Pediatrics

Hello to the OSFM community. We hope you're having a summer full of sun, fun and time outdoors! Here's some summer news from the clinic. Mental health offerings pediatric mental health mind/ body medicine, biofeedback craniosacral therapy Dispensary and Lab information Online dispensary update B vitamin interference with lab testing Pharmacy recommendations Function medicine lab testing Clinical updates and offerings New mammogram and slightly older colon cancer screening guidelines Cardiometabolic group class coming soon Smoke safety repost 2023 dirty dozen and clean 13 has arrived! Practice news Yoga space rental Alexandra Owen is joining the practice! Summer is a great time for visits MENTAL HEALTH SUPPORT The team at OSFM has noticed a distinct uptick in visits related to mental health in the past few years, and we'd like to share some of the ways we can help if you or your child/ teen is struggling. First, all of our doctors are well versed in integrative approaches to mental health care, including diagnosis, lifestyle medicine, nutrition, herbal and nutrient supplementation as well as prescribing medications. In addition we have a few specific approaches that you might find helpful. Dr. Short is back at OSFM and seeing patients virtually for: Holistic mental health support; including medication/supplement management Caregiver support for common childhood concerns and challenges Adolescent/Teen guidance for depression, anxiety and other mood disorders Acute medical visits when appropriate for telemedicine Dr. Short is offering mental health visits based on the FAST programs developed by Seattle Children's. These are modules/sessions (based on a variety of evidence based techniques such as CBT, ACT, DBT, etc.) that caregivers work through with in session to address issues (in their child's behavior) from anxiety, depression, early childhood concerns which include- managing tantrums, "big feelings", not listening, to caregiver self care, etc. Dr. Short teaches tools and strategies to families – These skills can benefit most families regardless of symptoms. For early childhood they are foundation skills to build relationships. Parenting is hard. and Dr. Short wants to support caregivers through these unique stages. Many of you know Dr. Nassim. She's been offering Mind-Body Medicine sessions . This approach is exploratory. T hrough this type of medicine we teach people about the connection between mind and body, and how to regulate their stress response. Through this practice, we ultimately become more aware and less reactive to our environments. This allows us to respond to our world in ways that align with what we value and how we want to live and show up in the world. The modalities we utilize are Acceptance and Commitment Therapy, Progressive Muscle Relaxation, Autogenics, Functional Breathing Techniques, Meditation, and Biofeedback (coming soon!) Craniosacral Osteopathic Manipulative Technique with Dr. McDanie l is another way to approach both physical and mental health concerns by working with the fluid, bones, fascia to reset and restore free movement and balance. DISPENSARY AND PHARMACY INFORMATION Fullscript : We encourage you to purchase your medical supplements from our reputable online resource rather than larger online retailers, as there is no guarantee of freshness or quality of ingredients. There have been numerous studies that show products’ contents are not reflected accurately on the facts label often. By purchasing through our online store, you can trust that you're getting the best quality supplements available and in the process support your local primary care naturopathic clinic. Link https://us.fullscript.com/welcome/oneskyfamilymedicine https://www.verywellhealth.com/safety-of-amazon-supplements-6500961 Finding a Pharmacy. Many of you used to use Pharmaca as your pharmacy of choice, and know that it was bought by Medly in 2021. Medley filed for bankrupcy shortly thereafter and the company was bought by Walgreens. All prescriptions were automatically transferred to Walgreens after the purchase. We've had many requests for pharmacy recommendations since this happened, particularly as people learned of Walgreen's decision not to stock medications used for abortion care in many states. Here are some local pharmacies you might try if you're looking for a new one Katterman's Pharmacy on Sandpoint Madison Park Pharmacy and Wellness Center in Madison Valley Ostrom's in Kenmore on Bothell Way Bob Johnson's Pharmacy on 85 th NW in Greenwood LAB TESTING TIDBITS Many people don't know that taking high doses of Biotin can interfere with lab test results , especially thyroid results. If you're taking high dose Biotin, which often happens with hair and nail formulas or high potency B complex supplements, make sure to discontinue 2 days before your lab tests to get an accurate result. We're excited to announce that our functional medicine testing services are now available via telemedicine , allowing you to optimize your health from the comfort of your own home. Our functional medicine testing approach looks at the underlying factors contributing to your health concerns, such as nutrient deficiencies, hormonal imbalances, and gut dysbiosis, cardiometabolic dysfunction and food allergy/ intolerance. By identifying these root causes, we can provide personalized treatment that can really make a difference in your progress moving toward health. Talk to your doctor if you're interested in learning more about functional medicine testing. CLINICAL UPDATES Have you heard that the US Preventive Services Task Force has announced new mammogram screening guidelines ? The new guideline suggests beginning mammograms at age 40 and doing them every other year until 74 . And while we're updating you on screening guidelines... in 2021 the colorectal cancer screening guideline age at first screening