Get in Shape in 2021

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by Dr. Ryan Stempniak, Resident PGY 1- Heuser Family Medicine Center

The new year is here which means New Years resolutions. For many of us that means introducing more exercise into our daily routine. Due to the pandemic, going to the gym may not be the ideal choice of exercise for a lot of people so I wanted to share some safe ways to get back into shape and provide some information to help you feel safer and healthier in this new year.

Tips for getting in shape:

  • The American Heart Association recommends getting at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or both spread throughout the week. This equates to about 20-25 minutes per day of walking or riding a bike, or 10-15 minutes of running, hiking uphill, fast walking or swimming per day.
  • For school aged children and teens the recommendation is 60 minutes of moderate-intensity to vigorous exercise per day, and for toddlers about 3 hours of active play on their feet each day.
  • Although being outdoors may pose less of a risk of contracting COVID 19, remember to keep at least 6 feet apart from others while exercising and wearing a mask while exercising may better prevent spread through aerosolized particles. Avoid crowds and close contact with others and take advantage of the beautiful Arizona weather and countless walking trails throughout the valley.
  • According to the American Heart Association, CDC, and Mayo Clinic, physical activity can help lower the risk of heart disease, stroke, type 2 diabetes, high blood pressure, obesity, dementia and Alzheimer’s, several types of cancer, and some complications of pregnancy. It can also improve sleep, memory, bone health, balance and symptoms of depression and anxiety.
  • Strength training or lifting weights can help strengthen your muscles and bones and prevent falls and osteoporosis. Some weight replacements that can be used around the house include canned goods, gallons of milk, laundry detergent or bottles of water. Also remember to assist your bone health by enjoying some of that Arizona sunlight which provides Vitamin D, and spend 10-20 minutes daily in sunlight (while wearing SPF 15 sunscreen or higher of course).
  • Be sure to contact your primary care provider for additional tips on how to get fit this new year and how to find the right exercise plan for you. Ask your provider about additional diet tips from our wonderful Nutrition team at your next visit as well.

Although 2020 has been an unprecedented year, there is hope on the horizon with the new vaccine. Continuing to wear masks, washing hands, and social distancing will ultimately be our best bet to a safer and healthier 2021. For more information about Arizona’s current COVID numbers, precautions, restrictions and more, visit the Arizona Department of Health Services Coronavirus page.

I hope everyone has a safe, healthy, and exciting new year!

Ask the Expert: COVID-19 Vaccine

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Alicia Ottmann, MMS, PA-C | Director of Advanced Practice

COVID-19 has been part of our lives for almost a year. With the welcome news of a vaccine, there is a lot of information to understand. That’s why NOAH’s expert, Alicia Ottmann, NOAH’s Director of Advanced Practice, answered some of the most popular COVID-19 vaccine questions.

When will the vaccine be available?

There are a few different versions of the COVID-19 vaccine, all in different phases of development or use. Currently (as of Dec. 22), the Pfizer and the Moderna vaccines have both received emergency use authorization by the U.S. Food and Drug Administration and are starting to be distributed and administered to people who need it.

The federal and state governments have categorized groups of individuals who will receive the vaccine first, these people are the highest risk for contracting the virus or developing complications as a result of infection. Examples of those who will be vaccinated first include healthcare providers and long-term care facility residents.

The next group will include people who are at increased risk of getting severely ill or who are more likely to be hospitalized if they contract COVID-19, this includes the elderly and essential workers such as bus drivers, teachers and grocery store workers. After that, the people that the CDC identifies as needing to take extra precautions – those who are undergoing cancer treatment, living with a chronic disease, etc. – will likely be next. The priority categories are similar from state to state, but subcategories and the rate at which they move from phase to phase may have some differences depending on where people live.

Vaccinating millions of people can take time, so for those individuals in the general population, who do not get vaccinated as part of the first priority groups, vaccines will likely not become available until spring of 2021 or beyond.

Can I get vaccinated at NOAH?

