Healthy Tips – September/October 2019


Topics This Issue:

Military Mindfulness

Strategies from working with vets facing PTSD

When introducing mindfulness to veterans living with PTSD, new PacMed physician Charles Falzon, MD, MBA, advises easing into it, rather than “jumping right into the deep end of that kind of work, because it can be emotionally provocative.”

“Meditation can be really intimidating,” observes Dr. Falzon, a former lieutenant in the US Navy Medical Corps and Integrative Medicine practitioner at Northwestern University. “The feelings people experience can be very uncomfortable because they’re not used to living in silence or stillness.... It can be very unsettling.”

Rather, Dr. Falzon recommends starting with small steps. “Focus for 30 seconds on what it feels like to take deep breaths,” he suggests. Or ease in with “yoga classes, going to a religious service or even simply putting your phone away during dinner and focusing on the people around you.”

This sort of “intentional action” also has tangible medical benefits. For example, taking time to chew intentionally, says Dr. Falzon, “gives your body a chance to process the food the way it’s meant to”—allowing salivary glands to perform the important first step of digestion. Mindfulness can recalibrate all four basics of health—defined by Dr. Falzon as diet, sleep, stress management and exercise—changing “how we feel and experience health.”

For processing new feelings, Dr. Falzon believes the most important building blocks are your social support system and engaging your medical team. That kind of outside help is necessary because we can lose our bearings, especially when overwhelmed by endless task lists.

Those of us who are task-oriented can learn from veterans in their approach to mindfulness. “The military people I’ve worked with are always extremely dedicated and excited to tackle challenges,” says Dr. Falzon. “Unfortunately, when it comes to mindfulness, trying too hard or looking for specific results can be counterproductive. It’s not going to get you there faster. How can we be ok with the path that we’re on and not necessarily try to build a new road?”

Luckily, mindfulness doesn’t require a goal—the journey can be a reward in itself. As Dr. Falzon describes, “Those new sensations can be a really fascinating experience. Hopefully, it’s something that patients find helpful— then we can keep building on it.”

Dr. Charles Falzon, practices family medicine at our Northgate clinic, listening closely and asking questions to focus on what will most help patients address their concerns.

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Leaving the Nest 101

PacMed provider offers some advice to parents with college-bound teens. (For younger children, check out the PacMed Back to School page for ideas on check-ups, healthy lunches and more.)

Stress abounds for former high schoolers as they prepare for college endeavors and begin to make the transition into adulthood. Parents have their hands (and hearts) full as well, making plans for their beloved offspring to flee the nest in pursuit of higher education. Though parting is such sweet sorrow, family medicine physician Ashu Verma, DO, is here with advice to help parents launch their teenagers off to college with care and confidence.

College students may have different back-to-school needs than their younger counterparts. What kinds of needs are those? Do they need health screenings and/or immunizations before arriving at college?

For patients in their adolescent or young adult stage (usually 12 to 18 years old), and parents of adolescents, we encourage openly addressing behaviors, associated questions, and the importance of regular health screenings. The five most common (and important) conversations for both adolescents, and their parents, include: Risky Health Behaviors (alcohol consumption, drugs, tobacco and e-cigarette devices, sexual activity); Physical Activity (engaging in 30-45 minutes of exercise most days of the week, exhibiting healthy eating and dietary habits); Mental Health (screening for depression and other mental health issues is also very important at this age); and Updated Immunizations (students and parents should keep all immunizations updated. It is also a good idea for the student to keep a copy of their immunization records for future references, as they transition out of the house. This can easily be kept on their phone and should include Tdap every 10 years, Menactra and MenB, HPV, Hepatitis A, Hepatitis B and Influenza yearly).

Are there any health concerns that are unique to college students? If a young person has a health concern while away at college, how should they proceed?

Parents and their college-aged children should become familiar with the health services available at their college, as most colleges and universities have university clinics on campus.

Keep in mind the following: Where is the clinic located? What are their hours? What’s the nearest clinic or doctor for after-hour needs? Do they offer mental health services at this specific university or college? It’s also important that the child know their insurance status and keep a card in their wallet.

How can parents help their children stay healthy from afar while they are enrolled in college?

Make sure your children are aware of their past medical history and the family’s medical history, such as autoimmune disorders, psychiatric, heart disease, or diabetes. They should be aware of any history of asthma, concussions, hospitalizations, surgeries, or allergies to medications. Ensure they know what medications they are taking, the names of these medications, details and the dosage. Also, it would be great for your child to have a small first aid kit that they can keep in their dorm room. This would include Band-Aids, triple antibiotic ointment, thermometer (make sure they know how to use it), sterile gauze/pads of different sizes, adhesive tape, antiseptic wipes, Tylenol or Motrin, and a list of emergency contact numbers and their primary care provider’s details.

