Author Archives: MidMichigan Health

5 Reasons Why Wounds Don’t Heal

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There are four key phases for a wound to heal successfully:

Infographic showing five common reasons why wounds don't heal: poor circulation, diabetes, infection, nutrition deficits and repeat trauma to the wound site.

[click image to enlarge] Specialized Wound Treatment Centers have better outcomes because they bring together many disciplines to not only treat wounds, but also to address the underlying barriers to healing.

  1. Hemostasis – clotting to control bleeding.
  2. Inflammation – swelling occurs as helpful materials are transported to the wound site and invasive microbes are pushed out.
  3. Proliferation – a protective layer of tissue is formed.
  4. Remodeling – rebuilding of tissue and revascularization and reorganization of the new tissue to function like the surrounding tissue.

Any factors that interfere with one or more of these phases can prevent wounds from healing. Some of the most common factors include:

  1. Poor Circulation – Oxygen and materials needed for healing can’t get to the wound site. Dead cells and harmful materials can’t be carried away.
  2. Diabetes – Diabetes interferes with healing in many ways, including lower oxygen levels, weaker immunity and decreased ability to form new skin cells and blood vessels. Diabetic nerve damage can also make it harder to sense a wound and seek treatment.
  3. Infection – Harmful bacteria can prolong inflammation and prevent new
  4. Nutrition Deficits – Wounds need energy, protein and other vital nutrients to heal.
  5. Repeat Trauma – Wounds on feet, moving joints and any body parts that may easily get bumped, rubbed or pressured are more susceptible to reopening.

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Reducing the Stigma of Mental Illness

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May is Mental Health Awareness Month. Many people in modern society seem to have a perception that the world is divided into two categories when it comes to mental health conditions; those who have them and those who don’t. This mentality leads to all sorts of problems, including stigma.

 According to the American Psychiatric Association a stigma is a pervasive negative perception of people with mental health conditions. They identify three types of stigma:

  • Public stigma – the negative attitudes others have concerning mental health disorders
  • Self-stigma – the negative attitude one has about their own mental health, which can show up as internalized shame
  • Institutional stigma – includes government or organizational policies that limit opportunities for those with mental health conditions, either intentionally or unintentionally

Humans have a tendency to divide the world into ‘us’ and ‘them,’ no matter what the topic is. People will put down ‘them’ in some way, to perceive ‘them’ as not as good as ‘us.’ This is true for mental health conditions as well as many other characteristics. Mental health issues have additional complexities involved with the perception.

Often people are uncomfortable with mental illness because they don’t understand it. Mental health conditions can result in behaviors that look bizarre or seem strange to some people. This is especially true for psychotic disorders. But people are often uncomfortable even with symptoms related to depression or anxiety, which are very common disorders. This may be because when people put all mental health conditions into one category and that category is associated with bizarre behavior they are likely to want to avoid it.

When people divide the world into two categories and perceive the ‘other,’ those with a mental illness, as somehow strange, they are not only perpetuating stigma and setting themselves up to treat others poorly, but they are also putting themselves at risk to feel shame when they, themselves, may struggle with a mental health condition, which they are likely to experience at some point; according to the World Health Organization, 46 percent of people will experience a mental health condition at some point in their life.

When people feel ashamed of their mental health status or repeatedly hear messages that they should feel shame, it’s less likely they’ll seek the care they need. According to the Centers for Disease Control and Prevention, embarrassment is one of the many barriers that stop people from seeking treatment. In fact, only about 20 percent of adults with a mental health condition actually seek treatment. 

There are many things people can do to reduce stigma. It begins with each person looking at how they think about mental health conditions. Instead of compartmentalizing the world, it is useful to recognize that every person is human and all humans have struggles at times. Sometimes these struggles interfere with functioning. When this disruption of functioning is great enough it may be diagnosed and may benefit from treatment.

People can also talk about it. Being open and honest about your own mental health can help others feel comfortable opening up about what they might be going through. People need to be careful with words. Using real mental health conditions as negative adjectives sends a message that those diagnoses aren’t taken seriously and aren’t worthy of seeking treatment for.