NOAH doesn’t have the vaccine yet. The vaccines have arrived in Arizona but are not available for us to order just yet. We are planning on offering multiple easy ways to get vaccinated, which might include drive-up appointments or drive-through events so patients can avoid coming into the clinic.

Keep checking the NOAH COVID page for updates about the vaccine, testing and other COVID news in Maricopa County.

How will I know when the vaccine is available for me?

If you are in one of the categories that will get vaccinated first – healthcare worker, frontline employee – then you will be contacted by whatever entity has been tasked with serving your employer. For example, healthcare workers, teachers, EMS, etc., all get assigned to geographic groups. The organization in charge of that group will be responsible for scheduling all of those who are interested in getting vaccinated.

People who are high-risk or who qualify because of their age will likely be assigned to one of these geographic groups, or will be provided with vaccination sites that they can go to (the details are still being worked out).

How do register for the vaccine?

If you qualify to get the vaccine because of your job, your employer will send your information to the responsible organization and they will contact you when it is time to schedule. The health department is working on the process for the remainder of the priority groups (1b, 1c etc.).

Different zip codes have different groups, or pods, that manage that information. For example, if you work in healthcare in Mesa, you will have a specific site where you will get vaccinated.

After the highest risk individuals are vaccinated, the general public will likely be able to get the shot at primary care offices or specific pharmacies.

Will we have to take it every year like the flu shot?

At this time we are unsure. We have recently seen some changes in the virus, similar to what happens with different strains of the flu year to year. At this time the vaccine is still effective, but scientists are learning more about COVID-19 all the time.

Is the vaccine going to work?

The COVID-19 vaccines currently available do not use a live, weakened virus, unlike many of the other vaccines we are familiar with. Both vaccines currently available are about 95% effective. This means that after someone gets both doses, they will develop an immune response that will fight off the virus the majority of the time.

However, we need around 70-80% of the population vaccinated to reach herd immunity which will allow us to recover from the pandemic and the strain that it has placed on our systems. Herd immunity helps to protect our entire community, especially those who cannot get vaccinated. It’s also worth noting that right now, the vaccines aren’t authorized for children.

Will it be effective if children can’t get the vaccine?

The reason we are not able to vaccine children under 16 years old is because not enough studies have looked at the safety and effectiveness in children. Those studies are currently underway, and it is a rigorous process. Since we know it is safe for adults, we have now started looking at children, pregnant women and other populations with the hope of expanding the number of people who are candidates. It will just take more time for it to be authorized for widespread use.

What will the vaccine cost? What if I don’t have insurance?

There is no cost for the vaccine. If you have insurance, it will be billed to your insurance company, but you will not be responsible for any portion. If you don’t have insurance, there will be no cost to you as it will be covered by federal funds.

What if I get one dose and miss my appointment to get the second?

Unfortunately, if you miss the window for taking the second dose, you may have to start the vaccine process over. The effectiveness of the vaccine hinges on getting it at the right time, the studies have not looked at huge differences in timing and thus we are unsure about whether you would need to start over, or if you could get the second dose outside of the recommended window of time.

Also, it is important for you to get your second dose from the same vaccine manufacturer. If the first dose is the Pfizer COVID vaccine, then the second dose also has to be Pfizer. No switching or mixing allowed.

Will this vaccine alter my DNA because it uses mRNA?

No, it won’t alter your DNA as it never enters the nucleus of the cell. The science used for the mRNA COVID vaccines has been used safely for other medical purposes for over a decade, but COVID-19 is the first time the science has been used in widely distributed vaccines. The way it works is, instead of giving our bodies a weakened virus or portion of a pathogen to trigger our immune system to make antibodies like typical vaccines, the mRNA process is giving our body the “recipe” to make the proteins which trigger an immune response (antibodies).

And, the good news is that the process to manufacture the vaccines is faster and looks to be highly effective, maybe more effective than traditional vaccine methods!

Check back with NOAH for more updates about COVID testing and vaccines and your other healthcare needs.

Chocolate Covered Anything Day – Benefits of Dark Chocolate

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Do you love a good piece of chocolate? While milk chocolate is fine to enjoy occasionally, it tends to be higher in sugar and fat. However, there may be some great benefits to adding a bit of dark chocolate to your diet a few times a week. To get the benefits, the chocolate needs to have a cocoa percentage of around 65-80%.

