Spectacular Thoughts
Spectrum Care - Kimmer Collison-Ris, MSN, FNP-BC, WOCN, MS CAM
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Recent Posts

About Nurse Practitioners
Organizing the Disorganized & Forgetful
Defusing Depression & Self-Destruction by Listening
What's a Travel Medicine Visit?
Where To Go For "The Right Care"

Most Popular Posts

What's a Travel Medicine Visit?
Where To Go For "The Right Care"
About Nurse Practitioners
Organizing the Disorganized & Forgetful
Defusing Depression & Self-Destruction by Listening


Medical advice
Mission Minded Thoughts
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Spectacular Thoughts

About Nurse Practitioners

Nurse Practitioners are among the most talented in the healthcare industry. Listening, assessing, collaborating, prescribing, coaching, and designing your health and wellness care is Kimmer's primary focus. NP's bring a blend of holistic health and medicine to each individual they treat. Basing their practice on evidence based medicine, nutrition, patient accountability, mental health and wellness; NP's are able to blend the best of both nursing and medicine. You deserve affordable high quality custom health care.

Although the term "nurse" is their title, don't let that fool you. NP's are qualified as an Advanced Practice Medical Provider to independently assess, diagnose, and prescribe medical treatments to you (unlike regular nurses) in most states. NP's have passed a rigorous National Certification Exam to obtain this privilege and are licensed both at the state and national level.

A  typical Advanced Practice Nurse Practitioner (medical provider) has no less than 10 years of advanced clinical medical practice experience. They will refer you to physician specialists when necessary.

Why not just go to Medical School? Opposed to the current philosophy in the health care system that medicine is built around illness and emergency services; Nurse Practitioners believe that people have their own unique wellness and their treatment should incorporate both wellness and disease models of medical care. Often a person's
illnesses and injuries can be prevented or managed with meds, supplements, diet, and lifestyle management behaviors.

Nurse Practitioners are committed to prevention and treating the underserved. Keeping quality healthcare affordable for everyone is a priority.

The best healthcare combines knowledge of wellness, disease, and lifestyle management to meet the needs of the patients. Prevention, counsel, assessment, and team medicine all contribute to healthy patients. Nurse Practitioner's knowledge of medicine and health & wellness is foundational to their care delivery. This affords you the best in advanced healthcare and medical practice.

Today, schools of Medicine are attempting to adopt and incorporate these same philosophiesof care into their medical practices.

Organizing the Disorganized & Forgetful

Do you get frustrated with your kids because they "don't listen" or "remember to do important things"?

Have you told them over and over to do something but they are forgetful?
Have you set up routines at your home?

Is there a homework area and daily homework times?
Is there a place to place important things?
Are the electronics, gadgets, and Facebook access set aside so they can focus?
Do they have routine chores?
Are they eating healthy food throughout the day, or left to their own fast food desires?
Do they live on energy drinks, coffee, or pop?
Do they exercise daily?
Do they go to bed and wake up at generally scheduled times?
Is the internet, video games, TV, or texting taking up the majority of their attention?

If you feel frustrated and worn out, you are not alone.

Most parents are so overwhelmed with the busyness of life that by the time they get to the early evening, the last thing they feel like doing is struggling with their kids. Modern society has virtually created unfocused/disorganized kids and teens.

You can see it everywhere.
Are you the parent who takes their kids out to dinner in the car only to note that instead of having conversations about your day, its monopolized by their Ipod or cell phone?

Do you think its normal to give your young child an electronic gadget to distract them  while you shop, drive in the car, or eat a meal? When you go out to dinner with your kids do they spend the majority of their time wrapped up on the cell phone with a game, texting, or checking Facebook?

Perhaps you don't fair much better. Do constantly check your cell phone for messages, emails, or facebook updates?  Do you and your partner or spouse spend less time in conversation and more time checking messages?

Focusing is an art and staying "on track" is very difficult because so much information and entertainment is readily available at our fingertips. Even if we have kids who get good grades most often you will find that their creativity is limited as they are constantly being interrupted by texts, IM's, Snapchats, and FB posts.

Besides electronics, diet has everything to do with how much focus and energy your kids have. Whether they are still growing physically, their brain will continue to grow until they are 21 years of age. It requires the proper amount of hydration (chemically free, filtered water), real food nutrients (fresh fruits/veggies), protein, as well as regular daily physical exercise. Exercise helps detoxify the system, increases circulation, helps with digestion, fights fatigue, provides mental clarity, and has been proven helpful in minimizing depression and anxiety.

