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December 28, 2016
Health
Women’s Edition
anxiety & Story By Lorie Palmer
depression Three local women start the conversation.
L
iving in a state with sparse mental health services – especially in rural Idaho County – can be tough for those who suffer with depression, anxiety and other illnesses. On top of the lack of professional help, the stigma of having a mental illness or not being “tough enough” to just “suck it up” can have devastating results for area residents. Idaho has one of the country’s highest suicide rates — on
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average, 46-48 percent higher than the national suicide rate (WWW.SPANIDAHO.ORG). Three Grangeville women recently opened up to talk about their personal stories of digging their way through the maze of depression and anxiety and what they did or are doing to help themselves. We hope their stories bring courage to others who may be faced with issues they cannot deal with alone and offer insight on the thought processes and decisions. ■
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December 28, 2016
“Nothing like that had ever happened before and I was convinced that my inability to prevent these attacks made me a liability to my family so I gave up driving entirely.” —ELLISSA CROWL, Grangeville
TAMMY NAIL, 34 Listen to yourself and your body “I have family history of depression among also some herbal things he recommended but other things on one side. There have been I never did try.” three suicides in the family on that side,” said Nail said she didn't talk about this with Tammy Nail, 34, of Grangeville. “So, for my- family at first because, “Sometimes I don't feel self, I have always tried to be aware of the pos- like family can see past walls that may be in sibility of its presence. I noticed I was having place or fronts which could hide what's really lack of energy, anxiety and mood swings.” going on inside,” she said. “And I don't think Nail had a newborn at home at that time we are always honest with ourselves.” and consulted with her doctor thinking maybe She said during times of depression she it could be post-partum depression. A test re- would bury herself deeper in her own vealed her thyroid was thoughts and it would not working properly. be a downward spiral. “At first I didn’t want to Once that was regulatShe did talk to her famispeak out at all, but then I ly and friends aftered, she said, there thought, ‘The things that wards, once she knew were still mood swings and anxiety. have happened in my life more about what she “I began taking a have made me who I am; was feeling and felt very low dose of Zoloft more comfortable. they are part of me...’” Nail said it is importo see how it would work. It was just right. tant for people to listen —TAMMY NAIL, Grangeville to themselves and their Just enough to take away the edginess that own bodies. lingered,” she explained. “The good news of “At first I didn’t want to speak out at all, but this drug is that it is less likely to be addicting then I thought, ‘The things that have hapand it's OK to take and stop taking when nec- pened in my life have made me who I am; essary without withdrawal effects. In fact, I they are part of me,’” she explained. “And if I only take this during hard winters now.” can help anyone by talking about what I have Her doctor also recommended exercise and gone through, then it’s worth it and important some "me" time,” she said. “Making sure to eat to speak up.” ■ healthy and be active were huge. There were
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ELLISSA CROWL, 32 A turning point “My family and I moved to Grangeville in February 2014. It was the middle of winter and we were trying to adjust to a new school, my husband’s new job, the instability of renting a home that was for sale, and we were 200 miles from our support system for the first time ever,” said Ellissa Crowl, 32 of Grangeville. “I wasn’t working at the time and the feelings of isolation were overwhelming. I wasn’t diagnosed with depression, but I definitely struggled to feel happy and joyful about our new situation. It wasn’t until nine months later that I met three incredible women who really helped me feel a sense of community.” During that time, she said she enthusiastically
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adopted the much slower pace Grangeville offers. “I walked everywhere and rarely drove because there wasn’t a need. In the spring of 2015, while on a trip to visit family in Boise, I had a panic attack on the freeway stretch between Payette and Nampa where the speed limit had been raised to 80 mph,” she recalled. “I figured that it was just a random occurrence, but even my attempts to drive within Boise produced the same issues with all the traffic. It was devastating that I was unable to successfully drive around my hometown. Nothing like that had ever happened before and I was convinced that my inability
