In this episode, we introduce you to Tim and explain how his journey as a Novant Health patient began. Highlights include: 

• 3:11 - Tim relies on faith to see him through. 
• 4:34 - He's found strength watching his mother battle the same incurable disease. 
• 5:33 - Struggling with a loss of independence. 
• 6:28 - An admirable determination. 
• 8:00 - Tim's journey began with neck and back pain. How that led to a cancer diagnosis. 

We’ll also hear from oncologist Dr. Patricia Kropf and neurosurgeon Dr. John Berry-Candelario on Tim’s care and the approach they bring to all their patients at Novant Health. 

Helpful links:

Leave Tim a note of encouragement: Join the discussion at the end of this article.
Listen to the next episode.

Listen to Episode 1 of Beating Incurable.

In the second episode of Beating Incurable, we dive deeper into the pain he'd been experiencing and how a visit with a specialist led to a stunning cancer diagnosis. Highlights include: 

1:23 - How a fracture in Tim's neck led to a cancer diagnosis.
2:10 - Something he never saw coming. 

3:20 - Myeloma bone disease, a side effect of Tim's cancer, put him at risk of paralysis from the neck down. 
4:33 - Helping patients take on a life-changing diagnosis. 
7:05 - How doctors would treat Tim's multiple myeloma.
9:22 - Explaining how he came to be featured in this story.
10:09 - Tim's first revelation on how cancer has changed him. 

Helpful links:

Leave Tim a note of encouragement. Join the discussion at the end of this article.
Listen to the next episode here. 

In the third episode of Beating Incurable, Tim Cooper has a stem cell transplant, an advanced treatment that could help push his cancer into remission. Highlights include: 

 
2:28 - Previewing how a stem cell transplant works. 
4:01 - Being in remission with myeloma is not the same as being cured of myeloma.
4:43 - Stem cell collection day.
5:54 - Tim packs for his "two-week" vacation at Novant Health Presbyterian Medical Center in Charlotte.
6:52 - Day of transplant. His "new birthday."
9:55 - Tim shares a tough day in the hospital.
11:00 - Better days would follow...

Helpful links:
 
Leave Tim a note of encouragement: Join the discussion at this end of this article.
Listen to the next episode here.

In the fourth episode of Beating Incurable, Tim Cooper struggles with loneliness and another set back in his health care journey. He also learns the results of his stem cell transplant. Highlights include:

1:46 - Living with cancer can be lonely.
2:32 - Coping with cancer. Tim shares what has helped him. 
4:04 - Tim shares a milestone: He was cleared to drive!
5:36 - Making strides towards regaining his independence.
7:29 - The results of Tim's stem cell transplant.
8:01 - How Tim felt about the news.
9:09 - Tim's low mood was only made worse by another issue he'd been dealing with.
10:00 - How doctors would address his worsening leg pain.

Helpful links:

Leave Tim a note of encouragement: Join the discussion at this end of this article. 
The fifth and final episode will be available soon.

Learn how you can support pregnant people in your life to reduce factors that contribute to pregnancy-related complications and deaths. It's also important to know the urgent maternal warning signs and when to seek care. 

Dr. Charles Bregier  0:27  
It is the perfect storm that's potentially brewing up there. If COVID remains bad, and it's a bad flu season, it could completely overwhelm our healthcare system in our whole country. And we could potentially not have enough ventilators or not have enough respiratory machines and not have other vital equipment that we need to take care of huge amounts of patients.

Gina DiPietro  0:49  
That's Dr. Charles Bregier, Novant Health medical director of corporate health, and you're listening to Novant Health Healthy Headlines. I'm your host, Gina DiPietro. Tens of thousands of hospitalizations each year could be avoided if more people got the flu vaccine. And keeping flu patients out of the hospital is vitally important with the latest surge in COVID patients.

Dr. Charles Bregier  1:13  
You know, COVID is still really strong out there. And if you get COVID, and then you get the flu, it could really be a "twindemic" as we talked a little bit about last year ... in terms of causing much more severe illness having one disease after the other, and especially in a relatively close period of time. It takes your body a while to recover from an illness.

Gina DiPietro  1:36  
I was curious if someone could have flu and COVID at the same time.

Dr. Charles Bregier  1:40  
You certainly can. But it's relatively uncommon to have two different viruses at the same time.

Gina DiPietro  1:45  
The flu shot is recommended for anyone six months and older, with rare exceptions, A primary care physician can answer those questions or check out our latest cold and flu stories on Healthy Headlines. Here again is Dr. Bregier.

Dr. Charles Bregier  2:00  
There is a variable degree of effectiveness from the flu vaccine. In a good year, it's thought to be about 60% effective. In a bad year, it's thought to be about 40% effective. We don't know if it will be closer to 60 this coming flu season or 40. Time will tell. And it's really important, I think, just as much this year as it was last year to go ahead and get your flu shot. Get it soon. If you get it in October, that gives you pretty good protection all the way through April, which is usually the end of flu season. Because, you know, flu season can start anytime after October. Most typically it doesn't start until January, February, but we have had some years where it's been bad in November and bad in December.

Gina DiPietro  2:45  
Let's dive into that point he made about efficacy for just a moment. I've spent the past year and a half reading about COVID. And this fact has always stuck with me. While a vaccines' efficacy is important, what's equally as important (and in a lot of cases even moreso) is how many people get it. If a small number of people get a very effective vaccine, it's not going to make a dent in a community's disease progression. But if every single person got vaccinated, it would make a huge difference in disease burden. Bottom line: It's a community effort. That goes for flu and COVID. If you haven't been vaccinated for either, you can get both in one visit. I'll let Dr. Bregier explain.

Dr. Charles Bregier  3:28  
It's fine to get them both at the same time. They are both inactivated vaccines, which means there's no "live virus" in either one of them. Not in any of the COVID vaccines that are approved or in the flu vaccines that are approved. And yes, the CDC has said it is fine to get them both at the same time. And it's kind of efficient, isn't it? You can walk into your primary care doctor's office at Novant Health and get your COVID vaccine and your flu shot.

Gina DiPietro  3:56  
What would you say to a patient who said, 'Well, I got the flu vaccine so I don't need the COVID vaccine or vice versa?'

Dr. Charles Bregier  4:03  
That's a great question. The COVID illness is caused by SARS-CoV2, right? It's a coronavirus. The influenza vaccine, its components are different influenza strains. So, they are really different types of viruses.

Gina DiPietro  4:18  
I've heard that younger children may be even at a higher risk this flu season due to low immunity from either not having had any natural exposure or possibly not having been vaccinated in previous years. You know, schools sent kids home last year. Do you think that that is true?

Dr. Charles Bregier  4:36  
It certainly is a concern in the medical community for exactly the reason you said. People have been out less, they've been getting sick less. Almost everyone that I know has not had any significant illness, other than perhaps COVID, for a year or year and a half. Natural immunity from different viruses that caue upper respiratory infections is much lower. That may translate into a more severe flu season, especially for very young children.

Gina DiPietro  5:07  
Healthcare systems have been working to overcome this notion of vaccine hesitancy, right? There's so much misinformation out there. And that is part of the reason why some people have not chosen to get their COVID-19 vaccines. Do you worry this notion of vaccine hesitancy might spill over into flu shots, as well?

Dr. Charles Bregier  5:34  
I think that it definitely does. People are wise to question things and to look into situations and look into the research and see what the experts say. But unfortunately, there's so much misinformation on social media. And a lot of that is propagated by people who are making really untrue allegations ... saying the vaccine is not safe. Whether it's a COVID vaccine or a flu vaccine, and they are safe. I'm trying to steer people away from the negative connotations of vaccine hesitancy. And let's talk about vaccine confidence. Building vaccine confidence for flu vaccines and for COVID vaccines. And really, when you look at all the information out there at CDC that shows how tremendously safe COVID vaccines are, and how safe flu vaccines are, and how much they reduce, you know, the death rates among our at-risk populations throughout our communities - that's what we need to focus on.

Gina DiPietro  6:32  
Do you think that physicians also have opportunities to build "vaccine confidence,"as you said, as they interact with their patients?

Dr. Charles Bregier  6:39  
It's an obligation as well as a privilege to try to share that information. We've all seen what happens to people who can be severely stricken by a bad case of the flu. And we can share the fact that 'Yes, I myself am very confident in the safety of the flu vaccine.' I step up, I get my flu vaccine right around October 1st. I want to get protected as quickly as we can.

Gina DiPietro  7:04  
Is there anything else that we haven't touched on that you think is particularly important for people to know?

Dr. Charles Bregier  7:12  
One thing I like to stress is that, you know, we are in this for the long haul. I know that we all are tired of COVID. We've been living COVID for more than a year and a half now. And we're now in the midst of this fourth surge, which is on the way to becoming the worst surge we've had yet. And the vast majority of our people in our hospitals are unvaccinated. Similarly, we have to keep our guard up regarding flu. And you know, people think, 'Oh, I just need to protect myself against COVID.' But you need...

John Howard  0:45  
What we've seen in our mass vaccination sites is even with walking appointments is very low utilization relative to the cavernous space we have there. In the amount of inventory, we have a vaccine. In other words, the demand for the vaccine has dwindled, and it dwindled quickly. We really sort of hit a wall. And we recognize that in our communities for any number of reasons that vaccine hesitancy or vaccine reluctance was now the order of the day. Our transition to address that is to say, how do we work more closely with individual folks who are trying to overcome either questions or concerns, or maybe they've heard things that aren't exactly true about the efficacy or the safety of the vaccines. And we believe that the best place for that to take place is in a patient's medical home, our final pivot has been to move away from the vaccination sites, and now to be able to provide those vaccines and primary care clinics, Family Medicine clinics, internal medicine, clinics, and even our pediatric clinics for those who are eligible because it's not all kids yet, but it is adolescence, and to make sure that patients have the opportunity to talk with their physicians and the comfort of their medical home, in the comfort of that relationship between a patient and his or her provider to say, let me understand this, let me really understand why I should do this or what my issues might be, or if I have particular questions, I have a space a safe space to have those answers. And we believe now with vaccine hesitancy being the order of the day, that is the best way for us to serve our communities and make the vaccine available to people is connecting them back with their physicians or their family practitioners or their nurse practitioners who are available in their clinics.

Gina DiPietro  2:45  
As Hohn just mentioned, bringing the vaccine into clinics where it's administered by a trusted physician is a new opportunity to reach unvaccinated people. Dr. David Priest, Novant Health chief safety quality and Epidemiology officer, explains the impact he's seen firsthand.

Dr. David Priest  3:03  
It's that personal touch that really makes a difference. And I've seen that in my own practice. Individuals come in adamantly opposed to vaccination, and after addressing each of their concerns, they're willing to get it. There's so much information and misinformation that's been moved around the internet, you know, some patients just throw up their hands and say, I don't know what to believe and all this. That one on one conversation addressing concerns would provide a really makes a world of difference. 

Gina DiPietro  3:25  
Gina here and back to my conversation with John Howard, Senior Vice President and Chief Operating Officer at Novant. Health Physician Network. He said the end goal is to have the COVID-19 vaccine available in most if not all Novant Health Primary Care adult and pediatric care clinics by the end of the year.

John Howard  3:43  
So I think that creates a great opportunity to reach out into communities into local neighborhoods where we have clinics and say, Hey, here's a place where this is available. And we think it allows for an encounter that is more engaged with a patient's health, then all of the community sites where you could go to a Walgreens or CVS, not that those aren't very valuable resources as well. But you can't have the same dialogue, because that's not when your provider,

Gina DiPietro  4:12  
We've heard a lot about the variants that people are starting to notice. And we've also heard a lot about how people just aren't quite sure how long the efficacy lasts. What would be the implications from shifting more to this clinic model and distributing COVID vaccines. If a booster shot might be needed, I imagine that it would make it easier to distribute those?

John Howard  4:37  
The good news is is that the vaccines that we have available, still tend to be effective against the current variants in the marketplace. And the highest incidence of those variants are current and states and counties which have the lowest vaccination rates. So it's a good even common sense indicator and beyond. All the epidemiological studies that you can simply look at a map and see where that's occurring. The bad news portion is that as long as the virus has the ability to replicate, it has the ability to mutate, which means that the current Delta variant, for example, will very likely not be the last variant unless we take away the opportunity for the virus to continue to spread. And the way to do that is to encourage more vaccinations. Which brings me to the second part of your question is, when we think about boosters, long term efficacy, keeping the vaccine down, because in many ways, this really is a battle. It's a battle for the safety of our communities against a virus that has disrupted our lives in significant ways that there is not a person that hasn't felt this. It's sometimes very deep, and long lasting or permanent levels, even losing loved ones. So the way to fight that battle, is to make sure that we're creating this as a normal part of what we deal with mass vaccination sites in huge events and stadiums, or at arena's, which we certainly did, to accelerate that initial bush is not the way for us to continue to combat it. So whether it's been booster shots, or whether it's getting more people who have not yet received the vaccine to receive it, the best way to do that is to make that a part of our ordinary health care delivery. And so I do think the retail outlets such as Walgreens and CVS are valuable. But I also think the physician office is a valuable resource. And it's why we put so much effort in making sure we have clinics enrolled, and that we have physicians and other providers are willing to help us in delivering the vaccine. And when the boosters are needed, as we're still gaining evidence on what the what really the link of efficacy is for these vaccines, that we have the ability then to provide booster shots as needed, when that time comes and when it's appropriate. But we're not there yet. And I do want to make that clear. Boosters are not being recommended or delivered at this time.

Gina DiPietro  7:10  
Yes, certainly an important distinction there. And really, it just speaks to COVID taught us that we never really know what might happen. So to have different options where people can get vaccines is really important, because we may not be able to predict what happens next.

John Howard  7:27  
And that's exactly right. And to add to your point there, it's important to understand that as boosters become available, and as we need to do that Novant Health is fully prepared and at the ready to reactivate some mass sites, we need to if it's important, and there's a window to do that in, we're going to meet the needs of our community. We're going to make sure we're empowered to appropriately battle this virus and to make sure that we're successful, I think everyone today is enjoying the opening up again of our lives. And we need to make sure that we keep the virus on a teils so t...

Gina DiPietro  0:10  
That's 64-year-old Margie "Kay" Pope of Sunset Beach, North Carolina, describing the most terrifying experience of her life. 

Margie "Kay" Pope  0:20  
I'll never forget it - it was November 7, 2019.

Gina DiPietro  0:30  
Welcome to Novant Health Healthy Headlines. I'm Gina DiPietro. In this episode, Kay explains how a funny feeling that November night sent she and her 65-year-old husband, Frank, to the emergency room in search of answers. More on that and how a cutting-edge software provided quick access to care when she needed it most. Now back to Kay.

Margie "Kay" Pope  0:56  
It happened in the middle of the night. Fortunately, I was awake at the time I was having trouble sleeping. And that ended up being a good thing at that particular time because I realized all of a sudden my right arm was going numb. But it was a weird feeling numb wasn't your typical, you know, my hand is falling asleep. So I woke my husband up because I knew something was wrong. We contemplated for a little bit and you know, what do we do? So we made the decision to go to the emergency room. We're about 30 minutes from Brunswick, the Novant Health Hospital in Bolivia. So we drove there, got there about three o'clock in the morning. And they started running all the tests on me. They did a couple of CAT scans, they I think they did an EKG and some other things. And also they were in conference at the time with New Hanover Regional Medical Center. I found out later the stroke center there, they discovered that I had a clot that had moved in my brain. 

Gina DiPietro  1:55  
She didn't know at the time, but that blood clot caused Kay to have a stroke. She was airlifted by helicopter from Novant Health Brunswick Medical Center in Bolivia, North Carolina, to Wilmington's New Hanover Regional Medical Center, recently acquired by Novant Health.

Margie "Kay" Pope  2:10  
When I got there, the stroke team was waiting for me wheeled me into a room did a procedure that I can't pronounce the name of and as soon as the clock was out, I was fine. All the symptoms were gone. Supposedly the procedure they did on me from what I was told they've got about a 4 to 6 hour window where they can do that. Otherwise it's too late. And I think that's kind of the point of what we're talking about is to acknowledge to people the faster you move on something like this, the better off the outcomes going to be. Because by the time I left the Novant hospital, airlifted to Wilmington, I could no longer speak. So the symptoms were gradually getting worse. It started with the numbness that I had no use of my right arm at all the right side of my face and started to droop for what they told me. And I was still coherent and awake. But I couldn't form any words, and I couldn't speak at all. 

Gina DiPietro  3:07  
Wow, that had to have been so scary. 

Margie "Kay" Pope  3:09  
Absolutely, the most terrifying thing I've ever had happen in my life. 

Gina DiPietro  3:13  
Was your husband with you the whole time? Was he able to fly in a helicopter? 

Margie "Kay" Pope  3:17  
No. And that was the bad part about that. He just saw me leaving the helicopter and didn't know what was going on.And then by the time he got there and they let him into saving the procedure was over and I was fine. And he was kind of in a state of shock because the last time he saw me, I couldn't speak, you know, and I had all these symptoms and the next time you saw me, I'm like Hi, I'm fine. So, he had a bit of an emotional turmoil to go along with it as well. 

Gina DiPietro  3:48  
You'll remember she arrived at the emergency room around 3am and by six or 6:30 that morning she was out of surgery. While the Pope's quick thinking to seek help certainly played a role. So did Viz.ai - a video based platform that provides remote access to a neurologist, the expert in stroke care. Here's some context. in a rural hospital setting, it often takes at least an hour to get results from some of the more critical scans. But with this AI the scan is uploaded instantaneously to a "cloud" to be read by artificial intelligence. If a stroke is detected, the emergency physician is alerted immediately as the patient is transferred to a facility that can provide stroke care. A team of medical professionals led by an interventional neurologist is already preparing to take that person into surgery. Here's Dr. Vinodh Doss, an interventional neurologist and medical director of stroke and interventional surgery at New Hanover Regional Medical Center who performed case surgery that scary night back in November. 

Dr. Vinodh Doss  4:52  
I'm awake. I'm at the hospital waiting for her to get there. We evaluate her it's clear that she still hasn't symptom should go straight to the angiography suite. And that's where we go to work. We got the artery open in a matter of minutes. And she obviously benefited from the care from beginning to the end. 

Gina DiPietro  5:13  
Since you've been using Viz.ai, have you noticed an improvement in outcomes for stroke patients? 

Dr. Vinodh Doss  5:19  
Oh, yeah. Using this technology, this is 21st century medicine. We know, if you come through our doors and Wilmington, you're gonna be triage and treated very quickly, we have some of the best treatment times in the country. But if you're just an hour, 45 minutes an hour away, that changes. And that shouldn't be the case using the technology. I think that's what it's been an eye opening experience with me just working with Brunswick on this, and how much providers have bought into it, and used it and leveraged it as in not just communicating, reducing unnecessary transfers, and encouraging the patients that really need to come to us and get treated. 

Gina DiPietro  5:59  
Let's get back to Kay's story. A big reason she's sharing her experience lies in the fact that she did not ignore her symptoms. Time is key if you're experiencing a stroke. That's because up to 2 million brain cells die every minute when oxygen and nutrients are cut off. 

Margie "Kay" Pope  6:16  
Fortunately, I didn't do my normal. Because I've always been a very healthy person have never really had anything like this happen to me. And I have a tendency to just say, oh, it'll go away, I'll be fine. Which is the worst thing I could have possibly have done. But fortunately, the way my body felt just told me there's something really wrong here. This is not going to go away on its own. But I sat up in bed, he got a wet washcloth, I was putting it on my forehead. And the other thing that was kind of strange is the symptoms were kind of coming and going, as I've described to people before it literally felt like a wave going through my body. And then after a few minutes, the symptoms went away. And I felt better. So we kept kind of hemming and hawing and saying, oh, everything's okay. Well, a nurse told me later, that was the clot moving. And the fact that like I said, I was kind of losing control of my right arm. just said, okay, common sense is going to kick in here. And it may be nothing, but I need to go find out what's going on. And I'm very glad I did. Because had I not done that the outcome would not have been good like it is now. 

Gina DiPietro  7:31  
Do you have any lasting effects at all from what happened? 

Margie "Kay" Pope  7:35  
Not from the stroke. But ...

Cliff Mehrtens  0:39  
Which pain relievers Should I take if I have a mild case? Sure. So, again, with COVID-19 infection, most cases are mild. And certainly people can experience mild to moderate symptoms and spend several days at home to recover and during that time have body aches, muscle pains, fevers. The most important thing to remember is that most over the counter, common medications we take to manage COVID-19 does not treat or cure the virus, but it manages symptoms. And so in general for body aches and muscle pains,

Dr. Karan Shukla  1:27  
instead of monofin or Tylenol, naproxen, or Aleve, ibuprofen,

which is sold under the name of Advil or Motrin can help lower fevers can help manage muscle aches and body pains and make the course of the illness a little bit more tolerable. The first thing is to remember that you want to make sure you're following dosing guidelines on the backs of the labels read exactly what the dose of the medication is that you are taking, and that you don't have any health industry health history that should prevent you from using these medications. Early on during the COVID pandemic, there was some question as to whether anti inflammatories like naproxen or Motrin, or Aleve, or ibuprofen, we're potentially going to make the process of the COVID infection worse, but subsequent follow up testing or studies have really not demonstrated that. And so whether it's Tylenol or ibuprofen or Motrin, or Aleve, either of these medications can serve to reduce fevers and to manage symptoms of pain.

Cliff Mehrtens  2:51  
But respiratory symptoms the things we would normally reach for during the year cold medicines I have a runny nose or I'm clogged up or things are, you know, I'm really having those sort of issues. How well and effective are those?

Dr. Karan Shukla  3:05  
Sure, a lot of the over the counter cough medications generally are helpful but are not as helpful as we would like to think of managing symptoms of cough. In general, I recommend my patients who are recovering at home, use a vapor rubs to help relieve coughs to make sure that they have an Air Humidifier and use steam inhalation to decrease nasal congestion. Certainly, honey can be used in ways to help soothe sore throats, in manage cough symptoms as well. You want to be aware that lower respiratory tract symptoms in COVID illnesses need to be monitored carefully. Because the lower respiratory tract symptoms like chest tightness or chest congestion, chesty, cough, difficulty breathing or shortness of breath may indicate that you're dealing with more than just an upper respiratory tract illness, but also potentially lower respiratory tract illness, which could be considered a pneumonia.

