Tim Meyers

Take Good Care – Stay In The Game!

Take Good Care – Stay In The Game!

By Shannon Dooley, MSN, FNP

Whether you’re playing a pickup game in basketball, heading back on the field in high school sports, enjoying an occasional hike or bike ride, or just enjoy being active, following certain principles can enhance your sports experience and reduce the chances of being injured.

Staying active with moderate and regular exercise is good medicine for most people. All kinds of good health outcomes generally come with regular exercise and sound eating habits. These include increased energy, reduced rates of common disease conditions, improved mental alertness and performance, high sense of well-being and more.

But if we’re not prepared or aware, any attempt to engage in exercise can result in discomfort or worse, injury. Here are a few suggestions that can help you enjoy exercise and stay in the game.

Set some goals for fitness.  Some people want to improve their fitness to help lose weight. Some may want to increase energy. Some may want to run in a marathon. Whatever your goal(s) it is generally helpful to write them down to improve focus.

Translate your goals into a daily routine. Many physicians and nurse practitioners recommend getting two and half hours (150 minutes) of moderate aerobic or physical activity a week. If you can squeeze more activity time in and occasionally bring in some more vigorous activity, you’re likely to get even better health benefits. Remember that even small periods of activity are more helpful and beneficial than no activity, especially in our sedentary society where many people work at a desk or sit for long periods of time.

When starting out, pace yourself.  If you’re planning on a run, getting on the court for a brisk game of one-on-one, or picking up some weights in strength conditioning, warm up first. Do some gentle stretching and body movements to help saturate your arms and legs with good blood flow and loosen up a bit. Don’t try to do too much too soon.

Discomfort or pain generally means something is not right.  Mild physical discomfort or stiffness can simply mean that you’re exercising some muscle groups that aren’t used to being exercised. That means your level of exercise is probably at a good level. As you increase frequency or exercise or workouts, those areas of discomfort will likely go away as you become more fit.

Chronic, uncomfortable pain is a different story. An ankle sprain, pulled or strained muscle, or dislocated joint all are areas that produce moderate to sharp pain and may require professional medicine treatment. Listen to your body.

Activity balance is important. If you’re planning on working out to build strength or endurance, make sure that you engage different parts of your body to uniformly build fitness. Exercising different parts of your body on different days can help build optimum fitness. For example, giving your biceps a rest on one day while focusing on abdominal muscles can help provide a good balanced approach to improving fitness. Progress slowly and don’t overdo it.

Be flexible. If you’re a little too sore, or don’t feel good, give yourself a day off. Don’t try to grind through pain.

Get professional medical advice. When we’re active, the odds are eventually we’ll get some kind of injury. Preventative work – warming up, eating a sound diet, getting adequate sleep, having good shoes, progressing at a reasonable pace and the like – can help us avoid injury. But we can accidentally come down hard after a rebound or step into an unseen pothole on a run and suffer a moderate or severe ankle sprain. If you suffer a painful injury, don’t try to tough it out – get professional medical attention. You likely will recover faster and suffer less pain, both in the short- and long-term.

Plus, if you’re injured and not able to play in an important game, or on the couch and can’t move, perhaps missing your friends and social outlet, (or feeling depressed due to change in routine), consider getting a different kind of coaching – seek professional mental health care through your provider.

And by the way, if you’re planning on starting up a fitness program – particularly if you’re 40 or above, haven’t exercised for a while, or have a condition like diabetes – it’s always good to check with your physician or medical professional before you begin. Your provider can give you helpful tips to maximize your fitness program and also check for any possible problems that may complicate your plans.

Using good sense and embracing a regular plan of moderate exercise will provide many benefits. Take good care – and stay in the game!


A Family Nurse Practitioner (FNP) with Southern Indiana Community Health Care (SICHC), Shannon Dooley also holds a Master’s Degree in Nursing and has been certified by the American Academy of Nurse Practitioners since 2003. She and her husband enjoy camping, traveling and family life with their son. 

Posted by Tim Meyers in Fitness, Sports Medicine
Q&A – SICHC Patient After Hours Nurse (AHN)

Q&A – SICHC Patient After Hours Nurse (AHN)

A Nurse Is Always On-Call To Help. 

By Candace Cook-Cline, LPN

While the daytime staff handles appointments, medical questions/concerns, billing questions and a myriad of other details, SICHC also has available to our patients an After Hours Nurse (AHN) for those in urgent need to talk to an on-staff nurse.  Read on to learn more about our AHN...

 

Q. How do I contact the AHN, and when are they available?

A. The AHN is available anytime the clinic is closed (early mornings, evenings, nights, weekends, and holidays). A patient needs to call and will be answered by our answering service, evaluated, and referred to the AHN nurse.

 

Q. Do I have to be a patient of SICHC?

A. Yes. You must be an established patient.

 

Q. What kind of things can I call for?

A. After Hours service is available for urgent questions or concerns that need to be addressed in a clinical manner outside of normal business hours, and that isn’t critical enough to warrant an ER visit.

That can include medicine questions, someone’s feeling ill, reactions to meds, concerns regarding an appointment earlier in the day, etc
.

 

Q.  Is the After Hours Nurse an employee of SICHC?

A. Yes. Our AHN Candace has been a nurse with SICHC for 10 years. So our patients will have the same familiar voice when they have concerns.

 

Q. Is there a lot of paperwork to fill out before calling?

A. No. Patient data and records are accessible by the AHN.

 

Q. Does the AHN have access to your records?

A. Yes. They have access to patient records and are able to order labs, imaging, and if needed, prescribe medications (authorized by on-call provider).

 

Q. Will my insurance be billed for the AHN service?

A. No. Insurance is not billed for after hours calls.

 

Q. Does the AHN speak Spanish? Or can assist the hearing impaired?

A. The AHN has a translation app to work with the hearing impaired. The AHN doesn’t speak Spanish, however they utilize a translator app, while not 100%, does assist in the communication.

