Laboratory Testing for COVID-19 in Boundary County
By: Greg Botkin, MD, Medical Director, Boundary Community Hospital
Part 1 of 2
Dr. Greg Botkin
I will try to teach this using questions and answers:
1) I am somewhat skeptical about COVID (SARS-CoV-2) tests after all the critical reports I have heard in the news. Does Boundary Community Hospital have the kind of lab tests we need for meaningful results?
I think skepticism is understandable at this point. The tests everyone had in the early months of the pandemic were of questionable reliability, and we are still not sure how accurate the published numbers were. But the world’s best biotech companies were working on the COVID problem from the beginning, and in recent weeks they have brought out technology which should be far more reliable.
Our Hospital has pushed hard to obtain these products. We have now put together a set of instruments and reagents that should be as accurate as any testing platform in the country. By the time this article is published we will have run almost three hundred tests here in our lab. The results merit a high degree of confidence. When we inform patients about the presence or absence of active disease we believe we are providing the most accurate report that medical science can now provide.
2) How were you doing COVID testing before you had in-hospital tests?
We took the nasal swab here at the Hospital, sealed it up and shipped it to the state lab in Boise, where they tested with technology supplied by the CDC. That biochemical process was developed very early in the pandemic and was far from ideal, especially if one is transporting samples from hundreds of miles away. We sent tests from about a hundred Boundary County residents; all registered negative for active disease. Some of us question the accuracy of those results. We began in-house testing as soon as we received everything we needed for solid technique.
3) There seem to be many different kinds of COVID lab tests. Why isn’t testing simpler?
It would be simple if we were counting germs in a Petri dish. This is complicated because the body’s response to an invading virus is highly complex. Part of the challenge is to make a test that targets only the SARS-CoV-2 virus. A positive test must show a reaction to SARS-CoV-2 (the COVID virus) and nothing else. And it must be sensitive enough, theoretically, to detect every sample that carries the virus.
The BCH Clinical Medical Laboratory has several machines to perform COVID-19 tests.
4) Sort out the different COVID tests for us. Which one do I need?
We should draw this out on a chalk board because the molecular biology is a beautiful thing. That will have to wait. Think of it like this: if you think you might be acutely ill with COVID we need to test you for active viral presence. The virus organisms multiply rapidly in the body after one is inoculated; our tests should be able to detect viral particles about a week later, when one begins to show symptoms of infection. When the infection has run its course the virus is harder to find because your immune system has identified it and torn the viral organisms apart. There are some exceptions to this, and if you hear about individuals who test positive for months it does not mean they are harboring an active infection. It means that for some poorly understood reason our tests are still sensing viral fragments.
In our lab here we have three tests which work very well to detect active viral presence. Two of these detect the virus’ RNA (usually called a PCR test), the other detects a specific viral protein (usually called an antigen test). We need a nasal swab to run either of these tests. If we think one of our patients might be actively infected we confirm this with at least two different tests, and then we repeat the process with a second sample a few hours later. If final results are positive it means (subject to the limitations mentioned above) that you have an active COVID infection, and that you are infected now.
These tests are being run with increasing frequency in our Boundary Community Hospital laboratory. The demand may become heavy enough that we run into some logistical limitations, so if you find yourself in a slowly moving line please be patient with us.
There are pressing reasons to know which of us are carrying an active infection, and we are now capable of providing that intelligence with a reliable test that takes about thirty minutes to show results. You will need a physician’s order to have the test done here. The Hospital web site provides details about what one must do to be registered and have a sample taken by lab personnel.
5) What about antibody tests? They were supposed to answer all kinds of questions about COVID, like how far has it spread, and when can we safely go back to work, play, and school.
Antibody tests are very different from the PCR and antigen tests described above. Scientists, physicians and policy makers have great hopes that antibody testing will draw back the curtains and show us just how far this virus has invaded society. Our hospital is fine-tuning our antibody testing technology and it should be ready to serve our community very soon. I will write more about that next week.
Due to the increased number of tests requested locally, Boundary Community Hospital is limiting COVID-19 testing to 10 am to 3 pm Monday through Friday. Your provider will tell you where to park to register for the lab tests when they write the order and send it to the lab. Lab Techs will take the samples at your vehicle and send the results to your provider.