Make it easier on yourself and your kids by improving their diets, giving them routines, and making sure they are getting plenty of rest (8-10 hours), physical exercise, and fresh water. A healthy diet is free from additives and colors, doesn't come prepackaged and processed. Feeding them whole foods and curbing their distractions can help improve their moods, your communication, and improve their focus.

Try these few tips:
-putting them on a schedule
-making sure they are drinking LOTS of fresh water
-setting aside a place to get homework done w/o distraction
-limiting their electronic, texting, and internet distractions
-Avoid turning on the TV or electronic device to distract your child
-Hang a chalkboard up to remind them of "to do's" that they can look at and check off
-having healthy food choices available (veggies & dip, fruit, yogurt, protein/pasta, smoothies)
-limiting junk food, processed foods, and fast foods in their diet
-making sure they get enough rest/sleep

Studies show that there are 54 things that decrease a child/teen/adult's focus that are linked to diet, interruption, subclinical dehydration, and lack of sleep

Help your kid's focus by helping them eat right, be scheduled, and avoid distractions. Also, be involved in their lives. Be engaged. Schedule time to hang out and process events in their lives. Is it gonna be easy? No!
Will it happen overnight? NO.
Is it needed? YES!
To help your kids and you have a better relationship and be focused, you MUST give your full attention. Seriously. Your full attention.

You can help be supportive of these changes by walking them through the process. Modeling this kind of behavior. And being fully present with them when they talk to you.

Try it. It will help their focus. It will help their relationships. You'll both get more done. And you'll know more about each other when you say no to "regular distractions".

Defusing Depression & Self-Destruction by Listening

Do you listen to your kids?
I mean really listen?
Most parent/child/teen difficulties result from teens feeling "unheard".
Most teen patients who cut, or are depressed, or are angry report "My parents don't care what I think."
"They promise me stuff and then never follow through."

Do you bribe, promise, and absentmindedly say, "Yes" only to take it back?
Are your inconsistencies making your kid "crazy"?
Teens often react out of frustration.
Self-harm and depression can result partially from inconsistencies and feeling powerless and unseen.
Building relationships that are positive reduces stress.
When problems crop up do you talk out the situation & plan together?
Or do you both yell?

 Do you regularly spend time hanging out with them so that when you have something important to say, they'll hear you?
Do you know them well enough to speak into their lives?
Can you empathize with them and see their perspective?
Do you coach them and discuss their daily lives and friendships?
Or have you put them on "autopilot" thinking, "they'll eventually figure it out".
Do you spend time apart and only enforce rules when it suits you?

You can help improve your child's/teen's mental health by being consistent, present, and listening.
By allowing them to open up and give their perspective.
Meaningful interactions often diffuse anger and frustration.
It won't happen overnight so give it time.
Be consistent.
And above all, don't talk.
Just Listen.

What's a Travel Medicine Visit?

