as possible during all of this. It will be good for you and your baby,” I told her.

“I am going to do that. Thank you,” she told me, steeling herself before exiting and returning to the deep freeze.

I am still waiting, and hopeful that she will come back.

Brandy Wiltermuth is a nurse practitioner who specializes in metabolic health, and a co-owner of Three Health in Edmonds, Wash. For the past 28 years, Brandy has taken assignments to help medically under-served communities on a contract basis. She currently gives medical wellness checks to workers during a COVID-19 outbreak in Yakima County.

Article published on Marketwatch

https://www.marketwatch.com/story/everyone-is-scared-right-now-i-take-care-of-farm-workers-in-yakima-county-a-coronavirus-hot-spot-this-is-my-story-2020-06-23

Posted in Blog Posts

Self-Care isn’t Selfish

Many years ago I heard a quote that has stuck with me: “You can’t pour from an empty cup.  Take care of yourself first.” I have no idea who said it, but it resonated with me. 

We often see patients who take care of others first. Then, if there are time and energy, themselves. At Three Health, we believe self-care is crucial to achieving and maintaining weight loss, and we are here to assist you in developing your own self-care plan.

To put it simply, we encourage our patients to treat themselves as kindly as they treat their friends and loved ones. Often, this is not as simple as it sounds. Self-care requires time-management skills, assertiveness, personal insights, and occasional relationship changes. Generally, this requires us to take a step back and assess if we are draining our personal “resources.”  At Three Health, we are excited to help our patients learn to replenish their energy and balance their lives. 

We also find that people are inclined to replenish their reserves by using unhealthy coping strategies such as over-eating, misusing alcohol, participating in risk-taking behaviors, or other self-destructive techniques to manage challenging emotions.  However, these strategies only bring temporary relief and a damaging cycle begins.

Many of life’s stressors are created or exacerbated when we are not focused on self-care and balance. Stress can come in one or more “areas of life,” meaning we can create stress in our lives by not balancing our PHYSICAL, EMOTIONAL, INTELLECTUAL, SPIRITUAL, AND FINANCIAL needs. We all know people who take care of themselves physically but pay no attention to their emotional needs. Others may have great financial resources but are in terrible physical shape. Ignoring any of these areas will create an imbalance, which in turn, creates stress.  

At Three Health, we focus on the whole person: mind, body, and spirit. Let us help you to create your best life! You deserve it!  

Visit our website Three Health.

By Marlene Sexton, LMFT 

Posted in Blog Posts, Featured

Motivation…Can I get that to go?

Motivation is what gets you started.  Habit is what keeps you going.

                                                                                 Jim John

It is not uncommon to be excited and motivated at the start of a lifestyle change. The difficulty comes in sustaining that motivation.

Profound weight loss requires developing new habits and changing your relationship with food. This can be difficult given the food culture in which we live. Most of us have been taught to use food for comfort or to show love.

We get several THOUSAND messages a day to eat. These messages can be subliminal, as in product placement in TV shows, print advertising, or even in our language (we call people “sweetie pie” or describe others as a “smart cookie”.) We also learn to reward (or punish) with food. Have you ever been told, “If you are good, we will stop and get ice-cream”? Maybe you’ve heard, “If you don’t finish your dinner, you can’t have dessert.” These messages condition us to see food as other than fuel for our bodies. No wonder diets are so hard to stick to!

At Three Health, we have taken a “lifestyle” approach rather than a “dieting” approach. A diet eventually ends when a person has reached their goal weight, or more often when a person loses motivation to continue. This leads to harmful “yo-yo” dieting.

So, we know what leads to losing weight only to gain it back; let’s take a look at some strategies for steady and sustainable weight loss.

One key to successful weight loss is to set realistic goals. Lifestyle changes do not happen overnight, so setting attainable goals leads to real success. Progress markers such as noticing your clothes are looser or that you can take the stairs more easily indicate success more so than a number on the scale. Set small, achievable, measurable goals and celebrate when you reach them.

