Category: Uncategorized

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 worked as a firefighter-paramedic and emergency medical services instructor. What drew you to this work and how do feel it has influenced your work as a nurse practitioner?

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.”

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)

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.