If your family has been isolating together since the early days of the COVID-19 pandemic, tensions may be on the rise in your household. Let’s face it - as much as you love your family, it’s hard not to get on each other’s nerves when you’re cooped up indoors for an indefinite amount of time. As life gradually begins to feel normal again in many areas, you can find new ways to address and alleviate these tensions. If you’re struggling with any of these sources of tension in your household, here’s how to lighten the mood.
 
Avoid Chaos and Confusion
 
Since the COVID-19 outbreak began, your family’s usual routines may have been thrown out of whack. Suddenly, your kids were home from school, you were working remotely, and you had to say goodbye to the old schedule that your family had followed for years. This may have caused confusion and chaos in your household, but establishing new routines can help you feel like you’re in control again. Create morning, afternoon, and evening schedules that everyone can follow so your family can regain a sense of stability throughout the next phase of this pandemic.
 
Address Lack of Exercise
 
Chances are, your family has been spending most of their time indoors for the past few months as a precaution. But according to MetalBladeCycles, a lack of physical exercise can contribute to stress and anxiety, and you’ll likely end up taking these negative emotions out on each other.
 
If you’ve all been feeling a bit moody and sluggish lately, it’s time to exercise outdoors! Try engaging activities like running, hiking, biking, and even rock climbing - all of these sports will boost your family’s overall health.
 
Gaining Quality Time
 
Perhaps your family has been neglecting opportunities for memorable quality time, and because of this, you’re feeling distant from each other. In addition to outdoor sports, your family can also take advantage of time in nature to simply relax together. Try spending a sunny afternoon in your backyard, having a picnic at a nearby park, taking a road trip to a local beach for the day, or even going on a weekend camping trip. Afterward, your family will feel refreshed and rejuvenated!


Make Space for “Me Time”
 
Getting enough “me time” is especially important for people in your household who happen to be introverted, but that can be tough to achieve when everyone is in isolation. According to VeryWellFamily, kids need time alone to develop their imaginations and feel more independent. They might enjoy solo activities like drawing and painting, playing with blocks, or telling stories with their dolls and stuffed animals, which will give you a break! If you want to encourage your children to spend more time reading, consider purchasing a few entertaining graphic novels for them. Before buying a particular book, research the storyline, make sure it’s age-appropriate, and check out a few Amazon reviews to ensure your kids will enjoy it.
 
Self-isolating is the simplest way to protect your family from contracting COVID-19. But there’s no denying that taking these precautions does present new challenges for your household. Many families in isolation feel exhausted and frustrated by the events of this year. However, if you come up with strategies to safely enjoy outdoor activities, find new sources of entertainment for your kids, and give everyone in your family some more time alone, your household will be able to ride out this pandemic with ease!

Guest blog courtesy of Elena Stewart
 
Photo via Pexels

After the long Idaho winter (seriously, snow in June?!) and all of the Covid lockdown, those nice summer rays warming your skin are the last thing you want to block, right?  Unfortunately, while a little Vitamin D from the sun is a good thing, a nice summer tan is a bit less healthy than you might think, and even worse for your skin is that first summer burn.  Even for those diligently applying sunscreen, chances are good that you’re putting it on all wrong.  Here’s what you should know about both the short and longterm effects of all that sunshine and how to enjoy the nice summer weather while protecting your skin.

What happens when you tan or sunburn?  A tan is your first line of defense against the sun.  Skin damage releases melanin, which in turn increases skin pigmentation, i.e. skin gets darker.  While this does provide some protection, this level of protection is only about SPF 3.  Once the level of skin damage begins to cause cell death, an inflammatory process increases bloodflow to the area, resulting in the warm, red appearance of a sunburn.  Tanning is more of a chronic damage whereas sunburn is more of an acute damage.  Even if you aren’t worried about the increased risk of skin cancer associated with this damage, do you really want to look like Magda from there’s something about Mary?  Skin damage from the sun is a BIG contributor to aging.

