NEWS+ – Southern Indiana Community Health Care

Aug

2021

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.

Aug

2021

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.

Aug

2021

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 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.

Aug

2021

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.

Aug

2021

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

Jun

2021

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.

Jun

2021

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.”

Jun

2021

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

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).

# # #

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/

Jun

2021

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!

May

2021

What to Know About Mammograms

By Stephanie Frye - Family Nurse Practitioner

May 9 starts National Women's Health Week and with that in mind, let’s talk about the health of our breasts.

Breast Cancer: Rates and Risk Factors

First the numbers: in 2017 among the top 10 cancers for females, breast cancer leads in the list of the new cancer cases and is the second on the list by rates of cancer deaths. In the U.S., about one in eight women will develop invasive breast cancer over the course of her lifetime, with an estimated 281,550 new cases of invasive breast cancer and 49,290 new cases of non-invasive (in situ) breast cancer expected to be diagnosed in women in 2021.

You can divide the risk factors for breast cancer into groups: those you can control and those you can’t. The first group includes smoking, drinking alcohol, being obese and being physical inactive. Also, if you’ve had radiation therapy to your chest or breasts, have taken the drug diethylstilbestrol (DES) or used specific forms of hormone replacement therapy during menopause, or certain types of oral contraceptives, your risk also increases.

As for factors outside your control, these include being 50 years old or older, having dense breast tissue, your reproductive history (when you started and stopped having periods), a family history of breast or ovarian cancer and genetic mutations such as BRCA1 and BRCA2. Certain races and ethnicities also face an increased risk. This could be due to various lifestyle patterns, reduced access to mammography or lower quality medical care.

Tip: Want to know more about what you can do? Download the Think Pink, Live Green: A Step-by-Step Guide to Reducing Your Risk of Breast Cancer for 31 risk-reducing steps you can take today.

Breast Cancer Screening: Breast Self Exams (BSEs) and Mammograms

Now that you know your risk, what else can you do besides making changes to reduce your controllable factors? Follow these two steps: know what’s normal for your breasts and undergo mammograms according to the schedule advised by your health care practitioner.

What are some breast changes that you should bring to your doctor’s attention? Komen.org lists the following:

A lump, hard knot or thickening inside the breast or underarm area
A swelling, warmth, redness or darkening of the breast or a new pain in one area
A change in the size or shape of the breast
Dimpling or puckering of the skin
Itchy, scaly sore or rash on the nipple or sudden nipple discharge
Pulling in or dimpling of the skin of your nipple or other parts of the breast

A breast self-exam (BSE) involves both looking at your breasts in a mirror and using your fingers to touch all the areas of both breasts while lying down and sitting. If you’re still having periods, do the physical exam a few days after your period starts, since your breasts are less lumpy and painful. (Follow the detailed instructions here.)

While a BSE shouldn’t replace mammograms, it could increase the odds of early detection as well as help you learn what’s normal for your breasts.

When you have an annual healthcare visit, you can ask for a clinical breast exam. It’s performed by a healthcare professional who is trained to know the various breast abnormalities and warning signs that could indicate a need for a more thorough screening.

Next on the list is a mammogram. This is a low-dose x-ray exam that gives doctors a closer look at your breast tissue to identify changes that can’t be felt during a breast exam. It can take about 20 minutes from start to finish, since each breast is done separately, with two pictures taken of each: one from the side and one from above. While it’s true that having your breast compressed between the machine’s two plates can be uncomfortable, remember it only lasts a few seconds.

There are two kinds of mammograms: screening and diagnostic. Screening mammograms are for those women with no symptoms of breast cancer, while diagnostic mammograms are used when a lump or other symptom or sign of breast cancer has been found. (Women with dense breast may benefit from having a digital screening mammogram rather than a film one since it may provide a better image.)

A three-dimensional (3-D) mammogram, also called breast tomosynthesis and digital breast tomosynthesis (DBT), takes multiple images of the breast from different angles, then reconstructs the images to give a three-dimensional image set. Studies have shown that this form of screening provides improved breast cancer detection rates and fewer "call-backs" for additional testing because of a potentially abnormal finding. It can also be more gentle on the breast than the conventional mammogram.

If your screening mammogram shows test result that suggest an abnormality, the next step may be any or all of the following:

An ultrasound—an imaging test that uses sound waves to create a picture of your breast
A magnetic resonance imaging (MRI)—an imaging test that uses a powerful magnet linked to a computer to provide an image
A biopsy—a test that removes fluid or tissue from your breast to examine for cancer cells

The schedule for screening mammograms can vary. According to the United States Preventive Services Task Force (USPSTF), women ages 50 to 74 years should get a mammogram every two years. The American Cancer Society says women age 40 to 44 should have the choice to start annual breast cancer screening with mammograms, while those age 45 to 54 should get mammograms every year, and after that switching either to mammograms every two years, or continuing with yearly screening. In general, it’s a good idea to discuss the best frequency and your risk factors with their health care providers.

For more about mammograms, download this fact sheet from the Office on Women's Health. You can also watch this video from Cedars-Sinai on the breast cancer screening process.

Free Mammograms
Patoka Family Health Care in November, 2021 - Call ahead to schedule your preventative screening.

May

2021

What You Should Know About HPV

By Stephanie Frye - Family Nurse Practitioner

There are more than 150 different types of HPV. They can range in appearance from small, painless, rough-surfaced warts to larger, more painful and flatter plantar warts. According to the CDC, 85% of people will get HPV infections in their lifetime

And while being called a “wart” doesn’t sound all that serious, it can be if your body doesn’t clear out the virus on its own. HPV causes about 44,000 cancers in men and women each year in the US, from cervical cancer (the leading cause) to cancers of the vagina, vulva, penis, anus, and mouth, according to Harvard Health. According to the CDC, more women (about 25,400) than men (about 19,900) develop HPV-associated cancers in the United States each year.

