Spring Newsletter 2023

April 24, 2023

Whether you are new to the clinic or have been with us from the beginning, we are glad you are here!

We had humble beginnings, and now we seem to be growing exponentially. With growth comes change. As the Greek philosopher Heraclitus said, “There is nothing permanent except change.”

We have new faces in the clinic, a clinic in Poulsbo and Manette, so many new patients, and a much busier practice.

Here are some ways we can improve your experience:

Communications

BUSY PHONES

Most days, we have two people answering phones and still can not get to each of you personally as you call in. This is why when you call, you need to leave a message. All front desk messages are handled by the end of the day. When you call and do not leave a message, we do not know you need us.

PROVIDER PHONE

Medication refills and specific needs from your provider- please do this on the provider line. It is a message phone and a text line 360-621-1104.

You can also reach this line by hitting option 2 when calling the main front desk line.

Price Changes

We had an increase in our membership price this year. This is our 4th increase since we opened our doors nearly 9 years ago. Our goal is never to price people out of our services, so if you are having a hardship, please let us know. We can work with you on payment plans or scholarships if needed.
With this, we will have some new charges for clinic add-on services starting in May (member prices; not for billable Medicare patients):

  • B-12  Injections: $10
  • Toradol Injections: $15
  • Joint Injections:$20 per body part
  • Tetanus shots: $47
  • CDL Physicals (starting in August)
    •  Member: $50
    •  Non Members: $150 (not Medicare)
  • Acupuncture
    • Members/Medicare: $40-$70
    • Non-Members:$100 (not Medicare)

Clinic Staff & Schedule

VACATION SCHEDULE

We are approaching warmer months which brings vacations for our staff. We strive for work-life balance; taking good care of ourselves helps us take good care of ourselves. We appreciate your patience if staffing is down when you want an appointment. It’s okay to see a different provider if yours is away.

URGENT CARE

We piloted an Urgent Care Clinic in our Manette location for February and March, hoping to help with the lack of community urgent care clinics on the weekends. We did this as a service to the community.  We were able to help about 6 patients during this time and may do another pilot of this idea in the Fall. For now, we will not be open on Saturdays.

STAFF CHANGES

Tammy will be moving back to South Carolina this summer to be closer to family. We will miss her terribly.

Appointments & Refills

MEDICATION REFILLS

Please allow 2-3  business days for all refills, especially controlled refills. Best requested directly thru your pharmacy or the provider line.

WELLNESS EXAMS

Plan for your yearly wellness exam; then, we can ensure you get in with your provider of choice at a time that suits you and us.

SAME DAY APPOINTMENTS

We do our best to get urgent exams (illness or injury) on the same day. This may not be with your provider if they do not have openings. Our providers communicate reguarly, so do not worry about seeing someone different.

TMC Limited Urgent Care

February 1, 2023

Effective February 4, 2023 we will be open for Limited Urgent Care needs to anyone in our community.  

The Manette Clinic will be open in our Bremerton office Saturdays from 10am-3pm for walk ins.

This will be on a first come first serve basis during these hours, last appointment will be given at 2:30pm. All services will be cash-pay at the time of visit. Our current members of the clinic will pay a copay to be seen on this day and non members of the clinic will pay the cash price based on services performed on the date of service.

For updates about this and more information please call the main office at 360-621-2696

COVID VACCINE UPDATE

October 2, 2021

Our clinic is no longer providing vaccines nor will we be providing 3rd booster shots. If you are looking for a COVID-19 vaccine please contact Ktisap Health Department to find a location near you.

If you lost or never recieved your Covid Vaccine card you can go to the website listed below to access your vaccine information through Washington State: https://wa.myir.net/login/

Please DO NOT CALL the front office and be advised that inbound phone calls regarding the COVID-19 vaccine will NOT be returned due to clinic capacity. Instead, feel free to check back via email. We will update the auto response for [email protected]. 

We appreciate your patience and understanding.

Stay safe and have a great day!

The Manette Clinic

 

Additional information regarding COVID vaccines may be found at:

 

The Manette Clinic Provider Spotlight With Deborah Tillman, Msn, ARNP-A-GNP-C

September 11, 2020

The Manette Clinic is fortunate to have some of the most knowledgeable and dedicated medical staff and administrators. Each one brings with them a wealth of experience. This spotlight is a chance to go beyond the bio and learn a little bit more about our very own Deborah Tillman, MSN, ARNP, A-GNP-C.