Don’t I have to get all of my Vitamin D from the sun?  While Vitamin D is important for bone and immune health, not all of it has to come from the sun.  Eggs, milk, and fish are important sources of dietary Vitamin D, and in fact, dietary intake can provide adequate levels of Vitamin D without the need for excessive sun exposure or additional supplements.

How should I put on my sunscreen and what kind should I use?  Sunscreen should generally be applied about an hour before sun exposure, and you should be using a lot more than you probably think.  For the face alone, a nickel-size amount is appropriate, but for the entire body, a shot glass-sized amount (a full ounce) is necessary.  Also, don’t forget to reapply frequently, every 1-2 hours, to prevent sunburn.

As for the type of sunscreen, SPF 15 blocks about 93% of UVB rays, SPF 30 blocks about 97%, and SPF 50 blocks about 98%.  Mineral sunscreen are typically more effective than chemical sunscreens.  Another benefit of mineral sunscreens is that they don’t contain ingredients like oxybenzone or octinoxate that can be harmful to coral and ocean ecosystems.

If you’re absolutely against sunscreen, there are certain clothing lines geared toward SPF protection.  Some long-sleeved shirts, pants and hats can also be effective protection against the sun, but remember that any area of exposed skin will still be vulnerable to UV damage.

So, should you hide in the shade all summer?  Not necessarily.  There’s evidence that some sun exposure may trigger release of nitric oxide and in turn lower blood pressure, but at the same time, there’s no sense in burning until you become a California raisin either.  As with most things, moderation is probably key.  Apply your sunscreen and don’t get sunburned, but go outside and have some fun, too.  It’ll be snowing again before you know it.

Dr. Nick

How does osteoporosis happen?  Our bones are constantly being broken down and replaced.  Whenever the creation of new bone does not keep up with the loss of old bone, they become brittle and weak.  When this happens even minor stresses can cause a fracture.  These fractures most commonly happen in the hip, wrist, or spine.  There are lots of things that contribute to the development of osteoporosis.  Genetics, age, sex, race, nutrition, lifestyle choices and medical conditions can all contribute to osteoporosis.  Unfortunately, White and Asian post-menopausal women are at the highest risk of developing osteoporosis.  However, there are lots of different options to help prevent bone loss or strengthen weakening bones. 
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There are different medical treatment options available.  The most common of these being bisphosphonates.  Bisphosphonates prevent bone from being broken done. However, this may lead to less new bone formation as it prevents old bones from being broken down.  In addition to this, this class of medications has lots of side effects- muscle aches, esophageal ulceration, osteonecrosis of the jaw, seizures and atypical fractures of the femoral shaft and even esophageal cancer.  Other treatment options include estrogen and estrogen agonists like raloxifene.  While it decreases the chance of osteoporosis, there are many individuals that are not good candidates for this type of treatment because of the increased risk of blood clots and even strokes. 

While we always recommend weight bearing exercises to prevent osteoporosis, recent studies have shown that exercise really bolsters bone mass in the hip and femoral neck decreasing the chance of developing hip fractures.  Studies showed that increases in body mass density at the hip and femoral neck were particularly noticeable in women age 65 or older if exercise training lasted more than 200 days.  Basically, exercise has a huge protective effect on bone mineral density and can prevent fractures without all the side effects that traditional medications like bisphosphonates and estrogen agonists can have.  The thought is that as we age, our bodies produce cytokines that are inflammatory and destroy bones.  Exercise prevents the production of these bone destroying inflammatory cytokines and increases growth factors that help produce new bone.  In women particularly, exercise has also been shown to have a positive effect on estrogen concentrations which helps with bone remodeling. 

With all the innovations of modern society- dishwashers, washing machines, Alexa to turn on our lights and delivery of everything from groceries to dinner, we have become very sedentary.  Unfortunately, our bodies were not built for this.  Our bodies were meant to be active.  Movement and exercise promote the resorption of old bone and the formation of new bone.  This is vital to preventing fractures, back pain from fractured or collapsed vertebra, loss of height over time and stooped postures. 

