Managing Anxiety

How does anxiety look & feel during a pandemic?

by Alberto Nacif, MD

Pandemics can be stressful. Holidays and elections can be stressful. Virtual school, social distancing and not seeing friends and loved ones can be stressful too. All these things together can be a recipe for anxiety. Anxiety and fear can feel overwhelming for both adults and children alike. Sometimes it can be hard to identify anxiety or understand the strong emotions that can come along with anxiety, especially for children.

What does anxiety look and feel like?

  • Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on
  • Changes in sleep or eating patterns
  • Changes in behavior
  • Difficulty sleeping or concentrating
  • Worsening of chronic health problems
  • Worsening of mental health conditions
  • Increased use of tobacco, and/or alcohol and other substances

What do you do when feeling anxious?

Being there for and taking care of family and friends is important but you should create a healthy balance with caring for yourself too. Here are some tips from the Centers for Disease Control on coping with the stress that comes with living through a pandemic.

  • Know what to do if you are sick and are concerned about COVID-19. Contact a health professional before you start any self-treatment for COVID-19.
    • If you think you may need a COVID-19 test, save your spot at an IHA testing location: ihacares.com/saveyourspot
  • Know where and how to get treatment and other support services and resources, including counseling or therapy (in person or through telehealth services).
  • Take care of your emotional health. Taking care of your emotional health will help you think clearly and react to the urgent needs to protect yourself and your family.
  • Take breaks from watching, reading, or listening to news stories, including those on social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.
  • Connect with your community- or faith-based organizations. While social distancing measures are in place, consider connecting online, through social media, or by phone or mail.
  • Make time for quiet. If you find comfort in prayer or meditation, make time to incorporate this quiet time into your day. As little as 10 minutes can make a difference in your anxiety level. 

Quick tips for taking control of your anxiety.

  1. Take control of your breathing. Try square breathing: breathe in through your nose, pause, breathe out through your mouth and pause, counting to four at each step. Watch Alberto Nacif, MD give instructions on square breathing here: https://bit.ly/2Izy1aL
  2. Tighten and relax your muscles. In areas where you feel physical tension tighten your muscles and then relax them. 
  3. Go to your happy place. Yes! It does exist! Think of a time or a place in your life where you felt at ease, happy or at peace. Focus on the positive feelings associated with this moment in time.

Know when it’s time to seek medical professional help.

If stress or anxiety get in the way of your daily life several days in a row, it may be time to contact your primary care provider. There are many resources available for managing these feelings and your provider can help you find the best fit for you.

Celebrating Thanksgiving During COVID-19

Traditional Thanksgiving gatherings with family and friends are fun but can increase the chances of getting or spreading COVID-19 or the flu. Please be sure to follow the Michigan Department of Health and Human Services (MDHHS) orders to make your Thanksgiving holiday safer and to help stop the spread of COVID-19.

The safest way to celebrate Thanksgiving this year is to celebrate with people in your household. If you do plan to spend Thanksgiving with people outside your household, take steps to make your celebration safer.

Wear a Mask

  • Wear a mask with two or more layers to stop the spread of COVID-19.
  • Wear the mask over your nose and mouth and secure it under your chin.
  • Make sure the mask fits snugly against the sides of your face.

Stay at least 6 feet away from others who do not live with you.

  • Remember that some people without symptoms may be able to spread COVID-19 or flu.
  • Keeping 6 feet (about 2 arm lengths) from others is especially important for people who are at higher risk of getting very sick.

Wash your hands.

  • Wash hands often with soap and water for at least 20 seconds.
  • Keep hand sanitizer with you and use it when you are unable to wash your hands.
  • Use hand sanitizer with at least 60% alcohol.

Attending a gathering.

Make your celebration safer. In addition to following the MDHHS order, consider these additional steps while attending a Thanksgiving gathering:

  • Bring your own food, drinks, plates, cups, and utensils.
  • Avoid going in and out of the areas where food is being prepared or handled, such as in the kitchen.
  • Use single-use options, like salad dressing and condiment packets, and disposable items like food containers, plates, and utensils.

Hosting a gathering.

If having guests to your home, please limit the number of people based on the MDHHS order. Additional ideas that can make your celebration safer include:

  • Have a small outdoor meal.
  • Have conversations with guests ahead of time to set expectations for celebrating together.
  • Clean and disinfect frequently touched surfaces and items between use.
  • If celebrating indoors, make sure to open windows.
  • Limit the number of people in food preparation areas.
  • Have guests bring their own food and drink.
  • If sharing food, have one person serve food and use single-use options, like plastic utensils and plates.

Consider new Thanksgiving activities.

