Better Health - March 2021

Dinosaur Jr. fall tour includes Northampton, Boston stops, see masslive.com/entertainment

Better Health D

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TOLERANCE FOR PAIN: Robert R. Edwards, Ph.D., D3 BLACK ART EXHIBIT: Northampton’s Oxbow Gallery, D9 BOOK REVIEW: ‘The Border: A Journey Around Russia,’ D12

| SUNDAY, MARCH 21, 2021

Pregnancy DURING COVID-19

& Post-Partum Care

By Cori Urban SPECIAL TO THE REPUBLICAN

Vanessa A. Piris, of Springfield, gave birth to her son in February 2020 and is pregnant with her second child.

Her first birthing experience — at Mercy Medical Center — “was the best birthing experience,” so, despite the COVID-19 pandemic, she plans to deliver her second child there.

“From the nurses, staff, consultants, pediatricians, midwives and doctors, they were all so supportive and I can’t thank them enough. I’m confident that I will have the same experience this time around,” she said.

Yet, as a mother during this pandemic, she is concerned with the potential of being exposed to COVID-19. So it gives her peace of mind that the chief of obstetrics and gynecology and medical director of the Family Life Center for Maternity at Mercy Medical Center “ensures our safety is her priority.”

Piris is referring to Dr. Elizabeth A. Rottenberg.

To address patients’ concerns about delivery in the hospital during a pandemic, every patient and visitor is screened per Centers for Disease Control and Prevention guidelines and COVID testing is offered to every patient that is admitted to the Family Life Center. To ensure proper isolation and decrease risk of transmission to other patients, visitors and staff, there is a designated COVID labor room, post-partum room and nursery. All staff is provided appropriate personal protective equipment, and patients and visitors are required to wear a mask when in any public space, such as hallways.

“As far as patients’ concerns regarding whether they will be able to have a support person

during labor, we have made the decision to allow each laboring patient, whether COVID positive or negative, a support person throughout their stay,” Rottenberg said.

“We have also been offering some earlier discharges for those who request it, to get patients back to their families and support people.”

As the pandemic has continued, there has been a decline in birth rates at the medical center that compares to national trends. “This may be because fewer women and couples were choosing to get pregnant during the height of the pandemic since it was such a vulnerable time from an economic and emotional standpoint,” Rottenberg said.

Mercy Medical Center provides prenatal and post-partum care to the greater Springfield area. COVID has given staff an opportunity to re-evaluate some of the ways they can reach the women within this community and provide them with more options for prenatal and post-partum care.

One program is Mobile Mommas that allows women to obtain much of their prenatal care virtually, under the supervision of a midwife or physician. “This will enable working women, women who are home caring for their families, and women that may not have reliable transportation (to name a few examples) to receive the same level of care as women who are able, or would prefer, to come to the office for their routine obstetrical care,” Rottenberg said.

During the pandemic, Mercy Medical Center has continued to see obstetrical patients in the office; the offices are COVID-free zones.

“The only exception to this is if a pregnant patient is positive for COVID or has had

ultrasounds,” the doctor said.

“Sometimes partners FaceTime during appointments, and other times my patients will record the fetal heart beats to share with their loved ones as ways to work around this challenge.”

One concern for women after they give birth is post-partum depression, a condition that affects just under 10 percent of the population in the United States. “We diagnose postpartum depression using the same criteria used to diagnose depression in non-pregnant or post-partum people,” Rottenberg said.

Symptoms include loss of interest in daily activities; depressed mood most of the day, nearly every day; feelings of worthlessness or inappropriate guilt; or diminished ability to think or concentrate.

“Severe cases can be associated with thoughts of death or harming oneself or others,” Rottenberg cautioned. “As you can imagine, some of the more mild symptoms of postpartum depression are also present in completely normal pregnancy or post-partum courses, so it is important to distinguish whether what a Center: Dr. Elizabeth Rottenberg comforts 5-hour old Kinsley woman is feeling is due to Roman at the Family Life Center for Maternity at Mercy normal hormonal changes Medical Center, March 5, 2021. Above: This is a patient room at and stress or whether it is the Family Life Center for Maternity at Mercy Medical Center, something that requires interMarch 5, 2021. (DON TREEGER / THE REPUBLICAN) vention.”

If a provider identifies a patient that warrants, and a known COVID exposure,” According to Rottenberg, is open to, intervention for Rottenberg said. For these there have been no changes post-partum depressive symppatients routine obstetrics to post-partum patients’ toms, they may be prescribed visits are done over the tele- appointments. medications and provided phone; patients resume their From a guest standpoint, with a referral to the behavin-person OB appointments the medical center does not ioral health department for once the latency period has allow any additional people counseling. passed. in exam or waiting rooms.

