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  • Kissi Rosabel Blackwell, MD

04/02/2020


Hello DPC Family,


It has been a rough few weeks for all of us: staying indoors, homeschooling kids and keeping them entertained, feeling stuck, depressed, or anxious. For Jennifer and I, add the concern for possible exposure and bringing home this disease to our families, and you've got one big recipe for disaster.


Today, I'd like to focus on ways of coping with the stress of this new world living with COVID-19.


Below you will find some tips from a psychologist about how to cope with quarantine and what things you can do to keep you mentally healthy. Unfortunately I don't know who wrote this and can't give them credit, but it's very well written, and I wanted to share it with you. I've also attached a calendar with some other ideas about how to cope each day of the month. I hope you find this helpful.


Thinking about and praying for you all during this time of uncertainty. We will get through this together! As always, I am available to you by text, email, phone, or video chat, so please don't hesitate to contact me if you need something.


Sincerely,

Dr. Kissi Blackwell, MD

Clarity Direct Care




FROM A PSYCHOLOGIST:


After having thirty-one sessions this week with patients where the singular focus was COVID-19 and how to cope, I decided to consolidate my advice and make a list that I hope is helpful to all. I can't control a lot of what is going on right now, but I can contribute this.

Edit: I am surprised and heartened that this has been shared so widely! People have asked me to credential myself, so to that end, I am a doctoral level Psychologist in NYS with a Psy.D. in the specialities of School and Clinical Psychology.


MENTAL HEALTH WELLNESS TIPS FOR QUARANTINE


1. Stick to a routine. Go to sleep and wake up at a reasonable time, write a schedule that is varied and includes time for work as well as self-care.


2. Dress for the social life you want, not the social life you have. Get showered and dressed in comfortable clothes, wash your face, brush your teeth. Take the time to do a bath or a facial. Put on some bright colors. It is amazing how our dress can impact our mood.


3. Get out at least once a day, for at least thirty minutes. If you are concerned of contact, try first thing in the morning, or later in the evening, and try less traveled streets and avenues. If you are high risk or living with those who are high risk, open the windows and blast the fan. It is amazing how much fresh air can do for spirits.


4. Find some time to move each day, again daily for at least thirty minutes. If you don’t feel comfortable going outside, there are many YouTube videos that offer free movement classes, and if all else fails, turn on the music and have a dance party!



5. Reach out to others, you guessed it, at least once daily for thirty minutes. Try to do FaceTime, Skype, phone calls, texting—connect with other people to seek and provide support. Don’t forget to do this for your children as well. Set up virtual playdates with friends daily via FaceTime, Facebook Messenger Kids, Zoom, etc—your kids miss their friends, too!


6. Stay hydrated and eat well. This one may seem obvious, but stress and eating often don’t mix well, and we find ourselves over-indulging, forgetting to eat, and avoiding food. Drink plenty of water, eat some good and nutritious foods, and challenge yourself to learn how to cook something new!


7. Develop a self-care toolkit. This can look different for everyone. A lot of successful self-care strategies involve a sensory component (seven senses: touch, taste, sight, hearing, smell, vestibular (movement) and proprioceptive (comforting pressure). An idea for each: a soft blanket or stuffed animal, a hot chocolate, photos of vacations, comforting music, lavender or eucalyptus oil, a small swing or rocking chair, a weighted blanket. A journal, an inspirational book, or a mandala coloring book is wonderful, bubbles to blow or blowing watercolor on paper through a straw are visually appealing as well as work on controlled breath. Mint gum, Listerine strips, ginger ale, frozen Starburst, ice packs, and cold are also good for anxiety regulation. For children, it is great to help them create a self-regulation comfort box (often a shoe-box or bin they can decorate) that they can use on the ready for first-aid when overwhelmed.


8. Spend extra time playing with children. Children will rarely communicate how they are feeling, but will often make a bid for attention and communication through play. Don’t be surprised to see therapeutic themes of illness, doctor visits, and isolation play through. Understand that play is cathartic and helpful for children—it is how they process their world and problem solve, and there’s a lot they are seeing and experiencing in the now.




9. Give everyone the benefit of the doubt, and a wide berth. A lot of cooped up time can bring out the worst in everyone. Each person will have moments when they will not be at their best. It is important to move with grace through blowups, to not show up to every argument you are invited to, and to not hold grudges and continue disagreements. Everyone is doing the best they can to make it through this.


10. Everyone find their own retreat space. Space is at a premium, particularly with city living. It is important that people think through their own separate space for work and for relaxation. For children, help them identify a place where they can go to retreat when stressed. You can make this place cozy by using blankets, pillows, cushions, scarves, beanbags, tents, and “forts”. It is good to know that even when we are on top of each other, we have our own special place to go to be alone.


