Category Archives: Integrative Medicine

David Rosen, MD, a critical care pulmonologist based in Bergen County, NJ, arrived home from a 3-day stint in the ICU. As usual, he changed his clothes in the garage, put them in a plastic laundry bag, and, clad only in underwear, he headed straight for the guest room shower.

Earlier that day, Rose had seen five patients very sick with COVID-19, in a hospital with only four ventilators. He was devastated by the agonizing situation that had ensued. How could he force a smile and pretend everything was okay when he greeted his young children? On the other hand, he didn't want to burden or frighten them.

Rosen's 6-year-old daughter could tell something was wrong. Rosen carefully explained that Daddy was sad because there were a lot of sick people in the hospital and he couldn't help all of them.

"There's a constant balancing act between being there for patients, acknowledging my own feelings about their suffering and the horrors I've been seeing, and being there for my own family and their day-to-day emotional needs," Rosen said.

While this balancing act is part and parcel of being a physician, it has been especially wrenching during the pandemic, when the needs of family seem to be pitted against the calling to be a doctor.

Fear of infecting children has motivated some to stay in hotels, send their children to live with grandparents, self-quarantine in a separate area of the house, or avoid physical contact with the children, according to Sara "Sally" Goza, MD, president of the American Academy of Pediatrics (AAP).

"These are hard, anguishing choices, which contribute to stress and burnout," she said, emphasizing that it is a very personal decision, based on individual and family considerations, and no single solution will fit everyone.

Rosen said that staying at a hotel was not an option for him because he has a newborn baby, a 3-year-old, and a 6-year-old. "It would have been an unfair expectation for my wife to shoulder all those parenting duties without any help from me."

He added, "Of course, I'm always concerned about potential contagion and I take every precaution through rigorous decontamination procedures, but I remind myself that it's right for our family for me to be as present as possible at this time."

Ilana Friedman, MD, a pediatric ophthalmologist, starts her workday well before she leaves for the Bronx, New York-based hospital where she is the associate director of a residency program.

"I've been setting the kids up for school in the mornings, making sure they have the food they need for the day, that they're organized and ready to begin their online classes, and that their schoolwork is done," she said.

"They also text me during the day if something comes up, and I check in with them to make sure they're on task with their work," reported Friedman, whose children are 10, 11, and 13 years old.

"When I'm at work, I'm thinking about the kids at home; but when I'm at home, I think about my patients, so I never feel fully present in either place," she said.

Even when you're home, you may not have emotional or physical energy to be present for children, according to Katherine Gold, MD, MSW, associate professor of family medicine and obstetrics and gynecology at the University of Michigan in Ann Arbor.

At the end of an intensive period in the labor/delivery unit, "I can't do anything but crawl into bed, so sometimes my kids fall behind on homework and chores because I'm the person in the family who tends to make sure these things happen," Gold recounted.

Conducting telemedicine visits from home often with young children underfoot has its own challenges. Although some practices are reinstating in-person patient visits, reopening amid COVID-19 often necessitates at least a partial work-from-home schedule.

"There's no question that it's disruptive to care for small children while trying to take care of patients," said Damon Korb, MD, a developmental pediatrician based in Los Gatos, California. How to navigate this depends largely on the age of your children.

It may not be realistic to have much telemedicine time when you're the caregiver to infants or toddlers; but for preschoolers, Korb recommended "stations in different parts of the room, such as specific areas for mushy stuff, balls, books, blocks, dress-up, and eating" and "rotating the child from station to station."

He also suggested "parallel play if possible, bring your computer next to them so they can be involved with their 'work' while you're involved with yours." For the sake of patient privacy, he suggested using a headset so the patient's words remain confidential.

Although child-related interruptions during a telehealth visit may be distracting, "it might be comforting for patients to recognize that their doctors also have challenges with children at home and that we're not doing everything perfectly which they may be experiencing in their own lives," Gold said.

By the time a child is 4 or 5 years old, you can set a timer and say that when the bell rings, you'll play with them for a few minutes or reward them for their cooperation, suggested Korb, who is the director of the Center for Developing Minds and the author of Raising an Organized Child.

Maiysha Clairborne MD, an integrative medicine physician who coaches other physicians in business and entrepreneurship, said her 5-year-old son has been home from school since the end of March. His preschool held classes 3 to 4 hours per day, and "that's been a big help in keeping him occupied and up with his schoolwork." She has organized for him to be "autonomous in class" while she conducts virtual sessions and coaches colleagues.

"I check up on him between patients and clients and have lunch with him as often as I can, make sure he has virtual play dates and activities such as arts and crafts, and I try to go on walks with him around the neighborhood," reported Clairborne, who is the founder of Stress Free Mom MDand the Next Level Physicians Entrepreneur's Institute.

When your children are in front of the screen, make sure they're doing so safely, Gold cautioned, noting that there has been an increase in online sexual predators since the beginning of the pandemic. "Regularly talk to your children, including teenagers, in an age-appropriate way, tell them not trust strangers online, and monitor their activities."

Gold suggested asking an older sibling, relative, or friend toengage with the youth on social media andbe the "eyes and ears"to ensure safety online.

Summer is usually associated with camp, sports, travel, and hanging out with friends. But how many of these activities can take place this year?

Some activities will be available, according to the CDC. For example, camps are allowed to open, with specific guidelines and protocols to prevent the spread of COVID-19. Experts recommend doing your "due diligence" to find out which group activities, if any, might be appropriate for your child, taking into account your own needs as well as those of your children.

But many physicians may prefer to keep children at home rather than risk sending them into group settings.

Korb encourages parents with children of all ages to maintain a daily structure. "Get up, get dressed, don't lounge around in pajamas all day, exercise each day, and do something social and creative."

He suggested making sure that kids have "outlets," like going for walks or hikes with the family, virtual play dates, or get-togethers with friends while keeping social distancing in mind or trying a new experience, such as guitar, cooking, gardening, or learning sign language.

Talking to children about social distancing and sanitizing requirements is especially critical as they begin getting together with friends in person.

"Even very young children can understand that 'germs' cause sickness and if you get too close to other people or touch things that they touch, you can catch the sickness," AAP's Goza said.

She recounted the story of a 5-year-old patient who proudly went to the sink in her office and began washing her hands "to make sure the germs don't get to us."

Rosen's 6-year-old daughter understands the importance of not getting close to people outside the family, and even his 3-year-old understands not to touch something lying on the ground.

"It empowers kids to know that they can help themselves and others stay healthy and safe," Goza said.

Even with the most creative alternative summer plans, children of all ages are facing disappointments about missed activities, missed milestones, and uncertainty about the future.

Korb's daughter, a high school senior, missed out on her prom, graduation, and visiting the colleges she had been accepted to. She still has not made a decision about college and does not know if colleges will even be open in the fall.

"This situation is difficult for all children, but especially for adolescents, whose identity is based on the friends they hang out with and what they do with them, and many are grieving the loss of their normal lives," Korb noted.

"When people are grieving, they have to grieve," he continued. "As physicians and parents, our job is to listen, not tell them what to do, not belittle what they're saying, but support them while they find their way through the situation."

Delaney Ruston, MD, documentary filmmaker of Screenagers and Screenagers Next Chapter, which focus on solutions for healthy screen use and adolescent stress, anxiety, and depression in the digital age, agreed. "Validation is the number one skill parents should master because teens want to be understood as much as they want anything."

"Most adolescents don't have a long-term perspective on what's going on in life, so it's important to provide reassurance and place things in perspective after validating their concerns and distress," Korb advised.

Taking a "big picture" view is also helpful. "I remember my high school and college graduations, but neither have played a huge role in my life in the long run, which I have shared with my daughter," Korb said. "I'm proud that she has handled the disappointment wonderfully."

It's unknown whether schools will fully or partially reopen, and physicians may still face challenges in helping children with homework in the fall.

Korb suggested that home schooling might be different from what it was during the beginning of the pandemic. "The need for online school caught most schools off-guard, but schools will be more prepared for online teaching this time around."

He suggested turning to teachers for additional help if you're unable to provide your child with sufficient support. Additionally, "there is an entire network of online tutors popping up in response to the pandemic," he said.

Asking family friends and relatives, such as grandparents, to pitch in with helping your child with schoolwork can also go a long way toward relieving the burden that has fallen primarily on parents and it might also make schoolwork more enjoyable for the children.

Like Friedman, Michigan family medicine professor Gold feels "pulled in all directions," but has concluded that she needs to adjust her expectations.

"It's simply not feasible to be a parent, educator, emotional support system, disciplinarian, entertainer, and therapist all at once, especially during a pandemic," Gold pointed out.

"As physicians, we have high expectations of ourselves. But the most important message I can share is that none of us can possibly be as good a parent as we would like right now, so we need to recognize we're doing the best we can and give ourselves permission to fall flat sometimes," stated Gold, whose younger children are teenagers.

"At the beginning [of the pandemic] I think my kids felt they were missing out because I wasn't home while their friends' parents were," New York ophthalmologist Friedman said. "But since then, they've become proud of me. I overheard one of them say to a friend, 'My mom's a healthcare hero.' "

She added, "It's not that I feel like some kind of 'hero,' but it was validating to know that my children understand what I'm doing and why, and this helps somewhat to alleviate my guilt at being away from them so much."

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MD Parents: Trying to Keep the Kids Busy and Safe During COVID-19 - Medscape

Oregon State University is helping the National Institutes of Health to harness the power of big data in the fight against COVID-19, the disease caused by the novel coronavirus SARS-CoV-2.

The NIHs National Center for Advancing Translational Sciences is creating a centralized, secure digital enclave for collecting medical record data from COVID-19 patients throughout the United States. The enclave is part of an effort called the National COVID Cohort Collaborative, or N3C, designed to help scientists expedite their understanding of the disease and to develop treatments.

For example, can we predict who might have severe outcomes if they have COVID-19? What drugs are most likely to exacerbate or be protective against COVID-19?

Vast amounts of clinical data are being generated that can be used to push research forward, but the datasets are hard to meld in meaningful ways, said Melissa Haendel, director of OSUs Translational and Integrative Sciences Laboratory.

In the United States, there hasnt been a standardized way to collect, harmonize, securely share and reproducibly analyze all the COVID-19 data being generated, she said. N3C is overcoming these varied challenges in order to rapidly transform clinical data into useful knowledge that can improve clinical care and understand the long-term impact of COVID-19.

Haendel stressed that multiple security measures will safeguard patient privacy throughout the data collection process and that the data will not include information such as names or addresses.

