Addressing mental health during social distancing
With all the additional stresses associated with the COVID-19 pandemic — financial, relational, and more — building habits and strategies to help mental health is important. Alex Majcher, a member of the behavioral medicine team at Pacific Medical Centers at its Federal Way clinic, spoke about how to build some of these strategies: what to include in your routine, what to avoid, and how to try to make the best out of an extremely difficult collective situation.
What are some tips on balancing news intake in a way that doesn’t heighten anxiety?
You should limit the amount of time each day you watch or listen to the news. Don’t leave it on all day as background noise, and don’t watch first thing in the morning or right before bed. If you get your news by reading it on your phone, the same applies; don’t open up your news app as soon as you wake up, and don’t read it in bed trying to fall asleep.
Additionally, if you struggle with anxiety around the news, focus on local outlets. Local news tends to present more succinct information rather than having panels that mix in a lot of emotionally charged opinions. This also helps you to focus on what is happening in your reality and can prevent you from feeling overwhelmed by what is happening all over the world.
What are proactive steps to take to ensure you’re being mindful of your mental health during social distancing?
If you are working from home, it is important to keep a routine similar to what you would have if you were still going to your office. Ensure that you’re maintaining a regular sleep schedule. When you get up in the morning, do all of the things you would have done on a regular day: take a shower, have your morning coffee and/or breakfast, get dressed, etc.
You also can try and find safe ways to help others. As social beings, we have the instinct to contribute to the well-being of the group, which is why it feels good to contribute to others’ well-being. During social distancing, this doesn’t need to go away — there are numerous ways to help others. Reach out to people who may be lonely by phone, or teach someone who doesn’t know how to set up and use social media so they can connect with others as well.
Additional proactive steps include:
- Do things that give you the opportunity to feel like you have achieved something, no matter how small it may seem. Do a project you’ve been meaning to complete at home, finish a puzzle, learn a new hobby or skill. Set a (realistic) goal for each day and work toward it.
- Make a list of things you can do at home that you enjoy, and schedule a time for them throughout your day.
- It doesn’t have to be intense, but get moving: a walk around the block or yoga will do.
- Spend a little bit of time outside each day, no exercise required! This will help prevent feelings of being boxed in or restless, which is common for people to feel these days.
What are the possible impacts of social isolation for those that live alone?
For those who live alone, social isolation can be difficult to experience. When you live alone, you’re already lacking a source of social support. A lot of people have a “work family” and are used to experiencing interaction outside of the home. This change can result in increased loneliness and boredom relative to people who live with roommates or family members.
Everyone’s anxiety is heightened now because of the pandemic and the impacts on their lives due to social distancing. People are concerned about their health and the health of their loved ones, and are afraid for their jobs and financial well-being. There is a lot to be anxious about right now, and being alone can exacerbate the anxiety because it’s easy to get stuck in those thoughts and worries.
All of the things listed above are risk factors for depression. Additionally, financial challenges also are contributing more to this concern for those living alone because they don’t have another person contributing to household expenses. Other symptoms include feeling unmotivated, thoughts of harming yourself or death, feelings of worthlessness or hopelessness, and fatigue. I recommend you seek medical attention right away if you are experiencing any severe symptoms.
What are the ways social distancing might actually be beneficial to mental health?
During this time of social distancing, it gives us time to recharge, and to take time out from our busy and/or regimented lives, allowing us to get the rest we need.
This is an opportunity to form connections with people you may not have known well before because you don’t see them in your everyday life. I have spoken with people I haven’t heard from in years when they reached out because of this. We are being forced to slow down and simplify our lives and it’s an opportunity we didn’t have before.
Along those same lines, I’m sure every one of us has that one thing at home that we have been “meaning to do” but never had the time — that artwork you wanted to create, the cabinet door to fix, that book you wanted to read, or game you wanted to play with your kids: Now you have the time!
What is the importance of unwinding and taking time for yourself?