“We provide a very supportIf a pregnant patient needs “This has been challengive environment and screen interventions or routine test- ing for both providers and patients at their intake, 28 ing while COVID positive, patients, as partners and weeks, and post-partum for they go to the Family Life family members have not symptoms that may warCenter for evaluation and been able to be involved with rant a further discussion or completion of these tests. prenatal appointments or intervention for depressive

symptoms,” said Rottenberg, who encourages women to discuss psychological distress with their obstetrical providers. “Being a new mother comes with many exciting, happy moments but it is OK, and normal, to not be happy all of the time during pregnancy and post partum. Talk to us about this; we are here to support women, either reassuring them that what they are feeling is normal and can be monitored or offering interventions to improve their symptoms and quality of life.”

For women who are pregnant but have not yet begun to receive medical/prenatal care for fear of the pandemic, the doctor emphasized there are many safe options for receiving prenatal care during this “uncertain” time. “All our offices are COVID-free zones, and all patients coming through our doors have been appropriately screened, per CDC guidelines. Our office staff has appropriate PPE, and all our waiting and exam rooms are sanitized after each patient.”

If there is still fear about entering a medical office during the pandemic, the Mobile Mommas option for obstetrical care is an alternative.

Rottenberg recommends that any pregnant or breast-feeding woman who meets criteria should receive a COVID vaccine. “The American College of Obstetrics and Gynecology, which is our national governing body, has recommended and deemed the vaccine safe in pregnancy and lactation,” she said. “The risk of getting COVID while pregnant far outweighs the risk of receiving the vaccine.”

For more information about Mercy Medical Center, go to trinityhealthofne. org/location/mercy-medical-center-1

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D2 | SUNDAY, MARCH 21, 2021

THE REPUBLICAN | MASSLIVE.COM

7

surprising

health

benefits of

walking

Folic acid and pregnancy

Folic acid is a B vitamin that the body uses to make new cells. Everyone needs folic acid, and the Centers for Disease Control and Prevention note that folic acid is especially vital for women before and during pregnancy.

That’s because folic acid can help prevent major birth defects like anencephaly and

spina bifida. Anencephaly is a serious condition in which a baby is born without parts of the brain or skull, while spina bifida is a condition that affects the spine. Spina bifida can contribute to potentially severe physical and intellectual disabilities. The CDC notes how important it is that women of reproductive age, even those who are not attempting to get pregnant, get 400 micrograms of folic acid each day. That’s because major birth defects of the baby’s brain or spine occur very early in pregnancy, typically between three and four weeks after conception. Many women are not even aware they are pregnant at that point, and that’s especially so for

women who are not trying to become pregnant. By ensuring they include enough folic acid in their diets, women of reproductive age can greatly reduce the risk of giving birth to a child with major birth defects. According to the CDC, most vitamins sold in the United States include 400 micrograms of folic acid, though it’s still best to read product labels and/or speak with a physician prior to purchasing a bottle of vitamins.

In addition, fortified foods, including some breads and breakfast cereals, contain the recommended daily amount of folic acid.

TrinityHealthOfNE.org

Dear Women’s Health Team, In 2014, we became parents. Then, 3 became 5. And Savannah makes a happy 6. You delivered us our family…and you will always be part of it.

Gratefully, Bob Benson

Individuals looking for a way to incorporate exercise into their lives need look no further than their own feet. Walking offers numerous health benefits to people of all ages, and it’s particularly beneficial to fitness novices. Walking can facilitate a transition between inactivity and increased intensity for those who may have been away from exercise for some time.

According to Dr. Thomas Frieden, former director of the Centers for Disease Control and Prevention, walking is “the closest thing people have to a wonder drug.” Any physical activity is a boon to personal health, and walking provides a host of benefits.

2. Boosts cardio endurance:

walked briskly for about an hour a day. Walking reduced the effects of weight-promoting genes by 50 percent.

Regular walks can improve cardiovascular endurance, which can help people progress to more rigorous physical 6. Tame cravings: People who have a sweet activity. tooth can take notice that 3. Burns calories: walking may steer people People can walk to burn away from overindulgence. calories and maintain or A pair of studies from the lose weight. The number of University of Exeter found calories burned will depend a 15-minute walk can curb on how briskly people walk, cravings for chocolate and the distance they cover, their reduce the chocolate conbody weight, and the terrain sumed in stressful situaon which they walk. tions. Walking also helped to reduce cravings for other 4. Improves sugary snacks.

cardiovascular health

The American Heart Association recommends adults get at least 150 minutes of moderate-intensity activity each week. Walking can fit that bill. Walking five days a week can reduce risk for coronary heart disease by roughly 19 percent, according to a report in the European Journal of Epidemiology.