While dark chocolate is a product higher in calories and fat, it also contains the following important nutrients:

  • Fiber – normal digestion and managing blood sugars.
  • Iron – delivers oxygen throughout the body and maintains hair, skin, and nails.
  • Magnesium – important for nerve and muscle function, a healthy immune system, and keeping bones strong.
  • Copper – may help prevent cardiovascular disease and osteoporosis.
  • Manganese – supports bone health, is an antioxidant, and plays a part in blood sugar regulation.

Dark chocolate is rich in antioxidants, which protect against cell damage from a variety of sources, such as inflammation, pollution, and exposure to other chemicals; and eating processed or refined foods, trans fat, and artificial additives. This form of chocolate, along with other antioxidant rich foods (like fruits, vegetables, nuts, and green tea) may help in reducing the risk of cardiovascular issues and lowering cholesterol.

Remember – even with these benefits, it is still essential to practice portion control with dark chocolate and maintain an overall balanced eating plan with fruits, vegetables, whole grains, lean proteins, and healthy fats.

Try this amazing Dark Chocolate Cinnamon Coffee recipe that’s perfect for entertaining or to have on a cold winter’s day!

Ways to Celebrate Family Caregivers

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While National Family Caregiver Month is recognized in November, it’s important to acknowledge that caregivers deserve to be honored, appreciated, and supported all year. Being a family caregiver over the last two years has been different than in past years.

Caregivers who help family members, friends, or loved ones who are aging in place or dealing with an illness (or both) give so much of themselves year-round. How can you celebrate a caregiver in your life? We have some ideas.

First, understand that caregivers face stress and concern. Caring for older adults and people with chronic illnesses or diseases can be hard, often involving long hours, physical labor, and emotional strain. The constant responsibility can lead to burnout, affecting their own health and well-being. Balancing caregiving duties with personal life, work, and other responsibilities adds to the challenge. The emotional toll of watching a loved one struggle with health issues, combined with the fear of doing something wrong or not being able to provide enough care, can be overwhelming.

This gives everyone even more reason to celebrate these individuals throughout the year! Here are some ideas:

  • Food is always a welcome choice: If you can order meals to be delivered or drop off something for the caregiver so they don’t have to cook for themselves later, it will be a welcome gift.
  • Help stock their supplies: If you know what they need to provide care, you can help out with extra supplies, or even books, games, puzzles, or other activities the patient or caregiver enjoys.
  • Personal pampering for caregivers: A personalized coffee mug for the coffee lover, a calming candle for the caregiver who likes to create a peaceful space, a journal for the writer, and lotion for everyone – because we are all (thankfully) washing our hands a lot more – are all great ways to show appreciation.

Everyone loves a thoughtful gift, but showing gratitude and understanding for the hard work caregivers do every day is one of the nicest ways to celebrate them all year round.

Getting Clean During Handwashing Awareness Week

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During 2020, we have heard experts, healthcare providers, friends, neighbors, and even our own young children talk about the importance of handwashing. While living through the COVID-19 pandemic has put handwashing at the top of everyone’s to-do list, we are here to celebrate how this one action has helped keep us healthy for years, and will continue to keep us healthy long after 2020.

Handwashing is an easy step to take throughout the day and has shown to be one of the best ways to keep germs from spreading, which is a big reason to celebrate! It is easy, effective, and already part of our daily routines.

A few rules of handwashing can help make sure you and the people around you are healthy and safe from germs.

1. You need soap.

Handwashing has to include soap. Rinsing hands might get dirt or something sticky off your hands, but the germs that can spread diseases and illnesses will still be there. If there isn’t soap nearby, use hand sanitizer.

2. Any kind of hand soap will do.

You don’t need to use antibacterial soap. Regular hand soap does the job without some of the added chemicals that you really don’t need.

3. Wash every part of your hand.

To get the benefits of washing your hands, you really have to wash your whole hand. According to the CDC, that means lathering hands well with the soap and making sure to wash the backs of your hands, between your fingers, and under your nails.

