Health Matters Observer
JUNE 2020
Finding
calm chaos in the
In times of uncertainty, scheduling self-care into your life is the first step to managing your mental health. PAGE 2
VIRTUAL MEDICINE
PICTURE OF HEALTH
DISASTER LEFTOVERS
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What you need to know on telehealth.
Discover reinvigoration in fun exercise.
How to use the stack of cans in your cupboard.
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JUNE 2020
Fear of unknown amplifies anxiety Lakewood Ranch psychiatrist shares tips to lessen anxiety amid COVID-19 pandemic and other stressful situations. LIZ RAMOS STAFF WRITER
Liz Ramos
Dr. Tariq Halim, a psychiatrist in Lakewood Ranch, encourages people to make a daily schedule to help lessen their anxiety over the unknown.
Everyone’s lives have changed over the past three months because of COVID-19. Florida shut down for a month, which forced businesses, restaurants, bars, hair and nail salons, and more to close their doors. Health and safety guidelines were put in place, which has caused people to follow the tape marked 6 feet apart as they stand in line at a grocery store or to wear a mask while in public. Now the state is slowly reopening, and everyone is adjusting to a new normal, but questions remain. Should a mask be worn? Is it safe to enjoy a meal outside at a restaurant? Will children be back in a classroom come fall? When will life go back to normal? With all the uncertainty comes an increase in anxiety for many. Isolation and fear of the unknown with COVID-19 has made some underlying issues, such as depression and anxiety, come to the surface.
PERSONALITY DIFFERENCES For people who consider themselves introverted, the stay-athome order might have been a relief, but for extroverts, social distancing and quarantine provide their own challenges. Introverts are happy to social distance and keep away from others, which made the stay-at-home order easier for them. “They’ve easily made it their normal to not go out and do things, and now it’s actually acceptable to not do those things,” Halim said. “For them, anxiety is decreased.” Extroverts, on the other hand, have not had as easy of a time adjusting to the new normal. As a result, extroverts are being forced to find other ways to socialize, such as by videoconferencing.
“Humans are built to be social creatures,” said Dr. Tariq Halim, a psychiatrist in Lakewood Ranch. “Staying indoors and locking yourself up from the rest of the world will make some more apprehensive, anxious and depressed.” According to a study by the International Journal of Mental Health and Addiction, the fear that pandemic viral infections
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“Start making a routine because there’s no such thing as normal right now, but you do your best to get to that point for yourself.” — Dr. Tariq Halim, a psychiatrist in Lakewood Ranch
can spread across large portions of populations could cause heightened anxiety. “Fear is a negative emotion symptomized by extreme levels of emotive avoidance in relation to specific stimuli,” the study states. “It is associated with clinical phobias and social anxiety disorder, and as such the potential for widespread public fear caused by pandemic viral infections could lead to significant levels of mental distress at the population level.” Halim said mainstream media has also played a role in amplifying fear among people because many media outlets tend to report “extreme cases,” but learning about COVID-19 from various sources will help ease anxiety. People with obsessive compulsive disorder symptoms based on cleanliness and organization could see themselves cleaning
more and doing more to stay organized because of their worries of public transmission, Halim said. For anyone experiencing anxiety or depression as a result of COVID-19, Halim’s most pertinent advice is to make a schedule and plan activities, a form of cognitive behavioral therapy. Using a planner relieves your mind from anxiety because it allows you to let things leave your brain to concentrate instead on more important things and to have better focus, which also helps you sleep better at night. Writing your thoughts down can help you focus on solutions, as well, instead of on the problems. “Start making a routine because there’s no such thing as normal right now, but you do your best to get to that point for yourself,” he said. “You have to have a mindset to make this our new normal, at
least for the time being. You have to understand and appreciate the fact that although we have to take these precautions, it doesn’t mean you stop doing everything you need to do.” Many people are working from home, a deviation from their routines. This change could cause people to work more and could even result in loss of sleep. Halim said people need to take necessary breaks to force themselves to step away from the computer and phone and to maybe take a short walk or do yoga. Halim suggests using the Pomodoro Technique, a timemanagement method in which work is broken down into intervals separated by short breaks. Although people are wondering whether it’s safe to venture outside and start returning back to normal, taking a first step is important even if it means wearing a mask or abiding by social distancing guidelines. “They don’t need to make it more complicated than it is, and once we understand that it is what we have to do, you don’t think about it as much as when you take it to the extreme and not see your family members,” Halim said.
