The Low-Down on Depression

Author: Erika Rajo, Psy.D., Trauma Psychologist, UMC

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Depressive disorders can make you feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings may make you feel like giving up.

Major depressive disorder is not the same as feeling unhappy or in a “blue” mood, feelings that can usually pass with time. It is important to recognize the signs of depression and to know that treatment is often needed and, in many cases, is crucial to recovery.

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According to findings from the National Institute of Mental Health, major depressive disorder is a leading cause of disability in the U.S. for ages 15-44 and affects approximately 14.8 million American adults, or about 6.7% of the U.S. population  age 18 and older in a given year.

Specific symptoms include:

  • Feeling sad, down, empty or hopeless
  • Decreased interest or pleasure in activities
  • Significant weight loss when not dieting or weight gain or decrease or increase in appetite
  • Changes in sleeping patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much
  • Listlessness or restlessness that is observable by others
  • Fatigue or decreased energy
  • Feeling worthless and/or helpless
  • Lasting feelings of hopelessness
  • Feelings of inappropriate guilt
  • Diminished ability to think, concentrate, or make decisions
  • Frequent thoughts of death or suicide, wishing to die, or attempting suicide (Note: People with this symptom should seek help right away by calling 911 or going to the nearest emergency room.)

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The Facts

The research shows that depression diagnoses are increasing at a rapid rate in the U.S. One recent study published by the Blue Cross Blue Shield Association (2018) found that from 2013 to 2016, depression diagnoses increased 63 percent among adolescents (ages 12 to 17) and 47 percent among millennials (ages 18 to 34). Although this rise in depression may seem alarming, the data may reflect a positive trend – an increase in the rate at which symptoms of depression are being recognized.

The bottom line is that increased awareness leads to earlier recognition/identification of symptoms, which then allows for earlier intervention and prevention! On that note, here are a few more facts you should know about depression:

  • While depression can develop at any age, the median age at onset is 32
  • Depression is more prevalent in women than in men
  • There is no clear cause of depression. Experts think it happens because of chemical imbalances in the brain. Many factors can play a role in depression, including environmental, psychological, biological, and genetic factors.
  • Depression and sadness are not one in the same. Sadness is a part of being human, a natural reaction to painful circumstances. All of us will experience sadness at some point in our lives.
  • It’s treatable! You do not need to suffer if you have depression. There are many effective treatment options available, including psychotherapy, medication, and electroconvulsive therapy (used to treat severe, medication-resistant depression).

 

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When should you seek professional help?

  • If your symptoms are causing notable distress or impairment in social, occupational or other important areas of functioning
  • If self-help strategies or behavioral interventions are not working
  • If your symptoms and associated distress/impairment persist for more than 2 weeks
  • If you have frequent thoughts about self-harm, death, or suicide

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Self-Help Strategies

There are also some strategies you can try on your own. Of note, these strategies can serve as a supplement to professional treatment but not as a replacement.

  • Set realistic goals for yourself each day.
  • Break large tasks into small ones and set priorities. Do what you can at a pace that feels right for you.
  • Avoid the urge to isolate. Spend time with friends and family. Confide in trusted, supportive people in your life and allow them help you.
  • Schedule activities that have boosted your mood in the past, such as going to a movie, gardening, or taking part in religious, social, or other activities. Doing something nice for someone else can also help you feel better.
  • Exercise regularly.
  • Eat healthy, well-balanced meals.
  • Write down 3 things you are grateful for at the end of each day. This may help replace the negative thinking that often accompanies depression.
  • Make a list of positive affirmations and recite them to yourself several times a day, especially when you catch yourself having negative thoughts.
  • Stay away from alcohol and drugs, which can make depression worse.
  • People rarely “snap out of” depression. Expect your mood to get better slowly, not right away. Feeling better takes time.
  • Seek professional help. If you think you may be depressed, see a healthcare or mental health provider as soon as possible.

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About the Author

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Erika Rajo, Psy.D. is a Licensed Clinical Psychologist, Assistant Professor of Clinical Psychiatry for LSU Health Sciences Center (LSUHSC) and the Trauma Psychologist at University Medical Center, New Orleans (UMCNO). She earned her doctorate in Clinical Psychology from Pepperdine University and completed both her predoctoral internship and postdoctoral fellowship training at LSUHSC. Dr. Rajo specializes in the psychological assessment and treatment of patients in an integrated medical setting. She also has extensive training and clinical experience in the treatment of psychological trauma and has been working with patients experiencing trauma-related difficulties since 2011.