People should educate themselves. Learning more about mental health conditions and available treatments can help people to be better prepared to help friends and family by recognizing symptoms of mental health conditions, and recognizing and accepting in themselves.

There is no shame in seeking help for a mental health issue. In fact, seeking treatment is a commitment to yourself and for everyone you love. Recognizing that there is no shame in mental health struggles will result in reduced stigma and increased compassion for yourself and others.

All humans have struggles; it’s part of the human condition. Recognizing this can help people to be honest and accept others, and themselves, without shame.    

For those who are struggling, MidMichigan Health provides a Psychiatric Partial Hospitalization Program at MidMichigan Medical Center – Gratiot. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit www.midmichigan.org/mentalhealth.

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Group Therapy at Senior Life Solutions

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With May being Mental Health Awareness month, I would like to take this opportunity to introduce myself and the services we offer at Senior Life Solutions. We provide group and individual therapy for an older adult population. We provide these services in person or by using a telehealth platform.

Due to COVID-19, mental health challenges have been on the rise in the senior population. This can be due to many factors, but isolation and loneliness appear to be two of the largest contributing factors. If you know or are an older adult struggling through this pandemic, there is help available. Many people feel ashamed, anxious or embarrassed about entering group therapy. This is normal. But for most people, even after one session they feel that they have been heard by their peers and understood by people that are going through very similar situations. 

Things that you might have noticed about yourself or a loved one like changes in appetite, sleep patterns, not enjoying the things in life that you used to enjoy or giving up on hobbies, can all indicate emotional distress. These are all symptoms of depression that many people mistake for “normal aging.” 

Grief is another issue that affects seniors. If you have recently lost a spouse, family member or loved one, your life might be feeling out of control, hopeless or meaningless.  It may feel like you are going through all of this alone or that no one could possibly understand. I have had many people say similar statements to me when they first start this program. 

But the truth is, there are many people who have gone through and are going through what you are experiencing right now. That is where the power of group therapy comes in. Recognizing your story in another person can give the feeling of hope and that recovery is a possibility. 

For some people, “the golden years” are not as golden as they should be. With the COVID-19 pandemic, it can seem that there is no way to get out to attend a program like this. This is where telehealth plays a huge role. We are able to offer these services and you are able to attend group from your home. Telehealth has been a real game changer during this pandemic as it has allowed people who otherwise would not be able to attend group and individual sessions get the help that they deserve. 

If you or someone you know could be helped by our services, call our office at (989) 246-6339 and we’ll guide you from there. On a personal note, I have been the program therapist since the beginning, and I’ve had the opportunity to work with many people and see the improvements that people make as they progress through the program. I feel blessed that I have the opportunity to play a part in people’s lives changing for the better.

David Bailey, L.M.S.W., is the program therapist for Senior Life Solutions.

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Don’t Let a Wound Limit Your Summer Fun

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One of the best parts of summer is spending time outdoors with family and friends. Whether you enjoy backyard cookouts, picnics at the park or swimming at the pool, lake or beach, you should take extra care to help identify and prevent common summer skin wounds.

Check for Wounds on Your Feet and Legs Every Day

This is especially important for people living with diabetes, vascular disease or other coexisting health conditions that may affect the body’s ability to heal. A small blister can quickly develop into a non-healing wound. Puncture wounds have a high rate of infection. Seek medical care if you have a wound that is not healing or shows signs of infection such as redness, fever or chills.

Prevent Bug Bites and be Aware of Allergies

Most insect bites are harmless and can be avoided with bug repellent and protective clothing. If you have a bug bite, use a topical anti-itch cream to avoid scratching your skin. Watch for signs of an allergic reaction. Seek emergency care if you are experiencing chest pain, difficulty swallowing or breathing, nausea, cramps, vomiting or severe swelling.

