Category: Lifestyle

Do you have an Advance Directive?

Everyone deserves the right to make their own decisions about their health. But sometimes we may found ourselves in certain circumstances in which we are unable to do so, such as during a coma, terminal illness, or serious injury. An important way that we can communicate our decisions during these times, however, is by having an “advance directive” in place.

Advance directives are written, legal documents that outline your decisions regarding medical care when you are unable to make them. They assist doctors and caregivers in making medical decisions on your behalf, and they can be written at any age.

There are several types of advance directives:

Health care power of attorney (also called “durable power of attorney for health care” or “health care proxy”). This is a type of advance directive in which you appoint a person you trust to make medical decisions on your behalf when you are unable to do so. This may be a family member, partner, or friend.

Living will. This is a written, legal document that outlines your wishes for certain medical or end-of-life care treatments. These may range from mechanical ventilation to tube feeding, to even organ and tissue donations.

Do-Not-Resuscitate Orders (DNR). This order informs health care providers not to perform CPR if your breathing or heart were to stop.

While advance directives are not required, it may be a good idea to have one in place so that you can have peace of mind knowing that you’re in control of your health care in the event that you are unable to make decisions for yourself.

It should be noted that state requirements regarding advance directives, such as living wills, may vary, so be sure to check your local state laws if you decide to create one for yourself. Also, be sure to keep a copy of your living will for yourself, as well as provide copies to family members, health care providers, and your health care power of attorney. Advance directives can be changed at any time, but just be sure to redistribute copies as necessary.

For more information about advance directives, check out the following resource links:

Advance Care Planning | UNC Health Care: UNC Medical Center

Living Wills and Health Care Powers of Attorney | North Carolina Bar Association

Living Wills and Advance Directives for Medical Decisions | Mayo Clinic

References:

Advance care directives. (2017, September 5). Retrieved from https://medlineplus.gov/ency/patientinstructions/000472.htm

Advance directives. (2017, July 24). Retrieved from https://medlineplus.gov/advancedirectives.html#summary

Creating advance directives. (2014, November 11). Retrieved from http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303?pg=2

Living wills and advance directives for medical decisions. (2014, November 11). Retrieved from http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303

 

The Magic of Mindfulness

Do you ever feel overwhelmed with work, can’t stay focused in class, or simply feel down most of the time? If so, you may have gotten caught up in the whirlwind style of functioning known as “multitasking.” It is likely that we all have at some point or another and for some, there is no way around it, so what can we do to combat the stresses of the busy lifestyles of 2017?

You shouldn’t have to uproot your whole working style or job just to find peace of mind. Today I’m going to propose a solution that you may have overlooked, mindfulness meditation. The following are the benefits that we know of today:

  • Decreased anxiety
  • Decreased depression
  • Increased empathy
    • With decreased negative feelings like sadness, tension, and anger
  • Decreased stress
  • Increased focus
  • Decreased blood pressure
    • While also improving the transportation of oxygen and carbon-dioxide
  • Increased immune function

As you can see, mindfulness does a lot more than simply strengthen our ability to focus. While you will see some of these benefits after your first time, there is evidence showing that after 8 weeks of practice neurologists seen an increase in gray matter density in brain regions associated with learning, memory processing, and emotional regulation.

Mindfulness is just one style of meditation. There are myriad resources out there to help you get started, but Headspace is my favorite. Have you tried meditating before? If so, let me know your thoughts on the practice and your favorite style.

 

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What is the low FODMAP diet?

There are some foods that are known culprits of abdominal bloating and gas, foods like carbonated soda, beans, and dairy. Pistachios and mangos aren’t usually included in that list. They are, however, both considered high FODMAP foods.

FODMAPs is an acronym for “Fermentable Oligo- Di-Monosaccharides And Polyols” and these short-chain carbohydrates are not always well suited for the intestinal tract. Decreasing high FODMAPs food may help relieve digestion problems like abdominal cramping as well as other intestinal issues like Irritable Bowel Syndrome.