Host a virtual Thanksgiving meal with friends and family who don’t live with you

  • Schedule a time to share a meal together virtually.
  • Have people share recipes and show their turkey, dressing, or other dishes they prepared.

Watch television and play games with people in your household

  • Watch Thanksgiving Day parades, sports, and movies at home.
  • Find a fun game to play.

Shopping

  • Shop online sales the day after Thanksgiving and days leading up to the winter holidays.
  • Use contactless services for purchased items, like curbside pick-up.
  • Shop in open air markets staying 6 feet away from others.

Other Activities

  • Safely prepare traditional dishes and deliver them to family and neighbors in a way that does not involve contact with others (for example, leave them on the porch).
  • Participate in a gratitude activity, like writing down things you are grateful for and sharing with your friends and family.

Safe travel tips for college students.

There is no universal approach to Thanksgiving this year for colleges and universities. Though some are encouraging students to stay on campus for the holiday, others are allowing them to go home for the long Thanksgiving weekend. Still more are sending students home to begin their winter break or finish their semesters remotely.

Take the risk seriouslyYoung people have been identified as sources of some family outbreaks, infecting their older, more vulnerable relatives who live in the same household. Experts also point out that travel could increase students’ risk of exposure to the virus, and that holiday celebrations held indoors could facilitate transmission.

Self-quarantine and get testedIn the days before leaving campus, students should be tested, preferably with a PCR test, the laboratory test used to diagnose the coronavirus. Many colleges and universities have been regularly testing their students, and some have rolled out special guidance for holiday travel.

Source: Centers for Disease Control


Save Your Spot for drive-up COVID-19 testing at select IHA Urgent Care locations 

During this pandemic, feeling sick can be scary. If you have symptoms like fever, cough, or shortness of breath, it is important to get tested for COVID-19. You should always contact your doctor with questions or concerns, but having test results will help with their recommendations for your care. 

IHA offers convenient drive-up COVID-19 testing for new and established patients. We offer both PCR and Rapid tests. Your provider will determine which test is best for you based on your symptoms. Rapid testing is not always recommended. Do not go to your local IHA Urgent Care or emergency department for COVID-19 testing. 

Patients in need of a COVID-19 test, please be aware:
1. You must have an appointment. Save Your Spot at one of our COVID-19 testing locations below.
2. Testing is being prioritized for symptomatic patients and patients who have had a high-risk exposure.
3. COVID-19 test results usually take 24 to 72 hours to return, but due to recent significant increases in testing – results are taking up to 5 days.
4. If you are not experiencing COVID-19 symptoms or have not had a high-risk exposure, please visit Michigan.gov to find an alternate testing location. 

Breast Cancer Basics

Understanding Signs, Symptoms and Risk Factors

by Tara M. Breslin, MD

October is Breast Cancer Awareness Month and a great time to spread the word about the importance of breast health all year long. Breast cancer is one of the most common forms of cancer diagnosed in the United States, typically in women, but it occurs in men as well. In 2020 alone, an estimated 276,000 women will be diagnosed with breast cancer. Most of these new cases will occur in women older than 50, but 10% will occur in women younger than 45. Recognizing the warning signs of breast cancer and early detection will mean more treatment options and a better chance of being cured.

Be aware of changes in your breasts

  • Lump in the breast or underarm
  • Bloody discharge from the nipple
  • Indentation or retraction of the nipple area
  • Change in breast size
  • Rippling (flattening or indentation) of the skin covering the breast
  • Crustiness or rash of the nipple or areola

What to you do if you notice a new symptom

Stay up-to-date with breast screenings

Regular screening for breast cancer is done before there are any signs or symptoms and is the best way to find cancer early when it’s easier to treat. The first step(s) of screening for breast cancer typically include mammogram and/or a patient’s awareness of changes in their breast.

  • Self-Awareness: Conduct regular and frequent self-exams of your breasts. Become familiar with your breasts, so you aware of, and able to, recognize changes right away.
  • Clinical Breast Exam: This exam is done in a clinical setting, by a physician who will use their hands to look for lumps or changes in your breasts.
  • Mammogram: An x-ray of the breast and the best way to detect cancer early. A screening mammogram is done for asymptomatic women, a diagnostic mammogram is done for women with a new symptom or mammographic abnormality.

A mammogram found something suspicious, now what?

If your doctor finds something concerning on your mammogram, the first step would be diagnostic imaging to further characterize the area.  This may include: diagnostic mammogram, ultrasound, MRI.