Protect Against Sunburn and Skin Cancer

Skin cancer is more common than all other types of cancer combined. You can help prevent cancer and sunburn with the right sunscreen, clothing and shade. Mild sunburns can be treated with over-the-counter remedies. Seek medical attention if you experience chills, dizziness, rapid breathing, nausea, extreme thirst, faintness or a rash.

Avoid Summer Shoes Like Sandals or Flip-Flops

Choose supportive shoes with closed toes and flat heels. Sandals, flip-flops and other open-toed styles do not provide good support and often cause blisters. Always wear socks. Ask your physician or podiatrist to check if your shoes are a good fit.

Seek Specialized Wound Care

A non-healing wound can limit your ability to enjoy your summer. If you are living with a health condition, such as diabetes, vascular disease, obesity or advanced age, you may be at greater risk for chronic wounds. The longer a chronic wound goes without proper care, the greater the risk of infection, hospitalization and amputation.

This article was originally published by Healogics, Inc. Through a partnership with Healogics, MidMichigan Health is able to offer expanded specialized wound care and hyperbaric oxygen therapy. Healogics is the nation’s leading wound care management company, providing high-quality wound care and consulting services to more than 500 hospitals across the United States. Member hospitals have access to advanced healing technologies including hyperbaric oxygen therapy (HBOT) management.

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Understanding Neuroscience of Trauma for Effective Healing

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It is common knowledge that past traumas change people. It is well known that trauma increases the chance of anxiety and depression, and disrupts functioning in a number of ways. But it may not be so common to think about how this change happens. It is through changes in our brain that trauma disrupts our thought patterns, emotions and behaviors. Recent research has dug deep to understand the details of these changes and what needs to be done to heal the brain so that we can experience less disruptive symptoms. According to researcher Jennifer Sweeton PsyD, M.S., M.A., (www.jennifersweeton.com) the goal of therapy is to change the brain.

There are several areas of the brain that become overactive or underactive because of traumatic experiences. These are then manifested in disruptive symptoms. The primary area that becomes overactive is the amygdala. It is the ‘smoke alarm’ of the brain. It asks, ‘Is this dangerous?’ Working with the memory center, it determines if something is dangerous and begins the stress response, which can be experienced as anxiety, or any of many physical symptoms. It also suppresses the higher thinking. When someone has repeated dangerous events the amygdala can become overactive and hypersensitive, resulting in an overreaction to even small events that would not normally be considered dangerous. When the amygdala completely hijacks the rational thinking it can cause a blackout or amnesia.

To heal from trauma the amygdala needs to be calmed and relearn what is truly dangerous, and what is not. This can be done within a safe therapeutic setting where the person learns to turn off the danger signals and can think through triggers that had set them off, to relearn that they are not really a threat.  

There are several areas of the brain that become underactive due to repeated trauma. The hippocampus is one of these areas. It is the storage area for autobiographical memory. It is the memory center that the amygdala works with to decide what is dangerous. With repeated trauma there can be atrophy in the hippocampus, which can cause memory problems. People can help the hippocampus to stop sending danger signals by working with memories that used to feel dangerous, learning that they are not dangerous. Bringing the memory up in a safe environment, and doing something with it, like telling the story, can reduce the sense of danger, because every time we remember something we remember the last time we remembered it, not the original, so we are reconsolidating each time. The hippocampus can also be strengthened with physical exercise, Omega 3 and meditation.

Another area of the brain that is underactive after repeated trauma is the insula. The insula is the part of the brain involved in awareness of the body and internal states including emotions. During trauma people learn to turn this awareness down or off as a way to protect themselves from the pain, either physical, sexual or emotional.  Turning it down can become a habit resulting in the feeling of numbness or, when turned off completely, can cause dissociation. Spikes in insula functioning can create flashbacks. This area of the brain needs to be on for healing to happen. Low insula functioning is the main reason attempts at therapeutic change fails, according to Dr. Sweeton. Use of sensory awareness exercises like movement, stimulation and mindfulness exercises can improve insula functioning.