While it’s important talk to your provider about your risk of bone loss and osteoporosis as you get older to see what options are best for you, don’t discount the importance of lifestyle choices like exercise to help prevent bone loss and fractures. 

Dr. Pam

A very common question at appointments lately is “I think my hormones are out of balance-can I get them tested?”  While society may tell you that an imbalance is the cause for everything from weight gain to mood change to almost any other symptom, it’s not likely the culprit for women with normal cycles, and here’s why:  the amount of sex hormones fluctuates markedly over the course of a menstrual cycle, and in fact, if they didn’t, there would be markedly dysfunctional cycles.  Here I’ll review what happens during the menstrual cycle as well as each hormone involved, how it changes over the course of a menstrual cycle, and also what it does.

What is the menstrual cycle?  The menstrual cycle starts on the first day of bleeding during the period and lasts until the first day of bleeding during the next cycle.  The lining of the uterus is shed and then begins to thicken again in case pregnancy occurs.  Ovulation generally occurs around the midpoint of the cycle (about 2 weeks before the start of the next cycle) in response to hormonal changes, and while the ovum (egg) is present, fertilization and pregnancy may occur.  If there is no pregnancy, then the cycle starts over again.  The length of the cycle can be calculated by using day 1 as the first day of bleeding and then counting days until bleeding starts again.  Typical ranges can be from 24-38 days.  Now that the cycle has been explained, we can move on to the important part – the hormones.
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1. FSH and LH – think of FSH as the director of a cycle.  Follicle stimulating hormone (FSH) comes from the pituitary gland in the brain and is responsible for the growth of an egg during the menstrual cycle until ovulation is triggered by luteinizing hormone (LH).  FSH is highest just before ovulation and then decreases following the release of an egg until it’s time for the next menstrual cycle.  In menopausal women, levels are consistently very high because the pituitary gland wants to stimulate release of eggs from ovaries that are no longer responding.
2. Progesterone – this hormone is released from the corpus luteum (a cyst formed on the ovary each month).  It increases in the second half of the cycle in order to support a pregnancy should it occur, but if there’s no pregnancy, the corpus luteum goes away and the decreased progesterone triggers a menstrual cycle.  High progesterone levels in the second half of the menstrual cycle are responsible for many of the PMS symptoms experienced by women including acne, mood change, headache, breast tenderness, and everyone’s favorite-bloating.
3. Estrogen – estrogen is produced by the dominant follicle in the ovary and increases as the size of the follicle increases over the first half of the cycle.  Increased estrogen thickens the lining of the uterus in preparation for possible implantation of the pregnancy.  Once estrogen levels are high enough, then the LH surge triggers ovulation and the second half of the menstrual cycle begins.  The decrease in estrogen in the latter part of the menstrual cycle stops the thickening of the uterine lining and works with the decreased progesterone levels to allow the menstrual cycle to start over if there hasn’t been a pregnancy.  Persistently high estrogen levels, such as those caused by estrogen production in adipose tissue in women with PCOS, cause continued growth of the uterine lining.  Continually elevated estrogen can ultimately result in unpredictable menstrual cycles as triggers for bleeding can be suppressed, and these cycles can often be very painful and heavy as several months worth of endometrial lining can be passed at the same time.  Over a long enough time, this type of bleeding can even result in endometrial (uterine) cancer.
4. Testosterone – testosterone, while generally thought of as a male hormone, is present in women, although in much smaller amounts.  Testosterone is a driver for libido and plays a role in developing/maintaining muscle mass and bone density.  There is a slight increase around the time of ovulation (in order to encourage procreation), but otherwise levels are pretty stable.  If testosterone levels get too high, women can experience acne, facial/body hair growth, deepened voice, male pattern baldness, heart disease and increased clitoral size.  While some of those effects are temporary, many of them may be permanent.