changed from 50 to 45. Heads up that we're planning to roll out a very cool cardiometabolic group this fall . Stay tuned or let us know if you're interested- this class/ group visit will be great for people with high blood pressure, high cholesterol, blood sugar dysregulation, or strong family histories of these things. Dr. Mary Barrett will be conducting the group online and we'll let you know more soon. What a blessedly clear and beautiful summer we're having! Each day I wake up feeling such gratitude for the clear air, the and the gorgeous green all around us. As you know, this isn't the case in much of the country which is experiencing the heat and smoke we've had here in recent years. In the spirit of preparation and in support of those who are in those hot smoky areas, we've udated our blogpost on coping with smoke season . The Environmental Working Group has releasted their 2023 Dirty Dozen and Clean 15 - a great resource for deciding where to put your energy and finances when choosing produce. Check it out, they even have an app! PRACTICE NEWS Are you or someone you know looking for a yoga space rental ? A yoga space is available for rent in our lower floor. We would love to see the space used within the community to promote wellness and good in the world. The space is ideal for yoga classes, meditation sessions, community acupuncture, and wellness retreats. We welcome someone who shares our vision of promoting health and wellness to the community. Contact us today to learn more about our yoga space rental options and to schedule a tour of the studio. We look forward to hearing from you! We're thrilled to announce that Dr. Owen will be joining OSFM permanently after she completes her residency in the fall. Dr. Owen will continue to offer comprehensive naturopathic primary care including pediatrics, offering frenotomy services and gender affirming care for all ages. Welcome Dr. Owen! Summer scheduling: Summer is the perfect time to take care of any medical needs that may have been put off. Whether it's getting a sports physical, annual exam, or catching up on immunizations, we are here to help you stay on top of your health this summer. Don't wait until the busy back to school and fall sick season to take care of your medical needs. We look forward to helping you stay healthy and happy this summer and beyond!

Preparing for fire season has become a critical part of our work of preventive medicine. If you haven't already done so, we'd like to encourage you to make sure that you have access to a place that stays cool and has clean air. We'll give suggestions here to help you create that in your own home, and nutritional and environmental advice to support you in times of heat and smoke. First, it’s important to keep an eye on the air quality when planning outings. See resources at the end of this article for keeping informed of the daily air quality. Avoid exertion when air quality is poor, or you are feeling symptoms such as eye irritation nasal congestion sore throat chest tightness cough shortness of breath headache If you are experiencing these symptoms and they are significant, make sure to see your doctor. Find or create an indoor oasis. If possible, use a HEPA filter and an air conditioner (one which does not pull air from outside) along with closed windows to create a safe space to be inside. Consider inviting friends or family over who don’t have access to AC and a good filter. Kids, pregnant people, elders and people with asthma or other heart/ lung conditions are at highest risk for significant breathing problems due to the pollution we are currently experiencing. If you can’t arrange a cleaner air space at home, consider spending the day at the mall or going to a movie. Avoid breathing campfire or barbecue smoke, burning incense or indoor candles, using perfumes or chemical cleaners. Voluntary smoking or vaping will be a further challenge to your lungs. Here are a few additional tips for keeping lungs healthy. If you know the principles of an anti-inflammatory diet… use them! Eat a rainbow of fresh fruits and vegetables. Raw and lightly cooked are especially useful. Emphasize berries Drink plenty of water, black or green tea. During this time, I suggest you take your weight in pounds, divide it by 2 and drink that many ounces daily. For example, a 150 lb person would drink 75 oz per day Choose healthy fish, grass fed meat and dairy products, pasture raised eggs rather than grain fed animal products Grass fed animals and animal products have a fatty acid profile that decreases, rather than increasing, inflammation Limit your vices. Alcohol and sugar stir inflammation. Good news though… dark chocolate is anti-inflammatory, and good medicine! We use curcumin, NAC and a wide variety of other herbs and nutrients to support lung function as well. Feel free to schedule a visit if you’d like an individualized plan. ADDITIONAL RESOURCES: The Department of Health’s Website is an excellent resource for more information about the fires, symptoms to watch for and general resources. Here’s a link to the EPA’s AirNow site, with location specific air quality information. Several of the weather apps now have this information as part of the daily forecast as well. Build your own airfilter from a box fan and MERV 13 filters Where to Play when it's Smoky in Seattle by ParentMap King County information on preparing for Wildfire Smoke https://envmedicine.com/wp-content/uploads/2023/08/NAEM-Wildfire-Patient-Handout-Final.pdf

