Quarantine and Chill – Coping with Quarantine

Originally published on Daily Dose of Vita, a lifestyle and medicine blog by Dr. Alyssa Cole (@doctor.cole)

With so much information about COVID19 disseminating across media outlets, I realized there is a MAJOR gap in one of the most important aspects of our current situation: your mental health. I partnered with Philadelphia psychiatrist, Dr. Joe Resignato (@joeyresmed), for an Instagram Live Quarantine & Chill where we provided an overview on how to process what is happening while maintaining a good headspace. Read below for a summarized transcript of our recommendations and a few FREE wellness resources at the end.

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DISCLAIMER: This is not to be taken as medical advice as we do not have a patient-physician relationship with viewers. This is educational and informative. If you have medical questions or concerns, we recommend talking to your primary care physician.

Dr. Alyssa Cole, DO is a Physical Medicine and Rehabilitation doctor (also known as a physiatrist) in Philadelphia, PA. Physiatrists specialize in the medical management of patients as they undergo physical, occupational, and speech therapy, helping improve their quality of life and reach their functional goals. Many of our patients have spinal cord injuries, traumatic brain injuries, strokes, or other musculoskeletal and neurologic conditions.

Dr. Joe Resignato, MD is a psychiatrist in Philadelphia, PA, specializing in the medical diagnosis, treatment, and prevention of mental disorders. Dr. Resignato is an expert in management of mental health and wellness, from PTSD to anxiety and depression.

“Death is in sight, Nowhere to hide, It’s All Over” – Headlines from several news articles about the COVID19 global pandemic that has swept not only the nation but the globe. These are statements that instill fear, anxiety, and panic in readers. How do we handle this type of fear media?

  • Viewers must understand that there are still several unknowns and questions even for us healthcare professionals. This is why it is important to focus on your sources including the CDC and WHO as well as other credible healthcare professionals. There is a lot of misinformation – anywhere from “blowing a hairdryer up your nose to kill the virus” to simply “this won’t affect me.”
  • There are vaccines under Phase 1 trials and anecdotal treatments but these have yet to be definitively proven. Rapid COVID19 testing was also recently approved by the FDA to detect SARS-CoV-2 within 45 minutes.
  • Stay informed but stay positive and understand why you’re doing what you’re doing. Social distancing means stay at home and this is to prevent the spread of the virus, especially to vulnerable populations. This additionally helps prevent the hospitals from becoming overcrowded and limiting resources. Recognize that for the majority of patients, they have mild symptoms and recover. Additionally, new data is coming to light that almost half of these patients have GI symptoms (maybe that’s why people bought all the toilet paper?) from anorexia to diarrhea.
  • Limit your exposure to news both in quality and quantity – (see below)
  • If you are going to worry, be productive with it – find out what you can do to help.

What are the effects of quarantine? Who is most at risk?

  • Post-traumatic stress syndrome, depression, and anxiety are all potential psychological effects
  • Individuals who have experienced trauma in the past, healthcare professionals and parents of one to two children
  • For more information, check out Dr. Resignato’s summary of a case study review about this topic HERE

What can people do to be productive in the community?

  • Outside of your duties at home and working, find ways to help others, especially healthcare workers – this includes continuing to social distance (remain six feet apart).
  • Advocate for personal protective equipment (PPE) by messaging suppliers and public health officials, donate masks or other medical supplies (Philly Mask Brigade is a great resource). Major fashion designers like Christian Siriano and Dev Charney of American Apparel have traded in gowns for masks, repurposing their manufacturing warehouses and factories to protect us.
  • Reach out to those you know on the front lines with messages of love and support as this is going to be a long road ahead for many of us.

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Can you differentiate between fear and anxiety and where this situation exists?

  • Understand where anxiety originates. Fight or flight/sympathetic activation – physiologic response to threat
  • Fear is the physiologic fight or flight sympathetic activation in response to a dangerous stimulus perceived as a threat (for example a Saber-Tooth tiger). If you did not have a fear response, your ability to survive would be at risk.
  • Anxiety occurs when there is no specific threat or stimulus to provoke the sympathetic response (there is no Saber-Tooth tiger). If anxiety is uncontrolled, this can be damaging to our mental and physical health.
  • We have to be able to manage what we are experiencing because there’s not much we can do to curb the threat.

What might be the manifestations of increased anxiety?

  • A recent NYTimes article discussed the differences between worry, stress, and anxiety
  • Worry is in your head and can cause you to go into a cycle in your head of worrying about something over and over again or even finding yourself in an endless narrative of worrying about one thing after another.
  • Stress is in your body, which can cause increased tension and muscle tightness, especially in your back and neck. A great way to manage this (outside of a massage) is with a foam roller to help relax your muscles.
  • Anxiety is a combination of worry and stress in your head and your body

How can people cope with these?

  • MAKE YOUR BED – This is the first thing you should do in the morning in order to set a precedent for future tasks to be accomplished the rest of the day
  • STRUCTURE – Create a to-do list and set a schedule for structure. Designate time for specific things and prioritize your activities. For example, outline a time frame of when you are going to watch the news instead of watching it throughout the day. If you are going to worry, set a time for this aside. Otherwise you are going to make yourself more stressed. You have to minimize the time you spend on things you cannot solve.
  • EAT  Make sure you are eating at least three well-balanced meals a day. Your body needs adequate nutrition to stay healthy.
  • HYDRATE – One of the most common presenting signs of patients with COVID19 is dehydration. Ensure you are actively drinking water throughout the day.
  • STAY ACTIVE – While you must continue to social distance and maintain six feet apart, you can still get outside and enjoy the fresh air and stay active. The exercise challenges on social media are a great way to connect with people and maintain your physical well-being.
  • LAUGH – They say laughter is the best medicine and they are not wrong. You have to enjoy the humor of the situation to lighten the mood and manage your stress.

