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Stone Turtle Health Blog

Gratitude Posts

October 8, 2015

Gratitude and acknowledgement. I'm seeing an uptick in these types of posts on social media and it's not because I'm following more hippy-dippy accounts, either. As community members, people are reaching out to help one another and are getting recognized. Maybe the actual helping hasn't increased but having a forum to sing someone's praises certainly makes it seem that way. My feeds are filled with friends, neighbors, and family members showing gratitude for gestures, gifts and for simple pleasures in daily life. It's a trend I wholeheartedly support, not just because it's "nice" or "sweet" to acknowledge someone for their work, but also because it's good for US to do so. Connections with an extended support network have been shown to improve mental health and illness outcomes in study after stduy. Community makes us healthier and recognizing other people's contributions to our community makes the ties that bind that much tighter. 

Tomorrow, my son turns one year old. Last year, at this time, we went through a terrifying journey and I want to express my gratitude for everyone who wa a part of it. First, my family, who helps in many, many ways from stocking his closet and sending home toys, covering some of my childcare needs to allow me to keep the clinic running and just holding him for me so I can get a hot meal or a drama-free trip to the bathroom. My long-time and new friends who've shared laughs and tears as we went from the NICU to home and I tried to figure out how to juggle everything. My patients and office mates who have been so understanding of my mommy brain and have welcomed CJ into the clinic family with open arms and occasional smiles of commiseration aimed in my direction. The doctors who covered for me while I wrestled with the heavy fog of early motherhood, shuttling back and forth to the NICU for 70 days, not wanting to get out of bed until it was time to go and see him. My colleagues who helped me figure out how to balance (-ish) life with a baby and a clinic. Our community in general, via Faccebook, that has shown me how deeply the need to connect lives in each of us. Women I never knew drove me back and forth to the NICU to see CJ for the first few weeks. Families hand down clothes and toys and we, in turn, pass them on to new babies that come along. Ballard is NOT the big city, it's a small town full of folks who are maybe trying out this "neighbor" thing for the first time, or they want things to be like when they were a kid and they realize the importance of connection in reaching that goal. 

His sitters. Oh, bless the young women and their moms who have covered my ass so many times and whose families have absorbed him into their midst, so he can have a mini-vacation from me, complete with older brothers and sisters. The initial fear of handing over my son to someone who looked barely big enough to lift him has been far outstripped by their impressive growth as caregivers and young women. It's a privilege to be a part of their lives and to watch them gain competence and enthusiasm, and to see CJ bond and build relationships with them. 

Thank you, everyone, for making this the BEST year of my life.

Happy New Year!

January 5, 2015

Wow! It's been SUCH a long time since I last posted and there is a reason for that. In October, I gave birth to my son, abput 3 months ahead of time. The intervening months have been a scramble of daily hospital visits, bringing on two doctors to cover for my mandated absence. and runnnig things behind the scenes. I have been incredibly fortunate to have Dr. Christine Cirovic and Dr. Madison Fandel caring for my patients while I was gone. Dr. Cirovic is remaining in the office, starting her own practice, in January and Dr. Fandel will hopefully continue to cover on occasion. Both very impressive new doctors that I look forward to watching grow and thrive in their own practices. 

First of all, the amount of gratitude that I have towards the staff at Ballard Swedish and Swedish First Hill knows no bounds. The Ballard folks took a very scary situation and made everything come out in the best possible way. At First Hill, the NICU and later the Intermediate Care Unit and Pediatric Special Care Unit folks were very compassionate and understanding. My son was there for exactly 10 weeks and I spent most of my time with him. The staff helped answer my questions, soothe my fears, and get me set up for a successful transition home before Christmas. A lot of their work, especiallly the paarent outreach program, is supported by the March of Dimes, which works to end polio, birth defects, and premature births worldwide. 

Secondly, my family, friends, neighbors and patients who took the time to visit, send food, give rides, or just check in with me deserve a big hug and many thanks. Without a strong support system, being a single parent is difficult enough, but being a single parent whose child is in the hospital is just the worst! Thank you to all of you for keeping me sane and not letting me stay in bed all day (most days). 

