Too Old for Pediatrics, Too Young for Primary Care — Enter Adolescent Specialists

Q: What is an Adolescent Specialist and why should teens see a doctor if they aren’t sick anyway? 

A: Wellness Visits are important for adolescents to learn about taking health into their own hands and getting a chance to talk about personal concerns with a doctor.  There are specialty trained physicians who are there to support and accept teens as they are, no matter what.  Today’s adolescents face tremendous social and academic pressures, as well as potentially life-threatening illnesses, habits, and behaviors.  Although a pediatricians and family practice providers can care for most adolescent problems, adolescents can receive greater benefit from seeing someone more focused on their needs and challenges.  Adolescent health specialists are medical doctors who have completed at least 4 years of medical school and 3 years of general pediatric, family practice, or internal medicine residency training who then continue specialized training and/or fellowships in adolescent medicine.  These specialists have the training and expertise to help pre-teens, teens and young adults with their complex physical, behavioral, and emotional health care needs—from physical exams and immunizations to reproductive and mental health care. 

Massage therapy assists some cancer patients

Q: Can massage help cancer patients?

A: With appropriate precautions and a skilled therapist, massage therapy can be part of supportive care for cancer patients who would like to try it.  Massage therapy, with or without aromatherapy (the use of essential oils) has been used to attempt to relieve pain, anxiety, and other symptoms in people with cancer.  Clinical practice guidelines (best practice standards) for the care of breast cancer patients include massage as one of several approaches that may be helpful for stress reduction, anxiety, depression, fatigue, and quality of life.  Clinical practice guidelines for the care of lung cancer patients suggest that massage therapy could be added as part of supportive care in patients whose anxiety or pain is not adequately controlled by usual care.  A 2016 evaluation of 19 different studies of massage for cancer patients in general found some evidence that massage might help with pain and anxiety.  Massage therapists may need to modify their usual techniques when working with cancer patients; for example, they may have to use less pressure than usual in areas that are sensitive because of cancer or cancer treatments.  It is best to find a Licensed Massage Therapist who is familiar working with medical providers and specializes in clinical massage.  Ask about the training, experience, and credentials of the massage therapist you are considering.

Daily Activity vs. Physical Activity

Q: Whenever I go to the doctor, they always say I should increase my activity level. I feel like I’m always on the go with housework, walking the dog, and running errands. Am I not doing enough already? Is my activity level really the problem?

A: The recommended Physical Activity requirements for adults is 150 minutes per week. If you divide it throughout the week that’s only 30 minutes a day for 5 days. This should be a continuous session at a moderate intensity. While you may be doing a lot of work at home or running errands, your heart rate is most likely not elevated for a long enough period of time to elicit the benefits of aerobic activity. I would count walking your dog as aerobic activity but only if it last for 30+ minutes and you are not stopping every couple of feet to wait for your pup! Continuous time under tension is key. There is also a second part of this suggested physical activity that tends to get overlooked. While you may be meeting your aerobic or cardio activity requirements, the CDC also recommends muscle strengthening activities in conjunction with aerobic exercise! Strength or resistance training is the number one form of both fat loss AND muscle building. If I had to choose to implement only one of these forms of training, resistance training would be the winner solely based on the amount of benefits it holds over cardio-based activity.

Some of these benefits include:

  • increasing your metabolism,
  • strengthening your bones,
  • increasing muscle mass,
  • balancing out hormones in males and females, and
  • improving your overall functional mobility in everyday life, which is the ability to move through full ranges of motions with complete control and stability.

Resistance training doesn’t have to be overly intense and can be performed in the comfort of your home which is convenient given the cold weather and current COVID restrictions. For more information or to set up a consultation with our fitness expert, please contact us at (360) 572-2202 or drop us a note at

RA and COVID-19

Q:  I am on Renvoq.  Can I receive any of the COVID-19 Vaccines? 

A:  Based on the current information, yes.  People with rheumatic diseases will not be able to get any of the live vaccines under development for the novel coronavirus. However, according to William Chen, MD, Chief of the Adult Clinical Studies, Center for Vaccine Development and Global Health, University of Maryland, “…we don’t expect that there will be any issue with non-live vaccines.”  The currently announced vaccines use a new technology whereby a genetic molecule called messenger RNA (mRNA) teaches cells to create a version of the coronavirus spike protein. This prompts the immune system to make antibodies against this protein so the body can recognize the virus and fend off future infections. Unlike traditional vaccines that use weakened live or dead versions of the entire virus, these new types of vaccines are expected to be as safe for immunocompromised patients and patients on immunosuppressant medications. 

Current, although limited, evidence shows that people taking disease-modifying antirheumatic drugs (DMARDs), including biologics, are not at a higher risk for getting COVID-19 and the death rate is the same as the regular population.  2.8% of those hospitalized for COVID have autoimmune disease which is about equal or even less than the percentage of those in the general public.  European League Against Rheumatism (EULAR) suggests that the majority of people with rheumatic diseases who contract COVID-19 have similar outcomes to the general population, regardless of which disease-modifying medication they take. There is some limited, observational data that there are some medications taken for rheumatic disease that may be slightly protective. 

Do note that certain medications may need to be temporarily stopped if you have a confirmed COVID-19 infection, have been exposed to someone with a COVID-19 infection, or are experiencing common COVID-19 symptoms such as fever, dry cough, or shortness of breath. However, please do not stop or change medication dosage without contacting your rheumatologist or primary care provider. This is especially important with corticosteroids, which should never be stopped suddenly.

COVID-19 Vaccine Pre-Testing for Reactions

Q: Flu shots have been making me progressively sicker. Skin rashes, large irritated area at shot site, etc. Might there be something like an allergy test with micro dosing to test COVID-19 vaccine reaction?

A: No, but as far as allergic reactions to previous influenza vaccines are concerned, none of these newly announced COVID-19 vaccines are grown in eggs, so egg allergies (the most common cause of reaction from influenza vaccine) should not be a problem. Also, make sure your provider knows of your reactions from influenza vaccine as there are egg-free options (for flu shots) that might work better for you.