Healthy Tips – January/February 2021

Topics This Issue:

Back to basics:
Parents, don’t delay your child’s care!

PacMed’s Dr. Adewunmi Nuga encourages families to keep their children’s health care current, on track.

With COVID-19 upending our lives, many parents have put their children’s regular health care on hold, delaying well-child exams, screenings and immunizations. But health matters. Parents ask me, How do I keep my family healthy? How do I manage if a new health issue arises? Your primary care provider can help you reset and move forward.

Get up-to-date with immunizations
The Centers for Disease Control (CDC) reports that many children are currently missing vaccinations (also called immunizations). This puts them at risk for preventable diseases, like whooping cough, scarlet fever, mumps and measles. Many of us aren’t familiar with these age-old childhood diseases! That’s because safe and effective vaccines for them have been used by families for decades, and outbreaks today are unusual. But that can change if we don’t keep up on childhood immunizations.

Of course, parents want their children to be protected from diseases. So how do you catch up? A good first step is to contact your primary care provider. They can help get your family back on track and answer your questions about immunizations for children and teens.

Check in for well-child checkups
These appointments are important because children develop so rapidly from age zero to 5, and then into their teens. Regular checkups help ensure early recognition of issues—which leads to early interventions and better outcomes.

During COVID-19, you can still schedule appointments for well-child visits and developmental screenings. These exams occur every few months during the first year, once or twice up to age 2, and then every year thereafter. You can learn more about the schedule of regular childhood visits at PacMed. Immunizations can be done during well-child visits.

Balance mental and physical health
Keeping our families fit, both physically and mentally, is an ongoing challenge these days. What’s important? How about the 4 S’s—

  1. Help kids manage screen time: Set limits, choose “time out” times for devices, model good behavior.
  2. Focus on getting enough good-quality sleep, for everyone. 10 hours for teens and tweens, more for toddlers, 7-8 for adults. Learn more about sleep.
  3. Make dinnertime a welcome retreat for sharing, laughing, understanding
  4. Sweating! Keep up your family’s outdoor time: neighborhood stair climbs (Seattle, Kirkland), walks and hikes, snowshoeing, jumping rope. Change things up with sports like tennis or ultimate Frisbee.

Get a flu shot—it’s not too late
The CDC reports that less than half of children overall had been vaccinated for the 2020–21 flu as of December. The flu shot is the best way to protect your family, which is extra valuable this year.

Adewunmi Nuga, MD, PhD, FAAP, is a pediatrician and internal medicine doctor at our Canyon Park (Bothell) clinic. She sees pediatric patients at Canyon Park Pediatrics at PacMed.

Hang out to dry: Resetting alcohol intake

For centuries, alcohol has been used to celebrate successes and calm stresses. We all create automatic habits, some related to alcohol—perhaps opening a beer when your team’s playing or enjoying a glass of wine every evening. A new year is a great time to step back and observe the effects that alcohol has on your life.

What are some of the downsides of alcohol to your body? Here are three, some more hidden than others:

A toxin. Alcohol is a toxin to the body, and therefore, overindulging comes with a few consequences. The body priorities the breakdown and excretion of alcohol as soon as it enters the body. This puts a hold on the digestion of food calories for later digestion or to be stored into fat cells, leading to an increased risk for weight gain and fatty-liver disease over time.

Weight gain. Alcohol, surprisingly, is higher in calories (3 more calories per gram) than carbohydrates or proteins. People also tend to overeat once they’ve had a bit of alcohol, especially on an empty stomach.

Sleep disrupter. Alcohol can impact your sleep. While it tends to have a sedative effect and can help people fall asleep, studies suggest that the breakdown of alcohol interferes with the later, restorative REM phase of sleep. This can make you more restless in the second half of the night, leading to issues the next day with concentration, memory recall and low energy.

Making a change can be a challenge. Some people do well quitting cold turkey, like with the “Dry January” movement. Here are some ways to ease into a changed relationship with alcohol:

  • Add a glass of seltzer or plain water in between alcoholic beverages. You’ll stay better hydrated, plus your hands will stay busy!
  • Track the times of day that you tend to drink, and see if you can hold off for 1 hour before taking a drink.
  • Check your favorite drink’s alcohol content, and find something similar with a lower percentage.
  • Find a support person or counselor to help you work through barriers to change and to assist with sticking to your goals.
  • Try one of our mocktails (see boxed list below)

Once you’ve started making a change, you will likely experience better sleep, more energy and perhaps weight loss. Your may also find positive changes in your mood. If you’re eliminating large amounts of alcohol over the long term, it can lower your risk for chronic diseases like dementia, heart disease and many types of cancer. You’ll also save money!

If you think you’d benefit from support in making a change and overcoming barriers, PacMed has a wide range of professionals in our Behavioral Medicine team.

