Month: November 2020

Reimagining the holidays, 2020 style

Reimagining the HolidaysOne pandemic silver lining may be a more meaningful season

If the holiday gatherings we cherish are disrupted by social distancing, how will we handle the long, dark season ahead? PacMed behavioral medicine provider Eun Ku shows us how a pandemic winter can be an opportunity to create the holidays we’ve always wanted.

After a long year of unimaginable changes, many fear the additional burden that winter may bring. While difficult, the pandemic presents an opportunity to get away from the “holiday rush” that many people complain keeps them too busy in the final months of the year. Rather than focusing on a loss of social connection throughout this holiday season, we may reimagine the pandemic as an opportunity to create the deeper, more meaningful holidays we crave.

As an active psychotherapist, I would like to help you better understand the mental health impacts of social isolation, and how we can engage on a different level to find a path forward during this important holiday season.

Connect on a deeper level

Those who practice responsible social distancing may be experiencing mental health impacts from isolation. People tend to cope in one of two ways. The first is through self-destructive behaviors—going to excess, such as overeating, drinking or binging on TV or video games. The other involves self-soothing behaviors, such as yoga, breathing exercises, walking, alleviating clutter or working on projects that help us feel productive. Obviously, the latter is more healthful long term.

As we invest in our own well-being, this increases our capacity for close connection with those dear to us. We feel more at ease when we’re connected with people we love and trust. The pandemic can be an opportunity to strengthen those bonds.

Consider setting up a schedule where you reach out to friends and loved ones on a regular basis. Rather than hectic parties, try connecting more deeply about your experience of the pandemic in your relationships. You might call Grandma on Sunday, schedule a Zoom call with a close friend on Wednesday and write a holiday letter to someone you haven’t connected with in ages on Saturdays. You can also deliver gifts to your friends’ doorsteps and say “hi!” with a wave from a distance. Letting people know you’re thinking about them feels good to you and to them.

If you have experienced a loss from COVID, the slower and more contemplative pace of winter may open up new space to grieve. Use these quieter months to reflect on the past year, loved ones and the changes that have taken place. If the feelings that come up seem too powerful to handle on your own, it can help to work with a mental health professional to process them.

Get creative with adventure
Staying safe from COVID makes cozy cold-weather gatherings trickier indoors. But a little creativity can open doors to a fulfilling season, both indoors and out.

If you love holiday getaways, engage the family in a virtual trip-planning adventure. Research the places you want to travel to in the future, when safety allows. Or hop in the car and take a short drive or mini-trip to treat your brain to beautiful fall and winter scenery or festive holiday lights—on homes or at a display like Stanwood’s Lights of Christmas drive-thru. Another fun idea is to pretend you’re spending your holiday abroad, by exploring recipes and cuisines from different cultures around the world.

Also, it’s healthy to keep moving! If you enjoy decorations, add more ornaments or lights throughout the house. Mix up your décor by painting a wall, rearranging furniture or putting up new artwork or photos. Take regular walks, do Zoom workouts with friends or search out some new spots for winter activities you love—like a hidden sledding hill or an open-air ice rink where you can maintain social distance.

Broaden your welcoming spirit
To center in on the more restful, meaningful holidays we crave, it can help to engage in mindful living. One approach to mindfulness fits well with the holiday gatherings we might be missing. Rather than inviting in a network of family or friends to your home, you can extend the same spirit of welcome to whatever thoughts and emotions pass through you.

Rumi, the 13th-century Persian poet, describes how we can meet our passing thoughts and feelings with courage, warmth and respect, as if they were guests at a hotel you were managing:

“The Guest House”
This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
As an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

—Jalaluddin Rumi, translation by Coleman Banks (The Essential Rumi)

The ongoing uncertainty of the pandemic may make us feel like we’re losing control, and when social distance meets the holidays, it is natural to feel a sense of loss around traditions we hold dear. However, with a little focus on what we find meaningful, a sprinkle of creativity and a spirit of welcome, the 2020 holidays may be closer to what we’ve always wanted. And that can yield a sense of joy and centeredness that carries forward into 2021 and beyond.