Cliff Mehrtens  4:22  
Let's talk about hybrid hydration excuse me, it's it's important throughout your life, but in this case, am I hydrating more if I'm trying to treat those symptoms? If so, what do you know liquids are more beneficial than others? What should I concentrate on?

Dr. Karan Shukla  4:36  
Sure. Staying hydrated during the recovery from any illness is very important. And during periods of illness, our body loses more water or more fluid loss through fevers or coughing, breathing rapidly. Certainly nausea or vomiting or diarrhea can add to those fluid losses. With COVID specifically, loss of taste or loss of smell may interfere with someone's appetite or desire to eat or drink. So staying hydrated is very critical at maintaining our body's metabolic processes at keeping our secretions or respiratory secretions loose, and when we are dehydrated, our secretions become thicker, which makes it difficult to clear and can lead to increased risk of pneumonia. So in general, a few tips would be to generally have clear liquids readily available to sip clear liquids or electrolyte containing rehydration solutions. Frequently, if you aren't able to tolerate drinking large quantities in or during that illness, you want to certainly make sure that you are having adequate urine output and that you're urinating every three to four hours. And generally that urine is clear and not very dark and concentrated. Though those could all be signs that you're dehydrated. By the time you're thirsty, or have a desire to drink, you're already past the point of being dehydrated when it comes to an illness.

Cliff Mehrtens  6:28  
Let's talk about isolating someone in multiperson house develops COVID-19 what are the key steps to isolating them in one portion of the house and limiting contact with them.

Dr. Karan Shukla  6:39  
So at the earliest signs of illness, you really want to start avoiding contact with people within your own home. And a lot of the times especially with COVID 19, I've seen that the symptoms can be very mild and very subtle. And people often mistake them for allergies or sinus infections or other upper respiratory tract infections, very subtle symptoms. So at the real onset of any symptoms you might be attributing to upper respiratory process, you want to generally avoid sitting with people in your home to eat or congregate. In other areas of the home where you would generally hang out. You would want to identify a particular bathroom if you have the ability to do so where you can use that other people who may not be having any symptoms can can use other bathrooms to avoid cross contamination. I would strongly encourage everyone in the home to wear masks at that point. Because you do not know who has the infection and who is in the process of developing symptoms. I think it would be important as well to clean all commonly touched surfaces, hard back chairs, table tops, remote controls, commonly touched doorknobs, to make sure all of these commonly touched surfaces are not potential vectors for transmission.

Cliff Mehrtens  8:17  
I know COVID-19 isn't a one size fits all sort of disease but virus but in general, someone with mild conditions about how long are they going to feel bad and before they start to turn a corner just in general before they that it runs its course.

Dr. Karan Shukla  8:33  
In general, a person with mild upper respiratory tract illness would be expected to have few days of symptoms that evolve during the course of their illness. They may start with stopped up nose or inability to smell maybe a little bit of irritated throat. They may go on to develop fevers, or chills or just not feel well. Typically the process of upper respiratory tract illness or a mild case of COVID-19 plays out over the course of a week to 10 days, after which the individual may start feeling better and have more energy and see resolution to their symptoms.

Cliff Mehrtens  9:17  
What are some of the warning signs? That tells me I'm no longer mild? I really need to seek emergency immediate care.

Dr. Karan Shukla  9:25  
Sure, it's very important that at the onset of someone's symptoms that they you know, take into account the date at which the symptoms started. The date at which they were potentially exposed may help to really monitor and log your symptoms or write them down as as descriptive as possible so that you can observe how the symptoms evolve. And certainly if you start out with upper respiratory tract symptom...

I’m Gina DiPietro, with Novant Health, Healthy Headlines. 

Those two questions are at the center of a Novant Health program called Choices and Champions, which helps patients and care teams talk through important decisions. It encourages patients to choose a health care “Champion,” or the person who will stand in their corner when they can’t speak up for themselves, and think about other medical choices they may face in the future.

End-of-life care is always top of mind for Dr. Colin McDonald, a neurohospitalist at Novant Health Forsyth Medical Center in Winston-Salem. It’s true for his young patients as well as his older ones – the seriously ill ones along with the healthy ones. He cares for critically ill stroke patients and others with neurological injuries, including head trauma.  

For 28 years, Dr. McDonald has been leading these conversations. In this episode, he talks with Melody Myers about why it’s important to have your care team document your “choices” in your medical record and to choose a Champion to speak for you if you are not able to speak for yourself. 

Melody 

So tell me about the Choices and Champions program at Novant Health and why it's important and how you've worked with it.

Dr. McDonald 

So there are two very important things that any patient needs. And I really say that no matter how young or how old. One of them is to have a discussion with a trusted clinician, who is able to document into the medical record, what their desires and wants, what their loves and dislikes happen to be, what their life would be like if certain things happen. And we call that choices, or advance care planning. Those are really notes that aren’t process-driven. Most of the time, they're blank text that you type into a computer, but they stand-alone so people can see, in October of 2020, Mrs. Smith had this attitude. And then you go forward from that. And suppose Mrs. Smith, in December of 2020, is now diagnosed, surprisingly, and out of the blue with a very aggressive and widespread cancer. At that particular point, Mrs. Smith's goals may have changed. 

So when we talk about goals and advanced care planning, it's meant to be a life story that evolves with the life and the health of the patient. So that's one part of it. And that's supposing, and that's where you're right most of the time, pre-hospitalization, that the patient is able to manifest, discuss, express what their choices are. 

However, as we all know cardiopulmonary arrests happen out of the blue, stroke-like events happen out of the blue, that's why we call them strokes. And when those things happen, a patient is not typically in a place to have the conversation about what their choices are. And that's where the Champion part comes in. You always look to the patient first, if the patient is able to tell you what their desires and wants would be. But you also tell the patient, there may come a moment, God decides where you're not able to do that. What I know, because I may not be there, I'm just one of the whatever, several thousand doctors at Forsyth Medical Center/Novant Health, I may not be there at that particular moment. What you need, you need a Champion that really knows you, understands this particular conversation, and then understands, knowing what they know about you what they know about your goals and desire, they understand that in almost any circumstance, no matter how difficult, we're going to be able to figure out what you Mrs. Smith would want done in this unforeseen circumstance.

Melody 

So what do you tell a patient who might be reluctant to name a champion?

Dr. McDonald 

I'll begin by saying, I'm the Champion for my mom and dad, and I have been for many, many years. And my mom, who's a registered nurse, she was the one that was reluctant years ago for me to become her Champion, because she thought it was almost too much weight. And so what I told my mom back then, and what I think a lot of champions really believe there's no greater demonstration of confidence or love, than you turning to someone that you love and trust so much, and say, “You are the keeper of my decisions when I am not able to make those decisions.” And I think when you put it in those terms, it's pretty often and I would say even more than that, most often the case that patients embrace that idea when they look at it that way.

Melody

So what do you tell a family member who doesn't want to honor the Champion named?

Dr. McDonald

Yep. And so let's first talk about what do you do about a Champion that's been asked, and doesn't want to become the Champion, kind of the reverse of where we're going here. What I tell them, and this is something that I had learned at the Massachusetts General years and years and years ago, we called it the curse and the blessing. And the way we described it is, the blessing is that your mom, your dad, your friend has so much confidence in what you know about this person. Let's say it's Mrs. Smith, and she has placed all the confidence in you that can be no greater blessing than that. And then you actually have to go hard Scottish on them after that and say –  here's where the curse comes in – I would be asking Mrs. Smith, if she was able to tell me … I never met Mrs. Smith, when she would have been able to tell me. You were here representing Mrs. Smith. Knowing what her wants and desires were, you can tell me all you know about her joys, her hobbies, her loves, etcetera, her fears. You can tell me all about that and I can help guide you to what I think she would want. But I need to know a lot from you. And once you explain that to most Champions, they're OK with it, they understand that it isn't their choice. They're making a choice in place of Mrs. Smith, who was unable to make that choice for herself. 

And that then gets to the other point, which I really don't see arise all that often. And that is what happens if you have multiple family members, and one of them has been identified as the Champion, and then there are some other children in the mix are other friends … and they may disagree as far as direction of care? At the end of the day, the Champion, if it is ascertained that that Champion was rightfully made, meaning when the patient was in sound mind and possibly sound body — but certainly sound mind — and made that particular decision, and you ascertain the Champion understands that they're making a decision based on Mrs. Smith's wishes, then it is pretty easy to discuss with family members: Ladies and gentlemen, this is who mom, dad, whoever, chose as her Champion. This is the person we need to be guided by. And I really, over many, many years, have almost never run into conflict once you sort of let families know that this was done with a lot of foresight on the part of the patient.

Melody  

How does a champion or advance directive take the burden off of the family?

Dr. McDonald 

People have very, very busy lives. And it is often the case that it is at that unforeseen moment that bad things happen to good people. When someone was totally not expec...

Cliff Mehrtens  0:39  
Tell me the top three exercises, in general I can do with limited equipment, the things that are most beneficial for me if I have 30 or 40 minute window two times a week.

Adam Culver  0:52  
So I would say rather than one or two exercises, I could categorize things and types of exercise and you know, you want to hit every, every group of muscles you can within that type of exercise. So I'd say I'd say resistance training. And if you could do anything to target the literally all muscle groups, you know, we we use there. And then cardio, of course, so trying to do something cardio wise that you're getting a full body experience, whether that be you know, most easiest thing to do obviously is run you know, which, which you can, can do at home. If you know if you're around the community, if you layer up in and want to do it outside, that's an option if that is not, you can certainly run in place. And you know, of course there a portion of our population who will have the ability, you know, have some extra options in terms of a peloton or a treadmill, things like that, obviously. But those those two things cardio and resistance training would be to two big groups. Again, if I had to, if I had to pick exercises, if that's more what you're looking for, I would say planks, I would say squat. And there's an exercise called a good morning. I would say though,

Cliff Mehrtens  2:53  
what about people who who fell in love with weight benches in their gym, or they really feel like they have to have a set of free weights which are hard to come by these days on

Unknown Speaker  3:03  
online.

Cliff Mehrtens  3:04  
There's still ways to build muscle without machines. Correct. You talk about resistance training, how can I do that if it's just me staring at the wall.

Adam Culver  3:14  
So there's bands and actually your, your body provides you know, using the right way can provide a whole lot of resistance that you can use to build your core muscle groups. So with with squats, you know, the great example of that push ups. So we're actually using our, our bodyweight for for that resistance. And sometimes when you max out there, let's say you are pretty, pretty slight person and you may be looking to put on some, some mass. You know, if if the person feels comfortable, you can you can improvise with things at home, if you've got some experience with with weight. And there are YouTube videos about about how to do that.

Cliff Mehrtens  4:16  
People in the military, they go through training and they don't run them through, you know, Gold's Gym, they're out in a field somewhere. You know, there's no fancy equipment, you know, in the barracks there, they're doing they're using resistance based on what they want.

Adam Culver  4:31  
You realize, you know, you don't need much. If you can find a find a something to simulate a pull up. You know, you would with those kind of complex movements, you are hitting a lot of muscle groups that are vital. So, you know, if you if you can somehow simulate a pull up or you know, actually put up pull up bar. I mean, that's a lot of what they doing in the military is just using those using complex movements that are just weighted by their body.

Cliff Mehrtens  5:13  
North Carolina is not a frigidly cold place. And like you said, If you lay around and you run, the first five minutes might hurt. It does maybe a little bit, but after that, a lot of times I'm peeling off because it's it's getting warm bodies. No, I'm starting to build up some heat. Is that really just an excuse? Oh, it's too cold outside.

Adam Culver  5:34  
There may be days, there may be times of the day that you particularly have to work out they say, five in the morning, where sometimes it may get get in the 20s get in the teens or, or what have you, and you don't, you just don't want to do it, then that's when you, you know, you go to run in place or using using stairs that you may have at home. But definitely, I mean, there are people in much colder climates than what we're in who are committed to getting out and running. And it's just layering up and having that commitment to do it.

Cliff Mehrtens  6:14  
Talk about the online component. There are plenty of things you can do, like you said, from the peloton to YouTube to you can do a yoga video online? Or is that a good suggestion for people who might not be as willing to go outside?

Adam Culver  6:30  
Yeah, I think it's, I think it's great. What, what YouTube and other apps that are just strictly dedicated to work out do is they remove that excuse, they remove that excuse of, Oh, I don't have anybody to tell me what to do. Or, you know, the doc gave me these papers A while back and told me I should work out like this. And I don't have anybody to demonstrate what that looks like. So you know, YouTube and some of these workout videos and apps, I mean, you have a one stop shop, or somebody's giving you a demonstration on what to do. And giving you motivation, you know, because usually there's some sort of, you know, you got an instructor that's leading you through everything. So that's where we, you know, we've got to come in with, with our motivation and commitment to kind of complete that circle. Yeah, on YouTube, you've got a range of channels that that you can go to define whatever you want to do, whether it's yoga, Pilates resistance stuff, high impact interval, or high intensity interval training. I mean, it's all there. It's true at whatever, whatever, you know, experience level you're at with a beginner at an intermediate experienced. So

Cliff Mehrtens  8:06  
if you found Utah to struggle because of COVID-19 restrictions working out at home, or are they more adaptive, they're just like, Okay, well this is where I am going to do this regardless. So I'm just gonna figure out a way to work my way out by changing the hours and changing the equipment I use or stuff like that people are working person is gonna be a workout person, no matter what.

Adam Culver  8:29  
You know, I've run into people all across that spectrum. I've got some patients who were avid gym goers before it became not as safe to go to a gym and they are really struggling with figuring out how they can get the get their workouts in at home. And then you know, I've got people on the other end of that spectrum who were not the avid gym folks but especially as the new year has come around have just taken that approach. You know what I'm not gonna let COVID take 2021 from me, too. And you know, just have gotten after it so yeah, I think what we had to do is really figure out what is it about the the gym that we miss, is it the camaraderie you know, talking in the locker room with with folks or just being in the gym with other people who are like minded trying to everybody's working towards a goal. You know, what, what is it that I'm, that I'm missing that you're missing? And surely there's a way at home where you can at least simulate some of that may not be the exact same but you can get some of that back. Oftentimes now like a lot of folks are working from home So it and we struggle sometimes with that, I guess the, we're doing the sa...

As COVID-19 vaccine distribution continues, the idea around ‘efficacy’ and which vaccine is most effective has been top of mind. But what does this number actually mean? And how much does it matter? 

Hi, I’m Gina DiPietro with Novant Health Healthy Headlines. In this episode, we hear the answer to those questions from Dr. David Priest, Novant Health senior vice president and chief safety and quality officer. He explains why it’s natural for folks to compare the vaccines to each other, and why that shouldn’t be the focus. Here’s more from Priest, along with ending remarks from Dr. Jerome Williams Jr. – Novant Health senior vice president of consumer engagement. 

Dr. David Priest:

When say Pfizer or Moderna came out with efficacy data 94 95%, what they really did was they said, Look, we had two groups of people, a group that got a placebo group that got the real thing. And this is how many cases of COVID we had in each group. And one of we compare those numbers and one was, you know, point 5%, compared to the other group, basically. So that's kind of where they came up those efficacy numbers. You can look at it several different ways - are you trying to prevent the most serious complications and COVID, hospitalization, death, serious illness, routine COVID cases that don't require hospitalization, and certainly aren't fatal. All of the vaccines are highly effective in preventing hospitalization and death. If you're talking about preventing just routine COVID, the Johnson & Johnson vaccine had a slightly lower number. But remember, it was tested and came out later. Tthere were variants around the world that weren't necessarily there when Pfizer and Moderna were being tested. So the actual difference in the vaccines may be less than those numbers suggest. That's something important to remember. The other thing is, I love the fact that we are arguing about vaccines that have 70 80, 90 95% efficacy, when in a typical flu season, the flu shot, which is very important thing to do for our communities might have an efficacy of 40% or 45%. Our standard and expectation as a society has really changed. And, and that's great. And remember that there's a couple of things that are important. One is it's really important how efficacious vaccine is, but equally important, and in a lot of cases, even more important is how many people get it, right? If you have a very a very effective vaccine, but a very small number of people get it, it's not going to make a dent in the disease progression in your community. Conversely, if you have a vaccine that really isn't that effective, but every single person got it, it would make a huge difference in disease burden. So it's not just the Hey, I want the 95%, one versus the 85%, where the 75%. One, it's enough of us need to get it. So I would not split hairs about each of these products, if you have an opportunity to - get one, given the current limitations and suppliers.

Dr. Jerome Williams Jr.:

The only other thing I would add, David is that when you talk about clinical trials, you have to understand that the vaccines that are out there, they were not compared against each other. They were not compared against each other. Okay. And so you can't really extrapolate one data point as it relates to efficacy to another trial, because it's not comparing apples to apples as you look at the data. But as we're talking, Dr. Priest really outlined the bottom line is we all need to get vaccinated no matter which vaccine. That's really to take them without getting too deep into biostatistics or anything like that. That's really the take home point.

Gina DiPietro:

Gina DiPietro again. So, the bottom line is – the numbers aren’t apples to apples. We should all focus instead on getting vaccinated in the first place. If you have an opportunity to receive a COVID-19 vaccine, take it. In the meantime, please continue to wear a mask, be socially distant and wash your hands. Thanks for listening to this episode of Healthy Headlines. If you enjoyed this podcast, please take a moment to rate and review us, and subscribe to this and all the Novant Health podcasts. We post new episodes all the time. Most are less than 15 minutes. 

knee pain can alter your life quickly or become a lingering irritation. But there are steps you can take to stave off potential injuries and needed terior ation, welcome to Novant Health healthy headlines. I'm Gina dipietro. Keeping your knees healthy as you age is vital to remaining mobile and avoiding arthritis. In this episode, Dr. Zachary sandbelt, a Novant, Health Sports Medicine Specialist talks to Cliff Mertens about what you can do to keep your knees in good working order. Thank you for listening.

Cliff Mehrtens  0:37  

Me first about why is it a good idea to strengthen my other leg muscles? And which one should I concentrate on to help knee pain?

Dr. Zachary Sandbulte  0:48  

So the first question, why is it why it's a good idea, the data is pretty conclusive on that, that if you keep your muscles strong around the around the joint, the muscles support the joint and take stress off the joint more and more. And so if you, if the opposite of that they get weaker and weaker, your joints gonna bear more of the burden. Okay. And so I think that working, you know, trying to strengthen all the muscles is helpful, you know, quads, hamstrings, but the data really says the most helpful is getting your quads, you also want to keep your muscles loose. And so if you have

Zachary Sandbulte  1:23  

a lot of tightness, particularly hamstrings, you can put a little extra stress on the joint. And so I tell people, you know, there's really two, two things that we know definitively make a difference for knees in the long run. In that, you know, leg strength and weight and weight, maybe even to the big the bigger one. But those two things, there's just, there's mountains of data that say these things really help keep these healthy over over longer periods of time. The example I give to patients a lot is they've looked at marathoners and people that have run a lot of marathons and they don't actually have any more incidence of, of arthritis than anyone else. And so it's kind of flies in the face of the intuition, which would be well, if you're running and pounding the pavements going away your knees out faster. But that actually is not the case. And then in May, May, in fact, be protective of the knees. And the rationale as well. If you run a bunch of marathons, generally speaking, you're strong, your muscles are strong, and you're generally fit, you know, you're not, they tend to not be real overweight. And so again, those that kind of two things I think are the most important.

Cliff Mehrtens  2:37  

Let's talk about weight, that's a good lead in, people hear all the time Oh, lose weight, it's easier on your joints. But explain what the whole pounds per square inch is. And how that affects you even a small weight gain or medium weight gain away of us can make a difference for create more pain, because it's pressing down on that joint.

Zachary Sandbulte  2:59  

Yeah. So the data that it's, it shows that if every pound you lose is about four to five pounds of stress off of the joint off the knee joint. And so, you know, even, you know, even if you have modest weight loss, you know, 10 pounds, well, if you if you if you kept it as is 50 pounds of stress off the joint, multiply that by five years or 10 years, that makes a sizable difference. And, you know, I always think about the kind of the example I used to say, you know, pick up, pick up some luggage, you know, before you go to the airport and walk around the house for a while and see how your knees feel and you, you can feel it, you can feel a sizeable difference. And that's, you know, how much you pack, I guess, but you know, even even like, you'll start to notice a difference. And so, it really, if you if you multiply that over years, yours, that really is gonna erode the cartilage quite a bit faster, that extra weight and stress.

Cliff Mehrtens  4:02  

What about people who they're not trying exercises, but they don't want to jump into something that's super high impact. They don't want to, they don't want that a lot of pounding on their legs, what are some low impact exercises that can help them?

Zachary Sandbulte  4:14  

First, the way I think of that is, first and foremost, exercise for what it is, that's the most important part. So even if we have people who say, look, I got a bed to run, fine, you know, that's what you need to do. That being active part to me is the most important, I think it is smart to to reduce the high impact, if possible, and sometimes you do have to kind of change activities. Running jumping are gonna be the worst. You know, walking is an impact activity, but it's very low impact. And so I think, fine. I think you know, ellipticals, fine cycling all those are great, to me the bestest swimming, it's just it's it's fluid motion. It's resistance. It's low impact, or no impact. You know, the problem is you'd have to have access to a pool. But that to me is the is probably the ideal exercise. So there's, there's a lot of ways you can skin the cat. But I think that that good real good ones that are easy walking is great. Cycling, elliptical, those are all fine. And swimming is great, too.

Cliff Mehrtens  5:23  

And swimming is not just using your muscles around your legs you're using, you know, you're getting the whole full body, shoulders and back. And it's pretty good

Unknown Speaker  5:31  

for you. Absolutely.

Cliff Mehrtens  5:33  

That's what with cardio too. It's It's It's a and you're not waking up with swollen knees from swimming.

Zachary Sandbulte  5:40  

That's right. I it's if you asked me what the purpose exercise is, that's as close as we get

Cliff Mehrtens  5:48  

something about range of motion, how does that help, if I have a bad knee or I want to avoid rain, developing my range of motion as I don't want to get stiffer as I get older.