Finally, I'd like to remind everyone that, as this is the start of a new year, this is also the beginning of a new leg of our journey together towards health. Resolutions are not so easily sustained but slow, steady improvement can lead to a lifetime of difference.  As we ease into 2015, our office will be implementing electronic medical records, which we hope will be more of a blessing than a curse. On occasion, my son may be in the office, as childcare schedules never go the way they're planned, and I consider it my own good luck to be able to bring him in when needed. From my perspective, anything other than another hospital stay is a good thing. I ask for understanding and patience in both of these areas from my patients, whose own families I love to see often. We would love to see you in the office in the coming year and I hope to continue to provide care for my friends and neighbors for a long tmie to come!

Happy New Year 2015!

Dr. Katie Baker

OPPOSE HB 2149

February 28, 2014
Below is my letter to the Washington State Senate Ways & Means Committee, regarding HB 2149, which guts the current medical cannabis law in favor of profit through recreational cannabis. The bill can be found here. 

Dear Senator,

My name is Dr. Katie Baker. I am a naturopathic physician, born, raised,educated and licensed in the state of WA. I serve communities in Seattle and Bellevue as a family practice doctor, but my patients come to me from all over the state. I am writing about HB 2149, which will be coming up for review in your committee on Monday. We were told it had died in the Healthcare Committee, but a loophole allowed it to move forward without a public hearing. Unfortunately, due to the late notice, I already have patients scheduled during the hearing and will be unable to attend in person. 

I understand the difficulty of differentiating between the protection of rights for medical cannabis patients and the I-502 mandates. Here are my particular concerns with, and reasons why I oppose, HB 2149:

1- Throughout the bill, the scientific term "cannabis" has been reverted back to "marijuana". This is an unnecessary switch back to a more inflammatory term. Since this bill, if part or all of it becomes law, is the basis for legal action, the proper scientific terms should be used. Anything else is specious.

2- Section 2.12.b. As the members of the committee with healthcare backgrounds who sponsored the bill know, there are currently NO objective measures of pain.Pain is, by its very nature, a subjective complaint. Internet research shows a single preliminary study from the Neurology department of the University of Boulder, using nMRI technology to map neuronal response to pain, but there have been no confirmatory studies to date and to ask all pain patients seeking cannabis authorizations to submit to nMRI, especially when many of them are living off of disability checks or are working poor, based on a single study is unconscionable.

Requiring that the severity of the pain significantly interfere with ADLs is an unnecessary phrase, given the current terminology of intractable pain and does not allow for relief for current patients who have relapsing or intermittent pain issues that are intractable; debilitating migraines would be a good example. They do not affect patients on a daily basis, but when they happen, patients can be sidelined for 1-4 days, unable to work, keep food down, or tolerate light, sounds, or smells.

Requiring referrals from principal care providers (as the recent amendment states) does not take into account the fact that some doctors do not believe in the use of medical cannabis and would deny their patients' requests for a referral. In many cases, such as with the VA or with larger medical groups, like UW Physicians, the PolyClinic, or MultiCare facilities, doctors are forbidden to write authorizations by their employers or their malpractice providers, on penalty of losing their jobs or their insurance coverage.

3- Section 2.12.g- Eliminating the panel of physicians who accept or deny petitions for new conditions as more research becomes available would put undue strain on patients and advocates in terms of time and money. The current panel is relatively conservative, in my opinion, but is surely a better way than requiring legislative amendments or disallowing new conditions.

4-My strong opposition to the sections creating a registry come in light of recent court findings in Mendocino County, Ca and in OR, where the DEA was allowed access to the cannabis registry.Other states with registries have been compromised and patient information has been unlawfully exposed. My concerns about patient privacy and HIPAA regulations have been voiced by many during the public comment period. A patient has an authorization on tamper-proof paper, etc in compliance with state law, and that should be all the "verification" that a state-licensed outlet should require. Currently, when a patient of mine goes to a dispensary, I am called to verify the authenticity of the authorization, including its expiration date (typically one year, in some instances 6 months). There are standard HIPAA procedures for releases of information to other healthcare providers in place now. If two providers are concurrently working with a patient, releases are not even required to discuss patient care. The issue lies in patients' discomfort in disclosing to some providers, not in the lack of access to available information. 

5- Section 5.2 - Limitations are too low. Severe epilepsy patients may use more than 8 ounces in a week or so. Requiring a physician to attest to being the primary care professional treating the patient- Many patients come to me as part of their healthcare team. I encourage them to tell their primary care doctor, their oncologist, their rheumatologist, or any other specialists about their cannabis authorization. At the present date, there are 3 major drug interactions indicated for cannabis (theoretical, according to Rxlist.com). While I do a medication and supplement review at each visit and discuss potential interactions with patients, many other primary care providers (PCPs) don't do this because they do not have the time or training. 