So you're going to travel to a remote place in the world?
It's expensive. And you've scrimped and saved for it. Don't make the mistake of believing you don't need a travel medicine workup. Skipping a real travel visit is a big mistake. 
Before you go anywhere, know what you need to do to protect yourself from harmful bacteria, illnesses, and disease born food/drink. Understand that there is a difference between seeing your family medicine provider and seeing a travel medicine specialist.
An experienced travel medicine provider will spend about 30-40 minutes examining you, getting specific details of your travel arrangements, taking a thorough history, and customizing a medication plan to help you have a great trip. It's good to know your family provider can see if you are current on your immunizations, but there is a whole lot more than checking shots at a visit. Don't compare apples to oranges when it comes to these specialty visits.
Why do I know? Because, I work with humanitarians who travel all over the world, often working in the most remote places in third world countries (where the most basic creature comforts are lacking). One of the biggest concerns about travel to these places is the need to protect yourself from dangerous diseases and childhood infections that are acquired through contact with contaminated water and food.
If you are planning on travel you must be proactive and protect yourself. Yes, get current on all your shots. Find out where you are going specifically. How you'll be traveling(plane, car, train, ect...).  What cities are you hubbing out of and what are the disease risks? What are the country health requirements? What kinds of accommodations will you have?
3 months before travel
First find your immunization records.  Look to see if you are current.  Typically your family healthcare provider should have your complete shot record if you see them annually.  If you are registered in school, they would have a copy of your current record (as the law requires it).
Next, set up an appointment and meet with a travel healthcare provider/prescriber who is familiar with travel medicine (most family doctors are not up-to-date on current requirements in their general practice for a basic 10 minute visit).  If you go to the health department requesting shots for your area of travel, you will meet with a travel medicine nurse who will charge you about $75.00 for advising you first.  Shots will be additional.  The health department does not take insurance and you will asked to pay for the assessment and shots at the time of visit so come with cash.
Note: some pharmacies specialize in travel medicine and they can give immunizations (with a written prescription from a provider) to persons over the age of 11 but they don't do travel exams. Most family medicine offices do not regularly carry the expensiveimmunizations (that expire quickly) for travel to a remote areas.  Some of these pharmacies additionally carry the rare prescription medicines that fight malaria and are often open on the weekends. Travel medicine assessments by a pharmacist cost about $80.00 per person plus the cost of immunizations and medications. Plan on setting up an appointment with the and bringing in your immunization records or a letter from your health provider.
The Center for Disease Control (CDC) is a good resource for looking up how to prepare for travel to the country you are visiting. It contains information on the kinds of shots and protection you may need. It describes in detail the types of medicines that are available to combat local diseases but it must NOT take the place of wise counsel from a travel medicine provider who is familiar with your health history and can interpret what would work best for you! The website does not have the same travel information a travel provider has and should not take the place of a travel workup.
1 month before travel
After meeting with your travel medicine provider and getting the proper vaccinations, start taking the prescribed medicines before you travel as recommended. If you are taking Typhoid medication, it typically is started 2 weeks before travel and you can't take it when you are taking other medications. When you do travel, be sure to plan on packing your travel medications in your carry-on luggage and saving the extra for use at home when you return. Don't stop taking your medications before you are done with the regimen. Don't take advice from non-health professionals who don't take their prescribed medications. Never risk your health--you can't afford to be sick with poor access to care or upon your return home.
A travel medicine provider will advise you on other health preparation you will need before you to travel.  Obtaining water treatment items, toiletries, protective bug spray, mosquito netting, insect repellent clothing, and insect repelling liquids to treat clothes, bedding, and mosquito netting is a step not to skip. Also, be sure to set aside germicidal lotions for use (but avoid placing them in your carry on bags due to airline liquid restrictions).
Your immunization history
Routine vaccines (shots),are for influenza (flu), chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) and are given atall stages of life.
Even if you don’t regularly travel, routine vaccines are recommended and necessary to maintain your health. Childhood diseases, like measles, rarely occur now in the United States, but are quite common in under developed nations. Your exposure to those diseases puts you at risk for acquiring them even if you have gotten those vaccines in the past. Should you travel, and not be current on your shots (vaccinations) your risk acquiring these childhood infections goes up exponentially.
Health Planning
Most people don't like to think about getting ill or having an accident during their travels but the fact is that most tourist accidents involve some kind of motor vehicles.  Make sure you have a health management plan should you become hurt or ill in the country you are visiting. 
Many travelers obtain travel insurance so they can see health providers or be taken to the nearest country for proper medical care. Purchase the traveler's insurance that allows you to be transported out of the  country should you get into a serious accident. The little amount it costs can save you thousands of dollars in medical bills.
Make the best of your time, money, and be safe when traveling. We only have one life to live--let's live it well!

Where To Go For "The Right Care"

There is a lot of confusion on where to go for Medical care when certain events happen.  This section will help you determine where to go for your needs.

When to Call 911:
  1. 1.Chest pain (even mild)
  2. 2.Breathing difficulty
  3. 3.Unconsciousness
  4. 4.Heavy or uncontrolled bleeding
  5. 5.Gun shot/stabbing
  6. 6. Rape
  7. 7.Car or Pedestrian accident
  8. 8.Stroke symptoms
  9. 9. Symptoms of  Shock

Reasons to use an ER
  1. 1.Chest pain-heart attack, stroke symptoms
  2. 2.New onset seizures
  3. 3.Uncontrolled high fevers
  4. 4.Uncontrolled vomiting
  5. 5.Complex broken bones
  6. 6.Uncontrolled bleeding
  7. 7.Intractable pain
  8. 8. Symptoms of Shock
  9. 9. Head injury/concussion
  10. 10. Victim of crime/accident
  11. 11. Elderly person’s new confusion, weakness, or fall (symptom of infection or stroke)
  12. Designed for Emergencies.
  13. More expensive than walk-in clinics & medical office visits
  14. Open 24 hours per day
  15. Usually sees all kinds of patients despite insurance & ability to pay

ER's are for emergencies only or severe new problems when a walk-in clinic is closed and the problem can’t wait till morning to see a health provider. Do not use them for routine illnesses that can wait till morning to see a general medical provider.