4. Take your time.

The amount of time you should lather soap around all parts of your hands is 20 seconds. You can hum (or sing!) the “Happy Birthday” song which is about 20 seconds if you need a little help remembering. Then, rinse for 10 seconds. This ensures all of the soap and the germs are rinsed off your hands.

Remember, washing your hands is the best way to keep yourself and others healthy. Let’s celebrate the easy and effective way to prevent the spread of illnesses this week and always.

Wash your hands!

Keep Your Mask. Ditch Your Acne. Tips for Combating Mask Acne

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By Karina, Luera, DO PGY-1 Heuser Family Medicine Center

Is your mask causing acne breakouts? Wearing masks can trap heat, sweat, and bacteria on your face, making it an ideal place for skin breakouts. Even though we must continue to wear masks to protect ourselves, our families, and our communities, there are still plenty of ways to keep your skin happy and healthy.

  1. Drink water and eat healthily.

    That’s right, the first tip to healthy skin starts within. Make sure you and your skin stay hydrated by drinking a minimum of 64 ounces of water a day. Also, make sure to eat a well-balanced diet that contains the vitamins and nutrients your skin needs to thrive.

  2. Wash your face every day.

    You should have a daily habit of cleaning your face with a gentle cleanser. If your acne is not improving with this regimen, you may need a medicated cleanser, so talk with your doctor about finding the correct regimen for you.

  3. Don’t forget to moisturize.

    Living in a dry and dusty desert can take a toll on your skin, so be sure to keep your skin hydrated on the outside too by applying a daily moisturizing cream.

  4.  Catch those Z’s. 

    When we rest, our skin is actively repairing itself, so don’t skimp on sleep. Aim for 7-8 hours of sleep each night to give your skin plenty of time to rejuvenate.

  5. Shield from the sun. 

    Too much sun exposure can be irritating to your skin. Your daily moisturizer should contain sunscreen to protect you from those harmful UV rays. Also, when you spend time outdoors, wear a hat to shade your face from the sun.

  6. Hands off.

    Although it is tempting, you should never pick at your pimples. Touching your face spreads bacteria and causes more irritation, which will make your breakouts worse.

  7. Wash that mask.

    If you’re using fabric masks, then they need to be routinely washed to get rid of the bacteria on them. If possible, wear a clean mask every day.

Masks will continue to be an important part of our community effort to stop the spread of COVID-19, but acne doesn’t have to come along with mask-wearing. Follow these tips and if you’re still struggling to control your breakouts, come see us at the NOAH Heuser Family Medicine Clinic. We are happy to help you find a personalized skincare regimen that will keep you healthy, inside and out!

Crohn’s and Colitis Awareness Week

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By Stephanie Olzinski, RDN

Crohn’s Disease and Ulcerative Colitis (UC) are both forms of inflammatory bowel disease (IBD) that cause inflammation in the gastrointestinal tract. People with these conditions can have moderate to severe symptoms and Crohn’s and UC currently affect over 780,000 and 900,000 Americans, respectively. Some people may go undiagnosed, however knowing the symptoms can help you determine which you suffer from and how to get help.

UC is characterized by affecting the large intestine and rectum whereas Crohn’s can affect any part of the gastrointestinal tract, but commonly at the site between the small and large intestines.

When examining symptoms, most people experience:

  • abdominal pain.
  • bloating.
  • inflammation.
  • diarrhea with or without blood and/or mucus.
  • weight loss.
  • anemia.

Nutrition plays a large role in managing symptoms of Crohn’s and UC as some foods or beverages can either help or worsen symptoms. Meeting with a Registered Dietitian at NOAH can help with determine the right personalized plan for you.

For Crohn’s disease, some people need a higher calorie and protein diet to maintain nutritional needs. Certain fibers should be limited, as well as fatty and spicy foods. 

For UC, consume more:

  • fibers from whole grains, fruits, and vegetables.
  • probiotic foods like yogurt and sauerkraut.

