Health Connection - June 2021

Author: MarinHealth

Health Connections Flyer

Health Consequences of the Pandemic: It’s Not Just About COVID-19

By Karin Shavelson, MD, FAPP

Karin Shavelson, MD, FAPP

There’s no denying the devastating effect COVID-19 has had on US health, from the loss of hundreds of thousands of American lives to permanent lung damage and a variety of long-term issues from “long haul” COVID-19 cases. But the pandemic has also taken another, more indirect toll on our health because fear of the virus led to many people to postpone routine care, or even medical care when health concerns arose. Delaying care can lead to increased health risks on many levels, and the consequences can be serious.

According to the National Institutes of Health, more than one third of adults skipped recommended tests and screenings during the pandemic, and 43% of patients missed routine preventive appointments. Delaying mammography, pap smears, prostate exams, colonoscopies and other routine cancer screenings puts you at risk for later stage cancers. In fact, during the early months of the pandemic when mammograms weren’t as widely available, the number of breast cancer diagnoses naturally declined. Now, the inevitable result of that is more women are being diagnosed with later stage cancer, which is harder to treat. Other preventive measures, such as removing polyps during a colonoscopy or getting the HPV vaccine, are important because they can prevent cancer from occurring in the first place.

Screenings, tests, and checkups aren’t the only health measures people have avoided during the pandemic. According to a report by the Centers for Disease Control, fear of exposure to COVID-19 led some 41% of U.S. adults to delay or avoid routine, urgent, and even emergency care. Many patients with chronic conditions like high blood pressure, heart, or kidney disease, also cut back on doctor visits. This is bound to have a negative impact on their health. And, with the added stress of dealing with the pandemic, millions of people across the country are at greater risk for pre-diabetes, high blood pressure, mental health issues and more, which may have gone undiagnosed and treated.

If you held off on seeing your doctor during the pandemic, we understand your concerns. But it is time to get back on track for your health and longevity. Clinics, hospitals, and healthcare providers, including MarinHealth Medical Center and our MarinHealth | UCSF Health Clinics, have been adhering to the strictest safety precautions throughout the pandemic. What’s more, as of this writing, more than 42% of people in the U.S. are now fully vaccinated, and that number is increasing daily. In Marin County, an impressive 80% of residents age 12 and older are fully vaccinated, and 89% have received at least one dose. If you haven’t yet been vaccinated, we urge you to do that right away. In the meantime, don’t put off getting the care you need. If you are concerned about your safety or just want a more convenient option, ask your provider if a telehealth appointment will work for your needs.

As devastating as COVID-19 has been for many, heart disease, cancer, diabetes, and stroke are still leading causes of the death in the US. You owe it to yourself—and your loved ones—to catch up on your doctor visits, screenings, and immunizations.

Ready to take an immediate step for your health? MarinHealth has made it easier to understand your risk factors for stroke, diabetes and cardiovascular disease. Our health risk assessments are free, confidential, and take just a few minutes to complete. Learn more about your risk levels by answering a few questions online. You’ll get results immediately that you can discuss with your doctor.

Learn more about your risk factors today:

Karin Shavelson, MD, FAAP, is the Chief Medical Officer at MarinHealth Medical Center.

Healthy at Every Age: A Men’s Guide

By Saw Aye, MD

Saw Aye, MD

Being fit and healthy in your twenties is no guarantee that you’ll age into a silver fox. We all age differently, physically and mentally, but there are a number of things men need to do to stay healthy at any age. It’s never too early—or late—to prioritize health and wellness, and these guidelines can help keep you on the right track during every decade in life.

No matter what your age, you’ll need to partner with a provider for the regular checkups and routine and preventive care. Depending on your age and health history, your checkup may include:

  • Height and weight tracking
  • Blood pressure check
  • A testicular exam to check for lumps or swelling
  • Cholesterol panel—Total, LDL, HDL, and triglycerides
  • Blood glucose or A1c test
  • Other blood tests, such as thyroid screening, based on your age and risk factors
  • Mental health screening
  • A mole exam to check for potential skin cancer
  • Vision and hearing tests
  • Immunizations for maintaining wellness, such as:
    • Influenza vaccine (yearly)
    • Tetanus-diphtheria-pertussis (Tdap) booster vaccine (every 10 years)
    • Meningococcal vaccine – discuss with your healthcare provider
    • Shingles (2 times) and pneumococcal vaccine (one time, after age 50)

Throughout your life, be sure to prioritize good quality sleep. Stick to a regular bedtime whenever possible, and make sure you’re getting enough hours of rest. As you age, your health priorities and risk factors for various conditions can change. Take a closer look at some of the important considerations for men at different ages in life:

20s & 30s: Living in High Gear

This is a time of firsts. Your first full-time job, your first promotion, your first home, perhaps your first child—you have a busy and demanding life. Now’s the time to commit to healthy habits that will help keep you well for decades to come. You may still feel like you can pull all-nighters, party every weekend, and work long hours with seemingly no consequences. But these habits are already starting to catch up with you.