Given the natural course of hormonal change during the menstrual cycle, a single hormone test may be misleading.  For instance, progesterone levels prior to ovulation will be lower, but by adding supplemental progesterone to “correct” this imbalance, a woman might then live in a constant state of PMS.  Unopposed estrogen in a woman with a uterus will likely lead to irregular bleeding and could cause endometrial cancer.  Testosterone supplementation at high enough levels could cause permanent hair loss (from the scalp) or permanent hair growth (on the face and body) among other issues.  Many times the good intentions to supplement a natural fluctuation in sex hormones will likely make symptoms worse rather than better, and in turn, this could result in further unnecessary tests and procedures.  For nearly all premenopausal women, the better bet may be some sort of contraception-based hormone management.  That being said, be sure to review your full health history with your provider before starting any hormonal therapy, contraception-based or otherwise, to ensure it’s a safe and medically-appropriate treatment option for your specific symptoms. 

Dr. Nick  

There are lots of people out there that are worried about not taking enough Vitamin D supplements.  Its more popular than most supplements out there including fish oil, probiotics, and antioxidants. 

​What is all the hype all about and is it real?  Originally, we were told that Vitamin D helps prevent thinning of the bones.  More recently is has been touted to be a panacea for just about everything.  It helps boost the immune system and mood, helps with muscle weakness, fatigue, prevents cancer/heart disease/diabetes and even helps slow down the aging process.  So whenever one supplement does all this, I think we should be a little skeptical. 

What does Vitamin D do?   It helps your intestines absorb calcium.  Without Vitamin d, your intestines can only absorb 10% of calcium from the diet; with it your body can absorb about 40%.  Your body needs calcium to make your bones strong.  Without enough calcium, your bones will start to thin, soften and can bow outward (known as Rickets in children) and can increase fractures in older adults. 

Many vitamins must be consumed from different types of foods because your body can’t make it.  Not Vitamin D.  Vitamin D is made in our skin when exposed to sunlight and then converted in the liver and kidneys to usable forms.  Vitamin D is found in certain specific foods as well.  Since certain states have long winters and less exposure to sunlight, the federal government has required that Vitamin D be fortified in certain foods like milk, yogurt and orange juice to prevent diseases like Rickets.  This disease is pretty much nonexistent in modern times because of fortified foods. 

So why did experts think Vitamin D was so useful for so many things.  Researchers did observational studies where they looked at people who took supplemental Vitamin D and found that they were less likely to have certain cancers, hypercholesterolemia, hypertension, heart disease, fractures and a myriad of other chronic illnesses that are common in our modern world. 

I thought Vitamin D was just supposed to help with bone health, so how did it help with everything else?  In these observational studies, the individuals decided whether they took additional Vitamin D or not.  The people that were more likely to take theses supplements were more likely to be healthy, i.e. exercise regularly, eat healthily, and thus less prone to chronic diseases like heart disease and diabetes.  When randomized controlled trials with Vitamin D were done (the researchers picked who got Vitamin D and who got a sugar pill), the results were quite different. Most of those studies did not show any benefit in the group that received Vitamin D supplementation.  Some even found that Vitamin D supplementation may cause more harm: high levels of Vitamin D could cause weakness (and increase falls causing fractures), vomiting, and kidney stones. 

So, what does all this mean?  First, Vitamin D is not a cure all despite what celebrities may tell you.  Second, the most important way to stay healthy is to get your vitamins and minerals from actual food and not from supplements.  Third, get some sunshine (just not too much!*) and stay active outside.  This will boost your levels of Vitamin D and provide way more benefit than you realize.  Talk to your provider and decide whether you need Vitamin D blood level testing.  Remember 97% of people in the US have adequate levels of Vitamin D (from the sun and fortified foods) when the Institute of Medicine and US Preventative Services Task Force determined that blood levels above 20 nanograms are adequate.  However, more than 50% of individuals were noted to have inadequate levels when certain commercial labs changed the necessary level to >30 nanograms to have an adequate amount of Vitamin D.  Hope this helps to clear up the craze surrounding Vitamin D.  It would be awesome if a single supplement in pill form helped cure everything, but for better or worse, the old adage still holds-if you want to be healthy, balanced diet and regular exercise trump supplements**.  Have a good summer and get your vitamin D the old-fashioned way, by enjoying that Idaho sunshine while it lasts!