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Continued from page 2 to prevent these attacks made me a liability to my family so I gave up driving entirely.” Crowl said she felt unhappy and felt as if it was impacting every area of her life. “It wasn’t something I could deal with by not dealing with it. Often, I think our hesitation to discuss uncomfortable topics is self-imposed, so I started addressing it,” she said. She was able to talk to not only her husband, but also open up to her girlfriends and, as it turned out, she said, they’d had their own struggles with anxiety and feelings of inclusion. “That was a huge turning point for me,” she said. She began to practice driving when she was alone. She made it a little further each time, pulling over as necessary. “I researched breathing techniques and pressure points, I journaled and I crocheted to relax,” she said. “But not being able to leave Grangeville convinced me that I needed to talk to my physician.” She started with the lowest dose of an anti-anxiety medication, which she said was difficult at first. She had trouble sleeping for the first few weeks and said she didn’t notice a decrease in her anxiety until she
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had been taking it for about two months. “But changes became evident over time and I felt really hopeful,” she explained. Throughout time she was able to come up with a driving plan that worked. Crowl checks in with her doctor at least every three months, and continues to spend time with her unofficial support group of friends. She also practices adjusting her perspective. “Something I’ve been doing for half my life, like driving, was something I took for granted until I couldn’t do it anymore,” she said. “Anxiety and depression can be crippling, so even little wins that help me see the progress I’ve made don’t go unappreciated.” It took Crowl a full year to be able to go grocery shopping in Lewiston and to finally make the drive to Boise without any issues. “Show yourself the kindness you would show a friend in the same situation, and be patient with your process,” she advised. “Intellectually, we can know that something is wrong but our brains are complex and it takes time to identify the root of an issue and how to begin correcting it.” ■
edge. I realized right away mouth swab done to provide something was not right. Peo- genetic testing. This revealed ple could look at me wrong – she has a genetic defect that even complete strangers -- and actually makes it dangerous I just had this extremely for her to take antidepresstrong desire to hurt them,” sants. she said. Now, she is exploring the Warden was scared and possibility of electric shock didn’t feel as if she could talk therapy. to anyone. She locked herself “I have been referred to Sain at home but when she con- cred Heart in Spokane. I am tinued to very scared f e e l about this worse, treatment s h e but I am sought tired of cryhelp from ing so a local much, or — REBECCA WARDEN, Grangeville having no clinic. “ B y feelings at this time all,” she I was sobbing so hard I could said. “My relationships with hardly talk, could barely see,” my friends and family have she recalled. “Because I did definitely changed and benot have a plan to end my life, come more strained as this has they could not help me and let dragged out so long for me.” me go home in that condition. Warden advises those who Finally, I became blessed. I have depression and anxiety was referred to an actual men- issues to search until they find tal health doctor at St. Luke's someone who can provide soin McCall where I was also set lutions with tools. up with a therapist. I immedi“It’s easy to get judged in a ately felt a connection with small community, so do not be her and for once I finally feel afraid to reach outside of the like, ‘someone gets me’.” community for help,” she said. Warden wants people to She also advises not to lay know that it is difficult for oth- blame on yourself. ers to understand how truly “We didn't choose for this desperate a person with de- to happen to us. In my case, I pression can be. truly believe it started with a “Someone ending their life birth control shot I was given is not selfish -- their mind has to help with some medical istruly convinced them the sues I was having,” she said. world would be better off “It completely threw my horwithout them in it,” she em- mones out of balance. I think, phasized. “They feel like they for me is just escalated from are doing their friends and there. Sometimes we try for so family a favor by ending it.” long to be strong and deal Warden’s issues have not with everything on our own been solved by medications, until there comes a point we which she has tried. She is cannot deal anymore.” ■ unique in that she had a
“We didn't choose for this to happen to us.”
REBECCA WARDEN, 38 Do not lay blame on yourself Rebecca Warden of Grangeville, 38, first found herself crying easily, feeling very uncomfortable around people and having a "pretty short fuse," she said, when it came to dealing with people. She was also tired all the time. Her issues progressed for the worse, including her body reacting to the medicine she was on. “I would be extremely nervous in the car. It did not matter if I was a passenger or driver. I found myself constantly thinking about things I wish would happen to me, to end my life,” she admitted. “At the beginning I didn't want to harm my-
self, I just wished something bad would happen, then it wouldn't be my "fault.” I also resorted to cutting myself to try and "relieve" some of the pain.” Warden said she was not very open with her friends or family about what was happening. “A few of my friends were aware of my feelings but did not know how to help me,” she said. She had a stomach issue she was hospitalized for and was given steroids when she had asked to not be treated that way. “I was truly put on the