Two more areas that are underactive after repeated trauma are the cingulate cortex and the prefrontal cortex. The cingulate cortex is involved in emotional regulation and decision making. The prefrontal cortex is the center for rational thoughts, goal-making and decision-making. When the amygdala senses danger it deactivates both of these areas. When the amygdala is over sensitized and habitually turned on, then both of these decision making areas are chronically turned off. They need to be activated to make good decisions. They can be strengthened with cognitive work, like talk therapy, once the insula has been activated and the amygdala has been calmed in a safe environment.  

It is more clear than ever that trauma in a person’s past has real changes in their functioning based on the direct effect of the trauma on the brain. It is also clear that there are many positive and effective treatments that can improve a person’s life and functioning. These therapeutic interventions are generally done within the support of individual therapy. Some people have found self-help tools that address many of these symptoms. For those who need more support than either of these approaches MidMichigan Health provides a Partial Hospitalization Program at MidMichigan Medical Center – Gratiot. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit www.midmichigan.org/mentalhealth.

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Adjustment Disorders

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All humans face stressful life events. Sometimes these stressful events are navigated with little difficulty. At other times they cause troubling symptoms. Adjustment Disorder may be diagnosed when a stressful event triggers symptoms. An Adjustment Disorder is a psychological response to stressors that results in clinically significant emotional or behavioral symptoms.

This may include a decrease in performance at school or work, substance use, changes in relationships and somatic complaints. Somatic complaints are complaints about the body including pain, nausea, headaches and body aches, which often have no medical explanation. This reaction to the stressful event is marked by distress that is in excess of what would be expected given the nature of the stressor, or causes a significant impairment in social or occupational functioning.

When these emotional or behavioral symptoms develop within three months from the onset of the stressor it may be an Adjustment Disorder. Symptoms may be present for several weeks and may last up to several months. The Adjustment Disorder may be considered acute when symptoms last less than six months, or chronic when longer than six months. They may occur at any age.

Adjustment Disorders are relatively common and require an identifiable stressful event that can be of any severity. This is different than Post-Traumatic Stress Disorder, which is a more familiar, but less common diagnosis that requires the presence of an extreme stressor.

Examples of the variety of triggering stressors that may lead to Adjustment Disorder include:

• Single events, like a termination of a relationship

• Multiple stressors, like business difficulties or marital problems

• Recurrent stressors, including seasonal problems at work

• Continuous stressors, like living in an area where there is frequent crime

• Developmental events, like getting married, becoming a parent, or going away to school

Adjustment Disorder may include emotional symptoms, like a depressed mood or anxiety, or both. It can also include disturbances of conduct, like angry outbursts or lying. Or, it can include both disturbances of emotions and conduct.

Adjustment Disorder is considered a short-term illness. With time and proper treatment it is likely to resolve and allow the person to return to their normal functioning. The treatment of Adjustment Disorder may include both medication and therapy. Often therapy alone can be effective in helping the person to improve their ability to cope with the stressor. These improved coping skills often include learning to use support systems more effectively, changing negative thinking and changing unhealthy behaviors.

The setting for such therapy may include outpatient therapy with a counselor or psychologist. Or, for more severe cases, it may include an Intensive Outpatient Program (IOP) or a Partial Hospitalization Program (PHP). IOP treatment is generally three hours of therapy three times a week. PHP treatment is six hours of daily therapy five times a week. It is rare that Adjustment Disorder requires inpatient psychiatric treatment. The needed level of care is determined by the severity of the symptoms and the amount of disruption to the person’s functioning. No matter what level of care a person needs there is no reason to feel ashamed for seeking treatment. Part of being human is leaning on other when there are struggles. And all humans struggle at times.

MidMichigan Medical Center – Gratiot has a Psychiatric Partial Hospitalization Program (PHP) for those who need this level of treatment. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit www.midmichigan.org/mentalhealth.