Sara Hull, NP-C Joins Boundary Community Clinics
/in Press ReleaseSara Hull, NP-C Joins Boundary Community Clinics
August 6, 2020
Bonners Ferry, ID – Boundary Community Clinics is happy to announce the addition of a new family practice provider, Sara Hull, NP-C.
Sara grew up in Bonners Ferry and moved back home in 2019 with her husband and two children. Currently, they’re enjoying the many outdoor opportunities offered in Boundary County and the slower pace of life after living in Kootenai County while completing her education.
Sara will be working with Susan Layeux, MD and Mike Yourzek, PA-C using a team care approach, and she is excited to serve her community, offering care to patients of all ages. To make an appointment to see Sara or any of the providers at Boundary Community Clinics, please call (208) 267-3655. Patient appointments are available Monday through Friday 8 am to 5 pm.
Summer 2020 CNA Graduation
/in Press ReleaseHospital Celebrates CNA Graduation
July 30, 2020 Bonners Ferry, ID
Boundary Community Hospital (BCH) and North Idaho College announced the graduation of the Summer semester Certified Nursing Assistant (CNA) class in Bonners Ferry. Congratulations to the new Certified Nursing Assistants: Gracie Adams, Aidan Webster and Malin Worley, who will all be working at the BCH Extended Care Facility, and Nina Byler, who will be working at Sunset Home.
Standing (l-r): Gracie Adams, Aidan Webster, Nina Byler, and Malin Worley with Instructor Kris Patterson, RN in front.
Whether at the local hospital, or at home with in-home services, the person more than likely helping take care of your personal needs is a Certified Nursing Assistant (CNA). A CNA is someone who has completed a certification course that includes classroom, lab, and clinical experience to ensure they are able to provide personal care in compliance with the state’s regulations. Over the past eight weeks, our newest graduates have learned the ins and outs of what it means to be a CNA in Bonners Ferry.
With time spent training with nurses at Boundary Community Hospital, the students come away with an appreciation of the dedication and skills needed in the real world. Boundary Community Hospital and North Idaho College are very proud and excited for these CNAs to take on their roles throughout the community. Gracie Adams praised their instructor, saying “We couldn’t have done it without Kris!”
Next semester at Boundary Community Hospital in Bonners Ferry begins August 18 through October 15, 2020. Space in the class is still available, so contact Kris Patterson, RN at [email protected] or call (208) 267-3141, Ext. 4312 for more information.
Nursing in Boundary County
/in Community, History, Press ReleaseCOVID-19 Update to the Community July 29, 2020
/in Press ReleaseHospital COVID-19 Update to the Community
July 29, 2020
Bonners Ferry, ID – Now that COVID-19 is present in our community, the Boundary Community Hospital COVID-19 Task Force made up of department leaders and medical staff has been meeting frequently to implement internal protocols so that we can meet the increasing challenges to keep our patients, nursing home residents, employees and community safe.
The BCH Clinical Medical Laboratory has some of the best COVID-19 laboratory testing in the area. With improved testing capability comes responsibility to ensure prompt results to the providers ordering the tests. Everyone is anxious to get the tests done if they have been exposed or think they have been exposed but keep in mind:
Emergency Check In – For the safety of everyone, including patients and staff, the Emergency Department has instituted curbside triage before accessing Emergency Services. Patients driving in should park in the designated Emergency Check-in Parking spot under the Ambulance Bay and call the Registrar phone number listed on the sign. Once checked in and screened, a nurse will come out to assess/triage and give further instructions. If you are in an emergency situation, please call 911. As always, the Emergency Department is ready 24/7 to serve you and care for our community.
Outpatient (Non-COVID) Lab Testing – Non-COVID-19 lab testing is available Monday through Friday 7 am to 5 pm. Drive Up Lab Testing is available Monday through Friday 8 am to 3 pm. Park in one of the designated parking spots by Outpatient Services and call the number to register. The lab tech will come out and take the needed samples at your car.
Visitor Restrictions in Place – All patients, visitors and staff are screened (including temperature checks) upon entering. Everyone must wear a mask while in the facility. BCH promotes social distancing “Western Style” and asks that everyone maintain a 6’ distance (the average size of a bear) from each other.