We're so happy to celebrate this almost-Spring with you! We're also thrilled to announce that OSFM is back to being fully-staffed. Thank you all for your patience as we navigated our lean season. As it turns out, we are now more well-staffed than ever, with 2 docs offering telemedicine in addition to our in-house providers. In this season's newsletter, we'll cover - Provider updates - Expanded telehealth services, and how to schedule them online - Apple Health, Molina and Coordinated Care- Please select your PCP before your visit - Hearing Screening - Masking Policy update - New online dispensary - Dr. McDaniel is offering Craniosacral therapy - Celebrating the return of the WATER COOLER! Pro Tip on scheduling telehealth visits. You'll need to select the visit type SECURE ONLINE VIDEO VISIT and may need to click the button that says ONLINE as well, or at least shouldn't select IN PERSON. In addition, if you want to view the schedules for all our providers you may need to select the blue button in the middle of the screen that let's you see the schedules of providers you've never seen included in your search. Remember you can also call the clinic if you need a same day appointment and your doctor doesn't appear to have a visit available- we hide some appointments for urgent care needs. We announced recently that Dr. Whitaker had her baby Levon, and now she's returned to practice . As always she's available for full spectrum naturopathic primary care including pediatrics. Welcome back Dr. Whitaker and Congratulations! Dr. Short is also returning to OSFM. This last year has brought a new chapter to her family life and she is now only able to see patients via telemedicine. She will primarily focus on women and children’s mental health, in addition to providing parenting support for caregivers. Dr. Short has a long-standing interest in assisting her patients’ in finding mental and emotional balance, and a desire to help patients feel more whole. She is able to provide both natural and more conventional treatments depending on her patient's needs. She looks forward to reconnecting with former patients and supporting new families too. For those of you with Apple Health - we have an important message and task for you! Molina and Coordinated Care both require that you choose a Primary Care Provider for your plan. That PCP must be your doctor at OSFM, or your visit may not be covered. It's okay (not ideal, but okay) if you've selected another doctor in the practice, but an OSFM physician must be selected before your visit is billed or it may not be covered at all. In that case you'll be billed for your visit - and we hope to avoid that! The process is fairly quick, we're seeing about 5-15 minutes for people to make the change. You can do this by: Logging onto your app and select a PCP right there, very quick if you have the app and account Calling the telephone number on your card and speak to someone- they can make a same day change this has mostly been surprisingly quick and easy for folks For Apple Health clients, you do not have to make these changes during open enrollment, you can do it anytime. You can also change from another Apple Health plan to one we take, which are Molina and Coordinated Care. OSFM now has hearing screening equipment. We are able to do routine hearing screens for kids starting at 4 years of age and every couple of years through elementary school. The screener works for adults as well. Feel free to ask at your next visit if you would like a hearing screen. Masking Update. On April 3, Washington State will no longer require masks in healhcare settings, long term care facilities and correctional facilities. This is BIG news and we expect, and even welcome, some awkwardness as we move into this new phase. We have been talking to you all about this often, so we know that many of you are no longer masking and will be thrilled with the change. We also know that many of you are still quite concerned about COVID and other infections and will not be excited about this change at all. The OSFM staff and physicians have been discussing how to ease this transition, managing our own sense of risk as well as meeting you in yours. We'll likely stop wearing masks during well visits as long as everyone is well, but will likely revert to wearing a mask for many reasons day to day. Please DO wear a mask if you or anyone in your household is sick Please know that we welcome you to ask us to wear a mask during your visit! We're quite used to them, and it will not be a hardship for us at all! If you're more comfortable with your provider masked, just ask For more information about this change, see this announcement from the Department of Health https://doh.wa.gov/newsroom/masking-requirements-healthcare-long-term-care-and-correctional-facilities-end-april-3 Online Dispensary . Many of you have used Emerson Ecologics or Wellevate for ordering dispensary items over the years. We're switching to a company called FullScript . One reason is that we can access it from within our EHR program and send you specific recommendations. We're not attached to you buying any supplements from us in-house or online, although we do appreciate the support when you do. We ARE attached you having our specific recommendations. So you may get a link to this new dispensary during one of your visits or by email afterwards. And let us know if you haven't received the information and would like it- we'll get you set up. Dr. Tracy McDaniel is now offering CranioSacral Therapy and Osteopathic Cranial Techniques - you can sign up for a full 50 minute session if you'd like. She's also incorporating some of this work into visits as treatment for certain medical conditions. Please call the clinic to schedule, as we don't have this set up on the portal yet. When this work is billed to insurance it often comes out of the same "bucket" as chiropractic visits and can be billed when medically necessary. Cash visits are $175 and do not need to have a diagnosis to justify the treatment. She's looking forward to offering treatments to infants in the future. For information about craniosacral therapy https://www.upledger.com/therapies/ And possibly the MOST EXCITING news to share... our WATER COOLER and TEA STATION are back online. Woo Hoo!