Here’s what else you should know about HPV

HPV is the most common sexually transmitted infection. While using condoms consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases, it’s not a fool-proof strategy, according to the CDC, because the virus can also infect areas that aren’t covered. Limiting the number of sex partners can reduce the risk, although even if you have only one lifetime sex partner, you can still get HPV. The only reliable method for preventing genital HPV infection is abstaining from sexual activity.

The FDA has only approved tests to find HPV in individuals with a cervix. Positive results can be then managed with extra testing and prompt treatment if the infection causes abnormal cell growth. (Note: There is no approved HPV test to find HPV in the mouth or throat.)

The HPV vaccine has a 15-year track record of success. Since the HPV vaccination was first recommended in 2006, there has been a significant reduction in HPV infections, with fewer teens and young adults getting genital warts. The HPV vaccine has the potential to prevent more than 90% of HPV-attributable cancers and has also reduced the number of cases of precancers of the cervix in young women. The HPV vaccine offers long-lasting protection against HPV infection and HPV disease—even against new HPV infections. This makes the vaccine a valuable weapon against causal HPV infection for cancers since it can take decades after the infection for the cancer to be diagnosed.

HPV is thought to cause 70% of oropharyngeal cancers in the United States – cancer in the back of the throat, tongue or tonsils. The vaccine protects against the types of HPV that can cause this cancer and can prevent this cancer from developing.

The HPV vaccine is safe and effective for children ages 9-12. Why start that early? According to Claire McCarthy, MD, Senior Faculty Editor at Harvard Health Publishing, the HPV vaccine is most effective if it’s done before your teen becomes sexually active. Those who haven’t been vaccinated at an early age can have a catch-up vaccination—recommended for females and certain special populations through age 26, and for males through age 21, according to the CDC. The Cervarix and Gardasil vaccines protect against most cases of cervical cancer; Gardasil also protects against most genital warts. Both vaccines are recommended for girls and women, while only the Gardasil is recommended for boys and men. Recently the HPV vaccine eligible age has been increased to 45. People aged 27 to 45 should discuss HPV vaccination with their doctor and their decisions on an individual basis.

The more you know about HPV, the better you can protect yourself and your children. While the Healthy People 2020 goal was to reach 80% in terms of HPV vaccination coverage, a study in JAMA Pediatrics showed that the U.S. was far below that number. Part of the reason may be that most adults, men and women, weren’t well informed about HPV, HPV vaccination, and the relationship between HPV and cancer. For example, more than 70% of adults didn’t realize that HPV causes oral, anal, and penile cancers. Since parents make HPV vaccination decisions for their children, it’s important to discuss the need for this vaccine with your doctor or your child’s pediatrician.

Apr

2021

What to Know About Endometriosis

by Missy Ray, MSN Family Nurse Practitioner

What is endometriosis?

Endometriosis, also called “endo,” occurs when tissue similar to the lining of the uterus (called the endometrium) is found in other areas in the body. These areas or patches of endometriosis can also be called implants, nodules or lesions.

Most often, endometriosis occurs in the peritoneum, the ovaries, the fallopian tubes, on the outer surfaces of the uterus, bladder, ureters, intestines, and rectum or in the space behind the uterus called the “cul-de-sac.” In rare instances, endometriosis may grow on the lungs or in other parts of the body. Endometriosis causes a chronic inflammatory reaction that may result in scar tissue.

What causes endometriosis?

While no one knows for sure what causes this disease, researchers are looking at several possibilities. These include problems with menstrual period flow, immune system problems, hormones or errors made during other surgery when endometrial tissue is moved by mistake.

You also may be more likely to develop endometriosis if you never had children, had menstrual periods lasting longer then seven days, had shorter menstrual cycles, or have a health problem that interferes with the normal flow of menstrual blood. If a family member had endometriosis, you are most likely at greater risk since there is a genetic component.

While you can’t prevent endometriosis, you can reduce the risk by lowering your estrogen levels, since that hormone is responsible for helping to thicken your uterine lining during your menstrual cycle.

What are the symptoms?

Common symptoms of endometriosis include very heavy periods and chronic pain in the abdomen, lower back, or pelvic areas, especially before and during menstruation or during sexual intercourse. Researchers have discovered that the severity or the location of the pain is not related to the size and location of the lesions, nor is it associated with a woman’s ability to get pregnant.

However, some women with endometriosis may have no symptoms at all, with the condition identified only when they have difficulty conceiving.

How is it diagnosed?

There is no simple test that can be used to diagnose endometriosis. If your SICHC family provider suspects you may have endometriosis, then the first step is usually a physical exam, including a pelvic exam, where your doctor will feel for large cysts or scars behind your uterus.

You may undergo an imaging test—either an ultrasound or a magnetic resonance imaging (MRI)—that will provide pictures of your reproductive organs. However, undergoing a surgical procedure called a laparoscopy is the only way to definitively identify that you have endometriosis. During the procedure, a small amount of tissue may be removed (biopsied) to be tested (diagnostic evaluation).

Download the First Consultation pdf from Endometriosis.org to help you prepare for your visit.

What are the treatment options?

