March 2021 OutreachNC by OutreachNC

MARCH 2021 - 1

Feature Intro: Carrying On: Strategies for Coping During COVID and Beyond

M A R C H 2 0 2 1

For anyone who has lived longer than a few hours, conflict and crisis are part of life. When we’re young, the conflict might be not playing with a toy a friend has, having to endure nap time per mother’s order or being forced to finish our peas before receiving dessert. As we age, the stakes get higher and the conflicts become, often, long term. There is job loss, death, illness, cross-country moves. Friendships wither and health fades. None of us escapes life without some sort of conflict, and how we deal with the crises in our lives is a key factor in how well these issues are resolved and how long they last. Coping skills are at the heart of conflict and crisis, whether we are aware we are using these skills or not. We cope during times of crisis in many ways. We have certain habits or skills we’ve learned to use from our childhood and others we’ve developed as adults. Some work better than others, but all coping skills are just that: skills. We can hone them, develop them and apply them strategically to best fit the situation and address the issues at hand. According to trusty Merriam-Webster, crisis is defined as “an unstable or crucial time or state of affairs in which a decisive change is impending, especially one with the distinct possibility of a highly undesirable outcome.” If we look at the current COVID-19 pandemic, the effects of living during a pandemic certainly fit the definition of crisis. These are unstable and crucial times. We are in a state of affairs in which decisive change is impending, and there is the distinct possibility of undesirable outcomes.

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CONTENTS

ASK THE EXPERT: CAREGIVER SUPPORT DURING COVID FEATURE: STRATEGIES FOR COPING DURING COVID AND BEYOND EAT RIGHT: MAKING DIET DECISIONS WELLNESS: PREVENTION IS THE BEST MEDICINE - COLON CANCER

LETTER FROM THE EDITOR

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

MARCH 2021 - 2 March is here, rain and all. On the soggiest of days, I remind myself this is the precursor to rampant wisteria, lovely gardens and longer days. I sit inside with cups of tea, the rain bleating at the windowpane, and make my to-do lists, hustle with work and eventually end the day with an indoor walking video and a quality short story. Life could certainly be worse. This month’s feature explores how we cope in times of crisis, much like my reminder of good things to come when the rain seems never ending. Fayetteville-area psychologist Rebecca Crain helps us dig into the issues we face during the COVID pandemic and how understanding, developing and using coping skills can help us get through and adapt during hard times. In Ask the Expert, Amy Natt offers suggestions for how to support caregivers, especially considering the restrictions of COVID. The USDA has released the latest Dietary Guidelines for Americans, and Callie Yakubisin helps us make sense of not only what the guidelines mean but how to create a balanced diet in our daily lives. March is National Colorectal Cancer Awareness Month. Dr. Ravikant Varanasi of Pinehurst Medical Clinic Gastroenterology shares tips and valuable insight into preventing colorectal cancer. As I think of all we face and must consider daily, from proper nutrition to colon health to losing a loved one to a pandemic, I am reminded of how easy it is to wish for simpler times. I turn to the words of Jean-Paul Sartre, who said,

There may be more beautiful times, but this one is ours. Let us embrace all that we face right now, endure and cope as best we can and find beauty in these moments and this time. It’s ours.

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ASK THE EXPERT: CAREGIVER SUPPORT DURING COVID

Amy Natt, MS, CMC, CSA | amyn@agingoutreachservices.com

MARCH 2021 - 3 My mom has been helping to care for my dad for the past 6 years. She has always done a great job. With the restrictions COVID has brought, she has been unable to attend her regular support group. He has also been in and out of the hospital a couple of times. We have offered to come for a visit to help her, but she has insisted that she can handle it. How can we continue to support her? This is a great question and common concern of many adult children who watch as their parents begin to navigate the challenges associated with aging. COVID and the restrictions, isolation and challenges it has presented, has increased loneliness and reduced the resources available when navigating care. Many support groups and in-person community groups have moved to a virtual platform. This changes the dynamic and many older adults shy away from this option. Your mom has probably been busy in her role of caregiver and may not be aware of some of the virtual groups now available and how to access them. You could certainly do the research for her and send an email outlining any options and the link to access them. Often, a spouse caring for a spouse has a wellorganized routine in place and a certain way of keeping things manageable. She has likely developed multiple coping mechanisms as a caregiver. While I am sure she would love to see you, this may be her way of maintaining control of the situation in difficult times. We often shrink our world when a crisis occurs, so it feels more manageable to us. Just knowing you are willing to come is a way to support her. Perhaps you can provide her with some dates in the future and ask if she would like for you to plan a visit and allow her to take a break for a day or two. I like providing this information in an email or handwritten note, so it does not take over every verbal conversation you have with her.