 

 

 

Lisa’s Story: The Wake-up Call that Saved My Life

Author: Lisa Miranda, Chief Operating Officer, UMC

In mid 2012, the sudden death of a colleagues’ husband spurred me to do something I had not done in 10 years. I went to the doctor.

I’ve worked in healthcare since 1986, and I fit the stereotype of a healthcare worker who didn’t always pay enough attention to her own health. So, for more than a decade, I hadn’t had a mammogram, blood work, routine checkup or even a sick visit to the doctor. I didn’t even have a regular physician anymore.

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But that unexpected death was a wake-up call that made me realize I had better get a physician and get a checkup. I chose a family medicine physician at Touro and made an appointment. She told me what I knew, and that was I really needed to get caught up on all of my screening exams and tests.

I have a history of very dense breasts and had previous biopsies of cysts that were benign, but because of many benign cysts, a physical exam is very difficult.  The doctor wrote my orders and I had a screening mammogram, which turned into a diagnostic mammogram and an ultrasound on the same day, which I had gone through twice before with benign cysts. This time, the news was serious. A biopsy revealed that I had breast cancer.

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I had always said that if I was diagnosed with breast cancer I would have a bilateral mastectomy to make sure there was no ability for recurrence. I met with my surgeon, who explained that due to the location and the size (very small and on the lower portion of my breast), there was no need for a mastectomy and he would have no problems obtaining clear margins with a lumpectomy.

I had my surgery and doctors found that in addition to the tumor in my breast, the cancer had already progressed to one lymph node.

Had I not had my wake-up call, I would probably had gone another few years without testing and the cancer would have at that time been throughout my body and I would not be here today.

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I received chemotherapy and radiation treatment post-surgery which put me into early menopause. Since my tumor was hormone positive, I can’t take hormone treatment for menopause and therefore hot flashes were a huge issue.

Throughout the experience, I was determined to not let my diagnosis rule my life. I went to all of my testing and treatments alone except for the last 3 in which I had neuropathy and couldn’t drive and had what I call “chemo brain.”

I gave myself my own neupegen shots after every treatment to keep my white blood cell count up and continued to work until I was unable to drive.

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During the treatments, I would bring a book, a pillow and a blanket and read until the Benadryl made me sleepy, take a nap, then drive home. One day, when I was receiving my treatment, I heard the patient across from me who was getting her first one (who had 3 people with her) ask the nurse if I was getting Chemo. The nurse later came to me and asked if I could speak to the patient who was very scared. I introduced myself and told her that I was on my 4th of 8 treatments and that I had never been nauseous or sick and used the time to relax and read. She was so surprised because I had “hair”. I laughed and whipped off my wig and showed her that I was bald as a cucumber.

Most people didn’t even realize I was undergoing treatment. My philosophy was to take each day at a time, don’t worry about something that hasn’t happened, and continue living. I feel strongly that the strength to persevere helps outcomes.

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I am an example of why it is so important to have your annual exams and testing. I would not be here today if I had waited even another year.

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Please join all of us at UMC in saying #YesMamm to an annual mammogram. Scheduling a screening is easy, and if you are over 40 years old with no known breast problems, you won’t need a physician’s order to get your screening mammogram at UMC. For more information, visit www.umcno.org/mammograms or to schedule an appointment, call (504) 702-5700.

Lisa Miranda.jpgLisa Miranda is UMC’s Chief Operating Officer. Prior to joining UMC, she worked for 27 years at Children’s Hospital New Orleans in a number of roles, including Administrative Director of Laboratory Services, Hospital Safety Officer, and Emergency Management Coordinator.

The Importance of Choosing and Using the Correct Child Car Restraints

Author: Bridget Gardner, Injury Prevention Coordinator, UMC 

This week, UMC is participating in National Child Passenger Safety Week.  As motor vehicle crashes are the leading cause of death for children and teens, it is important for our community to realize the number one safety feature in a vehicle is a seat belt or child restraint.

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Although so simple to use, many do not take advantage of the engineering properties associated with the life saving measures or bio-mechanics of restraints.  Seat belts or child restraints work in the same way to lessen the impact of force from a motor vehicle crash. There are 5 basic benefits to being restrained prior to a crash.

  1. Keeps you in the vehicle: Being thrown from a vehicle can be deadly.  It’s just too much force on the body and goes back to your old science class about Newton’s Law of Motion.
  2. Restraints cross the bony structure: You are built like a cage, with bony structures that protect the internal organs. Bones can withstand greater forces than internal organs.
  3. Spreads forces: Simple force calculation experienced in a crash is your weight multiplied by the speed of the vehicle. Spreading the force allows a distribution across the body, rather than placing the energy in one place.
  4. Protects the head and spinal cord: Once damaged, injuries can last a lifetime.
  5. Provides ride down: In fractions of a second, seat belts or a child safety seat harness allow a slowing of the force in a crash.