Zachary Sandbulte  5:56  

So joints generally speaking, joints want to move in there. If we immobilize joints, they'd get stiffer, and they do worse and worse. And so you want to, it's, it's important to keep moving joints. And I don't think you necessarily have to be pushing your motion as far as you can all the time. But you do need to be moving the joint. And so someone who says you know, but every time I hyper flex my knee, you know, it hurts, well, you don't necessarily have to do that. But I do want you to try to go through kind of your comfortable range of motion as much as possible. Because again, that is you use it less and less, it will get stiffer and stiffer, and it will actually get worse and worse. So you you want to try to keep moving your joints as much as possible. With that question, I generally tell people you want to you want to be moving, but kind of let pain be your guide to a degree. Don't push it as far as you can we, we really make yourself uncomfortable. But go through your range of motion. As long as as long as it's it's within comfort.

Cliff Mehrtens  7:03  

Speaking exercises, ...

Cliff Mehrtens  0:41  
That I guess maybe the top three or four injuries you see with runners? Yeah, most common, I would say. So.

Christopher Felton  0:49  
Stress injuries.

So like shin splints, or

Gina DiPietro  11:58  
Jeanie dipietro here again, as you heard, running injuries are common and affect almost every part of the lower body but they don't have to, with patience, the correct nutrition and warming up, and always a good pair of running shoes, you should be able to make running a lifelong enjoyment. Thank you for listening to this episode of Novant Health healthy headlines. If you enjoyed this podcast, please take a moment to rate and review us and subscribe to this and all the Novant Health podcasts. We post new episodes all the time. Most are just 15 minutes. Thank you for listening

Christopher Felton  0:56  
what we call kind of stress reaction injuries, where it's, it's not quite to the point where they have a fracture, they have a stress fracture, but it's they have that sort of Shin splint type pain. It can certainly happen in other areas. I mean, we'll see it, we'll see it in the in the hip, we'll see it in the foot. But most commonly in the in the tibia or lower leg. So that'd be that'd be the first thing. The second thing I would say is, you know, knee just kind of overuse tendon injury. You know, I was just thinking about, like going from, you know, in the spring when it's warming up, and maybe people are kind of getting back into running. And they maybe do a little more than what they want their bodies ready for

Cliff Mehrtens  1:43  
sure. 70 degrees, you know, I've been Let's go.

Christopher Felton  1:48  
That's right. Eight months ago, I was running, you know, five miles a day I can I can do that again. So yeah, and that goes along with the stress injuries, but but I would say tendon injuries are our number two. And that can be anything from Achilles to gluteus medius to the pair kneels in the ankle. But I would say tendon injuries are the are the second. And then I would I would maybe combine these two together. But like an IT band syndrome and plantar fasciitis,

Cliff Mehrtens  2:23  
what's a general rule for if you start to feel pain, pain isn't normal. I mean, there's difference between a little soreness and pain, what's the best way to self diagnose and, you know, figure out a plan where I don't want this to hurt this part of my body to hurt How can I What can I do as a runner yet still be able to run to prevent this sort of thing from escalating?

Christopher Felton  2:45  
Yeah, so I would say first thing is pay attention to your volume of your of your mileage. So if you can run a mile and and not hurt and not be real sore, then that's probably a good a good mileage for you, right now. If you run two miles, and by that second mile you're having pain, then that's that's too much. So keeping it keeping it in a mileage range, that it's not, it's not hurting you, too, I would make sure you have a good a good plan for, you know, a good warm up before you start. So five to 10 minutes of a good full body warm up, whether that's some calisthenics, or you know, running or jogging in place. That kind of thing to just kind of warm your body up before you get moving before you start running. And then certainly afterwards, when you're done, take that five to 10 minutes after your run to really cool down stretch. You're going to get more more out of your stretch after your runs than before. And then the last thing I would say is, is just make sure you have good shoe wear. Make sure that's updated before you before you jump in something that's supportive, something that's comfortable. And something that doesn't have more than, you know, 400 miles on it, what

Cliff Mehrtens  4:20  
is the biggest mistake that beginning runners make? And in relative relation to injuries, what do they do that leads them into danger?

Christopher Felton  4:31  
I would say too much too soon. I think just again, going back to the volume part, I think I think we kind of have this notion that you know, we want to get healthy. And maybe maybe the doctor is telling me I need to get healthy. And so it's like I need to I need to go from doing nothing to doing seven, seven days a week. And and that's just gonna be too much and they're gonna they're Gonna get injured? So I would say I would say that doing too much volume too quickly is probably the biggest

Cliff Mehrtens  5:07  
input. And what about people who are established runners, you know, you reach that plateau, you've been running a while you want to up it a little bit, I guess they have to operate them to the same mindset. You don't want to chew off too much too soon and make this big leap. From x miles to Xyz miles. Same thing.

Christopher Felton  5:25  
Yeah. Yeah. I hate to sound like a broken record. But I mean, that's really a lot of what it is, is just how much how much increase in your in your training that you do at a time. And generally, that's that's, you know, that is one of the biggest downfalls I think when people start breaking down and getting injured is they're they're just doing too much, too quickly.

Cliff Mehrtens  5:50  
It sounds like the key part of being a runner is having patience.

Christopher Felton  5:54  
Yes, but as counter opposite to a typical runners mentality. I think

Cliff Mehrtens  6:03  
I could do seven, if I could do seven, I could do not

Unknown Speaker  6:06  
sure. Sure.

Cliff Mehrtens  6:07  
Yeah. Why not? Yeah, that's

Christopher Felton  6:08  
absolutely. Yeah, I think I think another another good. Important point is, is what your nutrition is like, and making sure that your, your overall calorie intake is matching that increase in physical activity. Because if your body doesn't have the energy that it needs to go that extra two miles or mile and a half, or whatever it is, that can also lead to lead to injury and, and overuse injuries.

Cliff Mehrtens  6:43  
That's a good point. I think a lot of beginning runners don't realize that that fuel is important. You can't just have the mental draw to say I want to run and yeah, is a pretty day, you got to have I guess that energy.

Christopher Felton  6:57  
Yeah, and I think I think just, and I'm speaking from my own experience, but I feel like maybe on some level, we don't do as good a job of, of kind of emphasizing that to the patient. Or even just to the public in general, when they are starting to exercise, I think we have such this kind of like, you know, here's, we need to talk about like how gradually you increase your training volume, making sure you have the right shoes, making sure you have, you know, the right flexibility. But I think we leave out the fact that, hey, as you're burning more calories through the day, you need to be replacing those so that the next time you go out to exercise your body has the fuel that it needs to do that. That incremental increase in, in training. And also the quality of those calories. You know, it...

Dr. Sandy Charles  0:45  
Once you're diagnosed with coronary disease, is it reversible? Um, yes. So, you know, like you said, coronary disease is so prevalent, that the first thing I kind of tell people when they're diagnosed with it is that they're, you know, not alone. And to not to feel discouraged, but to feel engaged with their physicians and their medical care and empowered that what they can do will make a difference. And so, you know, I don't, it depends on how the coronary disease has manifested itself, and what complications have occurred. So some things that happen due to coronary disease are, in fact reversible. But a lot of things, at the very least, can be prevented from recurring, based on lifestyle changes, and, you know, understanding and adhering to the medical therapy, exercising amongst a variety of things. I imagine it's if you get that diagnosis, it's easy to panic and think, Oh, my arteries are blocked. This is it, the drain is never going to open again. I'm a goner. But that's not the case. Tell me specifically what it will what you can do to reverse some of that damage. And you just touched on lifestyle, exercise, things like that. Yeah. So to take a step back, you know, coronary disease can manifest itself in a variety of ways. And like you touched on essentially, it's, you know, is your plumbing blocked or not. And so there are a variety of ways that our patients learn of their diagnosis. You know, there are a lot of patients who have no symptoms at all, and just based on imaging, find out that they have a little bit of plaque. And these patients are ideal in identifying that the plaque is there. But thankfully, it's minimal enough that it's not causing any problems, but imperative to start therapy to keep it from progressing. So from for this patient groups, so important to start aspirin therapy, and Staton therapy, cholesterol therapy, regardless of what your cholesterol level is, because that actually stabilizes the plaque prevents it from causing heart attacks. And, and helps to keep the plaque from progressing to a lot of different vessels. But, you know, number one thing I tell my patients is if they're feeling well, exercise, exercise, exercise, watching and minimizing how much sugar and carbohydrates they take in and processed foods. And all of that helps to minimizing the complications and progressions from coronary disease. But there are a large subset of people who unfortunately, you know, find out that they have heart disease because they have a heart attack, or they start having chest pain. And these are people who have severe heart blockages. And for them, like their, you know, minimal plaque patients, it's super important to start aspirin and cholesterol medications. And those are things that should be continued for a lifetime, if possible. But these are people who go on to needing stents and other therapies to open up their blockage and, and so thankfully, for these people, they feel better after that is done. And then it's so important for them to, you know, get into the swing of exercising and trusting their bodies again, and knowing how much they can push themselves. And for them, additional medications are are also necessary. How important is it

Cliff Mehrtens  4:29  
for to pay attention to your blood pressure and your cholesterol levels? I know a lot of people might get a diagnosis early on as is high and they brush it off and think okay, no big deal. I'll worry about that. That's an old person's disease. Yeah, so thank you for bringing that up. That's something that's exceedingly exceedingly important. And that's because Heart disease is the number one cause of death for both men and women killing more people than all forms of cancer combined, yet 80% have heart disease.

Dr. Sandy Charles  5:00  
preventable, simply based on risk factor modification. So a lot of these risk factors that you mentioned, having high blood pressure, having high cholesterol, diabetes, these are things that people tend to not feel, and to not know that they even have, unless they're getting screened regularly. And unfortunately, you know, a lot of people just feel like, you know, they have something bad if they have these things, and it's a bad thing to start medications. But, you know, I tell people, you know, number one, a lot of these risk factors can actually be reversed through exercising regularly and consistently through a low sodium diet, and really paying attention to weight and what people are eating. You know, unfortunately, a lot of people just are not aware about how much sodium is in processed foods, and they think, Oh, you know, I don't put a lot of salt in my food. But I say, you know, if you go to chick fil a, and you just get a regular chicken sandwich, a lot of them have upwards of 80% of your whole days recommended amount of salt, in that and including a lot of those salads at fast food places. So it's really important to pay attention to what you're eating and to eat as many Whole Foods and plant based foods on exercise. And those can truly make a difference. And I, I tell people, you know, to really partner with their doctors to understand what medications are important for blood pressure and cholesterol and to really be open and comfortable to save, they're having side effects so that that can be be switched. But to really emphasize that medications don't have to necessarily be a lifelong commitment. Because I have lots of patients who with a commitment to exercise and getting on a healthy diet and cutting back on alcohol intake, which is an important thing to bring up, especially during this pandemic, where you know, a good number of people are actually drinking more than usual, you know, and obviously cutting back on smoking and, and touching based on stress and anxiety, all of these things, if they're modified,

can be can be optimized through lifestyle changes, and not just medications alone.

Cliff Mehrtens  7:27  
They're both important exercise and diet. And a lot of people pick either or it's hard to maintain both, which people have the most trouble doing and maintaining is it exercise? Or is it that low fat, low fat, low salt diet? Yeah, you know, what I, what I what I have seen is a lot of obstacles or hurdles really depend on the way you were raised and what you were exposed to. So, you know, the patients that I have grown up in households where, you know, their parents were always eating healthy and primarily veggies and their parents exercise, you know, they're more likely to engage in these things. And the converse is true for people who aren't as exposed but but I will say you know, it's equally it's equally difficult. But but but very possible to optimize both things. So I tell people that really nothing is more important than your health especially because a good portion of people with heart disease, unfortunately don't get the privilege of of having symptoms or having a chest pain as a as an indicator they that they have heart disease for a lot of people, you know, death is the first sign of heart disease or our cardiac arrest um, and, and and so really taking every opportunity to optimize health so yes, people say that they don't have enough time unfortunate...

Welcome to Novant Health Healthy Headlines. I'm Gina DiPietro. Just what is mindfulness? Ask 10 people, you might get 10 different answers. In this episode, Alicia Roberts speaks to Novant Health cardiologist Dr. Jonathan Fisher, a practitioner of mindfulness meditation for 10 years, about what it means to him and the many benefits it can bring to others in difficult times.  

Alicia Roberts  

You're a cardiologist, why and when did you become interested in mindfulness?

Dr. Jonathan Fisher  

I became interested in mindfulness as part of my own personal journey of healing from a whole number of psychological stressors that I had been struggling with for a long time. So, it was back around 2008-09, when, after years of working hard, I started to recognize that I was missing out on gaps of my life. That feeling of missing out. And there was a feeling of anxiety which I couldn't fully understand, was there at a baseline. 

Then I had some family tragedy — family loss. My sister who was 40 at the time, was diagnosed with a brain tumor. She was my best friend and she was my support when I was going through my own struggles with anxiety and depression. She was the one person who encouraged me to seek help, and that help was available. So, I started getting help with therapy, and then it was later on when she died that another friend of mine said, well there's this other thing that's called mindfulness, and she recommended a book to me by a Buddhist nun, whose name was Pema Chodron. So, I read that book, and it captivated me. Particularly one line, which said, “suffering begins to disappear when we can abandon the hope, or belief, that there is anywhere to hide. I resonated with that I recognized that I had spent a lot of energy hiding in various places emotionally, physically, from the challenges of life rather than learning to be with them, and I was lacking the skills, and one of the skills that was taught was meditation. 

Around that same time, I googled — literally into Google — “How can I be happy again?” And then I discovered this scientific field which I had never heard of called positive psychology. So, I dug deep into the field of positive psychology and, lo and behold, one of the first books I read there, called “The How of Happiness,” talked about meditation as one of the key skills and being happy, fulfilled person. And so, I was getting these signals that maybe I should explore this thing called meditation, and it was only later as I dug deeper that I realized that there are many types of meditation — over 10 different kinds of meditation — and just one of them is mindfulness. So, part of my journey was to explore various types of meditation: mind/body practices, yoga, qigong, tai chi, all of these things which I had never learned about in my medical education or growing up. As I began to experiment with them, I was literally doing experiments on myself by practicing this thing or that thing and noticing differences. I recognized that there were changes that were happening in my ability to be with the challenges of life and also to start noticing the joys in life as well. And then slowly, other people started to recognize the difference. 

Alicia Roberts  

Wow, that's very inspiring. So how would you rate its effective effectiveness for you? I mean if you were at a one in 2009, where do you feel you are now in terms of happiness?

Dr. Jonathan Fisher  

I think if I looked at an overall average — and you know it's not just a theoretical — part of my own journey has been to track my own sense of well-being and happiness. Again, like a scientist, I want to look at the evidence. There's a lot of judgment about happiness theory in general, because scientists and doctors may say, “oh, that's a bunch of hooey. Show me the numbers.” The challenge is that this is involves a different type of research. You can't measure the numbers, it's all subjective because no one can tell you how happy you are. So, we use measures, like you were saying, a one-to-10 scale. I'd say I'm at seven to eight, on average. With COVID, and with some physical struggles that I have, perhaps it's a five or a six sometimes. I think there's a number of reasons for that. On the one hand, these practices — and we could dive into whichever — we can focus just on mindfulness itself. There are several different angles where it helps. One of them is, it makes moments of challenging suffering less intense, less severe. On the other hand, it allows us to appreciate moments of joy and pleasure — to notice them, first of all, and then to savor them and linger with them, second of all. So, there's kind of a dual effect. There's a reduction in dealing with perceiving and responding, reacting to the challenges. And then there's also an intensifying of the positive emotions, that if we learn to pay attention, we realize we're missing a lot of them.

Alicia Roberts  

For those who don't know much about practicing mindfulness, can you explain what it is and kind of what it looks like practically?

Dr. Jonathan Fisher  

There are many definitions of mindfulness and if you were to ask 10 people, even teachers of mindfulness, you probably get 10 different answers. So, the answer that I would give comes from the microbiologist, who was also a meditation expert teacher, named Jon Kabat-Zinn, who is the reason that you and I are talking right now. Because in 1979, he discovered, at the University of Massachusetts, that patients who are suffering with chronic and severe ongoing pain that had failed all other therapies, he welcomed them into a clinic and developed a protocol. He taught them mindfulness, and after just eight weeks, he had achieved pain reductions for them, with them, that no one else had seen before. And so, over the next 40 years, these practices are now so widespread that they're in most major academic medical centers. And the definition that he uses, is paying attention to the present moment, on purpose, non-judgmentally. Paying attention to the present moment on purpose. Non-judgmentally. Another way of putting it is, practicing being completely aware of what's happening inside you, in terms of your thoughts, feelings, emotions — and outside you in terms of sounds, events, conversations. Being fully aware and accepting whatever's happening in that moment. without having an immediate reaction to it. So, creating some space where you can then decide how you want to respond to whatever is happening around you. So, that would be one definition of mindfulness. 

In terms of how it comes into play. It comes into play, potentially in every moment of every day. So much of the suffering that we experience as humans, is because of the thoughts and reactions that we have that are happening without our awareness, so we all have this inner narrative this little voice in our head that's saying, “oh this is good, this is bad.” But so often, it's going on without are recognizing and it can drive us to do things and act in certain ways that we may not find consistent with our highest values. And so, for example, if I have a teenage son, and there are challenges that are happening, or frustrations that are happening. If I'm not aware of feelings inside myself of, let's say frustration or anger that are rising, it may be so late that I don't even catch it and I may yell in frustration, whereas if I practice mindfulness, I pause. If I hear him say something or if I say something, I notice the feelings in my body. I give...

Initially, the COVID-19 virus was identified mainly by fever, cough and difficulty breathing. But then headache became a dominant symptom. And for many patients their headache pain lingers long after they've overcome the virus. Welcome to Novant Health healthy headlines. I'm Gina dipietro. In this episode, Dr. Megan Donnelly, a Novant Health women's neurologist and headache specialist talks to Cliff Mertens about what a COVID-19 induced headache feels like, and how doctors are treating that new wrinkle. She also offers some tips on what you can do to reduce stress, which can often trigger migraine headaches. Thank you for listening.

Cliff Mehrtens  0:46  

What is the connection between migraines COVID-19 or just Is it a thing? Yes. So it is so um, interestingly, there are multiple neurologic manifestations of COVID.

Megan Donnelly  1:00  

In terms of more ominous things, there's encephalitis seizures, increased risk of stroke, increased risk of cerebral venous thrombosis,

hemorrhagic encephalitis, there's a lot of things that we've been seeing along with even things like transverse myelitis, a condition called a dam and other acute myelinating disease that looks like a new onset really kind of florid Multiple Sclerosis attack.

And things like Yeon, Brae, which we've seen with other viruses, as well. But this one is behaving very differently than a lot of other viruses in the past. And one of the thoughts is that it appears that one of the very first symptoms that people have, even before they develop cough, is they will first get an osmia, which is lack of sense of smell. And then they can get if they're going to get headache, they can get really bad headache at that time. And then sometimes cough doesn't even come until another couple of days later. So there's theory that this this nausea is actually due to the virus crossing over and invading the cribriform plate and so that that's the initial neurologic manifestation. Because that's your olfactory bulb, which part of your, your one of your cranial nerves.

I personally at the beginning of this in March, I was very, very stressed just about the pandemic itself, I have several very important family members to me, who are immune compromised. And so my my profound level of worry was that beyond a normal stressor, I recognized in myself that that was toxic stress levels. And I started doing more practice of yoga and mindfulness meditation, deep breathing, because I knew that I needed to do that. Sometimes that's not enough, though. And so although i think that that's an important first mainstay of treatment, if it's not enough, then we need to recognize when we need to treat patients with medication and with psychotherapy to help. So if it's really the the stressors that are going on, that are the biggest cause of the uptake of headache, addressing those rather than just throwing more meds at the headache is going to be extremely important. So as with any health condition, treating the underlying cause of uptick

So from a headache perspective, yes, this, this has actually been found to be one of the presenting symptoms of COVID. So when I'm seeing somebody who, by the time they're I'm seeing them, oftentimes, they've already been diagnosed with COVID. And I'm seeing them for their headache, either there in you know, we have a local virtual hospital. So patients will be at home in virtual hospital, but then doing video visits with me. And that's been speaking of being able to offer video visits, it has been a wonderful resource for these patients to be able to have video visits, while they're sick while they're at home. But still get acute and adequate quality neurologic recommendation and care while they're at home and not be told, oh, well, you're sick right now, nobody can see you right now. And so I'm seeing them while they're actively sick. And I'm seeing also patients in follow up, you know, two weeks months later, after they've recovered from COVID, but they're still having post COVID headache. What it's presenting as is mostly kind of whole head, severe pressure pain. So it's presenting differently than that of migraine, which by definition is this International Classification of headache disorders, three criteria for migraine, which is unilateral throbbing with sensitivity to light or sound, or nausea. And this is more of a whole head pressure presentation. Um, and so so with this, the one of the concerns, obviously, I have to rule out and make sure I'm not missing one of the more ominous conditions. And so I often have to order imaging on these patients and I'll get an MRI make sure that they're we're not seeing stroke or encephalitis. And I'm getting venous imaging to make sure I'm not missing a venous clot, which is called a cerebral venous thrombosis. The reason for that is these patients are quite hypercoagulable from COVID. And so, so because we know these patients are hypercoagulable. I'm following current guidelines which are ever changing. And one of those things is starting them if they're actively sick with COVID on aspirin therapy based on this recommendation, to help decrease the risk of being hypercoagulable. And then managing their head pain and the ways that we do that. And this is unpublished data, but this is what's coming out of new New York where obviously they had their search before we did. And so we're getting some really helpful info on that. They're using gabapentin as one of the preventative treatments for this. We're in the process right now of writing up a case series of all of our patients from around the country who have who have COVID and headache. So I'm, it's going to be nice when we actually get that published. But I think it's going to be a very important piece of literature for everybody who sees COVID patients in treating that are our headache patients.

Cliff Mehrtens  5:40  

Is it still too early in the process of COVID to I mean, obviously, you can't do a large study and ended up study because it's still fresh and new. To to form any sort of theories or anything. You're sort of like, battlefield in it right now. Sounds like as opposed to we studied this for five years, because you haven't had five years.

Megan Donnelly  6:00  

Correct. We've had a couple of months. So yeah, so we don't have any randomized controlled trials. What we have are on the ground in the battlefield, advice that gabapentin nightly 300 to 900 milligrams, each night has looked helpful for these patients who have post COVID lingering headache, who we know have, at this time, normal resolved brains, so we're not seeing strokes, encephalitis, clots or anything. So you know, they're radiographically normal patients. It looks like gabapentin is helpful. But you're right, there isn't anything randomised controlled about it, it's the same way that we're having to do everything with COVID, which is by the seat of our pants.