I am incredibly passionate about starting kids off early with a nutrient-dense, healthy diet. Helping your child adopt these habits from the time they start eating solid foods will make them far more likely to persist through adolescence and adulthood and will yield dividends for life. The early years of a child’s life are very important for later health and development. One of the main reasons is how fast the brain grows starting before birth and continuing into early childhood. A clean (chemical free), nutrient dense diet is important for nourishing this rapid brain develop. The first two years are critical in developing health habits as children start becoming more restrictive by age 2. Breast milk is such a lovely “food” for kids so that I do not worry about nutrient component in the first year of life and yet if we wait to start variety after 1, kids are not receptive to it. It drives me crazy to watch toddlers become picky eaters, I find some comfort when I read that it is evolutionary - that kids keep themselves safe by not eating as much. I am always looking for the “perfect book” to help parents get started. I have yet to find one that I think is the one and only food bible so I am starting one! My food philosophy can be summarized by a few simple principles outlined in the list below. It is to strive for a diet that: 1. Is simple, based in whole “real” foods and includes lots of vegetables 2. Emphasizes local, seasonal, organic foods 3. Avoids the Dirty Dozen 4. Is high on variety, nutrient-dense foods and healthy fats 5. Avoids artificial colors, dyes, preservatives, trans fats, high fructose corn syrup, and artificial sweeteners WHOLE FOODS: I love 2 lists that help determine if a food is a “whole food” Cynthia Lair’s list of questions to determine if a food is a “whole food” Questions to ask before buying groceries: How many ingredients does the food have? If it’s a whole food, it has one ingredient. What has been done to it since harvesting? The less the better. Read the ingredient list on nutrition labels, and if you can’t pronounce it, don’t eat it Is this food part of a food or the whole thing? For example, orange juice is only a portion of the whole food, an orange is a whole food. It takes approximately 10 oranges to make an 8oz glass of juice. The orange is better for you because it contains fiber, which slows the absorption of sugar. We would never eat 10 oranges in one sitting, nor does our body easily digest the juice of 10 oranges at one sitting Can you imagine it growing? You can picture a broccoli plant or an apple tree, but a river of diet coke? Quiz revised from Feeding the Whole Family by Cynthia Lair Michael Pollen’s “Food Rules” Eat Real Food Not too Much Mostly Plants DIRTY DOZEN : Brains are uniquely vulnerable during their accelerated development as a young child. I therefore think it is important to have clean foods without herbicides and pesticides. The Environmental Working Group puts out a list of the “dirty dozen.” These foods have the highest amount of residue left behind during tests by the US Department of Agriculture and FDA. It is extra important to choose organic when eating these foods. If you need to save money or can’t find organic choices, choose the foods with the lowest levels of pesticides, “clean fifteen.” A printable list and iphone application for the Dirty Dozen and the Clean Fifteen is available at https://www.ewg.org/foodnews/dirty-dozen.php SIMPLE: Baby food does not need to be different than your own. I support family meals with everyone eating together. If the family is not eating ideally than this is an opportunity to revamp the whole family’s food. Babies will be less picky if from day 1 you start with your food. Keep it simple. I don’t love the long list of rules that come along with solid food introduction. I think solid food introduction should be as simple as offering a baby what the family is eating in a baby friendly way. I want parents to focus on foods to include in the diet rather than what to avoid. The only food not safe to eat in the first year of life is honey. Foods to focus on include: fruit, vegetables, oils/ fats and protein. If the family is not eating what a baby can, take this an opportunity to revamp the family’s food. VARIETY: Developmentally it is commonly seen that food variety decreases after 12 months. Goal is to have as much color, variety and texture prior to 12 months so that as a child becomes more selective you are left with some variety. EAT HIGH QUALITY FAT: As long as it is a whole food, do not be afraid of fats. Fats are critical for every cell in our body – especially the fast development brains of children. Fats make up the wall around each cell and are crucial for bone health, brain health, mood, immunity and satiety. Eating fat does not make one fat. Eating fat is crucial for our health and satiety. Children need adequate amounts of health high quality fats. Great sources of fat- fish, free range grass-fed meats, butter, olive oil, coconuts, walnuts, avocados, sesame oil, eggs, nuts and seeds. GUT HEALTH: Digestion is the foundation of health. We are not just what we eat, we are what we absorb and digest. Even with the best diet, if the body is unable to absorb nutrients in the digestive system- health suffers. Having the right gut bacteria is a cornerstone to health. Probiotics feed off fruits and vegetables and bad bacteria live off of sugar. • Foods to include in the diet for a healthy gut biome: kefir, miso, kimchi, krauts, tamari, apple cider vinegar • Foods/ lifestyle factors that damage probiotics: anti-bacterial soap, antibiotic medication, genetically modified foods, artificial sweeteners, chlorinated water. VEGETABLES: Vegetables are often the first food kids will start avoiding as a toddler. My advice is to have at least 10 ways to get green vegetables into their life prior to one year so that if you lose most of them you are still left with something! I recommend introducing the following vegetables before one year of age: 1. Pesto. 