No other devices will offer this type of protection. Children require child safety seats because they are too small to take advantage of the bio-mechanics with a seat belt alone.

Recently, the American Academy of Pediatrics made a few changes to their child safety seat policy. This caused much attention, however there were very few changes.  In summary, the following are considered best practice:

Infants and Toddlers

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TYPE OF SEAT:

  • Rear-facing only
  • Rear-facing convertible

General Guidelines: All infants and toddlers should ride in a rear-facing seat until they reach the highest weight or height allowed by the car seat’s manufacturer. Most convertible seats have limits that will permit children to ride rear-facing for two years or more.

Toddlers and preschoolers

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TYPE OF SEAT:

  • Convertible
  • *Forward-facing with harness

General Guidelines: Children who have outgrown the rear-facing weight or height limit for their convertible seat should use a forward-facing seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat manufacturer.

School-age children

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TYPE OF SEAT:

  • Booster seats

General Guidelines: All children whose weight or height exceeds the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are 8 through 12 years of age. All children younger than 13 should ride in the back seat.

Older children

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TYPE OF SEAT:

  • Seat belts

General Guidelines: When children are old enough and large enough for the vehicle seat belt to fit them correctly, they should always use lap and shoulder seat belts for the best protection. All children younger than 13 should ride in the back seat.

Let’s take the time to focus on the safe arrival of our friends and family.  After all, working in a Trauma Center, we know that no one is invincible from trauma, and the only way to lessen the number of injuries is through prevention.

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National Seat Check Saturday

The community is able to join us this Saturday, September 29, as we have 9 FREE child safety seat events occurring statewide on National Seat Check Saturday! Thanks to our partners at Louisiana Sonic Restaurants, we will also be distributing child safety seats to those in need.  The process is no longer accepting applications at this point, as all requests have been confirmed.  If you are in need of a child safety seat and finances keep you from correctly securing your child in the proper restraint, we will open the link for applications again in March.  Follow us on the UMC Injury Prevention page for upcoming announcements. www.umcno.org/injuryprevention.

Seat Check Saturday takes place from 9 a.m. to noon on Saturday, September 29 across the state at these locations:

  • Alexandria—Rapides Regional Trauma Center Medical Terrace, 211 Fourth St.
  • Baton Rouge—Baton Rouge Police Dept., 9000 Airline Dr.
  • Houma—Home Depot, 1717 Martin Luther King Blvd.
  • Kenner—Divine Mercy Church, 7337 Sal Lentini Pkwy.
  • Lafayette—Babies R’ Us, 5700 Johnston St.
  • Lake Charles—Southwest Beverage Company, 3860 Broad St.
  • Mandeville—Church of the King- Little Creek Campus, 22205 Little Creek Rd.
  • Monroe—Hixson Ford, 6300 Frontage Rd.
  • Shreveport—Sheriff’s Safety Town, 8910 Jewella St.

 

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Bridget Gardner, RN, is a registered nurse and coordinator of the Community Injury Prevention Program at UMC New Orleans. The Louisiana Passenger Safety Task Force is a network of certified child passenger safety technicians throughout the state, directed by the UMC  Trauma Program.

 

Yoga: An Exercise for Every Body

Author: Maryann Vicari, UMC Physical Therapist

In honor of September being National Yoga Awareness month, we wanted to shed some light on the practice of yoga and the many benefits it has for those who partake in it.

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Yoga, a series of stretches and poses associated with breathing techniques, offers the powerful gains of exercise. Some yoga styles are intense and vigorous while others are relaxing and meditative. No matter which type you choose, yoga is a great way to stretch and strengthen your body, focus your mind, and relax your spirit.

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Yoga can aid in strength and flexibility, as well as allow you to feel more focused and alert. In addition, a regular yoga practice (3-4 days/week) can improve functional mobility in activities of daily living (ADLs) and decrease fall risk. Moreover, yoga has been found to help improve these specific conditions:

  • Poor blood circulation
  • High blood pressure
  • Arthritis
  • Osteoporosis
  • Limited mobility
  • Lower back pain
  • Difficulty breathing
  • Headaches
  • Tension or stress
  • Depression

 

Yoga’s gentle movements are a one of the main reasons for its growing popularity.

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Yoga is great for people who have not been active for some time. It is also helpful for people who have certain health conditions like arthritis or osteoporosis because it does not require your joints to move through their full range, which can sometime be painful. Most importantly, you can modify the exercises/poses to fit your needs/abilities. At the same time, yoga is also great if you’re already fit and want a more challenging workout. As you become stronger and more flexible, it’s easier to do other kinds of exercises/activities like dancing, walking, or swimming.