Cliff Mehrtens  6:46  

Um, what about migraines, and triggers? I'm guessing a stressful situation like everyone is in probably doesn't help some people who deal with that on a pre COVID basis to just if stress triggers them, obviously, they have more these days. Well, how do you deal with that? What do you suggest for someone who might be facing that battle?

Megan Donnelly  7:08  

Great questions. You know, we're all weathering the sto...

Amanda Smith  0:52  
I'm more people staying at home, they're not commuting, so they have more time on their hands. So I would say

Cliff Mehrtens  0:46  
What part of the pandemic and staying at home and all that stuff can help me lose weight.

Amanda Smith  1:01  
I think the inclination has been for most people to use that to sleep in or procrastinate or scroll through more social media, but using that commute time for your exercise, whether it's going out for a walk, or you know if you have a treadmill or an elliptical hem to hop on. So definitely utilizing that commuting time. I think a lot of people have also slowed down during this time where there's not as many activities there's not as many social gathering. So being home more can allow us have more time to prepare meals at home. So cooking more at home, making sure that you're planning your meal. But definitely, you know, reducing eating out not as much fast food to with more time, in theory we should have more time for for planning those meals, preparing those and having that time for exercise.

Cliff Mehrtens  2:06  
The other side of the coin is how is it bad for people,

Unknown Speaker  2:10  
they're here,

Cliff Mehrtens  2:11  
they're stuck at home? How does that work against you trying to lose weight?

Amanda Smith  2:15  
Yeah, so a lot of people being stuck at home we we have that constant access to food. So if you're you can, you know you might be stepped away from your kitchen from your pantry. So I think again, it kind of goes back to planning. So if you're if you're planning to have, if you know you get hungry at 10 o'clock, what's the plan for that and having a plan, just like if you were going into an office, I'm keeping what I would call trigger or red light food out of your house. So if you know, there's cookies in the pantry, and that they call your name, and that you're going to go and eat 10 cookies at 10 o'clock, then it's best just to keep this food out of the house.

Cliff Mehrtens  2:58  
I'm laughing because I have that battle at the grocery aisle. If I stay off that aisle, they can't get into my house, they get into my house, I'm gonna find them and I'm gonna lie to myself, I'm gonna eat them.

Amanda Smith  3:08  
Right. And I think that's what you know, I tell my patients all the time, you have to be honest with yourself, if you know, you might bargain with yourself and say, Oh, I can just eat too and I'll be okay. But if you know deep down in your mind that you're going to eat 10 or 15 or you're going to eat the whole bag, then it's best just to leave them in the store. But on a on a side note to that is embracing grocery pickup. I'm number one, you don't have to go in with the crowds. But number two, um, they don't impulse shop for you, they say shop and they give you what's on your list and said there's no going down the aisle and boom, that looks good. Let me throw that into my basket. So, um, I have definitely I started using grocery pickup pre pandemic, just as a time saver. Um, but it's definitely something that that I've continued to embrace because it's such a time saver, but it does help you and it helps with budgeting because you can see how much money you're spending.

Cliff Mehrtens  4:12  
What about and this does this isn't obviously COVID related. This is any year moderation. You know, dieting people dieting doesn't have to be punishment. It's more like a lifestyle change and people look at certain foods and think I can I saw this during Thanksgiving. I cannot have any dessert. I cannot have any you know, anything sweet, anything salty, but talk about moderation and how that still remains the keynote centerpiece of any sort of lifestyle change.

Amanda Smith  4:42  
Sure. So like what I try to educate my patients on is healthy balance. And so, you know, we kind of follow this idea of an 8020 rule 80% of the time we're eating you know our whole grains, our lean proteins, our fruits and vegetables but 20% At the time, like, it's your birthday or Christmas or Thanksgiving, and there's that special dessert that you look forward to all year long. That's not the time to deprive yourself of that. Still, moderation as far as the portion size goes, not overeating is a big one that I really try to pound into people's heads is you know, when you're full, you're full, don't ever eat, you'll be hungry again, in three or four hours, you can always go back and get seconds or get what you weren't able to get the first time around, but over eating, then that makes us feel miserable for many hours. Um, but yeah, I mean, I'm a big believer in healthy balance and moderation and, and and not depriving yourself, I feel like when we deprive ourselves, that's when we really fall off the wagon hard at some point. And the same thing with exercise, you know, I encourage everyone to find an exercise that they enjoy. And don't use exercise as punishment. Because if you ate a slice of pizza today, exercise because you know, all of the other health benefits and it makes you feel good, and it's something you enjoy. It shouldn't be used as a punishment for what you've eaten that day.

Cliff Mehrtens  6:14  
A lot of people do that, I'm sure. Talk about eating and stress levels. Obviously, this is a stressful time for a lot of people in the world. And a lot of people lean on food, some people do alcohol, some people do Netflix, whatever. But some people turn toward food and that can be reckless, and that can be harmful.

Amanda Smith  6:29  
Absolutely. And so I think, you know, there are many people that rely on food for stress management. So I think having a plan ahead of time for you know, thinking about what are the tools in your toolbox for stress management, I'll tell my patients to have like a comfort kit and or, you know, some sort of a stress management toolkit and what goes in it is up to you, whether it's a devotional that you read some meditation, a lot of people it comes down to distraction, distracting your mind, because really all that stress is you know, our minds start going crazy. And then you know, we find ourselves nibbling on something. So a lot of people will use things like word word search or crossword puzzles, but having that already put together and somewhere that's accessible. So when you're feeling stressed, and can stop and acknowledge that you can turn to those better tools for stress management, rather than eating. And I think it comes back to you keeping those kind of trigger foods out of out of the house. Because most people I find, when they're stressed, they're usually very specific, they're looking for crunchy or salty or sweet. And so if we can keep those kind of trigger foods out of the house, and then during stressful times, just making sure that you are taking time for that self care and the healthy eating that taking the time to meal plan, drinking your water and and you know, just really setting aside that time for self care.

Cliff Mehrtens  8:11  
Talk about the importance of just sticking with the journey. And if you only lose a pound a...

The covid 19 pandemic has caused more devastation than any disease in recent American history. Frontline medical staff have a close up view of the sadness and they too have opinions about the vaccine. Welcome to Novant Health healthy headlines. I'm Gina Teatro. The safety and effectiveness of the COVID-19 vaccine is well documented, yet some Americans aren't interested in receiving it. In this episode, Dr. David pierce a Novant Health hospitalist talks to Cliff Burton's about the damage he's seen from the virus, the uncertainty for those who have contracted COVID-19 and why you should strongly consider getting vaccinated. Thank you for listening.

Cliff Mehrtens  0:47  

You treated a lot of COVID 19 patients I've heard, tell me what you've seen close up, we hear the stories about people being alone, you're the only person they see you're the conduit between them their family, sometimes, obviously, it's hard on them, but how hard is it on you as the as the caregiver?

Dr. David Pearce  1:06  

It, it is

it's heart wrenching. And I think it divides me as a person.

The way I've seen it,

just carve, you know, an entire half of a family away from the from the face of the earth.

You know, I treat of treated

folks that have

gone to the ICU and died and I've treated other folks who I was able to discharge home just in time to make it to their spouses funeral. Wow.

Cliff Mehrtens  2:50  

What's been the biggest reason and if you had a lot of conversations with people about the vaccine, obviously, we knew it was coming, but what seems to be their biggest

Is this sort of like the people who think a flu vaccine, you're actually getting injected with some flu, and it's gonna make you even though that's wrong?

In back to the vaccine, do you get a lot of questions from family members and friends? Today? I want to talk about the vaccine or question you about it.

Dr. David Pearce  1:47  

And I've held father's ends as they weep at the news that their young adult children have died from the same disease, lamenting that it should have been them. And not, not knowing not knowing what to say, you know, people ask why this is happening. And I hear a lot of folks to say I thought I did everything right, I still got the I still got this virus and I think the vaccine could, could definitely take that out of the equation. You know, I really, I believe that that it will, it will protect and shield, the majority of people from this kind of devastation.

Cliff Mehrtens  3:00  

fear of it or step toward not getting it.

Dr. David Pearce  3:06  

I think people are concerned that the vaccine is going to make them sicker than the illness May. I think that's what people are scared of.

You know, that's difficult to say, because I don't spend as much time I guess, speaking to folks about the vaccine, as I do in the trenches with this with the illness in particular, you know, to know exactly what people's hesitation is, but I know that, as a physician, my experience has been with with other vaccines and like the flu, that people do they feel or they fear the effects of the vaccine, you know, body aches, or and then of course, there are there's a whole school of thought out out there that that vaccines cause very untoward effects isn't the bottom line that a vaccine protects you against that illness. And really, that's

Cliff Mehrtens  4:06  

the goal. I mean, that happened with measles that happened with polio, that's gonna happen with this one. You know, people are worried about others and But really, the bottom line is, it protects one person from one disease. When it first started, there was a big surge, I remember there was a lot of a lot of attention given to to caregivers, people on the frontline like yourself, what you guys were going through, but you've been doing this a long time now.

Dr. David Pearce  4:36  

I remember the first time that I had to gown up and go into a room with a patient that I knew was positive with COVID and I was terrified

Unknown Speaker  4:45  

for fear of

Dr. David Pearce  4:48  

Well, I think for fear of contracting the illness myself, right. And, you know, I think we everyone has done done the very best they can with with PE and, you know, our administration has done a great job of obtaining PPD for us and making that, you know, a real possibility or a real safety net, I think. But the exposure is still there. Yeah, people are, people are dying, people are sick. And the numbers are unrelenting. And everyone's I think everyone's feeling really overwhelmed right now.

Cliff Mehrtens  5:31  

What else sticks out in your mind when you when you lay your head down? You think in those quiet moments? What, what jumps out at you about this disease that someone on the outside might not realize?

Dr. David Pearce  5:42  

We have no idea the what the aftershocks are going to be with this disease. For the for the people who survive it. never seen anything like this. I mean, you can try to draw some comparisons with the original SARS virus from the early 2000s. And, and in some respects, I think we've seen a little bit of the same trends. But I have deep concerns that they're they're going to be some long lasting, chronic illnesses in the individuals who seem to suffer most from this disease. And I, you know, I've taken care of, of other physicians who have been otherwise healthy and we are both face to face at a loss. When the question comes up, as it does point, am I going to get over this? And the answer is I'm not sure. I don't know.

Cliff Mehrtens  6:44  

For a lot of us who's to say a 25 year old, what what's gonna happen 20 years from now, are you long, it's gonna be hard, your heart gonna be affected?

Dr. David Pearce  6:53  

You can't. And if you look at the if you look at the numbers from the SARS, the original SARS virus, they do have some data. And there's there was at least one paper where they followed folks 15 years out to see, you know, and in particular, the individuals with acute respiratory distress syndrome develop the most severe form of lung injury. With the SARS virus, about four to 6% of those individuals at 15 years out still were having problems, but remember that disease never made it out of China. And and same with Middle Eastern Respiratory Syndrome, which is also a Coronavirus in the I think 2000 10s range that or a time period that that also was a similar outbreak and but we haven't seen worldwide numbers like this ever, you know, not not not since I think the the flu pandemic of 1918 in terms of overall severity. And we really d...

Cliff Mehrtens  0:49  
What's the best way to talk to someone who politically you might completely disagree with?

Soltana Nosrati  0:54  
So I know a little bit about that I am a unique person in my family and that everyone is one thing, and I'm completely the opposite. And so the topic comes up quite often. And they feel very strongly about therapy. And this isn't just extended families with my actual parents and my sister's. And what we discovered is initially, when all of this started happening, we were in opposing sides, and it got kind of heated. And we realized that the feelings we had for each other or a little bit stronger. And so we decided to focus on the issues. So instead of talking about who this person represents, versus this person represents, we stopped to okay healthcare, what do you think should happen with healthcare, and we found that we had a lot less to argue about things worked out really well. And we haven't really had an argument in probably about four years, despite everything that's happened, including what recently happened. And I, I see this by patients a lot. So

I'm a psychotherapist working in North Carolina, there is a diverse set of opinions here. And I come across patients often who don't agree with my personal opinion, although they're not aware of what it is. And I just try to see their point, so that I can help them with the issue that they're bringing forward.

Cliff Mehrtens  2:16  
Currently, as we're getting ready to change political political parties and a new president there's a lot of rage, a lot of anger, and it's it's bubbled to the top its way and a lot of people it's consuming them. But how can you individually How can you best control your rage at the current events that are going on in America.

Soltana Nosrati  2:39  
So instead of trying to shove it down as an unacceptable feeling, it's better to acknowledge that you have the right to feel the way that you do. And you got to listen carefully here. So if I'm angry, or I feel rage, it's okay. It's a human emotion. And it might not be as comfortable as joy and compassion. It's just as much of a feeling and people say anger is not a feeling is ask anybody's in his, you know, watch the news in the last couple of weeks. Anger is definitely a feeling, the feeling you can't control. We know this scientifically, when we're all the studies that have been done that you cannot control the way you feel. It's just the way you feel. But what you do have absolute control over is your behavior, the best way to mitigate maybe some impulsive behaviors you want to get into or anything like that would be to just acknowledge first that you have a right to feel anger. If you feel anger, acknowledge it, and then try to have some compassion in the same way that you would for someone that you really deeply care about. It's the only way you can sort of think clearly, and make better decisions. Because your behaviors, unfortunately, are 100% within your control. And you could always choose different even if you do feel angry.

Cliff Mehrtens  3:58  
So we're in a small group discussing something and someone brings up a point. That's completely opposite of what I may think, politically, do I pull them aside one on one to discuss it? Do I blurt out in the crowd? You know, you I totally disagree with you, you're wrong, on and on and on? What's the most? What's the most beneficial for both parties? How should I handle a situation like that?

Soltana Nosrati  4:22  
So if it's at work, I would avoid it because I'm pretty sure every single company I've ever heard had, has a strict policy against communicating about politics. But say you're in a small group with your friends and you're just having a chitchat like a dinner or at a you know, social gathering. It's okay to express your opinion. But you want to be very careful that when you're expressing it, you're choosing your words with respect. So if you have respect, you can have opposing opinions. Now just because you're choosing your words with respect. You also are in tune to this other person. So they're starting to act out because Your opinion tends to differ from theirs, the best option would be to just drop it. Wait until like a few days later, if you are friends and say, Hey, you know, you and I don't agree, but that really wasn't necessary. You know, that kind of thing? And sometimes leaving is a really good idea. Like,

Cliff Mehrtens  5:22  
what sort of questions can you ask to get a better viewpoint of someone's political views as opposed to being attacked using attacking sentences and words like that? What can I ask to get a better viewpoint with the way they might be thinking?

Soltana Nosrati  5:39  
So it depends on what they're thinking. Like I said, if it's if it's a strong opinion about a particular person, like the president, or a particular governor, or what have you, you're a highly unlikely to get very far. Because you can't argue with who you like and who you don't like, right? It's very, they either like them, or they don't. That's kind of how it falls. But if it's about a topic, I would ask the I often say things like, Well, why don't you educate me? educate me about you, and then ask questions that are meant to invoke information versus emotions. So okay, so I see that you don't like the new policy about health care? What is it that you don't like? And who have you seen done it? Do it better? Or what do you think is a better solution? So you kind of can gather information that's useful versus inflammatory?

Cliff Mehrtens  6:33  
What are some good tips to to find common ground, I realize this person may not know this group of people may not agree with me, and I'm never going to convert them. But how can we find common ground where we can coexist without, you know, burning down buildings or really attacking each other,

Soltana Nosrati  6:48  
um, focus on the basic needs. So everybody who has children cares about the children, everybody that has a home would like to keep it. Everybody wants to be able to work and support themselves. That's usually a common ground, regardless of what the political party is, or where that person happens to be in life does that. So it's very easy to have a productive conversation when you focus on the basic stuff.

Cliff Mehrtens  7:16  
What are some tips to avoid a confrontational tone, it's easy to yell and scream. And I call you an idiot because you don't think like I do.

Soltana Nosrati  7:28  
I am a hothead. I have a temper, I jumped into my into my my cultural background. But one of the best things that I learned is if you are going somewhere where you know, like, for example, is in a party where you know, some people will agree with you, and some people don't. My suggestion is, before you even knock on that door, take a few cleansing breaths, right? And remember why you're showing up in the first place? Like why are you going to this dinner party, when someone is having a saying something that you find to be upsetting pay attention to y...

Cliff Mehrtens  0:46  
What is the preferred length? for an adult nap? Yeah, for most people, it would be about 20 minutes or less.

And why is it called a power net? Kinda it's a short. It's a short, relatively short time period. But it provides a lot of benefit. So what are the what are the main benefits of

Dr. Nancy Behrens  1:14  
so a power nap can help you to feel more alert less sleepy, can boost your creativity, your productivity, and even help with your immune system.

What happens Some people claim that's not enough there, it takes them 10 minutes just to get their pillow comfortable, they need to polish off a 90 minute nap in the middle of the day. That leads to something I learned called sleep inertia. So explain how sometimes too much napping can be not beneficial to you in the middle of the day. Yeah, if if you sleep for 20 minutes or less, you're more likely to stay in the lighter stages of sleep, which can be refreshing and during that time. But if you go for a longer nap, like over night, over 30 minutes, you're probably going to enter slow wave sleep. And that's a very deep stage of sleep that it can be hard to wake up from. So you might actually feel less refreshed. If you try to wake up during slow wave sleep. If you go past 90 minutes, you're more likely to get into REM sleep. So if you go through a REM cycle, you could wind up feeling more refreshed. Somebody who's pretty sleep deprived to start with who's not getting enough sleep at night, might feel better after a longer nap like that, where they do get around period. But then we get into the danger that if somebody is sleeping for prolonged times during the day, that can make it harder to fall asleep at night and take away from your nighttime sleep. I wanted to ask you about that the timing of an app is important. You don't want to do it too early in the day. Pretty soon after you wake up. You don't want to do it too close to bedtime. What's optimally the best time? If you feel you have to take a quote, power nap? What's the best time for that? Yeah, for most people, that would be early afternoon. Most of us do have a dip in our alertness and energy levels, early afternoon like after lunch. And that's when some countries do actually take a siesta.

So if you're able to get a power nap in after lunch, that's a really great time to be able to do it.

Cliff Mehrtens  3:19  
What's specifically happens to your brain when you do take one of those naps that's beneficial. I mean, neurologically speaking for for a common person, can you try to explain to what that does to us how it helps us wake up to be more refreshed and sharper? Yeah, your brain kind of gets to rest a little bit too now from all the external stimuli and everything that you're doing for work. So you get a break that way, you go into a later stage of sleep, there are actually some changes in your brain chemistry. One chemical that's involved is adenosine. And that's a chemical that caffeine affects and sleep does as well. So a natural way to increase your alertness by affecting adenosine would be to get a little brief nap.

What sort of setting is important for a nap? I know a lot of times the sun is shining or it's July or it's noisy in my house. What what sort of things would you recommend someone who really wants to establish a good place to take this now? Yeah, so if you're actually able to get kind of away from everything going on, if you're able to lie down someplace comfortable, make everything a little bit darker, or use a sleep mask if you can't dark, dark in the room. earplugs can be helpful as well. So darker, quiet light down. If you have a little light blanket, even for your brief nap it'll probably be a more refreshing nap. You're more likely to doze off a little bit during that time that you have. Sounds very similar to what you'd recommend at night. Keep it? Yeah, kind of controlling the environment making it conducive to sleep.

Gina DiPietro  10:10  
Hello Jeannie dipietro again. As you heard a well place to nap is an easy and effective way to boost your energy and avoid dragging through the rest of your day. It's okay to schedule some downtime as little as 20 minutes works fine. Even if you don't fall asleep, you're giving your brain a rest and that will jumpstart your productivity and creativity. For more practical health tips and information search Novant Health healthy headlines. And if you enjoyed this podcast, please take a moment to rate and review us and subscribe to this and all the Novant Health podcasts. We post new episodes all the time. Most are just 15 minutes. Thank you for listening

Cliff Mehrtens  4:58  
What about people who feel They always need a nap, they're always playing catch up. Could that be signs of some sort of sleep disorder you have, you're not just tired, because you woke up early, you really have something going on at night when you should be sleeping solid.

Dr. Nancy Behrens  5:11  
Yeah, so if somebody is always feeling sleepy or fatigued, and especially if they are allowing enough time for sleep at night, which for most people is around that eight hours, although it can vary for some individuals. But if you're never feeling refreshed, we do worry that you could have some kind of a sleep disorder. Sleep apnea is a common sleep disorder that we see where people stopped breathing at night, often their their snoring and waking up during the night as well. Some people have restless legs and leg movements during the night. Some people act out dreams where they're actually thrashing around and fighting in their sleep. And then if these things are not going on, as somebody who's very sleepy during the day, we consider disorders like narcolepsy.

Cliff Mehrtens  6:01  
Is there a magic number for naps? If um, should I look at how many I'm taking per week? Or per month? Or is it just okay to do them? periodically? If you just feel like you need one?

Dr. Nancy Behrens  6:12  
Yeah, it's okay to some people actually do make a point of putting some time aside to rest possibly doze off during the day. And that can be very healthy. It's a nice way to decrease your stress levels. Even if you don't doze off for an actual nap, just taking that time to kind of be quiet, rest your brain relax a little bit can be very healthy.

Cliff Mehrtens  6:35  
Have you seen I know a lot of times stress plays a part in sleep or interrupting someone sleep. Have you seen during COVID-19 a time when a lot of people are stressed out about various things? Have you seen a lot of disruptions, more disruptions I should say, Now during the pandemic than normal?

Dr. Nancy Behrens  6:53  
Well, different things are happening. Um, one good thing coming out of the changes in a lot of people's lifestyle is that we've seen people, some people getting more sleep, because if they're working from home, they don't have that commute time. So they might be able to sleep in a little later. So there is a group of people that's actually getting a little more sleep and feeling better that way. On the other hand, a lot of people are stressed a...