 Dr. Pam

*Too much sunshine, particularly without the use of sunscreen, could increase your risk of skin cancer.
**Be sure to talk to your provider before discontinuing any recommended treatments.

As screen time increases, we’ve begun to see a number of health concerns ranging from headache and eye strain to posture issues and obesity to increased anxiety and loss of interpersonal social skills.  Some of the correlation can be more self-explanatory, i.e. hours a day craning your neck to look at your phone can hurt your neck, but some potentially negative health effects, such as those caused by blue light, may be more subtle.  Here we take a look at blue light and how it can affect your health.
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What is blue light?  Taking you back to grade school, a rainbow shows the different colors that make up white light, ranging from red at one end all the way to violet at the other.  Red has a longer wavelength and is less easily scattered whereas blue has a shorter one and is more easily scattered.  That’s why the sky generally appears blue.
Ok, but what does it do?  Blue light is awesome during the daytime because it can boost attention, mood and reaction times.  It’s not so great at bedtime.  Prior to electronic screens, humans essentially evolved to be dependent on the sun for this type of stimulation, and it’s why for however long humans have been around, people tend to be more focused during the day and sleep at night.  Now, with the advent of tablets and cell phones, some people can’t even get out of bed until they get their electronic fix and the blue light that wakes them up.

Um, is that a problem?  It may not be the end of the world to play on your phone a minute or two before getting up, but not being able to sleep at night due to screen time definitely isn’t a good thing.  Blue light decreases melatonin levels, which are responsible for your circadian rhythm, meaning that falling asleep can be harder.  In some cases much harder.  Given that just over 2/3 of the U.S. has trouble sleeping at least one night a week, it’s not unreasonable to think that there may be a correlation, especially as this is nearly an identical number to those in the U.S. with a smart phone.  Those sleep struggles can lead to obesity, heart disease, decreased libido, inhibited immune system, and even contribute to some types of cancer.

Yeah, but I’m not getting rid of my smart phone, so what can I do?  In an ideal world, stopping screen time for at least a few hours before bed is a good idea.  In a practical world, screen settings with warm light or blue light-filtering glasses/screen protectors may provide some benefit.  While some studies suggest these measures can help prevent some of the melatonin decrease associated with sleep disturbances, the data is mixed, so it’s unclear if these measures really make things better or just make us feel better about trying to do something.  The bottom line is that light is good during the day, and sleep is good at night 😊

Dr. Nick

Antibiotics are one of the great advances in medicine.  They have allowed us to treat infections and do surgeries like cesarean sections that would most likely have resulted in death from infection in the past. That being said, there are definitely times when antibiotics can be helpful, but there are also situations in which they aren’t.  To help explain the difference, here’s a quick overview.

First, what do Antibiotics treat?  Germs consist of bacteria and viruses.  Bacteria are living organisms that exist as single cells.  Bacteria are everywhere.  Some cause disease, some do not, and some are even beneficial like the ones that line your intestines and help with breakdown of food.  Viruses are not alive and invade our cells and use them to replicate.  Viruses are generally harmful.  Antibiotics only work against bacteria because they are living organisms.  They do not work against viruses. 