The cohort collaborative is funded by the National Center for Advancing Translational Sciences and is a partnership among NCATS-supported Clinical and Translational Science Awards Program hubs and the National Center for Data to Health, or CD2H.

The N3C platform will enable machine learning approaches and rigorous statistical analyses that require large amounts of data to reveal patterns.

The N3C pulls in extensive capabilities, and by leveraging our collective data resources, unparalleled analytics expertise and medical insights from expert clinicians, we can catalyze discoveries that address this pandemic that none of us could enable alone, said Haendel, who directs the CD2H program at the Oregon Health & Science University School of Medicine.

In addition to OSU and OHSU, CD2H consists of the University of Washington, Johns Hopkins University School of Medicine, Sage Bionetworks, the Scripps Research Institute, Washington University in St. Louis, the University of Iowa, Northwestern University and the Jackson Laboratory.

The CD2H was created in 2017 by a five-year, $25 million grant from NCATS.

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OSU helping to drive National Institutes of Health effort to harness analytics in COVID-19 fight - The News Guard

By Deepak Chopra, MD and Anoop Kumar, MD

When people seek personal change in their lives, they often dont get very far. Even in this day when online advice is bewilderingly abundant and self-improvement books are at our fingertips, change eludes us. One way to remedy this is to start from the ground up. Normally, we feel compelled to start where we are right now, and thats a tremendous problem.

No matter how different people are, each of us woke up this morning to the same situation. We are constantly involved in thinking, feeling, and doing. No one starts this activity afresh. Instead, we are heavily invested in habits, beliefs, opinions, hopes, dreams, and fears collected from the past. So our thinking, feeling, and doing is entangled with the past even when we want something new, better, fresh, and different.

You cant always use will power or desire to cut the ties that bind you to the past, but you can do something that will lessen the influence of the past: You can start to see yourself clearly. With that one intention, you are starting from the ground up, because seeing yourself clearly happens here and now. You detach yourself from your story, which is the accumulation of your past. You take a fresh look at what is generating all this thinking, feeling, and doing. The process has to have an origin, a source, a wellspring that sets the active mind going every minute of the day.

Normally, if we try to see ourselves clearly, we are actually looking through a lens. We filter and arrange our experiences. Some experiences we reject, ignore, judge against, or censor. Other experiences we encourage, value, appreciate, and allow to enter our minds. The lens you choose is critical, yet people often dont realize they have a choice. It doesnt strike them in the first place that they see themselvesand everything around themthrough a lens.

The lens you see through can also be called your mindset, worldview, or simply your state of awareness. Your perspective, on life, family, relationships, work stem from it. Things become confusing because we are caught up in the conflicting stories, explanations, and belief systems that everyone gets exposed to. This confusion can be sorted out once you start to see yourself clearly. Cutting through all the clutter, you discover that you actually know whats going on. Deep inside, you are fully aware already.

There are three lenses you can view life through, configured as Mind 1, 2, or 3 at this moment.

Mind 1: You view life as a separate individual. The leading indicator of Mind 1 is the sense of localization within the body. As a result of being limited by the body, Mind 1 can only detect a world of localized things. As we see ourselves, so we see the world. You localize yourself in your body, and as a result you see a world of separate things. Other people live inside their own bodies, which gives them their own sense of separation. In Mind 1 you provide fertile ground for the ego. I, me, and mine become all-important. This makes perfect sense, because your agenda as a separate person is all about the experiences of pleasure and pain that emanate from the body. Even a mental state like anxiety is rooted in the body, because what you fear comes down to a painful feeling in here. In every respect Mind 1 is dominated by yes and no to the experiences that come your way. To achieve peace, you must successfully compete in the arena of separate people and things, experiences and events.

Mind 1 seems totally right and natural in the modern secular world. Mind 1 is reflected in sciences total focus on physical things, from microbes and subatomic particles, from the Big Bang to the multiverse. A bestselling book from 1970, Our Bodies, Ourselves, applies to all of us in Mind 1.

Mind 2: Mind 2 is centered in the unity of mind and body. It isnt necessary to see yourself confined to the physical package of a body. In fact, this mindset can be turned on its head. In place of isolation there is connection; in place of things there is process; in place of hard facts, there is an easy continuous flow. You relax into the flow of experience rather than slicing life into bits that must be judged, analyzed, accepted or rejected. Mind 2 lets you see yourself more clearly, because in reality the mind-body connection is a single continuity. Every thought and feeling creates an effect in every cell. You can consciously create change in the whole system through a switch in awareness. Mind 2 is subtler than Mind 1you have moved deeper inside who you really are, and those aspects and abilities that were filtered out by Mind 1 begin to come into view. You are the one who experiences, observes, and knows.

For most people Mind 2 begins to dawn when they meditate or do Yoga, finding access to the quiet mind that lies beneath the surface of the restless active mind. With this discovery comes a way to see beyond the separate egos fruitless search for perfect pleasure, power, or success. As a deeper vision of self and life soaks through all experience, Mind 2 is established.

Mind 3: Mind 3 expands awareness beyond all particulars. It is a radical redefining of what we mean when we use the indicator I. It places you in an infinite field of pure awareness, where all things exist as possibilities. This is not only a clear view, it is clarity itself, because there is no thing or process to obstruct your vision. Boundaries dont exist. There is no past or future. Even the idea of a present vanishes. the clearest view you can possibly have, because there are no boundaries to limit your vision. You are awake, you see things without any filter, your past no longer holds you captive, and therefore you are free, which is why Mind 3 has been known for centuries as liberation. There are no more mind-forged manacles, as the poet William Blake memorably called our self-imposed limitations.

Mind 3 is open to everyone, but there is a large obstacle that must be overcome, which is this: We are convinced by the lens we see things through already. Each mindset feels real and complete. You identify with physical things in Mind 1, the most important thing being your body. In Mind 2 you identify with your field of awareness as it brings experiences and sensations that rise and fall. Because it takes an inner journey to reach, Mind 2 isnt where the mass of humankind is, yet without a doubt anyone can go there. Mind 2 is a more natural fit than Mind 1, in fact, because if you see yourself clearly, you cannot doubt that thinking, feeling, and doing is constantly on the move, ever-changing, ever renewing itself.

But Mind 2 has its own peculiar limitation. I lingers and holds its own by experiencing my thinking, feeling, and doing. There is no need for this. Everyone alive, with the fewest exceptions, has been indoctrinated into Mind 1. In Mind 2 you escape this crude, second-hand, socially approved indoctrination. But there is a subtle indoctrination that replaces it, which sees the spiritual life as higher, better, and more valuable than ordinary life. This leads to a subtle clinging, a desire to keep the spiritual goodies coming your way and a self-image superior to those people who have not yet seen the light.

The subtle tendency to possess any idea, however fine that idea is, keeps the ego going. Letting it go entirely feels threatening. Who will I be if there is no I anymore? But if you stand back, this fearful worry only exists because the ego is asking it. Of course I will never agree to its own demotion. I is about self-preservation. The shift into Mind 3 occurs when you see that there are countless moments when you did without your ego.

Every experience of joy, love, compassion, beauty, peace, and service sets the ego aside. You go beyond I in a simple, natural glimpse of who you really are. You are the field of awareness itself, unbounded and free. Every possible experience originates here, before the whole interference of ego, society, family, school, and painful memories even begins.

Thats why Mind 3 has been dubbed the first and last freedom. It is the freedom you attain when you realize that you had it all along. Clear away the clutter, and it is simply there. Mind 1 and Mind 2 are creations, while Mind 3 is uncreated. It is the womb of creation, and when we arrive there, the inevitable feeling is that weve returned home at last. NOTE: For a visual journey through these Three Minds, visit anoopkumar.com/mind.

DEEPAK CHOPRA MD, FACP, founder of The Chopra Foundation, a non-profit entity for research on well-being and humanitarianism, and Chopra Global, a modern-day health company at the intersection of science and spirituality, is a world-renowned pioneer in integrative medicine and personal transformation. Chopra is a Clinical Professor of Family Medicine and Public Health at the University of California, San Diego and serves as a senior scientist with Gallup Organization. He is the author of over 89 books translated into over forty-three languages, including numerous New York Times bestsellers. His 90th book, Metahuman: Unleashing Your Infinite Potential, unlocks the secrets to moving beyond our present limitations to access a field of infinite possibilities. TIME magazine has described Dr. Chopra as one of the top 100 heroes and icons of the century.

Anoop Kumar, MD, MMgt is a Mind-Body Strategist who is Board-Certified in Emergency Medicine and holds a Masters degree in Management with a focus in Health Leadership. He is a keynote speaker and author who enjoys bringing clarity to the intersection of consciousness and everything else. Anoop is the author of numerous articles as well as two booksMichelangelo's Medicine and Is This a Dream? In addition to speaking and writing services, he offers consultations with individuals, teams, and organizations interested in deepening their understanding and experience of human potential, mind-body systems, and consciousness. Visit Anoop at anoopkumar.com and @dranoopkumar.

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If You Want to Change, Start from the Ground Up - SFGate

More than 8.4 million people have contracted the coronavirus disease (Covid-19) and 453,290 have died across the world in nearly six months after it was first reported from Chinas Wuhan late last year.

Around 10 potential vaccines are now undergoing trials in humans, in the hope that a shot to prevent infection can become available in coming months. And even before any vaccines have been proven to work, several countries have already begun making deals with pharmaceutical companies to order doses.

The World Health Organization (WHO) hopes hundreds of millions of doses of coronavirus vaccine can be produced this year and 2 billion doses by the end of 2021, chief scientist Soumya Swaminathan said on Thursday.

The WHO is drawing up plans to help decide who should get the first doses once a vaccine is approved, she said.

Priority would be given to frontline workers such as medics, those who are vulnerable because of age or other illness, and those who work or live in high-transmission settings such as prisons and care homes.

Here are all the latest updates you need to know about Covid-19 vaccines:

Caution on dexamethasone

Dexamethasone, a cheap steroid that can help save the lives of patients with severe Covid-19, should be reserved for serious cases in which it has been shown to provide benefits, the World Health Organization (WHO) has warned.

Mike Ryan, the head of the WHOs emergencies programme, said the drug should only be used in those serious cases where it has been shown to help.

It is exceptionally important in this case, that the drug is reserved for use in severely ill and critical patients who can benefit from this drug clearly, Ryan said during a briefing.

Trial results announced on Tuesday by researchers in Britain showed dexamethasone, a generic drug used since the 1960s to reduce inflammation in diseases such as arthritis, cut death rates by around a third among the most severely ill coronavirus patients admitted to hospital.

