Lisa Isenberg, PNP
PPSW Horse
Savannah Porter
Amy Hurley, MD
Durango Pediatrician
Pediatric Partners of the Southwest
Dr. Jessica Marsh
Durango Baby Doctor

PPSW IS PLEASED TO PROVIDE THE MOST COMPREHENSIVE PEDIATRIC SERVICES IN DURANGO AND THE FOUR CORNERS REGION.

Patient Portal

We use our patient portal to complete paperwork before appointments, provide resources, and communicate with families about lab results, medications, and other topics. If you haven't signed up for portal access yet, please click on the link above and get set up!

Meet Our Providers

Below is our wonderful team of board certified Pediatricians, Physician's Assistants, and Pediatric Nurse Practitioners who specialize in the care of infants, children and young adults.

Click on any provider to learn more.

New Patient?

 Welcome to PPSW! If your family is brand-new to our practice, begin by creating a portal account by clicking on

PATIENT PORTAL above.
 

You can pay your bill to PPSW securely through Instamed. Click here to pay your bill now

Our Services

 PPSW provides the most comprehensive pediatric services

in Durango and the Four Corners Region.

PRIMARY CARE

Our PPSW providers are pleased to offer primary care visits in our office at Horse Gulch Health Campus. SAME DAY AND
SATURDAY SICK VISITS.

NEW! VIRTUAL VISITS.

CHILDREN'S HOSPITAL PEDIATRIC SPECIALIST VISITS

PPSW hosts In-Person and 

Tele-health Clinics in Durango

INTEGRATED BEHAVIORAL HEALTH

Specializing in Support and Community Referrals​

MERCY HOSPITALISTS

Our board-certified pediatricians serve as Mercy Regional Medical Center’s only pediatricians. Mercy Hospitalists provide 24 hour-a-day, 7 day-a-week coverage.

PEDIATRIC PARTNERS IN THE SCHOOLS

PPSW has multiple school-based health centers across southwest Colorado.

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ANNOUNCEMENTS

Changes to Visits

 

Updated 6/10/21

 

We are open to well and sick visits!

 

How are we keeping you and your loved ones safe while we do this?

 

1. We have one provider who is essentially the 'urgentcare' provider, assigned to seeing the 'sick' patients for the day.  The other providers are seeing only 'well' patients, those who do not have any symptoms of COVID.  

2. We are still utilizing telemedicine visits for most sick visits.  We will not have any fevers, cough, sore throat, diarrhea, or new rashes inside the clinic. We will still be evaluating these via telemedicine first.  If we need to see your child in person, we will schedule a drive-up visit where the provider comes down to your car for the exam. Depending on your conversation with our triage nurse/provider, we may see things like concussions, headaches, or chronic rashes in the office.

3. We ask that you try to minimize who you bring into the office with you if possible. This is simply to minimize the number of people we have in the office at any given time.  We are always happy to have the other parent/guardian on speaker to help facilitate their involvement.

4. While the mask mandate has been lifted for vaccinated people in public spaces, the CDC still recommends that everyone over the age of 2 wear a mask in medical settings.  We ask anyone who can (those over 2 years of age and without lung disease such as COPD) to wear a mask as soon as they enter the door and until they leave the office. If you do not have one we have a small supply of bandanas and cloth masks to share with you.

 

Please know that these precautions are to keep you and our employees safe so that we can keep taking care of you. Thank you for your patience and please let us know if we need to troubleshoot anything to help take care you.

 

Hope to see you soon!

COVID-19 Information

There are a lot of fears and miscommunication out there about coronavorus/COVID-19 so we wanted to share the resources we rely on in epidemics such as this. 

 

https://sjbpublichealth.org/coronavirus/

https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Childrens Hospital Colorado hotline for parents with questions about COVID-19: 720-777-2221

 

If you are worried your child has COVID-19, please call our clinic and talk to a triage nurse about the right way to be seen by a provider, and we can assist you through this process. Please do NOT take your child to a clinic or urgent care that will not be able to provide testing for COVID-19 concerns without first discussing with someone ahead of time so we can help make sure proper infectious disease prevention procedures are taken to limit the spread. We want to take care of your kiddos while also doing our part in containing the virus!