Cliff Mehrtens  0:37  
What are the safety precautions that athletes have to take during this time of COVID-19 I know it's different depends on what sport you play, what county or state you live in, what age you are, seems different and they're all being jumbled and stuff. But overall, what sort of safety precautions should a person take and let's break it down practice in game think that it's important to

Adam Culver  1:02  
acknowledge the personal responsibility that you have.

You know, and set a good example for your teammates as well as others out in the community as an athlete, that you need to be following the rules and making sure that you're doing everything that your authority figures are telling you to do. So whether that wearing a mask social distancing on and off the field, if at all, or court if at all possible. washing hands vigorously using hand sanitizer, all these sorts of things that we've been advocating the general public, do it exact same measures apply for, for athletes. In particularly with practice, the setting is a little bit more controlled. So on the individual team level, you've got coaches, trainers, etc, who can put some forethought in and figure out along with parents and other stakeholders, you know, what's the best, what's the best way to keep the athlete safe. And that's, that's different for each individual sport, etc. Like he, like he said, Game Day Fortunately, the North Carolina High School Sports Association has thought about these things as well. And so they're their guidelines that are in place to ensure that our athletes stay safe. And as well as community members and coaches everybody else. So if if you don't if, if folks don't know what to do, Surely there's somebody on site who does know what to do in terms of keeping keeping you safe.

Cliff Mehrtens  3:11  
Now, some sports are different, obviously more risky in terms of COVID-19 and others baseball and basketball, excuse me, football and basketball and much more body contact that if you and I are playing tennis across the net from each other, what sports to use, the more riskier and which ones are perhaps not as risky in terms of the virus.

Adam Culver  3:33  
So I think sports that when you have that physical, physical contact or there's a ball being passed around any anything that can allow a respiratory droplet to be easily exchanged to another person. So those are going to be things with physical touch. Like you said football basketball or their contact sports. So those are those are going to be your primary sports where you where you get concerned about spread in that way. Not that the other sports that are non contact Are you know, full foolproof, but definitely those contact sports have carry more of a risk in my eyes.

Cliff Mehrtens  4:30  
Is it safer for young athlete to be on a travel, you know, by cross state lines, somebody's going into Virginia, South Carolina we places like that. Your sports have become year round now basketball teams play around baseball teams play here. What about travel teams and safety.

Adam Culver  4:47  
So that's going to be again dependent on what the case numbers case load positive positive tivity rates, what they are in one the place that the athlete is coming from and then where the athlete is going. So that that's more specific, you know, you have to kind of look at that either on a case by case basis.

Cliff Mehrtens  5:20  
What about athletes who maybe have been inactive for two or three months not working as much as they would be if they were doing organized workouts throughout their offseason? They're excited they're getting back into it, the risk for injury is is a little bit higher, you know, certain injuries, what certain injuries should you be aware of, for, you know, lack of a better term, just going at it too hard, too fast, right out of the gate.

Adam Culver  5:47  
So that sets a good stage up for tendinopathy for folks that have issues with heat acclamation for his folks just to be over exerting themselves. And you know, because they haven't given their bodies the proper time to get used to putting the type of athletic stress that they normally wouldn't have gradually built up to, and been able to handle. So, to combat that, I've, what I've been telling folks is, stay ready, so you don't have to get ready. One of the things I love about sports is that there's so many parallels between regular non athletic life, and then what you do on the quarter field, and just like, you know, me as a doctor, I serve my patients best if I'm prepared, and I know what's coming in the door and thought about how I can help them best. So as athletes by just staying prepare, staying ready, keeping in shape as best they can. And, you know, I find that, that general preparedness is, is key in all facets of life.

Cliff Mehrtens  7:25  
Talk to what about what if a young athlete does contract COVID-19? What should they do medically? Or what should parents do medically? when can they return? Because that's the first thing they're going to ask, When can I get back to doing what I do?

Adam Culver  7:40  
Right. So generally, first off, we we need to see, if you suspect COVID, you need to contact your primary care provider to see what's the best way to get tested. If you have high a high index of suspicion, you want to be responsible and protect teammates and you know, others may be in close contact with you. So consider quarantine starting to self quarantine so that you don't spread it to those other parties. Of course, let coaches trainers, authority figures know what's going on. That's first off. And then once you if you do get a test and you test positively. What we've been having folks do is make sure that they quarantine 10 to 14 days from their first or from that from their positive test date. And throughout that time, they should be in contact with their primary care providers, letting them know if there's any change in symptoms. etc.

Cliff Mehrtens  9:08  
Gotcha. Gotcha. All right. Now I want to move into more of like the mental aspect of it. It just sort of asked you what can athletes and how can athletes feel you know, with a metal last season being postponed, or canceled or the uncertainty of Oh, if somebody else gets it? So this Friday, and I just found out on Thursday, you're just the whole athletes are used to routine. They know this time is needed when I do this, this time of the season is when we play this guy. But now things are a lot more jumbled. How do you help young athletes deal? What should they think about mental?

Adam Culver  9:46  
Again, I think this is one of those areas where there's a lot of parallel between regular non athletic life and your athletic life. So again, stay ready so you don't have to get ready. So if you continue to stay prepared for competition, whenever you are allowed to compete, whenever that whistle blows, you're ready to compete. And you don't run the risk of some of the injuries that come when you're not prepared. And I know that there's a lot of anxiety, definitely some stress and sadness about some of the uncertainties that COVID has, has brought.

Cliff Mehrtens  10:36 &nb...

After months of waiting, there is finally light at the end of the COVID-19 tunnel with the emergence of three new vaccines. Welcome to Novant Health Healthy Headlines. I'm Gina DiPietro. In this episode, Roland Wilkinson speaks to Dr. Charles Bregier, Novant Health medical director of corporate health, about the safety and necessity of these promising new vaccines.  

Roland Wilkerson  0:00  

So first, let's just talk a little bit overall about the incredible success story behind vaccines. I think there's been a lot of attention around people who question their safety. But the reality is, the vast majority of Americans get vaccines and trust them for themselves and their children, is that your experience as a physician, it's

Dr. Charles Bregier  0:24  

absolutely the truth that vaccines are very safe, and very helpful. And if you look over the history of vaccine development through the last hundred 150 years, it's really come a long way, with a tremendous emphasis on safety, and extensive studies that are usually done to make sure that they're safe. And you also have to think about the fact that we've learned a lot about vaccine development and learned a lot about do's and don'ts about what's safe, and what's not so safe. So know, based on you know, what we've learned for so long, it helps influence the approach to new vaccine development to make them much safer. And then you think about the the approval process with you know, stage one, stage two and stage three trials to get through you larger and larger and larger in terms of number of participants. And if there's any significant adverse effects among anyone, they often stop and look hard to see if there's anything that really could clearly link, a bad side effect or bad outcome with the vaccine, as opposed to what happens in the world at large. You know, like, you know, for example, people get in car crashes all the time, or fall off a ladder, or have things happen. And so there is a certain incidence of infections and illnesses and injuries that happen all the time. And so when you're looking at adverse effects, or possible adverse effects of the vaccine, you need to look and see what are the statistical risk of having that adverse outcome in the general population, and compare that with incidents maybe happening in the trial population that's received the vaccine to see if there's a difference, because if there's not a difference, then it's very difficult to make any assumption or assertion that there's relationship between the two.

Roland Wilkerson  2:27  

And we know that health care workers are going to be among the first who get the vaccine. So they are putting themselves out there on this, which I guess is the, you know, obviously, a vote for their competence as a safety of the vaccine.

Dr. Charles Bregier  2:44  

Yes. And I think that, from what I have heard, and just doing some polling of co workers and people that I've talked to, within Novartis and across healthcare, that the vast majority people are very interested and receptive to getting the vaccine, especially because COVID not only does it have a one to 2% mortality rate, but it also has a significant no morbidity rate in terms of long term feeling misses and recovery, recuperation periods, and possibly, you know, prolonged, you know, lung disease, other problems that could go on for a long time. And so we want to avoid all of that as much as we can. I think it's also good to think back to the fact that there's been a lot of hysteria that's demesne developed about vaccines, and, you know, possible adverse effects. And for almost all of them, especially ones that have been developed in the last 50 to 70 years, it's really not borne out to have any real validity. So, you know, you hear some things used to hear some things back in the 70s and 80s and 90s. About does the MMR shot cause autism? And the answer is No, it doesn't. There's never been a well, well done study that showed any relationship between them, that scenes save lives many more time at a much greater scale than any illness they may cause which is extremely rare.

Roland Wilkerson  4:09  

Are you getting a lot of questions from friends and family about the coming vaccine? A lot?

Dr. Charles Bregier  4:16  

Yes. People are asking me what do I think about it? And I said, I think it's very safe. I think there was over 40,000 people in both the Pfizer trial and the mudrunner trial, and no significant adverse effects noted in any of them several months after the trials have been concluded. And that's when you would expect to see adverse effect to be within the first month or two. So there's no bad effects have been seen. And people say to me, would you take the vaccine, and I'll say absolutely. The first day the vaccine is offered to me, I will stand in line to get it because I don't want to get COVID I know that the likelihood of me getting severely ill or even dying is a million times greater, perhaps literally a million if not 100,000 times greater from the from the COVID virus than it is from a very safely manufactured vaccine that's made from no inactivated. Genetic reproductions of

Roland Wilkerson  5:22  

different parts of the virus. So much has become politicized around this. What do you say to people who wonder how can we trust the government to get this, right?

Dr. Charles Bregier  5:37  

So, basically, I think CDC and FDA and wh O, so both national and international, widely respected and reputable organizations, take a good hard look at this. And they are the ones who really hold the drug manufacturing companies who are developing these accountable for the results. And for accuracy. I know that Pfizer a week or two ago, basically asked for their emergency use authorization from CDC and FDA and during a has similarly done so a couple of days ago, they will look very hard at all the data, and all the reports and all the information from all the people in these studies to make sure that they truly are safe. I truly believe that our government and CDC and FDA really have what's best for me and what's best for us in mind. I don't think that they want to do anything to cause anything bad to happen to me or anyone in this country. Conversely, they want to save lives and protect lives and improve health. That's what everything has become. And the proof is in looking to see what has happened in in medicine. Over the last couple of generations. You look at life expectancy, and you look at quality of life, both have increased and improved dramatically. But majority of people are born today are expected to have, you know, lifespans of up to 100 years now. Well, that, you know, was very rare a couple of decades ago. And it's because of all the initiatives and things we've done to make us healthier. And a lot of that has to do with preventing diseases like measles, mumps, rubella, influenza, COVID, all kinds of things that that vaccines are made to prevent.

Roland Wilkerson  7:31  

And to your point, the experts making these recommendations. They're scientists and doctors. So they're not the they're not the political side of government. They are, they are doctors and scientists.

Dr. Charles Bregier  7:44  

Yes, that's exactly right. So it's doctors and scientists for the working for the drug companies who are developing these, it's doctors and scientists for you know, FDA and CDC and who and others who have tremendous knowledge and experience in vaccine developm...

Dr. Cathy Rolih  0:01  
I think the first thing to do is to take a deep breath. Diabetes is an incredibly prevalent problem. Probably all of us know someone who has type two diabetes, either a parent or a sibling, or a spouse or a friend. And we've heard about all the negative outcomes that can happen related to diabetes. And therefore, many people come into the discussion with a high degree of fear and concern. And I have had patients break down in tears in my office, when I tell them that they have diabetes, because they have internalized all the negative messages in the world around them about diabetes. So first thing to do is take a deeper, second thing to do is to learn as much as you can, and educate yourself information from a reliable source. So don't go to Dr. Google and search diabetes, what do I do go to a source of reliable information. And the two places that I tell my patients to go to is the American Diabetes Association for both type one and type two diabetes, and to the jdrf. For patients with type one diabetes, those are national organizations, which really collect evidence based information, and authoritative and well founded recommendations for patients. So the American Diabetes Association website is diabetes.org. And the jdrf website is jdrf.org. So those are good places to start.

Roland Wilkerson  1:40  
So we all Google everything. What's wrong with googling type two diabetes, when you've gotten some really sad and surprising news,

Dr. Cathy Rolih  1:49  
probably googling type two diabetes is the same problem as googling anything, you don't know what you're going to get. Right. You know, just because it's on the internet doesn't mean it's true. And for people who are looking for information in a heightened state of concern, and high emotional state, they may not have as much ability to filter and critically evaluate the information that they're receiving. So that becomes important anytime, really, that you have a new health diagnosis is go to the most authoritative source. And your health care provider can also direct you to sources. So ask them where should I go to find more information, that's a good thing. Another place to find good information is to be from a diabetes education program. So people with type two diabetes in particular, who are newly diagnosed, should make sure that they're referred to a certified diabetes educator, and most communities, we can have places for people to receive that information.

Roland Wilkerson  2:53  
We talked about the best thing to do when you've gotten a diagnosis, what's the worst thing you can do besides looking for information and all the wrong places?

Dr. Cathy Rolih  3:01  
I think the worst thing to do is to panic and take on a fatalistic attitude. I have interacted with a lot of patients who have had family members with diabetes who have had bad health outcomes, and who's feeling has been when they found out that they were diabetic as well, that doesn't matter. Doesn't matter what I do, this was inevitable. My mother had a heart attack and stroke and my father developed kidney failure. So it's inevitable that that will happen to me too, and they just kind of threw in the towel from the beginning. That's the worst thing that you can do. So there are things as an individual with diabetes that you can do to improve your health. Those include learning as much as you can, about the disease process, working on increasing your physical activity. If even if you're not an athlete, or a jock, any kind of physical activity can help. Don't, don't think anything is too small. So even small changes are important. If you are completely sedentary, walking down to the end of the block, and back once a day is more than a good start. Another thing to do for patients with type two diabetes is to find a way to lose weight. I tell that to all of my patients. And I also add that's an easy thing to say and a difficult thing to do. But weight management really is critical for controlling diabetes, and the better you control your diabetes from the beginning, the better your outcome really is over the long run. And then the third tip thing is to listen to your healthcare provider regarding their recommendations regarding medication therapy, so not everybody needs to be on medication from the beginning, but some people do and sometimes that includes insulin, and oftentimes for People who have very high blood sugar elevation, insulin is the only choice we have, initially to manage their blood sugar. And with time, with changes in lifestyle, and improvement in weight, many patients can cut back or even eliminate their insulin therapy or even if they're on it immediately after diagnosis.

Roland Wilkerson  5:21  
Yeah, in some cases, can't you reverse your type two diabetes, or at least substantially improve your condition? Yeah, I

Dr. Cathy Rolih  5:31  
don't think it's over. I think that's a good statement. I myself have seen quite a number of patients who have made some very significant lifestyle changes and have been able to, and who had diabetes for a long time, actually, who've been able to, quote unquote, reverse their diabetes, particularly, to things weight reduction, sometimes not a lot, sometimes 15 or 20 pounds, sometimes more 50 or 60 pounds, depending on where the patient is in the course of their disease, and significantly decreasing their carbohydrate intake. So people who are on very high carb diets who drink lots of sugar sweetened beverages who eat a lot of starchy food, by making changes and significantly cutting back on the carb content of their diet can have significant improvement in their diabetes control.

Roland Wilkerson  6:26  
What are some of the key risk factors for type two diabetes,

Dr. Cathy Rolih  6:31  
there are several things to think about probably the number one thing to think about is body mass index. That's the calculated number that's kind of correlates your, your weight with your height, the higher the BMI, the worse. So if you have a BMI of over 30, year at an increased risk for diabetes, so know what your BMI is,

Roland Wilkerson  6:53  
and that's something that we can all look up there.

Dr. Cathy Rolih  6:56  
That's where Google comes, yeah,

Roland Wilkerson  6:58  
go to the CDC website, they've got a calculator if you're worried about other calculators, so this is something we anybody can do.

Dr. Cathy Rolih  7:05  
That's easy to do, you can do that yourself. So find your BMI number one. Number two is know your family history. People who have a first degree relative that is a parent or a sibling with type two diabetes have an increased risk of type two diabetes themselves. Those are people who, who should be aware and should be screened a third group is, well, it just is as you get older. So the American Diabetes Association recommends screening people after age 45. Because of prevalence of diabetes, type two diabetes increases with age,

Roland Wilkerson  7:43  
it is there a specific test for type two diabetes,

Dr. Cathy Rolih  7:46  
there are different ways to look for diabetes. In general, a fasting blood glucose value can be done basic...

Transcript:
Cliff Mehrtens  0:07  

Welcome to Novant Health Healthy Headlines. I'm Cliff Mehrtens. Smartphones are prevalent especially among teenagers. But are they doing more harm than good? A study recently published in the Journal of American Medical Association psychiatry suggested that teenagers who spend more than three hours a day on social media are more likely to develop mental health problems, including depression, anxiety, and aggression. For some insight into teens and social media, we talked to Novant health psychologist Dr. Courtney McMickens show discuss the dangers of social media, what parents can do to monitor their kid's activity there, and some tips about setting ground rules. You can find stories like this and hundreds of others by searching Novant Health and Healthy Headlines. Thank you for listening. 

Dr. McMickens, there's been a direct link and a recent study between the amount of screen time social media the teens spend on their social media devices and loneliness, depression and anxiety. Is that a real thing? Do you see that?

Dr. Courtney McMickens  1:13  

it is something we see often in the clinic. It's hard to say which came first, the social media exposure and interest versus the anxiety and depression. But what we do know is that spending lots of time on social media has been shown to be linked to depression and anxiety, as you mentioned, and it also facilities facilitates this isolation of kids to their rooms and away from other relationships in their lives, such as their parents or their friends. And they become absorbed in some of the comments and the likes and the comparisons. That's what I see a lot in clinic is a lot of concern about what other friends are doing, what they're seeing on social media, some of the replication of what is happening on social media that causes these consequences that are not always positive.

Cliff Mehrtens  2:15  

And that manifests itself how what do you see these young teens dealing with?

Dr. Courtney McMickens  2:21  

So a lot of worry about how they'll be perceived, if they're doing what their other friends are doing. Some kids do have limitations around this social media. So they worry about the fact that they have to tell their friends, they don't have Snapchat, or they don't have a certain platform, or they're not allowed to. And so then they start to feel as if they're not connected to people. So that can lead to some sadness and loneliness as well.

Cliff Mehrtens  2:53  

Seems like almost irony, because social media was developed for us to all connect to each other. But in a way it sort of can push people, teens and adults alike, push us into our isolation. How does a parent as a parent, what sort of advice would you give for them to deal with some signs they might see their child struggling with?

Dr. Courtney McMickens  3:15  

Well, first, I want to talk to your team about engaging in social media from the beginning, and set some ground rules as far as you having access to their page, being able to log on and check what they're doing, especially for younger teens, who are just getting out. Or just getting into that adolescent stage, and may not have the same awareness socially as older teens may. And also setting some limits around time that you use social media. And you know, making a rule about dinnertime knows no phone at the dinner table, that type of thing, so that you stay connected to the real relationships. And I think the challenge is that, and you know, this might be a generational thing. But some of the challenges that kids, adolescents view some of these relationships as real relationships, where we know that relationships include some physical contact, we it includes some ability to exchange in a bi-directional way, as opposed to one sends a message and wait for a response type of thing. And so and you want this long term, kind of history, so parents with their kids or kids with school people they attended school with, you want to have that type of relationship, as well as these relationships you have with people over the internet. So I think having that conversation initially, and talking about things to look out for when people are maybe showing signs that they're not engaging healthily in an online relationship, asking you to do things that you don't feel comfortable with, threatening to kill, tell people things about you that you've shared with them, and secrecy via the internet or social media, kind of knowing those land mines per se, from the beginning, and then setting some some some limitations around how we engage with social media.

Cliff Mehrtens  5:19  

This is a relatively recent development, obviously, with more people carrying smartphones and social media becoming a big thing. It's hard enough being a teeen anytime in history. This just adds to it. What are some of the other general things not related to social media that you see teens have to deal with? Just because that's the, you know, demographic they're in right now?

Dr. Courtney McMickens  5:43  

Well, I think it's always important to take a step back. And when we talk about anxiety, we're talking about our normal feeling, right? So all anxiety is not bad. Anxiety is like this feeling you get when you there's a perceived danger or perceived threat. And throughout developing mental stages, kids have anxiety that's normal, like an eight month old, who has anxiety about separation, or a four year old, five year old that has anxiety when they first start kindergarten, or preschool, that's all normal. The tricky part is when you get into developmental anxiety that goes beyond what we would typically expect and starts to interfere with functioning. So in adolescence, you know, the key to being an adolescent, that is all very egocentric, it's about them. And everybody's kind of looking at them and evaluating them. And so when you think about how that plays out, with friends, and, you know, making, forming a friend group, or deciding which sport to play, or deciding what you're going to do when you graduate from high school, and there's always this anxious about, well, are people going to judge me for my decisions? Or are people going to judge me for what I'm wearing. And so that's just kind of amplified in the social media context. But it's also amplified on a day to day basis, because everyone you go to school with now has access to other parts of your life that they wouldn't ordinarily have access to, which I think is what makes it different now than before, because either knowingly or unknowingly, you're giving people more of a intimate look into your life by sharing some of these details.

Cliff Mehrtens  7:31  

How do kids deal with that? And what would you recommend for parents who might enter into the world of cyber bullying?

Dr. Courtney McMickens  7:38  

Yeah, I would say from a most conservative standpoint, and I actually think this is probably the safest thing until we kind of know how things will pan out in the future is, is limiting access to smartphones at that age of 12 and 13, where they're not really necessary, and they may cause more harm than good...

Transcript:
Roland Wilkerson  0:06  

So the concept of wellness is completely saturated in American society these days. You see it everywhere. From prominent discussions on sober government websites like the CDC, to Gwyneth Paltrow was famous; what many would call infamous website known as Goop. This is Roland Wilkerson with Novant Health Healthy Headlines to help cut through the hype and misinformation often rampant around wellness claims. Today, we spoke with Nova health integrative medicine expert, Dr. Russell Greenfield, who has some thoughtful advice on evaluating the claims often issued under the broad umbrella of wellness. And we should note that the idea of wellness, taking care of yourself, is at the core of integrative medicine, which focuses on treating the whole patient.

