August 13, 2021

Dear Patient,

I am writing to you as we face yet another wave of COVID. I don’t need to go into the stress and unknowns we have been living with over the last 20 months. Instead, I would like to specifically address what we can control, explain additional changes in clinic procedures, and express my gratitude to those doing all they can to protect themselves and the rest of us. But first I want to share my very personal motivation to protect myself and those around me and my family.

As many of you know I started this practice over 15 years ago, and for the past several years I have been taking a backstage role. I went through an extremely difficult divorce that finally concluded in 2017. This character-building process only partially prepared me for what was to come. Some of you may be aware that my amazing bio-kid was born with several “superpowers” a couple years into my founding of Hands On Medicine. In the summer of 2019, approximately three months before some of my international public health friends brought this “novel virus” to my attention, I was faced with my largest challenge to date: my kid’s life. She may not yet completely understand the gravity of these health challenges, but I did.

Deep within the Wallowa Mountains my kid started having life threatening symptoms. I have found myself in numerous tragic situations throughout my life and around the world wherein a great deal of blood was dangerously present. But witnessing my kid bleed intestinally while I did everything in my power to get necessary medical help shook my tenacious spirit to the core. You as a reader do not need to know the details, but my kiddo has since been diagnosed with an autoimmune illness she will live with forever; this world is blessed with the survival of this amazing person, and I need you to do everything you can to protect her from COVID. Please.

We are all experiencing COVID fatigue. Every day we read the number of infected people rising. Those with severe disease are outpacing our hospital systems’ capacity to treat them. Kids are now contracting COVID in numbers yet unrealized and are due to start school in two weeks! These high numbers are largely due to our under-12 children not yet being able to receive the vaccine and approximately 30% of our adult population refusing it. The disease spread and mutation is the direct result of the unmet public health goal of herd immunity through vaccination.

Did you get vaccinated? THANK YOU! You will not get sick or as sick if you are infected with the COVID virus. It is very important to know a vaccinated person can still spread the virus.

What you must do to protect yourselves and those around you, especially those unable to receive the vaccine and the immune compromised, like my kid:

• Get vaccinated. Please trust science and do it. We are in this together.
• Talk about the importance of vaccination.
• Wear a mask inside and outside when in contact with the public.
• Talk about the importance of masking.
• Don’t touch your face or the outside of your mask.
• Change your mask after contact with the public.
• Wash your hands frequently with warm water, vigorous rubbing, and soap.
• Use hand sanitizer whenever possible.
• Keep your nails well-manicured and short.
• Stay as healthy as possible. Stay home if you’re not feeling well.
• Call the clinic for an appointment if you think you may have COVID, have had contact with a COVID positive person and/or have tested positive through a facility or home testing kit. I cannot stress this enough: Do not come into the clinic without disclosure. We will see you via telemedicine from your home or car. We may send someone to your car for a window visit.
• All positive tests must be reported to the county.
• Use air filters, open windows, and gather outside when possible.
• Use disposable tissues.
• Place all used tissues and masks in the garbage.
• Sinus rinse (and/or saline spray) twice a day if possible (do not use un-boiled tap water).
• Gargle (with an antiseptic mouth wash or strong salt water) and brush your teeth twice daily.
• Change your toothbrush on a regular schedule.
• Shower, including hair washing after a day of contact with the public.
• Do not wear your clothes more than one day when in contact with the public.
• Change your sheets, especially your pillowcase frequently.

This will be my kiddo’s routine if she returns to school:

• Dress in clean clothes, tie hair back.
• Wash hands.
• Eat a healthy breakfast and pack a healthy lunch.
• Brush teeth and gargle.
• Pack for the day tissues, hand sanitizer, and extra masks in a zip lock bag.
• Wash hands.
• Don fresh masks and a visor.
• Upon getting to school- double mask.
• Attend classes.
• Grow and experience joy.
• Have discussions with other kids regarding safety protocols and vaccine status.
• Educate children and adults about the immune system and her risks specifically.
• Wash hands frequently, applying a personal supply of hand sanitizer as needed.
• Clean table before setting out lunch.
• Eat with vaccinated kids.
• Pitch outer day mask before getting into the car for the ride home.
• Once home clothes go in the laundry and take a shower before settling into a home routine.
• Tutoring and lessons in our home will once again be with masks and outside when possible.