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Yoga can help:

  • Reduce your risk for injury. Each yoga pose targets specific muscles. This helps you increase your flexibility and reduce your risk for injury.
  • Reduce stress and increase concentration. Yoga can help soothe/focus the mind and lower stress levels. It does this by encouraging you to tune into your breathing which helps to focus your mind on the moment and poses.
  • Understand the mind and body connection. Yoga requires you to focus all your energy on each movement or pose exactly. This can help you tap into the connection between your mind and body.
  • Gain strength and stamina. More vigorous styles of yoga promote strength and stamina.
  • Improve balance and stability. Balancing poses require you to use your core muscles. This can help you improve your overall stability and decrease risk of falls.
  • Improve posture. Yoga poses strengthen and open tight areas of the body like the shoulders and muscles of the upper back. This can help you keep good posture throughout your day.
  • Develop body awareness. Yoga requires you to contract or relax specific muscles as you stretch into each pose. This can help you become more aware of your body’s strengths and weaknesses.

How Do I Start?

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It’s easy to find a variety of yoga classes. You can check with your local community centers, such as the Y or look at nearby gyms, dance studios, and health clubs. There are numerous yoga studios in the greater New Orleans area, many of which, offer specials (Groupon, etc) for new students. Finally, you can look up Yoga Journal’s Yoga Teacher Directory to see regional and national lists of yoga teachers and associations.

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It is important to find the right yoga style for you and a teacher you like. It’s hard to know what a class is like until you attend it. Even when two teachers use the same terms to describe their classes, the classes may be quite different, so feel free to experiment with different types of classes at different studios.

As always, be sure to talk with your health care provider before you begin yoga or any other kind of exercise. It’s a good idea to take a class with an experienced teacher. Let the teacher know about any health conditions you may have like high blood pressure or arthritis. Tell him or her about any injuries or physical problems. A good teacher will know which exercises are best for you and tell you which poses to avoid.

Give It a Try!

Yoga can help you get fit for life. It helps you deal with stress, pick up your child, control your dog, carry groceries, or work in your garden. It also can help to prevent or ease back pain and muscle or joint injury and give you self-reliance and self-esteem.

 

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Most important to keep in mind, the yoga routine is more than just physical — it involves the quieting of the mind. The bottom line is learning to pay attention. You fine-tune your attention, beginning with the body, and then moving to the mind. As you get deeper into your practice over the years, you start to see the mental and spiritual benefits. Namaste!


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Maryann Vicari

I have a personal soft spot for yoga, as I have been practicing it consistently for the past two years.  I recently became certified to teach yoga this past spring because I wanted to deepen my personal yoga experience and help bring awareness of yoga to my patients and others in the community. I’m currently teaching classes at Balance Yoga and Wellness Studio, and I sometimes lead my coworkers at lunch when we have time. Yoga has had a profound effect on my life, both physically and mentally, as well as spiritually.  I would recommend it to anyone who is looking for a new exercise routine or a way to improve functional mobility and general quality of life.

 

 

Pain Care: Prevention Before Treatment

Author: Harry J. Gould, III, MD, PhD

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When a patient says, “Doctor, it hurts when I do this,” the immediate thought in response to the implied request is “Don’t do that.”  Unfortunately, in today’s society, this seems to be the best and most effective advice that a physician can provide for their patients in pain.

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The United States is in the midst of what the Centers for Disease Control describes as “The worst public health crisis in American history.”

There are reports, almost daily, to enlighten us about the fact that the over-prescribing of prescription painkillers has led to countless overdose deaths and serious consequences associated with misuse, abuse, addiction, and diversion that plague society in epidemic proportions.

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As a result, there has been a strong push by the community and regulatory agencies to limit the prescribing and dispensing of opioid analgesics across the board, while paying little attention to the underlying cause.

Pain is often under-treated or over-treated, but mostly it is poorly treated.

The system’s response has precipitated a reluctance on the part of many physicians to provide pain care for many in need, further exacerbating the primary cause of the problem.

A frequent response is to change clinical focus and redirect efforts to offer one-dimensional assessment and management that relies on interventional modalities.  Unfortunately, not all patients are identical and interventions, if ordered inappropriately or too often, can be costly and have problems of their own.

The observations and policies have mandated change and have heightened the efforts of healthcare providers to find ways to “do no harm” in their efforts to help those in need.

How then can we improve pain care and overall quality of life?  Perhaps it is time to return to basics.

As a starting point, we should consider some important truths about pain.