Share what matters

End-of-life wishes and documents are one of the conversations you can have todayShare What Matters

See the resources at the end of this article for links to important documents and forms you might need.

COVID-19 reminds us that we don’t know what the future will hold. We may not have the chance to say or do everything we intend to. If there’s anything important to share with loved ones, it’s a good idea not to delay.

For some, this will include sharing sincerely with loved ones what they mean to you. Showing your care also involves letting them know your wishes if you are incapacitated and cannot speak for yourself. This will make a difficult time easier on them, and can give you peace of mind knowing your pets, finances, health care and other matters will be taken care of.

More than a will
Most people know they should prepare a will that outlines their wishes after death. There is another important set of documents for when you are still alive.

These “end-of-life” documents may come into effect if you suffer a coma, seek inpatient treatment for mental health or a substance abuse disorder, or enter hospice near the end of life. Even though you are still alive and in some cases may recover, you could be incapable of communicating or managing your affairs for a period of time.

End-of-life documents do two important things: They make your wishes known, and they empower others to take action according to those wishes. You get to choose a trusted person who will serve on your behalf. This person is then referred to as your “proxy,” your “agent,” or your “attorney-in-fact”—these terms are used interchangeably. You can also identify alternates in case your first choice is unavailable.

Choose someone you trust as your agent
Your agent is someone you trust to speak for you and make decisions on your behalf in two basic areas: health care and finances. After you prepare a document that gives them permission, your agent can be given access to your medical records and other accounts to help them support you. Some people choose the same person as their agent for both health care and finances, while others may choose a different person for each role.

A spouse, an adult child or a close friend can all be good choices to serve as your agent. You should pick someone as your first choice, and also one or more alternates in case your first choice is not available. Keep in mind, your doctor and care team cannot serve as your agent.

Once you have selected your agent and alternates, you should sit down and talk with them. Ask them if they are willing to be your agent, and share what responsibilities they will have and what your wishes are. If you have started a draft of your documents, you can share those. Give them an opportunity to ask questions and take notes. They may bring up things you haven’t thought of.

If you do not know what topics to cover when clarifying your wishes, that’s okay. You can look online or ask your doctor for a document template that will walk you through it.

Put it in writing: Health Care Documents
The first step is to make your health care wishes known. There are many different names for health care end-of-life documents, such as Advanced Directive, Living Will, POLST and Durable Power of Attorney. Don’t worry—you don’t have to fill out all of these! Most of them serve the same purpose.

PacMed recommends starting with the short Advanced Directive form available on our website. This form is only two pages and accomplishes the two most important things: It provides you with simple health care wishes to choose between, and has the legal force to empower the person you chose to serve as your health care agent to act on your behalf.

You can update or add to this with a more complex document if your wishes expand or change in the future. But getting this simple form on file now after a conversation with your agent means you will have immediate support if the unexpected happens.

After you complete any health care document, first sign it in front of a notary or two witnesses. Then make copies and share them with those who need them. Your doctor and your health care agent both need copies of your signed and finalized health care document. Keeping another copy on file at home and even posted on your refrigerator can help emergency personnel if they need to come into your home. You may also want to send a copy to your lawyer and your county assessor’s office for them to have on file.

After the short Advanced Directive is complete, you can always replace this with a more encompassing document, if you wish, such as the long Advance Directive from Providence’s Institute for Human Caring, a Durable Power of Attorney (DPOA) for Health Care, or a medical living will. Resources on these other types of forms are recommended in the sidebar.

Put it in writing: Financial Documents and Digital Assets
After your health care documents are on file, you may also want to think about other things. If you were incapacitated, who would pay your bills, including your rent or mortgage? Who would feed your pets and let your job know?

You need someone you trust to help manage your finances if you are not able. This person will serve as your “Financial Agent.” Their responsibilities could include working with your insurance and accessing any work or state benefits you may be due. If you stop receiving income, they may need to access your savings or liquidate assets to pay for your care. Having someone responsible help with your finances can keep your life in good working, until you may recover and return home.