I suppose this reads a bit like the routine we have here at the clinic, and it is. Staff arrive in street clothes and change into scrubs. We leave the scrubs to be laundered at the clinic every end of shift. We wash and sanitize everything frequently. Other continuing and returning practices in the clinic include more frequent tele-video appointments, reliance on the honest reporting of our patients for in-clinic appointment setting and on-site screening, ill patients seen during the last couple of hours of clinic and in a sick room. We will once again be masking with other staff and continue masking during patient visits. All of Hands On Medicine staff are vaccinated. We will wear N95s and other PPE with ill patients. We will continue to use HEPA filters throughout the clinic, changing filters frequently. We may need to bring back drive-thru testing. In the meantime we will continue to direct patients to testing and vaccination centers as needed.

Lastly, I give you my wholehearted appreciation for doing everything you can to provide for the health of your neighbors, people you know and do not know in our community, your healthcare providers, our families, and yourself. We remain committed to care for you through this pandemic and all its iterations. If patients have questions or concerns about COVID, please do not hesitate to call and make an appointment with a Hands On Medicine primary care provider.

With the best of intentions,

Shelda

Important Notice Re: Text Reminders

July 14, 2021

Dear Patient,

We regret to inform you that text and email reminders will now include the name listed on your insurance card.

Hands On Medicine has proudly served the LGBTQ community and those who have a chosen name for over 15 years. Now is no exception. Due to recent updates to our medical record system, the system we used for our reminders is now incompatible with the clinic and they have therefore unexpectedly dropped us. We have called, emailed, and researched many other systems, but unfortunately, nothing else is compatible.

The system we will now use is directly connected to our scheduling and medical record software. The system requires using a patient’s name in every text and email reminder, and the name they insist on using is what’s listed as the patient’s legal name. We have tried to get around this, however the legal name is necessary to fill prescriptions, referrals, etc. We also are unwilling to cease reminders entirely, as reminders have been shown to be incredibly helpful for many patients.

It is with a heavy heart that we make the difficult decision to use the reminder system that is available to us. There are many reasons why someone may use a chosen name and we want to honor every one of them. This is why we are going to continue advocating to our vendor that they update their system to honor a patient’s chosen name. We hope that one day your reminder emails and texts refer to you by the name you have chosen. In the meantime, you can expect the staff and providers to continuing to respectfully refer to you by your chosen name.

Hands On Medicine Now Has the COVID Vaccine!

April 7, 2021

Hands On Medicine now has limited supply of the Moderna COVID-19 vaccine. This is a two-dose vaccine, and it is not currently available for minors. Please give us a call to schedule your vaccination appointment! We are prioritizing established patients of Hands On Medicine.

Fifteen Years of Serving the North/Northeast Portland Community!

February 19, 2021

Dear Patient,

To say this has been a difficult year is to understate the obvious. As the Medical Director and Founder of Hands On Medicine, I wanted to reach out specifically to acknowledge the exceptional challenges we have all experienced, sometimes together and others in times in solitude. You are resilient and nothing short of amazing!

Thank you for all the grace you have afforded Hands On Medicine in the numerous lockdowns, cancelations, rescheduled appointments, changes to our clinicians’ schedules, and additional protocols. Every inconvenience you may have experienced over the past year has been in an effort to keep our patients, families, ourselves, and our collective community safe.

Hands On Medicine has been and continues to diligently test and treat SARS-COVID-19 via drive-thru testing, telemedicine visits and referrals for nearly a year. I am happy to announce that we have qualified as a COVID vaccinating clinic. We will notify all patients as soon as we receive our supply. We will continue to provide telemedicine and in-person visits depending on patients’ needs and safety. I can assure you that the clinic has maintained a very high quality of sanitation and safety through PPE and HEPA filter use, distancing as much as possible from other staff, continuous mask use, and diligent precautions within our social bubbles. In addition, every staff member has been fully vaccinated. We will continue all our strong safety measures in and outside of the clinic to maintain the safest environment possible.

The entire team at Hands On Medicine would like to help you obtain and maintain your health. Let’s get back on track. If you have any chronic health conditions for which you have not been seen in the past four months or greater, you need to call the clinic and make an appointment with your primary care provider in-person. If you established care as a new patient and are yet to have an inpatient clinic visit, you need to call the clinic. Please call and we will schedule you as soon as possible. Due to all our new COVID protocols and winter weather, it is very important to communicate regarding any need to cancel or reschedule. I know many of you have waited quite some time to be seen in the clinic. We are working in overdrive to make certain this happens.