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The Truth About Pain

  • Pain is subjective and is different for everyone based on culture, situation, experience, genetics, age and gender.
  • Pain is a modality that is essential for survival. It warns us of present and potential tissue injury so that we can respond and minimize damage.
  • The most important reason that chronic pain is so debilitating is less the uncomfortable sensation that is experienced and more the fact that pain robs us of our ability to control of own lives. Unfortunately, many chronic pain conditions are present for a lifetime.  Thus, the realistic goal should be to minimize the effect of the underlying condition causing the pain and reclaim control of our lives rather than to eliminate pain.

Too often, patients surrender responsibility for controlling their pain to friends, physicians, physicians, drugs or procedures.

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Taking Responsibility for Your Pain

As a patient, it is essential for you to take responsibility for your pain and to participate in your own care. This process can begin by considering and implementing some obvious positive behavior changes that can maximize pain control and minimize both physical and fiscal cost.

Things You Can Do to Control Pain

  • Eat a regular healthy diet, avoiding excess, with a goal to optimize body mass index (BMI).
  • Exercise daily — regular activity from baseline to 30-60 min/day tailored to the patient’s ability to tolerate activity without a backward slide. “No pain, no gain” is not always the best approach.
  • Be sure to get enough restorative sleep.
  • Balance life experiences and schedule time for yourself that allows for participation in hobbies and enjoyable leisure activities.
  • Be aware of habitual activities and positions that add undo ergonomic stress, e.g., poor posture, wearing high heels, wearing shoes that lack adequate support, sleeping on an old or non-supportive mattress or pillow, using inadequately supportive chairs and car seats. Tailor work and living environments to minimize but not necessarily eliminate stressors and eliminate high-risk conditions.
  • Learn and take advantage of alternative forms of coping and pain control, e.g., meditation, guided imagery, self-hypnosis and relaxation.

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With proper perspective and attention to basics, one is likely to realize improved general conditioning that enhances:

  • Healing and the immune system’s ability to fight off infection and disease
  • Improved cardiovascular, pulmonary and gastrointestinal health
  • Reduced stress
  • Improved mental health
  • Increased sense of self and well-being and an overall improved quality of life
  • Reduction in pain at any level

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When setbacks occur, first consider the use of topical heat, cooling or massage and prudent physical activity to improve strength, range of motion and endurance and seek counsel for a comprehensive pain assessment early when the basics have not provided adequate results.

Suicide Prevention: Know the Signs and Where to Get Help

Author: David Fein, MD, Medical Director of  Behavioral Health Emergency Room Services

Suicide rates have been on the rise, now standing as the 10th leading cause of death in the U.S. and the 2nd leading cause of death in teens. Now more than ever, it’s critical to know the signs that might indicate a person is considering suicide, where to go for help, and how to provide appropriate support and interventions.

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Risk Factors

While there are known risk factors for suicide, such as being older, male, or single, there are additional risk factors to be mindful of as well. These include dramatic changes in behavior, such as getting one’s affairs in order, giving away possessions, increasing substance use, and expressing feelings of being trapped, a sense of hopelessness, or the belief that there is no purpose or meaning to life.

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Many suicides occur during moments of extreme anxiety and hopelessness about the future. In fact, interviews of people who attempted suicide reveal that, oftentimes, they experienced profound regret about their decision almost immediately.

We should strive to never let temporary feelings of hopelessness drive us or a loved one to a permanent act like suicide. If you feel you are trapped with no way out and think the only solution is death, know that many resources are available to help you through the crisis.

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Where to Find Help

Each parish has a community mental health center and a mobile crisis unit that are available 24/7 to provide support for people in a behavioral health crisis. Calling the crisis unit does not necessarily mean you will be brought to the E.R. They are there to provide support to you – sometimes over the phone, sometimes in person.

Metropolitan Human Services District serves Orleans, St Bernard, and Plaquemines parishes. Call (504) 568-3130 for their clinic, and (504) 826-2675 for their mobile crisis unit. Jefferson Parish Human Services Authority serves Jefferson Parish. Call (504) 838-5257 for their clinic and (504) 832-5123 for their mobile crisis unit.

If a friend or loved one is in crisis and unwilling to seek help, another option is an Order of Protective Custody, which is signed off by the parish’s coroner and gives the police legal authority to bring the person to the hospital for an evaluation. To  request for an Order of Protective Custody in Orleans Parish,  call (504) 658-9660; in Jefferson Parish, call (504) 365-9100; in St. Tammany Parish, call (985) 781-1150.  