Your mental health is connected to your physical health. Taking time to relax promotes physical well-being as well as mental and emotional well-being. When you feel high-stress for an extended period of time, you are at higher risk for physical illness. It’s important to take care of yourself by getting restful sleep and doing relaxing activities (i.e. reading, yoga, stretching, taking baths).
Any tips on online or remote therapy? Is it as effective/are there ways to try to make it more effective? The benefits of online and remote therapy really depend on the reason for treatment and the personality of the patient. Virtual therapy is a really great tool to reach people who are unable to access in-person therapy because of social distancing, and overall because of living in a rural area, homebound by illness or lack of transportation.
I have also found that remote treatment has been the therapy of choice for those who have high social anxiety, and in my opinion, if that is the only barrier to seeking treatment, this is a fantastic option.
Tips to get the most out of virtual therapy include:
- Video is better than the telephone, and the telephone is better than texting. I know texting for therapy may be an appealing option for people today; in my opinion, text may be good for reminders of learned/practiced skills as a supplement to in-person or virtual therapy, but not a replacement.
- Make sure when you’re talking with your therapist, you’re in a quiet environment with no external distractions. I recommend a bedroom, quiet den, or even a backyard.
Living Well Alliance spotlight
Hear how the Living Well Alliance supports employee wellness programs. Christy Goff, registered dietitian, talks with iHeart Radio host Lee Callahan about many nutrition myths and heart-healthy recommendations. Click to listen to this iHeart Radio podcast!
Eating Right With PacMed • 28 min
See what LWA is up to this spring. We host monthly webinars that companies can join, offer popular “Yoga at Work” classes, plus have nutrition classes focused on specific topics, like bone health. Learn more about Living Well Alliance classes, webinars, screenings and other services and how we’ve adapted to COVID-19 stay home orders.
The Living Well Alliance is run by Pacific Medical Centers. Call us today at 206.621.4419 for more information or email LivingWellAlliance@pacmed.org.
PacMed and Living Well Alliance are trademarks of Pacific Medical Centers.
Refocus parenting
Submitted by a PacMed team member
One of the most challenging roles I’ve held as an adult is being a mother to my sons. I take it seriously, thanks to the example set by my mother. She was loving, attentive and committed, which taught me to value parenting my little people.
I believe focused, uninterrupted time is key. In the midst of the daily routine, build in connecting “moments.” These can be in the mornings before day care, over family dinner or throughout the weekend. Our family is fortunate to have a yard, and the kids have a couple of small plants they must water every day—a perfect reason for us to explore and play outside. In these moments, my husband and I allow our sons to open up and share from their perspective.
We unplug so we can fully engage with our sons. We ask probing questions about emotions and check in on the day’s highlights and challenges. By listening, we encourage and model positive behaviors. Conversations with kids can be surprisingly rich—they just need space to share themselves with us.
Remember, each child is an individual. They vary in interests, strengths, opportunities, emotions and how they respond to environments and people. As kids explore and find their way, set guidelines and boundaries that are appropriate. As kids grow and their worldview expands, do community outreach together (garbage cleanups, fundraisers, walks for a cause, volunteering, etc.) to teach them about social issues in a relational way.
In my humble opinion, you cannot show children enough love and encouragement. We are an affectionate family. We tell our children how important they are to us and that we will always have their backs—no matter what. The reward is seeing our children become strong contributors to life and the world around them.
IDEAS TO EXPLORE…
- Build focused, uninterrupted family time into each day
- Listen attentively and openly when your child shares
- Buy a small plant for your child to water each day
- Find support in a parent’s group
- Take time to talk with your child’s doctor
Nutrition: Fantastic fiber
Looking for a new spin on meal prep? One way is to focus on fiber. You’ll suddenly find your plate crowded with colorful vegetables, new grains and tasty spices!
Besides turning your approach to dinner upside-down, increasing your dietary fiber has positive effects on the prevention of many health complications like high cholesterol, high blood sugars, colorectal cancers and poor digestive health. A high-fiber diet is also often lower in calories and can increase feelings of fullness after meals—meaning, your new high-fiber cuisine also can promote a healthy weight!