The BCH COVID-19 Task Force stays connected with Boundary County Emergency Management, County officials, Panhandle Health District, local hospitals and health care facilities as well as State agencies. “We are always analyzing the current information, sharing our concerns and needs with other facilities, all while maintaining the healthcare needs of our community during this pandemic,” says Hospital CEO Preston Becker. “As a community hospital, we strive to provide the highest quality healthcare with compassion and respect. I am encouraged by the innovative thinking, the constant assessment, and desire to do what is best for the patient that is part of our daily discussions.”
###
Lab Testing in Boundary County Part 1
/in Press ReleaseLaboratory Testing for COVID-19 in Boundary County
By: Greg Botkin, MD, Medical Director, Boundary Community Hospital
Part 1 of 2
Dr. Greg Botkin
I will try to teach this using questions and answers:
1) I am somewhat skeptical about COVID (SARS-CoV-2) tests after all the critical reports I have heard in the news. Does Boundary Community Hospital have the kind of lab tests we need for meaningful results?
I think skepticism is understandable at this point. The tests everyone had in the early months of the pandemic were of questionable reliability, and we are still not sure how accurate the published numbers were. But the world’s best biotech companies were working on the COVID problem from the beginning, and in recent weeks they have brought out technology which should be far more reliable.
Our Hospital has pushed hard to obtain these products. We have now put together a set of instruments and reagents that should be as accurate as any testing platform in the country. By the time this article is published we will have run almost three hundred tests here in our lab. The results merit a high degree of confidence. When we inform patients about the presence or absence of active disease we believe we are providing the most accurate report that medical science can now provide.
2) How were you doing COVID testing before you had in-hospital tests?
We took the nasal swab here at the Hospital, sealed it up and shipped it to the state lab in Boise, where they tested with technology supplied by the CDC. That biochemical process was developed very early in the pandemic and was far from ideal, especially if one is transporting samples from hundreds of miles away. We sent tests from about a hundred Boundary County residents; all registered negative for active disease. Some of us question the accuracy of those results. We began in-house testing as soon as we received everything we needed for solid technique.
3) There seem to be many different kinds of COVID lab tests. Why isn’t testing simpler?
It would be simple if we were counting germs in a Petri dish. This is complicated because the body’s response to an invading virus is highly complex. Part of the challenge is to make a test that targets only the SARS-CoV-2 virus. A positive test must show a reaction to SARS-CoV-2 (the COVID virus) and nothing else. And it must be sensitive enough, theoretically, to detect every sample that carries the virus.
The BCH Clinical Medical Laboratory has several machines to perform COVID-19 tests.
4) Sort out the different COVID tests for us. Which one do I need?
We should draw this out on a chalk board because the molecular biology is a beautiful thing. That will have to wait. Think of it like this: if you think you might be acutely ill with COVID we need to test you for active viral presence. The virus organisms multiply rapidly in the body after one is inoculated; our tests should be able to detect viral particles about a week later, when one begins to show symptoms of infection. When the infection has run its course the virus is harder to find because your immune system has identified it and torn the viral organisms apart. There are some exceptions to this, and if you hear about individuals who test positive for months it does not mean they are harboring an active infection. It means that for some poorly understood reason our tests are still sensing viral fragments.
In our lab here we have three tests which work very well to detect active viral presence. Two of these detect the virus’ RNA (usually called a PCR test), the other detects a specific viral protein (usually called an antigen test). We need a nasal swab to run either of these tests. If we think one of our patients might be actively infected we confirm this with at least two different tests, and then we repeat the process with a second sample a few hours later. If final results are positive it means (subject to the limitations mentioned above) that you have an active COVID infection, and that you are infected now.
These tests are being run with increasing frequency in our Boundary Community Hospital laboratory. The demand may become heavy enough that we run into some logistical limitations, so if you find yourself in a slowly moving line please be patient with us.
There are pressing reasons to know which of us are carrying an active infection, and we are now capable of providing that intelligence with a reliable test that takes about thirty minutes to show results. You will need a physician’s order to have the test done here. The Hospital web site provides details about what one must do to be registered and have a sample taken by lab personnel.
5) What about antibody tests? They were supposed to answer all kinds of questions about COVID, like how far has it spread, and when can we safely go back to work, play, and school.