Common FODMAPs:

  • Fructose (fruits, honey, high fructose corn syrup)
  • Lactose (dairy)
  • Fructans (wheat, onion, garlic)
  • Galactans (beans, lentils, legumes such as soy)
  • Polyols (sweeteners containing sorbitol, xylitol, stone fruits)

The low FODMAP diet is a short-term restrictive diet to determine which type of foods trigger intestinal symptoms through the process of elimination. After about 6 weeks on this diet, each of the above types of FODMAPs is reintroduced (one type per week) as symptoms are noted per type and food sensitivities discovered.

Know thyself, and know thy gut! For more information on FODMAPs, check out these links:

Low FODMAP Diet: The D.I.Y Beginner’s Guide

Stanford University Medical Center Digestive Health Center

PrEP for HIV Prevention? Here’s what you need to know

Pre-Exposure Prophylaxis, or PrEP, has changed the way in which we talk about HIV Prevention. After being approved for preventive use by the FDA in 2012, there has been a sharp increase in PrEP prescriptions in the U.S. over the past several years. Currently, the only prescription available for PrEP is Truvada, which also serves as a treatment drug for those who are HIV positive.

Truvada is a nucleoside reverse transcriptase inhibitor, or an NRTI. When exposed to HIV, a NRTI works by masking itself as a building block of the virus’s genetic structure. While our own cells are able to recognize and correct for this coding mistake, HIV cannot, and as a result is unable to replicate and mount a widespread infection.

A quick distinction: Truvada as a drug is a form of PrEP, PrEP is a general class of preventive measures. Birth control can be thought of as a form of PrEP, preventing a pregnancy before it occurs. Even sunscreen is a form for PrEP. You apply lotion to prevent sunburn before it occurs.

But PrEP only works if you take it. According to recent findings from the Centers for Disease Control and Prevention, the majority of uptake of PrEP in the United States has been among middle-aged, white, gay men. But the HIV epidemic has shifted, with the CDC noting continuous inequalities in the southern states and among young African Americans.

More concentrated efforts need to happen to ensure that those who can benefit from PrEP are able to access and receive it. Gilead, the company that produces Truvada, has a copay card available, where they pay up to $3600 a year in copays for those living under 500% of the national poverty level. For more information on PrEP, UNC campus health also serves as a great resource on campus, and students can get more information by making a free appointment with Student Wellness by emailing LetsTalkAboutIt@unc.edu or by calling (919) 962-WELL(9355).

For additional Resources on what to know about PrEP, and how to have a conversation with your provider, please see the resources below for information from the CDC. For those looking for a PrEP friendly provider, here is a list of providers in the State of North Carolina who actively prescribe PrEP.

Sources –

Gilead Copay Card: https://www.gileadadvancingaccess.com/copay-coupon-card

Centers for Disease Control and Prevention PrEP Resources: https://www.cdc.gov/hiv/risk/prep/index.html

Centers for Disease Control and Prevention PrEP Information: https://www.cdc.gov/hiv/basics/prep.html

List of PrEP Providers: https://www.med.unc.edu/ncaidstraining/files/PrEPProvidersforDownload.pdf/view

Practicing Good Sleep Hygiene

Like diet and exercise, sleep is an important part of living a healthy life. Sleep supports healthy brain function, healthy growth and development, and our immune function. For adults, the National Sleep Foundation recommends 7 to 9 hours of sleep per night. But what happens if we don’t get enough shut-eye? This can affect our productivity, our ability to manage our emotions, and even our ability to fight off infections. In addition, a lack of sleep can increase our risk for obesity, heart disease, stroke, and diabetes.

An important part of getting enough and better sleep is practicing good sleep habits or “sleep hygiene.” Here are some ways that you can practice good sleep hygiene:

Sleep more consistently. Try to go to bed at the same time every night and wake up at the same time every morning by setting your alarm. This will help to reinforce your body’s sleep/wake cycle.