  • Biopsy: a small sample of cells or tissue is removed and reviewed under a microscope to determine if cancer is present. There are a variety of ways to perform a biopsy. Talk to your physician about the options available to you, if you require a biopsy.
  • Diagnostic Mammogram: an X-ray test used to diagnose unusual breast changes, such as a lump, pain, nipple discharge, change in breast size or shape or previous breast cancer. If your screening mammogram does show an abnormality, you may need additional imaging like a diagnostic mammogram.
  • Breast Ultrasound: Using sound waves to produce images of the internal structures of the breast, the breast ultrasound can help a physician determine if a mass an abnormality is more likely a solid mass or fluid-filled cyst.
  • MRI: The MRI uses magnets and radio waves to produce images of the breast. These images provide more information and details than other tests. Your physician may recommend a breast MRI for you if your biopsy results were positive for cancer or if you’re considered high risk for breast cancer. The breast MRI is intended to be used along with a mammogram, not as a replacement.

Who would be considered high risk for breast cancer?

As a person ages, their risk of being diagnosed with breast cancer increases, but there are a few other risk factors that you cannot change:

  • Age: Most breast cancers are diagnosed after age 50.
  • Genetics: Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
  • Dense Breasts: Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
  • Personal History of Breast Cancer: Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
  • Family History of Breast Cancer: A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

Understanding the signs and symptoms of breast cancer and your risk factors is important for every woman and man. If you have questions or concerns about your breast health, schedule an appointment with an IHA Breast Surgeon.

Trick-or-Treat

COVID-19 means a more frightful Halloween

By Martha Walsh, MD, MHSA, FACOG

Halloween and everything that surrounds it – trick-or-treating, costume parades, bobbing for apples – are fun, but can spread COVID-19 or other seasonal infections, like influenza. While celebrating Halloween this year will look very different from every other year, there are still ways to enjoy all that Halloween has to offer, while protecting yourself and your family from picking up a virus.

Giving Out Candy

  • Avoid direct contact with trick-or-treaters
  • Give out treats outdoors, if possible
  • Set up a station with individually bagged treats for kids to take
  • Wash hands or use hand sanitizer before handling treats, and in between trick-or-treaters
  • Wear a cloth mask

Trick-or-Treating

  • Wear a mask
    • Make your cloth mask part of your costume
    • A costume mask is not a substitute for a cloth mask
    • Do NOT wear a costume mask over a cloth mask. It can make breathing more difficult
    • Masks should NOT be worn by children under the age of 2 or anyone who has trouble breathing
  • Wash your hands
    • Bring hand sanitizer with you and use it after touching objects or other people
    • Use hand sanitizer with at least 60% alcohol
    • Parents: supervise young children using hand sanitizer
    • Wash hands with soap and water for at least 20 seconds when you get home and before you eat any treats
  • Stay at least 6 feet away from others who do not live with you
    • Indoors and outdoors, you are more likely to get or spread COVID-19 when you are in close contact with others for a long time

Make sure you are always doing the following. Every. Single. Day.

  • Wear a mask
  • Stay 6 feet away from anyone that does not live with you – indoors and outdoors
  • Wash your hands or use hand sanitizer frequently

If you decide not to take your kids trick or treating this year, here are some ideas how you can enjoy Halloween safely.

  • Decorate and carve pumpkins
    • Decorate your home for Halloween.
    • Carve pumpkins with members of your household or outside with neighbors or friends.
    • Walk from house to house, admiring Halloween decorations at a distance.
  • Visit an orchard, forest, or corn maze. Attend a scavenger hunt.
    • Go on an outdoor Halloween-themed scavenger hunt.
    • Visit a pumpkin patch or orchard. Remember to wash your hands or use hand sanitizer frequently, especially after touching frequently touched surfaces, pumpkins, or apples.
    • Go to a one-way, walk-through haunted forest or corn maze.
  • Other Ideas
    • Hide Halloween treats in and around your house. Hold a Halloween treat hunt with household members.
    • Hold a socially distanced outdoor costume parade or contest so everyone can show off their costumes.
    • Host a socially distanced outdoor Halloween movie night with friends or neighbors or an indoor movie night with your household members.

Flu Before Boo!

Protect yourself and your family during flu season by getting your flu vaccine before Halloween. Scheduling your flu shot is easy! Click below and choose an appointment time that works for you.

Source: Centers for Disease Control

Flu Vaccine FAQs

Source: Centers for Disease Control (CDC)

Flu season is here, which means Flu SHOT season is also here. Getting a flu vaccine this fall will be more important than ever, not only to reduce your risk from flu but also to help conserve potentially scarce health care resources in the wake of the COVID-19 pandemic.


What are the benefits of the flu vaccination?

Receiving the flu vaccines reduces flu illnesses, sick appointments, hospital stays, and missed time from work or school. It can also be lifesaving for high risk patients like children, seniors, and pregnant women.

Can the flu vaccine give me the flu?