 

Q. Insurance companies often have After Hours Nurse lines, what’s the difference? 

A. SICHC’s AHN line differs from insurance options, due to the continuity of care aspect. Being able to have all patient records readily available in one place and also have a patient’s regular provider informed of the call in a timely manner is a wonderful asset for our patients.

Posted by Tim Meyers
Dealing with Grief

Dealing with Grief

Dealing with Grief

by Theresa Faulkner, LCSW

Grief is a normal human emotion. But it can be hard to know if you are making progress in how you are handling a loss, or if you need to reach out for advice or support. In this post, you’ll learn more about the grieving process as well as some of the signs that indicate when it’s time to reach out for help.

Causes of Grief

“While losing a loved one is one of the most common causes of grief, other life events such as—divorce, job loss, a move, declining health —also can lead to feelings of sadness that can be overwhelming,” says Teresa Faulkner, Licensed Clinical Social Worker at SICHC.1  And it’s not just personal experiences that can cause feelings of grief. Disasters or traumatic events that affect your community can have the same impact, according to Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Tips for Survivors: Coping With Grief After Community Violence.

How the loss occurred can also impact your ability to cope with it. According to The University of Texas at Austin—Counseling and Mental Health Center, an unexpected loss (due to an accident or a crime, for example) is traumatic because it happened without warning. But that doesn’t mean that a predictable loss—for instance, one due to a terminal illness—is easier to deal with. While you may have more time to prepare for the latter, you are also dealing with two layers of grief: the anticipatory stage and the actual stage.2 

Common Grief Responses

There are many different ways that you can react to feelings of loss and pain. The fact is, not everyone grieves in the same way or for the same length of time. What are some of the normal grief reactions?3  They can range from lack of focus, anger, frustration or sadness to feeling numb, tired or depressed. Also, grief can come in cycles or be triggered by certain places or significant dates: birthdays, anniversaries or holidays, for example. 4 

As for how long the mourning period can last, according to Harvard Health Publishing, acute grief is typically experienced in the first six to 12 months after a loss, while persistent grief can go on for a year or more. The important thing to remember is not to rush the grieving process, but watch for some gradual improvement in your ability to cope.5   

“Gradually, though, you should start to feel that you are moving forward and that the overwhelming sense of loss begins to lessen,” says Faulkner.6   “As time passes, you might find yourself ready to reach out to others in your social circle or even help others who have also experienced a loss.”

Signs of Complicated Grief

In some cases, however, you can feel as though you are trapped in a grief cycle, unable to move from the initial overwhelming feelings of loss even after many months have passed. This could mean that you are experiencing complicated or traumatic grief experts. 7 

According to the “Tips for Survivors" pdf, some indications of complicated grief include feeling deeply angry about the death or loss, being unable to think of anything else but the person who is gone, and not being able recall happy times with your loved one. You might also have nightmares, feel distrustful about others and be unable to maintain regular activities or fulfill your responsibilities. This is when you need to reach out for professional help so you can move forward on your healing journey.

SICHC Support

Losing a loved one is one of life’s greatest stresses. And the impact can be physical as well as emotional, with researchers finding that bereavement can affect your cortisol response, lead to immune imbalance and cell inflammation as well as changes in your heart rate and blood pressure. 8 

“At SICHC, our LCSW team-based care approach provides a variety of evaluations from a Behavioral Health Wellness check to screening for depression and substance abuse. We will work with your healthcare provider to help you through your grief recovery,” says Faulkner.9   “It’s important to remember that you are not alone and that there are a variety of resources to help you navigate this journey.”



1 
Tips for Survivors: Coping With Grief After a Disaster or Traumatic Event

2 https://store.samhsa.gov/sites/default/files/d7/priv/sma17-5035.pdf

3  The University of Texas at Austin—Counseling and Mental Health Center — Sudden or shocking losses due to events like crimes, accidents, or suicide can be traumatic. There is no way to prepare. They can challenge your sense of security and confidence in the predictability of life. You may experience symptoms such as sleep disturbance, nightmares, distressing thoughts, depressed mood, social isolation, or severe anxiety. Predictable losses, like those due to terminal illness, sometimes allow more time to prepare for the loss. However, they create two layers of grief: the grief related to the anticipation of the loss and the grief related to the loss itself.

4 University of Texas at Austin’s Counseling and Mental Health Center https://cmhc.utexas.edu/griefloss.html#normal

5 University of Texas at Austin’s Counseling and Mental Health Center on its Grief and Loss page

6 Tips for Survivors: Coping With Grief After a Disaster or Traumatic Event
https://store.samhsa.gov/sites/default/files/d7/priv/sma17-5035.pdf

7 Tips for Survivors: Coping With Grief After a Disaster or Traumatic Event
https://store.samhsa.gov/sites/default/files/d7/priv/sma17-5035.pdf

8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384441/ — Research to date suggests that bereavement is associated with neuroendocrine activation (cortisol response), altered sleep (electroencephalography changes), immune imbalance (reduced T-lymphocyte proliferation), inflammatory cell mobilization (neutrophils), and prothrombotic response (platelet activation and increased vWF-ag) as well as hemodynamic changes (heart rate and blood pressure), especially in the early months following loss.

9 Mayo ClinicGrief: Coping with reminders after a loss If your grief gets worse over time instead of better or interferes with your ability to function in daily life, consult a grief counselor or other mental health provider. Unresolved or complicated grief can lead to depression, other mental health problems and other medical conditions. With professional help, however, you can re-establish a sense of control and direction in your life — and return to the path toward healing.

Posted by Tim Meyers in Behavioral Health, Grief, Mental Health
Helping Your Child Adapt to Kindergarten

Helping Your Child Adapt to Kindergarten

by Kathryn Poole, Family Nurse Practitioner

Being in kindergarten is a big step for your little one. But there are ways you can help your child mentally prepare for the transition and, along the way, make sure that you have all the health bases covered.

 

Establish routines.

