Search
  • Kissi Rosabel Blackwell, MD

As you all know, Wichita Falls and Texas as a whole has seen a dramatic spike in COVID-19 cases, so I think it’s a good time to talk about prevention of severe disease, testing, and what it all means.


Let’s start with prevention, because I think this is one of the most important things we should talk about in the face of the fact that we are all likely going to be exposed at one point or another, since we really have not contained this virus.

The CDC publishes this graph showing what underlying disease are seen most often in hospitalized patients.

What is interesting to note here is that the most common underlying diseases we see in COVID-19 patients who are hospitalized all lie in the spectrum of metabolic syndrome, namely, obesity, diabetes/prediabetes, hypertension, and cardiovascular disease. Understanding that these diseases all stem from excess insulin in the body means that we can make our bodies metabolically healthy by simply changing the diet. If our bodies have better metabolic health (lowered inflammation, reversal of diabetes, lower blood pressure, and improved cardiovascular health), then if (and perhaps, when) we do get COVID-19, we will have a better chance of having less severe disease and not end up hospitalized.

So how should we be eating? Very simply, we should be eating real and fresh foods and staying away from processed carbohydrates and sugars. We recommend a low carbohydrate and high fat diet to help reverse metabolic diseases like the ones mentioned above, and by watching the timing of meals (eating 2 meals per day with no snacks and keeping a 6-8 hour eating window). We have helped 11 patients completely stop insulin and have improved cholesterol, hypertension, and reversed diabetes in many others. THIS is how we prevent severe COVID-19 illness, and I invite you to take a hard look at your diet when considering prevention.

This is not to say that there are not other underlying conditions that can cause problems, such as asthma, COPD, kidney disease, and immune compromised states, but you can see from the graph above that the metabolic disease far outweigh the others. The good news is that we can do something about it!


Now, let’s talk about tesing for COVID-19 because there is a lot of confusion and misundrestanding. There are two different types of testing. We have the typical nasopharyngeal (NP) swab that is an RT-PCR test, where they find the viral RNA in the sample and are able to amplify it, and the antibody test which finds out whether you have potential neutralizing antibodies circulating from recent or past disease.

The RT-PCR test is the gold standard for finding acute disease. When you feel sick, this is the test we use. Currently the NP swabs have been found to be about 70% accurate in finding the disease, which means that up to 30% of the time, you may have a negative test and still have the disease. This means we cannot completely rule out COVID-19 with one NP swab. For this reason, we try to wait for testing until you are 3-5 days into the disease to try to allow the viral load to build so we can detect it. The potential for a false negative test also goes up if you are not having symptoms and have not been exposed, because the pretest probability is low. (Sorry, I know, statistics is boring).

The antibody testing is done after 7-14 days to see if circulating antibodies to SARS-CoV-2 (virus that causes COVID-19) are present. If you do this test too soon before antibodies are formed, you may get a false negative. The other problem is that the accuracy of this test relies heavily on the prevalence of disease in the population. Most of these tests report a 96.5% positive predictive value (positive test is actually positive) assuming that we have 5% prevalence in the population. Currenlty our prevalence in Wichita County is 0.38% (512 cases/132,000 population x 100). This means that the accuracy of this test is nowwhere near as accurate as 96.5%. Potentially, we could flip a coin and have the same odds of getting an accurate test. (Sorry, I know, more statistics).

So now let’s say you have a positive antibody test. What does this mean? Unfortunately, not much. It’s nice to have from a scientific perspective when we collect lots of data, but for you as an individual, it means less. Why? Well at this point, we have no idea whether the antibodies actually provide immunity (we assume they do), for how long (some have found antibodies waning at 2-3 months), nor what level of antibody you need to be immune (titer). We also don’t know if what we are testing is specific to SARS-CoV-2 as there could be some potential cross-reactivity with other coronavirus antibodies that cause the common cold. The good news is that antibodies are not the only way we fight off disease. Without getting too technical, we do think there is some cellular and innate immunity that may play a large role, which we cannot easily test for. It appears that since there is cross reactivity with other coronaviruses, people with immunity to these viruses might also have some natural immunity to SARS-CoV-2, which would explain why we have a lot of asymptomatic disease (people infected without symptoms).


Whew! If you have stuck with me so far, I’m impressed!