What is fiber?
Fiber is a type of indigestible carbohydrate found in plant foods such as fruits and vegetables, nuts and seeds, and whole-grain products. Fiber helps to bind dietary cholesterol before absorption and excrete it from the body, assisting in lowering overall cholesterol levels in the body. Also, in the large intestine, some fiber is fermented and transformed into a short-chain fatty acid, which then communicates with the liver to halt further production of cholesterol internally. A double win for your cholesterol numbers!
Lastly—and in honor of March being Colon Cancer Awareness Month—know that fiber feeds your gut’s beneficial bacteria that facilitate with proper digestion and immunity, thus reducing your risk for colon cancer and diverticulitis.
How much should I eat?
The recommended amount of fiber is 25 grams per day for women and 38 grams per day for men (or for those over the age of 51, 21 and 30 grams per day, respectively). Unfortunately, most Americans are falling far short of the recommended amount.
How do I add fiber to my diet?
When increasing your fiber intake, start slow and drink plenty of fluids, especially if taking any supplemental forms of fiber.
Here are some simple substitutions that can easily add more fiber into your diet:
- Snack on fruits and vegetables during the day.
- Have steel cut or rolled oats with nuts and berries for breakfast instead of cereal.
- Try avocado toast on whole-grain bread.
- For lunch, use whole-grain bread products and add veggies such as tomatoes, cucumber and spinach to sandwiches or wraps.
- Try vegetable-spiralized “noodles” as your lunch or dinner base (either pre-packaged or make your own) using butternut squash, zucchini or sweet potatoes.
- Toss an extra handful of vegetables or beans into casseroles and stews.
- Try brown rice, quinoa or lentil-based pasta instead of refined grains.
- Add oat bran or flour to home-baked items such as cookies and muffins and to savory dishes like meatloaf.
Any shopping tips?
Look for Dietary Fiber content on the Nutrition Facts label. It’s listed under Total Carbohydrates. A great source of fiber provides typically 5 grams or more per serving, while a good source provides 2.5 to 4.9 grams per serving.
Healthy eating!
Recipe: Sweet potato, sage and fried egg tacos
A hearty, savory start to or end of the day, with the classic Mexican combination of tortillas, fried eggs and crema. Enjoy!
Get the most from your doctor visits
Did you know doctors can have up to 2,000 patients under their care? That’s a lot to keep track of for any human being.
Rather than assuming your doctor will think of everything, it pays to drive your own care. Successful patients work with their doctors as partners in their health care.
We’ve seen successful patients do some creative things to take ownership of their care. See if any of these can improve your trips to the doctor.
Note: In light of the novel coronavirus, be sure to check with your doctor’s office on the best way to seek care—whether for flu-like symptoms or another concern. At PacMed, we offer virtual visits and tools specific to the COVID-19 outbreak.
Prepare
Keep track of symptoms or questions you have. Note the date, time and situation where symptoms show up. Take pictures if needed, and note temperatures or pain levels.
Use a notepad or an app like Evernote to record everything, including your medications. If something seems urgent, use this information when calling your clinic or nurse helpline to see if you should make an appointment, go to an urgent care clinic or visit the emergency room.
Prioritize
As you prepare to see the doctor, organize your most important questions at the top of your list. Tell your scheduler or care team what you want to discuss. This will help them schedule the right type of appointment so you have enough time.
Bring two typed copies of your questions to your appointment. Give the first to your MA or nurse when they show you to the exam room. Ask them to give it to the doctor, to help them get oriented before coming in to see you.
The other copy is for you to consult during your appointment. Go down the list, making sure to cover all your items. Take notes there too, since it’s hard to remember everything. You can invite a friend or family member along to help if needed.
Persist
After your visit, you may have specialist visits, tests or follow-ups to schedule. Make these before you leave the clinic, while it’s fresh in your mind.
Ask how long test results will take and set a reminder to check MyChart. Message your doctor if you need help understanding results when they come in and to find out follow-up steps to take.