Dr. Russell Greenfield  0:52  

I think you know, it's a little crazy out there. It's a little wild west, there's many, many, many products and all kinds of things. that people are saying we should buy, I think it's most important for listeners to understand, at least in my frame of reference, that health and wellness comes from within. And so really the role of a health care practitioner is to bring forth what we were all born with that innate capacity to heal, to be in balance, to respond well to treatment, if it is necessary, and to hopefully stay well through the long haul. We don't need a whole lot of external factors to build up our immune system or things of that nature, we need to participate in healthy means of living, we need to eat relatively well, we need to sleep relatively well. We need to manage our stress, we need to move there are certain compliments to conventional medical care that we might explore. And we need to honor and use conventional medical care where it is necessary. A big part of what we try to do Roland is, again make people comfortable with the idea that they don't have to choose between either or they don't have to choose between conventional medicine and a more natural approach to health and well being. There's a way to actually combine them. So we try to take that either or make it and help people participate more fully in their care and give them where possible, a greater sense of control over their future health. And we'll be.

in in in like in a sentence or two, what is wellness?

That's a tough one. But I can tell you what we think health is in my field. We define health as balance and balances, dynamic changes moment by moment, day by day. But what we really talk about here is resilience so that whatever comes our way, we can bounce back and get into that space of balance. So it's really comfort, resilience, ease. And what a lot of that means is again, building up what we were born with. So whether you use the term health or wellness, whatever the case may be, I think it's really more about helping people reach their true potential. And that means each and every one of us, including myself.

Roland Wilkerson  2:52  

And I think her point here is that basically the great American money machine has recognized that in a rate of medicine is catching on. And so you've you've got some characters who they're not medical providers, but they're people pushing supplements, and, and other things. You know, in the name of holistic medicine when in fact, it's really not holistic medicine.

Dr. Russell Greenfield  3:20  

It's true. And you know, just taking a look with social media and the internet and you can find all manner of information, anything that you really want to believe in to be honest with you, it doesn't necessarily mean that it's beneficial for us. So, you know, to the degree that we take a look at things like vitamin supplements and herbs, you know, it's fascinating. It is estimated that there are anywhere between 70,000 and 80,000 products out there that could be termed vitamin supplements and herbs, to be honest with you, my team myself, the physicians and physician assistants that I work with and the pharmacist, we believe in perhaps 20, maybe 25 of those products, but going into the health foods store or even our supermarkets nowadays, and certainly going on to the internet, it would be it would be easy for anybody could be convinced that any one of these things, any one of these 70,000 things could be beneficial for me. How do we decide? And does health really come in a bottle? We don't think so except with rare instances where perhaps a specific medication may be warranted, or even a specific vitamin supplement or herb might be warranted. But the majority of health actually comes from what we were born with. And the goal of a healthcare provider is to bring forth that innate healing capacity to its greatest benefit. And then if we need more than that, we can offer that too. We all need to take additional responsibility or maybe even most responsibility for our health and well being. So that means working with in my estimation, a good conventional medical practitioner, good primary care provider, etc. But it also means doing our homework, finding the good resources, finding the good references, find the good books to listen to finding the good people to learn from and do That in concert with our physician so that it's not separate, you know, you people are stuck in this equation of either or either they're going to use conventional medicine, or they're going to use this complimentary even alternative medicine stuff. And that might include vitamins, supplements and herbs. We try to take that either or, and make it an equation that looks more like and so for an otherwise healthy person, to be honest with you, the best opportunity for us as integrative medicine practitioners, is to work with somebody who is already well, and see we can make simple tweaks to their regimen to try and help keep them that way. So does everybody need a vitamin supplement herb? No. There are certain ones that were a little bit more fond of because it just so happens that people are a little bit more deficient. And let's say vitamin D as an example. probiotic therapy may be beneficial for a significant number of people, women over the age of 40 are more likely to be a little bit low in magnesium and so we might recommend those things. But beyond that, it's really based on the individual. So to make a blanket statement that everybody It requires a multivitamin everybody requires calcium or everybody should take coins MQ 10. I simply don't agree with that.

Roland Wilkerson  6:07  

Gotcha. So let me go let me go deep on one little topic because a couple of people I work with mentioned it all the sudden, charcoal is getting a lot of attention these days. What's your take on that?

Dr. Russell Greenfield  6:20  

Largely charcoal is being promoted as a way to detoxify, to get rid of toxins that were exposed to in the environment, and maybe even certain foodstuffs and things of that nature. Used sparingly, I would say, I don't think it's going to hurt anybody. The downside is to remember especially if you're taking medication or even vitamin supple...

Transcript:
Roland Wilkerson  0:06  

When it comes to cancer treatment and care, most of us think of chemotherapy, radiation and surgery. But there's another level of care that can be offered right along with traditional medicine. It's called integrative medicine, and it focuses on treating the entire mind and body. I'm Roland Wilkerson, and in this episode of Novant Health Healthy Headlines, you'll hear Dr. Russell Greenfield explain how integrative medicine, working in tandem with your oncologist and other providers can help with your recovery. And for our Charlotte, North Carolina area listeners stick around at the end to learn about a conference on the integrative medicine cancer that's coming to Charlotte on October 26.

So what is integrative medicine and what does it have to do with treating cancer patients? 

Dr. Russell Greenfield  0:58  

Thank you for asking integrative medicine. My peers and I defined as healing oriented care that takes account of the whole person. So certainly its body, but it's also mind its spirit, family, community environment, it's all of that. So we are indivisible systems and conventional medicine parses us out, you know, our physical body over here we take care of our spirit over here. in integrative medicine, we say we have to look at the totality of a person, we have to look at the whole person before us in order to help optimize health and well being and bring forth that gift that they have within that innate capacity to heal, to respond as well as possible to treatment and to fend off disease. That's our goal to bring that forth wherever we can. Now, we're not saying that this is alternative medicine, alternative pretty much implies we're not going to use conventional medicine. So we're not saying to folks, Hey, you know what, don't do surgery, don't do radiation or chemotherapy. Just take this herb. We're not saying that we're saying that we have a trust and a belief in good excellent conventional medical treatment. But together with that, there are things that people can do on their own to enhance their health and well being, maybe even enhance the successful outcome of treatment and help minimize side effects and stay well for the long haul. But that's where we come in, because there's so much information out there internet books, health, food stores, etc. Where are you going to go for credible information, we would like to believe that you can come to us, because otherwise, you're going to sources that may not be quite so credible. And then oftentimes, patients are uncomfortable going back to their doctor and asking questions about these types of things. Because they feel like they're going to be judged, or just flat out told, don't take any of that stuff. But there's so much pressure out there on the internet or in the media, or amongst our friends or other practitioners saying, well, you got to take this and you don't even have to tell your doctor about it. The problem with that is that some of these things we might take might actually counteract the conventional medical treatment we're using to try and beat that cancer in the first place. 

Roland Wilkerson  2:57  

What's an example, Dr. Greenfield. an integrative medical practice when it comes to cancer that wasn't done a generation or two ago. And how's that going? 

Dr. Russell Greenfield  3:09  

In the United States has actually been quite a growth in integrative medicine practice, starting with education that has been going on oh, I would say since the late 1990s. But remembering that even folks who have not gone through, let's say, formal fellowship, education, there are a lot of people in this country and beyond who said, you know, what, just focusing on prescription medication, there's got to be more to help. And so there are folks who were very brave and very forthright and saying, I'm going to learn more, and I'm going to work towards transforming our healthcare system to really make it be about health. So there are lots of brave individuals out there who saw that there was something better who explore things like acupuncture, explore things like Mind Body therapies, who took a look and discern between what might be promising what might be harmful and dangerous. And so there's a lot A lot of different things going on. And so now within the cancer space, there are societies like the Society for Integrative Oncology, which has many, many members. There are institutions like our own Novartis health, but also MD Anderson, Sloan Kettering, etc, that are all offering aspects of integrative oncology. In fact, National Cancer Institute certified comprehensive care centers, the vast majority of them offer some form of integrative oncology. Why? Because number one, our patients are asking about it. Number two, we have to help keep folks safe in the midst of all this. And number three, we want to give them ideas about things that might actually help them. So to that end, one of the things that's different these days, acupuncture is being used widely. Why? Well, in theory from a Chinese medicine perspective, part of what acupuncture does is it balances the chi, the life force energy of a person, and in part what that does theoretically is it helps the medication go exactly where it needs to go, while limiting side effects, how beautiful and what a almost poetic way to move forward and help to take care of oneself or other people. So you asked about what area might be a little bit different. Acupuncture is being offered widely in association with chemotherapy or immunotherapy. And certainly afterwards in case people have any side effects related to treatment, that is certainly a sea change compared to what was going on 20-30 years ago. 

Roland Wilkerson  5:27  

So I can see a lot of old school folks out there going acupuncture and chi, that sounds like a flaky hippie thing. It's so so so here's your chance to tell them why they might want to rethink that attitude. 

Dr. Russell Greenfield  5:43  

So I was one of those people you should know. So back in the late 1990s, I went off and did a two year fellowship at the University of Arizona College of Medicine, integrative medicine, in part because I wanted to see where are their data, if there are data at all? Is there an evidence basis to this kind of thing. And I learned something very, very important that I share with my peers all the time. There's a big difference between there not being any evidence, and my simply not being aware of the existing evidence. So as an example, you know, where my peers, and are all struggling to stay up to date in our own fields, let alone figure out what's going on with acupuncture. You know, we're trying to figure out what's the newest medication, the newest procedure, the newest study, whatever the case may be, but sometimes we're so busy, we just flipped past that acupuncture article, when there are evidence points around this. So the evidence perh...

Transcript:
Cliff Mehrtens  0:06  

Welcome to Novant Health Health Healthy Headlines. This is Cliff Mehrtens. Vaping, the term for using electronic cigarette has exploded in popularity recently, especially among teenagers and young adults. vaping devices are sleek, high tech and they're often barely noticeable, but their dangers are undeniable. Nearly 400 people in the United States have been hospitalized recently, and seven deaths have been connected to vaping. For some insight into e-cigarettes and vaping we talked to know from health pulmonologist Dr. Richard Pomerance, he'll talk about the effects of vaping can have on you whether e-cigarettes can help you quit regular cigarettes if you're trying and the risk involved with adding ingredients to your e-cigarette, be sure to stick around to the end for list of terms, the vapers used to describe what they do, and some of the equipment they use. You can find stories like the US and hundreds of others by searching Novant Health and Healthy Headlines. Thank you for listening. 

What are some of the effects you've seen and heard about with vaping?

Dr. Richard Pomerance  1:08  

So with electronic cigarettes, what has been described is a syndrome where people have very common respiratory complaints, cough, shortness of breath, low grade fevers, occasionally nausea, diarrhea, those type of things, it then progresses to give more pronounced respiratory problems that actually require the person to be hospitalized, need to be placed on oxygen, sometimes on a ventilator. And we call that lung injury. A lung injury encompasses the the lung disease that we're seeing. And we see that with other things. But the CDC has just come out with guidelines as to how to describe these cases. Specifically, they call a case as either a confirmed case or probable case. So in before, they used to talk about investigating a certain number of cases, but not going to describe that anymore. It's either going to be confirmed or probable cases. And the only difference there is that if you have recently used an e-cigarette and come down with a respiratory illness, that is not explained by other things. Specifically, it's not an infection. And it's not another condition that can cause these kind of problems. They're going to call it either confirmed or probable case.

Cliff Mehrtens  2:21  

Are e-cigarettes less, we've established that they're harmful, are they less harmful than a tobacco cigarette?

Dr. Richard Pomerance  2:30  

We don't know that right. Now. The other thing to keep in mind is that a lot of the case that have been described are not only with a flavoring product in there, but also for people which are using not commercially made product. So these are products, which people will take the one time use a container and actually go ahead and refill it. There's people that are selling things on the street, which have special blends, and that's particularly thought to be dangerous. So the specific CDC guidelines, which I really would like to make sure that everybody hears are that if you are, if you're a minor, you should not vape use an e cigarette or any, any form of it. That's across the line. Second one is that pregnant woman under no circumstances should use these products either. The third one is that adults that are not currently using a tobacco product should not start on using an e-cigarette or vaping. And then the last one to be any current user shouldn't buy any cigarettes or any of those products off the street.

Cliff Mehrtens  3:41  

I saw some CDC stats that said in 2018, almost 21% of middle school and high school children had tried an e-cigarette within the past month. Is that a startling number to you? And if so why?

Dr. Richard Pomerance  3:54  

It is startling there's a high crossover between using these products and actually going on to smoking, which I'm much more familiar with the ill effects of as as the medical community. So it is startling to think that one in five children are already using a product with a higher incidence of leading them to actually smoking cigarettes.

Cliff Mehrtens  4:14  

Someone comes to you and they're trying to say for instance, quit smoking. What would you recommend them to say, "Hey, Doc, thinking about these e-cigarettes" for all the reasons that we hear about "...you won't see me you won't smell me, I can do it."

Dr. Richard Pomerance  4:28  

It's conversation, I have 10 times a day.

There's no evidence right now that suggests that it's a good idea to do it that way. There's been some minor evidence that it might help certain people. But given the safety concerns that we have, we don't recommend it at all. We There are all sorts of great ways of actually working towards quitting smoking, it's something which might not be able to be done by that person alone, they really should seek out help. Now they're asking a medical professional, they're already on their way. The State of North Carolina for example, as do other states have resources available online, which are very good. So there are all sorts of great resources available Lung Association has resources that are available as well. The part that's that I really find troubling is people that will use these products go back and forth to cigarettes when it suits them. So they're in their workplace. And they think that they can vape, although many workplaces will now not allow that. And it's simply prolongs their effort. And they believe that that's a safer alternative, they're not smoking as much, therefore it's safe. When that's really not the case, I do want to alert you to there's other ways of using these products, which are particularly dangerous, though. There's things called heard, there's a method that people use called dripping, which is where they take an e-cigarette, the filling of it, and they'll drip it onto the hot coils of the actual e-cigarette and then vape it in gives them a particularly potent amount. So it's a really big effect that they'll have. But dripping, unfortunately is particularly dangerous they have seen that associated with some of these cases of lung injury. And there's also dabbing, in which they will just take the substance that's inside the the e-cigarette, oftentimes add other things and just heat it up alone outside of UV, even using an e-cigarette using like a lighter or something like that. And then going ahead and inhaling that really kind of dangerous activities. Clearly never a good idea. The the more worrisome trend is the THC and the CBD oil vaping. Those are associated with a higher degree of this particular lung injury that we're talking about now, which is in the news. But this has been around for a number of years.

Cliff Mehrtens  6:43  

Is that because of the intensity of it that it can get into your bloodstream or lungs quicker, I add it to my electronic cigarette. Therefore, a higher concentration is inside me quicker?

Dr. Richard Pomerance  6:55  

Well, anytime in which it's being added ou...

Transcript:
Roland Wilkerson  0:06  

So there's a particular quote out there that goes something like this. It's not what you don't know that gets you into trouble it's what you do know that's just plain wrong. This is Roland Wilkerson with Novant Health Healthy Headlines. And that same came to mind recently, when I talked with pediatrician, Dr. Rachel Fournet about certain behaviors, she wishes parents would simply stop doing, give a listen and see if there's anyone here you recognize.

Okay, so we're here today to talk about what pediatricians wish parents would stop doing. So let's hear it. 

Dr. Rachel Fournet  0:46  

So I would say one of the biggest things that I would recommend parents not do is lie to your pediatrician. So the relationship that a parent parents have with their pediatrician should be a sacred one. A special one, one where there's trust, there's communication freely both ways that the parents don't feel judged that the pediatrician, you know, doesn't get frustrated that we've talked about this seven times and you never listen. You know, it should be a really strong relationship. 

Roland Wilkerson  1:15  

What kinds of things are parents not being truthful about with their pediatricians?

Dr. Rachel Fournet  1:22  

Usually the things that they know the pediatrician will not approve of so tends to be co-sleeping. So most people know that pediatricians are going to recommend that the baby sleep in a bassinet or a crib on their back, no pillows or blankets, and not in the bed with the parents, you know, not in a doc-a-tot not in a 'rock and play'. And when you're in survival mode as a parent with a newborn baby who wants sleep more than two hours, you'll do about anything to get your child to sleep. So sometimes parents will rely on these devices and they'll maybe sleep with the baby in their bed or they'll sleep at the baby on their chest in the recliner. And then when you come to the pediatrician, you know, I'll ask well, okay, well tell me about sleep, not only how often are they waking up at night, but where are they sleeping? How are they sleeping? And I'll see the parents kind of look side to side at each other and say, "in the crib," and I'll say, "guys, you know, what's what's really happening in your home?" I don't go to their house, I don't know for sure what's happening. So I'm relying on the parent to tell me the truth so that I know how best to advise and educate. 

Roland Wilkerson  2:27  

What's another example?

Dr. Rachel Fournet  2:30  

Bottles. So our recommendation is starting at 12 months to wean off a bottle and under sippy cups, and bottles are one of those things that parents cling on to as a remembrance of them being a baby. They see their baby turning into a toddler, and there's that little bit of parental resistance to like move to that next stage. It might be because they're fearful of the terrible twos coming it might be because they just want to hold on to that kind of sweet baby stage a little longer. But parents either continue giving bottles into their well into 18 months two years old, which on my end, I would educate them that it can cause you know, tooth decay and it forms their teeth in a circle. And so there are negative reasons that we recommend stopping bottles. But so the parents are either afraid of having to move out of the baby stage too soon and they're clinging to it, or they think their baby is are taller now is very attached to the bottle and that it's going to lead to crying and impaired sleep. So I think parental fear of not sleeping is a huge driver in the things that they continue to do, even though we don't advise it. 

Roland Wilkerson  3:38  

Gotcha. What's next? 

Dr. Rachel Fournet  3:40  

So another thing that I wish parents wouldn't do is to listen to all the advice that's out there. So not that you know, we pediatricians know absolutely everything but this is what my entire life has been about is about learning everything there is to know about pediatrics and children and child raising and safety. So the way the internet is now you can find information and advice for your child on mommy blogs. You can find it on Facebook, mom groups, you can you know, the old lady in the grocery store is going to tell you oh that baby needs some Orajel on his teeth or and then he won't feel the pain and your own Grandma, the own grandparents might be giving you advice about you need to put rice cereal in their bottle. So they'll sleep better at night. It's fine if they sleep on their belly, you guys did it and you survived. And so parents’ especially first time parents are getting bombarded by advice all the time. So take the advice you get with a grain of salt. Do your own research, talk to your pediatrician first. We will help guide whether or not oh, you're right, we did us to sleep in our belly. And then we found out that 50% of SIDS deaths are from tummy sleeping. So all those children suffocated and died in their sleep because they were on their stomach. Once we turned them on their back, the SIDS rate dropped in half. And we had a solution. So yes, the grandmother's right. And yet science has told us that there's a safer way. And that's why we have changes in the recommendations, we change recommendations often in pediatrics. Now they recommend to stay backwards in a car seat until after two years old. Only a couple years ago, the recommendation was just turned forwards at one. So every year we're coming out with changes and updates and recommendations. And everyone on the street and everyone on the internet doesn't know that. So also keep in mind that your friends, you know mom groups, your people that you meet at the park people on on M2M Facebook groups, their advice is coming from a you know, an sample population of one to four children. So then you might say, Oh, my children all loved Similac lack formula, and Enfamil was the worst? Well, that's what worked for those four kids. Right? But that's not how science works. You can't do studies based on four people. And so take with a grain of salt that that might have worked for one mom, one family, one child, or my kid had that similar rash. And my doctor said it was this? Well, no no, and now like, rashes are tricky. Rashes are confusing, like and red bumps don't always mean it's the exact same diagnosis. So reach out to your pediatrician, we have triage nurses that are able to walk through you know, symptoms, ask questions, help guide you to accurate websites, we’ll let you know if it's something we're worried about, or give you that advice. And so that would be one number two.

Roland Wilkerson  6:43  

So I think your next one was related about when to research and when not to research.

Dr. Rachel Fournet  6:48  

So, 2am is t...

Transcript:
Roland Wilkerson  0:06  

At least 5% of American children have ADHD. According to the US government, it can wreak havoc in the classroom cause big problems at home and seriously damage a child's self-image, which can unleash a whole other set of problems. I'm Roland Wilkerson with Novant Health, Healthy Headlines. And today we're speaking with pediatrician, Dr. Rachel Fournet, who takes us through the key issues around this in less than a half hour. If you've got a child who's ADHD or you think they might be, you might just feel a little better have you here with Dr. Renee has to say here. 

One footnote, for many years, there was a distinction between ADHD and ADD. But today, the formal name is ADHD. But it still gets called ADD and everyday conversation. And that's what we do in this discussion.

Dr. Rachel Fournet  1:09  

So the way I describe it to parents is that everyone is born with a certain set of cards that makes up their temperament. So everyone is either an introvert or an extrovert, they are a high energy person or a low energy person, they are high intensity or low intensity. So when they feel happy, they're very, very happy, or when they feel sad, they're very, very sad. And then there's also children that are high at fast adapters, which means that they can kind of go from activity to activity very quickly, versus a slow adapter, which those kids don't do well going from activity to activity. And they need, they need more guidance and more mornings, "in five minutes, we're going to go get ready for bath," "in two minutes, we're going to get ready for bath." So these these different cards that make up your personality and your temperament can sometimes look very much like add. So a child might be fast adapting high energy, high intensity. So they are bouncing all over the place, they're going from activity to activity quickly. And they might be really loud and really excited. And that can look like a child who might have a hard time in a classroom setting. But it doesn't become ADD until their function is impaired. So that's the line that has to cross they need to actually fail to function in a classroom setting. So a lot of it might be that we've had warning signs, we've been wondering how they would do in kindergarten. But we're not going to know until they're there until we get those reports back from teachers when we start seeing that they're not keeping up with their peers, because their temperament is now impairing their functioning in a classroom setting. Okay, a lot of kids, it might be that the classroom is really hard, and they have a hard time functioning, but they're fine in the mornings at home, getting out the door on time, eating their dinner, going to bed, where their ADD maybe doesn't affect all aspects of their life. But then there's some kids where from sunup to sundown, their inability to rein it in and follow a task and stay on focus does start to affect how they function within their family unit as well.

Roland Wilkerson  3:20  

And so typically, it sounds like you're saying it really presents itself or it really becomes evident to parents and teachers when the child starts school.