There are also national services such as the Suicide Hotline (1-800-273-8255) and the National Alliance on Mental Illness (NAMI) (1-800-950-6264) which also has a Crisis Text Line (just text NAMI to 741-741). As always, emergency rooms and 911 are available 24/7 in case of an emergency.

Dr. Fein is an Assistant Professor of Psychiatry and Associate Director of the LSU-Ochsner Psychiatry Residency Training Program, LSU Health New Orleans School of Medicine.

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The Unprocessed School Lunch

Author: Rosetta Danigole, Lead Dietitian at UMC

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Planning School Lunches

The school year is upon us.  Now is the one of the busiest times for both parents and kids as they settle into new schedules and routines. For many, a big part of that experience is thinking about and planning school lunches.

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In today’s society more children suffer from obesity, autoimmune disorders, Autism spectrum, ADHD and gut sensitivities and allergies.  Parents have to consider these concerns as well as how to pack not only a healthy school lunch but also an economical one as well.

Processed Foods

The processed food craze has certainly contributed to these disorders with the addition of the preservatives, other chemicals and gluten that some children may be sensitive to.

The summer is the time when parents may be more lenient about food choices but hope to get their kids back on track with the school year.

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Some Recommendations

Remember to always keep the school lunches balanced with lean protein such as poultry, fish, lean beef, eggs, nuts or other meat alternatives.

Make lunches fun by making sure you use some of your kids’ favorite foods and be imaginative by including fun shaped sandwiches, a nice note from you, and maybe some stickers.

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Here are some ideas for the Unprocessed School Lunch with special consideration for gluten free if needed for those kids with digestive complaints.

  • Fresh Raw produce such as apples, berries, cherries, bell peppers, and carrots.  Cut them up in bite sized pieces and add a fun dip such as hummus or a nut butter (check school policy regarding nuts in school lunch boxes)
  • Dried fruit such as raisins, craisins, and apple chips are also great options.
  • Hummus or Avocado dips- You may be surprised the number of kids like these “dips”.  Try adding carrots for a crispy treat.
  • Gluten free Granola Bars or protein bars- This makes a great snack for your kids.  You can find those made with dried fruits, coconut, and flax held together by honey.
  • Popcorn- This is always a healthy snack and treat and makes a tasty crunchy treat instead of potato chips.
  • Protein options- Try boiled eggs, fresh sliced turkey, or homemade chicken strips for the protein items.  Kids may also eat grass fed turkey or beef jerky for a change. If you make a sandwich you can try pita bread, bagels or gluten free bread if preferred and needed.
  • Homemade soup in a thermos- This is an old-fashioned wonderful option for your kids.  Nothing like mom’s homemade soup when it comes for lunch.  If gluten sensitive you can always use rice noodles and add nut floured crackers on the side.
  • Yogurt- Try adding a low sugar yogurt or a piece of string cheese for a calcium boost.

Most important when you have the chance introduce kids to new foods and make sure the dinner meal is full of healthy vegetables, complex carbohydrates and lean protein.

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About the Author

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As the lead dietitian at University Medical Center New Orleans, Rosetta Danigole manages clinical dietetic operations. She is a member of the Academy of Dietetics and Nutrition and belongs to the clinical dietitian practice group. She has been a dietitian for 35 years.

 

Family Ties: Genetics and Breast Cancer

By Alix D’Angelo, Certified Genetic Counselor

While most breast cancers occur sporadically (usually linked to environmental factors such as smoking cigarettes and hormone replacement therapy), up to 10% are hereditary. Hereditary breast cancers are caused by DNA mutations that are typically passed down in families for generations.

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Individuals with a personal or family history with the following features may want to consider genetic counseling and genetic testing:

  • Young cancers (particularly under age 50)
  • Multiple family members with the same types of cancers
  • Multiple cancers in the same person
  • Rare cancer types (such as male breast cancer and ovarian cancer)

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Identifying individuals who have a gene mutation leading to a hereditary form of breast cancer is important, as there are screening, treatment and risk reduction options that can be life-saving.

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Genetic Counseling and Genetic Testing

While most people may be familiar with the BRCA1 and BRCA2 genes, which account for about half of hereditary breast cancers, there are over a dozen other genes that have been implicated in breast cancer risk, including genes such as ATM, CHEK2and PALB2.

Panel genetic testing that includes all of these genes and more is now available for individuals who meet medical criteria.GettyImages-865900230.jpgIf you think that you or a family member may warrant genetic testing for hereditary forms of breast cancer, speak with a genetic counselor or your doctor.

Alix D’Angelo, MGC,Angela D'Angelo.jpg CGC,  is an Instructor at LSU Health New Orleans Instructor and a Genetic Counselor at UMC New Orleans.