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December 28, 2016
Ask our readers: Best Mobile Fitness App? BY DAVID RAUZI, EDITOR IDAHO COUNTY FREE PRESS Our mobile devices can keep us more connected for work and personal relationships, but as well they can be devoted assistants in maintaining good health habits and fitness regimes. Used on their own or in conjunction with a gym membership, they can help improve health and an overall feeling of wellness. But there’s lots to choose from out there. What to consider? We asked Free Press readers for their advice. Fitbit was highly recommended by several women: “To make me feel good with how many steps I walk in a day at work, even though my feet hate me when I get home.” – Michelle Mizerka-Peters. “I have the Fitbit app on my phone, it is paired via Bluetooth to the Fitbit device that I wear on my wrist 27/7 (yup, it’s waterproof in the shower). The Fitbit counts my steps and tracks my sleep.” – Shana Chung “Fitbit also has a huge food database so you can log what you eat, and it knows the nutrition information. It tracks calories in and calories out, sodium intake, fats, etc., and it keeps a running log, which is nice to look back at.” – Carla Nuxoll Wilkins What else? “My fitness pal! You can track fitness and nutrition progress, enter in food you ate, how much you exercised, your steps, water you drank, etc. It's nice. Also, a huge fan of the Fitbit app if you have a fit bit - it tracks a ton of different things including steps, heart rate, flights of stairs, food, sleep patterns, and more.” – Avery A. Russell “Fooducate is a free app that allows you to scan a barcode on food items and it shows a "grade" in green, yellow or red and it explains why that grade was assigned. It's quick and it saves me from having to try to read the tiny print on labels. When my family all gathered once, we scanned every snack on the table and we were all surprised at some of the results.” – Wilkins “When I didn't have a doctor, I used ‘Doctor on Demand.’ Your first visit is free and $40 thereafter. You have your camera on, and do have your face-to-face appointment via cell phone. Very convenient!” – Louanne Garland “We use Find Friends for figuring out how close to home the other is, but it is very helpful on long runs, bike rides, or other outdoor activities where you might get separated from your partner.” – Colleen Kelly “I use VOIP and have my doctor's personal cell phone numbers. So, when I go to see the specialists in Seattle or Spokane, the specialist will use my cell to call the docs and eliminate the middle man of calling clinics. It's awkward but eliminates the hassle of arranging to call at specific times when the specialists them-
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selves do not know when they can talk to my local doctors. It's worked wonderfully since my diseases are rare in the area and the specialists are far and few in between. For my personal health, I use paper for calorie and workout times then transfer to Excel so I can graph and see progress or plateaus. I do this with my medications and blood sugar since the meds I take can affect my blood sugar. Then I use Fitness Pal when I need to know how many calories I burned using a specific exercise.” – Reyna Phillips Some top recommendations off the web: • Runtastic GPS Running and Fitness app – a fitness tracker (distance, time, speed, elevation, calories burned; running leaderboard; live tracking and cheering from friends. • Zombies, Run! By Six to Start is an immersive running game and audio adventure. Works at any speed (jog, run or walk; even on the treadmill). Turns exercise into a game. Hear your mission and music through your headphones. If you’re chased by zombies, you’ll have to speed up! Collect supplies to build up your base. Track your runs and share your progress, and create your own missions. • Nike+ Training Club – provides personalized workouts and adaptive training plans. Workouts focus on strength, endurance and mobility, with easy-to-follow coaching. Share and compare fitness progress with friends. • 30-day Fit Challenge Workout by NorthPark – Take the 30-day challenge at home to improve health with scientific workouts. Detailed video guides. Increases exercise intensity step-bystep. Records training progress automatically, and reminds you to work out every day. • Ultimate Full Body Workouts by Insplisity – a home workout app for muscle building and weight loss. Can do with just a set of dumbbells or just your bodyweight alone. Workouts are balanced with warm-up, exercise, and a cool-down routine. Exercises based on sports science and are suitable for both men and women. Reviews complement the quick workouts that are helpful and easy to follow, and are effective. • Pregnancy Exercises by B6Squad Dev. – Provides pregnancy exercises and fitness plans, as well as routines to cope with labor and get back into shape after birth. Reviews note the exercises are illustrated, well-explained and comprehensive. • Daily Yoga: More than 50 classes shot in HD video are just a few taps away. Each sequence has a specific focus, from increasing flexibility to strengthening your core. Plus, there’s a library with detailed videos of more than 500 poses. ■
“I have the Fitbit app on my phone, it is paired via Bluetooth to the Fitbit device that I wear on my wrist 27/7 (yup, it’s waterproof in the shower). The Fitbit counts my steps and tracks my sleep.” – Shana Chung.