While there is currently no cure for endometriosis, there are treatment options to help deal with the pain and any infertility issues it may have caused. Treatment choices will be based on the severity of your symptoms and the disease itself, your age and your desire to have children.

Treatment options for endometriosis-associated pain include hormone therapy, over-the-counter or prescription pain relievers, and surgical procedures (laparoscopy or laparotomy) to identify and possibly remove endometriosis patches. Hormone therapy may also keep new lesions from forming but generally don’t get rid of any endometriosis tissue already present.

However, not all treatments work well, and the symptoms may occur after medication is stopped or when a period of time has passed after surgery.

Does endometriosis cause infertility?

According to the American College of Obstetricians and Gynecologists, it’s estimated that close to four in 10 women with infertility have endometriosis, either due to inflammation from endometriosis inhibiting the movement of the sperm or egg through the fallopian tubes and uterus or because that inflammation has damaged the sperm or egg.

If the endometriosis is severe, it may have resulted in scar tissue or adhesions blocking the fallopian tubes. Removing endometriosis tissue through surgery may improve fertility.

For more information, visit these websites: Endometriosis Association, Endometriosis Foundation of America and Endometriosis Research Center, download this fact sheet from Office on Women's Health, or schedule an appointment with SICHC’s Woman’s Health team, or if you prefer, we can recommend you to an OBGYN specialist.

Resources

American College of Obstetricians and Gynecologists

CDC-Women's Reproductive Health

Endometriosis.org

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Office on Women's Health

World Endometriosis Society

Apr

2021

SICHC’s “Thrive” initiative: helping overcome ACE trauma

by Brandy Terrell, LCSW

As a parent, you want your children to develop resilience and be able to handle whatever setbacks and challenges they face. But it isn’t as simple as telling them to have a “stiff upper lip” or “learn how to take it” or “quit being a crybaby” when bad things happen.

While not every unfortunate event that children experience can be considered major, there are a significant number that fall under the ACE (Adverse Childhood Experience) umbrella—serious childhood traumas that result in toxic stress that can change brain development and affect such things as attention, decision-making, learning, and response to stress. (Learn more by watching the ACES Primer HD video.)

What are the types of ACEs?

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study categorized Adverse Childhood Experiences (ACEs) into three groups, the most common of which are:

abuse: emotional, physical and/or sexual
neglect: emotional and/or physical
household challenges: experiencing the divorce of parents, or having a family member who is in jail, has a mental illness or substance abuse problem, or is a victim of domestic violence.

But there are other types of toxic stress as well, notes the ACE and Resilience survey, including the loss of a loved one, homelessness and involvement with the foster care or juvenile justice systems. And it’s also important to know that, according to research results, childhood trauma is very common and can occur in all families, regardless of race, employment status, and income, insurance and education level. (You can view the 10-point ACEs quiz here.)

What are the effects of ACEs?

If an ACE is unidentified, untreated and unresolved, it can have lasting, negative effects on a child’s health, well-being, and opportunity, from increasing the risks of unhealthy lifestyle choices such as alcoholism, drug abuse, violence and other behaviors to a wide range of chronic diseases. Problems can continue into adulthood, making it difficult for the person to form healthy and stable relationships, hold down a job or manage finances.

What treatment and resources are available to treat ACEs?

That’s the bad news. The good news is that ACEs are preventable and if they occur, they are treatable. The sooner a child and the family as a whole receive help, the better the long-term outcome will be for everyone.

Here at SICHC, we are focused on helping our community understand the impact of ACEs and provide parents with the necessary resources and help. In 2019, we sponsored Thrive Orange County, working together with other local stakeholders to improve our community’s health and well-being.

Some of the initiatives that Thrive OC has developed include:

Handle with Care, a county-wide collaboration between school districts, the sheriff’s department, and town police departments to help students deal with trauma resulting from a family member’s involvement with law enforcement.
Mindful Schools at Paoli and Orleans schools to help students learn to self-regulate their stress response systems.
Project Unite Teen Pregnancy Prevention, funded by IU CRE, to reduce the high rate of teen pregnancy in Orange County using community input from parents, the faith-based community, and schools.
Healthy Relationships and Social Media pilot programs at Orleans Elementary and Mt. Lebanon United Methodist Church.

Thrive OC has brought the Miss Kendra Programs to Springs Valley Elementary Schools in 2020, with funding provided by Springs Valley United Methodist Parish, HealthLinc, and The Tony Bennett Foundation. Two advisory councils have also been established: the Mentoring Advisory Council with a focus on creating a county-wide mentoring program, and the Early Childhood Advisory Council, which will be involved in improving access to quality early childhood education.

Finally, Thrive OC has collected student ACE scores from Orleans, Springs Valley and Paoli students in various grade levels as well as community survey data—all to identify community norms and measure barriers and stigma associated with seeking care or treatment for a substance use disorder, or a mental health condition.

For more information about the Thrive Orange County initiative or to discuss any mental health needs, reach out to our office using our Contact page or by calling one of our office locations.

Mar

2021

Covid-19 mass vaccination clinic in Crawford County Saturday, March 27

MARENGO, Indiana – Southern Indiana Community Health Care (SICHC) will offer up to 90 administrations of the Johnson & Johnson one shot COVID-19 vaccine this Saturday, March 27. The Crawford County administration will take place in the 4-H Building. The address (for GPS location) is 1095 S State Road 66, Marengo, IN 47140.

People who wish to receive the free Johnson & Johnson vaccine must sign up in advance.

SICHC expresses its thanks for the free use of the 4-H Building, which is located across from the Crawford County High School.