Join her on August 29th for the next talk in the series of Susan G. Komen-New Orleans lunch lectures,  “Family Ties: Genetics and Breast Cancer.” It will take place 12 – 1 p.m. in the UMC New Orleans Conference Center, First Floor. Lunch will be provided. Click here to RSVP.

 

Protect your Children: Get them Vaccinated

By Gail Burke, DO, Family Medicine Physician

GettyImages-532334752.jpgWith a new school season starting, many parents are making lists to make sure their child has everything to begin the school year prepared. Protecting your child’s health should be number one on your list.

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One of the best ways to keep your children healthy is to get them vaccinated. From newborn to college age, you can protect your children from 16 serious diseases, including polio, meningitis, diphtheria, flu, rotavirus and tetanus. Vaccinations work! Some terrible diseases that ravaged human beings for centuries were eliminated with the discovery of vaccination, such as the dreaded small pox virus, which the World Health Organization declared globally eradicated in 1979.

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Vaccinations save lives

Before vaccines, many children died from diseases that vaccines now prevent, such as polio, measles and whooping cough. Those same germs exist today; because most children are vaccinated, we don’t see those diseases as often. Vaccination not only protects your child; it also protects the other children in the classroom and school, by something known as “herd immunity.” Germs can travel quickly through a community, such as your child’s classroom, and make a lot of children sick. If enough people get sick it can lead to an outbreak. But when enough children are vaccinated against a disease, the germs can’t travel as easily from person to person and the whole group is less likely to get the disease. That is “herd immunity!”

As a very busy parent, you’ve got enough to keep track of with your child’s multiple school and afterschool activities.  Keeping track of a vaccination schedule is one less thing for you to worry about, because your child’s doctor will do this job.

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Well-child visits and immunizations

Vaccinations are designed to be given automatically during well-child visits. Your family doctor or pediatrician will schedule these well-child visits and keep track of your child’s vaccinations and give you a health record with the history of your child’s vaccinations. This record is often required by your child’s school and other programs to ensure the health of all the children. And don’t worry. If your children have missed any vaccines, your doctor can use a “catch up” vaccination schedule to get them back on track.

There are free resources to help parents such as the CDC charts, “2018 Recommended Immunizations for Children from Birth through 6 Years old” and the “Recommended Immunizations for Children 6 years old through 18 years old.”

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Vaccination safety

Some parents are confused and worried about vaccinations. They’ve heard that vaccinations can cause autism or long-term neurologic problems. Moms and Dads want to do what’s in the best interest of their children. All parents, and children, deserve the best science-based information on this topic. The CDC and many scientific groups have done extensive research on vaccine safety; their studies continue to find there is no scientific basis for this claim. Based on these major research findings, the American Academy of Pediatrics and the American Academy of Family Medicine support vaccinations for all children, infancy through college age. You are encouraged to bring your questions and concerns to your family doctor.

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Additional benefits of vaccinations

There is another important benefit for parents who vaccinate their children. Their children are less likely to develop the childhood illnesses which require time off school for kids and time off work for parents. It also cuts down on need for doctor’s visits, and with very sick children, the need for hospitalization.

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Programs that can help

Vaccinations can be expensive and many families cannot afford to pay for vaccines on their own. If you are unable to afford vaccinations for your child or if the vaccinations are not covered by your health insurance, do not let this stand in the way of protecting your child. He or she may be eligible for programs such as the Vaccines for Children program, a federal program established in 1998.

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Finding your ‘Medical Home’

When you register as a patient at the UMC/LSU Family Medicine Clinic, this becomes your “Medical Home,” for you and every member of your family, no matter his or her age. One of the key beliefs of family medicine is disease prevention! We are dedicated to promoting your child’s health, through vaccinations and lifelong education on healthy lifestyle. We believe that vaccinations are one of the best lifelong strategies to prevent serious life threatening diseases and keep you and your loved ones healthy.

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Dr. Gail Burke is a board certified family physician in the UMC/LSU Family Medicine Clinic. To learn more about Family Medicine at UMC, visit http://www.umcno.org/familymedicine or call (504) 962-6363 to schedule an appointment.

Bounce for the Ounce: The Energy of Fruits and Vegetables

By Mary Thoesen Coleman, MD, PhD, FAAFP

Fruits and vegetables are packed with nutrients and minerals needed for our body’s health. They provide lots of energy (bounce) for the amount you eat (ounce).

GettyImages-611075624.jpgMediterranean diet

Fruits and Veggies are strong components of the Mediterranean diet, which in a number of research studies has been associated with decreased risk for cardiovascular disease.
In people who follow the Mediterranean diet, the good kind of cholesterol, HDL, increases, triglycerides reduce, and so do fasting blood sugar and blood pressure.