One mocktail please, shaken, not stirred.
A mocktail is a cocktail without the alcohol. Give one a try!*

  • Citrus Mimosa—orange, grapefruit or pomegranate juice mixed with flavored seltzer water or sparkling cider.
  • Pomegranate Mojito—mint, lime, soda water and a splash of pomegranate juice and/or limeade!
  • Blueberry Mojito Mocktail—sweet, minty and fresh
  • Virgin Bloody Mary—so many bold flavors, you might not miss the vodka!
  • Virgin Moscow Mule—try infusing the simple syrup with rosemary
  • A non-alcoholic beer … or a seltzer flavored with hops from Lagunitas Brewing Co.
  • An after-dinner digestive—like calming chamomile tea or a Tazo dessert tea
*Many recipes call for simple syrup, which is a cinch to make.

Ease into new habits

If you were inspired to make a New Year’s resolution and are struggling, here’s some sage advice from our experts.

Start small. To set yourself up for success, bit off a small piece—not the whole beast! If your aim is to run, walk or roll 2 miles a day and you’re starting at zero, begin with a realistic goal. Start with 1 mile on two days a week. Then build up with incremental changes.

Choose function over fiction. People often set big, number-driven goals: Lose 50 pounds by summer, Do a spin class each week. It’s easy to quickly feel disconnected from such vague, unrealistic goals! Can you choose something more meaningful, more functional? Like, lose 50 pounds before our family gathering next September. Or do three spin classes each week to prepare for July’s 30-miler with Jose.

Be patient and kind. With yourself! Change can be challenging, and one of the best motivators is to create a supportive team. Find a friend or family member with a similar goal, and egg each on, offer advice and a supportive ear.

Start safe. Before making any big change to your health routine (such as kicking off a new diet or exercise regimen), schedule a visit with doctor. They can help you choose the safest approach, given your overall health, and can even help you track and adjust your progress.

Looking for a primary care provider to help you with your healthy goals? PacMed Primary Care has a robust team of providers for the whole family at nine neighborhood clinics.

NUTRITION CORNER: Hydration quest

A tall, cool drink of water is sure to quench your thirst—and keep your body functioning properly and feeling good. Makes sense, since our bodies are 70 percent water. In fact, most all of the body’s major systems depend on water to survive. Today, we hope to convince you to take another sip and stay hydrated!

What WATER does for your body:

  1. WATER regulates our body temperature. Your body is a perfect HVAC system: When it heats up, it releases water as sweat. Then the evaporation cools the body. Without this essential system, you’d overheat when you exert yourself or exercise.

  2. WATER forms saliva and mucus. These slippery, moist substances aid in digestion, and they keep our nose, mouth and eyes moist. This moisture helps keep teeth clean, flushes grit from our eyes and prevents friction.

  3. WATER protects body organs and tissues. When your skin is plump with water, it’s more resistant to premature wrinkles and skin disorders. On the inside, water keeps your blood thinner, helping regulate blood pressure.

  4. WATER lubricates the joints. The cartilage in your joints and the disks of your spine are natural shock absorbers. They are about 80 percent water, so if you get dehydrated, your joints dry out and can’t absorb shock as well. Drink water to help decrease joint pain.

  5. WATER aids digestion. Dehydration can lead to a host of digestive problems, including constipation, an overly acidic stomach, heartburn and stomach ulcers.

  6. WATER supports the liver and kidneys. The kidneys regulate fluid in the body, while the liver filters or detoxifies your blood. With good hydration, your kidneys and liver don’t have to work so hard to flush out waste products. Dehydration can also lead to kidney stones, which can be enormously painful.

  7. WATER dissolves many critical minerals and nutrients. This makes it possible for them to reach various parts of the body. Water also carries oxygen to cells.

How much water do I need?
Every day, your body loses water through the breath, perspiration, urine and bowel movements. So it’s important to continue taking in water throughout the day. There is no universally agreed-upon quantity for daily water intake. The Institute of Medicine suggests an “adequate intake” per day for women is 11 cups and for men, 16 cups—from all sources, including food, beverages and drinking water. While this is a good ballpark, water needs will be different depending on how much a person sweats and whether they live in a hot climate, are physically active or are coming down with an illness.

In general, you can trust your natural thirst mechanisms. If you feel thirsty, then drink more water. You also can pay attention to the color of your urine. It should be very pale or colorless and odorless (except for the first pee after waking up). For the average adult, going pee 4-10 times in a 24-hour period is considered normal.

Watch for symptoms of dehydration, including dry mouth, fatigue, constipation and decreased appetite. (Contact your health care provider if you experience the more severe symptoms of dizziness, elevated temperature, confusion and decreased blood pressure.)