We see successful change when people recognize and challenge all-or-nothing thinking. A common self-defeating thought is, “I blew it by eating that cookie! I may as well have whatever I want now and start over on Monday.” Learning to put things in perspective can prevent a binge. Having a cookie does not mean you are lost in the woods, you are only one step off the path and it is easy to get back on!

The buddy system is another way to maintain motivation.  At Three Health, we offer a monthly support group along with weekly therapy groups. Making major lifestyle changes can be more difficult when we try to go it alone. Getting feedback from others can help us gain personal insights and healthy strategies to get through life’s tougher moments.

Small, non-food rewards such as a new book, a manicure, or a round of golf can be a new way of acknowledging successes and gives one the incentive to continue to practice healthy habits.

It is important to recognize that a healthy lifestyle—which involves nutrition, exercise, assertiveness, and boundaries—is a life-long goal and not a one-time deal.  Remember, you are worth the time and energy it takes to make healthy changes and Three Health is here to help!

By Marlene Sexton, LMFT

Posted in Blog Posts

Yes, You can use your Insurance

“Can I use my insurance?”

This is often the first question a patient will ask when seeking out medical care. And we know why. We all spend a lot of our own money on health insurance. We want you to be able to use your health insurance to reduce any of your possible medical expenses. As State of Washington, Department of Health licensed professionals, we are one of the few weight loss practices where you can use your health insurance benefits. 

Year after year we all pay higher monthly premiums, higher co-pays, and are seeing high deductibles—commonly $2,000+. Many of us can’t afford to go to the doctor. The whole system feels, well, broken.

If one does get sick and has to visit the doctor, usually for a prescription, the process starts with fewer choices for care. And there will be a co-pay. And then another bill from your doctor for the balance that the insurance company didn’t pay. And to make it even worse, If we haven’t met our deductible the bill will be for the entire amount. Ouch. 

Here’s how we, the medical providers, feel about insurance: 

We often wait up to six months to get paid a small percentage of what we submitted for payment months earlier. In the meantime, we must pay staff, rent, taxes, insurances, and utilities. We actually hire extra staff whose sole purpose is to try to get paid so that we can keep our doors open. Guess who ends up paying for all this? As with any businesses, one way or the other, it’s you. The consumer. 

A consumer? Yes. A consumer of healthcare. But, in the traditional insurance model, the consumer has little or no way to participate in choices or to understand what they’re really paying for.

We would like to change that.  

“So, can I use my Insurance?”   

With Three Health you can. Just a little differently than you’ve done in the past. We use a cash pay model. Which simply means you pay for our services when rendered. But in this model, you file the claim with your insurance company, and you get reimbursed directly. 

We provide you with a ‘super bill’ with the very same CPT coding that we would submit to your insurance company. We assist you in submitting the super bill to your insurance company for reimbursement.

Here is how you will come out ahead with the cash pay model.

Credit. As a fully accredited healthcare provider, claims can be applied to your out-of-network deductibles.

Tax Savings. You can use your HSA account to access tax-free funds dedicated to general healthcare services. 

Lower Costs. By eliminating extra costs to our practice we can package our services to you for less money. 

No co-pays. You will not be asked for a co-pay every time you you have an appointment with us. Remember, co-pays do not apply to your deductibles with the health insurance company. They are cash out of your pocket.

Telemedicine. This is a big one. We have the secure technology in place to provide you with expert care via the internet. This saves time. A lot of time. Time you’d normally spend getting here. Time in our waiting area. Time with the provider. And time to get back home.  

Time. We can give you, the patient, more face-to-face time. For the health insurance model to be financially viable, one medical provider needs to see 30 patients a day on average. That’s about four to six minutes per patient. That’s not good for anyone. Your provider should take the time to listen to you, answer questions, and make you feel like a person. Not a commodity.

Discounts. We offer our on-going cash-pay patients discounts for our services, biometric testing, and products. We can do this when we don’t have to wait month after month for single visits billed to the insurance company to be reimbursed. 

So, in addition to great care, we’ve created a model based on many years of experience and innovative thinking where you, the consumer, actually come out ahead for a change.

Questions? Just ask. Truly, we are in this together. 

Call us at 425-606-0022 for more information.

By Bradley Butterfield, LMHCA

The Team at Three Health