April 8, 2020 – Spring began a few weeks ago and – particularly after this past weekend – it became clear it was time to say Goodbye to Three Girls on a Sled whose carefree ride in the snow takes us back to a time before we had ever thought much about coronavirus and COVID was NO-VID.

Typically, our spring banner includes outdoor, spring activities (duh), but Young Girl and Online School seemed – given our present circumstances – to be a better fit.

[Aside: Of course, if your home is more like mine, this picture would need to include another, younger sister and some dispute about one of them “breathing too loud” and a father – numb to the sibling conflict – working feverishly to be sure the WiFi will produce enough bandwith for school and his office’s Zoom meeting that is scheduled to begin now.]

What Can You Say About This Past Month?

On March 5th we put up our first post about coronavirus disease / COVID-19 when Wake County announced its first case.

Over the last month, we have been gathering as much information as possible and processing it as a group. We have made plans and then remade plans as new information came available..

Medicine is always changing – changing plans is not necessarily a new thing. We always try to do things based on the best and most current information available.

The new thing was the speed of the changes – typically happening over years – these changes were happening over days and in some cases hours.

Let’s review all the changes at RCAM that are still current:

• All well care is moved to the Duraleigh office – only well children accompanied by a well adult are seen for well visits at Duraleigh
  • We are scheduling only “essential well visits” at this time – those are well visits that have a vaccine associated with them
  • If you had some pressing things you wanted to discuss at a well visit that is on the delayed list, consider scheduling a TeleHealth visit (see below)
• All sick child care was moved to the Brier Creek office – with a few twists:
  • Twist #1 – Curbside clinic was initiated for children with symptoms suspicious of possible coronavirus
  • Twist #2 – TeleHealth visits are becoming our new normal as a way to safely evaluate patients without the fear of increasing potential exposures
• All RCAM staff are now wearing masks and gloves – at both offices – add to that lots of hand washing and not touching your face and cleaning rooms after every patient

All of these changes were made to be as safe as possible yet still available to our patient families, to reduce exposures, and to slow the spread of coronavirus / COVID-19.

TeleHealth Medicine

TeleHealth Visits have some limits though I am surprised at how typically they can identify something treatable or rule out the need to come to our office or the Urgent Care or the Emergency Department.

We have spots available. Call and schedule a visit. The steps are laid out here.

Easter Holiday is Coming Up This Weekend

Good Friday is an official RCAM office holiday, so this Friday the 10th we will operate like we have on recent weekends:

• We will have an early clinic for newborns who need to be followed up from the past week
• All sick patients will be evaluated through TeleHealth visits

Meanwhile, The Brian Carter Era Began at RCAM

Brian Carter is our new office manager.

He began to learn the RCAM secrets when he started in December but he didn’t take the reins completely until after February 28th when Debbie Maness retired as our office manager after 42 years (!).

He hit the ground running. Brian would probably describe it more like a chase – as in it felt like he was being chased by a lion – as his first week on the job was highlighted by a pandemic.

Brian has been great. More about him later, but it is about time we introduced him to our extended RCAM-ily.

If you see someone in our office wearing a tie that doesn’t feature Sponge Bob (Dr. Sena) – that is more than likely Brian – give him a big Hello and Welcome.

Given the circumstances of his first month, he could probably use the encouragement.

Thank You

I am sure that everyone could use some encouragement.

The response of our administrative staff and nurses has been spectacular. The general day-to-day pressure on a pediatric staff is underrated, and now they quite suddenly have found themselves on one of the front lines of a pandemic.

They have handled some tough circumstances with a lot of grace and professionalism.

As pediatricians, we’ve had to work together even more than we usually do – Zoom meeting almost daily – making new plans and changing protocols that we just wrote. We have found another gear with how we work with and relate to one another and personally that has been great.

Patients and their families have even asked if they can help.

We have been gifted at least one box of N95 masks and numerous homemade masks.

Finally, the Raleigh pediatric medical community really stepped up. Specifically, Oberlin Road Pediatrics and Carolina Kids Pediatrics both sought us out directly. As it turns out, we didn’t need the help, but it meant a lot to hear from them, and we hope to return the favor sometime.

That’s how we’re all going to get through this – finding ways to help each other out.

Epilogue: Somewhat Related

For anyone still reading this, I had this post all ready to go late Sunday night.

I saved it to my computer and walked upstairs to say good night to my daughters.

When I returned, my screen looked entirely different.There were characters I had never seen before – and about 80% of my original post was completely gone. I tried to pull up the post I had saved, yet somehow that had been updated to the now-80%-gone post.