 

In the meantime here are some tips to help prevent infection:

1. DO practice good hand hygiene! Wash for 20 seconds and scrub all the nooks and crannies. Count it out or sing your ABCs or Happy Birthday! Do this before you eat or touch your face and after you sneeze/blow your nose/cough into hands, etc.

2. Do NOT touch your face without washing your hands first. 

3. Do NOT take your sick kiddos around the grandparents or people with medical conditions such as heart problems, diabetes, and lung problems. 

4. DO wear a mask when in public

When talking about possible COVID infection, we may talk about major and minor symptoms. For your reference, these are those symptoms:

Major Symptoms

- Feeling Feverish or Having Chills

- Fever >100.4 degrees F

- Loss of Taste or Smell

- New or Unexplained Persistent Cough

- Shortness of Breath or Difficulty Breathing

Minor Symptoms

- Sore throat

- Runny nose / Congestion

- Muscle / Body Aches

- Headache

- Fatigue

- Nausea / Vomiting

- Diarrhea

COVID Handouts

COVID Fact Sheet (CDC)

COVID How to Help When You're Sick (CDC)

Triage Notes - Diagnosed or Suspected COVID

Triage Notes - Exposed to COVID

Triage Notes - COVID prevention

COVID Fact Sheet (CDC) - Spanish

COVID How to Help When You're Sick (CDC) - Spanish

Resources to Help Your Kids During Isolation / Social Distancing

Tara Branch Pandemic Care Resources

How To Talk To Your Kids About Coronavirus

Six Daily Questions to Ask Yourself During Quarantine

How to Help Teens Shelter in Place

Greater Good's Guide to Well-Being During Coronavirus

A Kids' Guide to Coronavirus - The Daily (podcast)

Frequently Asked Questions

(last updated January 28, 2021 by Jessica Marsh, MD)

My kid got sent home from school…..now what?

If your kid is super sick (dehydrated, excessive vomiting, really high fevers, having trouble breathing, etc) we want to see them right away.  If they are mostly fine and symptoms are mild, we are trying to see them after 24 hours so that we know the trajectory of their illness a bit.  If symptoms are really mild and go away within 24 hours or it is clearly something not related to an infection (migraine, allergies, etc), we might not have to get any testing done to get them back to school.  If symptoms last beyond 24-48 hours we probably will need to order a test to get them back to school.  

 

First, we do a telemed appointment to figure out what you need.  Depending on the story we might test for strep, flu, mono or RSV instead of or in addition to COVID (depending on what safety level your county is in).  We may decide we need to check vitals or do an exam.  If we identify another problem we can treat, we go ahead and treat that issue.  If we don’t, we wait for the COVID test result, support your kiddo with fluids or other medications if needed, and see how your kiddo does.  

 

During Level Blue, Yellow, Orange, and Red if your child’s symptoms last past 24 for major symptoms (cough, fever, trouble breathing) and 48 hours for minor symptoms (diarrhea, rash, vomiting, headache, runny nose, sore throat, body aches) we cannot clear them for school again until their COVID test comes back negative and their major symptoms (cough, fever) have resolved for at least 24 hours.  During Level Purple they have to have a negative COVID test AND an alternate diagnosis to be allowed to go back to school before 10 days.  An alternative diagnosis would be an identified ‘bug’ such as influenza, RSV, or strep, or worsening of a chronic condition such as asthma or seasonal allergies, not just a cold or stomach bug since COVID often looks like a cold or a GI bug.  Loss of taste or smell is so specific for COVID19 that it is an automatic 10 day isolation period, no matter what the test result says!  

 

Even if you tell our triage nurse that the test was negative and the symptoms are gone, a provider still has to review this through a medical lens to write the clearance letter….this might take a few hours because we are also very busy seeing patients in clinic!  As soon as you get your test result, email the result to medicalrecords@ppswdurango.com.  You can let them know how your kiddo is doing regarding their symptoms, and a provider might have some follow up questions for you, but we will get you that clearance letter ASAP.  If we get the result first, we will contact you ASAP.