The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. However, you may experience some minor side effects like, soreness, redness or swelling at the shot site, a low-grade fever, and some aches.

For those that receive the nasal spray, the viruses are weakened and do not cause severe symptoms often associated with influenza illness. Side effects from the nasal spray may include, runny nose, sore throat, cough, wheezing, headache, vomiting, muscle aches, or fever.

Who should get vaccinated this season?

Everyone six months of age and older should receive a flu vaccine at the beginning of the flu season, typically every fall.

Who should not be vaccinated against seasonal flu?

A patients age, health or allergies may determine they should not receive the flu vaccine. Talk with your physician to ensure you or your children should receive the flu vaccine.

Should a flu vaccine be given to someone with a suspected or confirmed case of COVID-19?

No. Vaccination should be deferred (postponed) for people with suspected or confirmed COVID-19, regardless of whether they have symptoms, until they have met the criteria to discontinue their isolation. While mild illness is not a contraindication to flu vaccination, vaccination visits for these people should be postponed to avoid exposing healthcare personnel and other patients to the virus that causes COVID-19. When scheduling or confirming appointments for vaccination, patients should be instructed to notify the provider’s office or clinic in advance if they currently have or develop any symptoms of COVID-19.

Additionally, a prior infection with suspected or confirmed COVID-19 or flu does not protect someone from future flu infections. The best way to prevent seasonal flu is to get vaccinated every year.

Why should I get my child vaccinated?

The flu is dangerous for all people, but children under five years old are at an especially high risk when they get sick with the seasonal flu. The flu vaccine is your children’s best defense against contracting and spreading the flu.

When should I get a flu vaccine?

For people receiving one dose of the flu vaccine, the Centers for Disease Control recommends that people get the flu vaccine by the end of October. If your child requires two doses, they will need to be given four weeks apart, so chat with your pediatrician on the best time to give the first dose. Getting the vaccine in the summer months may result in reduced protection later in the flu season, especially for high risk patients.  There are benefits to receiving the flu vaccine later in the season, so it’s never too late to be vaccinated!

How effective is the flu vaccine?

The patient’s age and health status will determine the effectiveness of the flu vaccine, as well as how well the flu in the vaccine matches the flu circulating in your community. The CDC estimates that the flu vaccine reduces the risk of flu illness by between 40% and 60% among the overall population, when the seasonal flu circulating is well-matched with the flu vaccine. 

Besides vaccination, how can people protect themselves against the flu?

Getting the flu vaccine every year is your best defense against the flu. People should also take preventive actions every day. These include, frequently washing hands, covering coughs using the inside of your elbow, not your hand, and avoid having contact with people who are sick (even if they haven’t been diagnosed with the flu).

Where can I get the flu vaccine?

This year’s flu shot is available at IHA Primary Care and Ob/Gyn practices and pediatric doses are available at IHA Pediatric practices. Adults and children may receive the flu shot at any IHA Urgent Care location. Click below to schedule your flu shot.

Can the flu vaccine prevent COVID-19?

No, the flu vaccine cannot prevent you from becoming infected with COVID-19. You and your family should continue practice CDC recommendations to minimize your risk of contracting COVID-19, including, wearing masks outside of your home, social distancing and frequent hand washing.

What is the difference between Influenza and COVID-19?

Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses. Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. Flu and COVID-19 share many characteristics, but there are some key differences between the two.

There are some key differences between flu and COVID-19. COVID-19 seems to spread more easily than flu and causes more serious illnesses in some people. It can also take longer before people show symptoms and people can be contagious for longer. Another important difference is there is a vaccine to protect against flu. There is currently no vaccine to prevent COVID-19. The best way to prevent infection is to avoid being exposed to the virus.

Can getting the flu shot increase your risk of getting COVID-19?

Currently, there is no evidence that getting the flu vaccine can increase your risk of getting COVID-19.

Is it safe to go out to get the flu shot during the COVID-19 pandemic?

Yes. Getting a flu vaccine is an essential part of protecting your health and your family’s health this season. To protect your health when getting a flu vaccine, follow CDC’s recommendations for running essential errands and doctor visits, like wearing a mask outside of your home, social distancing and frequent hand washing. Continue to take everyday preventive actions.

What is IHA doing to ensure it’s safe for me and my family to come into the office for a flu vaccine?