Sitting two feet away from me was the cause: Buddy, our orange tabby cat.

He has a penchant for getting comfortable in odd places – for example, he loves climbing and lying on top of backpacks.

He is also well known in our house – as pictured here in what I call “Exhibit A” – for getting comfortable on my computer keyboard.

The post finally got done and I believe I have been forgiven for the words that came out of my mouth that night.

Happy Easter to everyone!

Try to enjoy what you can about being locked down with people who are likely pretty important to you – and try to ignore all of their loud breathing.

April 7, 2020 – If you have the CDC app like me, you probably got a notification like this yesterday.

From the CDC website, more detail about their recent recommendation for more general use of masks in the community:

“CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

We wish our office could offer all patients a mask but supplies are limited. Therefore,,,,

…RCAM is asking families who come into our office to bring their own masks if at all possible.

There is a lot of information available online about how to make and use a mask.

• From the AAP: Masks and Children During COVID-19 (update 04-14-2020)
• From the CDC: Advice about how to use a mask and a few methods for making your own
• Also from the CDC: FAQ about cloth face coverings
• Brief method – Here’s a 2-minute video that offers another method for making a mask:

• More Involved, No Elastic – here is a much more involved mask that is made without any elastic – like toilet paper, elastic has been recently become hard to find

Thank You

We’ve seen a lot of generosity – families have donated masks to our office – both medical grade N95 masks as well as homemade masks.

Bonnie, one of our nurses / lactation consultants / multi-talented individual, has sewn and donated herself an untold number of masks made from all kinds of fabrics.

Here is a picture of the best one she made:

Have a face-to-face conversation with your RCAM Pediatrician – like Dr. Gessner, pictured here – without having to leave your home

March 30, 2020 – Like most things, there are some steps to be sure to follow for a successful TeleHealth Visit.

The First Step is to Call RCAM and Schedule

For many people today, telemedicine is a convenient and effective way to see their healthcare provider. Before beginning your TeleVisit, make sure that you:

• • Call us at 919-781-7490
  • Have an active Patient Portal account, with username and password (you can set or re-set that up when you call to schedule)
  • Set aside a secure, private location

There are Two Options for Beginning your TeleHealth Visit:

1. Log in to your Patient Portal and click “Join Televisit” in you patient dashboard

…OR…

2. Begin through the reminder link sent to your email (where you also click “Join Televisit”)

After Beginning your TeleHealth Visit, Follow these Steps:

• Fill out any patient questionnaire, and provide requested personal information.
• Click “Proceed” to check your computer’s speed and ability to support a TeleVisit. If your computer does not have a webcam (most do), you will need to attach one.
• Click “Start TeleVisit” to enter the virtual waiting room.
• Your physician will soon afterwards begin the face-to-face TeleVisit, and disconnect when the visit ends.

March 25, 2020 – You may remember this now out-of-date post from 6 days ago:

UPDATE: For anyone still interested, the individual in question  that led to our office being shut down for 2 days tested negative for coronavirus disease 2019 / COVID-19.

March 22, 2020 – The Wake County Health Department this weekend gave RCAM the go ahead to open both offices.

Therefore, we will open at 10:00am on Monday morning after finishing some office cleaning (after Monday we will open at our regular time each day)

We will continue operating similar to our previous pandemic plan but with a few twists that include the addition of TeleHealth Visits.

Sick Child Care:

1-Nurse Phone Triage

• If you have a concern about your child – like usual – call the office and our front desk will take a message and one of our nurses will call you back
• If our nurse can’t help you, she will schedule you to see one our doctors for an online TeleHealth Visit

2-Nurse Triage to TeleHealth Visit

• As described in earlier posts, this is a video chat with an RCAM pediatrician who will use methods available to them at that time to assess and make recommendations about how best to treat your child
• The TeleHealth Visit is proving to be very important in our effort to limit our patients’ exposures
• The TeleHealth Visit typically ends with the pediatrician’s plan for treatment
• In cases where the pediatrician decides that the patient will need an in-person assessment, they will be scheduled to be seen in the Brier Creek Sick Clinic or the Brier Creek Curbside Clinic.