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The Power of Our Creativity for Our Mental Health

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Over the past century it seems that every type of creative activity has grown into a type of therapy. The first four decades of the 20th century were particularly productive. While music therapy was first noted as early as 1789, its first professional organizations were founded between 1903 and 1926. Art therapy and dance/movement therapy were first promoted in the 1940s with professional organizations following 20 years later.

There are strong reasons why these creative endeavors became recognized as therapeutic. But one does not need to be, or see, a professional to gain from some therapeutic effects of the creative process. Integrating some creative activity into daily life can give many of the same benefits.

The creative process is often thought to be related to artistic activities, but in reality creativity can occur in any area. This idea has been presented by psychologist Howard Gardner who introduced the theory of multiple intelligences during the last quarter of the 20th century. He stated that every area of intellectual development is an opportunity for creativity. This includes linguistic, logical/mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal and naturalist.

The essence of creativity is not the modality within which one works, but the process of using the imagination to produce original ideas. It is this process of making new connection that appears to have the therapeutic effect, whether it is in music, words, movement or mathematics. Participating in creative activity stimulates the brain by making new neurological connections, which improves the mood and increases mental flexibility, improving problems solving skills.   

Some of the benefits that have been noted in research are seen in all the areas, others are area specific. Some benefits are physical. Research suggests that music can improve respiration, lower blood pressure, improve cardiac output, reduce heart rate and relax muscle tension. Dance and movement can reduce the body’s stress response, enhance disease prevention and improve coordination and mobility. Creative activities can give a boost to the immune system.

Some effects are social, emotional or psychological. Research indicates that participating in visual art production can improve communication, improve concentration and help reduce feelings of isolation, as well as increase self-esteem, confidence and self-awareness. Therapeutic effect of dance and movement include improved mood management. Participating in the creative process in any form can help people focus, discover a sense of happiness and reduce burnout. The creative process nurtures emotional and social growth.

Trying a creativity activity may seem a bit intimidating to some people. This is likely because our society has created an artificial division between “artist” and “non-artist,” with the latter somehow being less gifted. Therefore, people don’t see themselves as creative and end up denying their own creativity. While it is true that there are people who decide to become professional artists, and there is a wide variety of talent, everyone has the capability of using their imagination in creative ways. And everyone can benefit from it with improved mental and physical health.

Those who need additional help to overcome mood disorders are encouraged to seek help. The Psychiatric Partial Hospitalization Program (PHP) mental health day program at MidMichigan Medical Center – Gratiot is available for those who need additional support. Those interested in more information about the PHP program may call (989) 466-3253. Those interested in more information on MidMichigan’s comprehensive behavioral health programs may visit www.midmichigan.org/mentalhealth.

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Ten Things Not to Do if You Have Lower Limb Pain

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Tendinopathy, or tendon pain, is a term that refers to a disease in the tendons. The tendons are fibrous connective tissues that connect muscle to the bone. Tendinopathy is often characterized by tenderness to touch and pain. Gluteal, patellar, achilles and hamstring tendinopathy are examples of lower limb tendon pain. Effective strategies for tendinopathies include ongoing, exercise-based regimens that slowly build up muscle power and tendon strength. In recent years, there has been significant advancement in how we understand and treat lower limb tendon injuries. Professor Jill Cook, the world’s authority on tendon rehabilitation, gives a nice overview of what not to do if you have lower limb tendon pain. The ten points are highlighted below.