All this being said, if you are going to get tested, you should really have a PCP you trust to be able to extrapolate all the statistical data and tell you what your risk may be and what the current recommendations are. This is all new to all of us so there are bound to be some mistakes and some adjustments in guidelines. Try to be patient and find a doctor you trust!



Kissi Blackwell, MD






  • Kissi Rosabel Blackwell, MD

I just wanted to update you all on how we will be handling visits over the next few weeks. Thankfully our operations did not change much, other than seeing a few less patients in the office, and we were able to provide you same excellent care you come to expect from us. You are all well-versed in emailing and texting me, and it was a simple transition. Thank you all for your patience and understanding!

As things start opening across Wichita Falls, we will also begin seeing more patients in the office for basic needs. We will start doing this on May 18, around the time all other businesses will open completely. This means if you have a need that requires a face-to-face visit, we will be able to schedule you in the office. As always, we can continue to do visits by text, email, video, and phone, and emergencies will always be seen in the office. If you had a lab visit that was placed on hold, Jennifer will be contacting you to reschedule this in our office. If you had a well visit (well child, well woman, pap, or physical) that was placed on hold, Jennifer will be contacting you and scheduling your visit for September. At this point we hope it will be safe to have more patients coming and going. If things change at that point, we will always keep you up to date. If you have a more urgent matter to discuss please let Jennifer know. PROCEDURE FOR VISITS: 1. We will be scheduling patients 1 hour apart to give us time to see our patients and clean thoroughly after each patient in order to keep you all as safe as possible. This means there will be limited in-person appointments. As always, phone, video, email, or texts visits are perfectly ok. 2. Sick visits will still be seen in the parking lot, if needed. Many of these can be taken care of by phone, but sometimes a visit is required. Please contact us first. DO NOT WALK IN. 3. We will require you to wear a cloth mask to your visit.

4. Only one patient will be allowed in the office a time. Please do not bring family members if possible. If you do not have childcare, we can make some exceptions.

5. When you get here for your appointment, please call us when you are in the parking lot. Jennifer will let you know when it is safe to come inside. She will have you use hand sanitizer at the door and check that you are wearing a mask before you come into the office.


We hope to be able to transition back to in-person visits fully in the next few months, but only time will tell exactly when and how. Thank you all again for your patience and understanding during this uncertain situation! Do not hesitate to contact us if you have a need that arises! Dr. Kissi Blackwell Clarity Direct Care

  • Kissi Rosabel Blackwell, MD

04/02/2020


Hello DPC Family,


It has been a rough few weeks for all of us: staying indoors, homeschooling kids and keeping them entertained, feeling stuck, depressed, or anxious. For Jennifer and I, add the concern for possible exposure and bringing home this disease to our families, and you've got one big recipe for disaster.


Today, I'd like to focus on ways of coping with the stress of this new world living with COVID-19.


Below you will find some tips from a psychologist about how to cope with quarantine and what things you can do to keep you mentally healthy. Unfortunately I don't know who wrote this and can't give them credit, but it's very well written, and I wanted to share it with you. I've also attached a calendar with some other ideas about how to cope each day of the month. I hope you find this helpful.


Thinking about and praying for you all during this time of uncertainty. We will get through this together! As always, I am available to you by text, email, phone, or video chat, so please don't hesitate to contact me if you need something.


Sincerely,

Dr. Kissi Blackwell, MD

Clarity Direct Care




FROM A PSYCHOLOGIST:


After having thirty-one sessions this week with patients where the singular focus was COVID-19 and how to cope, I decided to consolidate my advice and make a list that I hope is helpful to all. I can't control a lot of what is going on right now, but I can contribute this.

Edit: I am surprised and heartened that this has been shared so widely! People have asked me to credential myself, so to that end, I am a doctoral level Psychologist in NYS with a Psy.D. in the specialities of School and Clinical Psychology.


MENTAL HEALTH WELLNESS TIPS FOR QUARANTINE


1. Stick to a routine. Go to sleep and wake up at a reasonable time, write a schedule that is varied and includes time for work as well as self-care.


2. Dress for the social life you want, not the social life you have. Get showered and dressed in comfortable clothes, wash your face, brush your teeth. Take the time to do a bath or a facial. Put on some bright colors. It is amazing how our dress can impact our mood.