 

If my test is negative, can I go about business as normal?

Unfortunately not always.  What you are supposed to do after a negative test depends on the safety level that your county is under.  Depending on the type of symptoms and how long they lasted, you might be able to go back to normal, your kid might be able to go back to normal if they can wear a mask, or they might still have to isolate due to the possibility of a false negative test.  Definitely ask us during your appointment or when we are reviewing your result.

 

If I have been exposed to COVID, how do I end quarantine early?  Can I get a negative test?

If you have been exposed to COVID19 the CDC and the health department recommend testing 5-7 days after you have been exposed for contact tracing purposes. The safest thing to do is to quarantine (stay at home, away from others) for 14 days after you have been exposed.  This essentially eliminates the risk that you will accidentally spread it to anyone before you have symptoms or if you are the lucky person who has COVID19 with no symptoms.  However due to the burden of such a long quarantine, the CDC has offered shorter options based on new data that still minimize the risk of spreading COVID without knowing it but doesn’t eliminate that risk like the 14 day quarantine does.  

 

Before 12/2/2020 when the CDC revealed new recommendations, no amount of testing could end your quarantine early.  After reviewing more studies, however, they have realized that if you remain symptom free after an exposure for 10 days without a test or 7 days with a negative test, the risk of having/spreading COVID19 is significantly lower and thus the new public health strategy. 

 

So, let’s say you have a known exposure to COVID19.  If you don’t want to get a test or you don’t have access to testing, you can plan to quarantine at home for 10 days, then go back to work IF you are able to wear a mask and socially distance.  If you have access to testing and remain symptom free, you can get a test on day 5 after exposure and if negative you can end quarantine on day 7 if you can wear a mask and continue to socially distance until day 14. You are still at risk of developing COVID19 for a full 14 days after exposure.  Thus, if you develop symptoms after you have exited the shortened quarantine, you still need to isolate immediately and get tested ASAP!  The shorter quarantines are ONLY an option for people who are able to wear masks and socially distance (aka not little kids!)

 

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html

 

If I get diagnosed with COVID19, how do I end my isolation early?

If you do have COVID19, the only way to end your isolation period (10 days for healthy people, 21 days for immunocompromised people) early is to have two negative test results >24 hours apart.  This is NOT a recommended strategy, however, except for rare circumstances.  You shouldn’t leave isolation just because you feel better because you may still be contagious even though your symptoms are gone. 

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html

 

My kid just seems to have a cold/stomach bug, why do we have to test for COVID?

COVID19 in younger age groups usually looks ‘just like a cold’ or ‘just the flu’ or ‘just the stomach flu’ which is why we are usually recommending testing even for mild symptoms if they last longer than 24-48 hours. Only a third of kids who get COVID have a fever.  Sometimes they only have one symptom. Even if one person has a mild case of the infection, they can spread the virus to someone with a high risk condition who might have a severe infection.  A mild case does not mean you got a mild strain of the virus.

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/symptoms.html 

 

What test can I trust and what test has to be confirmed?

There are two kinds of tests to know if you are infected RIGHT NOW.  The two kinds of tests are an antigen test and a PCR test or a molecular assay.  An antigen test looks for proteins that are on the surface of the virus.  A PCR test and molecular assay look for the genetic material of the virus.  A rapid antigen test is only trustworthy if it is positive.  A negative antigen test usually has to be confirmed with a PCR test because an antigen test isn’t as reliable as a PCR test.  No test is right 100% of the time, but we in general are trusting a PCR test result except for rare instances.  Feel free to ask us what kind of test we are ordering and if we can trust it.  

 

https://www.fda.gov/media/140161/download

https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html 

 

Can I just get a test before I go see my grandparents (or other high risk individual) so that I know I won’t infect them?

A false negative (testing negative even though you have the virus) is more common early in the phase of illness when you don’t have symptoms yet.  You can get a negative test done one day and still end up having symptoms and then test positive just days later.  It is better to practice social distancing, mask wearing, hand washing, and cleaning common surfaces no matter what a test result is to protect your loved ones who are more vulnerable.  A negative test doesn’t mean you should attend a party or gathering with no social distancing. 

https://www.cdc.gov/coronavirus/2019-ncov/testing/diagnostic-testing.html

 

Why are you doing so many visits over telemedicine? You can’t tell anything from telemedicine. 

