In thirty-some years of practicing family medicine here in southern Indiana, I’ve learned a few things beyond the medical school curriculum. Here’s one you may identify with: a southern Indiana woman will dutifully drive forty-five minutes to take her grandson to the dentist, then turn around and drive forty-five minutes home—and never once think to schedule her own mammogram or check-up on the same trip.

With the above in mind, I’d like to remind you that May is National Women’s Health Month. This time around I’d like to offer some suggestions to make it real for you.

Last month I wrote an open letter to the women of our communities about the annual wellness visit—what I called one of the most powerful preventive tools we have in medicine. The month of May is a good time to try out some new ideas, because spring out here practically begs us to step outside, take stock, and start something new.

Let’s start here. Rural living comes with real gifts: fresh air, neighbors who actually know each other, legendary sweet corn and fresh tomatoes in the summer, and a restoring pace of life that big city people can only dream about.

But it also comes with real obstacles. Longer drives to specialists. Fewer evening appointment slots. And the quiet, unspoken expectation that Mom—or Grandma, or Auntie—will keep the whole operation running.

What women in rural areas face

National data tell us that rural women face higher rates of heart disease, diabetes, and depression than their urban counterparts. Not because country life isn’t healthy, but because the system is harder to navigate when the nearest specialist is an hour away and somebody still needs to feed the chickens.

So here are three things I’d ask you to consider this May. They are simple, they are doable, and—if you’ll humor me — they are how a person builds a life of sustained good health, not just a one-month wellness sprint.

Schedule the visit you keep putting off

You know the one. Maybe it’s the well-woman exam. Maybe it’s the mammogram you’ve rescheduled twice. Maybe it’s the blood pressure or blood sugar check you keep meaning to do “once things settle down.” Let’s be honest. Things never “settle down.” They just shift. So pick one—just one—and put it on the calendar before the month is out.

Most insurance plans cover annual preventive care at no out-of-pocket cost. But if you are uninsured, please call us anyway. We will work with you.

This month, move your body, outdoors, on purpose, as many times as you can

Spring in southern Indiana is one of the great unsung blessings of American life. Walk the dog. Walk without the dog. Pull weeds. Take the grandkids to a trail at Patoka Lake.

You don’t need a gym membership or matching designer workout clothes—you need twenty or thirty minutes of intentional movement, three-to-four times a week. Your heart, your bones, your blood sugar, and your mood will all send you thank-you notes within a very short time.

Tend your mental and emotional health like you tend your tomato plants

You know what I see almost everyday? The caregivers in our communities are world champions at running on fumes.

My point? Sleep matters. So do honest conversations — with a friend, your faith community, or, when the load gets heavy, a counselor. One in four adults will face a mental health concern this year. You are neither alone nor an exception, and there is no judgment here.

May is one month in twelve, but a healthier you starts with one step. Pick one of the three. Take it this week. Then call us if we can help.

You matter to the people around you. And you matter to us. Make the month of May your month!

A board-qualified family physician, Dr. Curtis Thill has been providing services for women and families for more than 30 years in southern Indiana.

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What should alert a parent or caregiver to the possibility that a child may have ADHD (Attention Deficit Hyperactivity Disorder)? Here are some important answers and considerations based on a recent presentation by Teresa Faulkner and Sasha Newland, both Licensed Clinical Social Workers serving on SICHC’s mental health team.

ADHD symptoms typically include unusual difficulty in sustained concentration, an inability to plan or finish tasks, talking too much, inattention and distraction, impulsive interruptions, a high need to be in constant motion, and other behaviors. To be certain, many children and teenagers occasionally experience these behaviors as a normal part of mental and emotional development. 

Children with ADHD often possess talents like enhanced creativity, resilience or curiosity – all with the capacity to be singular strengths. 

Normal behavior or ADHD?

But when challenging behaviors continuously interfere with schoolwork or life with family or friends, it might be time to have a discussion with a medical provider or mental health professional.