Create an optimal sleep environment. It may be helpful to keep any work-related items/electronics in a room other than the bedroom. This will allow you to better associate the bedroom with sleep. Also, use a comfortable mattress and pillows, and try to reduce any light and noise that can affect your sleep. Blackout curtains, eye masks, and/or ear plugs can help with this. Finally, keep your bedroom at a cool temperature (60-75 degrees Fahrenheit) to facilitate sound sleep.

Establish a bedtime ritual. Listening to relaxing music, stretching, or reading before bed can be helpful to prepare you for sound sleep. Avoid activities that are very stimulating such as strenuous exercise or using a computer.

Put away technology. Using electronic devices such as your cell phone and computer before bed can make falling asleep more difficult. This is because the blue light that emanates from your phone and computer screens stimulates your brain, which can affect your sleep/wake cycle. Avoid using these devices 30 minutes before bed.

Avoid cigarettes, alcohol, caffeine, and heavy meals before bed. Caffeine, alcohol, and cigarettes can act as stimulants that can keep you awake. Avoid these substances 4-6 hours before bedtime. Additionally, avoid heavy foods before bed as these may cause indigestion, disrupting your ability to fall asleep.

If you must, nap during the day. Taking naps later in the day may disrupt your drive to sleep at night.

Happy Sleeping!

Helpful Resources: 

National Sleep Foundation

American Academy of Sleep Medicine

American Sleep Association

National Healthy Sleep Awareness Project (from the American Academy of Sleep Medicine)

References: 

Circadian Rhythm and Your Body Clock. (N.d.). Retrieved from  https://sleep.org/articles/circadian-rhythm-body-clock/

Healthy Sleep Tips. (2017). Retrieved from https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips/page/0/1

National Sleep Foundation. (2015, February 2). National Sleep Foundation Recommends New Sleep Times. Retrieved from https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times

The High-Tech World of Sleep. (N.d.). Retrieved from https://sleep.org/articles/how-technology-changing-the-way-we-sleep/

Twelve Simple Tips to Improve Your Sleep. (2007, December 18). Retrieved from http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips

Peters, B. (2016, March 1). What Sleep Rituals Should Be Part of Your Bedtime Routine?  Retrieved from https://www.verywell.com/bedtime-routines-and-sleep-rituals-for-restful-sleep-3014947

Why Is Sleep Important? (2017, June 7). Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/why

Meditation and Stress Relief

Earlier this semester, I heard about Transcendental Meditation (TM) for the first time. It’s defined as a technique that trains one to turn “attention inwards towards the subtler levels of a thought until the mind transcends the experience of the subtlest state of the thought and arrives at the source of the thought” (Mahesh Yogi, 1969). A distinguishing characteristic of this form of meditation is the carefulness with which the pedagogy is preserved–requiring a training process to certify preservation of fidelity to the method. (Wallace, 1970).

An early and foundational study noted physiological changes attributed to practicing TM.  These included decreased heart rate and oxygen uptake, and changes in EEG frequency (Wallace, 1970). Generally, as we’ve heard in class from various individuals who practice, these manifest themselves as lower stress levels, in creased focus, and increased clarity and decision-making power.

Other positive benefits have been described in a variety of populations. TM has been suggested to facilitate decreased drop-out rates from urban schools, improve quality of life in children living with Autism Spectrum Disorder ,  boost immunity levels , and generally improve mental health and well-being.

This New York Times article chronicles the experiences of schools implementing TM in classrooms around NY, largely featuring success stories, while still noting that research on the use of TM in an academic setting is not yet conclusive.

There is room to speculate whether TM is radically different form other forms of inward reflection. Surely, there are many ways to reduce stress and enhance productivity, of which TM is just one. With TM on my radar, I look forward to seeing if research can discern TM as a distinctively beneficial.

 

Non-linked References:

M. Mahesh Yogi, The Science of Being and Art of Living (International SRM, – London, rev. ed., 1966), pp. 180-209.

Wallace, R. K. (1970). Physiological effects of transcendental meditation. Science, 167(3926), 1751-1754.