  1. Resting Completely. The old adage of “use it or lose it” applies to tendons. Just resting decreases the ability of the tendon to take the load. You have to reduce the load to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to take the load.
  2. Passive Treatments. Treatments that do not address the need to increase the ability of the tendon to take are not usually helpful in the long term. Treatments like electrotherapy and ice will only temporarily ameliorate pain, only for it to return when the tendon is loaded.
  3. Injection Therapy. Injection of substances into the tendons have not been shown to be effective in good clinical trials. Do not use them unless the tendon has not responded to an exercise-based program.
  4. Ignoring Your Pain. Managing the load on your tendon pain is a way of telling yourself that the load is too much. Reduce the aspects of training that are overloading your tendon, like running or jumping. On a very irritable tendon, isometric exercises have shown to decrease pain by 50 percent.
  5. Stretching Your Tendon. Adding stretching to most tendons only serves to add compressive loads that we know are detrimental to the tendon.
  6. Managing Your Tendon. A painful tendon is one that is telling you that it is overloaded and irritated, therefore adding further insult by managing it can actually increase your pain.
  7. Being Worried About the Images of Your Tendon. Don’t worry about MRI or ultrasound findings. There is evidence that pathological tendons tolerate loads, especially when you gradually increase the load.
  8. Being Worried About Rupture. Pain is protective of your tendon; it makes you unload it. Most people who rupture a tendon have never had pain before, despite the tendon having substantial pathology in it.
  9. Taking Shortcuts with Rehabilitation. The tendon needs to build its strength and capacity. Things that are promised of cures often give short-term improvement, but the pain comes back.
  10. Misunderstanding What Loads Are High for Your Tendon. The highest load in your tendon is when you use it like a spring, like when you’re jumping or sprinting. Other loads are low load for a tendon, although they have a beneficial effect on the muscles.

Get Ambas, P.T., is a physical therapist at MidMichigan Health.

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Avoid Back Pain with Smarter Shoveling

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Research shows 1,000 people end up in Emergency Departments each year after snow shoveling, with the majority of those visits are for back injuries. Snow shoveling is one of the most common causes of back injuries during the winter months. However, this type of injury is preventable if you know the best ways to remove snow without straining the back. The following tips can help you avoid low back injuries during the snowy winter season.

Warm Up Thoroughly

Cold, tight muscles are more prone to injury than warmed up, flexible muscles. You can warm up your muscles by briskly walking for a few minutes. Then, stretch your large muscles on your back, preferably with dynamic stretching by taking the muscles through full range of motion.

Use Ergonomic Lifting Techniques

Whenever possible, push the snow rather than lifting it. When lifting snow is necessary, make sure to use ergonomic lifting techniques: Bend at the hips and not the lower back. Then, bend with your knees and lift with your leg muscles, keeping your back straight. Keep your loads light and avoid twisting the back to move the snow to a new location. Always pivot your body to face the new location.

Switch Between Lifting and Throwing Snow and Pushing and Plowing Snow

Doing activity repetitively over time can lead to muscle fatigue, discomfort and even damage to the muscles and ligaments. This is why it is best to break up activities while shoveling.

Pick the Right Snow Shovel

An ergonomic snow shovel can help take some stress off your back. A shovel with a curved handle or an adjustable handle length can minimize painful bending. Small, lightweight plastic blades can also help reduce the amount of weight you are moving.

If it’s possible, using a snow blower can be a better alternative to shoveling. If you have a significant history of lower back issues or cardiac issues, it’s best to delegate shoveling to someone else.

Get Ambas, P.T., is a physical therapist at MidMichigan Health.

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Tips for Dealing with Anxiety

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Over the last year, there have been many different situations that may have caused you to feel on edge. Feelings of anxiety are a natural result – a rising heart rate, sweaty and feelings of tension in your chest and shoulders.

With so many things still unknown, particularly when it comes to the COVID-19 pandemic we’ve been battling for nearly a year, avoiding anxious feelings is simply unrealistic, and may even be dangerous in the long run. If you’re in the habit of pushing those feelings down, it doesn’t necessarily resolve the issue.

If your anxious feelings are becoming an issue, try these tips for mental and emotional relief:

Limit your social media engagement. Take time away from screens, posts and replies.

Maintain normal routines for sleep, nutrition and scheduled responsibilities.

Avoid excessive alcohol or drug use.

Focus on what you can control.

Check in with loved ones regularly to feel less isolated.

Given our current circumstances, anxiety is common and expected. But it’s important to seek help when those anxious feelings cross the line, for example, when it’s beginning to affect your day-to-day life.

Meghan Dahl is a behavioral health therapist at MidMichigan Medical Center – Midland.

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