Despite all the challenges over the years, I am proud to announce THIS SMALL MINORITY-OWNED, PRIVATE BUSINESS IS CELEBRATING 15 YEARS OF OPERATION THIS VERY MONTH! It is hard to believe that this one-woman primary care provider and two support staff has grown into a 15-staff clinic offering a consistently exceptional and diverse quality of primary care.

We not only survived the recession of 2007-2009, H1N1 influenza and pertussis outbreaks, personal crises, difficult family changes, and challenging community struggles – we have thrived! This would not have been possible without the love and support of my deep-rooted Portland family and friends, exceptionally sharp and hardworking staff, and the patronage of the community I grew up in. You have made the choice to support healthcare provided outside the big box and I thank you from the bottom of my heart!

Lastly, I am exceptionally proud of the Hands On Medicine team. I could not dream of working with a more compassionate, creative and collaborative group of professionals. Today we are facing the most challenging time in our professional lives and we are doing this work with pride and perseverance. We show up and take each day’s challenges one at a time together to help create a healthier community. Hands On Medicine has been here in inner N/NE Portland for 15-years and will continue for years to come. As I move forward in my life, and the clinic, patients and staff continue to grow personally and professionally, I will consider Hands On Medicine my largest success, second only to having raised and fostered several socially responsible, creative and community-minded kids within the framework of an amazing community of patients in my Portland hometown.

Again, you are all resilient and amazing. Thank you for your continued support. Call for your appointment and we will move forward one day at a time knowing that we survived the challenges of a worldwide pandemic because we did this together.

Sincerely,

Shelda Holmes, FNP

Founder and Medical Director

Hands On Medicine

A Message From Our Medical Director re: COVID-19 & the Light At the End of the Tunnel

December 7, 2020

Dear Hands On Medicine patients, families and community,

As the Medical Director at Hands On Medicine, it is with Gratitude and Grace that I write this update. We appreciate your continued support of this small, minority-owned business. We appreciate your understanding regarding all the appointment changes, protocol changes, and requests for your flexibility. And I thank you for your own expressions of Gratitude and Grace for our care and services.

Hands On Medicine continues to remain open 5 days a week. We are seeing patients via telemedicine and in-person, if needed. We are, however, temporarily closed to new patients (other than new additions to existing families). We continue to COVID test in the drive-thru and treat our COVID-positive patients. We are tracking all positive patients for long-term symptoms. If you have had COVID and your PCP (primary care provider) is not aware, please call the clinic for a telemedicine appointment.

As the Medical Director I cannot express how hard clinic staff are working right now. In fact, could someone please bring back the nightly pots and pans brigade? Nearly every member of our 15-member staff is juggling home-schooling children, childcare, work, and concern regarding sick family members. The collective exhaustion is heavy, very heavy. Please know we appreciate your grace and patience as we deal with the same oppressive environment you are, while tending to thousands of patients. I could not be prouder of this team and our patients!

Hands On Medicine continues to exercise an abundance of caution regarding cleaning the clinic and ourselves, wearing PPE and screening patients that have office visits (versus telemedicine), staying masked all day and distancing from one another while working, screening patients and ourselves for COVID, staying in our bio-bubbles and encouraging all those in our community to do the same. During these times of mixed messages and increased anxiety I would like to reassure each of you that Hands On Medicine is doing its very best to care for our patients, and we are doing a damn good job!

Do What You Can: During this pandemic there are many things we do not have control of, but we should control what we can:

• Wash your hands and all surfaces more than you think necessary.
• Cover your cough.
• Wear a mask when outside of your immediate bio-bubble.
• Do not travel. Period.
• Get your flu shot!
• If you have COVID symptoms or contact with a known positive, err on the side of caution; quarantine and call us for an appointment.

COVID-19 Vaccine/Preventative Medicine: We have been receiving an increased number of inquiries regarding the vaccine. The manufacturers are largely working with large pharmacies. The state and local health departments are working with the large hospital systems and other large organizations. We have no plans as of now to provide the vaccine, though this will likely change in the deep spring. Each and every one of the Hands On Medicine staff will be getting vaccinated (we already are 100% vaccinated for flu this year). We take preventative medicine seriously at Hands On Medicine; vaccination is a wonderful tool. The priority population cohorts have been established by the Oregon Heath Authority. Group A will be the first responders (police, EMTs, firefighters, etc.), healthcare providers in direct patient contact, and other front-line workers. Group B will be those at high-risk medical conditions and occupations. Eventually the vaccine will be available to everyone, but we cannot predict when. We will continue to keep you abreast of all concrete changes in recommendations, timelines, and availability.