Note: While water seems harmless, it can be dangerous to overhydrate. Taking in too much water can dilute your body’s electrolyte content. While rare, this can lead to water intoxication and possible death.

What’s the best source of fluids?
While all fluids and hydrating foods count toward your hydration, plain water is the best option because it has zero calories.

Caffeinated and alcoholic beverages tend to pull water from the body and make you urinate more, so while adding fluids you also lose more than with plain water. Sports drinks contain water, sugar, flavorings and minerals such as sodium and potassium. These drinks are marketed to imply that the ingredients are necessary to prevent dehydration, but even for athletes, the evidence for this is controversial.

Fruits and vegetables contain natural sugars and minerals, and are anywhere from 80 to 98 percent water. For example, watermelon contains 92 percent water, 8 percent natural sugar, and essential electrolytes such as, calcium, magnesium, potassium and sodium.

I always forget to sip. Help!

  • Carry a reusable water bottle everywhere
  • Drink water with meals and when ordering food out
  • Chill water ahead of time if you enjoy a cooler temperature
  • Set a timer for water consumption, download a hydration app or keep a daily “water log”
  • Eat foods that are full of water, such as melon, cucumbers, celery and low-salt, broth-based soups.
  • Create water intake challenges with friends and colleagues (see note above about overhydrating)
  • Buy or make carbonated water
  • Infuse water with non-calorie flavors—muddled mint leaves, cucumber, strawberries, or frozen citrus wedges or melon balls; food-grade flavor oils; a mint tea bag; sugar-free mixer
  • Explore flavored waters, so many choices!

Cajun Parmesan Salmon

Cold-water, fatty fish such as salmon are the highest in omega-3 fatty acids, which enhance the function of certain immune cells. Look for wild, rather than farm-raised fish for higher omega-3 content. Fish is also a rare source of vitamin D. So you can enjoy this crispy, well-seasoned salmon in good health!

Serves 4 | Total Time: 45 minutes


  • 1 tablespoon extra-virgin olive oil
  • 4 (4-oz.) fillets salmon
  • 2 teaspoons Cajun seasoning, divided (store-bought, or make your own!)
  • Freshly ground black pepper
  • 2 tablespoons butter
  • 3 cloves garlic, minced
  • ⅓ cup low-sodium chicken or vegetable broth
  • Juice of 1 lemon
  • 1 tablespoon honey
  • 1 tablespoon freshly chopped parsley, plus more for garnish
  • 2 tablespoon freshly grated Parmesan
  • Lemon slices, for serving


Sear Filets: Run the fish filets under water and pat dry with a paper towel and sprinkle flesh with 1 teaspoon Cajun seasoning and pepper. Add oil to a large skillet on heat medium-high heat until shimmering. Tilt to coat the pan, then gently lay filets in the oil, skin-side up. Cook about 6 minutes, checking the underside until the flesh is golden brown. Flip and sear the skin side for two minutes, before transferring to a plate.

Create Sauce: In the still-hot skillet, add butter and garlic. Allow the butter to bubble, then add broth, lemon juice, honey, the remaining Cajun seasoning, parsley and Parmesan. Stir over heat until mixture begins to simmer.

Reduce heat to medium and gently lay salmon into the sauce, skin-side down. Continue simmer until the sauce volume has reduced by half and salmon has cooked through, another 3–4 minutes.

To Serve: Spoon sauce onto plates, place salmon filets on center, and lay lemon slices on top. Sprinkle with parsley.

Nutritional information for one 4-oz. fillet:

Total fat: 19g Saturated fat: 5g Cholesterol: 84mg Sodium: 709mg Potassium: 62mg Total Carbohydrates: 7g Dietary fiber: 0g Sugars: 4g Protein: 30g

Recipe adapted from delish.

Living Well Alliance, Reimagined!

The Living Well Alliance (LWA) started the year off strong. However, the program itself will look a little different going forward.

To start, LWA coordinator and dietitian, Christy Goff, is moving into a clinical dietitian role at PacMed, where she sees patients four days per week. This means she is now available for individual nutrition counseling at PacMed and can help with referrals and scheduling appointments for your employees who are interested in nutrition services. (PacMed accepts many health insurance plans, but it is best to check with your personal plan and talk with your provider before scheduling.)

Also, all LWA programs will now be virtual offerings, with booking available on Wednesdays. You can still book individual company webinars. We offer two subscription options as well—one that continues our monthly nutrition webinar program and a new “Deskercise” subscription, with videos that focus on quick and gentle stretching and strengthening, led by a registered yoga teacher or physical therapist. Learn more at or email .(JavaScript must be enabled to view this email address).

The LWA will miss partnering with you all regularly, but we hope you continue to work with us at PacMed. In the meantime, if you would like some nutrition inspiration, check out these awesome cooking videos, filmed and edited by Christy herself!