The research body involved in the trial was the same one which found evidence that HCQ (Hydroxychloroquine) was not extremely effective on all Covid-19 patients.

That makes it the first drug proved to save lives in fighting the disease. However, some doctors were cautious, citing possible side-effects and asking to see more data.

Volunteers lining up to be infected

Thousands are signing up to take part in a high-stakes experiment willing to deliberately expose themselves to the coronavirus to test a potential vaccine, should researchers decide to proceed.

Known as human-challenge studies, these tests can hasten research by placing volunteers in the path of the virus, rather than waiting for accidental exposure.

Pascal Soriot, chief executive officer of drugmaker AstraZeneca Plc, said the controversial approach may become necessary at some point as the disease ebbs in some cities, making it harder to evaluate shots in the more conventional way.

The company is working with the University of Oxford on one of the most advanced vaccines against the virus.

The initiative is organized by 1DaySooner, a group that advocates on behalf of people who want to join challenge studies. The organisation has held discussions with potential partners and vaccine manufacturers in a bid to start production of the virus, said Josh Morrison, one of its founders.

More than a quarter of the volunteers are in Brazil, where the coronavirus is spreading fast.

Morrison said 1DaySooner has contacted vaccine developers planning final-stage studies there to suggest they consider people on its list for conventional studies, too.

Proponents note that the approach was used safely for diseases such as malaria, typhoid, cholera as well as the flu. Some experts are calling for a cautious approach.

Caution towards polio vaccine for Covid-19

Indian scientists have responded cautiously to a suggestion by global researchers that the oral polio vaccine be tested for Covid-19 treatment, saying it is a testable idea based on a sound scientific concept but may offer only limited protection against the infection.

With a vaccine for Covid-19 at least a year away, scientists say repurposing already safe and effective vaccines is the way to go for immediate relief against Covid-19.

The repurposed vaccines could include the oral polio vaccine (OPV) and the Bacillus CalmetteGuerin (BCG) used against tuberculosis, both part of the immunisation given to Indian children.

It is worth conducting a clinical trial, said Ram Vishwakarma, director of the CSIR-Indian Institute of Integrative Medicine (CSIR-IIIM) in Jammu.

A study was published last week by an international team of researchers in the journal Science. The researchers, including Shyamasundaran Kottili and Robert Gallo from the University of Maryland School of Medicine in the US, said the OPV should be tested to see if it might protect people from the SARS-CoV-2 virus.

They noted that the vaccine used to prevent poliomyelitis infections has been around since the 1950s, and is found to provide some protection against other viral infections.

Hydroxychloroquine wont stop coronavirus deaths

WHOs top scientist has said its now been definitively proven that the cheap malaria drug hydroxychloroquine the drug favoured by President Donald Trump doesnt work in stopping deaths among people hospitalised with the new coronavirus.

But Dr Soumya Swaminathan said there could still be a role for the drug in preventing people from catching Covid-19 in the first place and noted that clinical trials testing hydroxychloroquines role in this are ongoing.

Swaminathan said in a press briefing on Thursday that there is still a gap in determining whether hydroxychloroquine has a role at all in the prevention or minimising the severity of the illness in early infection or even in preventing it.

The UN health agency announced this week that it is suspending the hydroxychloroquine arm of its own trial testing various experimental therapies for Covid-19, referring to previous results from a large UK trial and a separate analysis of the evidence on the drug.

The other drugs being tested by WHO, including treatments used in the past for Ebola and AIDS, are still being pursued.

(With agency inputs)

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From warning on dexamethasone to HCQ: Latest on Covid-19 treatment, vaccines - Hindustan Times

NEW YORK (CNN) As states gradually reopen even as the pandemic wears on, many of us are concerned about our health and well-being. Especially now, with some continuing to stay at home and social distance while others join the throngs at nationwide Black Lives Matter protests, it may even be a priority.

From state to state, the loosening of restrictions vary, and within our local communities, the reality is that not only do people have different ideas on what constitutes social distancing but for many others still, in the face of racial inequality, the desire to create social change far outweighs the potential risk of spreading or catching the virus.

It's all the more reason to make sure we're taking the best care of ourselves to fortify against the disease. But while living a healthy life may be a desired goal, how to achieve it is another story.

Even if you're someone whose healthful habits were perfected to a tee during pre-pandemic times, you may find yourself struggling to engage in even the most basic self-care in these increasingly unpredictable days.

That's where a wellness routine can come in handy.

I'm not talking about a spa escape every so often or even regular massages or chef-prepared meals (though all of that may sound really nice). I'm talking about creating your own personalized routine that will benefit you physically and emotionally, one that simply requires a regular commitment to yourself.

Creating a wellness routine allows you to shift from diet culture and adopt healthy habits that easily fit into your daily lifestyle. What's more, having a routine allows you to focus on health goals by creating structure and organization, which can be particularly beneficial when things seem out of your control, like life during an unprecedented pandemic and simultaneous upheaval as people fight against social injustice.

In fact, predictable routines, or ritualistic behavior "developed as a way to induce calm and manage stress caused by unpredictability and uncontrollability, heightening our belief that we are in control of a situation that is otherwise out of our hands," according to researchers at Tel Aviv University.

"We need an internal structure because our external lives have become totally unstructured and that triggers anxiety and stress," said Robin Foroutan, a New York City-based integrative medicine dietitian and spokesperson for the Academy of Nutrition and Dietetics.

"In the beginning, we thought this was going to be a little break; a couple of short weeks, and then we'd resume life as we knew it. Now we know that probably is not going to be the case. We don't know how long this will last, but we can find ways to stay steady and structured on the inside amidst the chaos outside."

Engaging in a wellness routine with a focus on good nutrition, exercise, sleep and stress management can boost our health and well-being and strengthen our immunity during a time when we may need it most.

And while social obligations, travel and other commitments typically make it challenging to start new habits, being stuck at home without these distractions provides an opportune time to start creating a wellness routine that is accessible, doesn't require a lot of money and is something that you can count on during this uncertain time and in the future, too.

Health experts say it's important to create a manageable routine that you can stick with as part of a lifestyle not something overly ambitious that you can't sustain. One way to do that is to start small and build upon it, as you feel comfortable.

Here are some tips to get started in creating your personal wellness routine.

"Most people feel better when they are going to bed and waking up at consistent times, eating regular meals and snacks and getting a steady dose of exercise, said Marysa Cardwell, a registered dietitian, nutrition therapist and certified personal trainer based in Salt Lake City, Utah.

For sleep: Everyone's sleep schedule is different, and that's OK, as long as you stick to your natural circadian rhythms, experts say. That means going to sleep when the sun is setting (or a bit later) and waking up when sun is rising (or a little later, according to your individual needs).

Aiming for seven to nine hours of sleep is key, as it helps to "reduce the stress hormone cortisol and your adrenal load," Cardwell said.

Getting adequate sleep also bodes well for engaging in other healthful behaviors by going to bed at a reasonable hour, you'll be less likely to engage in nighttime eating or mindless eating in front of the TV, and you're more likely to wake up early and start exercise, Cardwell explained.

For eating: Setting regular meal times, and taking a break to eat your food mindfully is key, Cardwell advised, but when you actually eat is up to you. "Some do well on three meals per day with an afternoon snack; others prefer three smaller meals and three snacks."

Regardless of the pattern you choose, aim to eat at least every four hours, which prevents blood sugar from crashing and can lead to overeating. For example, if you're eating three meals and one afternoon snack, you might choose to eat breakfast at 8 a.m., lunch at 12 p.m., a snack at 4 p.m. and dinner at 7 p.m.

Taking a few deep breaths, enjoying the wonderful smells of the food you are about to eat and chewing food really well can all help make mealtime a healthful ritual, Foroutan explained.

Additionally, dinnertime can become a daily social ritual by sharing the meal with family or friends, advised Jen Scheinman, a Denver-based registered dietitian nutritionist and owner of Jen Scheinman Nutrition, a virtual nutrition coaching practice. "Even a Zoom dinner with a friend if you're by yourself can help you feel connected."

For fitness: Pick a time that you're most likely to stick with. That might mean taking a morning walk before your day gets started, or scheduling your favorite fitness class on your calendar so you won't forget.

"I shut my day down with a run or yoga at around 5:30 p.m. That's my last thing for the day. The more you can make it a routine, the less you have to think about it," Scheinman said.

Planning what you will eat and how you will exercise means that you are more likely going to do what you intend to do, which will ultimately help you achieve your health goals. For example, planning meals in advance means you'll be less likely to reach for quick sugary snacks when you run out of energy. It also helps to limit shopping trips.

"Not only does planning your meals ahead of time help cut down on the number of times you're going to the grocery store, but it can also help reduce food waste and ensure you have meals that were intentionally picked to fit your nutritional goals," said Denver-based registered dietitian nutritionist Kelli McGrane.

For food: Eating a nutrient-rich breakfast sets the stage for making other healthful choices throughout the day.

Choose protein-rich breakfasts like egg whites, cottage cheese or smoked salmon on a bagel; Greek yogurt, smoothies with low-fat milk, high fiber cereals with milk or peanut butter on whole wheat toast.

Scheinman recommended preparing breakfast foods ahead of time, like making overnight oats with milk. "It makes the breakfast routine less daunting."

For lunch and dinner, Cardwell encouraged a fist-size portion of protein, such as fish, chicken or beans; a fistful of carbohydrates like whole wheat pasta or brown rice; and a half plate of veggies. This will help meet your micronutrient needs, as well as fiber. Use fats sparingly, as a condiment, to make your food taste better, but limit fried foods and saturated fat, Cardwell advised.

For snacks, choose protein and carb combos, like cheese with crackers, sliced fruit with peanut butter, nuts and seeds with dried fruit or Greek yogurt. Pairing protein with carbs "helps keep your blood sugar level stable, and helps you stay fuller longer," Cardwell said.

Scheinman recommended using the weekends for batch cooking, like making chili or soups, which you can freeze to enjoy later in the week. Washing and chopping veggies and fruit during the weekend can also save you time during the week.

For fitness: Pick a fitness activity that inspires you and is doable. There are a lot of fitness apps offering free trials and online Zoom fitness classes, so you can use this time as an opportunity to try something new. Cardwell recommended aiming for at least 30 minutes per day, if possible.

If you are looking for a simple at-home cardio workout, MaryAnn Browning, founder and CEO of Browningsfitness in New York, recommended jumping jacks, high knees, butt kicks, burpees and switch jumps during which you'll jump to turn 180 degrees and then back again for 15 seconds each. Then repeat the circuit five to 10 times, depending on what you can handle.