Patient safety is, now more than ever, our top priority. We’re taking several precautions to minimize your risk of exposure to COVID-19 while visiting an IHA practice in person, including:

  • requiring all patients, guests, staff, and providers to wear masks in our practices
  • providers and staff wear personal protective equipment
  • taking the temperature of all patients, providers, and staff upon entry into our practices
  • limiting the number of people in our practices, which means you may be asked to wait in your car instead of our waiting room
  • spacing the timing of patient appointments
  • maintaining an acceptable (greater than 6 foot) distance between patients in all common areas
  • following the cleaning protocols laid out by the Centers for Disease Control (CDC) to ensure safe, sanitized environments
  • in pediatric practices, we’re scheduling sick and well patients at different times of the day

Scheduling your flu shot is easy! The flu shot is available at IHA and St. Joe’s Medical Group primary care and OBGYN practices, as well as, urgent care locations.  Click below to find a time and location that work for you.

Play it Safe

How to reduce the risk of COVID-19 exposure while playing youth sports

Many youth sports leagues are easing back into practice and in some cases competition. While it’s a much-welcomed change after a summer of quarantine, whatever you or your children play, you should play it safe. There are a number of steps you can take to help lower the risk of COVID-19 exposure and reduce the spread while playing sports. The more people a participant interacts with, the closer the physical interaction, the more sharing of equipment there is by multiple players, and the longer the interaction, the higher the risk of COVID-19 spread. Therefore, risk of COVID-19 spread can be different, depending on the type of activity. Read on for guidance from the Centers for Disease Control and Prevention.

Make a game plan to reduce risk

  • Lowest Risk: Performing skill-building drills or conditioning at home, alone or with members of the same household
  • Increasing Risk: Team-based practice
  • More Risk: Within-team competition
  • Higher Risk: Full competition between teams from the same local geographic area (e.g., city or county)
  • Highest Risk: Full competition between teams from different geographic areas (e.g., outside county or state)
  • If organizations are not able to keep safety measures in place during competition (for example, keeping participants six feet apart at all times), they may consider limiting participation to within-team competition only (for example, scrimmages between members of the same team) or team-based practices only
  • Similarly, if organizations are unable to put in place safety measures during team-based activities, they may choose individual or at-home activities, especially if any members of the team are at an increased risk for severe illness
Source: CDC

Prepare before you participate in sports

  • Bring supplies to help you and others stay healthy—for example, masks (bring extra), hand sanitizer with at least 60% alcohol, broad spectrum sunscreen with SPF 15 or higher, and drinking water.
  • Prioritize participating in outdoor activities over indoor activities and stay within your local area as much as possible.
  • If using an indoor facility, allow previous groups to leave the facility before entering with your team. If possible, allow time for cleaning and/or disinfecting.
  • Check the league’s COVID-19 prevention practices before you go to make sure they have steps in place to prevent the spread of the virus.
  • If you are at an increased risk for severe illness or have existing health conditions, take extra precautions and preventive actions during the activity or choose individual or at-home activities.

Stay home if sick

If the participant has symptoms of COVID-19, has been diagnosed with COVID-19, is waiting for COVID-19 test results, or may have been exposed to someone with COVID-19, they should stay home and not participate in any sports.

Have smaller team sizes

  • Sports with a large number of players on a team may increase the likelihood of spread compared to sports with fewer team members.
  • Limit your team to a core group of participants, by restricting non-team players from joining when your team is short players and not adding new members during the season.

Reduce physical closeness between players when possible

  • Maintain at least 6 feet between yourself and your teammates, other competitors, and officials while actively participating in the sport.
  • Focus on building individual skills, like batting, dribbling, kicking, and strength training.
  • Avoid high fives, handshakes, fist bumps or hugs.
  • Keep space between players in the practice areas, including on the sideline, dugout, and bench.
  • Wait in car or away from the playing area until just before the warm-up period or the beginning of the game.
  • Avoid congregating in the parking lot or near the field before or after games.
    • If it is not possible to avoid congregating, practice social distancing by ensuring there is at least 6 feet between participants.
    • If social distancing is not possible, wear a mask whenever possible to reduce risk of virus transmission.

Space out spectators by 6 feet

  • Limit nonessential visitors, spectators, and volunteers. Ensure they wear masks and maintain social distancing.

Wear a mask if possible

  • Wear a mask if feasible, especially when it is difficult to stay less than 6 feet apart from other people or indoors, for example in close contact sports such as basketball.
  • Lower intensity sports: Emphasize wearing masks and practicing social distancing for lower intensity sports.
  • Higher intensity sports: People who are engaged in high intensity activities, like running, may not be able to wear a mask if it causes difficulty breathing.
  • If unable to wear a mask, consider conducting the activity in a location with greater ventilation and air exchange (for instance, outdoors versus indoors) and where it is possible to maintain physical distance from others.
  • In situations where individuals might raise their voices, such as shouting or chanting, we strongly encourage wearing masks.
  • For youth athletes, parents, coaches, and sports administrators should decide if the kids need to wear a mask.
  • It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles. CDC does not recommend use of face shields for normal everyday activities or as a substitute for masks.