The sooner you can accustom your child to a regular schedule for sleeping, eating and school-related activities such as homework, the easier the kindergarten routine will be. According to Amie Bettencourt, M.S., Ph.D. from the Division of Child and Adolescent Psychiatry at Johns Hopkins, “Routines help children learn, make them feel safe and in control of their world, and foster their self-confidence and sense of belonging within the family.” [i] [ii]

Keep in mind that the kindergarten setting can be more structured than preschool. Your child will be expected to sit for longer periods of time, as well as transitioning from one activity to another, noted Dr. Bettencourt. This can be challenging since, at that age, they are still developing self-control and skills that help them focus and follow directions.[iii]

Soothe your child’s fears about the new school by attending an orientation (if one is given) or arranging for the two of you to visit the classroom or school ahead of time so your child will gain some familiarity with the environment.[iv] If the school is new to both of you, try to meet with the secretary, nurse, principal and others that you and your child will be interacting with.[v]

Once kindergarten has started, stay in touch with the teacher and staff members so you will be aware if your child needs help adapting to the routine. Also, realize that even the brief break during school holidays can affect your child’s ability to adjust when it’s time to go back, making it all the more important to stay consistent with the established schedule.

Don’t overlook the time before and after school. If you have a caregiver handling pick-up and/or drop-off, discuss this with your child. Is someone watching your child after school until you get home? Set up a routine for snacks, homework or playtime beforehand.[vi] Also, consider establishing a “parent” routine to make sure you review school-related information in a timely fashion, recommended Bright Horizons.

Lastly, build in time to talk with your child about school on a daily basis. You can share stories about your own kindergarten experience, or ask open-ended questions like “What was something new you did or learned today?” or “Who did you play with and what game did you play?” You can also ask what activity they liked and what was one they found difficult, which can also highlight something they may need help with. [vii] [viii]

 

Work on the basics.

While children learn new skills in kindergarten, there are some basics that they should be able to do even before school starts. Leapfrog has a useful kindergarten skills checklist that highlights areas to review to see where your child might need some help. These include social and motor skills, language, reading and writing skills, mathematics, social studies, science, creative arts and music, and reasoning and concept development.

If you have concerns about your child’s developmental readiness, discuss it with your child’s healthcare provider. The State recommended reading Learn More Indiana, suggests the sooner you take action to correct any delays, the better the outcome will be. Learn More Indiana has a downloadable publication that has tips and resources with more information.[ix]

 

Schedule a vision screening.

Since August is Children’s Eye Health and Safety Month, this is the perfect time to have your child’s vision checked, especially since healthy vision is a key factor in your child’s ability to learn, reach motor developmental milestones and achieve overall healthy development, says Prevent Blindness.[x] A vision screening identifies children at high risk for eye disease or who may already have a disorder, while an eye exam is a comprehensive evaluation of vision functioning and the health of the eye.[xi]

Learn more about the vision screening and eye exam requirements for school-aged children here.[xii] If you need financial assistance for vision care, Prevent Blindness has a list of organizations and services that can help.

 

Review the vaccination list.

August is National Immunization Awareness Month (NIAM). But with all the attention on COVID vaccinations, it’s easy to overlook the other types of immunizations that your child may be due for. Our vaccination page will walk you through the list of immunization your child may need. For more information about the Indiana 2020-2021 required and recommended school immunizations, visit the Indiana Immunization Coalition website.

Speaking of COVID, stay updated on any mask requirements due to the Delta variant and the high percentage of unvaccinated people. As of this writing, CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place. Question? Check with your child’s school.


[i] Dreambox Learning — August is Get Ready for Kindergarten Month: Sleep Schedule — Adjust their sleep schedule gradually to the school’s schedule.

[ii] Johns Hopkins — How to Get Your Child Ready for the First Day of Kindergarten—Kindergarten is a major step for young children — their first day of “big kid” school. As exciting as this time may be for some, many kindergarteners struggle initially with the long days, challenging curriculum and time spent away from loved ones. To get your student ready to learn, child psychologist Amie Bettencourt from the Division of Child and Adolescent Psychiatry offers helpful tips. What can parents do to help prepare? Establish strong routines at home. Routines help children learn, make them feel safe and in control of their world, and foster their self-confidence and sense of belonging within the family. Some key family routines that will help children feel ready for kindergarten include:

  • Bedtime Routines—Bedtime routines ensure kids get a good night’s sleep and will be ready for the next day’s adventures. Some important parts of a bedtime routine include a consistent bedtime and a predictable order of activities (e.g., take a bath, put on pajamas, brush teeth, read favorite story or sing favorite song, get a goodnight hug or kiss from their caregiver).
  • Reading Routines—Parents are encouraged to read with their children for at least 20 minutes a day to build language and literacy skills. This reading routine can be part of the bedtime routine or at another time convenient for you and your child. A good way to make this time child-centered (and increase your child’s enjoyment and engagement in this time together) is by letting your child pick out the book.
  • Family Mealtime Routines—Having a family mealtime routine is not only an opportunity to teach your children about healthy eating habits, but is also a chance to spend quality time talking with your children, which builds their language and strengthens their relationship with you. You can also build in routines around mealtime that will be useful to your children in school, such as washing your hands before dinner or teaching them how to clear dishes from the table.

 

[iii] Johns Hopkins — How to Get Your Child Ready for the First Day of Kindergarten—Kindergarten is much more rigorous today than when most parents were growing up. In fact, children spend much more time engaged in structured reading and math activities than time spent in socialization and play-based learning. As a result, there is a mismatch between a child’s developmental stage and the academic skills he or she is required to master. Below are some of the issues that new kindergarteners may struggle with:

  • A longer school day . Many children transition to kindergarten from half-day preschool programs, so spending a full day of school engaged in structured activities can be a difficult adjustment for them.
  • Transitions . Transitioning from one activity to another is challenging for most young children, particularly when they have to stop a preferred activity (e.g., playing) to engage in something challenging (e.g., learning to read), and a typical kindergarten school day is full of these transitions.
  • Sitting still and paying attention for long periods of time. The format of kindergarten has become much more structured and passive in nature, meaning young children are being required to sit still and pay attention to their teacher and to schoolwork for longer periods of time. This can be challenging for many kindergarteners who are still developing self-control and skills that help them sit still, focus and follow directions.

