Dear Community,

As you have likely heard, the FDA and McNeil Pharmaceuticals has announced a voluntary and precautionary recall of certain lots of OTC (over-the-counter) children’s meds.  I recommend checking any Tylenol, Motrin, Benadryl, or Zyrtec that you may have in your medicine cabinet to see if it is affected by the recall. Here is a link to the website listing affected NDC numbers or “lots”.  Most stores and pharmacies will replace your affected bottle with one that is not affected by the recall.

I hope this is helpful and finds you healthy and thriving.

Sincerely,

Dr. Chrissie

15 January 2010

Dear Friends of Nanopractice PDX,

Greetings! I am pleased to report that we are fast approaching the second anniversary of Nanopractice PDX and that things are going swell. Who knew that the giant risk of leaving big medicine would lead to such an excellent adventure? As you know, I set out to create a smaller, nimbler medical practice where the doc actually knows her patients and the care is truly relationship-based. My ongoing intention has been to create a place where patients feel heard, receive high quality, cost-effective care, have greater access to their medical provider, and are invested in the practice because of these attributes. Many of my colleagues could not understand why I would take on all the added responsibility and complexity of this venture while virtually ensuring myself a drastic pay cut. The answer for me was simple- this is my version of practicing medicine with meaning and integrity. Added integrity in how I do my work in the world fuels my late nights and weekend tasks and the fondness and admiration I have for my community makes the medicine I practice full of relevance and meaning. Of course I could do none of this without the willing participation and commitment of a group of people like you. Thanks for allowing me into your lives and for your confidence and cooperation!

2009 brought many exciting experiences. I was fortunate to host a dear friend and mentor, Dr. Bill Manahan for a few days last July. I have enjoyed hosting students and residents as well as helping some fellow docs jump-start their own micropractices. I attended a national conference in August with like-minded physicians who are in similar models of practice and I was even quoted in a few articles. I am looking forward in 2010 to continuing the quality improvement project called “How’s Your Health”. More on this later!

Suzanne Sanchez, my partner and unofficial manager of all things manageable, is taking on a few more administrative tasks in 2010 so you may be receiving email communications, etc from her. We hope this will free up some time for me to write articles and update the blog more frequently - feel free to make requests for blog topics and such. Some upcoming articles will be about vaccines and alternate schedules, healthy recipes, gluten sensitivity syndromes, and a virtual bookshelf of vetted resources. I hope to create a forum on the website where you all can collaborate with and learn from one another as well.

Here are some other fun Nanopractice PDX facts from the close of 2009:
- There are about 450 active patients and a waiting list of over 100 which is 9 months long now!
- There were over 1100 office visits in 2009. About 40% of these were pediatric visits.
- On average, one new patient was seen per working day in 2009.
- There were approximately 4500 outgoing emails and faxes in 2009, and about twice that many incoming for an average of 37 electronic communications per calendar day. Wow!
- Almost 150 doses of H1N1flu vaccine were administered here since November 6th (and I am still well stocked for those of you that need H1N1 or seasonal flu vaccination).

As you probably recall, a small annual fee was implemented in 2009. The annual fee is essential for the fiscal health and sustainability of Nanopractice PDX and it represents your ongoing commitment as a member of the community. The 2010 fees are now due: $60 per adult and $30 per child. You may send a check or use the form on reverse side to send credit card information by mail. As always, your prompt payment is much appreciated and will save trees! Please contact me for consideration of financial hardship discounts if needed.

Thanks for your partnership in health and may you each have a fun, fit, fantastic 2010!