[NOTE: You may schedule a TeleHealth Visit without talking to nurse first; just call and ask for a TeleHealth Visit]

3a-Nurse Triage to TeleHealth to Brier Creek Sick Clinic

• All sick care will be seen at Brier Creek

3b-Nurse Triage to TeleHealth to Brier Creek Curbside Clinic

• All acute illnesses with cough and or fever will be seen curbside in your car

Well Child Care:

1-Urgent Well Child Care

• The RCAM pediaricias feel like these are the well visits that should be completed as close to regular schedule as possible:
  1. Children under two years old who need vaccines
  2. The 4 or 5 year old who needs vaccines

2-Non-Urgent Well Child Care

• All other well child visits are considered non-urgent and could be put off for now
• TeleHealth EXCEPTION: if you have a concern that often gets discussed at well visits – things like sleep problems, constipation, focus issues, anxiety, etc., a TeleHealth Visit can be scheduled. Because that is done online via a video chat, it can be done at just about anytime.

3-Follow-Up Visits for Asthma, ADHD, Birth Control, Anxiety, Depression, etc.

• These visits would be scheduled as a TeleHealth Visit

Thanks for hanging in there with us.

Having our clinic shut down due to an individual with an indeterminate result was a bit jarring. We support our health department wholeheartedly though and admire the important work that they are doing right now.

We are all in this together, and your child’s health and safety are our number one priority.

March 21, 2020 – This video is very well done.

It is a clear explanation of pandemics and the general approach to trying to control them.

It is 8 minutes long and it is so good you don’t have to deduct that time from your daily screen time allotment.

Wait.. What’s that?

You stopped keeping track of screen time allotments…?

…?

…so have I

😐

March 18, 2020 – Today we just learned that an individual who was in our Duraleigh office between March 12th and March 17th may have coronavirus disease 2019 (COVID-19). This individual’s test came back inconclusive, so we can’t say for sure.

It is not likely that any patient or family had prolonged contact with this individual, but out of an abundance of caution, upon learning of the possibly positive test, we took the following steps:

• We immediately closed the Duraleigh Office.
• We contacted the Wake County Health Department regarding next steps.
• The Health Department was given a list of individuals who may have been exposed.
• Employees with significant contact with this individual have been placed on a 2-week quarantine.
• We are contacting a professional service to perform a deep clean of the Duraleigh office to eradicate any possible viral particles that could be presnt.

We will be contacting patients who were in the office at the time that this individual was present. If you do not receive a call, then you were not in our office at the same time as this individual.

From the time it became apparent that COVID-19 would be an issue for our community, the pediatricians at RCAM have been in almost constant dialogue about how best to meet the needs of our patients.

We stopped our walk-in appointments so that all potentially ill patients coming spoke with a nurse to determine the best and safest way to be assessed. We moved all well care to our Duraleigh office. We moved all sick care to our Brier Creek office and for patients at particular risk for COVID-19, we instituted a “Curbside Clinic” where patients could be evaluated and in some cases tested while still in their car.

The Brier Creek sick clinic and “Curbside Clinic” are both still operating and we hope to have the Duraleigh office re-open very soon.

We will not re-open before we have taken the necessary steps – patient’s and their family’s safety is just as important as being open and available..

March 15, 2020 – Like the rest of the world, we have followed news and medical reports regarding coronavirus disease 2019 (COVID-19).

We fully endorse recent recommendations for “social distancing” and doing what we can to slow its spread. There are things that we can and need to do right now.

This situation is unprecedented at RCAM, and, this weekend, the pediatricians of RCAM have made some unprecedented adjustments regarding how RCAM will operate during this pandemic.

IN SUMMARY…

…We are OPEN and  operating at our typical capacity – just some changes to the flow of how we do things to keep things as safe as possible for our patients.

1. No walk-in appointments

2. Well children appointments will be seen at our Duraleigh office

3. Sick children appointments will be seen at our Brier Creek office

4. To further limit exposures, children being assessed for coronavirus disease will be evaluated in their car at the Brier Creek office

MORE DETAIL / EXPLANATION:

1. No Walk-In Appointments at Duraleigh and Brier Creek Office

• All walk-in appointments are suspended until further notice
• For the time being, it is important that we speak to you directly to set up your appointment
• ALL office visits will be by appointment only

2. Only Well Children Will Be Seen at Our Duraleigh Office

• Well visits will by appointment only and only at the Duraleigh office
• Most follow-up visits, medication rechecks, well ear rechecks, etc. can be seen at the Duraleigh office as long as the patient is well
• Sick individuals may not accompany the well check (no sick siblings; no sick parents; everyone in your party needs to be well)

3. Sick Children Will Be Evaluated at Our Brier Creek Office

• Sick children would include any acute (short-term), infectious illness
• Also, any illness with fever (temp of 100.4F or more) or cough
• It will also include anything that can look similar to that (and that may include something that may also look like seasonal allergies)

4. Children Being Assessed for Coronavirus:

• All visits are by appointment only
• We will attempt to get as much medical information by phone
• These patients will be evaluated at Brier Creek while they are still in their car
• These patients should not enter the Brier Creek building (or the Duraleigh building)

A Word About Testing For COVID-19

• Test availability is limited
• Because of limited testing, we will only test when it is clinically necessary

There has to be One Final Word…

We are going to do our best to help your child. Everyone is a little more distracted with all the news and all the changes out there. We have committed to being patient with each other and patient with you.