For many of these patients, they would be candidates for the higher levels of possession proposed but their primary care professionals will not write authorizations. For others, their PCP is not the one handling the opiate. chemotherapeutic or other medications, it is a specialist such as an oncologist or pain doctor. Where is the burden of proof that cannabis requires more stringent oversight than these medications?

Home growing- Many of my patients come from rural parts of the state, where patient access points are few and of poorer quality than seen in the cities. Other patients live on a severely fixed income, often times less than $1000/month. These patients typically qualify for my sliding fee scale at the $20/visit level because their income is so low. They need the ability to grow their own plants because it is cost-prohibitive for them to afford their medication through dispensaries at today's prices, not to mention the proposed increases in costs via state-run recreational outlets.By lowering the plants from 15 to 3, it is ensured that any trouble with the growing process will wipe out a patient's medication supply easily. 

6- Section 11- While I approve of the idea of a working group to create standards of care for physician guidance, particularly one that includes professionals with actual botanical medicine training (naturopathic physicians),what we currently know about cannabis is that different people react to different amounts, preparations, and strains of the plant so a standard dosing schedule would be very difficult to determine. My typical recommendation for patients in this area is to begin dosing in the evening, or when there will be no chance for them to be impaired behind the wheel, in order to find an effective dose for them, while minimizing any impact on their lives during the process.

Thank you for reading my concerns. I am happy to answer any questions by you in person, or via phone or email. I strongly believe that feedback from physicians is sorely lacking in HB 2149 and oppose its passage.

About me: I am a 4th generation Washingtonian, in the second generation to make a career in healthcare. I have family who have served in the armed forces and  those who currently serve in law enforcement. I have over 25 years' experience working with children and families, studied botanical medicine for five years as part of my naturopathic doctorate studies, and have extra training in drug-herb interactions. My volunteer activities include working with the Sea-King County Public Health Reserve Corps, the Red Cross, the Make-a-Wish Foundation, my local Rotary and Chamber of Commerce chapters, and serving on the board of the Ballard Boys & Girls Club. In short, I believe that I am fulfilling my calling to serve families in my community and to practice responsible medicine. Part of my family practice includes writing cannabis authorizations for eligible patients of all ages, in accordance with state law.

Band of Brothers (and Sisters)

September 29, 2013

I'm a big fan of Kid President. This kid stands for positive change, "being awesome" and "more dance parties". His partnership with local actor Rainn Wilson, of "The Office" and Soul Pancake is a bright light in an often-cynical and sad world I think the message that they are sharing is important. I LOVE dance parties! I want to be awesome!

Last month, I did an awesome thing. Via Twitter, I thanked Anthony Shears, a local recording artist living in L.A., for a beautiful song he had written about domestic violence. He did an awesome thing- he replied. Our dialogue, such as it was, transferred from Twitter to Facebook, to phone & email. We dreamed about what we could do to REALLY make a positive change in the lives of children touched by domestic violence or in difficult home situations. Anthony spent a lot of his childhood at the Ballard Boys & Girls Club. He tells me there were some days where most of his meals came from there. The folks at the Ballard Boys & Girls Club helped keep Anthony, his brother and their friends off the streets by providing them a safe place where they could build healthy relationships and stay out of trouble. Mentors at the Club gave the boys opportunites to play sports and support to succeed in school. Anthony went on to attend Dartmouth and work in L.A. with some legendary recording artists; Norris is an Olympic athlete. They want to give back.

My own work with children spans 20 years, in various areas such as medicine, social work, teaching, and volunteering. I believe that if we support children who need it the most, we benefit ourselves through building a strong community. Another generation will be raised up with the values that we treasure. Values like integrity, honesty, a strong work ethic, creativity, and a sense of community are supported at Boys & Girls Clubs. 

Working with Anthony, Norris, and a team of amazing volunteers, we are designing the first annual "Field of Our Dreams Celebrity Softball Tournament" to benefit the Ballard & Wallingford Boys & Girls Clubs. Money raised will help to re-surface the softball field and provide scholarship funds to the 70% of children that rely on assistance to be a part of the Clubs. Scheduled for May 4 at B.F. Day Playfield, the softball game will have local celebrities and athletes and live performances. This event can't happen without volunteers- let us know if you'd like to help!