Here’s an important fact: while more than 10% of U.S. teens have been diagnosed with ADHD, many children (and later adults) go through life with an undiagnosed condition. That can affect quality of life, success in school (and careers), and interpersonal relationships within a family, work environment, or even later in a marriage. 

It is very important to understand that if one is in fact diagnosed with ADHD, that is not somehow a “strike” against one’s success in life. Positive navigation of life with ADHD is indeed possible.

Given the uniqueness and complexity of each person, a qualified professional should make an evaluation and subsequent diagnosis of ADHD. “Self-diagnosing” ADHD and possible self-treatment can lead to issues and unwanted consequences. 

Some myths about ADHD can lead people to think that the condition compromises the capacity to lead a happy and fulfilling life. Successful life with ADHD is widely demonstrated, including professionals like Olympic gold medalist Michael Phelps, Harry Potter film actress Emma Watson, NBA basketball legend Michael Jordan,  Olympic gymnast Simone Biles, technology legend Bill Gates, singer Solange Knowles, and many more. 

If one is diagnosed with ADHD, the goal becomes how to manage the condition and fashion personal pathways that lead to success.

Parents and caregivers are important

The role of parents and caregivers in supporting children and teens diagnosed with ADHD is critical. Children need to be supported and actively accompanied on this journey. SICHC professionals directly engage parents and caregivers, providing tools and techniques (including how to manage stress) to help their child develop successful pathways and learn how to manage day-to-day challenges.

SICHC professionals consider a variety of potentially contributing factors when evaluating for ADHD. These include developmental variations, as gifted children can display traditional symptoms of ADHD. SICHC professionals also evaluate potential neurological, neurodevelopmental, behavioral, societal, and medical conditions or patterns. 

Since ADHD in children can affect cognitive, academic, behavioral, emotional and social function, most treatment of ADHD begins with talking with a licensed professional  in cognitive behavioral therapy (CBT). After an evaluation, diagnosis, and initial treatment (including ADHD training for parents), medications may be prescribed.

Education about ADHD critical

Far too many myths – including potential unfounded confusion between ADHD and autism – exist. As all children are unique, educating oneself about what ADHD is and the positive means to deal with it remains critically important in supporting someone with ADHD.

Concerned that your child or loved one may be facing ADHD? There is real hope and support! And it’s never too late to seek help. 

For more information about SICHC professional mental health team, please visit https://sichc.org/mental-health/ or contact a professional at one of our offices (visit https://sichc.org/locations/ for more information).

The key? Don’t struggle alone – help is available for a successful life!

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Stout, who has led broad efforts to address and treat substance use in the greater Orange County Indiana area, has spearheaded efforts to elevate the quality of healthcare available to those facing substance use. Instead of treatment only being available through substance use and other treatment centers, Stout and Southern Indiana Community Health Care now increasingly integrate substance use treatment into family healthcare services.

This includes the local administration of MAT (medication-assisted treatment) options, where people facing substance use can be prescribed Suboxone or Vivitrol without having to travel to a specialty clinic (MAT treatment also typically includes a combination of counseling and behavioral therapies).

Properly administered, Suboxone can blunt intoxication from using drugs like heroin, oxycodone and other opiates, reducing cravings and allowing people an opportunity to transition away from a life of substance use. Injectable Vivitrol is also available through a MAT program, which use blocks euphoria or ‘high’ that alcohol and opioids produce. Vivitrol has also proven effective in helping people with substance use issues recover.

“There is still a stigma around substance use, and this stigma serves as a barrier to seeking treatment for those who need it,” Stout said. “By integrating MAT options within family medical treatment, this provides several advantages, including helping those facing substance use issues with improving their general health and also addressing issues like diabetes.”

(Recognizing that physical health and mental health go together, Southern Indiana Community Health Care utilizes an integrated care model. For more information, please visit https://sichc.org/mental-health/)

People with substance use issues can go to a typical facility like SICHC’s Valley Health clinic in West Baden Indiana and confidentially receive treatment. “My MAT patients sit in the same lobby as patients seeking healthcare for other reasons,” Stout said. “They don’t have to drive a long distance to a specialty clinic or face the stigma of publicly going to that clinic.”