For at-home fitness essentials, Browning recommended getting a set of yellow, green and red resistance bands, which can be used for back, bicep, triceps, shoulders and leg work. She also recommended looped bands to go around the calves or thighs, which strengthen the glutes and can help prevent knee and back injuries.

If you want to weight train but don't have equipment, anything that will give you muscle tension will be beneficial, such as jugs of water, books or even your children. "I use my kids I'll do planks and have them sit on me ... or I'll do leg presses while letting them do airplane," Cardwell said.

And don't forget to keep moving throughout your day. Tracking apps like Lose It! are a good way to see how normal daily activities can all count toward our daily fitness goals.

"Dancing with your kids or partner, yard work, house projects, sex and cleaning are all trackable activities. Doing these activities with intention and extra vigor all count towards a healthy lifestyle," said Cardwell, who is also a contributing dietitian for Lose It!

For sleep: Engage in a bedtime routine where you can quiet down and prepare for sleep. "Turn off electronics, including the TV, iPad, and cell phones an hour before bedtime," Scheinman advised. This helps to reduce exposure to blue light, which "the brain perceives as daylight, so your brain is not quite getting the signal that it's nighttime and melatonin is not produced."

Unplugging also prevents you from checking one more email or scrolling through social media while in bed, which can be stimulating and interfere with sleep, Scheinman explained.

Most experts recommended engaging in a morning ritual that brings you pleasure. "Starting your day with the same routine each morning can bring steadiness and calm to the rest of the day. You are starting from a more grounded and positive place, versus waking up; grabbing the phone and checking the news and getting stressed out," Foroutan said.

"The morning is a nice time to start integrating things you didn't have time for previously like taking the dog for a longer walk in the morning, making a nice cup of coffee you can sit and enjoy or engaging in a meditation practice," Scheinman added.

"It sets the day off with a healthy intention, with a sense of comfort. ... I know this is what I do," Scheinman said.

Foroutan enjoys waking up and writing down three things she is grateful for. "Starting the day with a thought about gratitude can be really centering. Writing it down does something extra it solidifies the thought and intention. Not every day is good but there's something good in every day. Even if it's one small thing that gives you a sense of gratitude that's really grounding and it can help shift your perspective."

Stretching your body after you wake up or doing a sun salutation can help to get your blood flowing and your body moving in the morning.

It's also important to prioritize self-care. "Make stress relievers like enjoyable activities a non-negotiable right now," Cardwell said. That may include knitting, taking an extra-long shower or bath, reading, taking a tea break, enjoying a glass of wine or calling family members. Even better, schedule these stress relievers into your day just like mealtimes and other obligations.

"We're taking stock of what's important ... and (our) health is important. Doing these things now can help you deal with the stress of right now," Cardwell said.

It can also keep you healthy and feeling good well into the future, too. That's a gift from quarantine life if there ever is one.

The-CNN-Wire & 2018 Cable News Network, Inc., a Time Warner Company. All rights reserved.

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If youre like many parents who planned your family summer vacation earlier in the year, youve probably spent the past few months trying to make new arrangements. Many families are skipping the flights and renting RVs for road trips. Disney World plans on reopening July 11, but you might not be ready for that type of vacation. According to a survey from MMGY Travel Intelligence, in partnership with the U.S. Travel Association, 47 percent of respondents said theyd be more likely to travel by car.

Youve likely set up a routine for your kids while they were under quarantine. Maintaining a routine is just as important for the summer. Encouraging routines around meals, naps and bedtimes, even in the summer, will help break up the day and provide structure for your little ones, says Nicole Grossmayer-Mercado, executive director of Little Smiles, a nonprofit that helps caring professionals bring joy to children in tough situations. But more importantly, maintain positivity. Above all, parents should be kind to themselves and not put pressure on themselves to create a backyard Disney World this summer, she says. Children will be happy if they see their parents are happy.

The good news is, businesses across the country have taken note and pivoted on their summer offerings, but theres a lot to consider. In a survey of 1,100 moms by Party City, almost 80 percent of moms said they were concerned on how they would entertain their children after 2 to 3 months of home schooling. By this time, you've probably tried all of the family board games and watched plenty of funny family movies. If youre juggling work and childcare, virtual summer camps may be a great way to keep your kids engaged during the day. But if youre over Zoom and want to limit screen time (unless its something educational!), this list offers plenty of fun ways to stay busy.

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1Make a List

The first thing author Jessica Speer and her kids did this summer was create a "Things We Want to Do This Summer" list. This helps us brainstorm and get our ideas on paper so the summer doesn't slip by, she says. Some of our usual activities, like traveling and visiting grandma, are not possible given the pandemic as well as financial constraints. My kids understand the need to stay home more this summer, so have been really accommodating to a different plan. Most of the activities are free and home-based due to the pandemic. Speer has found that since they came up with the list themselves, the kids have been especially engaged in the activities.

2Sharpen Your Skills

Most students will be heading back in the fall after a very unique school year. Whether it was cut short or became a modified remote learning experience, you may feel like your kids need a little catching up. Teachers will be ready in the fall to help kids get back on track, but you can do your part, too. Create a reading challenge with a fun reward at the end, like an ice cream party, movie night, or new toy. Now that youve taken on a part-time teacher role during quarantine, you may have noticed certain subjects where your kids could use some extra attention. Consider online options like Wyzant, which offers tutoring in more 230 subject areas.

3Camp in the Backyard

If you have the room, this is a great way to get out this summer, without going too far. Share scary stores, make some smores, and doze off under the stars. One classic idea you can't go wrong with is the backyard camp-out, says Theresa Bertuzzi, co-owner and co-founder of Tiny Hoppers. Get some blankets, pillows, and sleeping bags ready, because it's time to turn your backyard into a weekend adventure. Kids love to make a pretend campfire and roast marshmallows, play board games and just spend time being lazy in the tent. If youre a city dweller, or prefer not to camp outside, bring the tent indoors. Use some imagination and turn any room in your house into an outdoor oasis.

4Virtual Summer Camps

Many traditional camps across the country have canceled or postponed camp season, although thats largely dependent on your states current regulations. Coding, art, robotics, and karate are just a few of the options available. If your kids are regular campers, check with your camp to see if theyve developed a virtual experience. Party City and Little Tikes Camp Play@Home are two companies sharing fun activities throughout the summer. Another idea: Varsity Tutors, a series of free online summer camps for kids ages 5-18. Each week-long camp features live, interactive classes in photography, theater, coding and chess.

5Learn a New Language

Not only is learning a new language great for the brain, it promotes open-mindedness and introduces kids to different people, cultures, and ways of life. There are many ways for kids to learn Spanish, in particular, from the comfort of their own homes this summer, says Rachel Kamath, founder of Small World Spanish. She recommends lessons through the Homeschool Spanish Academy. For a wider range of languages, Rosetta Stone for Students is offering free access this summer.

6Stay Cool

Is your local community pool closed? If you have room for an inflatable pool, kids will appreciate the ability to splash around, even if its not the usual swimming experience. Think outside the box this summer and transform your backyard into an oasis thatll keep your kids busy all summer long, says Heather Meehan, an outreach consultant for Heart Water. All you really need is a couple of plastic swimming pools to create your very own beach scene. Fill one with sand and the other with water for a DIY surf & turf retreat that your kids will adore. You may also want to stock up on some water guns, slip and slides and sprinklers for some variety. There are a lot of water games you can play outside with your kids to stay refreshed in the hot summer months.

7Neighborhood Scavenger Hunt

Team up with local parents to create a fun way for kids to spend the day in their neighborhood. Create a list of plants that can be found in your neighborhood, says Debbie Lopez of Zivadream, an education advocacy and test prep review website. Be specific. Instead of asking them to identify a flower or a tree, ask for a rose or an oak. If you want to share the results, consider setting up a Zoom call, or posting the results on a neighborhood social media page.

8"Go" to the Zoo

Although many zoos are still closed, there are plenty of ways you can still stay connected from your home. For example, San Diego Zoo Global encourages parents, educators, and fans from around the world to stay connected to their favorite animals with wildlife cams, video stories, hands-on activities, games, and online classes. The Brevard Zoo in Floridas Space Coast is also offering a Zoom-based three-day session through August. The paid program offers animal encounters, scavenger hunts, zoo tours, and more. If you live near a drive-through safari, like Six Flags in New Jersey, you can get closer to the animals while social distancing.

9Grow a Garden

A great thing to do this summer is start a vegetable garden by saving your own seeds from fruits and vegetables. When we shop for vegetables and fruit, we try to find the ones with seeds inside, or the ones that can be grown from cuttings, says Elle Meager, founder of Outdoor Happens. Its very easy, lots of fun, and you still get to eat the vegetables so you dont lose any money. She recommends starting with pumpkin, squash, cucumber, and tomato. You can develop your own love for gardening alongside your kids.

10Foster (or Adopt!) a Pet

A piece of good news out of the coronavirus: many animal shelters are celebrating the boost in adoptions. According to the Humane Society of the United States, the rates of fostering have increased by 90 percent in some cities. Not only will your children have a new friend this summer, but theyll learn some valuable responsibility skills.

Author Jessica Speer jumped on the opportunity to help take care of a family of cats. On the first day of summer break, we saw a Facebook post that the shelter needed foster homes for kittens, she says. I called the shelter and they had a mother cat and six one-week old kittens. We picked them up later that day. My kids are thrilled to have this cat family in our house. They are never bored because they can always tend to the kittens. They weigh them daily to track growth, make sure the mom cat is fed and feeling loved, change the cat litter, and more. They love watching the kittens change and grow.

11Learn to Cook

Cook up some summer fun with free recipes and activities from Raddish, a monthly subscription kit and cooking club for kids. Kids will learn key skills in their at-home cooking camp, like cracking eggs and kneading dough. This year, the company is also offering virtual summer cooking camps (at a cost), with themes like Restaurant Camp, Around the World, and Summer Fun. The week-long camps are suitable for kids ages 8-13. Our cooking camps are designed to excite kids about the joys of cooking and help them hone a lifelong skill, says Samantha Barnes, founder of Raddish Kids. From empowering kids to start and run their own restaurant to taking them on a tour of the world through flavors, our goal remains the same: to nurture kids' confidence in the kitchen and beyond. The company also offers a popular kids subscription kit, designed for kids ages 4-14. Each monthly kit features a different theme ranging from seasons and holidays to cultures and creative cookery.

