November 12th: Audio update (Flu, COVID and wellness recommendations)
COVID-19: Cases are increasing in Colorado and around the country. We are staying up to date with recommendations from the Colorado Department of Public Health and Environment (CDPHE) and the experts at Children's Hospital Colorado. Some updates:
Resources are being stretched at this point We are still primarily utilizing Children's Hospital Colorado with their drive up testing locations. A hospital or lab based PCR test from a nasal swab is the most sensitive test at this point and that is what we recommend.
If you think your child may need a test, send us a MyChart Message or call our office to speak with a member of the triage team. Testing is generally recommended for children with cough, fever, chills or shortness of breath lasting more than 24 hours or any congestion, runny nose, sore throat, body aches, headache, fatigue, nausea or vomiting lasting more than 48 hours.
October 12th: COVID-19 and School/Daycare
We are monitoring the changing recommendations from the Colorado Department of Public Health and Environment. If your child has symptoms that may be COVID-19 related or has had an exposure at school or daycare, contact us and our triage team can begin to answer your questions. In many cases we will suggest a telemedicine appointment for evaluation with one of the providers. In other cases, an in-person appointment will be necessary.
September 27th: Audio Update. Listen to our latest audio update with information on the flu vaccine and COVID-19, including thoughts on testing and recent studies.
Our family is having the same conversation that many of you are having right now. How do we decide who we can see, when we can travel, what should we do about school, what about grandparents….? (more)
Testing for those with symptoms: For kids and parents with symptoms of fever, dry cough, body aches, loss of sense of smell. We can start with a telehealth or in person visit and then arrange for a nasal swab test. Currently we are recommending drive up testing with Children's Hospital Colorado which requires a referral from us and has a 24 hour or less turn around time.
Antibody testing: in most cases this is not for patients with active symptoms. This requires a blood sample and currenly we are referring kids (over 10 only) to National Jewish Hospital. We expect a reliable, rapid test for these antibodies to be available in our office in the coming months, but it is not available at this point. Antibody testing (IgG and IgM serology) is to determine who has already been exposed to the SARS-2 virus (COVID-19) in the past.
April 21: HIP is gradually expanding our capacity for well visits while maintaining all the precautions we have put in place. We look forward to connecting with many of you soon! Check out the new information below and our latest audio update here
Cultivating Wellness (new page)
Your HIP team is here to support you...
Know that your team at Highlands Integrative Pediatrics is adapting to these unprecedented times and continually reshaping the services we provide with key goals in mind
Keeping you and your family safe
Providing up-to-date corona virus recommendations, support and evaluations when needed
Addressing non-coronavirus illness and mental and bevavioral health concerns
Delivering the vital preventative and general health and wellness support that you have come to expect from us
Staying connected with you and your family to support wellness in these trying times
Only well children and well parent/gaurdians are being seen in our main exam rooms and come through the main entrance of the building
We are asking that one parent bring just the child who is due for a visit when possible
Well visits are taking place in the morning and early afternoon. In addition to our own ongoing assessment of the situation, we are following the current guidelines from the American Academy of Pediatrics, Children's Hospital Colorado and the State of Colorado
Families with illness concerns including fever, congestion, cough, body aches, sore throat etc who need in person visits are being seen in the later afternoon in our tent exam room (in the parking lot) or in our studio which has a separate entrance at the rear of the building.
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
lactation consultations, virtual sick visits (for some illness presentations), behavioral consults, COVID19 support
To schedule call or text (720) 583-4470 or send us a message in MyChart
Reliable Online Resources
Integrative Approaches to COVID-19 for teens and adults: https://uahs.arizona.edu/news/integrative-medicine-approaches-may-combat-covid-19
Children's Hospital Colorado: https://www.childrenscolorado.org/about/news/2020/march-2020/coronavirus
Colorado Department of Public Health & Environment: https://www.colorado.gov/pacific/cdphe/2019-novel-coronavirus
Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/index.html
Children's Hospital Colorado Urgent Care Locations: https://www.childrenscolorado.org/doctors-and-departments/departments/urgent-care-locations/ (Check for possible closures or other restrictions before going)
If your child has a cough and fever:
- Call our triage line or send a message on MyChart to speak with our nurses and physicians on call.
- 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 and start with a telemedicine appointment. The recommendations around testing are evolving. If you think your child may need to be tested, give us a call and we can give you the up-to-date recommendations. 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, contact our triage line for advise.
- Our staff will be wearing masks, in order to protect you and your family.
- We are using your car as the waiting room. Call us when you arrive for your appointment
- 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 needs to be seen in the office, we will ta
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.
Facebook: Highlands Integrative Pediatrics
Update 3/19/20: Ibuprofen and Elderberry
- Experts were worried that ibuprofen might make COVID-19 illness worse, so they
- 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.
- 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.