Do you have any more healthful tips and suggestions for parents and college-bound kiddos?

Living in a dorm, your child will be exposed to lots of new people in a new and unfamiliar environment. They will probably be using the same showers, toilets, sinks, doorknobs/glasses -- and unfortunately, exposed to lots of germs. Be sure to share the importance of regularly washing your hands often, especially before eating or touching your face. The use of antibacterial gels works just as well as washing -- share that they can carry a small container in purse or pocket. College is a period filled with fun, excitement, nervousness, and change. However, there are many people available to the student to help in that transition to make sure it is filled with happiness and good health.

Dr. Ashu Verma is a family medicine physician at the PacMed Canyon Park clinic in Bothell. She earned her medical degree and completed her training in Texas.

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WOMEN’S HEALTH: Preventive care for menopause and cancers

Here is a quick primer on three health issues and how to get the care you need:


Menopause marks the end of a woman’s fertility and occurs when the ovaries stop producing estrogen and progesterone. It becomes official when you’ve gone 12 months without a period. (The average age is 51, per Mayo Clinic.)

What should I expect? Everyone’s experience will be different. Symptoms can include weight gain, hot flashes, insomnia, night sweats, forgetfulness, dry skin, thinner hair, vaginal dryness and decreased libido. Menopause also increases your risk of heart disease, osteoporosis and urinary incontinence.

What can I do? Some women find menopause challenging. If you’re struggling with sleep or other symptoms, or simply have questions, make an appointment with your primary care doctor. You also may want to check your library for a resource like The Menopause Book (by Wingert, 2018) or Mayo Clinic, The Menopause Solution (by Faubion, 2016).

Breast cancer

About one in eight U.S. women will develop invasive breast cancer. When it is found in the early stages and treatment is initiated promptly, the chances for a positive outcome are improved.

What’s my risk? Risk factors include your family health history, earlier start of menstruation, fewer pregnancies, giving birth at a later age, working night shifts, using alcohol and, after menopause, hormone replacement, increased fat intake and weight gain.

Is treatment improving? Treatments have become less invasive and are tailored more accurately to the individual risk. This allows most women today to avoid mastectomy and chemotherapy.

What can I do? Address your breast cancer risk with a sense of importance and without fear. Ask your doctor about a mammogram and other screenings.

Cervical cancer

Cervical cancer is linked to infection with a virus called HPV (human papillomavirus). HPV is a common sexually transmitted virus. What’s important to know is that cervical cancer is highly preventable with regular screening, plus vaccination to help prevent HPV infection.

When should I get screened? Young women should get routine screenings starting at age 21. As long as the screenings are normal, women can expect repeat screenings every 3 to 5 years up to age 65.

Is there a vaccine? Do boys need it too? The HPV vaccine is recommended for boys and girls, starting at age 11-12. Getting vaccinated at these ages will ensure that, by the time a child becomes sexually active later in life, they will be at far less risk for the types of HPV that cause cervical cancer.

What else can I do? Cervical cancer affects different ages, communities and races of women differently, so encourage all friends and family to get screenings when they are due.

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Telemedicine adds cardiology services to PacMed south-end clinics

Ever wish you could be in more than one place at once? Now, at least your doctor can! With a local assistant by your side, our cardiologists can now evaluate your heart remotely. Visit our welcoming Puyallup clinic to chat with a cardiologist who can see your heart from a distance, saving you a stressful trip to downtown Seattle. Stay tuned as we add more telemedicine specialties and locations to bring the best care to you.

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Ask PacMed

Patients often ask...“I’m turning 65 next year. What do I need to know about Medicare?”

—answered by Linda Marzano, RN, MHA, Chief Executive Officer

Medicare is a great program, but it’s different from the commercial insurance you might be used to. You need to apply for Medicare within three months either side of turning 65—or you can’t join until the next enrollment period, and you’ll pay a penalty.

Basic Medicare includes Part A for hospital stays and Part B for outpatient services. Most people get Part A for free and pay a monthly premium for Part B. You can optionally add Part D for prescription drug coverage.

It’s important to remember, Medicare alone won’t cover all your health care costs. Medicare pays only 80% of items it covers, and it doesn’t cover long-term care, eyeglasses, dental care, hearing aids or extra perks.

To cover some of these extras, you have two options to add to Medicare:

  • A Medicare supplement known as Medigap. This pays the extra 20%—only for services that Medicare covers. You’ll pay an extra premium for a Medigap policy.
  • Medicare Advantage. These plans may cover vision, dental, hearing aids and long-term care, along with other perks like gym memberships, massage or acupuncture. However, you will likely still pay a portion of the extra 20% for covered services with Medicare Advantage. Some of these plans charge a premium and others do not.