Baketivity, a subscription-based baking box service, launched Bake-A-Camp. Campers will get a big baking box featuring four themed Baketivity kits with pre-measured ingredients, step by step instructions, and an activity book (all you need are the eggs, oil, and water). Each weeks kit will take campers through progressively advanced recipes and techniques as they explore one theme, or cuisine throughout the month.

If youre looking for less of a commitment to cooking, but still want to get your kids in the kitchen, plan your own in-house cooking workshop. Apart from learning to make yummy dishes, children also develop mathematical skills, safety measures, cleanliness, motor skills and more, says Will Ward, CEO of Assistive Listening HQ.

12Teach Your Kids about Entrepreneurship

Help your kids build a better future for themselves and encourage them to start a business. I've been advocating that kids start Stuck-at-Home Startups this summer to have fun and begin to build an entrepreneurial mindset that will serve them well in life and give them the opportunity to earn money for themselves, their family, or a good cause, says Brian Weisfeld, co-author of The Startup Squad. Weisfelds ideas for this summer include online tutoring, selling items for neighbors on eBay, designing and selling T-shirts, and taking photos for stock photo websites.

Ray Ronan, a literary agent, also encourages families to get creative and write a childrens book together. The idea transformed his kids into authors and entrepreneurs at ages 8 and 13. Hes developed an online video course called Write a Book with Your Kids to help other families get started.

13DIY Summer Camp

Neighborhood families can come together and organize their own mini summer camps and activities. Thats the thought behind Sittercitys DIY summer camp. The online source for in-home care also offers virtual sitting, a tool that allows parents to hire a professional to engage and play with children virtually for short periods of time throughout the day.

As a company filled with moms and dads, we understand how hard it is for parents trying to do everything at home right now, says Elizabeth Harz, CEO of Sittercity, Americas first online source for in-home care. Child care professionals are still in need of work and their support is available. Many daycares, schools and camps have been sidelined, but our platform continues to connect families with child care providers. A DIY summer camp is just one way to adapt to the current situation of needing care and wanting to provide some fun and normalcy for your family, but also wanting to keep your bubble as small as possible. The experience can range from outdoor activities like scavenger hunts and tie-dying to a coach leading small groups of community kids in parent organized soccer camps.

14Family-Friendly Experiments

Keep your kids entertained with these easy experiments, using ordinary household items. Mad Science has a collection of experiments, which are compiled on their website with videos and downloadable instructions. Some of the projects that may appeal to your family: a soap-powered boat, balloon hovercraft, DIY sprinkler, and bottle barometer.

KinderCare Education is also offering a weekly at-home activity hub with guides for all ages to help families stay active and engaged at home. Dr. Elanna Yalow, chief academic officer at KinderCare, recommends some other fun activities, like DIY scratch-paper fireworks, talking art, and a whole series of fun using ice.

15Learn About the World

Kids love getting mail, and with fun and educational subscription boxes, kids will have something to look forward to with perfectly timed gifts year-round. Teach children about countries from around the world and their cultures with Little Global Citizens. This subscription service, staring at $39.95, sends a box to kids, aged 4 to 10, to bring a new country and its culture to life. Little Global Citizens boxes include crafts, books, screen-free games, puzzles, recipes and more from countries like Kenya, China, India and Jamaica, says Akeelah Kuraishi, CEO of Little Global Citizens.

16Become a Young Artist

Kim Bloomberg, a Chicago-based art teacher, recently pivoted to creating camp-in-a-box experiences for tweens/teens. Art Beat Box takes the guesswork and the supply purchasing out of the equation by creating comprehensive art project boxes. Each box contains five higher level art projects, like mosaics, painting and polymer clay for ages 9-99. They include all of the supplies, materials and a video tutorial to complete each project. We saw a huge hole in the teen/tween market since so many projects are entirely geared towards younger children, says Bloomberg. Older kids really need to be occupied, but more importantly, this is a perfect stage of life to embark on a new hobby."

17Explore Nature

With summer camps and vacations on hold, a great summer activity for kids is to hit the trail for a hike. AllTrails, an outdoor recreation app, helps users find and navigate trails and parks, making getting outside easier and more accessible. Users can filter to find trails that are suitable for their needs, like kid-friendly or dog-friendly. The app has also added several features to help users maintain social distancing. We all know that its important for kids to get outside and play, says Dr. Suzanne-Bartlett Hackenmiller, an integrative medicine physician and medical advisor for AllTrails. Not only is it vital to our childrens physical, mental, and emotional health, but it promotes creativity, and teaches valuable social skills.

Natalie Lloyd, a parenting blogger at Milkweed & Messes, believes that one of the best ways to keep kids occupied during summer vacation is to get outside with them. Encouraging kids to explore their surroundings will allow them to work through any boredom while also getting the body and brain moving in ways that kids so desperately need, she says. Together, parents and children can learn about bugs, butterflies, plants, and more. Even when families are just walking and talking together, the bonding time is so helpful. Once youre outside for the day, dont forget to set up a family picnic. You can keep it simple with a brown bag lunch, or take some inspiration from these 94 delightful picnic food ideas.

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Keeping Kids Busy This Summer - Have Fun Without Summer Vacation - Country Living

Newswise Irvine, CA June 12, 2020 A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

The study, published today in Nature Communications, titled, Quantification of ongoing APOBEC3A activity in tumor cells by monitoring RNA editing at hotspots, reveals how the genomic instability induced by the protein APOBEC3A offers a previously unknown vulnerability in cancer cells.

Each day, in human cells, tens of thousands of DNA damage events occur. In cancer cells, the expression of the protein APOBEC3A is one of the most common sources of DNA damage and mutations. While the mutations caused by these particular proteins in cancer cells contribute to tumor evolution, they also cause breaks in the DNA, which offer a vulnerability.

Targeting cancer cells with high levels of APOBEC3A protein activities and disrupting, at the same time, the DNA damage response necessary to repair damages caused by APOBEC3A, could be key to more effective cancer therapies, said Remi Buisson, PhD, senior investigator and an assistant professor in the Department of Biological Chemistry at the UCI School of Medicine. However, to exploit the vulnerability of the cancer cells, it is critical to first quantitatively measure the proteins activity in tumors.

To understand the role of APOBEC3A in tumor evolution and to target the APOBEC3A -induced vulnerabilities, the researchers developed an assay to measure the RNA-editing activity of APOBEC3A in cancer cells. Because APOBEC3A is difficult to quantify in tumors, developing a highly sensitive assay for measuring activity was critical. Using hotspot RNA mutations, identified from APOBEC3A-positive tumors, the team developed an assay using droplet digital PCR and demonstrated its applicability to clinical samples from cancer patients.

Our study presents a new strategy to follow the dysregulation of APOBEC3A in tumors, providing opportunities to investigate the role of APOBEC3A in tumor evolution and to target the APOBEC3A-induced vulnerability in therapy, said Buisson. We anticipate that the RNA mutation-based APOBEC3A assay will significantly advance our understanding of the function of the protein in tumorigenesis and allow us to more effectively exploit the vulnerabilities it creates in cancer therapy.

This study was funded in part by the National Institutes of Health, a California Breast Cancer Research Program grant and an MPN Research Foundation Challenge grant.

About the UCI School of Medicine

Each year, the UCI School of Medicine educates more than 400 medical students, and nearly 150 doctoral and masters students. More than 700 residents and fellows are trained at UCI Medical Center and affiliated institutions. The School of Medicine offers an MD; a dual MD/PhD medical scientist training program; and PhDs and masters degrees in anatomy and neurobiology, biomedical sciences, genetic counseling, epidemiology, environmental health sciences, pathology, pharmacology, physiology and biophysics, and translational sciences. Medical students also may pursue an MD/MBA, an MD/masters in public health, or an MD/masters degree through one of three mission-based programs: the Health Education to Advance Leaders in Integrative Medicine (HEAL-IM), the Leadership Education to Advance Diversity-African, Black and Caribbean (LEAD-ABC), and the Program in Medical Education for the Latino Community (PRIME-LC). The UCI School of Medicine is accredited by the Liaison Committee on Medical Accreditation and ranks among the top 50 nationwide for research. For more information, visit som.uci.edu.

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UCI Researchers Uncover Cancer Cell Vulnerabilities; May Lead to Better Cancer Therapies - Newswise

STEAMBOAT SPRINGS Residents of Steamboat Springs are not the type to let a global pandemic stop them from enjoying the great outdoors.

For proof, ask Pete Van De Carr, owner of Backdoor Sports and a well-known face around the city, who just got off a river trip through the Desolation and Gray canyons in Utah. He is preparing for another voyage on the Middle Fork of the Salmon River in Idaho.

With business slow and extensive restrictions imposed by COVID-19, Van De Carr has found a silver lining amid the crisis in that he has more time to get on the water. He admits his profits likely will take a hit, and he sympathizes with those who have suffered much worse consequences due to the virus.

He also knows the situation is out of his control, so it is better to ride the rapids with a smile.

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Its really been a pretty glorious time for me, Van De Carr said of his free time to spend with family doing what he loves.

Amid the intense limitations Coloradans have been living under since March, recreation has been one of the few activities they can still enjoy and the state encourages. At the start of June, when Gov. Jared Polis announced a new phase of recovery, he called it Safer at Home and in the Vast, Great Outdoors, highlighting the millions of acres of federal land, city and state parks and other open spaces that allow for recommended distancing.

But as Van De Carr acknowledged, recreation is not what it was. The pandemic has wrought new challenges and frothed unprecedented concerns over his well-being that he never gave much thought to before the virus. On river trips, he keeps his distance from other families and wears a mask when necessary, something he has never had to do before.

As he said, Thats the reality of owning a small business there are no sick days.

Before COVID-19, exercising was a remedy to lifes struggles, a way to release stress from a long day at work and have fun with friends.

While it continues to serve that purpose for many, it is hard to escape the ever-pervading anxieties of getting sick or getting someone else sick.

Dr. Justin Ross, a psychologist withUCHealth Integrative Medicine Center in Stapleton, has studied anxieties caused by COVID-19. When it comes to exercise, he has heard patients list a variety of reasons for their apprehension, from passing people on trails who are not wearing face masks to exposing themselves to the virus at indoor workout facilities where sweat and spit are the currency of fitness.

Asrecent research from Belgium showed, the social distancing requirement of 6 feet might be inadequate for preventing disease transmission during higher-intensity activities that can spew saliva as much as 65 feet. That helps to explain why the state was reluctant to allow gyms and fitness centers to reopen until this month, and those that have opened must implement strict mitigation protocols.