[iv] Bright Horizons — GETTING READY FOR KINDERGARTEN: HOW TO PREPARE & WHAT TO EXPECT: Plan a kindergarten visit. Visiting the new classroom or school with your child will help make preparing for kindergarten easier for him/her. Make sure you include a visit to the cafeteria, gym, playground, etc. If possible, meet with your child’s new kindergarten teacher. Some of these may be included in an orientation that the new class or school provides. But, if not, try to arrange a school visit on your own. If a visit doesn’t work with your schedule, maybe a relative or neighbor whose child attends the same school can take your child.

[v] Bright Horizons — GETTING READY FOR KINDERGARTEN: HOW TO PREPARE & WHAT TO EXPECT: Keep informed of school happenings. If you child is leaving an early childhood education program, you may find that your child’s kindergarten experience may be less personalized than your experience in child care. You will have to act as your child’s advocate in some situations. Keep informed. Read everything that comes home. Occasionally visit the school or kindergarten classroom if your work situation allows you. Knowing the school secretary, nurse, principal, etc. and introducing yourself and your child to them may also help prepare your child for kindergarten.

[vi] Bright Horizons — GETTING READY FOR KINDERGARTEN: HOW TO PREPARE & WHAT TO EXPECT: Make a plan for before- and after-school. Make sure you and your child know the routine for before- and after-school care if that applies. Discuss where he/she will go, how he/she will get between school and child care, how he/she will get home, etc. Have a back-up plan for what to do in case you are late. You probably had a plan for your current early childhood center, but be sure that your emergency pick-up people know where the new school or after-school program is located and what the pick-up routine is there. Better to prepare ahead of time than wait for an emergency.

[vii] Johns Hopkins — How to Get Your Child Ready for the First Day of Kindergarten—Tell your child what to expect. Talk to your child about what kindergarten will be like to help them start preparing for this big transition. Children often have lots of questions about kindergarten, particularly if they are starting at a new school. Spend time talking with your child about what kindergarten will be like (e.g., who will be the teacher, what will the daily school routine look like, etc.). Involve him or her in picking out their school materials (e.g., backpack, clothes, etc.). You can also talk about what going to kindergarten was like for you as a way to model how your child can share feelings about kindergarten.

[viii] Johns Hopkins — How to Get Your Child Ready for the First Day of Kindergarten—So here are a few other ways that you can get the conversation started with your children about school:

  • Ask your children to tell you one new thing they did or learned about in school that day.
  • Ask your children to tell you one thing they liked and one thing that was difficult about school that day.
  • Ask your children about who they played with in school and what games they played.
  • Create a family routine around talking about your day. For example, during mealtime or another time when you are spending time with your children, you can model how to talk about your day by sharing one or two things that you did that day and then asking your children to share one or two things about their day.

[ix] Learn More Indiana [Led by the Indiana Commission for Higher Education, Learn More Indiana is a partnership of state and local organizations working to help Hoosiers of all ages complete education and training beyond high school.] — HOW SHOULD I PREPARE MY CHILD FOR KINDERGARTEN?: Taking action early to correct development delays can make a world of difference. If you have any concerns about your child’s development, contact Indiana’s First Steps program. They offer discounted speech, occupational and developmental therapy for children ages 0-3 who qualify. If your child is beyond the age of 3, your child may qualify for therapy or a developmental preschool program through the public school system or Indiana’s Head Start program. Give your young child the best possible basis for success with resources through Brighter Futures, including knowledge on learning and play, health and wellness, and resources to help find childcare.

[x] https://preventblindness.org/childrens-eye-health-and-safety-month-resources/ — August is Children’s Eye Health and Safety Month here at Prevent Blindness. You can help raise awareness of children’s vision and eye health as kids head back to school.  Our key message is that healthy vision contributes to children’s school readiness, ability to learn, overall healthy development and ability to reach motor developmental milestones

[xi] Your Child's Sight: Understanding Vision Screenings and Eye Exams — The Role of Vision Screenings

  • Identifies children who may be at high risk for eye disease or in need of a professional eye examination
  • Helps detect the possible presence of disorders at an early stage when treatment is more likely to be effective
  • Provides valuable information and education about eye health
  • Results in a referral to an eye care professional or primary care provider when screening tests indicate a need for diagnosis and treatment

The Role of Eye Examinations

  • Provides a comprehensive evaluation of vision functioning and the health of the eye
  • Is conducted by an Ophthalmologist or Optometrist who can diagnose and prescribe treatment for vision disorders

[xii] Know the Eye Exam or Vision Screening Requirements in Your State: This page provides a list of vision screening and eye exam requirements for school-aged children, by state.

Posted by Tim Meyers in Children, Community, Pediatric Care
Covid-19 Update

Covid-19 Update

by Yolanda Yoder MD

At the beginning of the COVID pandemic spring 2020, we pledged to help keep our community informed so that they could make wise decisions. Now 1 1/2 years later, we are all tired of hearing about it. Despite that, we think you need to know what we are seeing as local medical providers.

The delta variant surging across the central part of the US is rapidly spreading in our own communities at rates similar to our highest peaks last year. Below is the Indiana map showing the current surge.

And we are seeing it too. Sick people who feel awful. Hospitals filling back up again with those who are short of air. .....and with people too young to normally be in a hospital. People who had Covid last year are now getting it again.

It's hard to describe how we as health care providers feel when people we care for become seriously ill with something they might have been able to prevent....... its best described as grief mixed with horror that we are where we are. Imagine watching a tsunami wave in the distance, and yelling down on the beach to warn people of what is coming.....and they hear you but don't move.....and then you watch that wave go around some people but wipe others out. And then you play that same scene all over again with the next wave.

Nation-wide - over 95% of the people in the hospital with Covid are unvaccinated. Yes, vaccinated people can get COVID too and even pass it to others. That's why masks are important again for everyone during this delta flare-up. But vaccinated people are MUCH less likely to get seriously ill from Covid.