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December 28, 2016
New guidelines for frequency of screening C
BY JULIE HAMMATT, DNP SYRINGA HOSPITAL
ervical and breast cancer screening is an important part of maintaining women’s health, and new guidelines have come out discussing when and how often these screening examinations should be done. We are finding that more screening doesn’t always mean better outcomes. In fact, studies have found that cancer screening has led to many unnecessary tests and surgeries. With this said, it is still important to screen for cervical and breast cancer in women because early detection and treatment saves lives. Cancer screening guidelines are developed for women with average risk of cancer. Different organizations have developed cervical cancer screening guidelines, including the American Cancer Society (ACS), the U.S. Preventive Services Task Force (USPSTF), and the American College of Obstetrics and Gynecology (ACOG). The consensus is that cervical cancer screening should start
at age 21, regardless of the age of sexual initiation. Women age 21 to 29 should have a Pap smear every three years. Women age 30 to 65 should have their screening done every three years, and can extend this to every five years with HPV co-testing. After the age of 65, with an adequate history of negative Pap smear results in the past, cervical cancer screening is not necessary. Women who have had a total hysterectomy do not need to continue screening. If you have an abnormal Pap smear result, further testing and more frequent Pap smears may be indicated. Breast cancer is the second leading cause of cancer deaths in women. There in not as much agreement about breast cancer screening among professional organizations. At age 40, women should have a conversation with their primary care provider to evaluate when and how often they should have mammograms. Depending on your past medical and family history of breast cancer, screening may be started at age 40. For women at average risk of
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Fitness Tips
Stick to your resolution with tips from Parson BY DAVID RAUZI, EDITOR IDAHO COUNTY FREE PRESS GRANGEVILLE – Too tired? It’s boring? Not excited about the pain or discomfort? Tried it in the past and it just doesn’t do anything for you? Yes, those excuses are among the top for why people aren’t exercising. The negative factors push aside the benefits of exercise that are not only long-term in improving life quality but the short-term benefits that include improved energy, social interaction … and just plain feeling and looking better. As a group class ACE-certified (American Council on Exercise) instructor for The Gym in Grangeville, Jamie Parsons has heard the concerns; she literally feels your pain. “I’ve worked out all my life,” she said, and she knows what the mental obstacles can be in getting started on – or returning to – an exercise routine can be. So, here’s the often-asked question when women are thinking about exercise: What’s the effort involved in losing some weight? Well, let’s say you want to lose a pound a week; that’s 500 calories per day, discussed Parsons. “Make that a little more manageable,” by cutting out 250 calories per day in your diet and burning 250 calories in exercise. And on that exercise, make it a walk during your lunch hour or a half-hour workout class; again, something manageable for your schedule. “Activity managers are a big help. I really encourage it,” Parsons said. Fitbit and activity apps for your cell phone, while they’re not 100 percent accurate, “It’s better than guessing,” and they can be a motivator to meet goals and a reminder in the first place on fitting
exercise into the daily routine. But what is a good, manageable exercise routine? “150 minutes a week of moderate activity, such as walking at a brisk pace,” she said, an activity that increases your heart rate but that you should be able to talk comfortably during it. Moderate exercise can be 30 minutes a day for five days – two examples: walking on a level surface at three to 4 MPH, or even moderate housework -- and then two days of strength training. The point here to encourage activity is something not so structured; something that you enjoy or can be involved with that doesn’t fit the boring mold of standard exercise. Senior fitness is a specialty for Parsons, who pushes strength training in this area, specifically as prevention for osteoporosis, but overall to maintain activity levels. “Bone mass peaks in your 30s,” she said, and from here it can start to decline if strength training isn’t maintained. This can result in brittle bones, increasing chance for injury. “One of the top reasons people enter assisted living homes is they can’t go to the bathroom on their own,” she said, and one of the simplest exercises they can do to prevent that atrophy is squats: getting up and down out of a chair, unassisted. This is a simple exercise someone can do that, along with hand weights, can strengthen legs. “Two days a week you should be doing muscle building,” she recommended, resistance exercise with weight or free-weight machines, using the rubber band to pull against for arm and leg training, pushups, and even lifting your arms up with weights. And work those reps. So, for example, eight squats for three times, and then when that is comfortable, do 10 squats for three and then 12 for three. Same for weight training; work on reps until they become comfortable and then increase the weight and begin the 810-12 repetition again. “Age shouldn’t be a factor,” she said. You are never too old to start
or to start again, and you can strength train and gain that muscle back; “It can be built back up.” Exercise is different for men versus women. Parson explained men focus on the task of the workout; they don’t need a lot of guidance or structure. She sees women needing more structure but also not in repetitive “boring” patterns, that they enjoy the encouragement within the group to push themselves with what they see others achieving, “and they love the camaraderie.” So, within her classes, Parsons will vary exercise patterns and keep the session fresh each time, keeping the activity new and engaging while maintaining workout goals. “Fitting it into their schedule … they don’t have the time,” Parson said, is a top excuse for not exercising. So, start off with a 10-minute walk during a lunch break, and do this walk three times a day. Or find other activities you can be doing that increase heart rate and provide activity that are manageable to your schedule: walk or ride a bike to work, park farther away from a store entrance and push yourself to walk more. Break up your activities into more manageable exercises throughout the day. Before starting any exercise routine, Parson advised to consult with your doctor on what is best for you, especially for persons with special medical needs such as diabetes or high blood pressure. This doesn’t mean you shouldn’t exercise, but that your routine should be tailored to address your health concerns and avoid aggravating existing physical conditions. Exercise shouldn’t be boring or a chore, she said. Not excited about traditional exercise? Find something active you enjoy to do, “but it should be something beneficial and easy to do,” she said. “As we’re living longer and longer these days,” she said, “we want to stay strong and as healthy as we can.” ■
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