To make matters worse, parts of the country have seen a resurgence of the virus.On June 5, Utah reported its largest growth in COVID-19 cases in a single day after 439 peopletested positivefor the virus. Fortunately for Colorado, new case counts haveremained low, as Polisannounced Thursday, but he raised concerns about a second wave of infections, particularly with thousands of people gathering in police protests.

With these and other concerns on peoples minds, it is no wonder some residents, particularly those more vulnerable to the virus, are wary of recreating. The consequences have been far-reaching.

Organized team sports effectively ended with the stay-at-home order imposed in March. More than just a way to stay fit, these activities provide a sense of community for participants. They are as much a time to socialize as to exercise.

Sean Pummill works at the Tennis Center of Steamboat Springs, but he is no tennis expert. His game of choice is pickleball, and he has helped to amass a loyal group of players. Last summer, more than 80 people participated in a single day, Pummill said. The players range in skill level and age, from a 12-year-old to those well into their 70s.

The social aspect of the sport is what propelled it into the popular imagination about a decade ago, according to Pummill. Players chat between matches, exchanging gossip as well as beta.

I have a lot of friends I met solely through pickleball, Pummill said.

When the Tennis Center closed in March, he found himself yearning not just for the game itself but for the people he saw on almost a daily basis.

It was very jarring, Pummill said. I dont even know how to describe it.

He is not alone in feeling that way. A group of pickleballers put a lighthearted spin on their quarantine with a YouTube parody titled I wanna dink with somebody. (A dink is pickleball lingo for a type of soft volley.)Set to Whitney Houstons hit song, it features players reminiscing about days on the court and knocking over lamps trying to host a match in a cramped living room.

Even individual exercise has a communal aspect. When Old Town Hot Springsreopened on June 5 with a strict mitigation protocol in place Marketing Director Vanessa Cory noticed a cultural change within the facility. With more than 8,000 members, the fitness center and pools usually are places where people catch up with other locals alongside their workouts.

A lot of that connection has been lost with how we have to run the facility right now, Cory said.

Before the pandemic, chairs surrounded a fireplace in the lobby. It was a space for people to sit around, have a snack and chat with passersby. Due to mitigation protocols, staff had to remove the chairs. Now, members are more deliberate with their visits to the hot springs, the environment more regulated and clinical.

As numerous stories from around the world show, exercise is important. It improves not just ones physical health, honing the lungs and heart and muscles into fine-tuned powerhouses, but also ones emotional and mental well-being.

Those worried about getting sick might take note that exercise can buttress whatever regimen of expensive supplements and quasi-medicinal elixirs they might have adopted. Regular, moderate exercise has been shown to give the body more robust immune responses to vaccines and reduce ones risk of illness, according to areport from the American College of Cardiology.

Dr. David Wilkinson,an emergency medicine physician at UCHealth Yampa Valley Medical Center, said outdoor recreation might provide special defenses against COVID-19. As he explained, the virus itself is unstable outside of the body, and UV light kills it quickly.

All of those elements are outdoors and serve to protect you to some degree, Wilkinson said.

People who had or have the virus should listen to their body when it comes to exercising. Those without symptoms who feel up to it should start gradually and build from there.

What you dont want to do is exercise when you are still having symptoms, Wilkinson said, explaining how it hampers the bodys immune response and could get others sick.

For reasons scientists are still studying, even a brief walk through a forest provides health benefits. Such strolls have been a long-held tradition in Japan, calledshinrin-yoku, or forest bathing.

Participants of the practice tend to be less anxious, sleep better and sleep longer after spending as few as 20 minutes outside. Sojourns through forests also have been shown to strengthen the immune system, reduce blood pressure, increase energy and boost overall well-being. It has proved so beneficial, Japan launched anational campaign in 1982 to encourage forest bathing.

Wherever there are trees, we are healthier and happier, Dr. Qing Li, a Japanese physician who has spent years studying the practice, writes in his aptly named book,Forest Bathing: How Trees Can Help You Find Health and Happiness.

Fortunately for those in Steamboat, forested areas abound, with ample public trails to allow people myriad of options to walk and unwind. Wilkinson hopes people can see theses places as benefactors for their health, not threats.

I want people to get out there and get exercise but to remember the virus is still there and take steps to protect themselves, he said.

Leaders in other realms of exercise are making similar attempts to encourage a return to recreation and assuage peoples fears.

The Tennis Center has guidelines in place to operate at reduced capacity and require people to wear protective equipment in certain areas. Initially, only a trickle of players showed up for pickleball matches, Pummill said, but more return each week.

It is just great to see them again, he said.

Old Town Hot Springs went so far as to hire an expert epidemiologist to draft a 50-page reopening plan, which has protocols ranging from frequent disinfecting of rooms and equipment to requiring people to wear masks indoors, even while working out. The hot springs originally had a reservation system to limit the number of people. It since has switched to a first-come, first-served basis with reduced capacity, accepting only people who had memberships before the pandemic.

Our number one goal is to stay compliant so we can stay open, said Cory, the marketing director.

She hopes the fitness center can welcome more people and offer classes as the recovery plan progresses. Until then, Cory wants all members to feel safe when they come to work out or soak. It has not been easy to navigate the ever-changing rules and guidelines, but such is the reality of an unprecedented crisis.

As Cory put it, At the end of the day, we just feel grateful that we can be open.

To reach Derek Maiolo, call 970-871-4247, emaildmaiolo@SteamboatPilot.comor follow him on Twitter@derek_maiolo.

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Exercise anxiety: How COVID-19 changed the way we recreate - Steamboat Pilot and Today

publication date: Jun. 12, 2020

By Alexandria Carolan

This story is part of The Cancer Letters ongoing coverage of COVID-19s impact on oncology. A full list of our coverage, as well as the latest meeting cancellations, is availablehere.

A movement that began with a fatal chokehold on a Minneapolis street grew into demands for police reform, but outrage didnt stop there. Amplifying, reverberating, it became a call for racial justice in medicine, in oncology.

The COVID-19 pandemic focused Americas attention on health disparities. The murder of George Floyd led them into the streets, and they kept going, people from all walks of life, including thousands of doctors young and old, out there, taking aim at racism in medicine.

White Coats for Black Lives extends much further than the knowledge of the violence, a knowledge of the killing of young men and women by police, a knowledge of the police brutality against blacks. Consequently, all of this affects health care, Edith P. Mitchell, a member of the Presidents Cancer Panel, clinical professor of medicine and medical oncology in the Department of Medical Oncology, director of the Center to Eliminate Cancer Disparities, and associate director of Diversity Affairs at Sidney Kimmel Cancer Center at Jefferson, said to The Cancer Letter.

Some say this is the turning point, that clear changes will be made to increase diversity in leadership positions, that work will get done to narrow health disparities, that black patients will get the same care as white patients.

I am more than cautiously optimistic that this is our first step to healing, that this is our first step to really getting real change, Robert Winn, director of Virginia Commonwealth University Massey Cancer Center, said to The Cancer Letter. Ive never been more hopeful in my entire life. I think people are waking up from their slumber, and as a country, we are embracing and becoming our best selves.

There are no shortcuts.

Im thrilled that doctors are concerned about health disparities, but we need to get at the social root of the cause. And we need to tackle all aspects of the health disparities problemincluding, why is it that American society has created this thing? Otis Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, said to The Cancer Letter.

Perhaps the reason this movement feels so different, is the words Black Lives Matter have permeated the mainstream.

I would say, even as recently as a few months ago, to talk about police brutalityto even say the words Black Lives Matter was something that was felt to be political or controversial, Malika Siker, associate dean of student inclusion and diversity in the Office of Academic Affairs, associate professor in the Department of Radiation Oncology, student pillar faculty member, at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, said to The Cancer Letter.

I feel like that conversation has changed now, and people are no longer afraid to say those words, and not just say the words, but understand what they meanand show a commitment to social justice and anti-racism, said Siker, who is also academic vice chair of the Community Advisory Board at MCW Cancer Center, Medical College of Wisconsin.

In oncology, these doctors say staying silent about racism is no longer an option. If a physicians goal is to alleviate human suffering, how can the quest for racial justice be overlooked?

If you dont step out, there is no middle ground. Weve got to be anti-racist, and every person in their position, in the medical field, needs to speak out, step out and do what we need to do so that we are removing the knee from the neck in all areas, Mitchell, a former president the National Medical Association, said. We can therefore face a world of equity, health care equity, for all. Its not only ethically the right thing to do, but for this countryfor health care, for all, its the best instance.

At the start of Mitchells career, in the year 1972, she recalls being fitted for her white coat as a sophomore. The seamstress asked: Are you going to like working in the kitchen at the hospital?

Physicians have a responsibility to address racism, Christina Chapman, assistant professor in the Department of Radiation Oncology, University of Michigan School of Medicine, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, said to The Cancer Letter.

Its also the recognition that the physician does take a white coat off at the end of the day, but still has that responsibility, even in other sectors of their lives, to take a stand on racism, as one of the very critical roles in the healthcare system, Chapman said. Its to unite, and to not give physicians a pass on their responsibility in addressing racism.

Until recent events, doctors whose work isnt focused on disparities could simply not think about injustice. If they didnt live it, or actively engage with it, they didnt have to talk about it.

On the end of health disparities and our day-to-day lives as oncologists, its easy to just sort of ignore, or be very casual about the health disparities that we see and we encounter, Curtiland Deville, associate professor of radiation oncology and molecular radiation sciences at Johns Hopkins University School of Medicine, said to The Cancer Letter.

I hope that this time it helps people take it to the next levelreally trying to solve the cancer disparities that they see in the communities they serve, or even just at the individual level of the patient, or the immediate patient that they have, Deville, who is also clinical director of JH Sibley Radiation Oncology, and co-director, of JH Sibley Prostate Cancer Multidisciplinary Clinic at The Kimmel Cancer Center Sibley Memorial Hospital, said.

The decision to come out into the public square is never trivial.

Police have tear gas, a chemical weapon, no less. They have rubber bullets, which hurt like hell and can put your eye out. They have pepper spray, which adds injury to humiliation. They slug you with their truncheons, knock you to the ground, bind your hands with a zip tie behind your back, cart you off, and maybe tell your employer, whose views on racial justice might differ from yours.

The risk of COVID-19 makes the threat bigger.

If you need to protest, there is something that is a threat to your safety and your security and your livelihoodand you have deemed that that threat is greater than the immediate threat of the coronavirus, Deville said.

If youve been schooled in public health issues, you might find it hard to argue that racism is anything other than a public health issue. You would also see the overlap of COVID-19 and police brutality. George Floyd survived the former, but was killed by the latter.