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POMODORO TECHNIQUE
The Pomodoro Technique is a time-management strategy to help people be more productive by scheduling breaks into a work schedule. It was created in the late 1980s by Francesco Cirillo and named after the tomato-shaped (“pomodoro” is Italian for tomato) kitchen timer he used in college. The technique helps with managing distractions, eliminating burnout, creating a better work and life balance, and not working against time. The original technique has six steps: 1. Choose a task to complete. It could be a big project, work to study or something you have been procrastinating on. 2. Set a timer for 25 minutes. 3. Work without interruptions until the timer goes off. If during that time you think of something else important to do, write that task down, and return to your work. 4. When the timer rings, pause, and mark where you stopped. 5. Take a break for three to five minutes. Go for a brief walk, grab some coffee, or take a deep breath — anything not work-related. You deserve it! Then return to step 2. 6. Every fourth pomodoro (interval of work time), take a longer break of 20 to 30 minutes. Your brain uses this time to fully understand the new information and to rest before you begin again. Continue the process until your work is done. If you finish the task in the middle of a pomodoro, Cirillo suggests using the remaining time to review your work or to overlearn. The Pomodoro Technique has a few variations to best suit personal working style — working in 90-minute pomodoros to reflect a natural concentration cycle or working in natural time periods, such as in between meetings or until the dishwasher finishes — but you can also come up with your own twists to ensure your highest productivity.
Is There A Doctor In The House?
Yes, yours. As our community comes together to fight this pandemic, that also means keeping our distance. But at Sarasota Memorial’s First Physicians Group, we know that sometimes consulting a doctor just can’t wait. Thanks to our new Telehealth Program, patients can see their physicians from the safety and comfort of their own homes. Through online video calls made from a computer or smartphone, patients and physicians can enjoy the privacy and security of an in-person appointment without sacrificing social distancing or quality of care. Our FPG offices are excited to include this offering and standing by to accommodate you throughout this time. Call your physician’s office today and ask about Telehealth opportunities. And if you prefer to see your doctor in-person, know that our offices are still open and ready to receive you. As always, we’re happy to help.
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Hart said chronic stress can lead to physical or emotional disease, such as blood pressure, diabetes or even cancer. Additionally, trauma, like the COVID-19 pandemic, can “lock” your amygdala into stress mode. That makes it particularly important to engage in self-care, allow time to refocus and help the body move into a more relaxed state. Hart and Sarasota psychologist Denise Schonwald share their insights on self-care. MIND YOUR MOMENTS
Courtesy photo
Stress management educator Trish Hart practices yoga as a form of self-care. She says nutrition, physical activity, sleep and social interaction are all critical components of self-care.
Mindfully in the moment Health professionals explain importance of creating life balance. PAM EUBANKS SENIOR EDITOR
Y
ou hear people say it’s important to take care of yourself. Trish Hart, a stress management educator trained through Duke Integrative Medicine and Massachusetts General Hospital, has the science to prove it’s important.
Hart said the body’s stress response originates from an almond-sized section in the middle of the brain called the amygdala, which scours the environment around you looking for situations that are unsafe. It can trigger a sense of fear. Then your body reacts in one of four ways: fight, flight, freeze or faint. The amygdala communicates that stress down the body’s “wan-
dering” nerve, the vagus nerve, to all the other organs. “Self-care calms the amygdala and expands the other part of the brain — that part of the brain known as your prefrontal cortex,” Hart said. “You’re moving from the reacting part of your brain to the thinking part of your brain. It shuts off the stress response. We allow our bodies to reset [and] begin again.”
Be your best you!
“Anything we can do to take us out of our minds is great” Hart said. “Mindfulness is bringing attention to what is present in this moment. It brings the mind away from thoughts that might have happened in the past.” Hart recommends starting with simple breathing exercises or meditation to clear the mind; doing so helps create new neural pathways in the brain, which shift the brain’s stress response to a pause moment in which you can choose to react differently. FIND A PASSION
Schonwald said it’s important to find something you enjoy doing and then to do it. The action is what helps create a sense of balance for an individual. “It’s got to be something that brings them a lot of joy,” she said. “[Being with] animals can do that. It could be creating art.” KEEP MOVING
Both Hart and Schonwald said exercise is an important part to maintaining good mental heath. You should aim to exercise for at least 20 minutes a day. Both recommend yoga to keep muscles strong and flexible.
