Corona Virus Archive

Update, April 8th: Weekend Vaccine Clinic ***FULL*** (more dates to come)

When: Saturday, April 18^th, 10:00 AM to 2:00 PM

What: Appointments for immunizations and boosters only

How: Call or text (720) 583-4470 to book a spot.  You can also message us through MyChart.

Due to recent changes for COVID-19, we have unfortunately had to cancel many immunization appointments.  We want to provide an extra clinic day to allow for any of our patient families needing immunizations to get caught up or stay current!

Update, March 26, 2020: Social Distancing at HIP, Telemedicine, Well Visits, Nurse Visits…

We hope this update finds you and your family well. We are adapting to the current circumstances and are adding ways that we can support your family. We are staying up to date with the guidelines for medical practices from the American Academy of Pediatrics (AAP), Children’s Hospital Colorado and the Center for Disease Control (CDC).

Social distancing at the pediatrician’s office...

1. We continue with just 1/3 of our usual staff making for very limited numbers of patients at once
2. Well children are being seen in the morning and early afternoon and sick visits in the later afternoon. Children with illness who need to be seen in the morning will be seen in their car or enter through our separate back entrance to our studio space
3. We are asking that one parent bring just the child who is due for a visit when possible
4. We are using your car as the waiting roomand having you call when you arrive
5. Car visits when possible. We now have a canopy tent for the parking lot that will be set up on certain days to help with those visits

Telemedicine: We now offer virtual visits for Highlands Integrative Pediatrics families! These visits are with one of the providers and are  covered by insurance in the same way that in office visits are. In some cases, copays may be waived by your insurance plan.

1. Lactation consults with Molly Gilpin
2. This week, Abbie Foust is offering virtual sick visits, behavioral consults, COVID19 support, integrative medicine consults, and help with any other kid related issue you might be having.
3. Next week (3/29-4/3) Bryan Kono is offering virtual appointments for self-regulation/self hypnosis follow up, behavioral consultations, COVID19 support, sleep concerns, chronic abdominal pain, bowel and bladder issues and Stacey Pfannenstiel will be offering virtual sick visits and behavioral consultations
4. Lauren Welch and Kristen Freedmanwill have telemedicine visits available soon

To schedule call or text (720) 583-4470 or send us a message in MyChart

Well visits: Thank you all for your understanding with rescheduling/postponing some well visits as we prioritized younger kids. With your help we have thinned out our schedule to minimize contact in the office with others and continue to have only well children seen in the morning and early afternoon. Now that we have settled into this schedule, we have openings for some of those appointments that we had rescheduled.If you are one of those families, we may reach out to you in the coming days to get those rescheduled

Vaccine only visits: If your child had a nurse visit for vaccines postponed, we will be reaching out to you soon with options to reschedule. Again, we are scheduling these carefully to minimize contact with others.

Sick visits in office: Certain sick visits need to be done in person at the office. Our triage team can help with directing you to the right type of sick visit. See previous updates below for all the steps we are taking to protect patients in the office

To schedule call or text (720) 583-4470 or send us a message in MyChart

Update 3/22/20: Audio update for HIP families and Poetry Respite (link)
 

Update 3/19/20: Ibuprofen and Elderberry

• Ibuprofen:
  • Experts were worried that ibuprofen might make COVID-19 illness worse, so they recommended avoiding it until further research was done.
  • There is very little research overall on COVID-19, since it's such a new virus, so this is all very confusing for everyone.
  • The experts did some research. As of 3/18/20, Ibuprofen seems ok with COVID-19, but just to be on the safe side (since everything is so new and evolving), start with Tylenol first to treat fever (unless you have liver disease).
  • If you are on Ibuprofen (or other  NSAIDs, Non-Steroidal Anti Inflammatories) for other medical reasons, it's ok to keep taking them.