There are two pandemics, there are two infectious diseases. Theres COVID-19, and theres racism. Racism hasnt gone anywhere, and racism is of paramount importance, Chapman said.

The impact of racism extends beyond just the risk of police brutality and murderpeople arent simply out there protesting because of what happened to George Floyd. Theyre protesting because they know that the system that allowed that police officer to do what he did is the same system that creates residential segregation, and poverty, and health inequities that black people die from, she said.

On June 1, in Washington, D.C., in Lafayette Square, a park across Pennsylvania Avenue from the White House, police used tear gas, rubber bullets, flash bangs, horses, and a helicopter on peaceful protesters to make it possible for President Donald Trump to hold up a Bible, using St. Johns Episcopal Church as a backdrop.

Deville marched down the same street less than one week later, on June 6. The temperature was in the 90s that day, as tens of thousands of demonstrators took to the streets to let it be known that Black Lives Matter. Protesters marched peacefully to the White House from all directionsthe Lincoln Memorial, the U.S. Capitol, the National Mall. Chances are that if you were anywhere near downtown D.C. that day and you werent already in a protest, you would have become a part of one.

By then, D.C. Mayor Muriel Bowser had ordered that two blocks of 16th Street NW leading to Lafayette Park be renamed Black Lives Matter Plaza.

The words BLACK LIVES MATTER are emblazoned in yellow on the asphaltimpossible to miss.

It was a shift in what was becoming a very negative and hostile kind of situation, into a more positive direction forward, Deville said. Being able to be there for an hour or two was a very positive feeling.

The chants were unforgettable:

Say her name: Breonna Taylor. Say his name: George Floyd.

Its a call and response.

Its not just black people, marching, its all kinds of backgrounds who are, equally as enthusiastically shouting, Deville said. You really do feel it that they are just upset, and agitated, and not holding back. And theyre shoutingthese black people that were killedtheyre shouting their names out. It was very powerful.

The marches by the White Coats for Black Lives movement were held in multiple cities. Students, faculty, and staff showed up on June 5 at Johns Hopkins University campuses. Deville was there, taking a knee alongside other protesters.

Institutions participated, too. On the same day, Memorial Sloan Kettering Cancer Center, like other hospitals across the U.S., held a moment of solidarity. Hundreds of MSK employees joined in. At Chapmans University of Michigan School of Medicine, more than 1,000 students, staff, and faculty called in to a virtual protest organized by the University of Michigan Black Medical Association. Chapman was one of the virtual attendees.

The decision to protest is complicated for oncologists, who took the risk of being exposed to SARS-CoV-2.

The risk was worth it for Allison Betof Warner, assistant attending physician in the Melanoma Service and Early Drug Development Service at MSK. She stood with nearly 3,000 other health care workers in the East Meadow of Central Park.

Living in New York City and having worked on the front lines of COVID, I am very wary of any groups of people. That being said, I think its critical to have the voices of healthcare workers heard. Both COVID and cancer disproportionately affect people of color, Betof Warner said to The Cancer Letter. Racial disparities in access to health care profoundly affect our patients.

Betof Warner wore an N95 mask. She maintained her distance from other participants, who were primarily healthcare workers in New York. Masks were distributed to anyone who didnt have one.

I firmly believe that racial disparities are a public health issue, and therefore, its critical that we hear from doctors, nurses, and other healthcare workers that the time for change is now, she said.

Protesting is a personal matter. Siker doesnt judge those who choose to, or who choose not to.

At the end of the day, it comes down to an individual choice. For me, as an advocate, as somebody whos committed to social justiceand an oncologist still actively treating cancer patientsthis has been a really tough decision, MCWs Siker said. Because I know that if one of my cancer patients were to see me at an event, they might be disappointed that I would be putting myself at risk of contracting the virus, and therefore putting them at risk when they come to the clinic.

Chapman agrees. I treat head and neck and lung cancer, and my patients tend to be not only immunocompromisedbecause most of my patients are receiving concurrent chemotherapyand given that I treat lung cancer and I work at the VA, a lot of my patients have bad lung function, Chapman said. So, for me, I decided, given the risks to my patients, I havent gone out there.

The role of the physician is to provide guidance, to educate protesters on how to protect themselves, Deville said.

As a physician, I think you can educate people. If youre going to go out there, maybe there is no 100% safe way, but certainly, there are things you can do to try to minimize your risk. I mean, we tell people that all the time, right? Deville said.

Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance released a guidance for employees protesting in the time of COVID-19:

Wear a mask or face covering that fully covers your nose and mouth.

Strongly consider wearing or having ready access to goggles or eye protection for added protection (avoid wearing contacts).

Bring hand sanitizer and use it frequently.

Avoid sharing drinks, carrying others signs or touching objects that others have touched.

Attempt to limit your group size and maintain six feet of physical distance whenever possible during the activity.

Try to avoid crowded activities that involve shouting or singing in close proximity to others, and avoid those who are not wearing masks or face coverings if possible.

Bring your own water, food, or other personal items.

The epidemiological principles of pandemic containment have not changedit has always been to limit exposure, wear a mask and practice other precautions, Ishwaria Subbiah, palliative care physician and medical oncologist in the Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, at MD Anderson Cancer Center, said to The Cancer Letter.

Assuming no legislative mandates on gatherings are in place, the decision to engage in a peaceful assembly is the individuals to make. Patients with health concerns can engage their medical team to assist through a discussion of the risks to self and others of person-to-person COVID-19 transmission, Subbiah said.

Risk-taking is subjective. A pandemic makes the downside steeper.

If you have the luxury of having the conversation around, Should I weigh this versus that, then, you know, thats a privilege in itself that you should be aware of, Deville said. I dont know that a protest occurs for convenience. If you look throughout history, when did people protest when it was convenient?

While Hopkinss Brawley is hopeful that this movement will spark real change, he is concerned that COVID-19 will spread as a result of these protestsand African Americans have already been the hardest hit population in the U.S. African Americans make up 13% of the U.S. population, but comprise greater than 33% of all COVID-19 deaths.

We keep talking about this as if its a tidal wave. I think theres going to be a series of big wavesnot one big tidal wave. I think were going to see it in the fall, August, September, Brawley said. I cannot say that people ought to protest and not worry about the coronavirus. Every protester needs to understand the risks that they are putting themselves in.

While the oncology workforce is growing increasingly diverse, the leadership still appears to be predominantly white and male.

There are a total of 71 NCI-designated cancer centers. VCU Masseys Winn is the only black director. No data exist on self-identification by other directors. There are nine women directors (The Cancer Letter, June 5, 2020).

Senior leaders at cancer centers are finally starting to really grapple with the issues around diversity within their own ranks, or the lack thereof, Winn said. In fact, I think that its probably been the first time in my life time that Ive seen CEOs and deans and people not just reflect, but look at their own institutions and say, How can I be wanting to aspire to actually have diversity and not have any in my own ranks?

Leaders of many institutions have used the words Black Lives Matter in their public statements.

People need to take a critical look at their lives, their circles of influence and power, and be intentional about wielding that power in a way that includes voices that may not be at the table, MCWs Siker said. How that looks for each individual may be different.

Mitchell agrees. How many deans do we see are African Americans? How many professors are at the highest ranks and are African American? How many hospital directors, and how many cancer center directors are African-Americans? Mitchell said.

And what about funding?

NIH is evaluating how many individuals of African American or other underrepresented minority descent receive top grant funding from NIH. NIH is therefore contributing resources to study this and to improve the number of individuals receiving grants, and who become grantees for NIH funding, Mitchell said. This goes farther than police brutality, its involved with equity, and diversity, and inclusion.

For Deville, workplace diversity is a prerequisite to addressing health disparities and health equity.

In the areaI went into prostate cancer, the reason I was drawn to it was because I was going through my rotations and saw a lot of black men with prostate cancer. The fact that their outcomes were worsethey have death rates twice as highI was feeling like, why arent people as wound up about this as Im feeling? Deville said.

It says to me that, what a shame that patients often do not have providers that look like them. They often dont have that option in a large proportion of healthcare settings throughout the U.S. Its just sad.

NCI requires that its designated cancer centers have Community Outreach and Engagement programs focused on addressing health disparities.

Doctors are realizing that they have a social obligation. I actually wish they would push it a little further, because even amongst doctorsthe thought is always the racism, getting rid of the racism when the patient has a diagnosis and is being treated, Brawley said. And that, certainly, is an important part of it. But the thing to realize is that the police issue, the health disparities issuethey are all part of one thing. Theyre held together by this gravity of racism.

This gravity of racism is entrenched in an almost endless array of health inequities that affects the black cancer population. There are multiple barriers to treatment: cost, travel, inferior quality and delivery of care, and distrust.

African Americans have higher incidence of hypertension, diabetes, lung disease, prostate cancer, and now, COVID-19. To pull patients out of peril requires concerted effort by leaders in health care.

Therefore, we really must increase insurance for individuals. Again, its been recognized that those individuals who live in states where there has been expansion of Medicaid have better oncological outcomes, Mitchell said (The Cancer Letter, June 5, 2020; June 21, 2019). So, we can say that African Americans and other underrepresented minorities, whether racial or ethnic, have access to the best health care and that we can, in a few years, show that there were no differences in individuals based on their ZIP code and where they live, and the color of their skin.

Often, African Americans cant afford and dont have access to the latest and greatest drugs and technologies.

You get a system where, by innovating in a way that doesnt account for racism and doesnt account for other forms of discrimination, you actually perpetuate and exacerbate disparities, Chapman said.

Its not surprising that when we come out with the next targeted agent, and that when those agents initially are only available in the context of clinical trials, we know that minoritiesand especially black peopleare less likely to go to hospitals that have expensive technologies, have these drugs available, have clinical trials available, Chapman said.

New treatments should be designed in a way that allows for access, Chapman saidin ways that can be disseminated to hospitals that are not academic, that have a payer mix that is primarily Medicaid or for the uninsured.

Disparities remainand growin part because people have learned to accept them.

In other words, we have not only come, as a society, to accept that disparities will occur (as a law), but we can always explain them away by the differential distribution of individual risk factors (as the theory), Winn wrote in an editorial about the very subject in COVID-19 (The Cancer Letter, May 11, 2019). Thus, the individual risk factor theory becomes a unifying, acceptable explanation and a refrain that is absolving from our collective, societal responsibility.

To put it even more simply, underserved communities, are underserved, because they are underserved (as stated by Dr. Otis Brawley), and this has been made abundantly clear during the recent COVID-19 crisis.