You can’t have both Medigap and Medicare Advantage; you have to choose one or the other.

For help with your individual situation, PacMed offers free services, including Medicare information sessions and a hotline where you can ask questions or schedule a consultation. Just call 1.877.315.3279.

Health care decisions are important for your quality of life as you age. Please let us know if we can help.

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NUTRITION CORNER: Strategies for picky eaters

We’ve all seen a child crinkle their nose when served beets or stew! Helping a child become a happy, healthy eater takes patience and thoughtful attention. If you’re a parent or caregiver, keep in mind who is responsible for what:

  • The parent is responsible for what, when and where.
  • The child is responsible for how much and whether they eat.

This means that you choose and prepare foods, provide regular meals and snacks, and demonstrate how to behave when eating. You are in charge of making mealtimes pleasant, and letting your child grow into the body that’s right for them.

Children have a natural ability to eat as much as they need, and to stop when they’re full. So you can trust your child to eat the amount they need, and ease up on prodding them.

To help your child feel relaxed about meals and even confident in exploring new flavors, try these three tips:

Create a pre-meal routine
It can involve putting away toys, washing hands, a prayer or a song. Transitions may be hard for kids, and a routine helps everyone get ready for a meal in a calming and predictable way.

Involve your child in setting up meals
Help your child learn about preparing and cooking foods. You can offer simple tasks like tearing lettuce or mixing ingredients, or suggest something that avoids close contact with foods like setting the table, inviting sister and dad to the table or pouring water for everyone.

Eat as a family
Aim to make the dinner table the happiest spot in your house. Children will want to be there and feel privileged to be to participate in family meals. Eating with the family allows kids to model adult behavior around trying new foods and learning manners.

Finally, be considerate of your child’s preferences—but ultimately, remember the division of responsibility: you choose what is being offered, and the child decides if they want to eat it. Have the child help plan meals by requesting foods before grocery shopping or meal prep. Or ask them to choose between two items you were already planning to serve.

For more information on healthy, positive eating, visit The Ellyn Satter Institute. Looking for a pediatrician or dietitian who can give advice geared to your little one? Make an appointment with a PacMed pediatrician, family medicine doctor or dietitian. Happy eating!

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Baked Apple with Oat Crumble

Warm apples and a crispy topping make this a comforting fall dessert. Leave the skin on the apples for a dose of fiber, and serve with a small scoop of vanilla yogurt, if desired.

Serves 4 Prep 15 minutes / Cook time 60 minutes


  • 2 medium apples (such as Gala, Fuji, Honey Crisp or Pink Lady)
  • 3 tablespoons finely chopped pecans
  • 2 tablespoons uncooked regular oats
  • 1 tablespoon brown sugar
  • 1 tablespoon cold butter, cut into small pieces
  • ¼ teaspoon ground pumpkin pie spice
  • Pinch of salt
  • 1 orange, juiced (use some orange zest to add brightness to the finish product)
  • Optional: Serve with a dollop of vanilla yogurt


Preheat oven to 350°F.

Cut each apple in half horizontally (so stem is in one half and flower end is in the other). Use a spoon to remove most of the core from each half, leaving about a half-inch of apple in the floor of the rounded hole.

Use your fingers to combine nuts, oats, brown sugar, butter, spices and salt until mixture resembles coarse meal. Fill each apple half with about 2 tablespoons of the mixture.

Place apples in an 8-inch baking dish; pour orange juice in dish around apples. Cover with aluminum foil. Bake 30 minutes. Sprinkle a small amount of orange zest on top for color (optional).

Remove foil, and bake an additional 30 minutes or until apples are tender and easily pierced with a toothpick. (Baking time will vary depending on variety, size and ripeness of apples.)

Nutrition Information

Serving size 1/2 apple (without yogurt)

Calories 101, Total Fat 4g, Saturated Fat 2g, Cholesterol 8mg, Sodium 100mg, Total Carbohydrate 17g, Fiber 3g, Sugars 11g, Protein 1g

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LWA Spotlight

The Living Well Alliance has a new cooking video! Next time you need a fast, delicious and healthy meal, try our Vegetarian Peanut Bowl. It pairs colorful vegetables with buckwheat noodles and homemade peanut sauce.

Video and recipe for Vegetarian Peanut Bowl

The Living Well Alliance is run by Pacific Medical Centers. Call us today at 206.621.4419 for more information or email .(JavaScript must be enabled to view this email address).