If you smoke, quit and don’t start vaping as a smoking substitute. E-cigarettes contain toxic chemicals and emit aerosols that exacerbate asthma and constrict your arteries. If you drink, do so moderately and don’t binge drink. The CDC defines binge drinking as consuming five or more drinks in two hours for men. It is most common among adults aged 18–34 years, and twice as common among men than women. Heavy drinking can increase your blood pressure and trigger an irregular heart rhythm, such as atrial fibrillation or AFib. If you’re hot-tempered, start gathering tools and techniques to calm yourself, such as meditation or deep breathing. Research shows that in the two hours following an angry outburst, you are slightly more at risk for angina, heart attack, stroke, or abnormal heart rhythm. Exercise regularly and mix it up—it’s not all about developing a six pack. Recreational sports like tennis, basketball, or volleyball are a fun way to get some cardio and maybe make new friends too.

Get more tips for staying healthy and well in your 20s and 30s.

40s & 50s: Finding Balance

These are demanding decades, when you are juggling the responsibilities of work and family and starting to realize that you’re not as young as you used to be. If you work at a computer all day and sit for many hours at a stretch, take a break once an hour to move around. Try to work standing up for a while. Research has found that sitting for many hours at a stretch is a risk factor for heart disease, even if you exercise. Regular checkups are getting more important. If you have a family history of bowel or prostate cancer, make sure your doctor knows about it.

Colon cancer is becoming more common in people under the age of 50 and a new guideline anticipated later this year will likely reduce the age to start colonoscopy screening from 50 to 45. Talk to your doctor about your risk factors for prostate cancer. Men with an elevated risk should get a digital rectal exam and PSA test every year starting at age 45. Watch your weight—and your waist! A larger waistline is an indication that you could have more visceral fat, unhealthy fat that develops deep in the belly around the vital organs. You want your waistline to be 40 inches or less in circumference. Excess weight raises your risk for diabetes, high blood pressure, high cholesterol and metabolic syndrome, all of which can lead to artery damage and heart disease. If you are a current or former smoker and have quit within the past 15 years, ask your doctor about a screening for lung cancer with low-dose computed tomography (LDCT). Get more tips for staying healthy in your 40s and 50s.

60s, 70s and Beyond: Taking Time to Savor Life

The healthier you are at this age, the more you can enjoy your retirement, travel, and spend time with your grandchildren. It’s essential to maintain muscle strength and good balance as you age. If you have arthritis pain, walking and swimming are great ways to exercise without putting too much pressure on your joints. After the age of 70, your activity level has a direct impact on your health. Stay busy and connected to the people you care about. It’s more important than ever to pay attention to your health and keep your doctor appraised of any unusual symptoms. Your risk of heart disease, stroke, cancer, and falls is going up and you need to be mindful of any changes in your health. Your doctor will likely recommend the pneumococcal vaccine, which protects against a common form of pneumonia. After the age of 60, your nightly sleep recommendation is reduced to 7-8 hours as opposed to 7-9, but in your 70s and beyond a daytime nap can be a great way to recharge and stay energized for the day. We are increasingly seeing protein deficiency in seniors, so consider adding more protein to your diet—ideally from lean protein sources like fish, lean meats, beans, nuts and legumes. This is also a time to start thinking about a living will and an Advance Healthcare Directive, which may involve designating someone to make care decisions for you in the future, should you become incapacitated. Learn about other important screenings and health tips for men in their 60s, 70s and beyond.

Once you’ve turned 65, you’ll have a new healthcare benefit: Medicare! Once you’ve had Medicare Part B (Medical Insurance) for longer than 12 months, you are entitled to a yearly “wellness” visit once every 12 months to develop or update a personalized disease and disability prevention plan based on your current health and risk factors. Your provider may also perform a cognitive impairment assessment.

Remember, annual physicals are a must for all ages. No matter what your age, having a primary care doctor who can oversee and manage all of your healthcare needs is important. To find a doctor who’s right for you, click here or call 1-888-627-4642.

Dr. Aye is a board certified Internal Medicine Physician. He sees patients at MarinHealth Internal Medicine | A UCSF Health Clinic in Petaluma.

Counselors, Liaisons, Advocates and More: Social Work at MarinHealth

By Rebecca Maxwell, LCSW

Rebecca Maxwell, LCSW

A laboring first-time mom. An 89-year-old with end-stage heart failure. A teen in the throes of a psychotic episode. A badly injured car accident victim.

Each of these patients will be triaged and treated by our MarinHealth medical teams. But the psychosocial needs of these four patients are as different as their medical needs. The pregnant woman could be at risk for postpartum depression. The person with heart failure may need a hospice referral. The teen’s parents could use some counseling to process their son’s mental illness. The accident victim may be showing signs of Acute Stress Disorder. These are the kinds of in-hospital needs that can best be met by a Clinical Social Worker.