Some people ask the same person to serve as both their health care agent and their financial agent. Or, if your situation is more complex, you may want to choose one person to manage your health care decisions and a different person to manage your finances.

In order for your financial agent to act on your behalf with your bank, landlord, government agencies and more, you will need a strong legal document, known as a Durable Power of Attorney (DPOA) for Finances. This means the financial agent you choose will have power to act as your attorney-in-fact, another word for agent. “Durable” simply means the document will endure after you become incapacitated.

Banks have been known to refuse some DPOAs, so you might ask your bank if they have a template they recommend. You can also find starting templates online through services like RocketLawyer or LegalZoom, or have an attorney prepare the document for you. Make sure your DPOA is prepared for your state, since each state has different requirements.

Think about digital access when preparing your DPOA. So much of our business is transacted online these days, you will want to give your agent the power to use your online accounts. Make a plan for them to access your logins and passwords. Some ideas are to keep your password list in a safe deposit box, in a file in your home, or sign up for an online password service that provides “digital legacy” or “inheritance” features.

If you choose to have one person serve as your agent for everything—both health care and finances—then you don’t need two separate legal documents. You can prepare one Durable Power of Attorney document that covers both areas. In either case make sure the documents are clear and all your bases are covered. This will help your agent(s), health care providers and others avoid confusion.

Once your Durable Power of Attorney is complete, make it official the same way you did for the health care documents—have them notarized or witnessed, and share copies with your agent(s) and alternates, lawyer, county assessor’s office, and health providers if the DPOA covers health care. Keep a copy for yourself at home and posted on your refrigerator as well.

Final thoughts
When you die, the documents above all expire. To share your wishes about what happens with your money, property and body after your death, you also need to prepare a Will or Trust.

Rather than feeling daunted by the process, remember you can always update these documents later if you change your mind. You don’t have to be perfect.

The most important thing is to get started. Most who go through the process of completing their end-of-life documents find it empowering in the end.

We can feel a burden lifted once we put our wishes down on paper, and enjoy life more knowing things will be taken care of.

Corralling COVID in vulnerable communities

CHAZPacMed’s Population Health team uses data and dedication to target testing where it’s most needed

Early in the pandemic, when state and national coordination efforts were still getting underway, one small but mighty PacMed team took our care to the streets. As an arm of a regional collaboration with the Providence and Swedish family of organizations and other county, city, nonprofit and even grassroots and individual partners, PacMed’s efforts were part of many that formed a patchwork of local responses that helped Washington contain the virus early in the COVID-19 outbreak.

In normal times, the PacMed Population Health team crunches data to identify communities and individuals who may need extra care—and reaches out to see how we can help. When COVID-19 first appeared, this team was uniquely positioned to play a critical role on the frontlines.

Tanya Grant, MPH, RN, had moved to Seattle in 2019 to lead PacMed Population Health and Infection Prevention & Control. Before, in Oregon, she led efforts to streamline referrals and sharing of health records between medical clinics and community health partners. Her work draws on personal experience: She has been a nurse for 30 years while raising a special-needs daughter. This firsthand experience showed her “how messed up health care really can be for people—nothing’s easy.”

When health systems don’t talk to each other, patients can fall through the cracks. And during a pandemic, those who are disconnected from testing and care can speed community transmission of the virus. With this in mind, Grant and members of the team—Diana Dass, Abigail Gadia, Hannah Jornacion, Jeremy Viray, Jane Zerabruk, Louela Brown and others—took to the streets.

This was in early June, when protests were erupting nationwide to decry the killing of George Floyd and systemic racism. Knowing that these peaceful gatherings could serve as COVID-19 “super-spreader” events, Grant and her team were introduced by Providence’s President of population health management, Dr. Rhonda Medows, and given permission to set up shop at the epicenter: Seattle’s Capitol Hill Occupied Protest, or CHOP.