3. Get out at least once a day, for at least thirty minutes. If you are concerned of contact, try first thing in the morning, or later in the evening, and try less traveled streets and avenues. If you are high risk or living with those who are high risk, open the windows and blast the fan. It is amazing how much fresh air can do for spirits.


4. Find some time to move each day, again daily for at least thirty minutes. If you don’t feel comfortable going outside, there are many YouTube videos that offer free movement classes, and if all else fails, turn on the music and have a dance party!



5. Reach out to others, you guessed it, at least once daily for thirty minutes. Try to do FaceTime, Skype, phone calls, texting—connect with other people to seek and provide support. Don’t forget to do this for your children as well. Set up virtual playdates with friends daily via FaceTime, Facebook Messenger Kids, Zoom, etc—your kids miss their friends, too!


6. Stay hydrated and eat well. This one may seem obvious, but stress and eating often don’t mix well, and we find ourselves over-indulging, forgetting to eat, and avoiding food. Drink plenty of water, eat some good and nutritious foods, and challenge yourself to learn how to cook something new!


7. Develop a self-care toolkit. This can look different for everyone. A lot of successful self-care strategies involve a sensory component (seven senses: touch, taste, sight, hearing, smell, vestibular (movement) and proprioceptive (comforting pressure). An idea for each: a soft blanket or stuffed animal, a hot chocolate, photos of vacations, comforting music, lavender or eucalyptus oil, a small swing or rocking chair, a weighted blanket. A journal, an inspirational book, or a mandala coloring book is wonderful, bubbles to blow or blowing watercolor on paper through a straw are visually appealing as well as work on controlled breath. Mint gum, Listerine strips, ginger ale, frozen Starburst, ice packs, and cold are also good for anxiety regulation. For children, it is great to help them create a self-regulation comfort box (often a shoe-box or bin they can decorate) that they can use on the ready for first-aid when overwhelmed.


8. Spend extra time playing with children. Children will rarely communicate how they are feeling, but will often make a bid for attention and communication through play. Don’t be surprised to see therapeutic themes of illness, doctor visits, and isolation play through. Understand that play is cathartic and helpful for children—it is how they process their world and problem solve, and there’s a lot they are seeing and experiencing in the now.




9. Give everyone the benefit of the doubt, and a wide berth. A lot of cooped up time can bring out the worst in everyone. Each person will have moments when they will not be at their best. It is important to move with grace through blowups, to not show up to every argument you are invited to, and to not hold grudges and continue disagreements. Everyone is doing the best they can to make it through this.


10. Everyone find their own retreat space. Space is at a premium, particularly with city living. It is important that people think through their own separate space for work and for relaxation. For children, help them identify a place where they can go to retreat when stressed. You can make this place cozy by using blankets, pillows, cushions, scarves, beanbags, tents, and “forts”. It is good to know that even when we are on top of each other, we have our own special place to go to be alone.


11. Expect behavioral issues in children, and respond gently. We are all struggling with disruption in routine, none more than children, who rely on routines constructed by others to make them feel safe and to know what comes next. Expect increased anxiety, worries and fears, nightmares, difficulty separating or sleeping, testing limits, and meltdowns. Do not introduce major behavioral plans or consequences at this time—hold stable and focus on emotional connection.


12. Focus on safety and attachment. We are going to be living for a bit with the unprecedented demand of meeting all work deadlines, homeschooling children, running a sterile household, and making a whole lot of entertainment in confinement. We can get wrapped up in meeting expectations in all domains, but we must remember that these are scary and unpredictable times for children. Focus on strengthening the connection through time spent following their lead, through physical touch, through play, through therapeutic books, and via verbal reassurances that you will be there for them in this time.


13. Lower expectations and practice radical self-acceptance. This idea is connected with #12. We are doing too many things in this moment, under fear and stress. This does not make a formula for excellence. Instead, give yourself what psychologists call “radical self acceptance”: accepting everything about yourself, your current situation, and your life without question, blame, or pushback. You cannot fail at this—there is no roadmap, no precedent for this, and we are all truly doing the best we can in an impossible situation.