*credit for articles/reference guidance to EPID799c course resources made available to students

Networking the New Normal: Confronting Illness through Social Media

GUEST BLOGGER: Terri Beth Miller, PhD

This is not how you expected life to be. You’re run down. You’re hurting. You’re physically and emotionally drained. And it feels as though those closest to you are a million miles away, as though you’ve suddenly found yourself stranded on a desert island with no hope of rescue.

This is what it can feel like when you are confronting illness, when a diagnosis suddenly transports you to a new world you never wanted to visit, let alone permanently inhabit.

The truth is that illness, whether physical or psychological, chronic or acute, can be one of the most frightening, disorienting, and isolating experiences a person can face. And yet, if we live long enough, we will all confront this experience. After all, ain’t none of us getting out of this life alive.

But diagnosis doesn’t have to mean disaster. Our 21st century world offers resources once unimaginable to those seeking health information and support. Few are more potent than the vast social media networks available to connect people in the most far-flung corners of the globe with the simple click of a button.

This seemingly limitless connection can be an infinite comfort for those who are suffering from illness, allowing survivors to reach out to fellow survivors, who often can understand illness in a way that those who haven’t experienced it simply cannot. After all, family and friends may empathize. They certainly can provide a love and comfort that the virtual world cannot replace. But there is a special and necessary connection shared by those have felt the gnawing at the bones, the torment of the mind—by those who have the visceral, intimate experience of real, bloody, hand-to-hand combat with illness. This is the connection that social media can offer to those suffering from illness, a means to overcome the isolation that can cut as deeply as sickness itself.

In addition to the opportunity to connect with fellow survivors, social media is an exceptional outlet for sharing health information and resources, from exploring treatment options to connecting with care-providers. After all, an informed patient is an empowered patient. Because those who are suffering from ill health often feel a tremendous lack of control and a vast feeling of uncertainty for the future, this access to knowledge can restore the sense of self-determination and understanding that survivors knew before diagnosis. These resources can restore some normalcy, or at least something of a return of the survivor’s sense of self.

Nevertheless, extreme caution must be practiced. We are perhaps never more vulnerable than when we are battling illness, and unfortunately those who would prey on the hopes and fears of the desperate are legion. So while it is healthy—and, indeed, essential—to seek out all the knowledge and resources possible when battling illness, it is equally essential to be wary of promises that are simply too good to be true. Vet the company you keep and the treasures you store up in the virtual world just as you do in the physical one.  Avail yourself of the immense resources available to you online as you wage your battle with sickness. But do so from a position of strength and discernment. This is your body. This is your mind. This is your spirit and your life. Harness the best and highest powers of social media. There is tremendous solace, solidarity, and support to be found online for those battling illness, but only for those who use it wisely.

For more information on the most beneficial mental health online resources, please visit: https://openforest.net/4-best-mental-health-bloggers-period/

Terri Beth Miller completed a PhD in English Language and Literature at the University of Virginia. She has taught writing and literature courses for more than a decade and is a regular contributor to the http://openforest.net mental health self-help portal. View her profile on LinkedIn at https://www.linkedin.com/in/drterribethmiller.

Old-fashioned Soap & Water

Suppose you just sneezed into your hands. I would recommend trying to sneeze into the elbow crease, but things happen. Anyway, now that your hypothetical hands are sneeze covered, what do you do? Of course, you need to clean them. You have two options, use the hand sanitizer nearby or go to the bathroom and wash them with soap and water. Which do you think is better at sanitizing the hands, killing the germs, and preventing the spread of disease?

The CDC recommends washing hands with soap and water when it is available because it is the most effective method for reducing the number of microbes. Hand sanitizers without alcohol do not kill all germs, can promote germ resistance, reduces the growth of the germs without killing them completely, and may cause skin irritation. Hand sanitizers with alcohol are better, but still do not eliminate all types of germs including Cryptosporidiumnorovirus, and Clostridium difficile. If you are going to use hand sanitizers, opt for hand sanitizers containing at least 60% alcohol.