11. Expect behavioral issues in children, and respond gently. We are all struggling with disruption in routine, none more than children, who rely on routines constructed by others to make them feel safe and to know what comes next. Expect increased anxiety, worries and fears, nightmares, difficulty separating or sleeping, testing limits, and meltdowns. Do not introduce major behavioral plans or consequences at this time—hold stable and focus on emotional connection.


12. Focus on safety and attachment. We are going to be living for a bit with the unprecedented demand of meeting all work deadlines, homeschooling children, running a sterile household, and making a whole lot of entertainment in confinement. We can get wrapped up in meeting expectations in all domains, but we must remember that these are scary and unpredictable times for children. Focus on strengthening the connection through time spent following their lead, through physical touch, through play, through therapeutic books, and via verbal reassurances that you will be there for them in this time.


13. Lower expectations and practice radical self-acceptance. This idea is connected with #12. We are doing too many things in this moment, under fear and stress. This does not make a formula for excellence. Instead, give yourself what psychologists call “radical self acceptance”: accepting everything about yourself, your current situation, and your life without question, blame, or pushback. You cannot fail at this—there is no roadmap, no precedent for this, and we are all truly doing the best we can in an impossible situation.


14. Limit social media and COVID conversation, especially around children. One can find tons of information on COVID-19 to consume, and it changes minute to minute. The information is often sensationalized, negatively skewed, and alarmist. Find a few trusted sources that you can check in with consistently, limit it to a few times a day, and set a time limit for yourself on how much you consume (again 30 minutes tops, 2-3 times daily). Keep news and alarming conversations out of earshot from children—they see and hear everything, and can become very frightened by what they hear.


15. Notice the good in the world, the helpers. There is a lot of scary, negative, and overwhelming information to take in regarding this pandemic. There are also a ton of stories of people sacrificing, donating, and supporting one another in miraculous ways. It is important to counter-balance the heavy information with the hopeful information.


16. Help others. Find ways, big and small, to give back to others. Support restaurants, offer to grocery shop, check in with elderly neighbors, write psychological wellness tips for others—helping others gives us a sense of agency when things seem out of control.


17. Find something you can control, and control the heck out of it. In moments of big uncertainty and overwhelm, control your little corner of the world. Organize your bookshelf, purge your closet, put together that furniture, group your toys. It helps to anchor and ground us when the bigger things are chaotic.


18. Find a long-term project to dive into. Now is the time to learn how to play the keyboard, put together a huge jigsaw puzzle, start a 15 hour game of Risk, paint a picture, read the Harry Potter series, binge watch an 8-season show, crochet a blanket, solve a Rubix cube, or develop a new town in Animal Crossing. Find something that will keep you busy, distracted, and engaged to take breaks from what is going on in the outside world.


19. Engage in repetitive movements and left-right movements. Research has shown that repetitive movement (knitting, coloring, painting, clay sculpting, jump roping etc) especially left-right movement (running, drumming, skating, hopping) can be effective at self-soothing and maintaining self-regulation in moments of distress.


20. Find an expressive art and go for it. Our emotional brain is very receptive to the creative arts, and it is a direct portal for release of feeling. Find something that is creative (sculpting, drawing, dancing, music, singing, playing) and give it your all. See how relieved you can feel. It is a very effective way of helping kids to emote and communicate as well!

21. Find lightness and humor in each day. There is a lot to be worried about, and with good reason. Counterbalance this heaviness with something funny each day: cat videos on YouTube, a stand-up show on Netflix, a funny movie—we all need a little comedic relief in our day, every day.


22. Reach out for help—your team is there for you. If you have a therapist or psychiatrist, they are available to you, even at a distance. Keep up your medications and your therapy sessions the best you can. If you are having difficulty coping, seek out help for the first time. There are mental health people on the ready to help you through this crisis. Your children’s teachers and related service providers will do anything within their power to help, especially for those parents tasked with the difficult task of being a whole treatment team to their child with special challenges. Seek support groups of fellow home-schoolers, parents, and neighbors to feel connected. There is help and support out there, any time of the day—although we are physically distant, we can always connect virtually.


23. “Chunk” your quarantine, take it moment by moment. We have no road map for this. We don’t know what this will look like in 1 day, 1 week, or 1 month from now. Often, when I work with patients who have anxiety around overwhelming issues, I suggest that they engage in a strategy called “chunking”—focusing on whatever bite-sized piece of a challenge that feels manageable. Whether that be 5 minutes, a day, or a week at a time—find what feels doable for you, and set a time stamp for how far ahead in the future you will let yourself worry. Take each chunk one at a time, and move through stress in pieces.