Keep an eye on her stress level. Caregiver stress and burnout is a very real thing. Caregivers often ignore their own health/needs when caring for a loved one. One option may be a routine caregiver coming into the home, to provide a break each week. Sometimes hiring a professional is a good entry point to putting additional support in place. This would allow her to have an ongoing day each week so she could run errands or just have time to focus on herself. It would be consistent, and she would not feel that she was disrupting your routine or inconveniencing friends or family in any way. If you just want to make sure she knows you are thinking of her and support her, there are also little things you can do. • Send an encouraging note, letting her know what a great job she is doing and that you appreciate her dedication to your dad. • Have a meal or nice treat delivered to the house. • Continue to call her on a routine schedule and just check in and be available to listen. You don’t need to have all the answers, just be a good sounding board. • Keep a sense of humor and find ways to make her smile and laugh. • Share resources with her that might help your mom in her role as caregiver. There are some excellent books and, as communities reopen, small groups she can connect with. • Ask her what she would see as helpful. She may have a specific task in mind. Continue to offer your support both in person and from afar. When the opportunity is presented or a crisis hits, be prepared to follow through on that offer. Your mom is probably doing her best to get through each day. Just be patient with her and acknowledge the amazing job she is doing. It’s often a thankless job, so be her biggest cheerleader.

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continued from page 1 The COVID-19 pandemic is just the time to not only practice and sharpen our coping skills but a time when building them up will help us come through the other side stronger, wiser and more hopeful than ever. Fayetteville-area psychologist Rebecca Crain works in therapy to develop and strengthen coping skills for those hit hard by the COVID-19 pandemic. Crain’s clients face much uncertainty during this time. Grief and loss are huge themes she sees clients struggling with. Some clients, for example, are having a hard time receiving an autopsy of a loved one due to hospitals prioritizing COVID cases, which is understandable but still frustrating for the families of loved ones who are ill or pass away from non-COVID-related illness. Other clients struggle when loved ones pass away quickly or suddenly, and there is no time to say goodbye. Pandemic-related restrictions make grieving especially difficult in these circumstances. Still other clients may have time to say goodbye or spend final days or weeks with loved ones, but due to these restrictions, they are unable to see a loved one in his or her last days. This is challenging for both the family member who is sick and the family members who must remain at a distance. Finally, Crain’s clients experience the stress and fatigue of losing multiple loved ones, some due to natural causes and others due to COVID-related illness.

CARRYING ON:

Strategies for Coping During COVID and Beyond by Amy Phariss

Crain helps clients develop the skills necessary to address the crisis not only in the moment but also in the future, when emotions may change, and grief still lingers. These coping skills will be useful during the pandemic but also throughout life, when other crises show up unannounced. Even if we do not face the grief of losing a loved one due to a pandemic, coping is instrumental when going through any crisis or simply dealing with day-to-day stress.

It is best to learn and practice coping methods with everyday stressors so that in times of increased stress, we can use these skills and trust that (even if it is scary) we can overcome the obstacle. So, how do we cope during times of conflict so that we can best endure the crisis at hand and avoid or mitigate harm? What do we do to relieve stress, enhance feelings of control and deal with painful emotions?

MARCH 2021 - 5 How do we get through? Coping skills are broken down into three categories. The first type of coping skill is problem-focused coping which usually involves taking some sort of direct action to solve a problem. If, for example, you test positive for COVID, you can cope by asking the doctor for the best medicine to help healing, purchase food and necessary items for a 2-week quarantine, call friends to set up meal deliveries and download the app for Door Dash immediately. (I might know a thing or two about the Door Dash app after enduring COVID and isolating with a teenage boy.) The second type of coping is emotion-focused coping, which is often used when situations cannot be changed. COVID is a great example of a situation in which we might use emotion-focused coping. There is much about this pandemic that cannot be changed or controlled. We cannot control when quarantine and social distancing mandates will end. We cannot control how the disease is spread or whether or not we get it. We cannot control what others do (to wear a mask, not to wear a mask…to meet for Christmas dinner or not?). There is so much about a pandemic that is beyond our control, which is when emotionfocused coping becomes incredibly helpful. Acceptance & Commitment Therapy (ACT) is a great tool for helping deal with the thoughts that come with stressful, uncontrollable situations, like COVID. By addressing our thoughts, our internal reactions and how we process the situation, ACT can help us move from feeling angry and frustrated to feeling resigned or accepting of what is happening (even if we’re not happy about it). Acceptance is a difficult but healing and soothing emotion.