How did you come to work at The Manette Clinic?

Tillman: “I was assigned to The Manette Clinic for my first clinical placement as a nurse practitioner graduate student. After meeting with Tanya Spoon, touring the clinic, and setting up a student schedule, the university contacted me to say I’d been reassigned to another clinic instead. I told the university this was not possible as Tanya’s commitment had already been made with time and effort spent. I’d had such a good feel during my initial meeting that I didn’t want to give up the opportunity. My initial Manette Clinic experiences as a student set a high bar for the remainder of my training  and a year later when the opportunity presented itself to work at The Manette Clinic I didn’t hesitate.”

What drew you to The Manette Clinic?

Tillman: “From the first time I walked into the clinic, I felt welcome and part of a supportive team who had similar patient care goals.  Almost every patient I met as a student told me how much they appreciated the care they received at The Manette Clinic.”

What made you go into medicine?

Tillman: “Since I was in high school I’ve been drawn to medicine. Reflecting on my habit of buying anatomy books over the years, I decided to do something about it in my early 30’s by becoming a volunteer EMT. My first time riding in the back of an ambulance I felt like I’d found my place. Fifteen years later my heart didn’t want to give it up being a firefighter paramedic, however my body was telling me otherwise.  Becoming a nurse practitioner seemed like a great next step in helping folks with their medical needs.  I still feel at home in medical care settings and can’t imagine any other line of work.”

What do you want your patients to know about your medical style or approach?

Tillman: “It’s their life and their body, they get to decide how to go forward as best fits their preferences for life and how they wish to live it.  I need to know what their preferences are to best help them reach their goals.  I’m there to act as a guide who has some knowledge they may not have, some resources they may not have access to, and help work through with them the options’ benefits and risks.”

You also work in the community for The Manette Clinic, what is the most rewarding part of your time spent doing home care?

Tillman: “Over the years I’ve become comfortable being in folks’ homes as I work. I recognize the great trust placed in me as I’m welcomed into a home with family photos, favorite possessions, beloved pets, and all the mess that comes with day to day living that most casual visitors are not allowed to see.”

What is one of your passions outside of work?

Tillman: “I love to get outside and work hard, it doesn’t really matter the activity.  There hasn’t been much time for outside activities in the past 3-4 year. I hope to restart the habit and make new memories.  One summer I was part of a group of family and friends who hiked from Lake Quinault over the High Divide and to the Elwha River over several many days. Everyday was more beautiful than the last.”

Who is a living inspiration for you?

Tillman: “I’m inspired by anyone who gets knocked down and gets back up to keep trying to reach their goal.  No one is perfect, we all make mistakes, all unintentionally hurt loved ones along the bumpy road of life.  I appreciate when someone tries to do better next time, and keeps up the effort they can offer.”

What is your favorite thing about living in PNW/Kitsap?

Tillman: “The variety of activities available within a few hours’ travel time in any direction.”

Safety around our homes.

June 25, 2020

By Deborah Tillman, MSN, ARNP, A-GNP-C

Most of us have been spending the majority of our time at home these days along with the whole family.  Now might be a great time to create or update your home’s safety plan. If you don’t already have such a plan, putting one together and adding needed safety features may be welcome activities, especially if you’ve run out of fresh ideas after watching Frozen 2 for the tenth time.

Falls:

Trips and falls can happen to anyone of any age around the home. Risk of these can be substantially reduced with a few simple activities and additions to the home:

  • Clear your floors of small and loose items such as pet bowls, toys, electrical cords, throw rugs; anything that might slip away when stepped on or someone could catch with their foot and lose balance.
  • Arrange or remove furniture so there’s a wide walking path in all rooms, especially those leading towards exits to the outside.
  • Essential items should be placed where they can be easily reached by family members that may need them.
  • Add grab bars inside and outside of your bathtub or shower, and next to the toilet.
  • Add railings on both sides of stairs, and make sure stairs, hallways and any transitions in floor height have good lighting.
  • Outdoors areas should be well lit, with walkways smooth and free of puddles so mud and ice can not form.