2. Green smoothie 3. Seaweed 4. Frittata 5. Kitchari 6. Cauliflower in all forms- cauli rice, cauli pizza crust, cauli gnocchi MEAL PLANNING: My goal for you is for you to find 3 easy, simple meals for your whole family before one year of life. These are some of my favorite nutrient dense recipes that I have found even the pickiest of eaters will often keep these yummies as part of their palate. Breakfast: 1. Oatmeal- packed with additional fat, nuts, seeds and berries. 2. Nutrient dense baked good (pumpkin muffins, zucchini bread, etc) 3. Frittata with vegetables and herbs 4. Smoothie that includes: • 1 handful Vegetables (leafy greens, spinach, cauliflower rice, beets) • 1-2 cups fruit • Fat (nuts, seeds, full fat canned coconut milk) • Protein (full fat plain yogurt, nuts, protein powder) Lunch/ Dinner: 1. Sweet potato black bean spinach quesadilla 2. Sardine olive tapenade 3. Cauliflower pizza crust with pesto 4. Kitchari 5. Red Sauce loaded with vegetables 6. “patty recipes” a fun way to combine Protein + carb + veggies in a kid friendly way. Simple version would be a hamburger patty with shredded carrots and zucchini Soups: start early with soups to have this vegetable rich option for your child. Easy weekly meal plan formula: 1 crockpot meal + 1 fish meal + 2 vegetarian + 1 poultry + 1 red meat + 1 leftovers Easy main meal plan formula: Pick a Protein, Grab 2 veggies, Flavor with some Fat. Optional Carb PUREE IDEAS FOR 6-9 MONTHS: 1. pumpkin + fig + hemp/ Coconut/ olive oil 2. sardines + capers 3. root veggies + ghee 4. chicken thighs + cauliflower + ghee 5. Salmon + sweet potato 6. lamb + cauliflower + apricot 7. carrots + apple + beef BOOK REVIEW: In my search for the perfect food introduction book I have read quite a few and I thought it would be helpful to walk you through what I do and do not like about ones that I have read. Nourished Beginnings Baby Food By Renee Kohley I love this one! Great variety with a focus on nutrient density. Aesthetically pleasing to flip through- like art work! Does not include allergens so if you are trying to introduce allergens prior to 6 months as an opportunity to lower risk of allergies later in life this one does not help with that. High quality organ meats are an incredible super food for babies but this is not a common food for many families. Because I want baby food to feel simple to wrap one’s mind around an entire food group- I don’t want to create pressure of stress for you, but an awareness of the health benefits if it’s feasible for your family. Super Nutrition for Babies I absolutely love the food philosophy in this book! … "pathway to optimal health for us all is to eat a healthy diet,… “the younger the child when you begin optimizing his/her diet the greater the tools he or she will have to succeed, … if you supply the body with the correct nutrients it can do wonderful things.” I think their differentiation of food categories is brilliant- crap, okay, pure and super power foods. A lovely book that I highly recommend but I do find the book feels a bit elitist. I love the idea of starting babies with salmon “roe”. What a nutrient dense lovely food… until you check the price! I don’t want anyone to feel they need to spend a $100 on their baby’s first food Baby Led weaning I love baby led weaning for development hands on experience for kids. I have found in my practice that babies that are 100% baby led are pickier eaters than babies offered a larger variety. There is a slim chance your baby will pick up a puree of beets, spinach, pumpkin, cottage cheese combination! I typically recommend a combination of both puree and baby led. I think puree is a more efficient way to get nutrient and flavor density and baby led is great for development. Megan Garzia online course Lovely paleo food introduction focused on nutrient density. Nourishing Meals Cookbook and Whole Life Nutrition Cookbook Love these recipes. Everything I have ever tried from these are delicious. I recommend reading the food philosophy chapter like a novel. Ahhh… I very much agree with their food philosophy. Greens 24:7 by Jessica Nadel for green veggie ideas Some beautiful ideas to add greens to the whole families diet! Spirulina added to granola- brilliant! Feeding the Whole Family by Cynthia Lair I have to respect the maiden of whole foods cooking in the Pacific Northwest! She has inspired so many after her- Tom Malterre, Jennifer Adler. A beautiful woman with great family recipes with a baby option on the bottom of each recipe. The Simply Real Health's Baby Food Files: https://simplyrealhealth.com/simply-real-baby-the-baby-food-files-are-now-here/ Sarah is an inspiration to me! I love her food philosophy, tips on life and food. I find her recipes simple, delicious and perfect for the whole family. Check our her new "Baby Files" PDF on food introduction- amazing as is everything she touches! Michael Pollen’s Food Rules A coffee table stable for all! Feeding Littles online course: Still needing to watch but have heard great things! Solid Starts . Parents rave about this online and instagram resource RECIPE LINKS I am the type of person that absolutely cannot follow a recipe. I change things constantly but I love these as nspirational starting places • Oatmeal (sugar and dairy optional) https://www.thespruceeats.com/overnight-chia-seed-oatmeal-4151799 • Baked good with veggies: https://simplyrealhealth.com/noahs-blueberry-morning-baby-cake/ https://nomnompaleo.com/paleo-pumpkin-muffins • Eggs with veggies: https://www.theforestfeast.com/blog/2017/5/3/mothers-day-brunch https://thenaturalnurturer.com/crustless-potato-asparagus-quiche/ https://www.createkidsclub.com/egg-frittata/#tasty-recipes-8780 • Smoothies: http://www.nourishingmeals.com/2014/10/green-smoothie-recipe-for-babies-and.html http://www.nourishingmeals.com/2012/08/peach-ginger-mint-green-smoothie.html http://www.nourishingmeals.com/2009/09/super-antioxidant-smoothie.html • Kitchari: for the 4-6 cups of veggies my favorite recommendations: onion, celery, greens and cauliflower. https://www.elephantjournal.com/2013/05/my-favorite-kitchari-recipe/ http://www.nourishingmeals.com/2009/09/summer-vegetable-kitcheree.html Cauliflower https://www.superhealthykids.com/recipes/cheesy-cauliflower-dippers/ https://eatcaulipower.com https://www.floraandvino.com/creamy-stovetop-cauliflower-oats/ • Soups: http://www.nourishingmeals.com/2010/02/cream-of-broccoli-soup-dairy-free.html https://www.ilovevegan.com/creamy-vegan-broccoli-soup/ • Red sauce with Veggies: https://simplyrealhealth.com/social-distancing-meal-veggie-puttenesca/ • Patty recipes: https://wholelifenutrition.net/articles/recipes/sunny-sunflower-seed-burgers (double the parsley and carrots) http://www.nourishingmeals.com/2010/01/quinoa-salmon-burgers-gluten-free-egg.html (double the green herbs) http://www.nourishingmeals.com/2010/02/spicy-thai-mung-bean-burgers.html (double the green herbs and leave out the pepper)

Hello dear OSFM family. Let's try this again! We heard from many of you that you didn't receive our recent newsletter. I thought I'd save you all some notifications and just send it by text... Alas, here I am offering you our NEWS once again, in both text and email. This version CONTAINS THE LINK TO SIGN UP FOR FALL PHOTOS, so make sure to click in even if you have already read the rest! OSFM is ending our contract with Cigna/ ASH, and are temorarily not taking Molina/ Ambetter/ Coordinated care A reminder that we are short staffed this fall/ early winter We're thrilled to announce the arrival of a very special NEW HUMAN! A naturopathic twist on the love of all things Pumpkin Non-covered services fee - frequently asked questions Fall photo shoot with Alec Mills just around the corner- first-timers SIGN UP HERE One Sky Family Medicine will no longer contract with Cigna/American Specialty Health Network as of January 1, 2023, and are temporarily out of network with Molina and Ambetter/ Coordinated Care. We are in-network with: Regence/ Uniform Premera Blue Cross Lifewise First Choice Health Network Kaiser (PPO plan only) We're currently having difficulty with both Molina Healthcare and Ambetter Coordinated Care. We expect to be in-network with both again eventually, but for now they are denying coverage for all visits (except for existing patients of Dr. Gray who have Molina who will continue to have their visits covered) We'll be writing off charges for this issue through 10/10/22. However, until those contracts are once again active we'll need to collect cash for those services. You can find our cash prices here on the website. If you have out-of-network coverage, we'll be happy to give you a detailed receipt at the time of service, please make sure to ask while you're here because the standard electronic version is not sufficient for reimbursement. We realize that scheduling is a bit harder than usual , and want you to know we're working hard to keep the schedule running smoothly and keep visit wait times short. Our medical team is short several doctors right now, which we expect to be the case for a bit longer but not permanently! We've recently hired a new medical assistant, and look forward to you meeting Gal, and and excited to bring on Dr. Nassim Huertas as our first year Natruopathic Reisdent. We'll have their bio's up on the website soon. We'd love to welcome Levon Whitaker Eves earthside! Dr. Whitaker is now officially on leave and will be returning February 2023. Please join us in congratulating her and her family on their new arrival. We wanted to share one of our favorite treatments for constipation . A beloved naturopathic teacher, herbalist, midwife and physician Mary Bove, ND taught us this one in school. So simple... so effective, and perfect for Autumn! Hemp/Pumpkin/ Fig puree Blend 1 can pumpkin puree + 10 figs (soaked overnight) Add 1 tsp hemp oil to 2 TBS of puree take 2 TBS 2-3 x/ daily by mouth Non-Covered Services Program A reminder for those of you who have opted out of the monthly Non-Covered Services Fee by selecting the per-visit option. If you need forms, recommendations or other provider support and it's been more than 2 weeks since you were last in, please schedule a visit and we'll be happy to take care of those things for you. For detailed information on the program, visit out Non-Covered Services Page It's nearly time for our yearly Free family portrait event with our friend Alec of Alec Mills Photography . Alec has photographed 30 One sky families each fall for many years. This year she will prioritize people/ families who have not snagged an appointment in past years. Get a feel for her work by checking out some favorites from last year's event -- https://www.alecmillsphotography.com/Blog/OneSky-Family-MedicineMiniPortraitEvent . All One Sky families receive $100 Full session packages if they desire to book outside of this free portrait event. Once again, here's the link to SIGN UP May the cool fall days, the clear crisp air and the rhythm of fall be rejuvenating for you all!

Ooooooh! It's so wonderful to be able to introduce you all to baby Levon being snuggled by mama Dr. Whitaker and big brother Jack. Congratulations to this beautiful family!