People are paying attention because of the gruesome murder of George Floyd.

I think weve gone through a radical transformation with the recent events. And I think that theres a better understanding from our university administration about what this movement means to our black community and our students, Siker said. Its been great to see our administration step up and acknowledge that black lives matter in a public way, as well as support the students during this time.

Brawley is hopeful, too.

You go to Missoula, Montanawhere there are no blacksbut theres a Black Lives Matter protest. There were 300 people out for a Black Lives protest in Missoula, Montana, and they were all white, Brawley said. The majority of people under the age of 50, who are white, actually are starting to get it, and not be threatened by it. Caring about other people, and not feeling threatened, can get us very far in this movement.

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#WhiteCoats4BlackLives aims to lead to real change in oncology The Cancer Letter - The Cancer Letter

As states gradually reopen even as the pandemic wears on, many of us are concerned about our health and well-being. Especially now, with some continuing to stay at home and social distance while others join the throngs at nationwide Black Lives Matter protests, it may even be a priority.

From state to state, the loosening of restrictions vary, and within our local communities, the reality is that not only do people have different ideas on what constitutes social distancing but for many others still, in the face of racial inequality, the desire to create social change far outweighs the potential risk of spreading or catching the virus.

It's all the more reason to make sure we're taking the best care of ourselves to fortify against the disease. But while living a healthy life may be a desired goal, how to achieve it is another story.

Now, more than ever, the world needs trustworthy reportingbut good journalism isnt free. Please support the nation's longest continuously published newspaper serving the African American community by making a contribution.

Even if you're someone whose healthful habits were perfected to a tee during pre-pandemic times, you may find yourself struggling to engage in even the most basic self-care in these increasingly unpredictable days.

That's where a wellness routine can come in handy.

I'm not talking about a spa escape every so often or even regular massages or chef-prepared meals (though all of that may sound really nice). I'm talking about creating your own personalized routine that will benefit you physically and emotionally, one that simply requires a regular commitment to yourself.

Creating a wellness routine allows you to shift from diet culture and adopt healthy habits that easily fit into your daily lifestyle. What's more, having a routine allows you to focus on health goals by creating structure and organization, which can be particularly beneficial when things seem out of your control, like life during an unprecedented pandemic and simultaneous upheaval as people fight against social injustice.

In fact, predictable routines, or ritualistic behavior "developed as a way to induce calm and manage stress caused by unpredictability and uncontrollability, heightening our belief that we are in control of a situation that is otherwise out of our hands," according to researchers at Tel Aviv University.

"We need an internal structure because our external lives have become totally unstructured and that triggers anxiety and stress," said Robin Foroutan, a New York City-based integrative medicine dietitian and spokesperson for the Academy of Nutrition and Dietetics.

"In the beginning, we thought this was going to be a little break; a couple of short weeks, and then we'd resume life as we knew it. Now we know that probably is not going to be the case. We don't know how long this will last, but we can find ways to stay steady and structured on the inside amidst the chaos outside."

And while social obligations, travel and other commitments typically make it challenging to start new habits, being stuck at home without these distractions provides an opportune time to start creating a wellness routine that is accessible, doesn't require a lot of money and is something that you can count on during this uncertain time and in the future, too.

How to create a wellness routine

Health experts say it's important to create a manageable routine that you can stick with as part of a lifestyle not something overly ambitious that you can't sustain. One way to do that is to start small and build upon it, as you feel comfortable.

Here are some tips to get started in creating your personal wellness routine.

Set regular times for sleeping, eating and exercise

For sleep: Everyone's sleep schedule is different, and that's OK, as long as you stick to your natural circadian rhythms, experts say. That means going to sleep when the sun is setting (or a bit later) and waking up when sun is rising (or a little later, according to your individual needs).

Aiming for seven to nine hours of sleep is key, as it helps to "reduce the stress hormone cortisol and your adrenal load," Cardwell said.

Getting adequate sleep also bodes well for engaging in other healthful behaviors by going to bed at a reasonable hour, you'll be less likely to engage in nighttime eating or mindless eating in front of the TV, and you're more likely to wake up early and start exercise, Cardwell explained.

For eating: Setting regular meal times, and taking a break to eat your food mindfully is key, Cardwell advised, but when you actually eat is up to you. "Some do well on three meals per day with an afternoon snack; others prefer three smaller meals and three snacks."

Regardless of the pattern you choose, aim to eat at least every four hours, which prevents blood sugar from crashing and can lead to overeating. For example, if you're eating three meals and one afternoon snack, you might choose to eat breakfast at 8 a.m., lunch at 12 p.m., a snack at 4 p.m. and dinner at 7 p.m.

Taking a few deep breaths, enjoying the wonderful smells of the food you are about to eat and chewing food really well can all help make mealtime a healthful ritual, Foroutan explained.

Additionally, dinnertime can become a daily social ritual by sharing the meal with family or friends, advised Jen Scheinman, a Denver-based registered dietitian nutritionist and owner of Jen Scheinman Nutrition, a virtual nutrition coaching practice. "Even a Zoom dinner with a friend if you're by yourself can help you feel connected."

For fitness: Pick a time that you're most likely to stick with. That might mean taking a morning walk before your day gets started, or scheduling your favorite fitness class on your calendar so you won't forget.

"I shut my day down with a run or yoga at around 5:30 p.m. That's my last thing for the day. The more you can make it a routine, the less you have to think about it," Scheinman said.

Plan for food, fitness and sleep

Planning what you will eat and how you will exercise means that you are more likely going to do what you intend to do, which will ultimately help you achieve your health goals. For example, planning meals in advance means you'll be less likely to reach for quick sugary snacks when you run out of energy. It also helps to limit shopping trips.

"Not only does planning your meals ahead of time help cut down on the number of times you're going to the grocery store, but it can also help reduce food waste and ensure you have meals that were intentionally picked to fit your nutritional goals," said Denver-based registered dietitian nutritionist Kelli McGrane.

For food: Eating a nutrient-rich breakfast sets the stage for making other healthful choices throughout the day.

Choose protein-rich breakfasts like egg whites, cottage cheese or smoked salmon on a bagel; Greek yogurt, smoothies with low-fat milk, high fiber cereals with milk or peanut butter on whole wheat toast.

Scheinman recommended preparing breakfast foods ahead of time, like making overnight oats with milk. "It makes the breakfast routine less daunting."

For lunch and dinner, Cardwell encouraged a fist-size portion of protein, such as fish, chicken or beans; a fistful of carbohydrates like whole wheat pasta or brown rice; and a half plate of veggies. This will help meet your micronutrient needs, as well as fiber. Use fats sparingly, as a condiment, to make your food taste better, but limit fried foods and saturated fat, Cardwell advised.

For snacks, choose protein and carb combos, like cheese with crackers, sliced fruit with peanut butter, nuts and seeds with dried fruit or Greek yogurt. Pairing protein with carbs "helps keep your blood sugar level stable, and helps you stay fuller longer," Cardwell said.

Scheinman recommended using the weekends for batch cooking, like making chili or soups, which you can freeze to enjoy later in the week. Washing and chopping veggies and fruit during the weekend can also save you time during the week.

For fitness: Pick a fitness activity that inspires you and is doable. There are a lot of fitness apps offering free trials and online Zoom fitness classes, so you can use this time as an opportunity to try something new. Cardwell recommended aiming for at least 30 minutes per day, if possible.

If you are looking for a simple at-home cardio workout, MaryAnn Browning, founder and CEO of Browningsfitness in New York, recommended jumping jacks, high knees, butt kicks, burpees and switch jumps during which you'll jump to turn 180 degrees and then back again for 15 seconds each. Then repeat the circuit five to 10 times, depending on what you can handle.

For at-home fitness essentials, Browning recommended getting a set of yellow, green and red resistance bands, which can be used for back, bicep, triceps, shoulders and leg work. She also recommended looped bands to go around the calves or thighs, which strengthen the glutes and can help prevent knee and back injuries.

If you want to weight train but don't have equipment, anything that will give you muscle tension will be beneficial, such as jugs of water, books or even your children. "I use my kids I'll do planks and have them sit on me ... or I'll do leg presses while letting them do airplane," Cardwell said.

And don't forget to keep moving throughout your day. Tracking apps like Lose It! are a good way to see how normal daily activities can all count toward our daily fitness goals.

"Dancing with your kids or partner, yard work, house projects, sex and cleaning are all trackable activities. Doing these activities with intention and extra vigor all count towards a healthy lifestyle," said Cardwell, who is also a contributing dietitian for Lose It!

For sleep: Engage in a bedtime routine where you can quiet down and prepare for sleep. "Turn off electronics, including the TV, iPad, and cell phones an hour before bedtime," Scheinman advised. This helps to reduce exposure to blue light, which "the brain perceives as daylight, so your brain is not quite getting the signal that it's nighttime and melatonin is not produced."

Unplugging also prevents you from checking one more email or scrolling through social media while in bed, which can be stimulating and interfere with sleep, Scheinman explained.

Other tips for a successful wellness routine: a morning ritual and self-care

Most experts recommended engaging in a morning ritual that brings you pleasure. "Starting your day with the same routine each morning can bring steadiness and calm to the rest of the day. You are starting from a more grounded and positive place, versus waking up; grabbing the phone and checking the news and getting stressed out," Foroutan said.

"The morning is a nice time to start integrating things you didn't have time for previously like taking the dog for a longer walk in the morning, making a nice cup of coffee you can sit and enjoy or engaging in a meditation practice," Scheinman added.

"It sets the day off with a healthy intention, with a sense of comfort. ... I know this is what I do," Scheinman said.

Foroutan enjoys waking up and writing down three things she is grateful for. "Starting the day with a thought about gratitude can be really centering. Writing it down does something extra it solidifies the thought and intention. Not every day is good but there's something good in every day. Even if it's one small thing that gives you a sense of gratitude that's really grounding and it can help shift your perspective."

Stretching your body after you wake up or doing a sun salutation can help to get your blood flowing and your body moving in the morning.

It's also important to prioritize self-care. "Make stress relievers like enjoyable activities a non-negotiable right now," Cardwell said. That may include knitting, taking an extra-long shower or bath, reading, taking a tea break, enjoying a glass of wine or calling family members. Even better, schedule these stress relievers into your day just like mealtimes and other obligations.

"We're taking stock of what's important ... and [our] health is important. Doing these things now can help you deal with the stress of right now," Cardwell said.

It can also keep you healthy and feeling good well into the future, too. That's a gift from quarantine life if there ever is one.

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