Antibiotics are great at treating bacterial infections that can cause pneumonia, ear infections, or sinus infections, and they can prevent infections during surgery.  However, if these infections are caused by viruses like the common cold or the flu, antibiotics will not help and are only likely to stir up all sorts of issues:

1. First, antibiotics can have lots of side effects!  The most common side effects of antibiotics include vomiting, nausea, diarrhea, bloating, and abdominal pain.  Notice how the most common symptoms are GI related.  The reason for this is there are lots of bacteria in your intestines- some are good and help with the breakdown of food and some are bad.  In the process of killing bad bacteria, antibiotics may inadvertently kill some good bacteria in the stomach as well, and this is what causes these side effects.  Other symptoms include hives (a scaly itchy rash), coughing, and wheezing.  In fact, some individuals even have trouble breathing (this is an emergency that requires an urgent visit to the ER). 
2. The overuse of antibiotics to treat things like the common cold have led to antibiotic resistance.  As bacteria get exposed to antibiotics, they find a way to thwart the effects of the antibiotics on their cells.  This is how they become superbugs.  They find ways to combat the effect of antibiotics and survive despite being bombarded by different types of antibiotics.  What many physicians are worried about is as more bacteria become resistant, we will run out of antibiotics to treat common bacterial infections because they will be resistant to all the antibiotics currently available. 
3. Another side effect of antibiotics is a common complaint from patients to their gynecologist- vaginal yeast infections.  Antibiotics cause yeast infections in the vagina for the same reason they cause GI side effects.  There are many good bacteria in the vagina. Antibiotics can kill off these beneficial bacteria and cause an overgrowth of yeast in the vagina causing a cottage cheese like discharge and severe itching.  Alternatively, they may also contribute to bacterial vaginosis. 
4. Using antibiotics can cause other infections like clostridium difficile (c. diff).  C. Diff is a bacterium that can cause symptoms that range from diarrhea to a life-threatening inflammation of the colon.  When you take antibiotics to treat an infection, it can destroy some of the normal, beneficial bacteria in the intestines and cause an overgrowth of c. diff. 

There are lots of other theories out there as well that frequent antibiotic use in childhood may be a precursor to chronic diseases like asthma and obesity.  While the evidence for this is limited, we should be very wary of taking antibiotics when not necessary.  The best way to prevent these issues is by being a good steward of our current available antibiotics. 

In closing, here are a few quick tips for making the most of your antibiotics.

1. Please take antibiotics if your doctor encourages you to take antibiotics for illnesses or procedures.  Only take antibiotics that were prescribed by your doctor for you, take them as directed and do not skip doses in an effort to save them for later.   This often kills only the weak bacterial cells while leaving the stronger ones, which can cause your symptoms to return with a vengeance AND be harder to treat.
2. Trust your doctor if they feel your symptoms are more consistent with a viral illness and that antibiotics are not necessary. 
3. Consider probiotics foods while on antibiotics to help regenerate the beneficial bacteria of the gut.  This may help decrease the GI side effects, vaginal yeast infections and other issues caused by antibiotics. 

Dr. Pam

Were your plans to shed the baby weight upended by the COVID-19 crisis? If so, don’t panic: Weight gain is a perfectly normal response to major stressors, and it doesn’t have to be permanent. There are plenty of safe, healthy ways to get your body back on track. We’ve put together some tips you can use to help you feel like yourself again.
 
Focus on Nutrition
 
Your first step should be taking an honest look at your diet. Your primary goal should be hitting all of your nutritional needs. Stress-eating is rarely healthy eating. More often than not, when we’re stressed out, we turn to high-fat, high-sugar foods that don’t really do much for our bodies other than satisfy a craving. When we’re hitting our nutritional goals, however, we’re less likely to feel those cravings in the first place.
 
Moreover, our bodies will be able to work at their best when we meet our nutritional needs. This makes us more energized, sharper, and less likely to get sick. If you’re not sure what your nutritional needs are, you can always hire a nutritionist. These pros will help you figure out exactly what your body needs, and they’ll help you come up with a diet plan that will enable you to reach your goals safely. Other freelance workers, such as professional trainers or yoga instructors, may be good resources as well.
 
Switching to healthier snacks, focusing on portion sizes, and making sure you have a nutritionally complete diet will make a massive difference. Ask your nutritionist to help you figure out some healthy recipes you can make with shelf-stable pantry items, so you have ideas when you’re between essential grocery trips.