With the federal removal of certain data waiver requirements, MAT treatment became a viable option to integrate within more typical medical services. This is now more important than ever, according to Stout, as new illegal drugs in pill form that “look like” opiates are becoming more available on the street. “Dealers mix up illegal and highly dangerous combinations of fentanyl, heroin and other drugs, and illicitly press them in pill form to ‘look like’ oxycodone or other opiates,” she said.

The dangerous illegal and increased use of fentanyl has tragically resulted in additional deaths by overdose, Stout explained said. When prescription opiate availability decreased, people who used opiates turned to heroin as a substitute, opening the door for dangerous fentanyl.

Southern Indiana Community Health Care began exploring MAT treatment options in 2018, when tests showed opiate use among the obstetric population. Initial success of the program promoted SICHC to roll out integrated treatment options to the general public in 2019.

Stout noted that overdoses still tragically occur often. She emphasized that free opioid rescue kits are available without prescription or social contact. Life-saving Naloxone can be administrated by nasal spray or other means in an emergency overdose situation.

“There are many Naloxone Boxes and free distribution points around Indiana,” Stout explained, encouraging any with an opiate issue (or anyone with a family member or friend with an opiate issue) to secure a free, confidential supply at NaloxBoxes around the area. (NaloxBox locations and distribution points can be found at https://www.overdoselifeline.org/naloxone-indiana-distribution/). Several churches, public libraries and facilities, and recovery centers are host to free and accessible opioid rescue kits.

Recovery from substance use takes time and can include complications. In addition to seeking quality medical care, people with substance use are encouraged to take advantage of local peer support groups and 12-step recovery programs like Alcoholics Anonymous and Narcotics Anonymous. Safe Haven Recovery Engagement Center in Orange County offers several options. Interested people can also visit https://www.indianarecoverynetwork.org/

Together with a patient in recovery, Stout presented details about the MAT program and its integrated value during the recent Indiana Rural Health Associations annual state conference in French Lick.

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Already a focus in helping to address personal issues resulting from an unhealthy accumulation of Adverse Childhood Experiences (ACEs), self-care is being positively put into practice by providers and medical staff at Southern Indiana Community Health Care. 

Susie Benham, office manager of the English office of Community Health Care, has been taking part in a collaborative training process to help the organization become more trauma-aware and trauma-informed, including measures to address trauma results created by sustained stress and other factors. The training and awareness, coordinated by the Indiana Department of Health, involves formal training and information sharing, which is being presented to professional staff and employees at Community Health Care offices.

Recent university research by George Mason University and other institutions shows that burnout and exhaustion rates experienced by providers and professionals in primary care are increasing at twice the level of other medical professionals. Medical professionals working many extra hours and consistently foregoing self-care in order to serve others at all times can experience challenges. Recognizing that continuous sacrifice can actually produce trauma symptoms over time is important.

“Our staff has participated in presentations that explain what being trauma-informed looks like, how it can impact people, and how staff can better practice self-care,” said Ms. Benham. “Recommended self-care measures have already been put into place and staff are responding very well.”

What does self-care look like? These include the institution of special days off where professional staff are encouraged to do things they enjoy – read a long-neglected book, work in the garden, take a short trip – instead of working 10-12 hour days. The Community Health Care staff also are also given options to reduce stress through exercise programs, expressive art therapy, financial planning, yoga classes, and supportive weight management programs.

Rested and resilient medical staff are generally more effective, and they also can pass on their personal experiences to patients, encouraging patients to avoid burnout and exhaustion by practicing self-care measures.

Southern Indiana Community Health Care has recognized how untreated and unresolved Adverse Childhood Experiences (ACEs) can directly contribute to current and later emotional and physical challenges. Research has shown how ACE scores of four or higher can directly result in later substance abuse, hypertension, and even cancer.