When we can move toward acceptance, we can divert our precious energy toward what we can actually change or control rather than wasting our resources on those things we cannot control. Finally, the third form of coping is avoidance-focused coping, which sounds as if it might be negative but can actually be a positive coping skill. Depending on the situation and how avoidance is achieved, avoidance-focused coping can help relieve negative feelings and responses to situations that, again, may not be changeable in the moment. Avoidance can be as simple as saying: I can’t change my need to isolate due to exposure, so I’ll watch some Netflix for a few days and get through.

COPING IN ACTION Dr. Crain offers examples of effective adaptive coping skills, which include problemfocused coping and emotion-focused coping. Examples of Problem-Focused Coping related to COVID Anxiety: If you have fears about getting sick: Stock up on Mucinex, Theraflu tea, Emergency-C, vitamin C, and other helpful medications or vitamins. Get an air humidifier for respiratory care. And get the vaccine if you qualify. If you suspect you are sick or have been around someone who tested positive: Track your symptoms in a journal, get a COVID test (there are many drive-thru options available and you can schedule online), and communicate with your employer and family to formulate a plan to protect yourself and others. If you have received a positive test and are ill: Do all of the things above, and consult your doctor depending on the severity of your symptoms. Also, practice good self-care, communicate with others in your life to stay away or rearrange time off work, and educate yourself about the illness but be careful not to fall down a rabbit hole of Googling innocuous symptoms. *It is important to note that the problem-focused method works best when a person assessed the stressor as surmountable. Sometimes, anxiety gets the best of us and we might need to strategize with a trusted person to feel more confident in the problem-solving strategy. If you have overwhelming, uncontrollable, and intrusive worry, you may want to consider seeking the support of a therapist or medical professional.

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Examples of Emotion-Focused Coping related to COVID Anxiety: If you have fears about getting sick: Remind yourself of the efforts you are taking to reduce risk and exercise caution, wearing your mask, only going out when you must, washing your hands frequently, working remotely. Recognize that you are doing all you can with the information and resources you have at your disposal. If you’ve literally done everything you can do, worrying is unhelpful and a waste of time. Implement relaxation techniques like guided imagery or progressive muscle relaxation. I love the Insight phone app. There’s a free version too. Filter what you give your attention to. If you are obsessing about worsening COVID statistics, stop watching the news. Use an internet browser on your phone like Brave that does not automatically bring up news when you do a general internet search. Having a friend date over Zoom by ordering in a meal to share with your friends, even send a meal to your friend’s house and eat and chat over Zoom. You can even watch a movie together over Zoom. If you suspect you are sick or have been around someone who tested positive: Recognize what is within your power, and act on that. Let go of the pieces that you do not have control of. If you have received a positive test and are ill: Focus on comforting yourself emotionally and physically. Take it easy, rest and recuperate in consultation with your primary care provider, as needed. Try not to be too hard on yourself. Trust that your body is working hard to heal you and that you are proactively addressing your symptoms. Remind yourself of other difficulties you’ve successfully navigated.

Avoidance-focused coping simply involves distractions or diversions, and some are obviously healthier than others. Having several cocktails is a common form of avoidance, sometimes helpful, sometimes not. Going for a walk is another form of avoidance and can be quite helpful when we’re struggling with feeling confined and restricted. Avoidance-focused coping helps us highlight an important point about coping skills: they’re neither good nor bad. Coping skills are simply effective or ineffective, to varying degrees. While one person may need to avoid the news or social media during a crisis (or pandemic), another person will find engaging in these mediums helpful. Avoiding disturbing information or media can be an excellent coping skill for someone who finds this information anxiety-inducing or simply overwhelming. For others, collecting data and feeling informed is a problem-focused coping skill involving taking action (researching wellness tips, keeping abreast of the latest information and understanding public policy related to the pandemic). Each person’s response will vary, and the coping skills we need to work through a crisis will be equally unique and personal. There is a lot of loss and grieving right now for many people. There is loss of time, control, knowledge, understanding and connection.