• Elderberry:
  • Probably best to avoid elderberry for now.
  • Elderberry (Sambucus nigra) can be effective in preventing Influenza, but may worsen the COVID-19 infection. If you are science minded, or want the mechanism of action, a full explanation is below.
    • Sambucus nigra (Elderberry): There is preclinical evidence that elderberry inhibits replication and viral attachment of Human coronavirus NL63 (HCoV-NL63), different than COVID-19, but a member of the coronavirus family.
    • Sambucus appears most effective in the prevention or early stage of corona virus infections. Of note, Sambucus significantly increases inflammatory cytokines, including IL-B1 so should be discontinued with symptoms of infection (or positive test). An evidence-based systematic review of elderberry conducted by the Natural Standard Research Collaboration concluded that there is level B evidence to support the use of elderberry for influenza which may or may not be applicable to COVID-19 prevention. Typical dosing of 2:1 elderberry extract is 10mL -60mL daily for adults and 5mL-30mL daily for children.
    • To Avoid: Given the integral role of inflammatory cytokines (namely IL-1B and IL-18) in the pathogenicity of COVID-19, as well as the impossibility of predicting which individuals are susceptible to the “cytokine storm”, technically called secondary hemophagocytic lymphohistiocytosis, or sHLH, it appears to be prudent to avoid high and regular use of immunostimulatory agents which increase these cytokines. Again, in the absence of human clinical data, caution is warranted with elderberry, an immune activating agent, due to preclinical evidence of increased IL-1B and/or IL-18 production in infected immune cells.

Update: 3/16/20

Update from Highlands Integrative Pediatrics: 3/16/20

Dearest HIP families,

In this time of great uncertainty and change, we want you to know that we are here for you.  In spite of fears surrounding COVID-19, we hope that we can help empower you to stay healthy, feel informed, search out joy, and remain connected to your community. We are committed to keeping your family as healthy as we can and are grateful to be able to serve our community during this difficult time.  Even though the situation with COVID-19 is rapidly changing, we will do our best to provide regular updates and be as transparent as possible about the current healthcare recommendations. We will also post regularly on our Facebook page and (brand new) Instagram account:

Instagram: @hipediatrics

Facebook: Highlands Integrative Pediatrics

So…. here’s the nitty gritty for right now:

If your child has a cough and fever:

• Please DO NOT go to the Emergency Room or Urgent Care. Please call our triage line or send a message on MyChart to speak with our nurses and physicians on call. This is to avoid any potential exposure to your family, and to help prevent crowding in our Emergency Rooms.

• As long as there are no breathing problems or symptoms concerning for an ear infection (ear tugging, difficulty sleeping, increased fussiness), we may advise you to stay at home. It is no longer recommended to test every person with cough or fever for COVID-19.  If your child or any family member develops cough, congestion with or without fever, we recommend that you self-quarantine for 10 days from the start of your symptoms.
• If you are unsure whether your child is having breathing concerns or other symptoms that require evaluation, please send a MyChart message or call our triage team.
• If your child or a family member has a medical condition that may put them at more risk from a respiratory illness (asthma, cystic fibrosis, diabetes, heart conditions, immunocompromised) and your child has a fever and cough, we may recommend coming to the office to be examined and have a nasal swab done for influenza and possibly COVID-19
• Influenza is still circulating in the community. If your child is under 2 or has asthma or other chronic medical conditions we may recommend a visit to HIP to test for the flu if they are in the first 48 hours of illness or there are breathing concerns or prolonged fever (>4 days)

If you require a visit to our office:

• Our staff will be wearing masks, in order to protect you and your family. If any of our staff develops fever or cough they will be tested for COVID-19 and quarantined at home for the recommended time. 
• You may wait in your car until we are ready to see you, to avoid prolonged time in the waiting room
• We suggest bringing as few family members as possible to the office
• We are able to do strep swabs, flu tests and some exams from your car, to avoid unnecessary exposure in the office. If your child appears too sick to be managed from the car, we will take them inside for further evaluation. 