Many people have waited to get the vaccine for a variety of reasons but mostly due to the newness and concern about side effects. Dr. Sanjay Gupta's recent article addresses this concern as follows........."As far as safety goes, more than 4 billion doses of coronavirus vaccines have been administered worldwide. In the United States alone, more than 347 million doses have been administered. These are some of the most widely used medical products on the planet, and as a result, there is a remarkable amount of real-world data.

Throughout the vaccination campaigns, the number of side effects has been and remain consistently and extraordinarily low. The CDC is constantly searching for side effects. That is how the agency was able to confirm 28 cases of rare blood clots among the 8.7 million doses of the Johnson & Johnson vaccine administered in the US. The side effect monitoring system is very sensitive and the news has been good. Overall, side effects have been minuscule.

What is not minuscule is the number of deaths caused by Covid-19: more than 4.2 million deaths worldwide, including more than 610,000 here in the United States". (written by Dr. Gupta)
56 of those deaths were among our citizens of Orange County. 17 from Crawford County. In addition to the deaths, we've seen strokes and lung clots in middle-aged people. And there are many others affected by "long-haulers" Covid symptoms of shortness of breath, fatigue, and memory trouble that goes on for months. These are not fake numbers. These are people we know.

Please get the vaccine.

And when you get the vaccine, remember that it takes 2 weeks of time after the final dose to be considered likely protected from serious infection..... so remember to mask up well with one that seals around your nose and mouth.

Sorry for the intensity in this post. It's been a long year for everyone, including medical teams and the tone of this post reflects that reality.

We sincerely hope most of us can agree on one thing. That we don't want to experience this virus smoldering on and on in unvaccinated people....and having more time to mutate into new variants....and keep causing havoc on so many levels. We can work together to change that.

Thanks for reading,
Yolanda Yoder MD
__________________________________________________________________
We have much gratitude for those who helped the community during this challenging time.
We especially thank Heather Nichols for her 1 1/2 year-long attention to keeping us informed with daily posts to this local Covid info page:

https://www.facebook.com/groups/580815819187936/posts/894050061197842/?notif_id=1627920591513449&notif_t=page_group_post&ref=notif

Posted by Tim Meyers in Covid-19, Rural Healthcare
Protection – It’s Worth a Shot

Protection – It’s Worth a Shot

By Yolanda Yoder M.D.

The good news is here! Effective vaccines are available and being administered that can help end this deadly COVID-19 crisis. We all look forward to the day when our community and our country reaches what is called “herd immunity” and COVID-19 is history.

Some have asked questions about the vaccines. Some inaccurate information has appeared on social media and other outlets, which can be confusing. Sometimes even our own family members can receive information that may be confusing, which can cause more concern.

As you probably know, we at SICHC have been at the frontline during this entire crisis. We always have committed ourselves to doing what it takes – even treating patients in parking lots when we had to.

We’ve researched and are quite familiar with the vaccines currently being administered in Indiana – Pfizer, Moderna and J&J. I personally was vaccinated and am glad to be protected.

Here is what we want you to know about the COVID-19 vaccine program:

  • Millions of Americans have already received one of the approved vaccines and now enjoy protection from this deadly COVID-19 virus. 
  • Out of those millions of administrations, only a very few people have had allergic reactions
  • The available vaccines underwent the most intensive safety monitoring in American history.

I’d like to answer some common questions about the vaccines and encourage you to read further so you’ll be confident in getting the shot.

If the vaccine came out so fast, how can it be safe?

In the past, it took time to develop new technology, time to get enough people to be part of the trials and time to grow the virus in culture dishes, then killing it to put it in vaccines. 

Fortunately, advances during the past 20 years have given researchers technology they can use for these vaccines, the fact that 70,000 people quickly volunteered for the phase 3 trial, and a production process that made creating the vaccines much more efficient. 

Plus, once trials were complete and results submitted to the FDA, vaccine-producing companies took a calculated risk and started manufacturing vaccines in anticipation of approval, recognizing the critical need.  The result was they had millions of doses ready and waiting to ship out once FDA approval was granted. 

So even though it might seem a bit too fast to be safe, the truth is the research and production of COVID-19 vaccines are the result of two decades of scientific research and technology development, followed by rigorous testing.

Can I get a case of COVID-19 from the vaccine?

No—you cannot get a case of COVID-19 from the vaccines because they don’t have live viruses that could cause this.

Will I get sick from the COVID-19 vaccine?

You won’t get sick, but you might have an initial reaction as your immune system responds to the vaccine. The common side effects are similar to those you might have experienced when you received a flu shot:

  • There might be mild pain, redness or a little swelling on the arm where you received the shot.
  • Over the next day or so, you may feel tired, have a mild headache, some chilling, or even a mild fever or some nausea.
  • For those who receive two shots (Pfizer or Moderna), the side effects may be a bit more intense after you receive your second shot (particularly if you previously had Covid).

Don’t worry if you feel any of these symptoms. These side effects just show that your immune system is being trained to track down and destroy the virus if it tries to infect you in the future. (In the unlikely event that symptoms persist or grow worse, check with your family doctor or medical professional)

The same is true for people who have recovered from a prior case of COVID-19. They may initially experience more intense (and familiar) COVID symptoms, but they will likely go away in a day or so.

And if you don’t have any reactions, that’s okay, too. The vaccine is still working and you are still benefiting from receiving it.

I’m pregnant or breast-feeding. Should I still get the COVID-19 vaccine? 

If you’re pregnant or breast-feeding, you may rightly wonder if it’s okay to be vaccinated. Vaccines are available for pregnant women, but like other experts in the field, we at SICHC think that it’s a good idea to talk with one of our physicians or medical professionals before you get vaccinated. 

I have some underlying health conditions. Can I still get the vaccine?

There are situations – like people with underlying conditions – that should be checked out before a person receives a vaccine. We can help you if you wonder if you’re in that category.

I had COVID-19. Do I still need the vaccine?