Community Health Care has successfully partnered with area schools and businesses to offer mindfulness and other trauma-reducing techniques for students and employees. Fore more information about this successful community initiative, read the online Limestone Post story “Public Schools in Orange County Reply on Unique Health Partnerships” here. https://limestonepostmagazine.com/rural-indiana-schools-unique-health-partnerships/ 

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Beautiful fall foliage. Great memories of grandmother’s special pies and cakes. Christmas music favorites on the radio. 

And rising stress levels. Across the board. 

Even before the major stresses brought on by the COVID-19 hot mess, to one degree or another, each holiday season traditionally brought unwelcome guests: stress, anxiety and depression. A recent national survey conducted by the American Psychological Association (APA) revealed many causes of stress associated with the pre-COVID-19 holidays – ranging from “extreme stress” to joy-sapping depression. 

Perhaps you can relate, especially when holiday gatherings can become more complicated from possible family COVID-related safety issues. In addition to the major stressors of “lack of time” (69%), “lack of money” (69%) or “pressure to give or get gifts” (51%), the APA found that people get stressed out over family drama, broken relationships, travel issues, children issues and more.

Family holiday gatherings also underscore the feelings of loss and outright grief when a family member or close family friend has died since the last time the family gathered. In a COVID-19 age, these feelings may be magnified.

Like a family turkey, many people unfortunately “stuff” their feelings during the holidays. They “soldier up” and conceal what they may be experiencing, saying to themselves and others “I’m okay,” when in fact they’re not.

When feelings and stress are “stuffed,” or ignored, they often re-appear in our bodies in the form of poor sleep/insomnia, lack of energy/fatigue, headaches, stomachaches, bad moods/irritability and more. When we feel this way, sometimes we try to “self-medicate” by overeating or drinking more alcohol than usual.

This year it’s especially important to think about this. Earlier in October, three major national medical organizations banded together to declare a solemn national emergency of mental health issues. Hospitals, clinics, and doctor offices have seen alarming rises in children-related psychological and mental health issues. We’ve personally seen this alarming trend here at our Southern Indiana Community Health Care offices, especially with debilitating social anxiety among children. 

Citing “soaring rates” of anxiety and other issues, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, the Children’s Hospital Association called for immediate action, including better integration of behavioral health services into primary care services, particularly for children.

What can you do about all of this stress and emotional turmoil? Here are some suggestions:

1. Acknowledge what you’re feeling. If you’re stressed because you can’t get what you want done in a timely manner, acknowledge it. If you’re stressed out because a close family member or friend passed away since you last gathered together, realize that it’s normal to feel sadness, even intense grief. When you experience major loss, don’t try to force yourself to try and “be happy.” Major feelings from major events like loss of life take time to process and heal.
2. Set realistic expectations. For many people, preparing for and serving a significant meal for a lot of family members is just like performing on stage. You may want things to go absolutely perfect but setting those standards too high can bring on heightened anxiety. You don’t have to be perfect, or just like what your mother or grandmother used to prepare. 
3. Accept that this year will possibly be different. With COVID-19 issues still lurking around, many people may not feel comfortable in getting together in close quarters. Last year many families discovered the free 30-minute setting for a ZOOM call and brought extended families together online. If people decide not to come, try to let it go emotionally without allowing the drama-makers in your family having control of your emotions.  
4. Make time for yourself. Stopping and taking a moment to get grounded and re-centered is a great way to deal with mounting anxiety. Deep, deliberate, conscious breathing can help relax tense muscles. Some mindful meditation can also help re-center and keep you focused.
5. If things get overwhelming, ask for help. Holiday stress can magnify other existing issues, especially if you’ve experienced recent loss. Children also are under all kinds of new stresses. Talking with a professional certified counselor or medical professional can provide useful ways to coping and deal with these issues.

This is called the “happiest time of the year” for a good reason. Deal positively with stress and make some great new memories!

A staff therapist at SICHC, Teresa Faulkner is a Licensed Clinical Social Worker (LCSW) and a Substance Abuse Professional. She is trained to work with trauma, grief, anxiety/panic attacks, depression, phobias and other behavioral health issues. 

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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 Clinic—Grief: 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.

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