With the school year starting and the weather cooling, we wanted to share some updates from the OSFM team as we cross over into Autumn! OSFM is ending our contract with Cigna/ ASH October 3, 2022 flu/ bivalent COVID booster clinic A reminder that we are short staffed this fall/ early winter Non-covered services fee - frequently asked questions Fall photo shoot with Alec Mills just around the corner One Sky Family Medicine will no longer contract with Cigna/American Specialty Health Network as of January 1, 2023 . We are in-network with Regence, Premera, Lifewise, First Choice Health Network/ Kaiser PPO plans and Molina Healthcare. Please see our cash prices listed on the website, and check your out of network benefits if you'd like to submit for reimbursement. We'll be happy to give you a detailed receipt at the time of service, please make sure to ask while you're here because the standard electronic version is not sufficient for reimbursement. Monday October 3 will be our 2022 Flu/ COVID vaccine clinic . You can schedule either vaccine online by choosing the COVID vaccine visit type and noting whether you'd like a COVID booster, flu or both. It's fine to schedule a flu vaccine only, but you'll still need to select the COVID vaccine visit type to do so. Just a glitch in the scheduling system. PRO TIP: If you cannot see any appointments available on the portal, click the long blue bar in the middle of the page that says "Discover other providers from One Sky Family Medicine" flu vaccine will be available for adults and children 6 months + we'll be offering bivalent COVID boosters for adults and children 12 years +, as long as it's been 2 months + since finishing primary series or having most recent booster. SCHEDULE NOW We realize that scheduling is a bit harder than usual , and want you to know we're working hard to keep the schedule running smoothly and keep visit wait times short. Our medical team is short several doctors right now, which we expect to be the case for a bit longer but not permanently! OSFM is actively in search of a new doctor. We're excited to be bringing on our next Naturopathic Resident in 2 weeks and also have a wonderful new medical assistant, Gal. We'll have their bio's up on the website soon. Dr. Whitaker will be out on parental leave beginning in mid-October . She'll be available for telemedicine visits through mid-October, you can schedule online and select Secure Online Video Visit as the appointment type, or call the clinic and we'll help you schedule an appointment. Non-Covered Services Program A reminder for those of you who have opted out of the monthly Non-Covered Services Fee by selecting the per-visit option. If you need forms, recommendations or other provider support and it's been more than 2 weeks since you were last in, please schedule a visit and we'll be happy to take care of those things for you. For detailed information on the program, visit out Non-Covered Services Page It's nearly time for our yearly Free family portrait event with our friend Alec of Alec Mills Photography . Keep your eye out for our booking announcement coming soon. Alec has photographed 30 One sky families each fall for many years. This year she will prioritize people/ families who have not snagged an appointment in past years. Get a feel for her work by checking out some favorites from last year's event -- https://www.alecmillsphotography.com/Blog/OneSky-Family-MedicineMiniPortraitEvent . All One Sky families receive $100 Full session packages if they desire to book outside of this free portrait event. May the cool fall days, the clear crisp air and the rhythm of fall be rejuvenating for you all!

Are you a licensed Naturopathic Physician who LOVES primary care, pediatrics, women’s health, fertility, and preconception? Gyn care and menopause ? Serving the LGBTQIA+ population? If so, we would love to talk to you. OSFM is a busy, fun, mixed insurance-based/ cash integrative primary care practice in the Ravenna neighborhood of north Seattle . We see patients in-person and by telehealth and use AthenaOne EHR . OSFM is about to have 2 doctors out on medical leave . We have been considering hiring our next doctor for some time, and this is the nudge we needed to begin the process. We are open to the following possibilities: Permanent full-time, employment Permanent part-time on-site employment Part-time remote employment- telemedicine and after hours on-call coverage (WA license required) Locum tenens- 6-12 months beginning in September 2022 We care deeply about working with fabulous humans and doctors who excel in primary care and preventive medicine as well as their specific areas of interest . We are a collaborative team, have a strong sense of community, have a wonderful patient population, and are committed to group learning and development. Our ideal candidate is someone who: is a creative and nimble thinker, a problem solver will step into the group and help shape the practice for the better is passionate about Naturopathic Medicine and has a deep relationship to the Principles of Naturopathic Medicine loves working with people- including kids and babies is willing to work with families all along the vaccine-choice spectrum, from full CDC schedule to declining all vaccines, with patience and respect practices medicine with Heart We would be thrilled to work with a well-established and experienced physician who has a deep understanding of pediatrics and whole family primary care . We would also consider a new physician, especially if they have completed a 2-year residency and have pediatric experience . Employment details: OSFM is known for being family-friendly and extremely flexible to help facilitate physician control of work/ life balance . We pay a salary that is calculated quarterly based on productivity . We offer benefits for full-time employees (4+ days of patient care) including health insurance, dental, long term disability insurance, CME allowance, liability insurance . For more information about the practice, please visit our website www.oneskyfamilymedicine.com If you are interested in the position, please send a CV and cover letter to tmcdaniel@oneskyfamilymedicine.com