Navigating the medical system can be complicated. Taking ownership of your doctor visits is one thing you can do to have a better experience—and better health outcomes.
Let us know if these tips helped you at StayHealthy@pacmed.org.
Gut Health
Listen to Dr. Brooling’s podcast with Providence about Gut Health.
Dr. Ludwig Receives Lifetime Achievement Award
Dr. Rick Ludwig Is the 2020 Leaders in Health Care Lifetime Achievement Award Recipient
Ludwig serves as interim chief executive officer at Pacific Medical Centers and as medical director of the U.S. Family Health Plan at Pacific Medical Centers.
Dr. Rick Ludwig recognized the potential of value-based care long before it was a thing.
During his residency at a fee-for-service hospital more than 40 years ago, Ludwig noticed costly interventions that did little for patients. He became an early advocate of value-based care, or a form of reimbursement that rewards providers for keeping patients healthy.
He began to champion value-based care and preventive medicine while working at Pacific Medical Centers in the early 1980s. Guided by this mantra, he earned several promotions in the PacMed system and launched PacMed’s Quality Committee and Patient Care Committee, which instituted preventive screenings for many diseases long before it became standard practice.
Because of Ludwig’s advocacy, PacMed is now one of only six regional health systems across the country that has an ongoing contract with the Department of Defense through the U.S. Family Health Plan to offer care for current and former military members and their families.
Novel coronavirus, COVID-19
- COVID-19 vaccinations are available to individuals who qualify according to state guidance. PacMed is partnering with public health partners in a mass vaccination effort. Learn more.
- PacMed is recommends public testing for COVID-19. Visit our COVID-19 Testing page for details.
- PacMed is offering in-person and virtual visits for patients to address your medical concerns. Schedule now online, through MyChart or by calling 1.888.472.2633.
Some visit types may require a COVID-19 test before coming in for care. We will let you know. You can help by monitoring your own symptoms. If you are experiencing COVID-19 symptoms, please call your health care provider as a first step, before coming into a clinic, doctor’s office or emergency department. We can help triage your case and direct you to the best care for you.
You may also use our online Coronavirus Assessment tool.
PacMed is working closely with the Centers for Disease Control and Prevention (CDC), as well as state and local health authorities. Our shared goal is to care for affected individuals while taking steps to limit person-to-person spread within our communities.
King County issues regular updates on COVID-19 and public health measures. Read the latest bulletins.
Overview of the virus
COVID-19 is an illness caused by a new strain of coronavirus. It is believed to spread in ways similar to the common cold—such as through coughs, sneezes, or handshakes.
A person who has caught the virus may not show symptoms for between 2-14 days. This is called the incubation period. The person can spread the virus during this time. The virus may also live on non-disinfected surfaces for up to 9 days.
We are following established infection prevention protocols and remain prepared to care for patients. We have trained and practiced for these scenarios. When you enter a PacMed clinic, you may see certain staff members wearing masks. This is a preventative measure. Patients who exhibit any respiratory symptoms will also be asked to wear masks.
Chloroquine/Hydroxychloroquine prescription for COVID-19
There are no US Food and Drug Administration (FDA)-approved drugs specifically for the treatment of patients with COVID-19. At present, clinical management includes infection prevention and control measures and supportive care. There are no currently available data to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection.
www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html
How to protect yourself and others
The following practices are recommended to stop the virus from spreading through different pathways:
- Practice social distancing, avoid public gatherings and work from home when possible.
- Wear a mask when leaving your home. Masks are now required in Washington State when social distance cannot be maintained.
- Clean your hands often by washing them with soap and water for at least 20 seconds or using a hand sanitizer that contains 60%–95% alcohol. Soap and water should be used if hands are visibly dirty. It is especially important to clean hands after going to the bathroom; before eating; and after coughing, sneezing or blowing your nose.
- Cover your cough or sneeze—using your elbow or a tissue. Then throw the tissue in the trash. (Putting a tissue on a table contaminates the surface of the table with germs.)