14. Limit social media and COVID conversation, especially around children. One can find tons of information on COVID-19 to consume, and it changes minute to minute. The information is often sensationalized, negatively skewed, and alarmist. Find a few trusted sources that you can check in with consistently, limit it to a few times a day, and set a time limit for yourself on how much you consume (again 30 minutes tops, 2-3 times daily). Keep news and alarming conversations out of earshot from children—they see and hear everything, and can become very frightened by what they hear.


15. Notice the good in the world, the helpers. There is a lot of scary, negative, and overwhelming information to take in regarding this pandemic. There are also a ton of stories of people sacrificing, donating, and supporting one another in miraculous ways. It is important to counter-balance the heavy information with the hopeful information.


16. Help others. Find ways, big and small, to give back to others. Support restaurants, offer to grocery shop, check in with elderly neighbors, write psychological wellness tips for others—helping others gives us a sense of agency when things seem out of control.


17. Find something you can control, and control the heck out of it. In moments of big uncertainty and overwhelm, control your little corner of the world. Organize your bookshelf, purge your closet, put together that furniture, group your toys. It helps to anchor and ground us when the bigger things are chaotic.


18. Find a long-term project to dive into. Now is the time to learn how to play the keyboard, put together a huge jigsaw puzzle, start a 15 hour game of Risk, paint a picture, read the Harry Potter series, binge watch an 8-season show, crochet a blanket, solve a Rubix cube, or develop a new town in Animal Crossing. Find something that will keep you busy, distracted, and engaged to take breaks from what is going on in the outside world.


19. Engage in repetitive movements and left-right movements. Research has shown that repetitive movement (knitting, coloring, painting, clay sculpting, jump roping etc) especially left-right movement (running, drumming, skating, hopping) can be effective at self-soothing and maintaining self-regulation in moments of distress.


20. Find an expressive art and go for it. Our emotional brain is very receptive to the creative arts, and it is a direct portal for release of feeling. Find something that is creative (sculpting, drawing, dancing, music, singing, playing) and give it your all. See how relieved you can feel. It is a very effective way of helping kids to emote and communicate as well!

21. Find lightness and humor in each day. There is a lot to be worried about, and with good reason. Counterbalance this heaviness with something funny each day: cat videos on YouTube, a stand-up show on Netflix, a funny movie—we all need a little comedic relief in our day, every day.


22. Reach out for help—your team is there for you. If you have a therapist or psychiatrist, they are available to you, even at a distance. Keep up your medications and your therapy sessions the best you can. If you are having difficulty coping, seek out help for the first time. There are mental health people on the ready to help you through this crisis. Your children’s teachers and related service providers will do anything within their power to help, especially for those parents tasked with the difficult task of being a whole treatment team to their child with special challenges. Seek support groups of fellow home-schoolers, parents, and neighbors to feel connected. There is help and support out there, any time of the day—although we are physically distant, we can always connect virtually.


23. “Chunk” your quarantine, take it moment by moment. We have no road map for this. We don’t know what this will look like in 1 day, 1 week, or 1 month from now. Often, when I work with patients who have anxiety around overwhelming issues, I suggest that they engage in a strategy called “chunking”—focusing on whatever bite-sized piece of a challenge that feels manageable. Whether that be 5 minutes, a day, or a week at a time—find what feels doable for you, and set a time stamp for how far ahead in the future you will let yourself worry. Take each chunk one at a time, and move through stress in pieces.


24. Remind yourself daily that this is temporary. It seems in the midst of this quarantine that it will never end. It is terrifying to think of the road stretching ahead of us. Please take time to remind yourself that although this is very scary and difficult, and will go on for an undetermined amount of time, it is a season of life and it will pass. We will return to feeing free, safe, busy, and connected in the days ahead.


25. Find the lesson. This whole crisis can seem sad, senseless, and at times, avoidable. When psychologists work with trauma, a key feature to helping someone work through said trauma is to help them find their agency, the potential positive outcomes they can effect, the meaning and construction that can come out of destruction. What can each of us learn here, in big and small ways, from this crisis? What needs to change in ourselves, our homes, our communities, our nation, and our world?



© 2017 by Clarity Direct Care. Designed by Strands of Silver Co.

  • White Instagram Icon
  • White Facebook Icon
  • White Twitter Icon

1908 Elmwood North, Ste 102 Wichita Falls, TX 76308

(940) 441--CARE (2273)

(844) 299--0602

DPCA+Website+Badge+WHITE.png