Antibody tests are very different from the PCR and antigen tests described above. Scientists, physicians and policy makers have great hopes that antibody testing will draw back the curtains and show us just how far this virus has invaded society. Our hospital is fine-tuning our antibody testing technology and it should be ready to serve our community very soon. I will write more about that next week.
Due to the increased number of tests requested locally, Boundary Community Hospital is limiting COVID-19 testing to 10 am to 3 pm Monday through Friday. Your provider will tell you where to park to register for the lab tests when they write the order and send it to the lab. Lab Techs will take the samples at your vehicle and send the results to your provider.
Eating Well Through Summer
/in Press ReleaseEating Well Through Summer
By: Shantel Pluid, RD, LD
Registered Dietician, Boundary Community Hospital
Summer is in full swing and that means access to more grilled foods, delicious fruits and savory vegetables. Picnic food does not always necessarily mean healthy and low calorie, but it does mean tasty! There are a few things to steer clear of, while still leaving plenty of other appetizing options to choose from.
Before filling your plate at a barbecue, take inventory of all the options available and prioritize what you would like to eat. Taking the time to think about your meal before filling your plate will give you some time to think about portioning and how you can balance your food groups.
Grill Options:
Desserts:
The abundance of summer can bring temptation at the picnic table. For your health, remember to choose wisely.
TSE and COVID-19
/in Press Release, Time Sensitive EmergencyHere to Help – TSE and COVID-19
By: Wanda Wilkerson RN, BSN, CEN
June 4, 2020
Boundary Community Hospital, Boundary Ambulance, and Life Flight Network work as a team to get patients to the highest level of care as swiftly as possible for better outcomes.
The Covid-19 Pandemic has had many negative impacts on the medical field, but one unanticipated impact is on community members who are experiencing Time Sensitive Emergencies (TSE) like stroke and heart attack.
When the Pandemic began, all across the nation people were directed to remain at home and not come into hospital emergency departments (ED) in order to avoid overtaxing front-line emergency staff. People listened, they stayed home and self-isolated and watched the news and became more fearful. According to the Washington Post, ED volumes have been down by more than half all over the country. This in itself is not a bad thing until you wonder what has happened to all the heart attack, stroke, and trauma patients. From the highest acuity to the lowest acuity, people seem to be avoiding needed medical care out of fear of infection from the Covid-19.
It is extremely important to seek medical help for those emergent time sensitive events such as Heart Attacks, Strokes, and Trauma; for those times when every second counts to save heart muscle and brain matter; for those times when any delay in care and medical treatment can have a huge impact on the health of the patient and their families for the rest of their lives.
The news media have placed the fear in us to the point that many very sick people are not following up with their physicians or seeking emergency care, or even calling 911 for an ambulance when it is needed. There is so much misinformation out there resulting in people often not knowing who or what to believe. The increased stress alone would have us believe that there would be more heart attacks not less.
According to the Washington Post: “A report to be published by the Journal of American College of Cardiology on nine high volume Cardiac Catheterization labs across the country found a 38 percent drop in patients being treated for a life threatening event known as a STEMI – the blockage of one of the major arteries that supplies oxygen-rich blood to the heart. The study compared what happened this past March, when Covid-19 cases were climbing, with the treatments delivered from January 1, 2019, through Feb. 2020.”
The number of Stroke patients seeking medical help is also down by 30 percent in emergency departments as reported by the Washington Post.
Don’t delay if you recognize any symptoms of a STEMI heart attack which include chest pain, shortness of breath, dizziness, nausea, sweating, and possible pain up into the jaw or down the arm. Stroke symptoms include facial drooping; arms drift downward when asked to hold them up, as well as slurred speech. If the person shows any of these symptoms, call 911 immediately. Fast emergency medical services (EMS) transport to the hospital with pre-hospital notification that they are on the way can save valuable time when time is of the essence.
“Please seek medical attention when you or your loved ones need it,” says Emergency Nurse Wanda Wilkerson, RN. “Boundary Community Hospital has changed what we are doing and have new regulations, policies, and guidelines to help keep you and your loved ones safe as well as keeping the hospital and emergency staff safe. The key is to make sure people with symptoms overcome their fear and get prompt treatment that may save their lives or avoid long-term complications of untreated heart attacks and strokes.”