When your hands are visibly dirty, always use soap and water to clean them. The CDC and numerous studies support evidence that hand sanitizers are effective when used on slightly dirty hands, such as after daily activities in typical hospitals or office settings, but are ineffective when used after dirtier activities, such as playing sports, gardening, or camping. If hands are exposed to hazardous chemical substances, use soap and water to wash your hands; hand sanitizers were not made to remove or neutralize chemicals and they may be ineffective or exacerbate skin irritation or damage.

So, in our hypothetical sneeze situation, find a sink and wash your hands correctly. If that is not an option, use the hand sanitizer; it’s better than nothing. Just remember to wash your hands as soon as soap and water is available, avoid contact with public surfaces, and don’t touch your face. Other ways to reduce the spread of disease include:

  1. Get vaccinated, including yearly flu vaccinations and booster shots
  2. Use antibiotics sensibly, don’t take antibiotics to fight a viral infection
  3. Disinfect bathrooms and kitchens regularly, such as wiping surfaces and washing towels
  4. Practice safe sex, such as using a condom
  5. Stay home when you’re sick, both from work and going to public spaces
  6. Be smart about food preparation, such as cooking meat thoroughly
  7. Don’t share personal items, such as toothbrushes or lipstick

Resources:

University of Puget Sound (n.d) Preventing the Spread of Infectious Disease. http://www.pugetsound.edu/student-life/counseling-health-and-wellness/health-topics/preventing-the-spread-of-infec/

CDC (2016, Feb 22) Show Me the Science-When & How to Use Hand Sanitizer. http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html

How to Have a Healthy Holiday Season

By: Aria Gray MPH: Maternal and Child Health candidate 2017

As the song goes… “It’s the most wonderful time of the year,” but is it? The holiday season is a wonderful time to enjoy time with friends and family, but it can also be a stressful time. Airports are crowded and you may be exposed to more people (and germs) than you are used to. I often forget to take care of myself and end each holiday season with a very memorable cold, and this year it is my goal to be as mindful as possible. It is also important to take care of not only your physical health but your mental health as well.

Below are some important tips to remember to have a healthy holiday season.

Holiday Health Tips

  • Wash your hands often
  • Stay warm
  • Manage stress
  • Travel safely
  • Handle and prepare food safely
  • Eat healthy
  • Be active

How to handle holiday stress

  • Take time for yourself
  • Volunteer
  • Have realistic expectations
  • Remember what is important
  • Seek support

What will you be doing to have a healthy holiday season this year?

Let us give thanks

By: Courtney Luecking, MPH, MS, RD Doctoral Candidate: Nutrition

Thanksgiving is my favorite holiday. It is an opportunity to take time away from routines, gather with family and friends, and literally give thanks. The history buffs can check their knowledge about the origin of Thanksgiving, but I would like to concentrate on the science behind the power of gratitude.

Check out this beautiful infographic for a more in depth summary, but the short of the long is that expressing gratitude has numerous physical and mental health benefits. Studies have linked gratitude with improved sleep, increased energy levels, and increased self-esteem. One trial also found those who kept a gratitude journal for 10 weeks were 25% happier than the group who did not keep a journal.

Read more about the benefits of expressing gratitude here and here.

With all these benefits, why limit it to one day a year? Instead, why not find some space for gratitude all year long?

be-thankful

Here are some ideas to intentionally acknowledge what or who you are grateful for throughout the year:

  • Snap a daily photo. Get inspiration from 365grateful, a stunning display of all the wonderful – big and small – things in the world
  • Keep a journal or list – paper, word document, or note on a phone or tablet
  • Try an app
  • Write a thank you note – for a purpose or just because
  • Jar of happiness
  • Meditate
  • Pray
  • Count your blessings

Let us give thanks not only this Thanksgiving holiday but more frequently in the upcoming year. After all, don’t we have much to be thankful for?