If you’ve been in the mountains in the last week (Eagle, Summit, Pitkin or Gunnison counties):

• We strongly recommend that you minimize contact with other people, even if you are not experiencing symptoms, given the high rate of community transmission in those areas. 
• If you are experiencing symptoms (fever, cough, shortness of breath), you must be isolated for at least 10 days after the onset of symptoms. It is only safe to leave isolation if your symptoms are improving and until you’ve been fever free for 72 hours.
• For more information on this, please visit: https://www.colorado.gov/pacific/cdphe/news/cdphe-strongly-advises-all-visitors-and-residents-eagle-summit-pitkin-and-gunnison-counties

How to keep your family, and our community, healthy:

• Minimize any close contact with people outside of your household at this time. Social distancing is important to help prevent the rapid spread of COVID. 
• Stay home when you can, and support those in your community who can’t 
• This is a great time to get your family outside! Walk, hike, jog, bike ride, play in the park… just try to keep about 6 ft from you and other people if possible :)
• The obvious things: Wash your hands frequently with soap and water. Avoid crowded spaces as much as possible. Wipe down common surfaces with regular household cleaning products (doorknobs, cell phone, counter tops, the steering wheel, etc).
• Remember to breathe. Inhale deeply so your belly rises for 4 counts, hold for 7 counts, exhale slowly for 8 counts. Repeat. Teach this to everyone you know. 
• Put gratitude front and center. Appreciate the small things. Stay in joy. Stay as relaxed as possible. 
• Take care of your community. Support each other. Get creative in doing so. When able, help elderly neighbors and family members who are most at risk.  Support small business when able.
• Be kind. To everyone. Especially those who are working in service industries including (but of course not limited to) grocery stores, pharmacies, and mail delivery. Let's support each other through this.  
• Practice being more in control of your feelings. This website is a fun way for kids (and parents) to explore that concept:  http://imaginaction.stanford.edu

We are here if you need us. Lots of love from your HIP healthcare team.

Update 3/12/20

As many of you have heard, Edison Elementary closed today after a parent there tested positive for the new corona virus (SARS-CoV2 is the name for the new virus and COVID-19 is the name of the illness that it can cause).

Because we are in close proximity to Edison and have patients that attend that school, we are taking steps to limit the immediate spread of the virus within our practice community and the wider Denver community. While the risk to healthy children from the new corona virus is relatively low, children with underlying medical conditions may be at higher risk in addition to older people in our community. It is important that we do all that we can to slow the transmission throughout the population. Thank you for your help and understanding as we work together to navigate this as a community.

1. We will be moving essential Well Care Visits to the morning and will have sick visits in the afternoon. Essential Well Visits would include newborn through 18 months old where vaccines are due.
2. We are asking that families reschedule their Well Care Visit if the parent or child is ill with fever or respiratory symptoms (cough, congestion). If your child is sick please talk with our triage team first to see if they need a sick visit scheduled.
3. We will have some availability for urgent morning sick visits in our studio space which is isolated from the rest of our office.
4. We are working on offering testing in the coming days for SARS-CoV2/COVID-19. We are following the Colorado Department of Public Health guidelines for testing. Up to date guidelines for who should be tested can be found at: https://www.colorado.gov/pacific/cdphe/covid-19-testing. Those who meet criteria for a test will be examined in their car when possible and tested there without entering the office.
5. All parents and children seen for an office visit with fever and cough will be asked to call from the parking lot so they can be met outside, given a mask and taken through our side door to their exam room.
6. To reduce the spread of viruses in the office we have removed shared toys and books and are sanitizing common area surfaces hourly. We continue to wipe down exam rooms thoroughly between patients and we will continue to emphasize that.
7. We will continue to triage for other illnesses to determine if your child needs to be seen in the office for a sick visit.

If you or your children do not meet the criteria for testing but are sick with cough or congestion, we would urge you to do your best to stay at home and avoid group activities.