“We thought it was really important to be out there in the underserved areas,” says Grant, “to do testing to prevent problems for those communities.” The team strategically located across from the bay of Porta-Potties at Cal Anderson Park and near vital services. They were creative in encouraging people to be tested. “We did trade some snacks for a COVID test on a couple of presumably homeless individuals who were sleeping outside,” admits Grant.

“Everyone was so receptive to getting tested—most people wore masks, and the few that did not, I offered a mask and they accepted it. Also everyone accepted hand sanitizer. This was encouraging,” says Zerabruk, a social worker with the team. “The peaceful atmosphere surprised me.”

Using a computerized system, people were given a number to call for results. People who tested positive were also contacted directly by cell phone. They were given information on how to stay and keep others safe, and referred to King County Public Health, which then conducted contact tracing.

Grant says they tested 450 protesters, along with others who were camped out at the CHOP. “We were able to identify four active infections and prevent other potential community spreads.”

Eventually, “the very last day, it got really sketchy, and the city asked us to move out because they couldn’t guarantee our safety,” says Grant, “so we just moved to the Skyway neighborhood, because we knew that was an underserved population.”

Grant came by this knowledge honestly. The Population Health teams across PacMed, Swedish and Providence use data to understand individual and community risk of disease as the result of many overlapping factors. These factors, known as social determinants of health, include things like race/ethnicity, income, access to transportation, ZIP code and more. “Place matters. Where you live, matters,” says Grant. For example, “we know for diabetes, you’ve got to be able to afford your medicine. You need to be able to afford the good food that we want you to eat. And you have to be able to come into the clinic and be able to monitor your blood sugar appropriately so that you don’t have bad outcomes.”

Based on data they had gathered and analyzed, the Population Health team knew some of the highest risk in King County would be found in the southern ZIP codes, and that “people of color were adversely affected with infections—there are actual disparities that exist. We realized that pretty early on, before even the literature came out about it.”

This knowledge steered the team to their next stop: the Holy Temple Evangelistic Center of Skyway, a Black-led church in a small community tucked between Renton and Tukwila in South King County. They pitched their pop-up tent and set out the “Free COVID Testing” sign. Church leaders got the word out. And because, according to Grant, “there wasn’t a ton of testing in South King County when we when we first went down there,” people came.

Population Health Coordinator Jeremy Viray was struck by people in the area talking about the stress of the pandemic. “Most of the time,” Viray explains, “the folks were really appreciative that we were present and serving their community.”

Even though PacMed’s small Population Health team can only visit each location for a short period of time, those early efforts made an important difference in heading off early potential outbreaks among vulnerable groups.

The nearby Abu-Bakr Islamic Center of WA in Tukwila heard about the PacMed team and requested a visit. While the team could spend only an afternoon there, those hours proved crucial for protecting the community. Grant recounts:

We had about 50 tested—it was in four hours, one Saturday afternoon at the Islamic Center. And two of those were positive. In fact, there wafs one mosque member there who was positive, and she lived in a household of 12 people. We coordinated with King County, and they tested that entire household to make sure there wasn’t additional spread. It turned out another member of the household also ended up testing positive. So, that was a very public health intervention, where we were able to stop an early outbreak.

While Grant’s small team can’t be everywhere at once, their nimble and data-centric approach allows them to get to the best place, at the right time—playing an essential role on Puget Sound’s frontlines against the COVID pandemic, and then connecting with other partners in the response for follow-up.

Their presence in the community is opening even more doors: A Skyway fire chief dropped off his card, saying he wanted to get involved, and the Cambodian community in White Center asked for help with COVID testing at an upcoming event. Grant shares how another community organizer “gave us quite a few leads. So once we’re out in the communities, it’s amazing—to be able to follow up and provide additional services to those underserved locations.”

Grant says the connections being forged by many groups like hers—such as the City of Seattle Navigators, the Reach arm of Evergreen Treatment Services, even grassroots community organizers—are beginning to forge care coordination relationships that will serve us all, in our current public health challenge and in the future. These efforts are organically building an infrastructure that our nation’s health care system has left piecemeal for far too long.