With Gratitude,

“Dr. Chrissie”

Since we are all baring more of our skin in this heat wave, I thought it might be a good time to mention skin infections.  I’ve had several healthy patients develop significant skin infections over the last year and thought I would address it in a brief blog.  We all have bacteria living on our skin - it’s normal.  Staphylococcus aureus is one of the most commons as is Streptococcus.  Most of the time, these skin organisms are innocuous and cause no problems.  However, there are some troublesome strains out there such as the famous “MRSA” which means a Staph bacterium that has become resistant to certain antibiotics.  One of the more common places it is spread is in athletics: wrestlers and football or basketball players have skin to skin contact which can spread the bacteria directly or the skin of one player is in close contact with a mat or other surface where the skin of another player was recently, spreading the bacteria indirectly.  In this vain, yoga mats (and other work-out surfaces) may also be an important point of contact with troublesome bacteria.  As one is moving through sun salutations or holding chataranga (sp?), the skin may allow entry of bacteria.  Anecdotally, at least one of my patients likely contracted a serious skin infection in this manner.

A good approach to containment and prevention is to use only your own yoga mat.  If that is not possible, please be sure to wipe down the community mat you are using with a bacteriocidal cleaning product.  Being sure to bathe after contact with a shared yoga mat may also be helpful.  If using gym equipment, wipe down the areas that come into contact with your bare skin before and after use.

Signs of infection are warmth and redness in the affected area that spread, fevers, chills, and pain.  Please do not delay care of a potential skin infection as delayed attention can result in more serious would that are slower to heal and may even require hospitalization with intravenous antibiotics.

To your health!

-dr chrissie

Dear Community,

Greetings! Thanks to your kindness and participation, Nanopractice PDX is now over one year old!

I have been touched and humbled by the trust this practice community has placed in me.  I have learned much with and from you all and am deeply honored to have witnessed triumphs, assuaged fears, and hopefully, to have empowered you to take steps toward creating healthier habits.  One highlight of this year has been the enthusiastic reception that continues to welcome Nanopractice PDX into being.  By November, a waiting list for adults was required to support a sustainable pace of growth while maintaining availabilities for existing community members.  I offer gratitude to each person who has referred a friend, family member, or colleague, and I am honored by your positive regard.

Ours is a unique and interdependent practice community, I think, as this kind of creative healthcare cannot be achieved without the context of an active and reciprocal relationship.  I appreciate the shared excitement and willingness to create a new way of experiencing allopathic medicine.  I am indeed fortunate to be able to use my Western medical training to evaluate and treat illness, while using my integrative medicine resources and referrals to simultaneously support your individualized journeys in healing in so many ways.

I have enjoyed as much as anyone the comforts of my small office, the absence of waiting room time, and the lengthier, more relaxed visits we are able to share.  I am pleased to offer direct email and phone access, and I really love knowing the people I serve.  This makes my experience as a healthcare professional much more meaningful.  That said, I am still refining this young practice and looking for ways to improve.  I am committed to staying “nano”-sized to preserve accessibility, and I am committed to making the practice increasingly sustainable while offering new and valuable services like an upgraded website and blog!  As a one-woman enterprise, it will come as no surprise to most of you, that this means lots of time spent on patient care, research, and investigation of referral sources outside our visits.

A common theme among many practices that strive to offer this level of interaction and access to one’s personal physician is an annual fee.  Some even offer an annual membership and stop billing insurance! I considered implementation of an annual fee at the outset of this practice, but decided to weigh the pros and cons after the first year.  After careful analysis and some market research, I have concluded that a small annual fee is needed to subsidize the slower pace and intentional mission of Nanopractice PDX.  This fee will be $60 per year per adult, and one-half that per child (think: $5/ month).

How it works this year: The first 2 months of 2009 will be pro-rated so that the 2009 fees are $50.00 and $25.00 for adults and children respectively. (A couple, then, would send $100 for 2009 and a family of four would send $150).  I ask that these fees be paid relatively soon though I am sensitive to the economic climate and am open to conversation about extenuating financial circumstances.  Please consider this letter your “invoice” to avoid additional billings.

For new patients joining the practice mid-year, the prorated fee should be paid at the first appointment, and starting in 2010, the annual fee should be paid at the beginning of the year.

If there are some among you who have decided to move on to other providers, it would be helpful for me to know that so as to adjust the waiting list, et cetera.

I look forward to our upcoming visits, and I so enjoy being part of your lives.

With much gratitude and affection,

“Dr. Chrissie”