They see patients on a first come, first serve basis.  The wait varies depending upon the urgent problem.

Generally, they are staffed by Physicians, ARNP’s, and PA’s who can diagnose, treat, and write prescriptions.  Lab work can be drawn and x-rays taken & interpreted here.

Their goal is to “treat & street” or admit to the hospital for surgery or medical treatment.

Walk-in Clinics
Usually they have see patients on a first come, first serve basis.  The wait will vary depending upon the particular problem. They are staffed by Physicians, ARNP’s, and PA’s who can diagnose, treat, and write prescriptions.  Lab work can be drawn and x-rays taken & interpreted here.

Walk in clinics are designed for situations when you can’t see your health provider and really shouldn’t wait.  

Your Doctor or Health Provider's office
If your problem doesn’t involve chest pain, or bleeding, breathing difficulty, a broken bone sticking out of your body, unconsciousness, stroke symptoms, then this place is for you. Then go to your Doctor or Health Provider for these issues:

Illnesses, fevers, rash, health concerns, pain management, depression, substance abuse problems, sprains, strains, reoccurring seizure, pregnancy, abuse, moles....

Worsening pain, a head injury (mild concussion), a mild burn, uncontrolled vomiting/diarrhea, a food/medication reaction, sprains, strains, uncontrolled fevers, an uncontrolled earache, or worsening severe sore throat, or a severe worsening migraine.
It is not for problems that have been going on a long time or for an emergency.

Your family medical provider should be someone you can talk to and who knows your general health and well being. When you have a chronic health problem (more than several weeks), a worry or health concern, need a regular check up, or have a stable new illness--they are the best providers to see.  You can see a family doctor, an ARNP (Advanced Registered Nurse Practitioner) or Physician Assistant. Your medical provider will do a better job with your general health problems than an emergency department or a walk-in clinic provider because they know you and your health history. 

Do not use them for emergencies.  This could delay important treatment or end in a serious consequence. If you have chest pain or breathing difficulties or a serious bleeding injury--Call 911. Avoid using a walk-in clinic when your health provider’s office is closed and the problem can wait till morning. Always use them for routine illnesses, health check ups, episodic illnesses like the flu, a severe cold, or new injury. You usually can get shots, tests, and health information that is specific to your needs.

Waiting to be Useful

Many of us wait for a time to be useful. 
It seems my whole life, I have waited for opportunities to be useful.
They don't have to be big.
Sometimes they are really quite small.
Like when I've been on construction mission trips
To Mexico.
And although I lack the necessary skills to build things sturdy.
I have found I can carry supplies.
And I can paint.
I can hang sheet rock.
and I can assist someone more skilled than I.
Every once in awhile,  I get to do what I love best...
placing a bandaid on someone.
or pulling out a splinter.
Or treating a building cold.
Whatever it is, I just know, that if I can be useful in some small way
it is worth the wait.

This last week I had the opportunity to experience the transition from waiting
to actually doing.
I got to help a really good friend of mine
work with a new team of people.
Folks who desire to help others
desire to care for others
desire to love on others
and desire to help those struggling and alone at the end of their lives,
live as fully and as comfortably as possible.
And even though most of those new volunteers had very little experience
caring for ill people
let alone providing healthcare,
I was excited at the prospect of just coming alongside
and caring for them
as I got to learn from them and laugh with them and get to know them

It was amazing.
Standing with these people and working as a team.
I felt privileged and in awe
I felt humbled and excited at the same time.

And I remembered that many years ago,
I stood on the flat cement slab that one day became this Hospice
secretly longing to be a part of it's beginning.
I know that helping to build and sand and mud and paint this building
was part of it's beginning
but I really wanted to help be apart of the medical side
the caring and comfort side
the "you're not alone in this, your doing a great job side".

My wait has come round full circle
And I know that my secret hopes and desires have been answered
And I know that
we all matter
regardless of how much experience we have
or how much we know
or where we've come from
We are all apart of something bigger
We all need eachother
And we all need to be given a chance to give something
No matter how big
How small
or how in between
Everything we do matters
and can make a difference in someone else's life.