The same triggers for Crohn’s can affect those with UC as well. Recording a journal that highlights foods/beverages consumed alongside the types of symptoms and when they occur can be great to review with your dietitian. He or she can determine what triggers your symptoms as well as provide recommendations of a healthy diet that fits your specific needs.

How Important is Healthy Skin?

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Did you know your skin is the largest organ in your body? Your skin protects you, tells you a lot about your overall health, and it grows and changes with you throughout your life. Our skin has a big job to do, which is why keeping skin healthy is so important.

Here are some useful tips to keep your skin healthy at every age.

Pay Attention to Dry Skin

Dry skin can be the result of environmental factors, or it can be because of what is happening inside our bodies. Either way, pay attention to it and hydrate your skin. Drinking a lot of water – 8 glasses – throughout the day, is one of the best things you can do for your skin (and other parts of your body!).

Dry skin can also become a problem if not treated with itching, flaking, even bleeding from dry skin. Many of us in Arizona have to deal with “hard water”, or water heavy in calcium and magnesium. This can make it harder for soap to wash off your skin, so spend a few extra seconds rinsing your hands, face, and body. Moisturize with ointments, creams or lotions after showers, baths, and handwashing, but make sure they don’t contain alcohol which can have the opposite effect.

Baby’s Skin Can Have Different Needs

Babies are a wonder, and so is their skin! Baby acne, birthmarks, diaper rash, hives, eczema, and others are common in babies, but they are things all new parents and caregivers should be familiar with. The American Academy of Dermatology Association has detailed information about these conditions and many more. If you ever have questions about your baby’s skin, talk to your NOAH provider.

Protect Your Skin from the Sun

The great news is that sunscreen is both the easiest and best way to protect your skin from harmful ultraviolet rays. Try for SPF 30 and wear it all year on whatever part of you isn’t protected by clothing – think hands, arms, face. Sun can cause skin aging and increase certain types of skin cancer.

Everyone deals with some types of skin troubles during their life. Whether it is acne, blackheads, rashes, or dry skin, it is helpful to know how to protect your skin and when it’s time to call your provider. If you have any questions, make an appointment with your provider.

Healthy Eating Tips for Living with Diabetes

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Diabetes can be managed and treated with medicine and changes to what you eat and drink. People living with diabetes need to give their body a little help by being proactive.

For someone diagnosed with diabetes or at risk of developing diabetes, making changes to what and how much food they eat can have a big impact. These tips will help people make good decisions about what to eat and how much to eat.

Tip #1 – Portions Matter

In a lot of ways, portions can be deceiving. Larger portions at restaurants and even larger plates in our own kitchens can mislead people about how big their portions should be. A few decades ago, the average American dinner plate was nine inches, today they average around 12 inches.

Diabetes portioning

When you plan out your meals and snacks, a good way to measure the portions is using your hand or basic measuring cups. Here are some examples:

  • The palm of your hand is a good measurement for meat, seafood, and poultry.
  • A cupped hand, about ½ cup, is the right amount of pasta, potatoes, chips, and nuts.
  • At least one heaping cup, or both hands cupped together, for vegetables like tomatoes, cucumbers, spinach, and more.
  • For fats like butter or olive oil, use about a tablespoon per meal.
  • About 1 cup, or a fist, is the amount of milk, fruit, rice, beans, soups, yogurt.

Tip #2 – Swap Your Proteins

Protein is an essential part of a healthy diet. The types of proteins eaten, though, are not all the same in their health benefits. Keep the portions from above – about the size of the palm of your hand – and consider which proteins are best.

Best ProteinsProtein to Limit
ChickenFilet mignon
Turkey/lean ground turkeyPorterhouse
Pork SirloinRib eye steak
Fish (not breaded or fried)Ribs
ShrimpPork belly
CrabHotdogs
Tofu or soyBacon
Yogurt (low sugar or plain)Chorizo
Eggs (max 7 yolks/week)Corned beef
Low fat (93/7) ground beefPastrami
Lean beef cuts – names with “loin” or “round”Any fired or breaded meat, chicken or fish
Beans and lentils 

Tip #3 – Feel Free to Snack

Snacks are good! Don’t deprive yourself of nutritious, energy-boosting snacks, especially when you are living with diabetes. There are plenty of ways to enjoy something mid-day without sacrificing health or flavor.