“People coming for the vaccine need to remember that they will remain onsite for a 15-minute monitoring period after they receive the vaccine, which is standard procedure,” said Dr. Yolanda Yoder, SICHC Medical Director. “We will adhere to CDC guidelines for social distancing 6 feet apart and wearing masks".

If you haven't pre-registered for Saturday, please sign up for a Moderna vaccine at our Paoli vaccine clinic open Monday-Thursday 9am-5pm by signing up on the state’s website at ourshot.in.gov or call 2-1-1.

Mar

2021

SICHC clinics to distribute free digital blood pressure cuffs, grant funding to enable widespread monitoring, improved access

PAOLI, Indiana – Patients with high blood pressure (hypertension) served by Southern Indiana Community Health Care (SICHC) clinics will soon be able to receive a free digital blood pressure cuff monitor, according to Yolanda Yoder, MD, SICHC Medical Director. SICHC secured a $159,000 grant from the federal Health Resources and Services Administration (HRSA) to initiate the four-county program.

The grant funds will be used to purchase and distribute the specialty blood pressure cuffs, which can securely transmit health care data through a cellular enabled device, and to purchase the healthcare software required to receive, process and secure the confidential data. The data will help SICHC medical professionals treat high blood pressure remotely.

Eligible SICHC patients receiving treatment for both “controlled” hypertension (blood pressure maintained at 120/80) and “uncontrolled” high blood pressure (blood pressure typically appearing at 140/90 or above) will receive the free digital units.

“With SICHC receiving the HRSA hypertension initiative grant, we will be able to support our patients who have high blood pressure by also offering learning opportunities, heart health education, and provide routine follow-up phone calls between patient visits,” said Cynthia Gillespie, a Certified Community Health Worker (CCHW) with SICHC. “We are working to provide cellular-enabled blood pressure monitors to the majority of our hypertension patients who do not currently have access to in-home self-monitoring devices.”

Once the secure remote cloud software is in place, several blood pressure cuff monitors will initially be distributed. The goal is to create access of blood pressure cuffs for up to 2,600 patients in four counties. Hypertension patients served by six SICHC clinics in Crawford, Martin, Orange, and Washington counties will be eligible to receive the free digital devices.

As Mrs. Gillespie explained, the remote monitoring access will be coupled with patient and community outreach to help people practice sound nutrition that can promote heart health (including cooking classes). SICHC will also provide instruction and information for area residents to learn to practice stress reduction techniques (including mindfulness) to lower stress-induced elevated blood pressure.

Given transportation issues faced by some SICHC patients and the inability for many people to leave their homes due to COVID-19, this remote patient monitoring (RPM) technology will enable doctors and other medical professionals to make a closer and timely review of patient health in the time between scheduled visits. Patients will be able to digitally record blood pressure, which the monitor will then automatically send to a cloud-based platform. The information will then be accessible for providers in the secure Electronic Medical Record (EMR) system.

The grant is being administered as part of SICHC’s goal by providing health care services focused on the entire person. Mrs. Gillespie explained that her role as a community health worker (CCHW) “is to help improve access to quality health care, along with improving health outcomes.” She added: “I will follow up with patients who have hypertension between office visits to support them with their health plans, medication management, and be able to connect them to other community recourses - anything from food, housing issues, financial and employment assistance, transportation arrangements to and from doctor appointments, and other health or social services.”

SICHC’s grant for its southern Indiana operations was part of HRSA funding that was also provided to health care institutions in Elkhart, Indianapolis, Jeffersonville, Portage, Richmond and Valparaiso.

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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/

Feb

2021

Telehealth Checklist: Preparing for Your Virtual Doctor Visit

By Krisendra Markham – Quality and Data Manager, FMH Coordinator

While telemedicine (delivering medical care at a distance) and telehealth (the electronic and telecommunications technologies and services used to provide telemedicine) have been around for decades, COVID-19 has made remote care a more popular option to help reduce exposure for patients and healthcare staff.

Having a Telehealth Virtual Visit at SICHC

Your Southern Indiana Community Health Care (SICHC) telehealth appointment can take place on your landline phone or with your computer, laptop, smartphone or tablet.

SICHC offers video and smartphone visits through FollowMyHealth, a secure message and video platform available through the FollowMyHealth App on your smartphone (Apple or Android), or through your computer’s web browser.

Although having a FollowMyHealth account isn’t required. Just call any of our four offices and a staff member will help schedule you for the type of appointment that best fits your needs. (If you have a FollowMyHealth account, you can schedule your appointment through that portal.)

Once your appointment is scheduled, a staff member will call you before your appointment begins to ask some routine questions, and, if needed, give you additional instructions. Your care provider will then start the visit (phone call or video).

TIP: If you’re using the FollowMyHealth App, you can supply much of this information prior to the virtual appointment. For example, you can upload a close up photo of a skin rash. Here is a link to the FollowMyHealth YouTube channel to get familiar with the platform.

What to Do Before Your Visit

• Find a quiet space. You want to be able to focus on your appointment without interruptions from children, pets or roommates. A separate room, going to a friend’s house or even sitting in your car (while it’s parked!) can give you the privacy you need.

• Prepare your device (for video). Close other applications to prevent distractions and keep your internet speed from slowing down. Then position your device so you are visible on the screen and the lighting in the room doesn’t shadow your face.

• Review any instructions or emails from your provider. These can include how to log on to the FollowMyHealth app or gather specific health information such as your temperature, blood pressure, blood sugar, or weight.

TIP: If you need to download an app, do it well before your visit so you can road-test it and address any problems.