Hart also said that if you’re confined to a desk, make sure to get up and move at least every 90 minutes. EAT RIGHT CONSISTENTLY
Hart said it is important to eat every three to four hours to ensure your blood sugar levels stay balanced. This helps steady your mood. She recommends eating as many plant-based foods as possible and to be mindful to limit stimulating foods, such as coffee and chocolate. Schonwald said that when you feel stress, you want to eat sugars and carbohydrates, but those foods actually feed your sense of anxiety. Instead, find something else to focus on until the urge to stress-eat goes away. “The body wants to get rid of energy,” she said. “Take a walk to process it.” PRIORITIZE SLEEP
Hart said individuals should strive for seven to eight hours of sleep daily and try to have a routine at bedtime. Try to have a set wake-up time and a set bedtime each day, and make sure to give yourself time to relax. “Give yourself 30 minutes to an hour to wind down,” Hart said. “Shut off the technology. Take a bath. Read. We need to work with the natural sleep drives of your body.” MAKE SELF-CARE A ROUTINE
If you’re having trouble finding time for self-care, consider doing as Hart does. “I make an appointment with myself on my calendar,” Hart said. “I put Time for Trish. It gets me moving into something I enjoy for self-care.”
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The need-to-know on telehealth Have questions about virtual medicine? We have you covered. HARRY SAYER STAFF WRITER
T
here have been numerous ways medicine has been practiced through the centuries. One of the first major approaches was home visits, where the town doctor would make personal visits to people with various ailments. Then came the reverse, when patients traveled to centralized hospitals and doctors. It has been that way for some time, but a new approach is gaining prominence. Telehealth — where a health care provider and patients communicate virtually — has been an option for years but has seen a surge in popularity of late. It’s partly necessity. The ongoing pandemic caused health providers to encourage as little contact as possible with contagious patients. But some medial professionals believe it’s here to stay. “I think it was inevitable that we’re going to get to this point sooner rather than later,” said Michael Schandorf-Lartey, the chief medical officer at Doctors Hospital of Sarasota. “Obviously, the COVID-19 crisis basically created the existing situation. … [Telehealth] is not going to come down because it was headed there anyway.”
Photos by Harry Sayer
Angeleah Halaby, stroke coordinator for Doctors Hospital of Sarasota, outlines how the technology is used.
How does it work? Health professionals use video telecommunication systems to treat patients remotely. This often involves video to get a better idea of what ails the patient. It can be done through cellphones, computers and other technology. What are the benefits? Telehealth allows health centers to connect with emergency physicians and specialists to treat patients they wouldn’t be able to see otherwise. It also helps streamline and speed up patient care, which can be critical in timesensitive situations like a stroke. “If it’s an emergency, [and] you
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don’t get here quick enough, we can’t give you the treatment that you need,” said Angeleah Halaby, stroke and sepsis coordinator for Doctors Hospital of Sarasota. A timely response from a health specialist working remotely can save time, which is valuable if the person’s brain is in danger. Telehealth can also be seen in psychiatric treatment and with patients in the intensive care unit. It’s particularly useful determine whether a patient needs temporary detainment at a treatment facility due to mental illness. “You have this system where as soon as the patient comes in the emergency room, or even before
Doctors Hospital of Sarasota Chief Medical Officer Michael SchandorfLartey contacts patients remotely through video technology
they come, you’re activating the protocol,” Schandorf-Lartey said. “So it’s very timely attention to the patient’s needs and saves a lot of unnecessary Baker Acts.” In addition to emergencies, telehealth is commonly used for minor urgent care, such as seeing if a cut or bruise is serious or needing treatment for such ailments as pink eye or fever. It is also helpful for needing medication while you’re out on vacation. Seasonal residents can rely on it to connect with a doctor no matter what home they’re in, rather than having a doctor in both locations. Is it difficult to understand? Most new technology takes a second to make sense, and fam-
ily practice Dr. Meghan Buhler with First Physicians Group has recently implemented telehealth into treating her patients, many of whom are in their elder years. She says they’ve picked it up quickly. “[My patients wanted] access to us as a provider but didn’t want to be near anyone,” Buhler said. “It’s been an adjustment, but everyone has been pleased with the outcome. My patients like being able to physically see me, and I like seeing them where we have that connection. … Even our patients who are older and might have had a negative thought about technology are surprisingly good at it.” What are its drawbacks? The advantages of telehealth with its greater accessibility and efficiency are clear. The drawbacks, though, are harder to define. Schandorf-Lartey worries the transition to a digital approach will take something away — the human element of medicine. “There’s something to be said about sitting across someone and having them look into your face, talk to you about what’s going on,” he said. “I think the downside is that we’re going to lose something — that commonality, that feeling like we’re all the same beings that are connecting on a certain type of level. “But I guess with any progressive system, there are always positives and negatives, and this may be one of the negatives that we’ll have to negotiate or navigate our way around.”