Minimize sharing of equipment or gear

  • Encourage players to bring their own equipment if possible, like gloves, balls, and helmets.
  • Limit the use of frequently touched surfaces on the field, court, or play surface.
  • Bring your own water to minimize use and touching of drinking fountains.
  • Clean and disinfect shared items between use.
  • Don’t share towels, clothing, or any items used to wipe your face or hands.
  • Avoid sharing food, drink containers (e.g., coolers), and utensils.

Cover your coughs and sneezes.

  • When coughing or sneezing, use a tissue or the inside of your elbow. Used tissues should be thrown away and hands washed immediately with soap and water for at least 20 seconds or use hand sanitizer with 60% alcohol.
    • If soap and water are not readily available, hand sanitizer that contains at least 60% alcohol can be used.

Wash hands

  • Wash your hands with soap and water for at least 20 seconds or use hand sanitizer with 60% alcohol.
    • Before and after you play.
    • Before adjusting your mask—review information about proper use, removal, and washing of masks.

Limit travel outside of your area

  • Consider competing against teams in your local area (neighborhood, town, or community).

Checklist for coaches

  • Send a welcome email or call parents (for youth players) and/or players. Inform them about actions that the sports program will take to protect players. Remind them to stay home if sick or if they have been around someone who is sick.
  • Be a role model. Wear a mask and encourage family members, fans, officials, and sports staff to wear one during practices and games.
  • Provide hand sanitizer with at least 60% alcohol to players before and after practice/game and encourage them to wash their hands with soap and water.
  • Educate players about covering coughs and sneezes with a tissue or their elbow. Discourage spitting.
  • youths practicing basketball
  • Encourage players to focus on building individual skills
  • Remind players about social distancing and identify markers (such as signage or tape on floor).
  • Encourage your players to focus on building their individual skills and cardiovascular conditioning, so they can limit close contact with other players.
  • Check with your sports administrator to make sure they are following cleaning and disinfection recommendations.
  • Clean and disinfect frequently touched surfaces on field, court, or play surface (such as drinking fountains) at least daily or between use.
  • Clean and disinfect shared equipment.

If you have questions or concerns about your child participating in sports this fall, make an appointment to talk it over with yout pediatric provider.

Busting Myths: Breastfeeding as a working mom

by Lisa A. Hammer, MD, IBCLC

You’ve heard about the benefits of breastfeeding your baby. You know breast milk is best for your baby (the antibodies!). But let’s face it, returning to work after weeks of cozy breastfeeding sessions creates a lot of anxiety and pressure (pun intended) for mom. There’s so much information out there online and from every woman you know that’s ever had a baby. We’re here to breakdown some of the most common concerns around returning to work and continuing to provide breastmilk for your baby. Read on to learn how some common myths around breastfeeding while working are, well, busted.

Myth: Nursing less often will create more milk when I do nurse.
Actually, the more you nurse (or pump), the more milk you will produce. Your body is creating your milk supply based on demand. Feed your baby when they ask (in their own way), and your body will produce the milk they need. If you are returning to work, this will help in ensuring you are producing what your baby needs while pumping.

Myth: My baby won’t breastfeed once they get used to bottles.
You will always be your baby’s favorite way to get their milk. When your baby is with you, they will expect to be breastfeed. If your baby has a predictable feeding schedule, when you return to work ask your caregiver to hold-off on giving them a bottle close to your arrival, so you can breastfeed your baby when you return home. Also, be sure you drink plenty of fluids, avoiding caffeine and alcohol. Staying hydrated is important in general, but especially while breastfeeding.

Myth: I need a freezer full of milk to return to work.
Just when a new mom or dad feels like they are adjusting to life as parents, it’s typically time to return to work. For a mother who is breastfeeding, this transition can be especially difficult. A few weeks before your re-entry into the working world, start mixing some pumping and bottle feeding into your baby’s routine. This will help in two ways; your baby will get some practice with and be more willing to take a bottle and you will have some milk stored for backup. We recommend a minimum supply of two days’ worth of breastmilk for a smooth transition. As you pump at work, you will get into a rhythm of producing what your little one needs. You don’t need a freezer stocked full of milk in order to return to work.

Myth: I can’t breastfeed and pump at the same time.
There’s a balance between pumping and breastfeeding. Once you find it, your body will respond and produce the milk required. To start working pumping into your feeding schedule, pump between breastfeeding your baby. Pump about an hour AFTER you feed, and at least an hour BEFORE your baby’s next feeding. If you are returning to work, take note of when your baby typically eats, and pump based on that schedule. Continue to demand milk consistently and your body will get the signal to produce enough breast milk for your little one.