Grant says, “I had the perception, coming from little old Corvallis, Oregon, that Seattle was going to be further along that journey. But it turns out that the problem with care coordination, and collaboration across entities, is the same everywhere.”

However, from her service at the frontlines of the COVID pandemic, she adds, “I was so humbled to meet so many people that were so passionately engaged in caring for that population. At the CHOP, for instance. I was just really humbled to see all the grassroots organization and care for one another that they have there. I mean, there were some challenging individuals… but you know, they all have needs, and we were happy to be there to be able to provide some link to the medical community. Those are the people that I feel like we’re meant to serve: people who don’t necessarily know which way to go. It’s just a real honor to be able to help folks navigate the whole system.

“I think now we can really shift the conversation about social determinants. I think that what happened with George Floyd—his death—really has changed the conversation in a way that I think we’re going to be able to really address race inequity and health care. And it’s going to be exciting work.”

Tanya Grant and the PacMed, Swedish and Providence Population Health teams work behind the scenes to serve our patients and the broader community.

“A huge breath of fresh air”

Sabina Saburova Glaspie struggled to breathe for years—until she found USFHP and PacMed

GlaspieOver six years and across three military bases on two continents, Sabina Saburova Glaspie—mother of two and a legal assistant for the U.S. Department of Justice—struggled to take in air.

After jogging, she says, “I would not be able to breathe.” Others noticed as well. Her husband, friends and even strangers would ask, “Is everything okay, while you’re breathing like that?” “This has been bothering me for so many years,” Sabina says. “Nobody listened to me, that it’s a nose issue. Nothing else.”

Sabina had a sense of what her problem was, but the many doctors she consulted all prescribed the same thing: asthma medications that didn’t help.

That was until her husband, Brandon Glaspie, transferred to serve as a Staff Sergeant at Joint Base Lewis-McChord. The family opted into the US Family Health Plan (USFHP), a TRICARE Prime managed care option for active-duty military families in the Puget Sound area.

This allowed the family to visit the medical team at PacMed.

Sabina started with a virtual consultation, then a visit to PacMed’s Ear, Nose and Throat team (also called otolaryngology). She was nervous at first, due to COVID-19, but “I saw a lady wiping down the elevator button, so that was very, you know, reassuring.”

Her primary care physician, Dr. Alexander Park, referred her to surgeon Dr. Michael Lamperti—all in the same office. Sabina calls her care team “Awesome… very upfront and honest.”

After clearing a COVID-19 test, Sabina’s surgery went smoothly. She had heard that patients bruise up or develop bags under their eyes after similar procedures, but “I didn’t have any of that,” she says. “I had a great experience…. The people around me can’t even tell that I had something.”

Asked what she would tell other patients, Sabina says, “With COVID, I think a lot of people are scared. I know I was…. It was a big, scary moment for me, going to the hospital and under anesthesia for the first time. But the doctors talked me through it, and I had to have some faith in them. In the end, they actually, you know, trained to do this. I should be able to trust them, and I had a great outcome.”

Just a few weeks out from surgery, Sabina is still healing up, but she already feels some relief. “It was, literally, such a relief to get that off my shoulders. Somebody believes me—you actually got listened to. That was very helpful that somebody’s actually paying attention to, you know, to my health, with me, and being a little more proactive.”

Sabina expects even more relief when the swelling goes down. “I can imagine that it would be just a huge breath of fresh air.”

Prepare a home health kit to get more out of virtual visits!

Get the most out of a phone or video visit with your doctor with just a few items. Check your vital signs, give your care team data they need, and even administer basic remedies they might recommend to feel better. Remember extra batteries!