Do No Harm: In addition to this strong principle of preventative medicine, we hold strong to the principle of doing no harm. If your provider is not available at the exact time you want, or needs to reschedule you, or is interrupted by a COVID-related urgent management issue, or you end up seeing another provider in the clinic during a pinch, please remember we are doing our very best to provide the best quality of healthcare possible during this pandemic.

Thank you again for your Grace and Gratitude. We are in this mega ultramarathon together.

Sincerely,

Shelda Holmes, FNP

Founder & Medical Director

Hands On Medicine

A Message From Our Medical Director re: COVID-19

March 24, 2020

Dear Valued Patients and Community Members,

I recognize this is a time of exceptional uncertainty and stress. Hands on Medicine remains committed to our founding mission to provide exemplary care to individuals and families in our community through exceptionally high quality of care and patient empowerment.

In an effort to continue to provide high quality care and limit exposure and spread of COVID-19 we have implemented numerous procedural changes. On March 16^th we rolled out telemedicine for the vast majority of patient visits (please see the above links for each provider’s online “waiting room”).

Despite the recent “Shelter in Place” order, we understand that you and your families continue to need care: new baby/mama visits, well-child developmental assessments, injuries, illnesses and chronic health and illness management and medications refills. If you need medical care, do not hesitate to contact us for medical triage to determine an appropriate course of action. Please note that while we are COVID-19 testing when clinically necessary, every possible precaution is being taken to protect our staff, their families, patients, their families and our community at large.

I think it is especially important to recognize the extent to which these times are straining us psychologically. For those of us struggling with an exacerbation of anxiety, depression or other mental health challenges, please know that you are not alone. I strongly encourage all of us to reach out for help when we need it. Just because we are in “isolation” does not mean we should be isolated. To this end, we have hired two fabulous full-time therapists: Maddison VanderHoff, LCSW, and Myra Bazell, LCSW. Both Myra and Maddison are also doing telemedicine appointments.

As a devoted professional medical provider for over twenty years, I can wholeheartedly state that Hands On Medicine staff and procedures are surpassing all standards of care and expectations. Together we will see this pandemic through and be a stronger community because of it.

In health and solidarity,

Shelda Holmes, FNP

Medical Director

Hands on Medicine

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COVID-19 FAQ

How have you changed procedures to keep staff and patients safer?

• All patients are screened for COVID-19 symptoms before and at the time of their visit.
• Adult patients must come unaccompanied and children under 16 may have only one guardian.
• All patients and staff must wear a mask at all times in the clinic.
• As before the pandemic, all work spaces and exam rooms are sterilized and cleaned multiple times daily.
• When possible, we are seeing most of our patients via telemedicine.
• We are exclusively testing patients for COVID-19 outside in their cars to prevent exposure inside the clinic.

What should I do if I think I have COVID-19 symptoms?

Please call and make a telemedicine appointment with your PCP if you have COVID-19 symptoms. We will assess your symptoms and guide you through the next steps. While you are waiting for your appointment please isolate yourself to protect others.

What if I don’t have COVID-19 symptoms but I want to get tested for COVID-19?

We are following the Oregon Health Authority guidelines regarding testing people for COVID-19 who do not have symptoms.

How can I protect myself and others from COVID-19?

• Learn about COVID-19. The CDC has very helpful information about how the virus spreads and what you can do to reduce your risks here.
• Wash your hands often: before and after eating, after blowing nose and using the toilet, after tending to the toileting of others, after coughing and sneezing, and at least every couple of hours.
• Avoid sharing indoor space with other people outside your household.
• Social distance, keeping at least 6 feet between yourself and other people.
• Wear a mask when you cannot social distance.
• Cough and sneeze into your mask, under your shirt, or into your elbow.
• Stop smoking. Your PCP can help you quit tobacco. Schedule a telemedicine visit to discuss this.
• Keep your nails short, hair pulled back and try not to touch your face.
• Shower every evening, including hair (our hair captures microbes and pollens).
• When wearing a mask, do not pull the mask onto your hair. Instead, pull your mask down.
• Clean all surfaces and frequently touched/shared items daily.
• Do not let your pets sleep with you.
• Pets should not be touched by anyone outside of your household.

Government Links

• Multnomah County COVID-19 Page
• Oregon Health Authority COVID-19 Page
• Centers For Disease Control COVID-19 Page