We have been SHOCKED at home much you can do over telemedicine.  Of course sometimes we absolutely need to look in an ear, feel an abdomen, listen to lungs, etc but there are a ton of things we can confidently assess over telemedicine by itself. We are trying to continue to take care of our patients while also minimizing your and our exposure to illness when we see each other.  We decide how to do that with you.  During your telemedicine visit we will decide together if we need an in-person exam and coordinate that.  We want families coming in for well visits to feel safe, so we are still seeing all sick patients at their car or in one of our heated tents.   

 

If I get an antibody test and it shows that I had COVID before can I assume that I’m immune to COVID?

This one is tricky.  An antibody test may tell you if you had COVID19 in the last few months but in some cases it can also pick up some antibodies to the old coronavirus that causes the common cold. There are two problems with assuming that you’re immune if you have positive antibodies.  One, we don’t know for sure that these antibodies are truly protective if you get exposed to COVID again.  (Similarly, most people have had strep throat more than once.  Our immune system doesn’t always remember how to fight something we have had before.)  Two, we don’t know how LONG our immune system can remember COVID and respond to it. All that to say….the CDC says that once you’re diagnosed with COVID19 that you don’t have to quarantine if exposed to COVID for 3 months after you’ve had it.  BUT if you get sick, we still have to test you anyway because you might have gotten it again.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

 

If I get COVID, should I get tested afterwards to make sure I’m not still contagious?

This is another tricky one.  The problem is that you can still test positive after you are no longer contagious.  So sure, if you have two tests that are negative you are probably fine.  BUT some people will test positive for MONTHS after they had it even though they aren’t contagious.  This is why we aren’t recommending testing to clear yourself to be around people. For healthy people, the CDC recommends isolating yourself for 10 days.  If you were REALLY sick (breathing tube, ICU, etc) or you are immunocompromised (receiving chemotherapy for cancer for example) they say isolate for 21 days.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html

 

What do you think about the COVID vaccine? Will you get it? Are you recommending it?

All of our providers have received the COVID vaccines.  Some of them received the Pfizer, some the Moderna vaccine. While these are both approved under emergency use authorization at this time, we all felt like the vaccines were safe enough and effective enough that we were all very excited to have the privilege of receiving the vaccine.  

 

At this time, the Pfizer vaccine is approved for those who are 16 years and older.  The Moderna vaccine is only approved for those 18 years and up at this time.  Studies are currently being done on adolescents to determine safety and efficacy.

https://www.fda.gov/media/144414/download

https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-recipients.pdf

 

Why do I have to wear a mask the ENTIRE time I am in the office? Can’t I just take it off when I’m by myself in the bathroom or exam room?

Before we answer that question, let’s go through the three modes of transmission for respiratory infections.  

1.  Contact - you actually come in contact with the virus in secretions.  For example, you shake someone’s hand after they wiped their nose or you use the same door handle that someone used after sneezing into their hand and then you pick your nose or wipe your eyes.  This is why you should ALWAYS wash your hands after you blow your nose, cough into your hand, etc and BEFORE you touch your face.   

2.  Droplet - you breathe in the big droplets containing the virus that someone else breathes out when they are near you.  Usually when it is spread by ‘droplet’, the virus is on big particles that fall out of the air quickly and so the air is thought to be safe as soon as you leave.  This is why the recommendation is to stay 6 feet away from people.

3. Airborne - some infections such as chickenpox, measles, and tuberculosis can hang out in the air on teeny tiny particles that float in the air for a long time and can float far away.  

 

Initially, scientists thought that COVID only spread via contact and droplet (thus the 6 feet distancing, hand washing, wearing masks and not touching face recommendations).  They soon realized that in certain circumstances, that COVID could spread like an airborne illness.  These more rare circumstances usually involve someone producing these droplets (singing, talking, coughing, exercising without a mask) for more than 30 minutes in an enclosed space. Enough virus can be present in that space to cause infection for people who are more than 6 feet away or who passed through that space after the infected person left the area.

https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html

 

Do you ever get tired of talking about COVID?  