Yes, even if you’ve had COVID-19 and have recovered, we still strongly recommend that you get vaccinated. You will likely have natural immunity after recovering, but nobody knows how long that will last. Getting a vaccine improves your long-term protection.

Once I get the vaccine, can I go back to living a normal life?

Once you are vaccinated, it can take up to two weeks before you are fully protected. It takes that long for your immune system to completely respond. During that time there is a small chance that you could be re-infected with the virus and come down with COVID-19 before your immune system is up-to-speed, but it’s only a very small chance. So continue to wear your mask, wash your hands and keep your distance. 

Everybody in my extended family has gotten the vaccine. Can we get together safely? 

Once everyone has gotten vaccinated and the two-week window has passed, you should be okay to get as a group in a home or private setting.
[from CDC: 
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html ]

You can also visit inside a home or private setting without a mask with one household of unvaccinated people who are not at risk for severe illness.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html ]

But even if you’re vaccinated, the CDC recommends not visiting indoors, without a mask, with people at increased risk for severe illness from COVID-19 or attending medium or large gatherings.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html ]

Remember: our country has to reach “herd immunity” levels before we can all be safe.

Do family members or friends have concerns? 

It’s certainly okay to have questions, especially about something as important as the COVID-19 vaccine. It’s also important to get good, solid answers from professionals and reputable sources. We’re a trusted resource – we’ve been on the frontlines for months – and we’re happy to provide more information.

Your protection is worth a shot. And remember – your COVID-19 vaccine is free.

 

P.S. By the way, while we’re talking about vaccines, the COVID vaccines certainly aren’t the only important vaccines. Making informed decisions and staying up to date on vaccines is important for you, for your family and for public health in general. If you’re thinking about pregnancy or are older, you especially should talk with a physician or medical professional about staying appropriately up to date on vaccines for measles, mumps or rubella (MMR), flu, Tdap (whooping cough), hepatitis B and others.
Click here for a list of immunizations.

Posted by Tim Meyers in Covid-19, Immunizations
Team-Based Care: What It Is and How It Benefits You

Team-Based Care: What It Is and How It Benefits You

Among the many things the pandemic has taught us is the importance of having a community around you. Working together as a team, sharing knowledge and providing support is beneficial in so many ways, which is why SICHC has introduced Team-Based Care into our practice.

What is Team-Based Care? According to Stephanie Frye, FNP, it’s a multidisciplinary team approach used for patient care with a goal of improving patient outcomes. And it starts with the initial encounter. 

“In team-based care, the overall health of the patient is most important. Every provider has a nurse that assists the patient to the exam room and starts the process of asking questions: does the patient have specific needs that should be addressed, what medications are they are on, do they need a referral,” explained Stephanie Frye, FNP. “A lot of things can come up during a routine appointment and with this approach, if we see that the patient needs something beyond the purpose of the visit, we can do a ‘warm handoff’ to another member of the team who supports the patient with that concern.”

Because SICHC has many different multi-disciplinary levels of services available, like mental health counseling, addiction and recovery treatment, and chronic health care management, the team-based approach is especially effective. Everyone—from the administrative personnel to the clinical staff—is part of the team, so if a patient needs insurance assistance, help with telehealth, or community resource support, the connection can be made immediately to start the process.

“A big benefit is that it helps our providers focus on the patient,” said Quality Assurance Coordinator Lindsey Gardner, RN. “Patients get one-on-one with their provider because the nurse has taken care of all the other tasks, especially those needed for preventative care and overall wellness. The medical support staff are really empowered to take proactive steps, so you're really looking at services coming from everybody in the organization.

“Even the staff who are involved with the patient before the actual office visit play a part,” added Katarina Koch, Fund Development Manager. “They are an essential part of helping the patient get ready for their visit and can alert the team if something comes up during that interaction that may be a cause for concern.”

Team-based care is all about empowerment. Team members work to the top of their licensure, and patients are encouraged to engage in their own health and be part of the healthcare decision-making process.

“Personally, I feel like you have better patient outcomes when you empower the patients,” said Stephanie. “As part of my practice, I do try to involve the patient, asking them how they feel about a proposed treatment or giving them options about certain types of care.” 

SICHC also has a strong connection with resources outside the practice, both in the community it serves as well as beyond. “We have a community health worker at our Paoli office who is a good resource person for patients who need help from outside agencies or community-based services. With a total of six offices that cover four counties, we have an extensive list of contacts.”

Additionally, SICHC partners with Indiana University’s Center for Rural Engagement on many health initiatives that allow the practice to expand beyond the clinic walls by engaging the health of the whole community and connecting patients with locally available resources.

“We have several different partnerships with IU faculty and students who support patient care,” said Katarina. “For instance, SICHC’s chronic care management program works with students from IU School of Nursing who come to Orange and Crawford County to provide home visits for our chronic care patients and support them in a variety of ways. At the same time, the students are learning from the patients who teach the student how they manage their chronic conditions.”  

SICHC is going through the process of being designated a Patient-Centered Medical Home (PCMH). According to the National Committee for Quality Assurance (NCQA), PCMHs improve quality and the patient experience, increase staff satisfaction, while reducing health care costs. 

With the team-based care approach, SICHC takes care of the whole health of our patients. As Katarina explained, “We are taking our whole family care to a new level as SICHC continues to be a vital safety net for the health of our rural communities and a part of our patient’s medical family.”

Posted by Tim Meyers in Patient Whole Health, Team Based Care

IRHA names Yolanda Yoder, MD as its 2021 “Doc Hollywood”

IRHA names Yolanda Yoder, MD as its 2021 “Doc Hollywood,”citing Dr. Yoder’s “exceptional commitment to high quality healthcare”

Yolanda Yoder, M.D. SICHC Chief Medical Director

Yolanda Yoder, M.D.
SICHC Chief Medical Director

TERRE HAUTE, Indiana – Recognizing outstanding service in rural healthcare, the Indiana Rural Health Association (IRHA) selected Yolanda Yoder, M.D., chief medical director for Southern Indiana Community Health Care (SICHC), for its 2021 “Doc Hollywood” award.