• Compile your concerns. Make a list of any symptoms, questions or worries you want to discuss during the appointment. Has anything changed since your last appointment? Are your vaccines up to date?

• Collect your meds. Make a list of prescription medications as well as any OTC (over-the-counter) medications or supplements you take on a regular basis. Do you need refills for any prescriptions? Have the bottle available and double-check the dosage instructions.

• Have a notepad handy. During the visit, you’ll want to take notes so have pen and paper at hand. If you prefer to use a device, don’t try to take notes on the same one you’re using for the telehealth appointment, but have a second one ready.

• Gather your health data. This includes your health history, recent vaccines, other healthcare providers and the phone number and location of your local pharmacy.

What to Do During Your Visit

• Stay focused. Don’t eat or drink, take calls or check your email during your visit. Your full attention should be on the visit, just as though you were in the examination room.

• Ask questions. If you aren’t sure what the doctor said (sometimes there can be a problem with the audio) or you need additional details, don’t hesitate to ask for clarification. If the doctor orders bloodwork or other tests, confirm where they are to take place and when you can expect results.

• Review your treatment plan. Before you end the call, review the treatment plan your doctor recommended and ask what you should do if your problem persists.

What to Do After Your Visit

• Follow instructions. If you need to make another appointment (either virtual or in-person), change your current medication schedule or begin taking a new one, be sure to do so.

• Bring your notes. If your doctor advises you to see another physician or go to the ER, bring your notes from your telehealth call.

• Track any changes. The doctor will want to know if your symptoms improve or if you notice any new changes.

Concerned About Insurance Coverage?

Call your insurance provider beforehand to confirm coverage. Phone and video visits are billed to your insurance just like a regular office visit. If you do not have insurance, please call our Self Pay Department for more information at 812-723-7121 or visit our payment options webpage.

If you’re on Medicare or Medicaid, know that Medicare has temporarily expanded its coverage of telehealth services, but you should check with your state regarding Medicaid coverage for telehealth services.

Other helpful information to know before your virtual doctor visit.

This checklist with tips from Telehealth.HHS.gov and American Academy of Allergy, Asthma & Immunology will help you prepare so you can get the most from your appointment. You can also watch this video from the Hawaii State Department of Health Genomics Section to learn more about what to expect from a telehealth visit.

Feb

2021

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/

Jan

2021

5 Tips for COVID Mental Health

By Teresa Faulkner, Licensed Clinical Social Worker

COVID-19 affects everyone, not just those who have caught the virus. Even if you haven’t been physically infected, you most likely have been affected by it emotionally in one way or another. And the longer the pandemic lasts, the more challenging it can be to find ways to cope with the feelings it has caused.

How you deal with COVID stress depends on your background, your level of social support and many other factors. But by using these five tips, you will be better equipped to deal with the current situation as well as other stressful times in the future.

Acknowledge your emotions.

It’s important to recognize and acknowledge what you’re feeling. It’s natural to feel anxious, afraid, frustrated or lonely. And don’t be surprised if your feelings change over time. One day you may feel full of energy and the next day be unable to focus. Accept how you are feeling and practice good self-care: eating healthy foods, exercising and getting enough sleep.

Feeling helpless? Remind yourself that there are steps you can take to reduce the odds that you will contract the virus, such as following the CDC guidelines: wearing a mask, practicing social distancing, avoiding crowds and washing your hands.

Take a breath and a break.

Take those deep breaths. It may sound like it’s too simple to really have any impact, but deep belly breathing not only gets oxygen into your body but can also slow your heartbeat and help stabilize your blood pressure. This counteracts the negative impact of stress breathing (short, shallow breaths) that can lead to symptoms like chest tightness, heart palpitations or dizziness.

Also, during the day, take periodic breaks and practice relaxation techniques. This will help generate a sense of calmness and relaxation.

Connect with friends and family members.

One of the biggest challenges with the pandemic is that it has increased feelings of isolation. No longer can you meet a friend for dinner to talk over your problems, since doing so would put both of you at risk. However, there are ways you can share how you feel with those you trust. Phone calls or video chats can help replace in-person get-togethers. Even occasional walks (with masks and practicing social distancing) can make you feel less alone. Sometimes when you share your emotions, you find out others feel the same way, too.

Develop a routine.

COVID-19 has undoubtedly disrupted your schedule and way of life, forcing you to try to adjust to a new “normal” that seems to change every day. When everything around you seems out of control, creating a routine can actually give you a sense of power. Make it simple and do-able—for example, eating and exercising at established times or setting small goals to work toward. While your COVID routine may bear no resemblance to the one you had pre-pandemic, the objective is to follow a schedule, which will then give you a feeling of security. An additional benefit is that by having a routine, you will also be taking better care of yourself.

Shut off the info flow.

While you may think it’s a good idea to stay on top of all the latest virus developments, this can actually increase your stress level. Periodically, give yourself a mental break by shutting off the info flow. Take breaks from watching, reading, or listening to virus news stories, including those on social media. Instead, seek out pockets of calm: read a good book, go for a walk, listen to music or find activities that engage your mind and body.

And when you are ready to catch up on pandemic news, make sure that you are getting it from a reputable source like the CDC. You’ll have a better understanding of the risks and will be less likely to spread misinformation.

Let Us Help You

While COVID-19 is unlike any health crisis we have faced before, it’s important to remember that it is a temporary situation. Thanks to medical research, vaccines are now available to combat the virus and new treatments have been developed to help those who contract it.

However, if you have trouble coping with your emotions, develop physical ailments that last for several days, or turn to unhealthy coping mechanism such as drinking or drug use, then consider seeking professional help.