A Clinical Social Worker is a highly educated and trained professional. In addition to academic classes, the masters-level program Clinical Social Workers complete includes hands-on experience through internships and field placements. Upon graduation, a person is considered an Associate Social Worker. In California, the next step is to rack up 3000 hours of work under the clinical supervision of a Licensed Clinical Social Worker (LCSW). Then, the ASW is eligible to take a clinical exam for LCSW certification. Some LCSWs may choose to further specialize in fields such as oncology or behavioral health.

The overarching purpose of our hospital-based Medical and Psychiatric Social Work Services is to address the psychosocial problems patients and their families and caregivers face in an acute care medical setting. The job can include a broad range of responsibilities, such as:

  • Interviewing clients to gather information about their background, needs, or progress
  • Working with a patient’s medical teams to monitor and address that person’s evolving medical, physical, mental, and emotional needs
  • Providing education and counseling for patients and their families
  • Providing short-term therapy for behavioral health issues
  • Making referrals for post-discharge services
  • Advocating for patients
  • Investigating child neglect and child or spousal abuse and initiating protective action when needed
  • Directing crisis intervention
  • Helping clients navigate the healthcare system
  • Screening patients for substance abuse, PTSD, suicidality, harmful alcohol and drug use, and other mental and emotional problems
  • Facilitating discharge from the hospital

At MarinHealth, all new patients are screened upon admission to determine if additional psychosocial support is needed. The initial assessment contains built-in screening tools to identify at-risk individuals requiring further assistance from a social worker. Additionally, a provider or RN can initiate a social work consultation at any time during a patient’s stay. Family and friends can also request social work support at any time. When needed, the social worker then performs a thorough psychosocial assessment along with other evidence-based screening and intervention, which is documented in the patient’s medical record and shared with their patient’s medical team. Our social workers participate in daily team conferences to discuss individual patients. They also update patient families within the parameters of health information privacy laws.

We have designed the Clinical Social Work program at MarinHealth to promote the personal and professional growth of our team members, who range from interns and recently graduated Social Workers to Licensed Clinical Social Workers with decades of experience. We require all social work employees who are not yet licensed be working towards their independent clinical license and provide clinical supervision to help them achieve that goal. We also provide continuing education opportunities for licensed staff to meet mandatory continuing education requirements. We are fortunate to have a great pool of local talent so that our social workers have a lived-in understanding of our community and the resources available to our patients. At MarinHealth, our social workers are valued members of the interdisciplinary care team and embody the values and standards of the National Association of Social Workers Code of Ethics.

Rebecca Maxwell, LCSW is the Director of Behavioral Health at MarinHealth Medical Center.

Tap into the Healing Power of Nature

Once again, for the 11th time in 12 years, Marin has been named California’s healthiest county by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. While several factors influence this impressive ranking, there’s no doubt our beautiful environment plays an important part in our health and wellness.

Simply put, the great outdoors is good for you. That’s the thinking behind the Japanese practice of shinrin yoku, or “forest bathing.” More than a walk in the woods, forest bathing is the conscious, contemplative practice of tuning in to the sights, smells, and sounds of the forest. The Japanese view forest bathing as an important part of wellness care because of the mental, physical and spiritual health benefits it delivers. Those same benefits are also evident in ecopsychology studies that are designed to understand the human need for nature.

You don’t have to be in a forest to experience the benefits of being in nature. If you prefer a stroll on the beach or hike in the hills, go for it. Just get outside the urban environment. In one Stanford study, two groups of 60 participants went on walks. One group took a 50-minute nature walk surrounded by trees and vegetation, while the second group walked along a high-traffic roadway. When the two groups were compared at the end of their walks, the nature walkers experienced an increase in working memory performance, reduced anxiety, and a more positive affect.

Research indicates that spending time in green spaces—forests, parks, mountains, or even gardens, or in, on, or by water—oceans, lakes, or rivers—decreases anxiety and improves mood by reducing the production of the stress hormone cortisol. Behavioral and brain issues such as ADHD and aggression tend to lessen in natural environments, while creativity and even conversation is enhanced. Studies have also shown physical benefits of spending time in nature, including lowering heart rate and blood pressure, enhancing immune function, and accelerating recovery from illness. Many modern hospitals are factoring these findings into their designs. Here at MarinHealth, we planned strategically placed green spaces throughout our new Oak Pavilion to enhance a sense of calm and promote healing. We also made sure all our patient rooms had large windows to let in plenty of natural light and views of nature.

So how much exposure to nature should you try to fit in to your week? The European Centre for Environment & Human Health at the University of Exeter recently conducted a study of 20,000 people. Compared to people who did not spend time in nature, those who spent two hours a week in parks or other natural environments were more likely to report good health and psychological well-being. It did not appear to matter whether the two hours were spread out over several days, as long as that weekly threshold was met. The benefits held across occupations, ethnic groups, and socioeconomic conditions. People with chronic illnesses and disabilities benefitted as well. Read Healing Stories from MarinHealth patients.

So whether your healing place is the forest, the mountains, or the beach, make some time to get out there and let nature work her magic on you. In search of a new nature spot? Check out our favorite Healing Places in and around Marin.