Boundary Community Hospital has been designated as a Level II STEMI, Level III Stroke, and Level IV Trauma Center by the State of Idaho. The designations for the Hospital are part of the Idaho Time Sensitive Emergency System (TSE) and are reserved for Hospitals that meet the stringent criteria established by the State as part of the statewide TSE system of care that includes three of the top five causes of death in Idaho: trauma, stroke, and heart attack.
PT Dry Needling
/in Press ReleaseDry Needling for Pain Relief
Dr. Jessica Seaburg, PT, DPT, OCS
Boundary Community Hospital Rehabilitation Services
By: Dr. Jessica Seaburg, PT, DPT, OCS
Boundary Community Hospital Rehabilitation Services
Dry needling is a technique physical therapists (PTs) use for the treatment of pain and movement impairments. You may have heard of the “opioid epidemic” and be concerned about how to manage pain without these addictive drugs. Dry needling can be a big part of the solution. It is an effective and very safe way to resolve muscle pain without pain medicines and their side effects.
What does dry needling look like?
During the treatment, a PT will insert a very thin, solid, “dry” needle, one without medication, into a muscle. This allows the PT to target trigger points, which are taut bands of skeletal muscle that may not be treated effectively by massage. PTs wear gloves when dry needling and observe all relevant safety guidelines.
Does dry needling hurt?
The sensation experienced with dry needling is typically a deep ache or cramp, which quickly subsides within about 30-60 seconds. Often the muscle will twitch or jump as the needle is inserted.
What can I expect from dry needling?
Dry needling is like pressing a “reset button” for the muscle. People typically have immediate improvement with pain and the ability to move the problematic area. It is common to experience some mild to moderate residual soreness for 1-2 days after treatment. Most people are nervous before receiving dry needling and then say, “Wow, I’m glad I tried that!”
What conditions can dry needling help?
Because dry needling treats muscle pain, it is especially helpful for conditions such as muscle strains, trigger points, tension headaches, and post-surgical muscle pain. Many people think all their pain is coming from arthritis or disc problems, when in fact much of it is coming from their muscles – and this pain can be greatly improved with dry needling.
I’m scared of needles – can a PT help me without dry needling?
Absolutely! Dry needling is just one tool in a large toolbox. In cases when PTs use dry needling, it is one technique that is part of a larger treatment plan. PTs have a host of other effective treatment options to help reduce pain without dry needling. In my experience, however, combining dry needling with other therapeutic treatments allows patients to return to their prior level of function more quickly.
Is dry needling the same as acupuncture?
No. Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles and supported by research. While acupuncturists and PTs use similar types of needles, the assessment, technique, and purposes of the treatment are different.
Is dry needling safe?
Yes! PTs are experts in human anatomy and receive extensive post-graduate training to be certified in dry needling, so the risks are minimal. Your PT will thoroughly evaluate you and provide education on possible risks prior to treatment.
Want more information on dry needling?
Check out: https://www.choosept.com/dryneedling
Where can I get dry needling?
Dry needling is a specialty for Physical Therapists. You should look for someone who has completed extensive post-graduate training in “Functional Dry Needling” through KinetaCore or similar program with experience in dry needling in a rehabilitation setting.
Dr. Jessica Seaburg, PT, DPT, OCS is a Physical Therapist at Boundary Community Hospital who specializes in restoring functional movement and is a Board-Certified Clinical Specialist in Orthopedic Physical Therapy.
Your Baby’s First Tests
/in UncategorizedYour Baby’s First Test
By: Sarah Prescott
When awaiting a new bundle of joy, parents are eager to finally hear the doctor pronounce the arrival of a healthy baby. An Apgar Score is given to a newborn to quickly assess their physical condition and health. However, there is another test that each newborn will undergo that is critical to discovering what may be hidden from plain sight and be crucial to their future development. This test is known as the Newborn Screening Test and it is required in Idaho to be done on all newborns. It is responsible for identifying a range of genetic and inherited health conditions that can lead to a myriad of developmental delays and potentially even death.1 Even though these conditions are rare, it is important to identify them as soon as possible so that any necessary treatment can begin immediately.