Here at Southern Indiana Community Health Care, our offices include a mental health counselor as part of our care team. This allows us to treat the whole individual, physically and mentally. In response to the COVID-19 pandemic, SICHC has expanded our behavioral health services to include virtual visits, offering the same high-quality care from your trusted provider. We have also added two virtual group sessions: substance use and anxiety.

For more information, contact one of our four offices, and a staff member will help schedule you for the type of appointment that best fits your needs. You can also request appointments through your FollowMyHealth account.

Trust our team to help you through the emotional challenges caused by COVID-19. Reach out to us. We’re here to help you. Remember, we are all in this together.

Dec

2020

Pregnancy Tips During COVID

By Yolanda Yoder, MD, Family Practitioner and Member of the SICHC OB Team

Pregnancy is a joyous time but pregnancy can be stressful for expectant mothers. This stress is natural. After all, during pregnancy, everything is changing: from the way you look to the way you feel physically and emotionally. And now with COVID-19 complicating nearly every aspect of your life, your stress level may be even higher if you worry about being pregnant during a pandemic.

What steps can you personally take to lower stress levels and stay healthy during your pregnancy, in spite of COVID?

Eat Healthy

Good nutrition is important for both you and your baby. That means avoiding a lot of sweets and following a well-balanced diet with fruit and vegetables, dairy, good carbs with fiber (like oats and other whole grains) and healthy protein: nuts, chicken, fish and beans. Want help planning a healthy meal? Check out the guidelines at Choose My Plate.

As for the old saying “eating for two,” the American College of Obstetricians and Gynecologists (ACOG) recommends skipping that in favor of thinking of eating twice as healthy. Try practicing mindfulness in all your activities- including eating. Become aware of your habits, do your research, work with your provider, and let your focus rest on being healthy.

Having twins? You only need about 600 extra calories extra a day to support your growing babies. Make them good calories and you won’t have to worry about overeating (and by the way empty calories tend to leave you hungry). Overeating during pregnancy means more stress on your body and more weight to lose after birth. Good meals and snacks leave you feeling satisfied and content—and healthy.

Exercise Regularly

According to the American Pregnancy Association, just 30 minutes of mild to moderate exercise several days a week can help lower cortisol levels—the hormone that fosters anxiety. Exercise also eases constipation, reduces back pain and promotes healthy weight gain as well as improves your overall fitness, says ACOG. Even just simply taking a walk every day can make a difference, physically, mentally, and emotionally.

Get Enough Sleep

Sometimes it can be a challenge to get good quality sleep as your body adjusts to the growing baby. While in the first trimester you may feel drowsier than normal and may even have to take naps, physical changes in the second and third trimester can make it harder to get the shut-eye you need. Between the kicks and the bathroom trips, you may find you’re just as tired when you get up in the morning as when you went to bed the night before.

Tips from the Sleep Foundation include reducing your fluid intake in the evening, avoiding spicy or acidic foods if you’re prone to heartburn, using pillows to support your body in a comfortable position and trying relaxation techniques to help calm your mind. ACOG offers a simple breathing technique to try: Breathe in for 4 seconds, hold for 7 seconds, and breathe out for 8 seconds. Repeat three times. Still having trouble sleeping? Talk to your doctor if your insomnia persists.

Seek Social Support

Social support during this time is very important, but COVID-19 has conversely made it harder to spend time with friends and family members. Find ways to be with others while staying socially-distant—perhaps taking a “masked” walk together or even having virtual get-togethers, when you can talk about what is happening during your pregnancy. You can also reach out to other expecting and new mothers through online groups.

Monitor Your Stress Levels

In the same way you are watching how much you eat and exercise, you need to watch how much stress you’re exposing yourself to, and as much as possible, limit your contact to it. The March of Dimes recommends taking periodic breaks from watching or listening to the pandemic news stories or limiting your time on social media to help reduce anxiety. Experiencing extreme feelings of sadness, hopelessness or despair? Talk with your doctor or other health care professional so you can get the extra support you may need.

For more advice, download the free fact sheet from the March of Dimes: COVID-19 Things to know if you’re pregnant—available in many languages.

Let Us Help You

Now that you have some ideas in what you can do to stay healthy for your sake and the wellbeing of your baby, here’s what we at SICHC will be doing to make this wonderful time easier for you.

We do everything we can to create a safe environment for our mothers and babies. We take special care to ensure that all six SICHC locations are frequently sanitized and cleaned according to CDC guidelines, and we limit the number of patients to keep interaction at a minimum.

We’ve also temporarily opened an office on Cherry Street in Paoli for obstetrics and newborn care only, in addition to our pregnancy care services at our Shoals and Salem locations.

And when appropriate, we can schedule a virtual visit to reduce your in-office time. For more information about this option, contact one of our offices, and a staff member will help schedule you for the type of appointment that best fits your needs. You can also request appointments through your FollowMyHealth account.

We encourage you to trust our team to provide not just a safe environment, but also to walk with you through both the physical and the emotional challenges of your pregnancy.

This is a special time for you, your baby, and your family. Our experienced team stands ready to share and support your journey – contact us today.

Dec

2020

New SICHC obstetrics offering successfully providing critical services in Salem, Shoals, and other areas of southern Indiana

SHOALS and SALEM, Indiana – Southern Indiana Community Health Care (SICHC) new obstetrics services for expectant mothers and families is “being well-received and making good progress in reaching mothers, babies and women,” according to Yolanda Yoder, MD, SICHC medical director. The new services include general obstetrics, pregnancy, well-baby, and well-woman services here and in other areas of southern Indiana, including expanded services in Crawford county.