The point isn’t to find the perfect set of coping options but to work through the best options for you, your family and your situation. Depending on cultural factors, faith, financial security, health and more, your coping skills and options might look different than a neighbor’s, friend’s or even a spouse’s or child’s. This is the beauty of how we all approach life, deal with the ups and downs of living and endure what can sometimes be very difficult times. Having compassion and understanding for ourselves as well as others is important in supporting all of our health and wellbeing.

MARCH 2021 - 7

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Adaptive Based Umbrella (Active)

Passive / Distraction Based

Emotion Focused Strategies

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EAT RIGHT: MAKING DIET DECISIONS

MARCH 2021 - 8 As I was reading the newly revised Dietary Guidelines for Americans, which were released in December 2020, I was reminded that the coronavirus isn’t the only public health crisis Americans are working to overcome. First released in 1980, The Dietary Guidelines for Americans, which are published by the United States Departments of Agriculture and Health and Human Services, provide evidencebased guidance on what a healthy diet should look like. Although these guidelines are re-evaluated and re-written every five years, many Americans continue to miss the mark on meeting them, leading to growing rates of chronic diseases like diabetes, heart disease, and obesity. It is the job of health professionals like registered dietitians to help translate these guidelines for everyday Americans.

Guidelines note that the general US population is not consuming enough potassium, vitamin D, calcium, or fiber, putting them at risk for health concerns. When you take a closer look at Americans over the age of 60, research shows this age group is also under consuming vitamin B12 and protein.

Protein helps support muscle mass which begins to decline as we age and vitamin B12 plays a role in nerve function and the production of red blood cells among other things. Since many older adults are already eating enough meat, poultry, and eggs, the guidelines recommend increasing protein from other foods. Protein options like dairy foods—which provide potassium, calcium, vitamin B12, and vitamin D—along with pulses like beans and lentils— which provide fiber—are a smart choice because they are a source of those under-consumed nutrients.

Here are several key takeaways:

1. The same healthy meal can be enjoyed by all ages—grandchildren to grandparents— because most foods recommended for a healthy diet apply to all. But there are some special considerations that need to be made based on your age. The Dietary

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fruits and vegetables can all be healthy options. Choose no-sodium-added versions of vegetables

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MARCH 2021 - 9 and canned fruit in 100% fruit juice when possible. Incorporate these foods in meals you already like to eat. For example, if you love Mexican food opt for a homemade bean burrito bowl. Start with a whole grain like brown rice or quinoa, load it up with your favorite vegetables, some avocado for healthy fat, and then top it with plain non-fat Greek yogurt or reduced-fat cheese.

3. When making food choices be sure to check out the nutrition facts label, paying close attention to added sugars, saturated fats, and sodium. A food that contains more than twenty percent of the daily value of any of these three items is a high source. Also, remember that foods not made at home tend to be higher in both saturated fat and sodium along with calories. The good news is many restaurants now have nutrition information on their menu or the internet to help guide you. When nutrition

information is not available, remember the basics of balanced nutrition: aim for a quarter of your plate to be lean protein like chicken, beans or fish, a quarter as grains with whole grains like brown rice and oatmeal preferred, and half to be fruits and vegetables. Dairy foods, like a cup

of milk with your meal, should be incorporated as well with most of them being low-fat or fat-free.

You don’t have to follow a rigid playbook to eat healthfully and prevent chronic disease. The dietary guidelines recognize that people need to make their own plays to win the game, and a healthy diet is going to look different for everyone. If you have not made healthy eating a priority in the past, small changes to what you eat are an opportunity to have a positive impact on your health. Visit myplate.gov for easy-to-follow guidance on healthy eating, or work with a Registered Dietitian if you need more support in understanding how to tailor your own personal diet and preferences to meet the Dietary Guidelines.