Our first step: The upcoming Ballard Boys & Girls Club Auction to begin the fundraising for the field, held October 25th at 5:30 with both silent and live auctions. More information can be found here, as well as tickets ($45, including free childcare and a salmon dinner)

Food Revolution Day 2013

May 9, 2013

You all should know by now how much I love Jamie Oliver and his Food Revolution, promoting healthy foods in schools and communities. May 17th is the date for his Second Annual Food Revolution Day, a worldwide grassroots effort to provide fun and education experiences around food to local communities. I love what he is doing for so many reasons: healthy kids are better learners, healthy families can work together to make changes in their communities, and healthy communities can provide better support for those who need it most. I strongly encourage my readers to attentd or even host a Food Revolution Day activity in their neighborhood, even if it's as simple as hosting a vegetarian potluck or barbecue for their friends and neighbors. Check out a book about food from the library and read it to your children. Reach out to the local food bank and donate or volunteer to provide more healthy food to their customers. Visit your children's school to see what their school lunch program offers. Try a healthy new dish from a cuisine you aren't familiar with. There are TONS of ways we can improve our diets and our family's lifestyle, from meatless Fridays to making sure we "eat a rainbow" every day. We have the tools within our reach to fight the epidemics of obesity, diabetes, and other chronic illnesses that are distinctly related to our lifestyles. This is one thing that we can do something about. Viva La Revolution!

 

Should My Baby Wear Sunscreen? FDA article reponse

June 25, 2012

According to this article on FDA.gov, it really depends. Babies' skin is more permeable to the chemicals in sunscreen and their higher skin-to-body ration means more will be absorbed. Avoiding exposure is best! There are also tips and tricks for protecting infants from harmful UV rays. A big thank-you to Vital Family Medicine for sharing this article with us!

Guest Blog: Exploring Best Practices for a Healthy Pregnancy by Katie Moore

June 14, 2012

Today, I'm excited to share this guest post from Katie Moore. She is an active blogger who discusses the topics of, motherhood, children, fitness, health and all other things "Mommy". She enjoys writing, blogging, and meeting new people! To connect with Katie contact her via her blog, Moore From Katie or her twitter, @moorekm26.

(When Katie Moore came to me with the idea to write a guest post on my blog, I was thrilled. This post is timely because of my recent decision to start a family. The preparation and planning that have gone into this decision mean that it will be some time before we're joined by a little one, but all signs seem to be reassuring me that the best time to start is coming soon. Without further ado, here's a wonderful post on improving your chances for a healthy pregnancy.- Dr. Katie)

 

Exploring Best Practices for a Healthy Pregnancy

 

Pregnancy is an exciting time full of planning and joy for many women, but others will feel the burdens of stress and worry. Hormone changes and the symptoms common to each trimester can add to the stress. Researchers have found that stress during pregnancy is a major contributing factor to complications, and this means that every mom will benefit from learning ways to reduce worry and conquer stress. 

For the best chance at a healthy pregnancy and delivery, it is worthwhile to learn a variety of coping techniques. Several resources are available for gaining an introduction to the techniques of stress management, including books and videos, pregnancy and birthing classes, and other expecting mothers. All these resources will be useful in exploring the following relaxation techniques

 

Before starting any new exercise or diet routine, it is important for a woman to sit down with her doctor and discuss her desired changes. A doctor’s knowledge will be invaluable during pregnancy, from planning what prenatal classes to take all the way to planning whether or not to utilize umbilical cord blood banking, a doctor is the best person for all of these questions.

Guided Meditation
One of the most useful skills for any new mom, meditation is a component of most alternative pain management courses, including Lamaze and the Bradley Method. Clinical research has proven numerous physiological benefits accrue through the practice. Some of these benefits will help in maintaining overall health, and others provide particular benefits during pregnancy and birth. 

Meditation is a skill, however, much like exercise. Practice will make it more effective, and a guide will be extremely beneficial at the beginning. The guide or teacher will help by taking the student along an internal journey that increases awareness of the body and aids in relaxation of the nervous system. Like other skills, it becomes easy to meditate alone after practicing with a teacher.

Exercise
It was once thought that exercise increased the risk of miscarriage and pregnancy complications, but research has proven this assumption to be false. In fact, responsible use of exercise can significantly reduce the risk of many complications and help in overcoming symptoms. A teacher can help by introducing exercises that can reduce the duration of labor and allow faster recovery from delivery.