The Newborn Screening Test scans for 47 such conditions. In Idaho, 1 in every 1,000 babies is born with one of these rare genetic conditions that could in some cases could be fatal.2 The test is done in two parts, with the first blood sample taken from a small pinprick to the baby’s heel being done at 1-2 days old, and the second sample being taken at 10 to 14 days old. The sample is obtained in the Hospital where the baby is born or the Pediatrician’s office and sent out to a Lab in Oregon for testing. A blood sample can also be obtained at the Boundary Community Hospital Outpatient Laboratory and sent in to the Oregon Lab if the parent has been given the proper testing materials to bring in with them to the Lab.
The results of these tests are sent to the baby’s Pediatrician who will then notify the parent of any findings. It is scary for a parent to receive such a call and get the news that their child has a genetic condition or defect that may change the course of their life. It is best though to receive this call as soon as possible so that a proper diet can be started for an amino acid deficiency disorder or medication taken to prevent slow growth due to Congenital Hypothyroidism. Without the results of the Newborn Screening some of these conditions may lead to the loss of a child, or not knowing that there is an issue until irreversible developmental delays are observed. The conditions identified by the Newborn Screening Test usually mean a great deal of education and understanding along with a treatment plan that will be lifelong. A Pediatrician or Specialist will help parents navigate decisions and treatment plans regarding any of these identified conditions.
As the mother of a child who tested positive for one such rare condition, I can speak to the stress and uncertainty that comes along with a positive diagnosis. I can also speak to the strong sense of gratitude I have for the Newborn Screening Program and the fact that had my child’s condition not been identified at 2 weeks of age they might not have the same quality of life that they do today. If you are expecting a child or planning to become pregnant, it is important to know what to expect regarding the Newborn Screening Test and the important role it plays in the lives of Idaho families.
OT Myths and Misconceptions
/in Press ReleaseBy Dr. Yahtil Huaute, OT, DOT
Boundary Community Hospital
April 8, 2020
Yahtil Huaute, OT, DOT is the Occupational Therapist at Boundary Community Hospital.
April is National Occupational Therapy Month! There are plenty of myths and misconceptions about occupational therapy services, the providers, and the history. Here are the top 5 myths or misconceptions of occupational therapy:
1. Occupational therapists help you get a job. Occupational therapy addresses tasks that occupy your time, not your employment. Occupational therapists (OTs) can assist in work hardening skills to allow you to return to your employment, or in the ergonomics of your working tasks, however the term occupation is pertaining to tasks that occupy your time. This can include working, homemaking, caregiving for others, taking care of yourself, cooking, cleaning, shopping, driving, and so on. The goal is to get you back to living the life you want!
2. Occupational therapy is for old people. OT’s work with every age, from birth to death. Approximately 1/3 of the national occupational therapy caseload is with children, this includes newborns in the NICU, toddlers in early development, school age children, and older children all the way up to transitioning into college. In working with the pediatric population, therapist are treating the whole family to allow for the best outcomes. Many adults attend occupational therapy for a variety of reasons including hand/arm injury, job ergonomics, or debility due to illness.
3. Occupational therapists only work in a medical setting. OTs can work almost anywhere! The most common settings are school districts, private clinics, home health, nursing homes, and hospitals. There are less common settings as well, including mental health settings, programs in the community, or within a private company. Working in a private company allows therapists to address employee needs and to avoid work injuries through good equipment placement, proper body mechanics, and adjusting the environment to avoid repetitive movement injuries.
4. Occupational therapists and physical therapists (PTs) are the same. There is some overlap between the two, however OT is focused on what people need to do in their daily lives and PT is focused on strength and movement. For example, if you have a stroke, PT will work on restoration of movement, coordination, gait and balance whereas OT will work on tasks like feeding yourself, dressing yourself, and other tasks you need to return to your life. OT will also make recommendations for, and provide training with, adaptive equipment as needed.
5. OT’s just play games and do puzzles with kids. Kids learn through play, so the play is therapy in disguise. A puzzle can be used to work on fine motor skills, visual scanning, attention to task, and the ability to see patterns. Playing with a ball works on kid’s hand-eye coordination, timing, adjusting how hard or soft to throw the ball, and visual convergence. If a kid looks like they are playing during OT, then they are doing exactly what they are supposed to be doing. Play is essential to children’s growth and development.
Rehabilitation Services including Occupational Therapy, Physical Therapy and Speech Therapy are considered essential healthcare services. The team at Boundary Community Hospital offers appointments Monday through Friday in Outpatient Services with some pediatric telehealth appointments.
###