- Avoid touching your eyes, nose and mouth.
- Stay home except for food shopping and medical appointments.
- Self-quarantine if you have been told to by a medical professional.
- Routinely disinfect frequently touched objects and surfaces. You can use a cleaning spray or wipe that includes effective disinfectant ingredients, such as 62%-71% ethanol (ethyl alcohol), 0.5% hydrogen peroxide or 0.1% sodium hypochlorite (bleach).
- If common cleaning products are unavailable, you may be able to dilute the effective chemicals with water to create a safe and effective solution (see this handy dilution calculator).
- Note: It can be very dangerous to mix different cleaning products together. It’s safest to only dilute with water.
Higher-risk populations
COVID-19 is more serious for older adults and those with certain health conditions or other risk factors. Health care workers and first responders may also be at elevated risk of getting COVID-19 due to close contact with affected populations. Please check with your health care provider if you suspect you may have elevated risk.
If you fall into a high-risk category, we recommend taking additional precautions to protect yourself from exposure:
- Stay at home as much as possible.
- Have items delivered or ask for help with shopping and errands.
- Avoid potentially infected people.
- Diligently following the protective and disinfecting measures listed above.
If you feel sick
Confirmed symptoms of COVID-19 include:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
If you think you have been exposed to the virus and have these symptoms, please call your health care provider as a first step, before coming into a clinic, doctor’s office or emergency department. Your health care provider can give you instructions for seeking care, and will help you avoid exposing others. You can find phone numbers for each PacMed clinic here: www.PacMed.org/locations.
In addition, you may also utilize virtual visits with a health care provider, or an online coronavirus assessment tool provided by Providence.
Additionally, if you are in King County and believe you were exposed to a confirmed case of COVID-19, please contact the King County novel coronavirus call center: 206.477.3977, between 8 AM-7 PM daily.
When to stay home
You should stay home if:
- You have been told by a health care professional to self-quarantine.
- You believe you have been exposed to the virus, even if you are not showing any symptoms.
- You are sick or have COVID-19 symptoms (also contact your health care provider).
- You have traveled to a country that the CDC lists at a level 2 or 3 travel health notice and feel ill.
- You are in a high-risk category as outlined above (over 60, preexisting medical condition, etc.).
Thank you for working with us to keep yourself and our communities safe. If you have questions about whether you should come into the clinic or another facility, such as an emergency room, please call us first at 1.888.4PACMED (1.888.472.2633).
Other resources to stay informed
- COVID-19 Testing at PacMed
- King County Public Health:
COVID-19 Updates and Alerts
King County cases self-report line: 206.477.3977
(Call between 7 AM-8 PM if you believe you believe you were exposed to a confirmed case of COVID-19) - WA Dept. of Health:
2019 Novel Coronavirus Outbreak (COVID-19)
Washington State Novel Coronavirus Call Center: 800.525.0127 (for general information) - U.S. – Centers for Disease Control (CDC):
Coronavirus Disease 2019 (COVID-19) Updates - World Health Organization (WHO):
Advice for the Public
Coronavirus Q & A
Rolling Updates on COVID-19 - Johns Hopkins CSSE:
Real-Time Global Outbreak Map
How reliable are heart monitoring devices?
What surprises many is that heart disease – and the conditions that lead to it – can happen at any age. According to the CDC, high rates of obesity and high blood pressure among younger people ages 35–64 are putting them at risk for heart disease earlier in life. Knowing that half of all Americans have at least one of the top three risk factors for heart disease – high blood pressure, high cholesterol, and smoking – make February the perfect time to consider our hearts’ health.
With heart health comes the popular question of heart monitoring devices. Are these devices accurate? What are the best heart monitoring devices on the market? In an effort to better understand heart health, cardiologist Dr. Philip Massey with Pacific Medical Centers has provided valuable insights on these topics.