7. Reduces joint pain:

Walking improves blood flow and helps protect the joints.

This can keep people from developing arthritis and other stiffness.

Walking has many health benefits that can support the entire body.

5. Counteracts effects of weight-promoting genes:

Researchers at Harvard Medical School looked at 32 obesity-promoting genes in more than 12,000 people who

1. Strengthens bones:

Walking can slow down the loss of bone mass due to osteoporosis. Arthritis.org notes that a study of postmenopausal women found that 30 minutes of walking each day reduced their risk of hip fractures by 40 percent.

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SUNDAY, MARCH 21, 2021 | D3

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THE REPUBLICAN | MASSLIVE.COM

Some high tech ways to

STOP snoring

Tolerance for

By Cori Urban

SPECIAL TO THE REPUBLICAN

When climbing into bed, no one wants to endure a snorefilled night of fits and starts.

Snoring may be inconvenient, but it’s more than just disruptive.

Snoring may indicate a serious health issue.

The American Academy of Sleep Medicine notes that snoring may be associated with obstructive sleep apnea, a serious sleep disorder and a risk factor for heart disease, diabetes, stroke, and many other health problems.

Men’s Health magazine says some 90 million Americans snore, with 37 million doing so on a regular basis.

Men are more likely to snore than women. Sometimes snorers can be so loud they disturb bed mates and even those in nearby bedrooms.

People who snore, and their loved ones who deal with the cacophony each and every night, are often on the lookout for ways to alleviate snoring. Despite an abundance of innovation in recent years, anti-snoring solutions have been slow in coming.

But technology continues to evolve, and some new

anti-snoring solutions have been developed.

· Track your overnight breathing.

Snorers can use tracking devices to see just how well they are sleeping each night. When worn at night, devices like Fitbit® can track breathing and will rate which levels of sleep a person reaches: deep, light or REM. It also records if a person awakens during the night, even when people do not realize their sleep was interrupted. This data can paint a clear picture of sleeping behaviors.

· Test snore ratings.

Smartphone users can use an app called SnoreLab to rate snoring. The app is left running next to a bed.

If it detects snoring, it will record an audio clip and rate the snoring on a scale that ranges from Quiet to Epic. The premise behind the app is that before snoring can be addressed, one must recognize that it is happening in the first place.

· Smart sleep masks.

The Hupros Sleep Mask is an example of a smart sleep mask. It works with a smartphone to detect snoring. Then the mask gently vibrates to encourage a person to change positions to open up airways and reduce snoring.

The mask also has a nose piece that will be engaged if a change of position doesn’t stop the snoring.

It delivers expiratory

positive airway pressure (EPAP) - allowing a wearer to breathe in through the nose, but making it hard to breathe out in the same way. This creates resistance meant to expand lung volume and reduce airway vibrations.

· Change positions.

Another device that is supposed to help a person change positions to relieve snoring is the Philips SmartSleep Snoring Relief Band. It straps around a user’s torso to monitor sleeping position. If snoring occurs, the device will nudge the snorer on his or her side, a position that is less likely to induce snoring.

· Go low tech.

While there are many digital devices that may help alleviate snoring, one option does not require a device. A new pillow, such as a wedge pillow, can slightly elevate the head, which may promote better breathing.

Snoring is problematic for millions of people. Turning to technology may help people get the rest they need.

Different people have different tolerance for pain.

“We don’t fully understand (why), but we suspect 20-30 percent of the variation is from genetic differences, and additional contributors include people’s past experiences,” explained Robert R. Edwards, Ph.D., an associate professor and pain psychologist at the Brigham & Women’s Hospital Pain Management Center.

For example, he continued, a person who works in a coal mine in Canada or as a porter helping people climb Mount Everest in Nepal, might have a greater pain tolerance than someone with less challenging physical job requirements. Similarly, a person’s psychological state can lessen his or her pain tolerance; if being tested in a lab by someone who makes him or her anxious, the person’s pain tolerance goes down.

Edwards attended the University of Alabama at Birmingham, completing a doctorate in medical psychology and a master’s degree in public health. He then completed a postdoctoral fellowship in pain psychology at Johns Hopkins before joining the faculty in psychiatry there. He began work at Brigham & Women’s Hospital in 2008.

Edwards is currently working on a study of chronic lower back pain, and he hopes to add 50-60 participants to the more than 200 enrolled in the study at Brigham & Women’s Hospital.

The Strategies To Assist with Management of Pain study concentrates on non-pharmacologic treat-

pain.

ments for pain and includes studies of yoga, acupuncture, meditation, exercise and physical therapy. “These can be really helpful for people with all sorts of pain conditions,” Edwards said.