Fire: 

Nine in 10 structure fires occur in the home and more than 8 in 10 fire-related deaths resulting from home fires.  Only 1 in 5 parents regularly practice fire escape plans at home, and only half of parents report their children know what to do in the event of a fire.  When a fire does happen at home, children can become frightened and hide. By educating and practicing with our children for these types of emergencies, we can save lives and even have a little fun while doing it.  Kids of all ages may find this a fun diversion and it can be as simple or as elaborate as you wish:

  • Have family members draw out on a sheet of paper your house with outside exits anyone can use clearly marked.
  • Pick a family safety spot that’s near your home, yet a safe distance away, for everyone to meet up in the event of an emergency.
  • Press the smoke alarm test button with all family members present so they know what the beep sounds like.
  • Then press the smoke alarm test button again, this time everyone walks to the safety spot in two minutes or less (use a timer). Two minutes is how much time a family has to safely exit the house in the event of a fire.  
  • For children under six, assign an adult to help them during the beeping sound and reaching the family safety spot activities.
  • Consider posting your house plan (with exits and family safety spot clearly marked) for everyone to see, like any good work of art.

(Sources:  National Safety Council, 2020; IAFF, 2018)

COVID-19, the Bully

March 19, 2020

By Nita Baer MA Lifespan Integration Therapist/Consultant Spiritual Director 

Surreal times! I’ve entertained a host of emotions this week as our community shuts down and the stock market flails. COVID-19 feels like a bully and the fall out chaotic. I’ve known bullies since day one. No fun!! 

This bully put our world into a steep, disorienting learning curve. Super uncomfortable! As humans we prefer comfortable because at a subconscious level our animal (reptilian) brain equates “sameness” with safety. Our first, subconscious question, in every situation is … “Am I safe?” This need for safety is found in your amygdala that was formed 80% in uterus and the last 20% in the first couple months of your life. Your amygdala houses your fight, flight, freeze, and collapse responses. All information comes in through your bodies five senses for screening by the amygdala before moving into conscious thought. 

If you were born into a home were your parent responded with warmth and kindness when you cried your outlook on life is much more likely to be, “Yes, I am safe. All will be well, and all manner of things will be well.” Thank your parent! 

If your parent was unpredictable for any reason, or unable to soothe you because you were sick, your matrix was wired much, much, differently. Your brain tells you, “If I am uncomfortable, I am in trouble. Nothing that causes me to feel uncomfortable ends well for me. We are going to die!” 

This anxiety does not improve by telling yourself to get a grip! In fact, dismissal will ramp up your emotions big time. Think of your amygdala like a young child. If a child thinks the adult in charge is not going to watch out for them, they freak out. If the child knows the adult in charge will be kind, stay with them even if they have big emotions, the child will calm down. 

This is because the worst thing a human can experience is a felt sense of abandonment. Abandonment to an infant (remember the forming age of your amygdala) means we die. A felt sense of abandonment verses physically being left is what matters. If a child cries or reaches out to their caregiver who is preoccupied with their phone or too busy, the child becomes anxious. Right now, in our community there are many people feeling anxious. Not uncomfortable, not restless, but perched on the edge of a panic attack, or well into a panic attack. They struggle moment by moment to ride the wave of emotion. They may startle more easily, anger may have a shorter fuse, they may withdraw or become really clingy. 

And these can be normally really high functioning folks! Like you and me! For those of you who believe, “All will be well,” the dysregulated emotions of the anxious may seem uncalled for, overreacting, a waste of energy, foolish, etc. How very privileged you are! Be thankful your amygdala is working well for you! 

This is a time for you to offer empathy (Brene Brown has a great free online animation regarding empathy) and offer constructive alternatives. Somewhat like a kind parent who validates a child’s emotion and then helps the child reorganize. Reorganizing an infant may be all about changing a diaper. Helping an adult reorganize may look like taking a walk, doing yoga, telling a funny story, offering art supplies, helping them consider what is true about the present moment. 

You who feel anxious… for God’s sake stay off the news!!! You all know the drill by now. Social-distancing, wash your hand, quarantine if you feel sick. All the details are too much and unnecessary! 

If you are reading, this the truth is, you have many more resources then when you were a child. The uncomfortableness of this moment is not the same as when you were an infant. Now you have many, many more options. You can call a friend, take a walk, a bike ride, weed, (our yards may look amazing this year!) read a funny story, do Qi-Gong, yoga, Sudoku, read something inspirational, do art, cook good food. (Yes, there is food. People in China are not starving, I checked!) The vast majority of you are not stuck in a blanket needing someone to pick you up! 