“Rural areas traditionally present a number of unique challenges that expectant mothers or women who seek OB-related services may face, including limited service” said Dr. Yoder. “We have expanded our strong OB service offerings with our physicians and Melissa Ray, a family nurse practitioner, to meet these important needs in Washington, Martin, and Crawford counties, as well as the patients we serve in Orange and elsewhere in southern Indiana.”

“Pregnancy is a very special time for expectant mothers and families, and I count it a privilege to help support them with OB, well-baby, pediatric, and well-woman services,” Ray said. “Every pregnancy is different, and our entire medical staff recognizes the uniqueness of each patient and goes beyond to ensure great care is delivered.”

Melissa Ray, MSN Family Nurse Practitioner

Ray provides OB services at the Choices Life Resource Center in Salem and at the Martin County Health Department/WIC facility in Shoals, as well as SICHC’s other locations in Orange and Crawford counties when appropriate.

In addition to being a family nurse practitioner, Ray holds a master’s degree in Nursing.

Ray directly cares for expectant mothers through in-person visits (observing COVID-19 precautions) and by telehealth connectivity. At 36 weeks into a pregnancy, Ray’s patients are transferred and then served directly by SICHC physicians, including Dr. Sean Salés, Dr. Karen Farris, and Dr. Yoder. Babies are normally delivered at the IU Hospital in Paoli by SICHC physicians with visiting privileges.

SICHC secured a grant from the Indiana State Department of Health earlier in 2020 to specifically help provide obstetrics services to counties that had been designated as medically underserved for OB.

Ray presently travels between SICHC medical offices in Shoals, Salem and elsewhere to see patients and provide general OB services. “Missy Ray offers our expectant mothers and their babies superb depth and first-hand experience,” said Dr. Yoder. “In addition to being a qualified and experienced nurse practitioner caring for OB patients and families these past four years, she served in the hospital delivery room for 16 years and as a general RN.”

“It’s very exciting to provide these services and help mothers, babies, families and women in general lead healthy lives,” said Ray. “I especially appreciate working with the OB and extended medical team at SICHC, because everyone here puts patients first, treating and supporting them as people, not a set of chronic conditions – there’s a very high commitment to service.”

Ray also appreciates being able to offer general women’s health services, including preventive measures like mammograms and pap smears. “We want to elevate the level of woman and family health, which can be a challenge for woman and families living in rural areas,” she said.

Serving as a nurse practitioner has special moments, including once when Ray helped with a delivery that was being securely streamed by video to a military serviceman serving in Afghanistan. “That was an amazing moment, giving a father serving across the world the chance to see his baby being born in southern Indiana – those are priceless experiences.”

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Aug

2020

How health partnerships can help rural communities prep for COVID

Yolanda Yoder M.D. and Priscilla Barnes PH.D.

Friday, Aug. 21, 2020 | Author: Priscilla Barnes, Ph.D. & Yolanda Yoder, M.D.
National Rural Health Association – See the story here

With stark images of urban hospitals overrun with patients, the national media coverage of COVID-19 has focused largely on cities. Less discussed and less understood is the impact on rural communities, which have been grossly underprepared for a pandemic. As we contemplate an additional wave of the virus, now is the time to assess how rural communities can achieve greater resilience.

We now know that having an adequate supply of ventilators, testing, and PPE is essential, but this alone won’t be enough. Just as important are the structures we have in place — specifically, community partnerships around health. In hindsight, it is increasingly clear that communities that developed relationships within their health network were able to respond faster and more effectively than communities where organizations operated in isolation.

Given the realities facing rural America — physician shortages, a dearth of health care resources, and a population that’s highly vulnerable to chronic disease — these partnerships were always important, but increasingly so during a pandemic. This virus has served as a wake-up call to strengthen these partnerships and tackle rural health challenges in a more committed and enduring way.

Building more resilient rural communities means maximizing existing resources, staging health interventions that address root causes, and thoughtfully sharing information. Partnerships are at the core of these interventions. We must find ways to incentivize and support community health networks that include health care providers, local and national nonprofits, businesses, and local government officials. Such partnerships, whether they are formal or informal, can help rural America whether the next wave of the virus and address underlying health challenges.

Fundamentally, rural health partnerships enable communities to more effectively address social determinants of health. As America’s experience with the pandemic has made clear, populations that were already experiencing health disparities have fared worse than those that were not. Rural health partnerships can help address social determinants of health that lead to disparities and remove some of the strain from health care providers.

When community health organizations band together to holistically address social determinants of health — as we have seen in Orange County and Daviess County, Ind., through the development of community health improvement plans — we can free up practitioners within the formal health care system to do what they do best. When patients are receiving help gaining access to housing or food from community partners, doctors and nurses are able to concentrate on treating the most serious cases. In rural America, where the proportion of providers to the general population is far below the federal recommended level, this type of coordination is especially needed.

Such coordination also applies to sharing resources like in-demand PPE between community health organizations. As we prepare for a potentially prolonged economic downturn, we need to extend this model to address other social determinants of health. If one community’s food pantry stock is bare, another town may have a surplus. We need to expand rural health partnerships to enable this type of coordination.

The impact of rural health partnerships can also be felt in less obvious ways. One of their most important functions is information sharing. Rural health practitioners often wear many hats and lack the ability to focus deeply on any one area of their practice. Health partnerships can ease this burden by delivering customized solutions. The Indiana University Center for Rural Engagement and Southern Indiana Community Health Care recently developed a new app to track the spread of COVID-19 in consultation with local physicians and public health leaders. Moving forward, it will provide surrounding communities with advance warning of an outbreak.