“We usually describe our work as looking at ‘biobehavioral’ aspects of pain because when we look at how our studies help, we try to measure a variety of factors from the behavioral (for example, do people exercise more as a result of our treatments) to the biological (for example, do our treatments help to reduce peoples’ level of stress hormones, do they increase pain tolerance),” he said.

The study of chronic lower back pain he currently is working on involves an 8-week training program (eight weekly 2-hour sessions) to learn one of the two methods taught in the study.

The methods include training in cognitive-behavioral pain management strategies as well as meditation. “These methods are known to help many people better cope with chronic lower back pain and live a more fulfilling life,” he said.

Treatments are done remotely by Zoom, but participants may call in if they prefer.

Participants are randomly assigned one method.

Participants come from throughout New England and from all walks of life. “Back pain affects a lot of people everywhere, and lots of patients with back pain are looking for extra help with pain management,” Edwards said.

The study is enrolling patients with chronic back pain who are using opioid medications (for example

Percocet or Tramadol) for pain management.

This study may be a good fit for persons who

• Are interested in learning new methods designed to help manage your back pain • Are prescribed daily pain medication for your back pain • Are 21 or older • Experience daily lower back pain for at least three months • Agree to be assigned in a random way to learn one of the two methods to help manage pain.

“We hypothesize that both methods will help participants to reduce the intensity of their pain and to reduce the amount of pain-related limitations that they suffer from,” Edwards said. “The idea is to try to improve quality of life for people suffering from back pain.”

There is no cost to participate in the study; participants are compensated for their time and effort.

For more information, go to STAMPstudy.org.

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D4 | SUNDAY, MARCH 21, 2021

THE REPUBLICAN | MASSLIVE.COM

Stay safe when working in the yard this

spring & summer A day spent working in the yard is an ideal way to pass the time on spring and summer afternoons.

A pristine landscape can add value to a property and instill pride in homeowners who put a lot of thought and effort into their lawns and gardens.

A sun-soaked day can make it easy to overlook potential threats when working in a lawn or garden. But safety precautions are of the utmost necessity when working in the yard, where the risk for

serious injury is considerable.

Study hilly areas of the yard For example, the American prior to mowing so you Academy of Orthopaedic Surknow which areas are safe geons reports that, in 2016, to mow with a riding mower more than 90,000 patients, and which areas are best including nearly 5,000 chilmowed with a walk-behind dren, were treated in hospital mower. For greater control emergency rooms for lawn when using a walk-behind mower-related injuries. mower on an incline, mow Lawn- and garden-related parallel to the slope. injuries can be prevented without going to great lengths. · Apply and

· Know your terrain before mowing.

Knowing the terrain in your own yard can reduce the risk for accident or injury.

This can be especially important when mowing the lawn with a riding mower.

Adhere to manufacturers’ recommendations regarding inclines to reduce tipover accidents that can pin riders beneath the mower.

require a ladder. The Orthoutes before going outside pedic Institute of Pennto allow the sunscreen to sylvania reports that more bond to your skin. Reapply than 164,000 people are sunscreen at least every two injured each year falling off hours, and more often if a ladder. Ask a significant you’re sweating excessiveother or neighbor to hold ly. The SCF recommends the ladder in place while broad spectrum sunscreens, you climb up to reduce your which protect the skin from risk of falling. If cutting both UVA and UVB rays. large branches, cut them Though a product with a piecemeal to reduce the risk sun protection factor (SPF) reapply sunscreen. of being injured by heavy of at least 15 is acceptable Sunburns may not require falling branches. when walking the dog or trips to the emergency driving to work, the SCF · Inspect the property room, but they can still be advises using a product for insect hives. serious. In fact, the Skin with an SPF of 30 or higher The OIP notes that the Cancer Foundation notes when engaging in extendmost common insect stings that sunburn is a leading ed outdoor activities like in spring come from bees, cause in the majority of casgardening or mowing. wasps and hornets. Homees of basal cell carcinoma, · Employ the owners who are not careful squamous cell carcinoma buddy system. can inadvertently come and melanoma, which is the Use the buddy system across hives when doing deadliest form of skin canwhen pruning tall trees or spring cleanup, making cer. The SCF recommends performing any tasks that them vulnerable to bites applying sunscreen 30 min-

and stings. That can be very dangerous for anyone, and especially so for people with a history of allergic reactions to insect bites or stings. Inspect areas where you’ll be working to make sure insects haven’t put down roots in your property. If you discover any hives and are hesitant to remove them on your own, contact a local landscaping firm.

Lawn and garden accidents and injuries can be serious.

Thankfully, accidents and injuries are easily prevented when homeowners take a few simple safety precautions while tending to their lawns and gardens.

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