We appreciate the good will that you extend to us – to our administrative staff, our nurses, and our physicians.

Let’s get through this.

March 5, 2020 – This week we learned that Wake County had its first case of coronavirus.

This type of thing is a very unusual event and we don’t know how it will affect our area.

The pediatricians at RCAM – as well as many others – are hoping for the best and preparing for something else.

In the coming weeks we will be following the news just like you, coordinating with local medical agencies and making whatever adjustments seem appropriate at the time.

Our present goal is to help keep coronavirus out of public spaces.

To that end, our office currently would not be the best place to go if you think your child has coronavirus and so if you call for an appointment, we will start by asking a few questions.

When you call our office to schedule an appointment…

When you call our office – prior to scheduling an appointment – we will be asking the following:

1. Have you or your child traveled outside the United States in the past 2 weeks?
2. Do you think you or your child may have been exposed to coronavirus?

If the answer to either question is yes, a nurse and / or a doctor will need to review your case to decide the best way – and the best place – to set up your appointment.

Morning Walk-Ins at Duraleigh

Do not walk in to our office if either of your answers to the above questions #1 or #2 are, “Yes.”

Call first and let’s discuss the best and safest way to have your concerns addressed.

Some helpful resources for learning more about Coronavirus / COVID-19:

Good, basic summaries:

• At the American Academy of Pediatrics (AAP) website, healthychildren.org, a good summary of the basics.
• The News & Observer has some coronavirus facts with local emphasis

More detail:

• The Center for Disease Control and Prevention (CDC) website is a central site with lots of up-to-date information.
• The World Health Organization (WHO) website is another centralized site with lots of information.
• The European Centre for Disease Control has up-to-date, worldwide information.
• Also from the AAP, the Red Book Online provides summary information and lots of links to more information.
• From Johns Hopkins, a global case map.

February 25, 2020 -This Friday, February 28, 2020 will mark the end of a grand era at Raleigh Children & Adolescents Medicine.

After 42 years, RCAM office manager Debbie Maness is retiring to become the ultimate grandmother.

She Started as a Nurse; She Became our Office Manager

Debbie came to us as a nurse in 1978 from the Rex Hospital Neonatal Intensive Care Unit. At that time, our office was known as “Fleming, Edwards, and Goldman” – our three founding pediatricians who could also be known as the “Mount Rushmore of RCAM”.

After working at RCAM for about 10 years as a nurse, Dr. Fleming approached her about taking on a then newly created position: office manager.

I am sure that when she agreed to take that position, she could not have possibly imagined the volume of challenges that would come her way. There was always something new, and that new charge always fell in some form on the office manager.

Debbie successfully led RCAM over 4 decades as the practice of medicine changed dramatically. Throughout that time, she kept us on task, and she kept a good spirit.

“Debbie Maness Week”

RCAM therefore declares February 24 through 28 to be “Debbie Maness Week” and for it to be a time to celebrate Debbie’s 42 years of dedication, skill, and attitude.

1-Monday, February 24th – “Wear Your College Allegiance Day”

Debbie loves the N.C. State Wolfpack – for better and for worse.

She always pulls for her team, and-on Monday-we wore our college allegiance to work in her honor.

2-Tuesday, February 25th – “1978 Day”

On Tuesday, we’ll make attempts to remember the year that Debbie started her career at RCAM.

3-Wednesday, February 26th – “Red And White Day”

Another tip of the cap to Debbie’s Wolfpack – but, we’ve tried to keep it generic, so the Tar Heels and the Blue Devils among us won’t feel uncomfortable.

4-Thursday, February 27th – “Dear Debbie Day”

We’ll try to put our thoughts and feelings into words for our dear friend Debbie.

5-Friday, February 28th – “Let’s Drown Our Sorrows in Baked Goods”

Debbie is a baker and one time honored method of dealing with loss involves baked goods. We’ll honor Debbie’s hobby and fill our stomachs on her last day at RCAM.