Make a choice to breathe deeply many times a day. Breathe in to the count of eight, hold it, exhale deeply and pause. Repeat ten times. If anxiety is increasing, count anything and everything. Count backwards by three or seven. Counting drives you into your left brain that will help your right brain (where your emotions hang out) calm down. Smell something yummy, feel the seam of your jeans, notice the colors around you. And breathe some more! 

To be human is amazing!! We all grew our own heart and lungs, we are tenacious, resourceful and strong! Remember vast majority of folks want to help you! 

Be well! 

Resources:

Lee Holden Qi-Gong, online classes and he is offering free wellness routines. 

Oak App for breathing.

Luminosity is a brain training app. A constructive place to put your mind to work.

Down Dog App offering free routines right now. 

Mindful Eating

November 26, 2019
We love the idea of mindful eating, if you have never heard of this before, checkout this excerpt from the Institute of Functional Medicine. This subject seems pretty appropriate for our celebration season.

What Does “Mindful Eating” or “Intuitive Eating” Mean?

The two terms are often used interchangeably, but they mean different things. Mindful eating is the process of paying attention to your actual eating experience without judgement. This sounds simple and straightforward, but the process can be complex, especially for those who are not used to it. A mindful eating practice helps you become aware of the reasons behind your hunger (emotions, lack of food, tradition, schedule, etc.).

Intuitive eating is a broader philosophy that incorporates mindful eating. It emphasizes attunement of mind, body, and food, and focuses on strengthening the relationship with all three of those elements. This approach includes using nutrition information without judgement and respecting your body regardless of how you feel about its shape.

 According to Evelyn Tribole, MS, RD, those who practice intuitive eating

  • Eat for physical reasons, rather than emotional reasons
  • Rely on internal hunger and satiety cues to guide when, what, and how much they eat
  • Give themselves unconditional permission to eat

Mindful and intuitive eating practices are helpful for everyone, but they are especially important for those who have suffered from disordered eating patterns, or who feel like food controls their life. They provide a respectful and healthy way to reconnect with food while gaining a deeper understanding of your mind and body.

Mindful and intuitive eating practices are not diets. They are mindsets that require you to trust your natural instincts and listen to your body’s natural hunger and fullness cues. In these practices, there is no room for outside influences like social pressures to eat or not eat certain foods. There is no directive to eat or not eat specific amounts of food at specific times. Instead, these practices teach you to listen to how your body is feeling and allow you to make food choices for yourself without judgement.

Getting Started

Mindfulness is a struggle for many people, and it takes time and dedication to master. Work your way up to eating mindfully every day and forgive yourself when you don’t. Being aware that you don’t always have the time or energy to eat mindfully is part of building a successful mindful eating practice. Trust your instincts, and your body’s instincts. It can take weeks, months, and sometimes years for mindful or intuitive eating to become a natural part of your life. Be patient with yourself and enjoy the process of building a stronger mind-body connection and improving your relationship to food.

Tips for Eating Mindfully and Intuitively

  • Prepare. Cooking for yourself is the best way to prepare your body to eat mindfully. When you are preparing food, the sights and smells ignite the part of your brain that readies your body to accept nourishment. If you are eating at a restaurant, enjoy the sounds, smells, and sights as you wait for your food.
  • Put away electronics. Allow yourself to hold space for one thing: eating. Make sure all electronics are away from your eating space and eyesight.
  •  Sit down. Take a deep breath, center yourself, and give yourself permission to eat as much as you want and enjoy the food in front of you. If desired, this would be the time to give thanks, pray, or say grace. Express gratitude for all of the people who had a hand in growing and making your food, including yourself.
  • Develop a mealtime ritual. This may include setting the table or turning on some relaxing music to enjoy during the meal.
  • Be still. Dedicate at least part of the meal to silent enjoyment of the food.
  • Connect. When eating alone, connect to your mind and body. Note to yourself how the food tastes when you chew slowly and savor it. Pay attention to your body’s reaction. When eating a meal with family or friends, connect with them over the meal. Talk about the food together.
  • Take in the food with all of your senses. What does the food look like? Is it appealing, or unappealing? What do you hear? Is the food sizzling? Is the music you chose relaxing? What does the food smell like? Are there smells other than the food? How does the food feel in your hands or in your mouth? What’s the texture like? How does the food taste? Is it savory, or sweet? Taste everything and chew slowly. Try to identify ingredients and flavors. This activity can be helpful for anyone looking to heal their relationship to food. It can be an especially fun activity with children to help them understand and appreciate what they are eating.
  •  Listen to your body. Recognize when you have had enough to eat, or when you want more. Honor those internal cues as natural and healthy. A major sign of fullness is that food becomes less appetizing or doesn’t taste as good as it did when you began the meal. Note that internal regulations can be disrupted for certain people, particularly those with eating disorders and diabetes. Significant intake of sugar and processed foods can also disrupt the body’s natural fullness cues. If you find yourself eating uncontrollably, you may need to limit the amount of food you put on your plate at first. Waiting five minutes before getting seconds can also help your body become more attuned to hunger and fullness cues.
  • Reject the dieting mindset. Do not attempt to restrict your intake of foods or significantly limit calories. Don’t punish your body for craving foods that others might deem as “bad” or “unhealthy”. Let go of the notion that your body must conform to societal standards of beauty. All bodies are worthy of love and life. Shift your focus away from actions you think will change the way your body looks. Instead, focus on actions that will improve the way your body feels.