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WELLNESS: PREVENTION IS THE BEST MEDICINE

Ravikant Varanasi, MD, AGAF | Pinehurst Medical Clinic Gastroenterology

MARCH 2021 - 12 If you had about a 5% chance of developing a potentially fatal disease, wouldn’t you want to do something about it? Colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer-related death in the United States, with over 50,000 people losing their lives annually. Though screening could prevent approximately 60% of these deaths, about one out of every three Americans is not up to date with colon cancer screening. All too often, we hear the news of someone famous being diagnosed with colon cancer. President Ronald Reagan and baseball great Darry Strawberry both survived colon cancer. But many celebrities, including cartoonist Charles M. Schulz and actress Elizabeth Montgomery, have succumbed to the disease. Last year, we were saddened to hear that Chadwick Boseman, a young, talented actor with so much promise, lost his battle with colon cancer. Over the last several years, celebrities like Katie Couric and Will Smith have advocated for colon cancer screening and the importance of screening colonoscopy. Multitarget stool DNA testing is also more common, and it is now unusual to watch television without seeing a commercial featuring a talking Cologuard® box with arms and legs sitting on a toilet. But even with the increased awareness, many people would rather avoid the subject of colon cancer prevention. Since 2000, March has been designated as National Colorectal Cancer Awareness Month, which means there is no better time to talk about

the importance of colon cancer screening. The good news is that colon cancer can be prevented. Most colon cancers begin as polyps, small growths on the inside surface of the colon. Polyps come in different shapes and sizes, and they have different microscopic characteristics. Certain polyps, such as adenomas and serrated polyps, have the potential to turn into cancer over several years. The growth of polyps and transformation into cancer is often silent, as colon polyps seldom cause any symptoms. So even though a person may feel well and apparently be in good health, a colon polyp could be growing and surreptitiously transforming into a life-threatening malignancy. Fortunately, getting screened can significantly reduce your risk of getting colon cancer. Because it usually takes several years for a polyp to turn into cancer, colonoscopy with polypectomy (polyp removal) can effectively prevent the disease. Additionally, timely diagnosis of colon cancer is essential, as treatment of early-stage colon cancer offers a greater than 90% chance of survival five years after the diagnosis. No one will argue that getting a colonoscopy is enjoyable or exhilarating, and the doctor’s office is everyone’s least favorite place to visit. But after the twenty-minute exam is over, most people marvel about how easy the procedure was and how they should have never worried about it in the first place. The day before the procedure, a clear liquid diet is consumed, culminating with drinking a laxative the evening before and morning of the examination. While this is usually the most disagreeable part of the process, it is also the most important. The cleaner your bowel preparation is, the better your colon examination will be. There are several

different bowel preparations available and you can discuss the options with your doctor. Do not allow fear or dread of the cleansing process increase your risk of dying from a preventable disease. Since the procedure is done while you are sedated, the exam itself is painless and basically feels like a short nap. In addition to the cleanliness of your colon, another critically important factor that determines the quality of your colon examination is your doctor. All doctors who perform colonoscopy should be aware of their ADR, or adenoma detection rate. This doctor’s “report card” is the rate at which one or more precancerous polyps are found during a screening colonoscopy in patients 50 years and older. Current standards suggest a minimum ADR of 30% for male patients and 20% for female patients, but you can expect higher rates from your doctor. Don’t be afraid to ask your doctor what his or her ADR is. Wouldn’t you want your house inspected by someone who is likely to find a preventable problem, so you don’t have to make costly repairs later? Your colon health should be no different. Studies have shown that for every 1% increase in a physician’s ADR, the risk of colon cancer decreases by 3% for the patient over the next year. If you are going through the process of getting a screening

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MARCH 2021 - 13 colonoscopy, it is imperative that the exam be done well. The American Cancer Society recommends that all individuals age 45 and older get screened for colon cancer. You might need a screening exam at a younger age if you have a family history of colon polyps or cancer, a personal history of inflammatory bowel disease, or other medical conditions. Your personal medical and family history will determine when and which type of colon cancer screening test is best for you. A screening tests for colon cancer are covered by insurance. There are many resourceful websites where you can get additional information, including the American Cancer Society (www.cancer.org) and the American Society for Gastrointestinal Endoscopy colorectal cancer awareness website (www.screen4coloncancer.org). If you have not done so already, talk to your doctor about getting screened for colorectal cancer. A screening colonoscopy is an easy, safe, and proven way of reducing your chance of dying from a common but preventable disease. Having a colonoscopy will give you peace of mind. And it may just save your life. .

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