Hello from your OSFM team on a hot summer evening. We hope you're all well-hydrated, cool enough and have been enjoying our beautiful northwest home this year. As we move into this late summer, we wanted to share some information and clinic updates with you. Back to school forms and physicals COVID 19- we now have Novavax for adults and Pfizer for kids 6 months and older How we'll be providing estimates of cash visits when we're out of network with your insurance Electronic health records and the Cures Act- sharing data with apps, privacy and lab reporting Important staff updates GEARING UP FOR BACK TO SCHOOL SEASON Now is a great time to schedule Well Child Visits, Sports Physicals and vaccine visits . Make sure to bring any forms you need with you to your visit, and please pre-fill the portions you can. If your child is up to date on their physical (within the last year) and you need a vaccine or sports form completed, please fill it out as much as possible and upoad it to the portal if you are on the monthly NCS plan. We'll be happy to fill out those forms by portal. If you are not on the NCS monthly plan, then please schedule a visit and we'll do it then. If you simply need a Certificate of Immunization Status , you can access it through the state website which you can find on our website at https://www.oneskyfamilymedicine.com/immunization-records. Their help line is quite good, so give them a call if you have trouble accessing your records. COVID-19 NEWS AND UPDATES Do you need rapid home COVID tests ? Try asking at the counter of your local pharmacy. Your insurance will cover 8 tests per family per month. For more information, visit https://doh.wa.gov/emergencies/covid-19/testing-covid-19. You can also order free tests from COVIDtests.gov​​​​ OSFM now has Novavax, a non-mRNA based COVID-19 vaccine . If you are 18 years or older, have never had a COVID vaccine or are allergic to the mRNA vaccine components, we'll be happy to schedule you for this 2 shot series. Please call the clinic to schedule, as we are only giving them at specific times until we have more supply- if you schedule online, we may not have vaccine for you when you arrive. We also now have COVID vaccine for all children 6 months and older . We currently carry the Pfizer COVID vaccine for children and Moderna and Pfizer for adults. You can schedule this online by selecting the COVID vaccine visit type. Please remember that masks are still required when you visit the clinic in person. And please make sure to let us know if you are ill before your visit, we often start with a short phone call before bringing people into the clinic so that we know what precautions are necessary. INSURANCE, BILLING AND REGULATIONS UPDATE The Non-Covered Services program has been going well, allowing us to continue to provide administrative and support services that are not billable to insurance. Some of you who have chosen the per-visit option have come to find that you do in fact need more frequent support between visits. If you're finding yourself holding back from asking for support, we suggest you reconsider the monthly option. We were able to work out our credentialing issues with Cigna (American Specialty Health ), at least for the time being. For those of you who have Cigna insurance, you may want to begin a conversation with us about other options moving forward as we're not sure how much longer we'll be contracted with them. There's a lot going on in the regulations pertaining to medical care . One change is the No Surprise Billing Act , which helps protect folks from unexpectedly high medical bills when they didn't know their provider was out of network. We've been directed to send folks an estimate of their visit when we are not in-network with their insurance, so if that is the case for you, you'll be asked to sign an estimate form each time you come for a visit stating that you know that you can see an in-network doctor at a lower cost. We'll send these forms electronically, and you can sign right from your phone or computer. We've also spruced up our website so that findng cash prices is easy! We can't list everything, but have done a thorough job of listing our most common visit types, labs and procedures. Another big change being rolled out is under the 21st Century Cures Act . A main goal is helping people have access to their own medical records, interfacing with apps like apple health and other patient facing tools. You'll begin to notice that your visit notes show up in their entirety rather than just as a summary. That means that you'll see more medical terminology and shorthand which can often be confusing to people who aren't in the medical field. In addition, you will likely begin receiving your own lab results before we've even reviewed them . This will be great in some ways, and potentially problematic in others. For example, many people find it stressful to see abnormal lab results without an explanation. Normal labs may be closed out before we see them, so if your labs were done as a part of a workup of a problem, make sure to schedule your follow up visit so we can continue to explore the cause of your issue. Please know that this change is coming from Congress, and is well intended. If you have questions when you see your results, please schedule a visit and we'll be happy to go over them in detail with you. Lastly, be on the lookout for apps asking you for access to your health data . With your permission, they may pull data from your electronic medical record for use in your chosen applications. OSFM STAFF UPDATES Dr. Kate Short will be out of the office indefinitely to care for a family member who is undergoing medical treatment. We’ve assured her that we will take excellent care of those of you who have been under her care at One Sky Family Medicine. When you call the clinic to schedule your next visit, please call well in advance so that we can discuss your healthcare needs, check insurance compatibility have a bit extra time to help get you on the schedule at a time that works for you. You are also welcome to text Noel using the SpruceHealth app https://spruce.care/oneskyfamilymedicine or send us a message on the patient portal. We understand that this change is sudden, and that many of you have been with Dr. Short for many years. Please know that we’ll do our best to help you land with the right doctor for you and/or your family. Our dear Dr. Lauren Whitaker is having a baby , and will be taking parental leave this fall and early next year. If you'd like to see her before her leave begins we suggest you schedule in August or September. As always, we'll be here to care for you while she's out of the office and will make sure she's up to speed on your health when she returns. Dr. Mary Barret is about to finish her 2 year residency with OSFM and will be moving to Texas, starting her own practice and getting married! We're so lucky that she has agreed to provide telemedicine services for our patients here in WA during her transition out of state. We have a new resident joining the practice as well, stay tuned for an introduction in the fall. We are so excited that Dr. Alexandra Owen will be staying for a second year of residency. This is a lot of staffing change, we wanted to let you know that we'll be doing our best to keep our scheduling running smoothly. It might take a bit longer to get an appointment this fall, and we ask for your patience as we navigate being short staffed. OSFM is conducting a search for another full time naturopathic physician and a medical assistant. Let us know if you know of anyone who would be a great fit!