Understanding Thyroid Disease

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The thyroid is a very important organ that – frankly – doesn’t get the attention it deserves, until something goes wrong, like getting diagnosed with thyroid disease. Here at NOAH, we want to turn our focus here for Thyroid Awareness Month.

What is the thyroid?

The thyroid is a small, butterfly-shaped organ in the front of your neck that wraps around your trachea (throat or windpipe). Its job is to create and release important substances to help your body function. In the case of the thyroid, its job is to release hormones that control your metabolism.

Why is the thyroid important?

The thyroid has an important job to do – regulating your metabolism. Your metabolism is how your body turns food into energy. When your thyroid is working correctly, you don’t think about it. It adjusts the amount of hormones it releases to meet what your body needs. Then, the thyroid creates more hormones and continues the process. Pretty nice.

But like with many things, we don’t notice or appreciate it when it works correctly. However, when the thyroid has trouble doing its job, the results can be serious.

What happens when the thyroid doesn’t work correctly?

Thyroid disease can be caused by two different types of problems with the thyroid: making too much hormones or making too little.

  • Hyperthyroidism is when your thyroid makes too much of the hormones needed to regulate your metabolism. Then, your body uses the hormones too quickly. It can cause people to feel anxious, lose weight too quickly, have trouble sleeping, and make your heart beat faster.
  • Hypothyroidism is when your thyroid doesn’t make enough of the hormones needed to regulate your metabolism. With too little hormone, you can also feel overly tired, gain weight, experience forgetfulness, and feel discomfort with cold temperatures.

Both are serious medical conditions and should be diagnosed and treated by your medical provider.

How do you get thyroid disease?

The risks for thyroid disease are broad and it effects around 20 million Americans. It can be genetic and passed down from family members, but other risk factors include having another medical condition. It’s worth noting that while anyone can have thyroid disease, women are five times more likely to be diagnosed than men, and people age 60 and older are also at a higher risk.

Are there diagnoses and treatments?

Because the signs and symptoms for thyroid disease can look like other illnesses, it is important to talk with your doctor if you have any new symptoms. Your medical provider will do physical exams and most likely blood tests to confirm a thyroid condition.

Treatments will depend on what type of thyroid disease you have and how serious it is. Most patients are prescribed medications.

Many people live healthy, normal lives with thyroid disease, but this thyroid awareness month it is important to learn all about it for yourself and for others. Working with your medical provider and integrated care team at NOAH will make it easier to navigate this or any other health concern or diagnosis.

Know More About Sugar

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By Brandon Bolton, Registered Dietitian Nutritionist

This week is Sugar Awareness Week. It is a time to spread awareness and prevalence of sugar and the damaging too much sugar can have our bodies. During Sugar Awareness Week, we should set a few goals to help reduce how much sugar we eat and drink – especially with added sugar. A great place to start is to understand sugar a little more. These healthy habits can carry forward for the rest of the year!

Natural sugars are found in foods such as fruit and milk. Added sugars are found in processed foods like soda, fruit juice, candy, cookies, cakes, breakfast cereals, condiments, and much more. A diet high in added sugars can cause weight gain and an increased risk of heart disease, type 2 diabetes, cancer, fatty liver disease, and much more.

The American Heart Association recommends most women consume no more than 24 grams of added sugars (6 teaspoons) daily, and men should consume no more than 36 grams of added sugar (9 teaspoons) daily. Children ages 2-18 should try to eat less than 24 grams of added sugar daily. For reference, the average person in the United States consumes around 71 grams of added sugar per day (17 teaspoons). Be sure to check your food label to get a better understanding of how much sugar is in your food.

Here are some tips on how to decrease your intake of added sugars:

  • Swap sodas, juices, sweetened teas, and energy drinks for water or unsweetened seltzers.
  • Drink your coffee black or use a zero-calorie sweetener such as Stevia.
  • Try plain yogurt and add fresh or frozen berries.
  • Consume whole fruits and vegetables instead of sugar-sweetened smoothies.
  • Replace candy with a homemade trail mix of fruit, nuts and a few dark chocolate chips.
  • Use olive oil and vinegar in place of sweet salad dressings like honey mustard.
  • Look for cereals, granolas, and granola bars with under 4 grams of sugar per serving.
  • Use natural nut butters instead of sweet spreads like Nutella.
  • Avoid alcoholic beverages that are sweetened with soda, juice, honey, sugar, or agave.
  • Shop the perimeter of the grocery store, focusing on fresh, whole ingredients.
  • Try to prepare meals at home, it can be hard to tell how much sugar is in foods when eating out.
  • Consume a diet that is rich in fruits, vegetables, and whole grains.
  • Check nutrition labels to see how much sugar is in your product.

If you have any questions regarding sugar or any other nutrition related concerns, please reach out to one of NOAH’s Registered Dietitians!

Healthy Weight Week: Healthy is More Than Your Weight

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By Mina Goodman, Registered Dietitian 

The name Healthy Weight Week can be somewhat misleading. What most people think of with “healthy weight” might be getting on the scale, setting a new weight goal, or starting a 2021 crash diet. This week is more so about finding your healthy weight which can be determined by making small and personalized diet and lifestyle changes. Although Body Mass Index (BMI) and weight changes might give us an idea of health, it is only one piece of the puzzle to a healthy life. That’s why it is important to recognize other factors that affect weight, health, and happiness.  

Instead of counting calories or restricting how much you eat, try these to help achieve to a healthy weight: 

  • Accept your body shape and size.