Dr. Rachel Fournet  3:32  

Correct and usually sick 5,6,7 years old tends to be when these conversation starts happening. So what I do first with parents is really break down what part is the child's you know, inherent personality, what other things in their environment and in their lifestyle could be contributing. So I always go through a very thorough diet history asking about what are what are they eating for breakfast, lunch and dinner? How much sugar are they getting in their diet, there's been some more, I guess, subjective findings where parents have found that artificial dyes have kind of affected their child's add and made it made it worse, I think the main thing that they should look at is just clean eating. So where you tend to find dyes, you also tend to find sugars. And so is it the diet or is it the sugar either way, they probably shouldn't be eating that fruit snack, or the Starburst candy or, you know, cookies or a muffin for breakfast. So looking at their diet, looking to see if they have a good energy outlet. So every child wakes up with a certain amount of energy every day that they need to flush out of their system. When children are on iPads, and they're playing video games after school and they sit all day in a classroom, when they sit when they get home. They never flush out that energy from their system. And that can look a lot like ADHD, they're you know that they're pent up, they're bouncing all over the place. They're not listening, they're, you know, impulsive and hitting their brother. And sometimes you just need to like harness that energy, get them involved in sports, karate is fantastic ride their bike, even if they don't need to join a sport, have them like run laps around the house before dinner and time them with their siblings to have a race and see who's fastest. You know anything to say that you know that they're kind of burning it off. And then I also want to have a good sleep history. So poor sleep can look like add the next day. It is very hard to focus if your brain did not get to recharge the night before. And so finding out you know, does a child go to bed at a reasonable hour meaning usually before 9:30, 10:00pm? Are they getting good quality sleep? Are they snoring? Are they restless? Do they wake up after 10 hours but still seem really tired and groggy? Are they school age but still taking naps? Those are all signs that maybe there's something disrupting their sleep causing them to look like they have ADD in the classroom. And then the last piece of the puzzle is rolling out that there's an any other comorbidity happening like anxiety or depression. And in little kids, sometimes anxiety doesn't look like it does in adults. It doesn't always, you know, kids can't verbalize "Oh, well, I can't fall asleep tonight, because I'm worried about what's going to happen tomorrow in school." No, instead, they you know, they avoid going to school, they get stomach aches before school, they get headaches before bed. They physically feel their worries. And so if a kid has a lot of anxiety, especially about school, well, when they're in school, they can't focus because their brain is going a million miles a minute thinking about all the things they're worried about. So they can't do the task at hand. So by asking all of these questions, usually we're able to kind of paint a picture of, you know, do we need to work on some things first, and get out sugar from the diet, maximize exercise, maximize good quality sleep, make sure there aren't other anxieties and comorbidities, then we try to get feedback from the teachers. So the tool that we use is usually the Vanderbilt form. And that there's a parent and a teacher one. And what that is helpful with is knowing are these issues happening in both places. Because sometimes you'll have teachers raising the child very high on the Vanderbilt saying that they have a DD, but the parent who maybe is not ready to move forward with medication management, they rate that the child has zero symptoms. So that will then lead to conversations of readiness like are what are you worried about? Are you worried about a stigma? ...

Transcript:
 Cliff Mehrtens  0:07  

Welcome to Novant Health Healthy Headlines. This is Cliff Mertens. Concussions get plenty of attention every football season. It's a violent sport based on collisions, and concussions are inevitable. They happen a lot at every level of football, but they can also occur in other sports, even for kids playing at recess or having fun time in the backyard. An estimated 283,000 children every year seek some sort of treatment in emergency departments for traumatic brain injury. Most of those traumatic brain injuries are concussions. For some insight into concussions, especially those in football. We talked to Novant Health Dr. Kip Corrington. He's a former college star and NFL player, Dr. Corrington can shares his personal and family history with concussions. Some advice for parents of young football players and other athletes, and what to look for if your youngster suffers. Be sure to stick around to the end. For an interesting connection between Dr. Corrington's career and mine. You can find stories like this and hundreds of others by searching Novant Health and Healthy Headlines. Thank you for listening.

Dr. Corrington, you played football for a long time. Did you ever have a concussion?

Dr. Kip Corrington  1:22  

I had multiple concussions. Three major ones starting in high school. And the last one was in 1989. And there was a pretty significant one where I had to have a CT scan to be evaluated, make sure there wasn't any serious damage. And then on top of that, you know when you play football during a particular game, you probably have 15 to 20 mini concussions every game.

Cliff Mehrtens  1:51  

Can you tell when that happens to you? When you're standing there after a play? Or maybe a play or two later? Can you tell that you're experiencing those symptoms?

Dr. Kip Corrington  1:57  

Oh, yeah, we used to joke about it back in the day, because you know, it wasn't a serious thing, then we'd call it seeing stars or being dazed. And it was just part of it. 

Cliff Mehrtens  2:11  

You were expected to play through it, do you back then it's not the same now. But you are expected to play through those moments. What, do you have any scary stories about our funny stories about teammates who are wobbly, you could see it in the huddle or locker room or sideline teammate was really struggling with something like that.

Dr. Kip Corrington  2:28  

Oh, yeah, we and again, it was a different time. And so back then it was kind of a badge of honor to play through even a major concussion at times. But those were the times when somebody would be taken out of the game was when they would literally pass out on the field. But again, it wasn't, we would be evaluated at a medical center if it was that severe. But when it comes to the small micro concussions, you know, that was just part of the game. And it probably is still is actually

Cliff Mehrtens  3:07  

A violent collision can cause a concussion. But a lot of the CTE damage that we see in the spotlight these days from football and other sports is the accumulation of hits practice for months. Not so much what happens in a game. But talk about how that has an effect on athletes, especially football players. Repetitive 1-2000 hits per season for a high school player helmet to helmet hits, what what sort of damage that can do and how's that has come more into the spotlight?

Dr. Kip Corrington  3:38  

Well, there's a lot we don't understand about it. And a lot of the data comes from post mortem data, unfortunately. So we don't really have a control group. But but the thinking is, and some of the computer simulations that they've used, it's not even the direct, head on blow. That's the problem. It's usually the kind of blows that cause torsion of the brain, a twisting of the brain. And they've used a lot of computer simulations to evaluate this. In fact, there's a guy out at Stanford that used to play and he does a lot of research in this area.

Cliff Mehrtens  4:14  

What sort of advice would you give to a parent whose child was interested in playing football, and in regards to concussions, and maybe some concerns they might have?

Dr. Kip Corrington  4:24  

I mean, I'll be honest with you, I was ecstatic when my son decided not to play. I didn't discourage him, because, you know, the team sports like football, there's so many good lessons to be learned from them, you, you become so close to your fellow teammates, it's a difficult sport. And so through that you learn a lot of life lessons. I think the main thing is just to understand what you're getting into and until the late 2000s, that really wasn't public knowledge. So but on the flip side, you can get a concussion, run your bike, you can get a concussion playing soccer, you can get a concussion, falling from you know, from a ladder in there's so many different ways that you can get concussions, it's just that with football, it's it's a surety. Because it is a part and parcel of the game.

Cliff Mehrtens  5:24  

What sort of on a basic level, someone who's hasn't maybe a younger child just getting into the game, what should they look for what sort of symptoms would be indicative of some sort of concussion?

Dr. Kip Corrington  5:35  

A major concussion would be loss of memory, some speech difficulty, headaches, dizziness, vomiting, could be part of it. The micro concussions are a little bit more difficult. Again, most people would describe it as seeing stars.

Cliff Mehrtens  5:54  

And like you mentioned, it's not only football, football gets a lot of the attention because it's a collision sport. But a sport that gets a lot of has a lot of concussion rates is girls' soccer. Again, balls to the head, and head on head collisions wearing no protection. How do you guard against concussions in other sports and all sports overall, you really can't prevent them. But what are some preventative measures that maybe athletes can do to maybe limit their chances of this happening?

Dr. Kip Corrington  6:23  

Well, I think with football, some of the rules changes can help. The helmets themselves are not designed to prevent concussion. They're designed to prevent fracture. But if you try to take your head out of the tackling as much as possible, well, that'll decrease your instance, unfortunately, you're going to have collisions that are accidental all the time. So other sports I you know, I think that in girls soccer, for example, or soccer in general, but girls I'm thinking about because I had a daughter that had to stop playing the because of concussions. You know, headgear might be an important thing in the future. Most of the concussion...

Transcript: 
Roland Wilkerson  0:07  

Roland Wilkerson for Novant Health and Healthy Headlines here. So the drink of the summer of 2019 appears to be spiked. So Sir, I just realized There are mountains of this stuff at the grocery store. I just hadn't been paying any attention till we started working on this piece. Part of the sales pitch from the beverage industry is that these drinks are actually better for you than other forms of alcohol. Some of them are even sold in skinny cans to appeal to women. So we had to ask Novant Health Registered Dietitian Andrea Hiatt, our spiked sensors actually, quote unquote healthier. I think her answer might make some of you happy. But she's also got some words of caution. And for those of you who've never tried one, stick around at the end, for one craft beer fan's review.

So we're here today to talk about spike seltzer; what is a spike cells.

Andrea Hiatt  1:01  

So these hard sparkling waters are something that they kind of played a spin-off of those Lacroix's and now added the alcohol in them, that a lot of times when they have that alcohol in them, it's not anything that is like a vodka, or you know, any of our liquors that are added to the hard seltzer water, what it is, is it's natural flavorings or different fruit juices that they might add to it and it's fermented. So that's where that alcohol is coming from. A lot of times, but most of them are about four to 5% of our, our alcoholic volume. So pretty much typically to the same point of like a light beer.

Roland Wilkerson  1:45  

So um strictly speaking is a 12 ounce spiked seltzer healthier than that a light beer or a glass of wine.

Andrea Hiatt  1:55  

So, you know, we talked about healthy, it's like, oh, there's a lot of gray space. There, I wouldn't say that it's necessarily healthy, it could be a better choice for you. So when you take it, take a look at that 12 ounce, hard seltzer, you know, it does have around 100 calories, it is low in sugar, and it is a lower alcohol volume. So you know, if we're having maybe one of these, you know, at a at a family function, or if we're you know, going out for the summertime, that's going to be something fine for us to have, when we look at our Corona lights or Michelob Lights, or Michelob Ultra, those are going to be very similar, that now they could have a little bit higher alcohol content as well. Some people might want that bite of actually tasting the alcohol where the hard sell because you might not taste as well. So, you know, if you compare them, they're kind of similar in some ways. But what really has made it kind of that healthy trend is that they take water, and it's just that water and it spiked. So so people think, Oh, well, I'm staying hydrated when I'm drinking this, but really, alcohol dehydrates you. So either way, whether it's our wine, or beer, or our spike cider, or a spiked seltzer, those are going to be things that will dehydrate us, and we'll need to have more water throughout the day. It is definitely a great thing if somebody is looking to watch their calories, also to watch their sugar content. But like I could say the same thing for those beers as well. The lighter beers, when it comes to wine, wine is going to be a little bit higher in calories and higher in sugar that some people were on kind of that rose a trend back in the day. And that was kind of showing that seems similar where it's a lower calorie a little bit lower in sugar as well, because they were mixing some things. So taking a little bit of the red wine and then mixing it with like a hard seltzer. You could do something like that as well, or just a regular seltzer. So if somebody wanted to, or preferred that, it could be technically as healthy as a, as a hard seltzer. The other thing to look at is the artificial sweeteners in there or artificial flavors, when they say that or when they say natural flavors, we don't really know what they're putting in there. So you know, we can have different additives that might not be natural, even though they say that. So usually, if you can't pronounce it, then it's probably something that's more chemically made than actual, you know, something that we're that we're able to get from the ground or from, from our food itself.

Roland Wilkerson  4:40  

So bottom line, it sounds like when it comes to, quote unquote, the health rating of a hard seltzer versus a light beer, they're really about the same, right? And it's a matter of preference,

Andrea Hiatt  4:55  

I think so for sure. You know, with with that Michelob Ultra 95 calories, Miller Lite, 96, Corona, light 99. So if you look at most of those spikes ulcers, they're going to be around 100 calories and two grams of carbohydrates very, very similar. It really kind of comes down to the flavor. It also kind of comes down to also gluten free. You know, some people are gluten sensitive. So if they're allergic to gluten, they can't necessarily have beers. But for the most part, a lot of those hard ciders, seltzers are gluten free, you definitely have to check the label. But that is something that for the most part, people who have a gluten sensitivity can enjoy versus the beer.

Roland Wilkerson  5:40  

Okay, here's something I've always wondered, does it really matter if you have a drink, that's 100 or 200 calories more than another drink in terms of, let's say, if you're reasonably fit, person who has good control their weight is that extra 100 or 200 calories will the higher calorie drink going to make that much of a difference?

Andrea Hiatt  6:03  

I say if you're having it in moderation, it's going to be okay. So whenever I talk to my patients about eating healthy, or talking about maybe an event that they're going to, well, maybe we're planning for that. So maybe during the daytime, we're adding more activity into our daily routine, maybe we're having a lighter breakfast and lunch. So we're, you know, accounting for those extra calories that we might be having in that beverage, you know, there's definitely lighter options that you can do. So say if you wanted a margarita, you can do a lite version of that. Some people prefer to have the actual Margarita and have the the calories and the sugar that come with that. But you know, it just really comes down to moderation. And then also making sure that, that you're accounting for it too. I really like you know, making sure that you're tracking your diet. So if you can make it work within your diet and going over a little bit of your calories, it's going to be okay, as long as you're not doing that on a daily basis. So you see a lot of people that might go away on vacation, and they'll come back and they said, Oh my gosh, I gained a ton of weight. And it might not be that they were eating really any differently. It could be the alcohol that they were taking in. So you know, when we look at that hard seltz...

Transcript:
Roland  0:07  

Welcome to Novant Health Healthy Headlines podcast. This is Roland Wilkerson. Research shows that four out of 10 Americans see a counselor at some point in their lives. And among college students, there's an unprecedented rise and demand for counseling services. To help understand how counseling works, we speak with nobody how psychiatry, Dr. Obi Ikwechegh, a leader in behavioral health was also treated many patients over the years. We started with a story about a patient he was able to help discuss a few misconceptions about therapy, and learn about a few steps we can all take when we're feeling overwhelmed by life. Be sure to stick around at the end, where we reveal the TV show Ikwechegh says best captures the therapy experience. This one surprised. You can find stories like this and hundreds of others by searching Novant Health and Healthy Headlines. Thanks for listening.

What's an example? Or what do you think, are a few of the most misunderstood aspects of therapy that the general public,

Dr. Obinna Ikwechegh  1:14  

I like that, because I'm running over my head of all the things that people misunderstand about therapy. One of the most common misconceptions is that therapy is just going to talk about your problems. Or your therapist is just like a friend that your pain. None of that is true. I'm talking about your problems in the social context is helpful, because it lets you broaden yourself. Therapy, on the other hand, is designed to be solutions focused, there is a goal that you're trying to achieve. Now, the goal might not be to solve the problem, the goal might be to set that the problem is not changing, and identify ways to deal with that problem.

Roland  2:07  

What's an example of a patient you were able to help? Significant issue in their life?

Dr. Obinna Ikwechegh  2:16  

Oh, I have so many of those. But one that really sticks out to me was several years ago. I was in an office based practice, and had this patient, he had lost a child in a tragic accident. But part of the Baxter was this child was at a local hospital four months required to feeding and was in and out of consciousness for a protracted period of time, that child ended up dying. By the time I was seeing this patient that had been about eight or 10 years in the past. But he still kept that child's room almost frozen at the time that the child died. So there was still blood clothes on the bed, there was two tubes that have been associated with the hospital stay. But more importantly, for all those years after the child died, he would go out and buy toys that fit with the child's age when the child died. When I met him, he came with a family member and his family members said that room is piled high with things. And I just think this is abnormal. We identify that some of the things he needed was being able to walk through his grief and re engage with live without being frozen in this time that his child has died. And we began to look at some of the distortions of his thinking, for instance, is thinking that his child was somehow still in that room, that his child was somehow still this nine year old person at this time, the child if the child was still alive would have been about 19 or 18. And progressively, he began to take steps to change this thinking, you recognize, yes, my child had died. Yes, that was a traumatic thing. But I'm still alive. I have other children that I have to attend to. He progressed to the point where he was able to engage in a charity that you know, help children who were sick. For me, that was some level of altruism, that took him away from this deep place of loss, he went to the point where he was able to donate all this toys to needy children. And by the time he exited out of therapy, I wouldn't say he had forgotten that he lost a child tragically, but he had achieved significant normalcy, because he had been able to address the distortions in his thinking, his behavior consequently had changed. And I like to say that his emotional state had changed as a result of all this other things that he had done. I see that as an example of therapy being successful, and therapy getting important to maintaining function.

Roland  5:30  

Wow, that's, that's very powerful. It must be, it must be gratifying to actually make a difference in somebody's life like that.

Dr. Obinna Ikwechegh  5:39  

Absolutely. I'd say that in my line of work, some, some things are tough. There are people who have been through therapy and just haven't been able to navigate to a better place. But instances like this actually, give me the joy to show up to walk over there.

Roland  5:59  

What's in it example? Or what do you think, are a few of the most misunderstood aspects of therapy, that the general public,

Dr. Obinna Ikwechegh  6:08  

I like that, because I'm running over my head of all the things that people misunderstand about therapy, one of the most common misconceptions is that therapy is just going to talk about your problems, or your therapist is just like a friend that your pain, none of that is true. I'm talking about your problems in the social context is helpful, because it lets you bought in yourself. Therapy, on the other hand, is designed to be solutions focused, there is a goal that you're trying to achieve. Now, the goal might not be to solve the problem, the goal might be to a set, that the problem is not changing, and identify ways to deal with that problem. And therapy can doesn't always feel good. You know, there's a concept that therapy, when we think of therapy as the word, it might evoke, improvement, and feeling good, and being okay. Sometimes therapy is painful. An individual who has experienced significant trauma may have repressed all that. And once they get into therapy, all of that comes flowing out again. So those are things that people have to keep in mind before engaging in therapy, I don't think that therapy ever creates a situation of Aha, I never knew that about myself. Most of the things we realize in therapy, we had some concept about therapy just allows a safe place for us to process things objectively, and come to some resolution about this things.

Roland  7:59  

So not everybody has access to a psychiatrist like you? What would you say to people who find themselves overcome with depressing or negative feelings? What can they do in the moment, to regain a sense of equilibrium and not not feel overcome by those feelings.

Dr. Obinna Ikwechegh  8:26  

You know, try to get sleep, try to get some exercise in, engage in those social arrangements outside of work. A some kind of TV network around you engage in exercise, things like that on a regular basis, kind of retrain your brain function. And that goes along with what you feel. Let me just say this, there's a saying that birds can fly over your head, you're responsible if you let them build a nest in your head. I believe the negative thoughts can come to us, ...

Transcript:
Yoona Ha  0:06  

Hi, everyone, this is Yoona Ha, your host for today's Healthy Headlines podcast episode that really focuses on what it means to take on the role and the responsibility that comes with representing a racial and gender minority in nursing. I sat down with Jermaine Dalton, a nurse manager in behavioral health at Novant health, to learn more about his journey in nursing, and discuss why diversity is so important in nursing and especially more broadly, and healthcare. We start with Jermaine walking us through his incredible experience being the first black male in his nursing class in the early 90s. Here's what Jermaine had to say about that experience.

Jermaine Dalton  0:55  

I was asked questions of what is it? Like? What is your experience? Like? Are you treated and he differently? Are people saying things differently to you, because you're a black male, and you're the first black male or the expectations any different because you're a black male? You hear all of the racial inclinations, you were admitted, because you were a male, you are admitted, because you were black, you were admitted, because you were black male. You hear a lot of different things. And 1819 years old, you're thinking man, you know, what does this mean for me? And and while I was never raised to look at myself, as a look at myself as a statistic, I was never raised to look at myself as being a person who was going to be admitted or was going to obtain something because I wasn't male, or because I was black, or what have you. I was always raised to do the best you can do. And my philosophy is I can show you better than I can tell you. So I went in with that philosophy thinking, now I'm going in, and I'm just going to do what I do. And I'm going to, you know, successful complete this program. And when I successfully completed, then I can show you know, I'm not a token, no, I'm not here because I'm a male. No, I'm not here, because I'm black. I'm here because I have the talent and the ability to succeed. So looking back, then I had a point to prove. Now I look at it as I was meant to be an example to my community of what you can achieve, I was looked upon then as being the person to say, hey, let's just see what happens. And he'll set the tone, he'll set the pace, and he'll let us know, yes, we can, or No, we can't. Now I look at it as being one of those people who can say, you know, don't talk about it, just do it. I want to be the person that says you can overcome socio economic barriers, you can overcome racial barriers, you can overcome hatred, you can overcome whatever is thrown at your feet, just step on it, use it as a step to take yourself higher and elevate yourself to the next level. Because you don't have to fall victim to it. So now more than ever, it's very important to me to be able to say, I didn't know you can do it. So it's important to be an example.

Yoona Ha  3:11  

And what are the socio economic challenges that you've either experienced firsthand, or you've heard, you know, from your community members on? What are the barriers to getting to those positions?

Jermaine Dalton  3:23  

First, I think we look at socio economics. We see that even not only in the black community, but several communities, especially in the black brown minority communities, we see that there's a socio economical socio economic barrier, we see that finances can be challenging. So when we look at that nursing school is not cheap. Nursing school can be quite expensive. So sometimes, getting the financing and getting those funds, finding that financial support that you need to go through nursing school can be difficult. Secondly, is cultural, still within the black and African American community, as well as other minority communities, when you look at nursing, men in nursing, in certain arenas can still be frowned upon and is still frowned upon. So for black men in particular, you know, we want to go out, we want to shine, we want to do the best that we can do for our communities and for our families. But there's still this stigma attached to black men and nursing. And it's in certain arenas. It's not cool for black men to be in nursing. Men are supposed to be mechanics and firefighters, police officers, paramedics, but why would a man go into nursing? And again, certain arenas, nursing is considered a woman's profession or profession for women, not for men. I wholeheartedly disagree with that. And I believe that we need to get more black men and minority males into nursing. And that will help the nursing profession How will it help worse, number one, seeing diversity? But number two, we can overcome those. I guess perceptions that women are the only ones that can do x y&z men are the only ones that can do A, B, and C. And we can come together as a unit and as a group, to better serve our communities and better serve our populations. Working together, we can achieve more. diversity is important because as we look across America, even now, and today, we see a diverse population, we see a melting pot of cultures, and ethnicities coming together. So I understand that in certain cultures, male nurses taking care of female patients is unacceptable, or vice versa. But when you look at the big picture, in the grand scheme of things, sometimes certain cultures and ethnicities feel more comfortable. Having a person of their own culture and their own ethnicity is nothing against the other individuals who may be caring for them. But they feel that hey, this person is from my culture, they understand what I'm going through, they understand where I am, I don't have to explain everything. So there are barriers that I may not have to break down, that others may have to break down. So as a black male, in the in the African American and black community, we find that black men can at times be private. So when I walk, for example, I was taking care of a patient a few years ago when I was working, and a physician. And this gentleman was pretty stoic he you know, what's going on? How are you feeling? You look like you're not feeling well. We were transporting this patient actually here to PMC. He just was not feeling well. Something was not right, sir. What is it, and he was not talking to my partner, who happened to be a white male. I began to talk with him, made him feel very comfortable. Got him to a point that he began to open up and we found that this gentleman was having chest discover. We put him on the monitor started doing EKG doing things and this gentleman in the back of our ambulance, I was working for critical care transport, was having a heart attack.