Information sharing can be as simple as sending daily or weekly updates and COVID-19 safety recommendations. Other groups have developed an online directory of financial and physical resources such as food and medication delivery services for individuals and families. Some respond directly to inquiries and manage social media channels dedicated to informing organizations and residents and supporting local needs.

Rural health partnerships yield tremendous value that we cannot afford to ignore. As we expand our work, we need local governments and community-based organizations to help us better shape our approach to fit individual rural communities. But this is just a start. We need continued investment and partnership from government to strengthen rural health networks.

If necessity is the mother of invention, then crisis is the mother of adoption. Rural health partnerships were providing value for rural Americans before COVID-19. Now that the pandemic is here, such partnerships are indispensable and should be greatly expanded.

Dr. Priscilla Barnes, Ph.D. is an associate professor at Indiana University Bloomington School of Public Health and an affiliate faculty member at the IU Center for Rural Engagement.

Dr. Yolanda Yoder, M.D. is a physician of family medicine at Southern Indiana Community Health Care.

Aug

2020

SICHC expands obstetrics services into Crawford, Martin counties, restores critical services to medically underserved areas

SICHC Obstetrics Team — NEW OB TEAM – Southern Indiana Community Health Care (SICHC) launches new OB services for expectant mothers and families in Crawford, Martin and Washington counties. From left: Dr. Karen Farris, Dr. Yolanda Yoder (SICHC Medical Director), Dr. Sean Sales, and Missy Ray, FNP.

New family practice physician will also join SICHC in August, serving families and OB patients in Orange County as SICHC also opens new facilities in Shoals and Salem.

PAOLI, Indiana – Long-time medical provider Southern Indiana Community Health Care (SICHC) formally launched its new obstetrics services in Crawford and Martin counties in early August. The new OB service will now provide a full spectrum of services, including well-woman visits, female health, birth control, pregnancy care (pre-natal and post-partum), well-baby care, tobacco cessation and other OB-related services.

“We are very pleased to introduce these new services locally in what has sometimes been described as a medical desert for critical OB services for pregnant mothers and babies,” said Dr. Yolanda Yoder, MD, SICHC Medical Director. “We are excited that our medical professionals will begin seeing obstetrics and gynecology patients this month in Crawford and Martin counties.” SICHC is also planning to bring OB services to the Salem area in Washington county later in August.

The new OB services will be provided at rural facilities in English, Marengo, and Shoals. The facilities provide convenient access and reduce barriers of transportation in securing quality health care, including being closer to under-served Hoosier mothers and segments of Indiana’s Amish population. The services in Shoals will take place at the Hoosier Uplands Health Department/WIC site, which is partnering with SICHC to provide a broad spectrum of services.

“Rural Indiana faces real challenges in combating infant mortality and securing quality pre-natal, pregnancy, post-partum and well-baby care, and we are grateful to see SICHC stepping up to deliver these important health care services where there is a demonstrated critical need,” said Indiana State Health Commissioner Kris Box, MD, FACOG. “SICHC’s demonstrated commitment to provide health care regardless of a patient’s ability to pay represents a real asset in these medically underserved and economically challenged areas of southern Indiana.”

A traveling Family Nurse Practitioner (FNP), Missy Ray, MSN, will serve OB patients in the three offices. In addition to holding a master’s degree in nursing with her FNP certification, Ms. Ray has considerable experience in obstetrics. SICHC has also secured the services of Dr. Karen Farris, a family practice physician, who will begin taking appointments in mid-August for OB patients in the SICHC Valley Health Care office in West Baden Indiana (Orange County).

Service to OB patients will be directly coordinated with the selected delivering physician, including secure video, phone, and electronic connectivity with the physician during prenatal visits. Patients will transition to direct physician care at 36 weeks in SICHC’s Paoli or West Baden offices until delivery, which will take place at the IU Health hospital in Paoli, according to Dr. Yoder. Transportation assistance is available for patients in need.

“SICHC has a demonstrated passion for providing medical services to communities and regions in southern Indiana that sometimes face serious challenges in securing access to health care,” said Nancy Radcliff, SICHC CEO. “We are privileged to continue to do what it takes – even seeing patients in our facilities parking lots during this time of COVID-19 – to support the patients, families and rural communities in our southern Indiana region.”

SICHC OB services will be offered at three locations:

Uplands Health Department/WIC – 127 West Water Street, Shoals, IN
Patoka Health Care – 307 S Indiana Ave, English, IN
Crawford County Health Care – 5604 E. White Oak Lane, Marengo, IN

Hours are 9 a.m. – 4 p.m. (EDT), with offices closed for lunch between noon and 1 p.m. To schedule an appointment, please call 812-723-3944 and specify the location.

Another new SICHC OB service site will be operational this fall in Salem, Indiana in Washington County.

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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/

A Nurse Is Always On-Call To Help.

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Having a Telehealth Virtual Visit at SICHC

What to Do Before Your Visit

What to Do During Your Visit

What to Do After Your Visit

Concerned About Insurance Coverage?

Other helpful information to know before your virtual doctor visit.

Acknowledge your emotions.

Take a breath and a break.

Connect with friends and family members.

Develop a routine.

Shut off the info flow.

Let Us Help You

New family practice physician will also join SICHC in August, serving families and OB patients in Orange County as SICHC also opens new facilities in Shoals and Salem.

**Take a breath and a break.**