Get Moving
 
With gyms closed, many of us have fallen off of our workout routines. Unfortunately, this doesn’t just mean you might gain a little more or lose some muscle. Exercise is vitally important for every aspect of health, from immune function to emotional well-being. When we stop working out, we’re more likely to experience the kinds of stress and anxiety that lead to overeating, leading to a vicious cycle.
 
Find ways to exercise either in your home or around your neighborhood. Going for a run, bike ride or hike is a great way to burn some calories while getting some safe, socially-distanced time outside of the house. You can also check out exercise videos on YouTube or virtual workout classes if you don’t have any good place to workout outside. Remember to listen to your body, and only workout after you’ve had the all-clear from your doctor. Postpartum bodies may take some time to get back to their pre-pregnancy fitness level, so go easy on yourself if you’re not quite where you want to be yet.
 
Seek Mental Health Care
 
The postpartum period is a difficult one emotionally. Mix a massive physical feat, huge life change, enormous hormone dump, and sleep deprivation together, and you have a potent cocktail for acute mental health issues. Throw a pandemic into the equation, and the odds of developing some level of emotional problems go even higher. Remember to keep an eye out for signs of postpartum depression and anxiety, which can crop up anytime within the year following childbirth.
 
Even if you don’t think you have anything diagnosable going on, it may still be worth it to reach out to a mental health professional. Telehealth sessions are a great way to get some of the anxiety you might be feeling about the current situation off your chest. Moreover, they can give you coping mechanisms you can use to get through the tough times without turning to emotional eating.
 
Living in a postpartum body is tough in the best of times. You don’t feel like yourself, your body doesn’t work the way it used to, and you’re stressed out all the time. Don’t put pressure on yourself to lose too much, or too quickly. Find a safe, healthy plan that you can commit to, and be gentle with yourself along the way. Your body has done something amazing - treat it well.
 
Photo Credit: Unsplash
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Guest blog courtesy of Elena Stewart

These are really stressful times.  Even for those of us in Bonneville County with so few Covid 19 cases and the majority of our hospitalized patients with Covid 19 being from out of state, this is really hard.  The stress of getting Covid 19, potentially giving it to an older family member with questionable health, and the financial stressors of having an economy in shutdown mode is very stressful.  Every day I get asked how to deal with the anxiety and the stress that this has caused.  The good news is the original projections have been wrong so far.  The fear of millions dying, the fear of having a health care system being overrun and not having enough beds and ventilators has not come to fruition.  The Lancet medical journal has now estimated the mortality rate to be about 0.6%, with the majority of deaths occurring in patients who are either elderly or who have underlying health issues, and this does not even take into account the huge number of asymptomatic carriers that already have it.  As testing improves and immunity testing (a test that would allow us to know if you have already been exposed to it) becomes more readily available, the mortality rate will likely decrease further.  So, we can all take a deep breath.  Here are some coping mechanisms that can be helpful to get us through this pandemic and economic shutdown.

1. Decrease screen time: Since a lot of us are now doing schoolwork or working from home, our screen time has already skyrocketed.  Unfortunately, increased screen time is associated with increased anxiety, weight gain, depression and insomnia.  Also, the media has stoked fear and anxiety about Covid 19 even further.  Turning off the constant barrage of projections and modeling may help decrease the anxiety related to this novel virus.  
2. Getting Outside: Spending time outside whether it be exercise (running, cycling, etc. especially as all the gyms are closed) or yardwork or other activities is really important because it helps expose the skin to sunlight maintaining healthy vitamin D levels, which in turn decreases the chance of seasonal depression and keeps us healthy.  Exercise also releases natural endorphins.  Endorphins have been shown in studies to be just as effective at combating depression as antidepression medication.  Exercise will also help combat weight gain that is bound to happen by being stuck indoors and feeling the pressure to eat your way through your coronavirus food stash before it expires (anyone know what to do with 2 dozen brown bananas?!)
3. Spring Cleaning and organizing can be therapeutic for some especially when you’re stuck indoors all day.  It will give us an opportunity to channel our inner Marie Kondo and have a fresh start when everything opens back up. 
4. Explore new hobbies.  Whether it be cooking or doing puzzles or sewing masks, exploring new hobbies will help deflect energy towards something positive. 
5. Take up meditation.  Even if you’ve never done it before, there are a number of easily accessible apps to guide you through the process.  Meditation can reduce anxiety and stress, lengthen attention, improve sleep and lower blood pressure while also providing a more positive outlook on life and even making you a kinder person.  That last benefit may prove extra beneficial when cooped up with someone who may be getting on your last nerve!
6. Read a book.  While for some, bad reality TV provides a temporary escape from daily stressors, reading can expand vocabulary and knowledge, improve memory, decrease depression and stress, and even improve sleep (especially with some boring nonfiction!).  In all seriousness, though, a book can be an oasis from the worries of your day without the baggage of screen time.