The Mediterranean diet emphasizes eating plant foods such as vegetables, fruits, plus nuts and seeds.

How much? We should eat more than 2 servings per meal of non-starchy vegetables (starchy vegetables such as potatoes, peas, and corn do not count) and 1- 2 servings per meal of fruit.

  • A vegetable serving is ½ cup of cooked vegetables or 1 cup of raw vegetables.
  • A fruit serving is one small fruit or ½ cup fruit juice or ¼ cup dried fruit.

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Is fresh best?

The best choices of fruits and vegetables are those that are minimally processed, locally grown, and fresh.

Frozen fruits and vegetables are reasonable alternatives to fresh. Canned fruits and veggies are less beneficial due to loss of minerals and nutrients in processing and addition of salt and preservatives.

Such vegetables and fruit are also good sources of fiber.

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MyPlate recommendations

MyPlate is the current nutrition guide published by the U.S. Department of Agriculture Center for Nutrition Policy and Promotion. MyPlate is a visual reminder about the right mix of fruits, vegetables, grains and proteins.

Fruits and vegetables make up half of food on a meal plate, with veggies a greater proportion of the half than fruits.

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Things I have learned:

  • You can get too much of a good thing. Smoothies or juices made from fresh ingredients can concentrate too much of good thing. For example, juicers frequently add spinach to smoothies and blended juices but spinach is high in oxalates and when consumed frequently in concentrated form with low Calcium diet may put you at risk for kidney stones made from oxalates. (I believe I contributed to my own kidney stone experience by drinking too many juices packed with spinach and not having enough Calcium in my diet).
  • If you drink too much fruit juice, you can elevate your blood sugar. In one of my patients with diabetes, making one change in his diet (eliminating fruit juices) brought his sugar from very poorly controlled to completely controlled.
  • If you eat too many fruits, you can also elevate your blood sugar. One of my patients who was eating 12 bananas a day was unable to control her blood sugar despite high doses of medication until she lowered her banana intake.
  • Fruit drinks (not fruit juices) do not have the nutrients present in fruit juices and typically add calories without being healthy choices.

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Tips for adding veggies to your diet:

  • Cut up fresh vegetables (I use different ones including asparagus, cabbage, mushrooms, onion, broccoli, cauliflower, and Brussels sprouts) and cook them in olive oil. Eat for breakfast, lunch, or supper. Olive oil is a healthy part of the Mediterranean diet and it helps to make the vegetables more filling.
  • Cut up fresh vegetables and put them in plastic containers for lunch snacks. I like to cut up yellow and red peppers, radishes, cucumbers, and broccoli.
  • Make a fun salad that includes lots of colorful veggies and fruits–several lettuce varieties (Romaine, butternut), arugula if available, nuts such as walnuts or pecans or pine nuts, pumpkin seeds or other seeds, fresh vegetables such as broccoli, cauliflower, red peppers, yellow peppers, radishes, green onions, a dash of blueberries or strawberries, maybe some coconut flakes or cilantro or parsley. If desired, add left-over cooked chicken or tuna. Mix with home-made dressing from extra virgin olive oil (1 part olive oil ), 3 parts vinegar (mostly white but some apple cider vinegar), 1-3 tsps. Dijon mustard, and black pepper.
  • Fresh fruits make good desserts and I like to add to yogurt (a good source of Calcium and part of the Mediterranean diet) for a healthy dessert or to whipped cream without sugar.

Mediterranean diet-friendly options

Vegetables

Artichokes, arugula, beets, broccoli, Brussels sprouts, cabbage, carrots, celery, celeriac, chicory, collard greens, cucumbers, dandelion greens, eggplant, fennel, kale, leeks, lemons, lettuce, mache, mushrooms, mustard greens, nettles, okra, onions (red, sweet, white), peas, peppers, potatoes, pumpkin, purslane, radishes, rutabaga, scallions, shallots, spinach, sweet potatoes, turnips, zucchini.

Fruits

Apples, apricots, avocados, cherries, clementines, dates, figs, grapefruits, grapes, melons, nectarines, olives, oranges, peaches, pears, pomegranates, strawberries, tangerines, tomatoes.

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Dr. Coleman is a physician in the Family Medicine Clinic at UMC and is the Marie Lahasky Chair and Professor for the Department of Family Medicine, Director of Community Health and Director of Rural Education at LSU Health New Orleans. To learn more about Family Medicine at UMC, visit http://www.umcno.org/familymedicine or call (504) 962-6363 to schedule an appointment.