Myth: I will have to stop breastfeeding when I return to work.
Every mother has a legal right to take breaks from work to pump. That said, many women may still be anxious about taking this time. While you are pregnant and before you go on maternity leave, chat with your boss about a pumping schedule. That way, your boss will know what to expect upon your return and you will have some peace of mind knowing there is a plan in place to ensure you can continue to provide breast milk for your baby. Also, be sure to understand the accommodations available to you in the work place for pumping. Where is the room? Where will you store the milk you pump throughout the day? To get your questions answered, chat with a human resources rep or a colleague that recently transitioned from maternity leave and pumped at your office, to get your questions answered.

Myth: I won’t be successful at work if I have to stop and pump.
For a mother that wants to continue providing breast milk for her baby, taking the time to pump will create peace of mind, and allow you to be more focused when at your desk. You may even want to use the time you spend pumping to catch up on some emails, or read through an article or report that you can’t seem to work into your day while sitting at your desk. Some of your colleagues will understand when you excuse yourself a few times a day to pump, and others may not. The fact is, it’s your right to take time to pump during the work day, so try to focus on your baby and not the opinions of those around you. If you have concerns, talk to a manager or supervisor.

Breastfeeding is a wonderful way to take care of your baby, but it can be a struggle too. If you are feeling stressed about producing milk for your baby, make an appointment to chat with a provider. There is no “one size fits all” when it comes to breastfeeding, and they can provide the support you need as you work through challenges that come with being a new mom.

Originally Posted August 2019


Did you know IHA offers Breastfeeding Medicine? While breast milk is felt to be nature’s first food, breastfeeding does not always come naturally. Breastfeeding is a physiological process that involves both the mother and baby. We provide specialized breastfeeding care for both mother and baby. Learn more about IH Breastfeeding Medicine below.

Summer Snacking

Thirst-quenching and healthy snacks perfect for hot days

We’re entering the final weeks of summer and no doubt soaking up as much time outside as we can before temperatures fall. All that time outdoors mean sweating which may put you at risk for dehydration, vitamin and mineral deficiencies, as well as skin sensitivities. Eating fresh, in-season fruit is a great way to combat the effects of summer heat. Try one – or several – of these picks next time you head out(side).  

  • Watermelon: 90% water means it’s great for hydrating. Watermelon is also high in cramp fighting potassium, lycopene and immune-booster gluathione.
  • Grapes: At 90% water, grapes are the perfect summer snack. They are also a great source of vitamin K and manganese. Plus, with a bit of fiber, they keep you feeling full.
  • Blackberries: This powerhouse of a fruit contains a lot of polyphenols, chemicals that can help cut inflammation that leads to heart disease. They also help your lower intestine break down sugar which could lower your odds of developing type 2 diabetes.
  • Bananas: Before you go bananas working out, be sure you have a banana on hand. They can help your body recover from tough workouts, and some cyclists said having a banana before they ride helped them go faster and recover faster than those that only had water.
  • Pistachios: Rich in protein, fiber, and vitamins and minerals, this small, but mighty snack is also high in antioxidants and may help with inflammation. Plus, about 20 of them is only around 80 calories and less than a gram of saturated fat. You may even burn a couple calories cracking them open!
  • Lemons: Not just a pretty garnish, lemons and limes are packed with antioxidants like vitamin C and flavonoids. Try one in your next glass of water.
  • Kiwis: This little fruit is mean, green, germ-fighting machine! Rich in vitamins C, E and K, high in fiber and contains lutein which may protect eyes from some diseases. Like the banana, the kiwi also has some potassium, a must have for heart, muscles, nerves and more.
  • Strawberries: This summer staple if full of vitamin C, fiber, antioxidants and folic acid.
  • Blueberries: When it comes to antioxidants, this is a blue-ribbon berry. They give the digestive system a boost, with up to 14% of your daily fiber intake and contain vitamin c you need to promote healing and give your immune system a boost.
  • Peaches:  You’ll feel peachy after you have one. A single peach can give you 10% or more of the vitamin C you need each day. A great way to boost your immune system and help your body’s ability to heal.
  • Pineapple: This fruit tray favorite is full of vitamin C, has some fiber to help your digestive track, bromelain, an enzyme that may ease inflammation, and manganese for muscle tone and bone health. Plus, one cup contains only 82 calories!
  • Avocados: Another great source of potassium. Avocados are full of heart-healthy fats and fiber, vitamins
  • Cherries: Delicious as they are healthy, grab a bag of cherries and you’ll get the anti-inflammatory effects of the antioxidant quercetin. Not to mention, help kill cancer cells, control blood sugar and help prevent heart disease.
  • Cantaloupe: Sliced, cubed or blended into a smoothie, the cantaloupe is rich in potassium, vitamin C and beta-carotene. Chilled, it’s the perfect summer afternoon treat.