Most low-impact, moderate-intensity forms of exercise will be appropriate throughout pregnancy, including walking, swimming and cycling. Weight training can be beneficial as well. 
One analysis of the literature showed that strength training reduces severity of maternal hypertension and post-partum depression while also reducing the risk of gestational diabetes. As great as exercise is, all expectant mothers should consult with a doctor and either a trainer or other fitness expert with experience in pregnancy exercise.

Diet
Though it is often overlooked, the modern diet is full of artificial ingredients, unhealthy fats and simple sugars that contribute to the body's stress load. Healthy food choices at the grocery store are generally more expensive, but eating healthy at home is actually cheaper than most people realize. A diet with a lot of 
variation is best, but there are some foods that should always be avoided. 

Enrolling in classes early is a great way to get a head start on a healthy pregnancy, and more learning is always better. If local resources are lacking, multimedia sources can help any mom get the knowledge she needs to get baby off to a good start.

 

 

 

 

Legacies

November 29, 2011

I had the wonderful experience of going to a musician's memorial the other night. Dave Conant, a mentor to my partner and a friend to my partner's family, passed away ten years ago. His daughter, widow, and friends decided to hold a wild night of music and memories in his honor, providing a large part of Seattle's music scene an opportunity for remembrance and celebration of his life at Hale's Palladium, the venue for the local Moisture Festival. I only knew a very few people and was initially uncomfortable to be the odd man out, but quickly found myself enjoying the music and feelings of camaraderie I found there. It was a very touching tribute, telling me as much about his friends and family as it did about the man himself.

Last night, my partner and I got to talking about what he wanted to pass on to his son. I was thinking in terms of tangibles and he meant values and lessons. This led us to a discussion about parenting, me questioning the best ways to pass on lessons to kids at different stages of development, what values are important to pass on and how to get the message across. These kinds of discussions are ones I cherish the most with my partner; I learn more about him and come to respect him even more each time we talk about serious issues because of his thoughtful and thought-provoking musings. He had recently watched Pearl Jam's documentary "20" and came away with the idea that we, as parents, try to instill a set of "guard rails" to help our kids survive and thrive in society, but it's the kids who push against the guard rails at an early age that become breakout stars in their field.

I look around and see so many parents struggling for the fine line between being overly permissive and being resented by their kids by being too strict. I struggle with my own experiences with finding my niche in our combined family, developing a relationship with my partner's son is on my mind a lot. I love him to pieces, I want to be of support to him as he grows into a young man, I have the best intentions. Hell, I even have a degree in Human Development (with a focus on early child development) and a minor in Psychology and some of the time, it doesn't help a damn bit because I'm fumbling in the dark when it comes to our interactions. It's not my responsibility to raise him, to teach him my values. I understand that, but I also believe that as a human being I have a responsibility to be a good role model for any child in my life, be they family, friend, or patient. I feel honored that I have an opportunity to share experiences with some pretty special young people and I want to be a positive influence, something that helps them as they grow and learn to be good people.

Growing up, I thought my parents and grandparents knew everything there was to know about raising kids. I never questioned whether I was loved, I never was abused, I rarely even THOUGHT about disobeying them (though it's true that if there wasn't an explicit rule for a given situation, I might be found carving my initials in the bathroom door and blaming my sister for framing me). Now, I find myself missing my deceased grandfather because I feel he would be better able to get a handle on things in our house, he would know what to do to restore order. Or questioning my mother at dinner the other week, trying to find out what her secret was, how she got the three of us girls to do what she said almost every time just by lowering her voice and narrowing her eyes. How my father could tell us we were going to do chores and we just DID them. I never resented them and never questioned that they were doing the right thing, but I find myself envying them sometimes. How will I ever get a two-year old to put on clothes that are appropriate for the given weather? How will I keep a ten-year old from starving to death when he won't eat vegetables or food that doesn't come from a box? And, dear lord, what in the world can I do when my kids get old enough to date, to drive, to sneak out at night, to have SEX?!? What kinds of values can I instill in them that will keep them alive, happy, and successful in whatever way they define? How will I prepare them, share the best things that I've learned with them to help them in their lives?

Maybe it's too soon to be worrying about these things, without a child of my own yet, but I think it's good to have these discussions with myself, and with my family and friends, to continuously develop ways to live a life consistent with my values so that I can honestly say when I leave this world that the kids in my life knew who I was and what I stood for and that I made a positive difference in their lives.