Author Archives: MidMichigan Health

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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Reduce Your Risk of Cervical Cancer

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January is Cervical Health Awareness Month, and there’s a lot that women can do to help prevent cervical cancer.

Cervical cancer happens when normal cells in the cervix, the bottom part of the uterus, change into abnormal cells and grow out of control. Most women whose cervical cancer is found and treated early do well.

In 2021, the American Cancer Society estimates 14,480 new cases of invasive cervical cancer will be diagnosed in the United States and 4,290 women will die from it. One of the major causes of cervical cancer is Human papillomavirus, or HPV. HPV causes 99 percent of cervical cancer. HPV can also cause vaginal, penile, anal, mouth and throat cancer.

HPV is a very common infection that spreads through sexual activity. About 79 million Americans currently have HPV, but many of them don’t even know that they’re infected. That’s because HPV generally doesn’t have any symptoms. In fact, in many cases, the body can fight off HPV naturally, but in serious cases, the body is at risk for serious complications.

Thankfully, the number of cervical cancer cases is declining, because of screening tests that are able to find cervical precancerous cells before they turn into cancer. The HPV vaccine also protects men and women from HPV.

At MidMichigan Health, we encourage women to begin getting regular Pap tests at age 21. Talk to your gynecologist or health care provider to determine how often you should get these screenings.

We also encourage pre-teens to get the HPV vaccine; it is most effect for boys and girls to get the vaccine between the ages of nine to 12. Teens and young adults age 13 through 26 who have not been vaccinated or who haven’t gotten all their doses should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens.

If you haven’t received a Pap test or the HPV vaccine, it’s important that you talk with your health care provider to determine a course of action that works best for you and your health. Being proactive in your health care is key!

Brendan Conboy, M.D., is a board-certified obstetrician/gynecologist who sees patients at MidMichigan Medical Center – Alpena. He received his medical degree from Wayne State University School of Medicine, and completed his residency at William Beaumont Hospital in Royal Oak. Those who would like more information about becoming a patient may contact his office at (989) 356-5228.

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Sustainable Change

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The New Year is a time of change. Many embrace the season as an opportunity to create resolutions with great intentions to be healthier but are often disappointed weeks later when they are unable to sustain them. There are several reasons why resolutions prove to be difficult to maintain, but with thought and planning, one can make lasting change for the better.

A potential problem with a resolution is that it is too far outside a person’s norm. Not only is this type of resolution hard to start, it’s difficult to sustain.

For example, if someone doesn’t exercise, setting a goal of exercising 60 minutes a day may be too far outside their normal exercise time of zero. The difficulty with this type of goal is self-image. If you don’t see yourself as someone who exercises, it will be hard to sustain a goal of 60 minutes a day of exercise.

The following are some of the dos and don’ts of kicking off the new year with a commitment of
healthier habits.
Don’t:

 Set a goal that is too lofty to attain
 Choose something you are physically unable to do
 Expect change to be easy
 Proceed without a plan
 Give up too quickly; plans can be adjusted

Do:
 Set a small goal to begin and build from there
 Work on self-image; visualize yourself being a person who is successful at it
 Engage in deliberate self-talk like “I am choosing healthy behavior” and “I can do that”
 Work the resolution into your routine by connecting it to something you already do until it
becomes a daily, healthy habit
 Understand that even small increments of change are successes

No matter what type of change one is working on, a better chance at sustainability includes starting small, visualization, recognition that it can be accomplished and connecting it to something already present in one’s routine. Small steps become habits until the larger goal of living a healthier lifestyle is reached.

“Focus on one day at a time, one step at a time. Soon days turn into weeks and each
small step becomes a habit and helps you reach your larger goal. Remember doing something is better than doing nothing at all

Michelle Lucchesi, M.A., L.L.P., is a therapist at MidMichigan Medical Center – Gratiot’s Psychiatric Partial Hospitalization Program. To learn more about the program, call (989) 466-3253, or visit www.midmichigan.org/pphp.

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What You Need to Know about Taking Medication During Pregnancy

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Whether you’re thinking about getting pregnant, or you’re currently pregnant, you might be wondering how to know which medications are safe to use during your pregnancy. This includes everything from prescription medications, to over-the-counter cold remedies to your daily multivitamin. How do you know what’s safe, and what you should
stop taking to protect yourself and your baby?

Nearly every pregnant woman will face a decision regarding medication at some point
during their pregnancy. However, there’s not detailed information on effects of many
medications when it comes to pregnant women, because they are not included in safety
studies.

What we do know, though, is that there are some cases in which it would be more harmful to stop taking a medication during pregnancy, if, for example, the medication helps control a health condition. On the flip side, there are also certain medications that increase the risk of birth defects, miscarriage or developmental disabilities. Certain things, such as the dose of the medication, during what trimester you take the medication and what health conditions you have, all play a role in this as well.

The best thing to do is to discuss any medications you are currently taking with your
health care provider. You can do this even before you are pregnant, as there are some
medications that are unsafe in early pregnancy. Your provider will help you create a
treatment plan so that you, and your baby, are as healthy and as safe as possible.

Throughout your pregnancy, you’ll want to check in with your doctor before starting or
stopping any new medication, and this includes prescriptions, vitamins, supplements or
over-the-counter remedies. Even after you deliver your baby, your doctor will be able to
work with you to determine if you should continue taking your medication or, when it’s
safe for you to resume taking medication you stopped taking during pregnancy.

Together, you and your doctor can work together to come up with a plan to keep you and your baby as healthy and safe as possible.

Obstetrician/Gynecologist Shawna Ruple, M.D., sees patients at MidMichigan Obstetrics & Gynecology in Midland. Dr. Ruple specializes in routine and problem gynecology care, gynecologic surgery, prevention of female reproductive cancers, birth control options, caring for women while pregnant and more. For more information on in-office treatments and procedures, contact her office at (989) 631-6730.

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