Interested in learning more about how your diet impacts your health? IHA offers nutrition counseling services at many practice locations. Nutrition counseling is provided by IHA nutrition specialists/registered dietitians. Their expertise can provide you with the necessary knowledge to achieve all your individual and family dietary needs.

Learn more by contacting IHA Primary Care.

Hiring In-home services or repairs

Source: Centers for Disease Control

CDC offers the following tips for staying safe and slowing the spread of COVID-19 while scheduling services or repairs inside the home. This may include installation and repair of plumbing, electrical, heating, or air conditioning systems; painting; or cleaning services.

In general, the closer and longer you interact with others, the higher the risk of COVID-19 spread. Limiting close face-to-face contact and staying at least 6 feet away from other people is the best way to reduce the risk of COVID-19 infection, along with wearing masks and practicing everyday preventive actions. Before welcoming service providers into your home, consider these tips to help keep you, your family, and the service provider safe during in-home services or repairs:

Before the visit

  • Check with your local health department to see if there is a stay-at-home order in your state or local community that restricts non-essential activities or services. If a stay-at-home order is in effect in your community, consider if the service request is essential or if it can be delayed.
  • If you or someone in your home has COVID-19, has symptoms consistent with COVID-19, or has been in close contact with someone who has COVID-19, wait to schedule non-emergency services that require entry into your home until it is safe to be around others.
  • If you or someone in your home is at higher risk for severe illness from COVID-19, such as older adults or those with underlying medical conditions, consider not being inside the home during the service, or find someone else who can be in the home instead.
  • Do as much of the pre-service consultation as possible before the service provider arrives, to reduce the amount of time the service provider spends inside your home. For example, discuss the details of the service request on the phone or by email, and send pictures ahead of time.
  • Discuss any COVID-19 precautions the service provider is taking, including the use of masks for the duration of the service visit, any pre-screening procedures (such as temperature checks) and using the restroom during the service call.


During the visit

  • Do not allow service providers to enter your home if they seem sick or are showing symptoms of COVID-19.
  • Ask the service provider to wear a mask before entering your home and during the service visit. Also, you and other household members should wear a mask. Consider having clean, spare masks to offer to service providers if their cloth face covering becomes wet, contaminated or otherwise soiled during the service call.
  • Avoid physical greetings, for example, handshakes.
  • Minimize indoor conversations. All conversations with the service providers should take place outdoors, when possible, and physically distanced indoors, if necessary.
  • Maintain a distance of at least 6 feet from the service provider, and limit interactions between the service provider and other household members and pets.
  • During indoor services, take steps to maximize ventilation inside the home, such as turning on the air conditioner or opening windows in the area.


After the visit

  • If possible, use touchless payment options or pay over the phone to avoid touching money, a card, or a keypad. If you must handle money, a card, or use a keypad, wash your hands with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol after paying.
  • After the service is completed, clean and disinfect any surfaces in your home that may have been touched by the service provider.

If you have symptoms of COVID-19 and need to be tested, Save Your Spot at Fever and Upper Respiratory Illness Clinic at an IHA Urgent Care near you.

Practice Safe Sleep

Safe sleep guidelines for parents of infants.

Source: American Academy of Pediatrics (AAP)

According to the Centers for Disease Control, there has been a major reduction in the number of baby deaths during sleep since the recommendation to place babies on their back to sleep was introduced in the 1990s. Today, there are a number of additional safe sleep practices to keep sleeping babies safe and sound. Read on for the latest guidelines for infant safe sleep from the American Academy of Pediatrics.

SAFE SLEEP:

  • Put the baby to sleep in a safety-approved crib. Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.
  • Have your baby share your room, not your bed. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The American Academy of Pediatrics recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.
  • Put baby to sleep on their back. Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.
  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing. Do not overdress as the baby could overheat.
  • If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.

SAFE CRIB:

  • A firm, tight-fitting mattress
  • No loose, missing or broken hardware or slats
  • No more than 2 3/8” between slats (width of a soda can)
  • No corner posts over 1/16” high
  • No cutout designs in the headboard or foot board
  • If you are unsure of the safety of your crib, call the Consumer Product Safety Commission (CPSC) at 1.800.638.2772
  • For more information, visit the American Academy of Pediatrics at healthychildren.org and the Consumer Product Safety Commission at cpsc.gov

If you have questions or concerns about safe sleep practices for your baby, get in touch with your pediatric provider. Rest assured, they will help you and your baby get some much needed ZZZ’s, safely.