2020 has been challenging on a number of levels.  While it started off with a lot of promise, for many health concerns have gone from a more nebulous concern (I should probably get in for my pap soon) to a daily worry.  Add in some financial hardships as so many people have lost their jobs and top it off with confinement at home in close quarters with limited privacy and outlets for stress, and it’s easy to see how stress can become overwhelming.  Fortunately, these restrictions can’t go on forever, and eventually life will have to return to normal.  We hope that when it does, we can get back to supporting all of the local restaurants and other businesses that make this community special.  By then, we’ll all need a haircut 😉
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​Dr. Pam

​For many women, taking prenatal vitamins is a chore.  I often hear “Do I really have to take them?”  They’re too big to swallow, they make me sick, they make me constipated, I forget, and I don’t like to take pills are just a few of the reasons that some women give for not taking them.  It turns out, though, that prenatal vitamins actually play multiple important roles in having a health pregnancy, and unless you’re in a very small minority, it’s unlikely that you’re getting all of these nutrients from your diet alone.
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1.  Folic Acid – you want a prenatal with a minimum of 600 micrograms of folic acid although, depending on your medical history, you may need up to 2000 micrograms per day.  Folic acid helps prevent neural tube defects.  In case you were wondering, the neural tube is the part of the embryo that becomes the brain and spinal cord, so of all of the growing parts of your baby, this is definitely one of the most important.
2. DHA – this is an omega-3 fatty acid that helps with development of your baby’s brain and eyes.  You’ll want to shoot for 200 milligrams per day.
3. Iron – 27 milligrams of iron per day helps reduce your risk of anemia during pregnancy.  A low blood count decreases the amount of oxygen delivered to your baby, and since he/she can’t breathe on their own just yet, oxygen has to come from mom.  Additionally, anemia near the time of delivery lowers the reserve for mom and increases the chances that she may have to have a transfusion if she has more bleeding than expected during delivery.
4. Calcium and Vitamin D – 1,000 milligrams per day is important for a developing baby’s bone growth and muscular function, and it also helps prevent bone loss in mom as her baby grows within her.  Adding 600 IU of Vitamin D daily helps your body with the absorption of calcium.

So far, we’ve largely focused on benefits of prenatal vitamins for baby, but there are also several benefits for mom as well.  For instance, the folic acid in the prenatal vitamins can reduce risk of ovulatory infertility by up to 40%.  Also, for women who take prenatal vitamins for 3 months prior to conceiving, there is a reduced risk of hyperemesis gravidarum (severe nausea and vomiting in pregnancy).  Prenatal vitamins begun prior to conception are the most effective in reducing risk of birth defects anyway, so about 3 months before trying to conceive could be a perfect time to start taking them.

These are the reasons that prenatal vitamins are so useful in having a healthy pregnancy.  Whether you take regular ones, gummy ones, expensive ones or cheap ones, prenatal vitamins are important.  While they won’t fill in the shortcomings of an Oreo and Cheeto-based diet, they can increase your chance of conceiving, reduce risk of birth defects, and reduce the odds of severe nausea in pregnancy.  That’s why prenatal vitamins can be a win for mom and baby 😊
Dr. Nick