The important thing about a well-chosen snack is that it can be both filling and nutritional. A few snack-specific tips:

  • Think of snacks like mini meals when it comes to portions.
  • Do not snack when bored or while multitasking.
  • Snacking shouldn’t be an everyday habit.
  • Only eat snacks when you are hungry.

If a snack is needed to prevent low blood sugars, talk about this with your doctor or provider.

Here are a few good snack options for you to try.

Diabetes Snacks

Tip #4 – Not all Drinks are Equal

Don’t let what you drink ruin your day. The best drink is always water. It has no calories, carbohydrates, or sugar, and your body will thank you for drinking plenty of water every day. Sometimes, though, we all want something a little different, with a little more flavor.

Many drinks from restaurants or grocery stores are full of a surprising amount of sugar, calories, and carbohydrates. Some ways to take control:

  1. Bring your own drink. Whether it is water, coffee, or something else, if you bring your own with you, you won’t be buying something that could have high amounts of sugar and calories.
  2. Instead of getting pre-sweetened tea, get unsweetened tea and add your own – much less – sugar, or natural substitutes to sweeten it.
  3. Juice can be loaded with sugar and carbohydrates. Consider eating a piece of fruit instead. If it must be fruit juice, cut the juice with water and strictly limit the amount you drink.
  4. Coffee and tea lattes and similar type drinks taste so good and may appear a safe choice – tea is healthy, right – but how these drinks are made changes whether they are a healthy option. Limit sugar, creamer and syrups added.
  5. Smoothies can be a healthy and efficient way to get loads of fruit, which is an important part of a healthy lifestyle. Don’t rely on store-bought, pre-packaged smoothies to be low in sugar or carbs, though.
  6. Soda, pop, Coke, no matter how you say it, these drinks are loaded with sugar. In fact, a regular soda can have more sugar than two servings of ice cream!
Diabetes Drinks

Getting a diabetes diagnosis can be a big transition for the person diagnosed and their family. Working with your doctor, healthcare provider, nutritionist, family, and support system together will make changes easier to stick to and improve your health. For more tips on living with diabetes from NOAH, click here.

Celebrating Thanksgiving in 2020

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This year we have experienced many changes, from the way we celebrate birthdays and graduations, to elbow-bumps in place of handshakes. One of the more challenging differences of living through a pandemic, though, is going to be the holiday season, starting with celebrating Thanksgiving.

Typically, people travel to see family and friends, visit multiple homes on Thanksgiving and the days around it. Many people enjoy getting out with friends to local bars and restaurants. None of that, however, is safe in 2020 with COVID-19 increasing it’s hold on our communities and our health.

Celebrating Thanksgiving in 2020 may not be what we are all used to, but it can still be full of good food, friendly faces, and happy memories without risking anyone’s health and safety.

Tips for Thanksgiving 2020

  • Hold a Thanksgiving dinner just for your immediate family in your home.
  • Enjoy the beautiful Central Arizona weather and visit neighbors outdoors and with some distance between you.
  • Share your favorite recipes with friends and family, rather than making and bringing food to a big group Thanksgiving.
  • Delivering meals to isolated friends, family, or others in the community in a safe way.
  • Virtual Thanksgiving dinner with loved ones near or far.

Remember, that while health is critically important with COVID around, we also need to take care of our mental and emotional well-being. Seeing faces on screens and hearing voices over the phone doesn’t take the place of in-person holiday gatherings, but it is much better than not having that interaction at all. Relationships and seeing people you love – even on a screen that has grandma’s thumb covering it half the time – are so important.

Enjoy and embrace something new when you celebrate Thanksgiving, and remember to call, text, video chat, and safely visit (with masks or at a distance) with people you care about. If you need additional support from a counselor or community resources, reach out to the NOAH team for more information about services to support you and your family so you have a happy, healthy time celebrating Thanksgiving.