1. Why do you think heart monitoring has become such a point of interest in fitness?
Heart monitoring has become incredibly popular over the last few years. Monitoring your heart’s activity providers people with an indication for how hard they are working out. I’ve noticed heart monitoring to be particularly useful for those who are not necessarily as familiar with working out and knowing what range their heart should be in to ensure they are partaking in a healthy and safe workout. The formula to calculate your maximum heart rate is 220 minus your age. So, if you’re 50 years old, your maximum heart rate would be 170 beats per minute, and your training zone would be more like 85 to 145 beats per minute. Which is 50-85 percent of one’s maximum heart rate.
A lot of new and popular fitness regimes, including Orangetheory Fitness, Peloton and Mirror all rely heavily on heart rate. Again, this is incredibly useful information when you need to understand whether you are working out in a healthy range.
2. How important is it to monitor your heart rate?
I believe monitoring heart rate is incredibly important and a great indicator of your physical health – whether you are working out or in a rest state. Generally, while at rest, a heart rate of 60-100 is considered healthy, however, you should always consult with your physician to be certain.
I also believe having a better understanding of your active and resting heart rate can help you perform better, safer workouts. Knowing this information will allow for people to safely push themselves during workouts, as they will be aware of the safe zone they should be aiming for. This will also help you build up your endurance, which is incredibly important for athletes who are training for physical milestones – marathons, races, etc.
3. Are you a proponent of heart monitoring during working out?
As with everything, there is a level of vigilance needed. Your active heart rate should not be the only indicator of a healthy and safe workout. However, smartwatches can be incredibly useful to users and the market for manufactures continues to grow – Apple, Samsung, Garmin and Fossil are just a few of the watches I see my patients use. Benefits of smartwatches can include:
- Reminding users when to exercise via a built-in step counter
- Heart rate monitor, which can let users know when they are working out too hard
- Heart regulation measurement, which is incredibly beneficial to patients 50+ as this feature can pick up potentially irregular heart rhythms
While nothing is 100 percent accurate, I do believe smartwatches provide more positives than negatives and have no issue with my patients utilizing them during their workouts and daily lives.
While smartwatches can be remarkably accurate, I always caution my patients on relying on exercise equipment to monitor their heart rate. Exercise equipment (elliptical, treadmill, bike, etc.) that measures heart rate via a hard grip are less accurate and should not be solely used to measure heart rate when working out.
Fitness companies, such as Peloton and Orangetheory Fitness, that utilize a chest strap to monitor heart rate are much more accurate and can be used to adequately determine your heart rate if you do not own a smartwatch.
4. What does our heart rate say about our overall health?
In general, heart rate shows how active and in (or out) of shape someone is. Having a lower resting heart rate in the 50s or 60s typically indicates someone is in good health and overall good shape. I always check heart rate during yearly physicals because if someone’s heart rate and blood pressure are not under control, they are at a higher risk for developing a variety of health problems, including a stroke. These risks are increased in patients 40+ so ensuring you have a yearly physical is very important.
5. What are some ways we can keep our heart health in check?
There are quite a few things you can do on a daily basis to ensure your heart health is in check. Make sure you are getting the recommended 150 minutes of exercise weekly, which roughly translates to 30 minutes, five days a week. While it has become trendy to ensure you hit 10,000 steps a day, I instead recommend focusing more on the duration of time spent working out versus the number of steps you’ve taken in a single day.
Also, make sure you are mindful of what you are eating. Focus on eating more whole foods with less saturated fats – think leafy greens, veggies, fruits vs. starchy, carb-based foods.
Lastly, make sure you work with your primary care provider to know the heart rate numbers you should be aiming for, whether that is when you are at rest or working out.
6. Is there anything else people should be aware of regarding heart health?
The most important take home is to stay active. While you do not need to use a heart rate monitor, I recommend you understand your healthy ranges and try to stay within those when active – whether that is walking or intense cardio. Also, remember that no two days are the same. If you are not able to exercise one day, understand that is acceptable. Ensure you are targeting 150 minutes of activity per week to help your heart remain healthy. Lastly, be sure to see your primary care provider annually, who can ensure you are staying on track with your heart health!