That changes the ballgame. He was not responding to my partner who was a white male, but he began respond to me. I can't explain why we got this gentleman we changed the course of action, we took him to the cath lab after we got him to the cath lab did well recovered. We went to visit him after the fact and he think that's both. But just the fact that he had that black male there to speak with that broke down or chipped away that ice or whatever that wall was, possibly saved his life. So getting into the culture, and having that cultural representation, again, not only for the black community,...

Transcript:
Cliff Mehrtens  0:08  

Welcome to Novant Health Healthy Headlines. This is Cliff Mehrtens. Alzheimer's disease affects nearly 6 million Americans. And that number will increase over the next few years as the baby boomer generation ages. We don't know the exact causes of Alzheimer’s disease and there's no cure, but it's widespread. For some insight into Alzheimer's, we talked to Novant Health behavioral neurologist, Dr. Mark Pippenger, who discusses the impact Alzheimer's has on a patient's close family members, how Alzheimer's affects more than just your memory loss. Some misconceptions about the disease, and what does Alzheimer’s and its treatment look like 10 years from now, be sure to stick around till the end to learn how Alzheimer's got its name. You can find stories like this and hundreds of others by searching Novant Health and Healthy Headlines. Thank you for listening. What's the biggest a misconception or two that you hear about Alzheimer's?

Dr. Mark Pippenger  1:05  

Well, I think one of the biggest misconceptions is that it's just part of normal aging. And I see patients all the time who have been to their primary doctor and their children are worried because they're forgetting things. They can't keep up with their medicine. And they're told it's just normal age. And that's probably one of the biggest misconceptions is it is somehow normal. It's not it's very, very common, but it's not normal. So Alzheimer disease, it's never normal. Another misconception I see concerns the medications we use to treat the disease. So many physicians think that the medications don't work. And so they won't give people medicine for Alzheimer disease, because they have the impression that drugs are not effective. And that often comes from not understanding how the drug is supposed to work. So the drugs that we use delay decline, they don't make people better in the short run, not often, sometimes a little. But people think that they're supposed to fix the problem. If they're effective, and they don't, they just delay things getting worse. So I'd say that that particular misconception stops many people from having the benefit of treatment, because other people think that it's not worth giving the medicine, we think actually that they do have a big effect.

Cliff Mehrtens  2:31  

As our population ages more baby boomers are going to reach the ages of 7075 in the next few years. That's what does Alzheimer's and its treatment look like 10 years from now.

Dr. Mark Pippenger  2:44  

in 10 years, we're extremely hopeful in the field, that in 10 years time will have drugs that will more effectively shut down the progression of disease. And it's a realistic goal, we believe because a lot of research is going on every year. In fact, just next week, I'm going to the big annual research meeting where we review all that's going on. And it's a full week of activity. Every day, all day, there'll be 4-5000 clinicians and researchers present reviewing all of this. So a lot is going on, we really believe that in 10 years time will have drugs that will significantly slow down or even totally stop disease progression. At that point will probably be using more sophisticated tools to try and diagnose the presence of Alzheimer disease before someone even becomes memory impaired. So before the earliest memory changes, we want to be able to diagnose the disease. And there's every expectation that in 10 year’s time, we'll be able to do that. And we'll be able to give drugs that are more effective in slowing down or even stopping disease progression.

On the plus side of 50 doc and sometimes offered thanks for not what I had for breakfast, but the name of the Tom Hanks movie I tried to recall that I saw 20 years ago or something like that. And people my age will sometimes joke about you might be - 'Oh, you have Alzheimer's,' - it's not a funny subject. But memory loss like that is not always an indication that something serious is wrong as part of the normal aging process. Isn't that right?

Cliff Mehrtens  4:20  

That's correct. There are cognitive changes, which actually begin, you know, as early as your 30s or 40s, we start to see some changes in the normal individual. And the normal changes will consist of a slowing down of mental processes, difficulty retrieving memories quickly. And and that will take the form of not being able to think of the name of someone you run into, or not being able to think of a word you want to use in conversation. So you're talking to somebody and you want to tell them about your laptop, and for some reason that word just escaped to you. And you can't come up with the word laptop. And you may have to describe it, you know, that little portable computer, and then later the word laptop comes back to you. So it becomes more difficult to multitask to keep up with more than one thing at a time. Because the speed of your thinking slows down and you can't switch between things as easily. All of those things are commonly seen with normal aging. They don't indicate a disease being present. But, you know, diseases like Alzheimer's disease also often begin with losing memory for words and memory for names. So when is it a problem, you need to get checked out? Well, I tell people, anytime you're worried about it, it doesn't hurt to see a specialist who's experienced in the field, who can do a little extra testing and maybe reassure you that what you're experiencing is normal for your age. Or on the other hand, if there is a problem, may be able to take steps to do something to try and help. 

Dr. Pippenger, Alzheimer's isn't only about memory loss, there's some other moods and things that happened that are affected tell us what sort of moods that can be created or altered for someone who has been diagnosed with Alzheimer's?

Dr. Mark Pippenger  6:06  

Sure, you're right, the disease affects more than just memory. You know, typically memory is the thing that's affected first. And that's one of the most important symptoms that we see. But along with the memory problem, we get changes in emotion. Depression and anxiety are more common in people who have Alzheimer disease and who develop dementia. And part of that may be prompted by the cognitive impairment itself, so that someone begins to lose the ability to do things. And they are on some level aware that they're not able to do it. And so they need to rely on someone else for safety and security. And they become anxious if that person isn't immediately available. So that's one way anxiety can be created by the disease. But the disease may affect the chemical structure of the brain and make it easier for that person to become anxious, easier for them to become depressed. So particularly when people with Alzheimer disease are bored, or when they don't have anything to do. Depression is more common. And we also have a range of behavioral symptoms, which will occur in most people with Alzheimer's disease at some point will have some behavioral symptoms. And those very often are also prompted by the cognitive deficits so that a person who has Al...

Transcript:
Yoona Ha  0:06  

Hi, everyone, welcome to Novant Health's healthy headlines podcasts. This is Yoona Ha. In a previous episode, you heard my colleague Roland Wilkerson talk about how therapy works. This week. I'm with Registered Dietitian Andrea Hyatt to talk about diets that don't work. We've all been there eager to shed a few pounds or find a new diet that helps us be healthier. Well, Andrea, who works at Novant Health's weight loss solutions has really heard at all when it comes to dieting, from the Sleeping Beauty diet to Keto diets, which one's work? And how do you navigate this endless stream of fad diets? We're here to find that out today.

How would you spot a fad diet?

Andrea Hyatt  0:54  

So there's a couple of things is a diet promises a quick fix, then we kind of know, okay, this is probably something that's too good to be true. So that's something that you know, you really want to look out for, if they say you're going to lose 10 pounds or 10 inches in five days, well, that's probably something that is not going to last life long. So you know, you want to kind of stay clear of those sorts of things. Anything that excludes or restricts of food group. So if it says I lost 20 pounds by cutting out all carbohydrates, or I've lost 20 pounds by just drinking water, you know, those are some things that you will see with those fad diets. And you want to make sure that any type of diet is going to be something that is more balanced than other things is like promoting a magic through food. So like the grapefruit diet, or the cabbage soup diet, I've lost weight when I just ate cabbage soup for you know, two weeks, well, obviously, you're going to lose weight because cabbage doesn't have much in there, there's not much protein. Lot of times when people lose that weight, they're either losing their water weight, or they're also losing some of their muscle mass because they're not taking in enough protein. So you know, just because it promises the super food doesn't actually mean that it's a food that's going to benefit us. And then the other thing is, you know, check the research out on there, that you know, I always am looking at the research when it comes to either the intermittent fasting, the keto diet, any diets that are out there, I'll go on our nutrition blogs and nutrition websites to see what the other dietitians are saying. Also go on to evidence based journals as well to kind of see where this you know where everything is. I definitely would stay away from things like the media, or celebrities. So if a celebrity said, Well, I lost this weight on the ketogenic diet, well, that's not a research based type of thing. They probably have some other things that are going on, they might have a trainer, they might have somebody cooking for them. So just because a celebrity endorses, it doesn't mean that it's actually working. Same thing with, and I don't like to say his name too much, but Dr. Oz. So Dr. Oz has a lot of following. And a lot of people that I talked to, they'll say, Oh, well, Dr. Oz told me that this is fine. So I'm going to follow it. And you know, there's not much research that he does with those different diets or those different things that he recommends. So it is very important to do your own research and to kind of find out that information for yourself as well. There's the grapefruit diet, so you only grape fruit for the whole, like two weeks, there's the juicing where you only drink, you know, certain types of juices. There's also the Sleeping Beauty diet, have you all heard about that? Oh my goodness. So the Sleeping Beauty diet is where people actually take sleep aids, and sleep through their diet. Instead of eating when when they feel hungry, they will just take a sleep baby, go to sleep. So that is something that I have heard people do, which is really, really crazy. That's the Sleeping Beauty diet. 

Yoona Ha  4:17  

So how does that actually work for let's say, if you had a nine to five job, how would that work? Would you just you know find time to nap your your hunger?

Andrea Hyatt  4:27  

I guess so, I don't know too much about it. But I know that like for people who have problems with thumb stacking at nighttime. So instead of having that snack at nighttime, which was maybe the thing that was their culprit that they had said was making them gain weight, maybe they'll just take a sleeping pill and go to sleep early instead of snacking. So I've seen that happen, I've seen people that would spend a couple days in bed, where they are, they've just kind of stopped eating all together. So that this way they can kind of sleep through the they're, they're fast almost. So that was a very interesting one that I have had people that were on the gluten free diet. And with the gluten free diet, it is a it is a great diet for people who do have a gluten sensitivity or a gluten allergy. But I have a lot of people that follow either a gluten restrictive diet just because they want to lose weight. So I tell a lot of people that that is not probably the best option for them. Now if they do have a sensitivity, or they have an allergy, perfectly fine to follow. But when we start to restrict certain food groups in our diet, that's when a fad diet actually occurs and we don't want to be restrictive, because then then we're not going to be successful with that diet either.

Yoona Ha  5:45  

What do you think are the most dangerous types of diets out there? Especially when we introduce supplements into the equation? And your from your perspective? What's the most what are the most harmful kinds out there?

Unknown Speaker  5:58  

Well, I think that the keto diet could be harmful if you know if it's for somebody that has high cholesterol as diabetes, that sort of thing, if they're pregnant have gallbladder issues. So I think any fad diet could possibly be harmful, if it's, you know, wrong for that person. There are some other diets called like the HCG diet, where people are getting shots of a hormone that is produced when people are pregnant when women are pregnant, and they follow a less than 800 calorie diet. So usually a 500 calorie diet, and then they're taking shots of this HCG hormone to get them to lose weight. And so I think that that is something that is pretty harmful. I think that that would be something that I would not recommend. Usually people who do that will lose the weight, but then again, not learning how to eat the right way. The other one is the Sleeping Beauty diet would be one that I would say would be harmful. Because let's let's just face it, you're sleeping through your diet and sleeping through your day, that so that would be something I would not recommend you can get, you know dependent on sleep aids as well when you do that. So I really think that any type of fad diet could have some potential for some problems. The two diets that I get a lot of questions about are the ketogenic diet and the intermittent fasting. So w...

Transcript:
Roland  0:08  

Anger, denial and loss of control. These are just some of the emotions that can erupt when a family member friend or partner has received a devastating medical diagnosis. And it can get a lot worse when the patient has an appointed a champion who can speak for them and make decisions on their behalf. They can't do it themselves. And if the family is split, look out. I'm Roland Wilkerson, nobody health healthy headlines. And today we're talking with registered nurse, Alicia child's about the importance of having a healthcare champion, and getting your health care choices down on paper. Alicia has seen a lot over the years, and will help us understand why we need to make our wishes known. At the end, we'll come back and tell you about a free site where you can learn how to start the conversation and get all the paperwork up. You'll also find stories on this topic and hundreds of other healthcare topics and no bond health healthy headlines. Thanks for listening.

What's it like? When families are divided over? family members care, and there's nothing on the record as to what the patient wants...

Alicia  1:25  

it can be very chaotic, because as you know, anything can happen, at least someone you're not too young to get sick, you can have the stroke, you can, you know, have an accident in a boat, or you can accidentally, you know, almost drown. I mean, anything can happen, people overdose all the time, you don't expect someone in your 30s or, you know, early 40s 50s to, you know, become chronically ill. But I'm also the manager for the inpatient Harris hospice unit. So they see that a lot, the different family dynamics, someone may have, you know, 6%, having kids, and everyone wants to have their opinion of how the care should go, you may have kids and families who haven't seen their loved one for you know, 10 years, but they feel that they have the right to come and make decisions. That can be very, very chaotic, it can be stressful for the, you know, the patient, if a patient is still, you know, coherent, it's stressful for the team members, as well as the family. So you can't even focus on your last moments with your loved one, your focus is now on the stress of control. A lot of times, that's really what it is, is control.

Roland  2:33  

So talk about that a little bit. What do you mean,

Alicia  2:38  

for example, there was a patient who had a stroke, unexpected stroke, and he had a girlfriend, you know, of, you know, X amount of years, plus he had his children who may or may not have been involved in his care. So there could have been some family dynamics prior to the patient, you know, come in, of course, and the girl often thought that she should make the most rational decisions for her, her long term, you know, significant other, and here you have the kids. So is it gets very hairy. So our hospice team is really good about getting our liaisons involve our social workers or physicians and having family meetings and saying, Hey, there isn't a designated power of attorney, but we have to come to a conclusion, we have to come to a conclusion that's whether whether or not your point one person or whether or not they come to a decision about that person's health, you know, collectively as a whole?

Roland  3:35  

And what's in a, can you think of a case where of where a patient had all the all the paperwork and all the decisions in order? What was that, like?

Alicia  3:48  

You can I mean, you can totally tell the difference, just by walking into, you know, someone's from most of the time that that family as well as that patient, they're at peace at what, what their decision is. And I always have examples, for example, we had a, you know, early 40s, male, you know, young daughter, you know, fairly newly married, but he was diagnosed maybe a month prior to him, coming to us, but, you know, having that conversation with the physicians and, you know, accepting what his diagnosis and his prognosis was, number one, and then it all depends on their, you know, their faith and religious beliefs, and where they are in that process. And then when the whole family's on the same page is a totally different, a totally different environment. And it makes it less stressful for that patient, because I mean, they're still there, you may not think they're listening, but they're still there in as well, for the kids. For the wife, for the moms, everybody involved is a much, it's a much much different kind of how

Roland  4:57  

so how is it different? What is what's it? You touched on this? What's it like in a patient's room? When, when I health care, power of attorney and directive and, and everything is in place? What's that, like, compared to

Unknown Speaker  5:16  

compared to when families are split, is

Alicia  5:18  

peaceful? Not and I'm not just saying that for the team, but for the patient is peaceful, and you have that time to reflect with the family about their loved one. You know, you can, for example, we have, you know, activities that we do with, say, if you have a young child or grandchild, we do handprints but the family, so they're more likely to be at a place where they can create those memories versus a family that may be in complete denial, and they're still fighting for, you know, you have half of the family fighting to keep, you know, your loved one here, you have the other half, you know, you know, accepting the fact that there ready to move on, and all situations aren't really, you know, life and death, I'm just speaking on behalf of oncology and hospice, a lot of times someone may find themselves in a chronic, chronically ill situation, but not necessarily the point of death.

Unknown Speaker  6:17  

In so you touched on something

Roland  6:21  

really interesting for the patient, what, what's it like for them, when maybe they're kind of coming in and out of consciousness, and there's a lot of stress in the family about what to do, and they can't end the patient isn't in a mental state to make their own decision? What, what's that like for them? Do you think? Of course

Alicia  6:44  

agitation? I mean, again, people think that just because their loved one is unconscious, that they're they're not. They're not there. But they can absolutely, in many cases, probably the ICU or intermediate units, a lot of patients that may come out of their, you know, critically ill state may even tell their loved ones. Hey, I recall when you guys were talking about, you know, you know, ABC, whatever, whatever. So I'm sure for those ...

Transcript:
Roland  0:07  

Welcome to the Novant Health Healthy Headlines podcast. This is Roland Wilkerson, and today we're talking with Dr. Obinna Ikwechegh, a leader at Novant Health, and a psychiatrist who's worked with countless patients over the years. Today's topic, how to say no. In May, the World Health Organization elevated definition of burnout from a state of exhaustion to a syndrome resulting from chronic workplace stress. Burnout doesn't just happen at work, of course, almost anyone with a set of responsibilities in their life is at risk of becoming overwhelmed. And at the same time, many of us have learned that saying, yes is an easy way to keep our job and keep those around us happy. So we consulted Ikwechegh, who said there are many ways to navigate the mine field of No, you could find this story and many others online, just search for Novant Health and Healthy Headlines. Thanks for listening.

So before we get to the how, let's talk about the why. Dr. equation, why is it so important? To be able to say no,

Dr. Obinna Ikwechegh  1:11  

The word no by itself connotes negativity. It connotes disagreeable illness. So the default of the human psyche is to come across as helpful, dependable, reliable, you know, in the workspace, the thing that thinking that you're a team player. So every time we're faced with a decision whether to say yes or no, the society has primed us to say yes, because we want to come across as helpful. If you went through life, without any sense of control, I think it creates a lot of powerlessness and ultimately a lot of resentment. So being able to say no, I think it allows you to take back some control, and prevents all this negative emotions that might result from lacking that ability.

Roland  2:07  

And so let's talk about that just a little more. What happens when you have a lack of control in your life? How does that color how you go through things day to day in your life,

Dr. Obinna Ikwechegh  2:22  

I think most most significantly gives you the sense of irrelevance. Because if you feel that you have no control over your life, you feel dumped on and you feel my views don't count. And that gets you back to the sense of powerlessness resentment, and really an inability to make any progress. I'll explain it better this way. If one felt that had no control over what happened in the daily at it is, it might give you the sense that I don't even need to show up because it wouldn't matter one way or the other. Or if I show up, I'm not contributing to anything because you know, Roland is just going to tell me what to do and power things on my plate. And I have no control over what I do. And I think that will really hamper anybody, even the strongest of us.

Roland  3:27  

Why can it be so hard for so many of us to say no? So what's your advice to somebody who says yes, way too often? What's a good way to start learning to say no.

Dr. Obinna Ikwechegh  3:46  

I've always said I'm a psychiatrist, I look at everything from the concept of therapeutic intervention. If I had someone before me treatment, who said I've lived my whole life pleasing other people and saying yes to everything, my recommendation will be enough for the next several months. Say no to everything. More practically, what you might start off with will be never say yes, but say me think about it. And I'll get back to you. That allows you room to actually look at all the things in your life to make sure that you're saying no to something that you can actually fulfill, as opposed to reinforcing the feeling that people are making me two things. which reinforces your sense of powerlessness.

Roland  4:36  

In what if it's extra hard for, for you to say no? Like, what's what's a baby step that somebody can take, if you if you've built up this lifetime habit of saying yes, pushing back on people is going to be really difficult. So what's a, what's a baby steps someone can take.

Dr. Obinna Ikwechegh  4:55  

And as a lead in to that, if I may, recognizing that saying no, to a thing that you truly don't want to do? Is reinforcing your sense of integrity, might help you go to this next step of the baby steps like we're talking about. Being able to recognize internally that my know is a yes to something else would help you take those steps. So one thing to do may be offer somehow, without committing to do that thing. So if I said to you, Roland, you come to me, I say, hey, I'd like for you to do XYZ thing. And I said, Roland, I'm going to be going to my daughter's recital, I cannot do it. But here is Johnson down the cubicle, who has done this work already, I think he might be helpful, or here is a website that you can look at that will give you all the answers that I would have given you. I'm offering you some help. I'm reinforcing that what you're asking me to do is important. But I'm honoring my own integrity that says I can't do this, without taking away from this other thing that that I had already committed to. I think that's a quick way to strengthen yourself for the art of saying no, which is recognizing that you want to do it from a place of integrity.

Roland  6:27  

And why is integrity important in in the in the context of saying no?

Dr. Obinna Ikwechegh  6:36  

Really, that saying no is a tool of integrity, because for me, I know this might not be a literal definition. But integrity simply means that I do what I've said I'm going to do. So if I had said to someone else, I'm going to do this than that. And I want to live up to that promise, they're admitted, I want to stay in that place of integrity in that interaction, then saying no, to you, allows me to uphold this integrity of something that I had already committed to. So in the end, saying no, is really a place of respect for you. And respect for my own integrity. Because I'm living up to something that I've already said I was going to do. I think in the workplace. We've talked a lot about work, life balance, it's easy to become so compartmentalize, well think All right, this is what I have to do everything without recognizing that there are these other things about our lives, from good example that I have young children, that's important to me. So if I really said to my daughter, I'm going to be at that recital, if I don't show up. That's a debt to my integrity, the next time I talk, I'm going to do that something. So that's important to put that in the wider context of how my life intersects with the work that I do. In that whole understanding, like I'm explaining, it makes it easy for such a woman to be able to say, I'm going to live up to this integrity to my daughter or to whatever else that saying yes to would have taken from

Roland  ...