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JUNE 2020
ABOUT EMILY
Age: 77 Occupation: Retired Residence: Sarasota Favorite hobby: Taking bagpipe lessons Best advice: Do things that are fun.
Ryan Kohn
Emily Snuttjer, 77, is a new convert to rowing.
Finding fun in exercise The Sarasota rower feels brand new at 77 thanks to her daily trek on the water.
RYAN KOHN SPORTS REPORTER
A 4:30 a.m. wake-up call is not usual, nor unwelcome, for Emily Snuttjer. It simply means it is time to row. Snuttjer, 77, rows with Sarasota County Rowing Club every day the weather cooperates, including weekends. She will be on the water for about an hour,
sometimes more, rowing 4-5 kilometers down and back. Then Snuttjer, who is retired, will head home, where she eats her favorite breakfast: beets, blueberries, bananas and oats, with some ground flax seed mixed in for added health benefits. It might sound like the routine of a rowing veteran, but in actuality, Snuttjer has only been rowing since 2017. She was born
in Mobile, Ala., but she moved to the area from Anniston, Ala. Snuttjer said she grew up around the water, with her family going to Mobile Bay to water ski and fish — all things, she joked, she could do stationary. Snuttjer said when she arrived in Sarasota and saw how close she was to the water, she knew she had to find a way to take advantage. When she heard about SCRC’s Learn to Row classes, she decided to try it. She has not looked back since. “I am the most sedentary person in the world,” Snuttjer said. “If something is not fun for me to do, I am not going to do it. Rowing is fun on so many levels. It’s wonderful. It has gotten me on the water again.” She said the feeling she gets from rowing is not unlike that provided by tai chi — an “internal massage.” Snuttjer said she believes people get scared of trying the sport because they hear how grueling it can be at the upper levels of racing. At the lower levels, Snuttjer said, it is easy, almost relaxing. Getting on the water has done more for Snuttjer than provide an outlet for fun. It has also helped her become more social. Snuttjer lives in a 55-and-up community, she said, and rowing is full of younger people.
“I don’t think many people my age know many younger people,” Snuttjer said. “It’s exciting. They are high-energy people. Being around that energy, it keeps you going. We have fun. We do some off-water activities as well as the rowing.” Snuttjer said her newfound love of rowing inspired her to remain active. For the past year, she has been working with a personal trainer three times a week. She eats well — exemplified by her breakfast — and tries to ingest as many high-nitrate foods as she can. “They are performance enhancers, and I need all the performance enhancers I can get,” Snuttjer said, laughing. Rowing helps Snuttjer expand her lung capacity, but she has also been giving her lungs a workout a different way: playing the bagpipes. She met a bagpipes instructor through rowing and has now been taking lessons for about two years. Snuttjer said that the lung capacity required for rowing is nothing compared to bagpipes, and as a result she is still in the learning stages — though she is not opposed to playing gigs once she gets good enough. All of these experiences are what Snuttjer means when she says her enjoyment of rowing has levels. The sport is fun, of course, but everything surrounding it has reinvigorated her as well. “It’s the best-kept secret in the world,” Snuttjer said. “I started rowing at 75. If I can learn it, anyone can learn it.” If nothing else convinces people to row, Snuttjer said, maybe this will: It’s another activity you can do sitting down.
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Rethink your emergency stash of canned goods
STAFF WRITER
Nat Kaemmerer
Chili is a great opportunity to use up a variety of leftovers.