Taking its name from a popular film where an inspiring urban surgeon discovers the rewards of practicing in a rural setting, the annual IRHA “Doc Hollywood” recipient is chosen by a group of independent medical professionals who review nominations from across Indiana. The award was presented before the keynote address from former U.S. Surgeon General Jerome Adams on June 16 at the annual IRHA conference at French Lick, Indiana.

According to Cara Veale, IRHA CEO, Dr. Yoder was chosen for a variety of reasons, including the fact that “Dr. Yoder’s exceptional commitment to high quality healthcare throughout her four rural county service area is well-documented by medical peers, state officials, local leadership and patients themselves. As one local leader noted, ‘our region relies on her for her wisdom, discipline, substance, truth, teamwork, responsibility and excellence. She is always willing to encourage innovation and entrepreneurship. She’s a proven leader.’”

Further, Dr. Veale continued in announcing the award, “In addition to her work with establishing the community organization Thrive Orange County to positively address critical adverse childhood issues, Dr. Yoder quietly but aggressively champions the integration of high-quality mental health services directly in SICHC primary care service offerings. She sees and understands the need for quality mental health services, especially as area residents face issues associated with the COVID-19 crisis. She powerfully recognizes the need for professional, peer and local support for dealing effectively with substance abuse issues and more importantly, recovery.”

“She insists on high standards of health care service delivery and leads by example, leveraging her unique position as a community physician to be a key influencer,” Dr. Veale added.

Regional medical professionals, including senior administrators at the IU Hospital in Paoli and the Center for Rural Engagement at Indiana University noted that Dr. Yoder is well-known for her collaborative – rather than competitive – approach to establishing and elevating quality healthcare.

In receiving the award, Dr. Yoder expressed that she only wished “that the award could be made in the name of the entire team at SICHC, who truly make this level of service possible.”

The Doc Hollywood award nomination is open to any individual in Indiana who has shown dedication toward improving health care in his or her own underserved, rural or other underserved community.

See video of Dr. Yoder receiving the 2021 award by clicking here.  

Exceptional Service in Healthcare - Officials of the Indiana Rural Health Association (IRHA) named Yolanda Yoder, M.D. as the IRHA 2021 Statewide "Doc Hollywood" recipient for exceptional leadership and achievements in healthcare. Dr. Yoder presently serves as Chief Medical Director for Southern Indiana Health Care operations in four counties. From left: Tara Hatfield, IRHA Board President; Cara Veale, IRHA CEO; Yolanda Yoder, MD (the new 2021 Doc Hollywood); and Jerome Adams, M.D., former U.S. Surgeon General (Now medical commentator for WISH-TV).

Exceptional Service in Healthcare - Officials of the Indiana Rural Health Association (IRHA) named Yolanda Yoder, M.D. as the IRHA 2021 Statewide "Doc Hollywood" recipient for exceptional leadership and achievements in healthcare. Dr. Yoder presently serves as Chief Medical Director for Southern Indiana Health Care operations in four counties. From left: Tara Hatfield, IRHA Board President; Cara Veale, IRHA CEO; Yolanda Yoder, MD (the new 2021 Doc Hollywood); and Jerome Adams, M.D., former U.S. Surgeon General (Now medical commentator for WISH-TV).

 

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About the DOC HOLLYWOOD Award - Drawing from the popular film “Doc Hollywood” where actor Michael J. Fox plays an inspiring Los Angeles surgeon who finds real satisfaction in rural healthcare, the Doc Hollywood Day vision is about recognizing individuals who care professionally for people in rural and other underserved communities. It is a time for celebration and fun, but it accomplishes a serious purpose of recognizing unsung heroes of rural healthcare.  Access to quality healthcare is a key component in terms of individuals’ physical and mental health; it is also a key component in communities’ economic vitality.  Without healthcare, along with schools, industry, water systems and other infrastructure, communities wither and die. Raising visibility and awareness about these unsung heroes, and celebrating their contributions, enhances rural Indiana’s ability to recruit people into these professions and areas to ensure access to quality health care and viable, thriving communities.  This remains particularly imperative as Indiana rural healthcare heroes continue to provide extraordinary care amidst an ongoing public health emergency.

About the Indiana Rural Health Association The Indiana Rural Health Association (IRHA) was organized in 1997 and is a nonprofit organization working to enhance the health and well-being of rural populations in Indiana through leadership, education, advocacy, collaboration, and resource development. The strength of the organization is through the present diverse membership and the founding organizers who are committed to impacting the health of citizens through the identification of rural health issues and through advocacy roles in both the public and private sectors. IRHA membership is made up of 3,300 diverse individuals and organizations, making it the largest state rural health association in the nation, and a nationally recognized leader in rural health care. For more information, visit www.indianaruralhealth.org

About the Southern Indiana Community Health Care (SICHC) nonprofit organization – Well-known as a high-impact health care provider committed to continuity of care, the nonprofit Southern Indiana Community Health Care (SICHC) organization is committed to providing high-quality, comprehensive, community-sensitive health care utilizing Christ-centered principles to medically underserved, rural communities.  As a Federally Qualified Health Center (FQHC), SICHC serves as a “safety net” provider for vulnerable populations and focuses on increasing access to primary care services for Medicaid and Medicare patients in rural communities. SICHC offers medical care in medically underserved areas of Crawford, Martin, Orange, and Washington counties. SICHC is a member of the National Health Services Corps and receives program funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. SICHC offers services to all persons, regardless of the person’s ability to pay. For more information, please visit https://sichc.org/

Posted by Tim Meyers in NEWS
What to Know About Osteoporosis and Bone Health

What to Know About Osteoporosis and Bone Health

By Jennifer Shafer, MSN

 

Make no bones about it, you’ve got to pay attention to the part of your body you can’t see but what keeps you strong – your skeleton.

But when was the last time you gave your bones some attention? Probably not lately. Bone health tends to get overlooked until something happens: a fracture or a test that shows your skeleton is less than sturdy. By then, you may have already developed osteoporosis—a condition where your bones lose calcium and become weak.