References

Bacon L. Health at every size the surprising truth about your weight. Dallas, TX: BenBella Books; 2010. 

Bacon L, Aphramor L. Body respect: what conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX: BenBella Books; 2014. 

David M. Nourishing wisdom: a mind/body approach to nutrition and well-being.

New York: Bell Tower; 1991. n The Center for Mindful Eating – Home. The Center for Mindful Eating – Home. http://thecenterformindfuleating.org/. Accessed March 4, 2017.

 Tribole E, Resch E. Intuitive eating. New York: St. Martin’s Griffin; 2012.

Practicing Gratitude

August 1, 2019

There has been some great research projects on the benefits of gratitude in our country as well as around the world. Keeping a journal of gratitude can increase your well being and life satisfaction.

Every day find something that you are grateful for and journal or just sit and think about it. It helps to be specific and write down things like “today my friend called me and told me how much they care about me and I’m really grateful for her/him”. This practice will help with your general outlook and mental health.

Here are some tips and ideas on how to incorporate gratitude into your life:

  • Tell people what you are grateful for.
  • Focus your gratitude on people instead of things
  • Write something down every day
  • Keep a gratitude log/or jar
  • Write a gratitude letter to someone who has had impact to you.
  • Share your grateful moments around the dinner table
  • Anticipate beauty and be grateful for it (it’s all around you)
  • Build a ritual around gratitude every day!

Summer!

July 31, 2015

Summer is here and we all want to feel better as the weather is warm. Here are some practical ways to help modify your current diet and life choices:

  • Make sure that at least half of each meal is plant based
  • Consume a wide variety of colorful fruits and vegetables. All of the different colors found in plants are derived from phytochemicals which may help prevent cancer.
  • Try exploring local farmers markets or consider signing up for Community Supported Agriculture (CSA) to enjoy locally grown and seasonal produce. Find some options near you at http://www.localharvest.org
  • Choose whole grain carbohydrates like whole grain breads, pasta, crackers and brown rice to help meet the recommended daily fiber intake of 25-38 grams per day. Use nutrition fact labels to help identify high-fiber foods by choosing carbohydrates with > 3 grams of dietary fiber per serving.
  • Incorporate plant sources of protein (like legumes, such as beans and lentils) into meals to reduce saturated fat intake.
  • Get out and walk. Work in your yard or garden. Get outside every day, even if its still cold. It’s good for the mind and body.
  • Limit non-work screen time to less than 2 hours a day.
  • Have a positive attitude. Attitude can affect your inflammatory levels in your blood.
  • Limit Alcoholic beverages

Hopefully this is helpful to you. Please comment with what you are going to do to the rest of the summer to stay healthy and happy!

-Tanya

Typical Services Inside A DPC Office

July 20, 2015

When using a Direct Primary Care Doctor who includes a monthly, quarterly or annual membership plan, most practices will provide all patients with:
Unlimited Access to your doctor or doctor’s office.

Many DPC doctors and offices can provide same or next-day care for urgent medical issues such as sprains, respiratory illnesses, cuts requiring stitches, urinary tract infections, fractures, and more.  If you are not sure whether your condition is something your paricular DPC doctor/office can take care of, we recommend you call and they will help direct you to the best place to get it addressed.
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