By Freya Robbins, CDFA™
It brings a giggle to my lips and my mind when I see a young person post this as their Facebook status. Yet, relationships are complicated, aren’t they?
n 1 can garbanzo beans, rinsed
and drained n 1 can black beans, rinsed and drained n 1/2 can cannellini beans, rinsed and drained n 1/2 can pinto beans, rinsed and drained n 1 can corn, rinsed and drained n 1 can crushed tomatoes n 2 tablespoons tomato paste n Cumin, to taste n Salt and pepper, to taste n Medium onion, diced n Cooking oil n 3 tablespoons chili powder n 2 tablespoons sugar n Cayenne pepper (optional) n 1 pound ground beef or turkey (optional)
From my perspective, both personally and professionally, creating and keeping a healthy intimate relationship with your partner might be the most difficult relationship challenge ever. Let’s face it, we have been through a storm of changes lately, from COVID-19, to children being schooled at home, to us working from home, being socially distanced from friends and family and financial challenges to boot!
Directions: Heat oil in a large saucepan over medium heat. Add diced onion, and cook until translucent. Add optional ground meat, break apart with a wooden spoon, and cook until browned, about seven minutes. Add salt, pepper, cumin, chili powder, sugar, optional cayenne and tomato paste. Stir to combine. Add tomatoes, with or without their juice. If not using juice, add in 1 can of water, or more if you like a thinner chili. Add beans and corn. Stir to combine. Bring the pot to a low boil, then turn down to a simmer. Let it cook for at least 20-25 minutes. Make sure to stir occasionally. Let chili stand for five minutes before serving. Top with croutons, bread, cheese or crackers. You can also freeze your leftovers to save longer.
Stress wreaks havoc with us and if left untreated results in physical problems. When we are stressed our brain naturally responds using the flight or fight scenario. That works well if we are hunters and gathers and someone is chasing us. But this time it is just our spouse and they are not out to hurt us. They are just being them! Experiencing anxiety or concern about your relationship is normal but pretending like it is not there or that it will get better without some positive action is unrealistic. Isn’t that the definition of insanity? Doing the same thing over and over and expecting it to be different? Do not be afraid to address the anxiety and stress. You owe it to yourself and your relationship.
Relationships do not improve on their own, really! Maybe you need a check up from the neck up, or at least from the heart up, to see what is going on and what you can do to bring about positive change. Ask your spouse to go to marriage counseling together or see a counselor alone if you prefer. The reason I believe that stress causes physical ailments is that I know a little girl that was abused as a child. Her heart could not take what was happening to her. When she was a young adult, she was diagnosed with a type of cancer that was exceedingly rare. There is no history of this type of cancer in her family but there was history of abuse. Stress, trauma, and anxiety left untreated will result in bigger problems. If your relationship needs a stress reducer, take it seriously. I am an advocate of healthy relationships and long-term marriages. Some people wait too long to get help, to talk about their feelings. Things can be said and done that make it hard to get past. Divorce Mediation can help you end a broken marriage amicably. Marriage Mediation can help you look at your relationship honestly and determine whether it is important enough to continue to work together to preserve what you started. Zollinger Mediation is here with open arms to help you take your first steps.
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It would be difficult to look at canned recipes and not include chili. This dish can be made vegan, or a healthier swap can be made with ground turkey instead of ground beef. Here’s the ultimate “dump recipe.”
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RELATIONSHIP STATUS:
NAT KAEMMERER
CHILI
JUNE 2020
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Wondering how to make canned veggies healthy again? It’s easier than you think.
You’re not really a Floridian until you’ve gotten your first disaster prep under your belt. Most years, that means stocking up on water and food in case of hurricanes. This year, canned and frozen foods and toilet paper were swept off the shelves to stock up for the coronavirus pandemic. Now as life begins to open up again, what in the world will you do with all those cans? They can’t be healthy, right? Wrong. Mostly. “A canned green bean is better than no green bean,” local nutritionist Nora Clemens said. “The canning industry has really high standards for processing their foods, and that includes quickly putting them through the canning process, so that they’re processed at the peak of their freshness.” That means those carrots in a can probably retained more of their original nutrients than those carrots currently hanging on in your refrigerator drawer. You should strive to get your fruits and veggies in whatever way you can, so don’t waste cans if you think they’re less than fresh foods. Canned veggies often have salt added to them as part of the canning process, but Clemens said if you give them a good rinse, you’ll be able to get perfectly good produce. Same goes for fruits, which are often packed in a lot of sugar or syrup. “I want … to show people not to freak out and say: ‘Oh, I’m being such a bad parent. I’m buying canned vegetables and fruits,’” Clemens said. “No, they can do that and just rinse it, and it’s still good.”
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