While osteoporosis can affect both sexes, it’s more common in women, affecting about one in five women 50 and older, but only one in 20 men in the same age range. The more you know about the disease, such as your risk factors, diagnostic tests and treatment options, the better you can work to keep your skeleton strong. 

What are the risk factors?

There are certain factors that can increase your risk for developing osteoporosis. These include:

  • Your sex—Women are more likely than men to develop osteoporosis, in part because they have lower peak bone mass and smaller bones.
  • Your age—As you grow older, and especially after menopause, bone loss happens more quickly, and new bone growth is slower.
  • Your body size—If you are slender and thin-boned, your risk goes up. If you are extremely underweight either due to overtraining or anorexia nervosa, your risk also increases, regardless of your age. 
  • Your race—White and Asian women are at highest risk for osteoporosis, while African American and Mexican American women are at lower risk.
  • Your family history—If one of your parents has a history of osteoporosis or hip fracture, researchers believe that increases your risk.
  • Your estrogen levels—Lower estrogen levels due to menopause or the abnormal absence of menstrual periods due to hormone disorders or extreme levels of physical activity can increase your risk.
  • Your diet—If your diet is low in protein, calcium and vitamin D, or if you engage in excessive dieting, your risk for bone loss and osteoporosis increases.
  • Unhealthy lifestyle choices—Being physically inactive, engaging in chronic heavy drinking of alcohol or smoking all increase the likelihood that you will develop osteoporosis.

Other factors can include certain medical conditions such as endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, or certain types of cancer as well as long-term use of specific medications. 

How is osteoporosis diagnosed?

According to the CDC, many people don’t know they have osteoporosis until they break a bone. That’s why it’s important to follow the screening guidelines to determine the condition of your bones, so you know what steps to take next. Women 65 and older and women 50 to 64 who have specific risk factors should be screened, says the CDC

The first step to gauge the health of your bones, says the National Osteoporosis Foundation (NOF), is having a clinical exam to evaluate your overall health and determine what risk factors may affect your bones. Your doctor may have you undergo a bone mineral density (BMD) test—a painless procedure that measures your bone density on different places such as your hip, spine, forearm (between the wrist and elbow), wrist, finger or heel.

If the results indicate bone loss, your doctor may order laboratory and other tests to determine if you have another medical condition that could be causing osteoporosis. The FRAX® Risk Assessment tool estimates your 10-year fracture risk based on information about your bone density and other risk factors, explains NOF. It guides treatment decisions if you meet the following conditions: you are 50 or older and postmenopausal, you have low bone density (osteopenia) and you have not taken an osteoporosis medicine.

What are the treatment options?

Treating osteoporosis doesn’t use a one-size-fits-all approach. You and your doctor should discuss what is the best way to treat your condition. But there are some steps you can take right now to help keep your bones strong and hopefully prevent any further bone loss. 

Recommendations include being physically active, performing weight-bearing exercises regularly, limit your alcohol intake, stop smoking, and follow a healthy diet that includes adequate amounts of calcium and vitamin D. According to the Surgeon General’s Report on Bone Health and Osteoporosis, this means 1,000 mg of calcium and 600 IU of vitamin D a day if you’re 19 to 50 years old. For women 51 to 70 years old, the calcium amount increases to 1,200 mg a day. For those over 70, the calcium amount remains at 1,200 mg, but the amount of vitamin D increases to 800 IU a day.

However, always discuss any new supplement plans with your health care provider since there may be contraindications. For instance, some supplements can affect any pre-existing conditions you have or medication you are currently taking.  

Bottom line? You need to do everything you can to keep your bones strong so they can support you!

Posted by Tim Meyers in Aging, Bone Health, Osteoporosis, Womens Health

Twelve Indiana Healthcare Providers Receive Grants to Improve Accessibility for People with Disabilities

01/28/21

Grants provided by MHS as part of Provider Accessibility Initiative

INDIANAPOLIS – (January 28, 2021) – MHS, in partnership with the National Council on Independent Living (NCIL), has awarded 12 healthcare providers across Indiana with grants to make their facilities more accessible to people with disabilities. The awardees applied for grants which are part of the health plan’s Provider Accessibility Initiative (PAI), with the full list of grantees including:

  • Porter Starke Services DBA Marram Health Center
  • Eric A Yancy, M.D.
  • Forniss Optometric P.C.
  • Walker Medical Group
  • HealthLinc, Inc.
  • Open Door Health Services
  • Edgewater Health
  • Tulip Tree Health Services of Gibson County
  • Montgomery Medical Associates LLC
  • Southern Indiana Community Health Care
  • Community HealthNet Health Centers
  • Goshen Family Physicians

The goal of the PAI is to increase the number of practitioner locations that meet minimum federal and state disability access standards. Providers in the MHS network selected to receive grant funds submitted applications to NCIL, explaining their need for more accessible facilities. MHS selected recipients based on the impact of the improvements on its disability access network adequacy, as well as the number of MHS members with disabilities impacted.

In the application process, providers proposed a list of potential improvements for each of their facilities. Upgrades like doorway and restroom modifications, more accessible exam tables and procedure chairs, and braille signage are just some of the improvement additions intended to be made with the additional funds. Some providers submitted multiple applications for several of their facility locations to make improvements.

“We are very excited to receive this funding. We will be able to serve a much larger segment of our community with dignity. I don’t want any patient, particularly kids, to feel like their care is an extra burden to staff or family. Everyone’s experience when going to the doctor should feel comfortable. A wheelchair should be able to enter a room easily. A transport chair should be able to go up a ramp easily. More importantly, a patient, should not even notice their experience is different than any other patient. I am proud to play a part in maintaining the dignity of others,” said Dr. Roland Walker, M.D. of Walker Medical Group.

For more information about the grants and the provider accessibility initiative, visit: www.ncil.org/provider-accessibility-initiative/

Posted by Tim Meyers in Disabilities Accessibility, Grants, Rural Healthcare