Sometimes.  But we are also very thankful that the vast majority of our patients are going to be fine if they get infected and that a lot of our job right now is making sure we keep schools a safe place!

 

Can I just get a test without a doctor’s order?

You absolutely can.  A couple disclosures though.  1. You usually get access to faster tests when you have an order.  2.  Not everything is COVID.  We are seeing a ton of mono and strep, right now! And flu is right around the corner!

 

What are you most worried about with COVID19 in your patients?

That’s easy.  Mental health and weight gain.  Social isolation is hard on all of us, but especially kids and teens.  We are all under more stress than normal, which manifests differently for all of us.  Additionally, we are seeing increasing rates of obesity in our patients, which increases their risk of diabetes, heart disease, high blood pressure, etc  

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Getting-Children-and-Teens-Outside-While-Social-Distancing.aspx

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Building-Resilience-in-Uncertain-Times.aspx

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Stress-and-Violence-at-Home-During-the-Pandemic.aspx

What are you doing to keep me safe when I bring my loved ones to the office?

  1. We are screening all employees for illness daily

  2. We are not letting potentially exposed employees work in the office

  3. All staff and patients/visitors over the age of 2 years of age are required to wear masks in the office to protect others

  4. All staff wear faceshields or eye protection when they are within 6 feet of patients to limit their exposure 

  5. During Level Red when we have high community transmission we are taking the history part of every in-person visit over tele in an attempt to decrease the amount of time we are in the same room.  After we talk about everything we will then come in for a brief exam and wrap-up.  The goal of this is to make sure that if we have COVID and don’t know it yet, that you don’t have to quarantine just because you were in the room with your contagious provider for more than 15 minutes!

  6. We are cleaning surfaces after every use with virucidal wipes or cleaners

  7. We are cleaning computers/phones/doorknobs throughout the day

  8. We are social distancing as employees to minimize the possibility of an outbreak at work

  9. We are not allowing patients with possible symptoms of COVID in the office - we are seeing them at their car or in a tent outside with removable walls and heater at the Horse Gulch and Bayfield locations.

 

Should I worry that my kid might get MIS-C (multi-system inflammatory syndrome in children? 

Scientists think that MIS-C happens when the immune system gets triggered by COVID19 and causes inflammation in multiple organ systems causing those organs to not work properly.  This can happen when your kid has COVID19 or up to a few weeks after they have it.  Sometimes, you won’t even know that they did have it!  MIS-C is very rare and children with MIS-C have a good outcome with proper treatment.  However, they can be very ill and need ICU care to get them through the illness.  

 

It is good to know what to watch for.  Kids with MIS-C will typically have fever for more than 24 hours and have evidence of inflammation in many organs including their intestines, heart, brain, lungs, skin, or kidneys.  Monitor your child for fever, abdominal pain, diarrhea, vomiting, neck pain, rashes, bloodshot eyes, fatigue.  Please seek medical attention right away if you notice trouble breathing, pain/pressure in their chest, confusion, inability to stay awake, bluish lips.  We can sometimes rule this out based on history and exam, but we may need to order bloodwork to know for sure.

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/covid_inflammatory_condition.aspx

 

Why do I have to sit out of sports if I’ve been exposed to COVID19 or had COVID19?

COVID19 is a virus that seems to affect the blood vessels of the heart even in mild cases.  It can also cause inflammation in the heart muscle itself and make people more prone to sudden death during exercise. Thus, the American College of Cardiology recommends that if you’ve been exposed to someone with COVID19 that you rest for 14 days after your exposure to make sure you aren’t going to get COVID19.  They recommend that if you get COVID19 that you rest for 14 days once your symptoms have gone away and THEN you can gradually return to play (kind of like returning to play after a concussion).

https://www.acc.org/latest-in-cardiology/articles/2020/07/13/13/37/returning-to-play-after-coronavirus-infection