Each body is not the same shape and size, which may be important when setting expectations for realistic weight loss goals. It’s difficult to judge a book by its cover when it comes to health because it is assumed that people at higher weights are sicker or live shorter lives. Research has shown that people in overweight and obesity class I BMIs may have improved longevity compared with normal weight, underweight, and obesity class II or greater BMIs.  

  • Find movement you enjoy.

Exercise doesn’t have to be training for a marathon. Taking a walk with friends, family, or a good playlist is a good option. Experiment with online work out videos, swimming, biking, roller skating/blading, yoga, tai chi, gardening or other home projects, and whatever other activity you can think of. No matter your weight, physical activity is important to do on most days.  

  • Eat more fruits and vegetables.

Fruits and vegetables are full of fiber, water, vitamins, minerals, and energy for our body to use. Eating more whole and plant-based foods like fruits, vegetables, whole grains, beans, nuts, and seeds can reduce risk of chronic diseases and help to maintain or lose weight.  

  • Try to stress less.

If our bodies are in a constant state of stress, it can be difficult to maintain weight. Here at NOAH, we have behavioral health services like counseling and psychiatry to help manage stress, anxiety, and depression that may be affecting how difficult is to lose weight.  

  • Sleep quality matters.

Sleep is another factor affecting weight and health. Most adults need 7-9 hours of sleep per day and that should be quality sleep not altered by drugs or alcohol. Having a nighttime routine can help improve the quality of sleep. This can include turning off screens a few hours before bed or having a hot cup of herbal tea at the end of the night – you can make the routine your own or look online for other common routine tips and ideas.  

  • Drink enough water.

Most adults need at least half a gallon of water daily, which is 64 fl oz. Others may need up to a gallon per day. The body cannot work as well without being properly hydrated so look for ways to increase your fluid intake through herbal/sugar free teas, naturally flavored seltzers, or herb/fruit infused waters. If plain water works for you, try carrying a water bottle wherever you go, setting reminders on your watch or phone, or leaving bottles/glasses in places you usually sit or by your bed to start drinking first thing in the morning. 

Remember, being healthy isn’t necessarily about what the scale says. Many people can be healthy, or at least healthier, by making a few of these intention changes in their daily lives. If you want additional assistance, guidance, and support to living healthier, contact NOAH about our Nutrition Services.

Sleep Awareness Week – Healthy Sleep Hygiene

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By Katelyn Millinor, LPC | Behavioral Health Quality Manager

Healthy sleep, also known as sleep hygiene, describes good sleep habits. Guidelines and tips NOAH offers patients for better sleep comes from years of expert research and experience. And, while there are medications that can help with sleep, they are usually only helpful in the short-term. Your NOAH provider can talk about the best ways to get better sleep, but in general, we recommend healthy sleep hygiene as the main most important step.

Healthy Sleep Tips

  • Consistency – One of the best ways to sleep well is to go to bed and get up at the same time every day (even on the weekends). This regular rhythm will help you feel better and help to set your biological clock.
  • Exercise – Regular exercise is a good idea regardless, but it also helps with sleep making it easier for your body for you to fall asleep and have deep sleep. Avoid exercising 3-4 hours before bed time. Morning walks are a great way to start the day feeling refreshed.
  • Don’t Toss & Turn – If you cannot fall asleep after about 15-20 minutes, get up and do something calming or boring until you feel sleepy again (in another room if possible). Sitting quietly on the couch or reading something are good options.
  • Limit Light – Avoid certain lights before going to bed, particularly screens. Cell phones, computers, televisions, and other devices have blue light that disrupts sleep. Change the settings on your device to switch the light at a set time every night, and turn off overhead lights or lamps.
  • Don’t Watch the Clock – People who struggle with sleep often watch the clock too much. Frequently checking the clock can wake you up more and reinforce negative thoughts.
  • Eat a Healthy Diet – A healthy, balanced diet will help you to sleep well. But when you eat matters! Do not go to bed hungry because that can disturb sleep. Also, a big meal before bed can also disturb sleep. If you are hungry before bed, try a light snack and be sure to avoid greasy or heavy foods near bedtime.
  • A Bed is a Bed – Don’t allow your bed to become your kitchen, dining room, office or other multi-functional space.
  • Avoid Naps – Avoid taking a nap so you are tired at bedtime. If you must take a nap, make sure it is only for 20-60 minutes and is at least 6+ hours before bedtime, ideally no naps after 3 p.m.
  • No Alcohol, Caffeine, or Nicotine – If you plan to have caffeine, alcohol, or nicotine (cigarettes, cigars, etc.) don’t have any 4-6 hours before going to bed. These substances act as a stimulant and interfere with the ability to fall or stay asleep.
  • Fewer Beverages – Try not to have too many beverages in the evening. This will limit the night-time trips to the bathroom.
  • Set The Mood – The right environment is important. Your bed and bedroom should be comfortable for sleeping; a cool, quiet, and dark environment is best.
  • Shower or Bath – Having a hot shower or bath 1-2 hours before bedtime can help you relax and get a better sleep.
  • Routines – Having an evening routine before bedtime can prepare the body and mind for sleep. You can develop your own routine such as stretching, baths, or breathing exercises. Daytime routines are equally as important to having healthy sleep, so try to keep those the same.

As always, if you are trying these tips with little or no success, give your NOAH provider a call and we’ll gladly meet with you to discuss options in achieving a good night’s rest. At NOAH, we’ll work with you and your family to choose the best path for overall health and wellness. You may also request an appointment online.

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!