  • Home Health KitThermometer. Get a digital model that goes in the mouth—these are more accurate than skin readings.
  • Oxygen saturation/pulse monitor/oximeter. You can have alarmingly low oxygen saturation and not feel it! Slip your finger in this small device for a quick reading that can point to respiratory illnesses like COVID-19.
  • Blood pressure cuff. Get a cuff for the upper arm with an easy-to-read display. Body posture is important—follow the cuff instructions (more tips online). See below for tips on getting an accurate reading.
  • Scale. Keep it basic, nothing fancy needed.
  • Tylenol. Unlike ibuprofen or Aleve, Tylenol doesn’t cause GI upset or bleeding, and it’s OK for those 65+. Choose Extra Strength/500 mg. If you are allergic to Tylenol or have liver disease, talk with your provider before taking.
  • Nasal rinse. Irrigating the nasal passages helps to relieve congestion. You’ll need a neti pot or a special squeeze bottle, distilled water and a saline mix (find a recipe online).Buy saline packets at drug stores, or make your own solution: 8 ounces of distilled water + 1/4 teaspoon non-iodized salt + 1/4 teaspoon baking soda. If you use tap water, it must be boiled (and then cooled) to prevent infections. Rinse the bottle/neti pot after each use with sterile water and air dry.

Don’t delay! Some of these items may be on back order. Keep these along with your first aid kit to stay healthy from the safety of home. Also, we’d like to share these tips for taking your blood pressure…

7 Simple Tips to Get an Accurate Blood Pressure Reading

USE CORRECT CUFF SIZEMeasuring Blood Pressure
Cuff too small adds 2–10 mm Hg

Cuff over clothing adds 5–50 mm Hg

Talking or active listening adds 10 mm Hg

Full bladder adds 10 mm Hg

Unsupported back and feet adds 6 mm Hg

Crossed legs add 2–8 mm Hg

Unsupported arm adds 10 mm Hg

COVID winter exercise: Tips from a Diabetes Star

Terri HorsebackTerri Woodrow knows a thing or two about self-care while living with diabetes. As one of PacMed’s doctor-nominated “Diabetes Stars,” we had planned to print a story on her approach to healthy living before COVID-19 hit. We were lucky to reconnect with her around her busy schedule, now that she’s back in the (virtual) classroom as a para-educator, to hear how she’s adjusted her health routine for COVID times.

When the weather’s nice, get out and about
“I’m fortunate to live close to an urban park area, so when the weather’s nice I’ll go for a 30- or 40-minute walk. It’s always nice to get outside in the fresh air, especially during the winter time.”

Revisit past activities, try new ones
“One love of mine is aerobics. I used to teach it back in the day. I gradually switched from aerobics to running. When I couldn’t run anymore, I tried swimming and other low-impact activities, but was never consistent with them. Recently, I rediscovered aerobics. I found an instructor (Jenny McClendon, a licensed physical therapist) on YouTube. She has a love of teaching seniors and beginners in hopes they know it’s never too late to start an exercise program. It’s perfect for me, now that I’m 65. I’ve also done line dancing a few times a week and resistance training with elastic bands. If it’s something you love, you’re apt to stick with it.”

Find a pace that’s right for you–and keep going
“Along with diabetes I’ve had a few other health issues, like back and shoulder problems, so I’m not able to go all out anymore. I’ve learned through my PacMed doctor and diabetes educator how important regular exercise is to my ongoing health. So, I find the pace that’s right for me and keep rolling.”

Start with the tools you have–but start
“You don’t have to belong to a gym or buy fancy equipment to exercise. Resistance bands are a good, affordable investment. For light weights you can use water bottles filled with dried beans or soup cans. One YouTube video shows you can get in a complete workout just using a chair!”

Mental health affects diabetes, too
“I’ve learned that added stress can cause glucose levels to spike. When COVID-19 hit, and then the riots started, my numbers went up. I’ve learned to limit my news intake, be gentle on myself, stay positive and find things to look forward to. It’s funny, now I get compliments on being so optimistic!

“One thing I’m looking forward to is a three-week driving tour of Yellowstone and the Grand Tetons with a friend. We had to cancel the trip this year because of COVID, but we’re determined to do it next year. I love the planning and anticipation … it’s almost as fun as the actual trip!”


Also read how Terri got started on the path of living a healthy life with diabetes in Traversing the Diabetes Trail.

PacMed is nationally recognized for providing high-quality diabetes care. We help patients manage their diabetes through education, classes and support. Learn more about diabetes care at PacMed.