You can save the world by staying home, watching TV, and wearing PJs 24/7.

  • LIST – List three things you are grateful for and understand that we are not just going through this, we are growing through this TOGETHER. 3 things you’re grateful for
  • MEDITATE – Headspace is offering free subscriptions to healthcare professionals. There are several great resources to meditate as well (see below). As someone who does not like to sit still, I was not keen on trying this but with practice have improved and feel like I am able to think more clearly.
  • CONNECT – with family, friends, and yourself! From virtual happy hours to spa days, take this time to focus on yourself, your passions, and your relationships.
  • MINIMIZE ALCOHOL – We do NOT recommend drinking alcohol to ease your anxiety or help you sleep. If anything, this can exacerbate your symptoms as it is harmful for mood and sleep. Alcohol is a depressant and in response, your mind will become overactive. When the alcohol wears off, you will be even more “revved up” than before, which is often why you end up waking up earlier and do not have a good night’s sleep. Also keep in mind alcohol is a liver toxin and recent data has shown that SARS-CoV-2 causes elevated liver enzymes and possible viral hepatitis (meaning it can also damage the liver).
  • JOURNAL – Pick a song and in the time the song plays, write down your thoughts – whatever comes to mind. I got this idea from my friend Beth.
  • STOCK UP – If you are going to “hoard” something, we recommend stocking up on YOUR prescriptions that YOU need. Insurance companies are offering a three-month supply so as to limit the number of trips you have to make to the pharmacy.
  • GET A THERMOMETER – If you or a family member start to feel sick, you want to make sure you have a thermometer to monitor your temperature for fevers.image.png

Any advice for helping people sleep at night?

  • Your bed should ONLY be used for sleep and sex
  • Set a bedtime and have a bedtime tradition
  • Try blue-light glasses to filter out the light that can otherwise cause your body to stay awake longer
  • Avoid activities like exercising, watching TV, or eating late at night
  • Put your phone away
  • Think of three good things that happened that day to uplift your mood
  • Meditate beforehand
  • If you still cannot sleep, you may want to talk to your primary care doctor about alternatives

I am currently feeling stressed about this situation but Dr. Resignato, you mentioned you’re feeling sad. Can you elaborate?

  • Many of us are mourning what our children, our friends, our family, and ourselves are missing in life. This is why it is so important to stay connected and to seek help from experts if you feel like you are having difficulty coping with the situation.
  • On the bright side, at least there’s no FOMO

What recommendations do you have for families now tasked with working and teaching their kids?

  • Find ways to entertain and teach your kids through arts and crafts, science experiments, cooking, and more. Pinterest has some great ideas for these types of activities.
  • You can practice meditating with them, practice quiet time, do yoga or other exercises together. A lot of people have found making videos like on TikTok to be a fun outlet and bonding experience.
  • Get outside – I have seen neighborhoods get creative and host things like Zumba classes while social distancing.
  • Understand that there are some who don’t live with anyone – hug your partner or kids a little bit longer for those people.

What can healthcare workers take away from this?

  • Please know that you are not alone.
  • Several healthcare workers are worried they are under-protected and that they could put their loved ones at risk. There are many who are or will be redeployed to areas of medicine they have not practiced in years. As a result, we must OVER prepare so that we are not under-equipped. Consider the worst situations and pivot your thinking to how we can turn them into the best version of the worst possibility.
  • I personally am struggling with the fact that as much as I am helping patients, I cannot help my neighbors for fear of exposing them given we are in such a high risk of exposure.
  • The emptiness of 6 feet has never been so LOUD and the idea that I do not know when I will be hugged again is difficult to process. It has helped to talk with other physicians who are experiencing similar feelings.
  • Dr. Resignato brought up a great point to be aware of the potential for survivor’s guilt as our ER and ICU colleagues fall.

For those just tuning in, can you summarize what we have talked about (the 5 Ds) and how this relates to the community?

  • Dr. Resignato cites a conversation he had with Dr. Salman Akhtar, MD, a world renowned psychoanalyst, who suggests using the “5 D’s” to mitigate the effects of a pandemic: Deploy, Distill, Depathologize, Distinguish, Direct.
  • Deploy: Follow all directives and instructions from public health officials and government
  • Distill: Distill the quantity and quality of what you are watching or reading when it comes to news – ensure the sources are CREDIBLE. Designate time for this activity rather than taking in the news all day and worrying, which can make you more stressed out.
  • Depathologize: You do not have to diagnose yourself with something because this is normal stress. It is okay to feel sad, worried, anxious, or hurting. These are normal reactions and does not mean something is wrong with you or you are developing a complex. It is natural.
  • Distinguish: Distinguish between physical and social distancing. The term is poor because we should not socially isolate ourselves. You want physical distancing between people (six feet apart) but you can still keep in touch and connect with them, especially virtually.
  • Direct: Direct your attention elsewhere. It is okay to play and have fun, to dance, or to sing. Dr. Resignato brought up a great point that if you sing, you become two people – you are the person singing and the person listening.
  • Do not be in denial about this as COVID19 is a real threat. It is not the time to have a party or ignore what is happening. We implore you to take this situation seriously.

Also, HUGE shout out and thank you Jenny Meassick (@jennymeassick) for posting a great video that complements this discussion…and for letting me steal Joe for two hours to host this IG Live!

Free Wellness Resources:

  • Headspace – great meditation app
  • Blogilates – You know how much I love my Cassey Ho workouts. These are FREE on Youtube and she often puts together a monthly calendar with your daily workouts.
  • DoYogaWithMe.com – free online yoga and meditation videos (you can choose what level you want and how long you want to work out for)

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