24. Remind yourself daily that this is temporary. It seems in the midst of this quarantine that it will never end. It is terrifying to think of the road stretching ahead of us. Please take time to remind yourself that although this is very scary and difficult, and will go on for an undetermined amount of time, it is a season of life and it will pass. We will return to feeing free, safe, busy, and connected in the days ahead.


25. Find the lesson. This whole crisis can seem sad, senseless, and at times, avoidable. When psychologists work with trauma, a key feature to helping someone work through said trauma is to help them find their agency, the potential positive outcomes they can effect, the meaning and construction that can come out of destruction. What can each of us learn here, in big and small ways, from this crisis? What needs to change in ourselves, our homes, our communities, our nation, and our world?



  • Kissi Rosabel Blackwell, MD

A few updates on COVID-19.

So far, in all of Wichita County, there have been 182 people tested, 47 negative tests, and 8 positive cases confirmed. You can keep up to date on these numbers at this website.


We have tested two patients at our office. One was negative and the other is pending.


Unfortunately, we are probably only on the cusp of this outbreak right now, so we need to continue to be vigilant.


There have been quite a few people contacting us with fever and cough, so I'd like to make a few recommendations on what to do if you get sick and guidelines regarding testing.


First of all, we do still have regular cold viruses and flu circulating, so just because you have symptoms does NOT mean it is COVID-19. On the other hand, we cannot test everyone, so our patients with mild cases will be handled with isolation and frequent contact with me to determine the need for testing or escalation of care.


If you were to get COVID-19, you should expect on and off fever (100.4 or greater) for several days, and sometimes weeks. You may find one day you feel better and the next day worse again. This is common and expected. The most common symptoms are dry cough, fever, body aches, and mild shortness of breath. Some also get sore throat at the beginning. Runny or congested nose is not common, but still possible. The symptoms are fairly non-specific so identifying the virus by symptoms alone is difficult. A few things you should do if you find yourself sick:


1. Rest. Remember, your body is fighting a war inside and you need to allow your body to focus on that fight.


2. Isolate yourself. Stay in one room and one bathroom in your house, if possible. Disinfect surfaces and your hands frequently.


3. Treat the symptoms. See below. Patients can contact me if symptoms become severe.


Isolation can only be lifted once you have been without fever for 72 hours off all anti-fever medications, have had improvement in respiratory symptoms, and AT LEAST 7 days have passed since the beginning of your symptoms. See the CDC recommendations here. Any household contact should stay home for 14 days and monitor themselves for fever or symptoms.


  • For the cough and possible congestion, you can use a combination of Sudafed, Mucinex DM, and Zyrtec over-the-counter, or your doctor may prescribe cough medication. Please check with you doctor before you start any regimen, since Sudafed can increase your blood pressure.

  • If you start to become more short of breath, your doctor may prescribe an inhaler to use every 4-6 hours as needed. You should avoid the use of a nebulizer machine, as this can aerosolize the virus (leave it hanging in the air). You can, however use a spacer, and your doctor can prescribe you one if you need it.

  • For fever and body aches, please try to use only Tylenol (acetaminophen). There is some controversy about whether it is ok to use ibuprofen and other NSAIDs. Currently, there is no clear proof that taking NSAIDs is dangerous. However, we recommend you use Tylenol (acetaminophen) for aches, pains, and fever, unless your doctor has directed you otherwise or you cannot take acetaminophen for some reason.


Remember, fever is not necessarily a bad thing. Your body creates the fever to make a hostile environment for the virus, and we don't want to interfere with this too much. If your temperature is mildly high (99-100.4), try to leave it alone and allow your immune system work. If your temperature is 100.5 or greater, and you feel badly, then take Tylenol (acetaminophen).


For possible prevention, consider starting an over-the-counter low dose zinc and vitamin C supplement. Emergen-C packets or Airborne are a good options. We don't have any clear proof these work for prevention, but the theories of why they might work are sound. You should also continue taking these if you become ill.


If at anytime the shortness of breath becomes severe or you start feeling confused and/or lethargic, please head to ER or call 911.


With regards to testing, our office is only testing current patients. We only have a limited supply of tests and are not doing widespread testing for those with only mild symptoms. Keep in mind that most people will recover on their own and the isolation is to keep others from getting sick that might be more at risk for severe illness.


Most testing locations are only testing those that have potential high risk (travel or contact with a sick individual), fever, and shortness of breath. Considerations may be made for those who are healthcare workers and/or have underlying medical conditions, such as diabetes, heart disease, lung disease, cancer, or immunocompromise. Please be aware that if you do not meet criteria, you will not be tested and will be asked to go home and self-isolate.


Unfortunately the ability of the test to completely rule out disease is limited, and a negative test does NOT necessarily mean the person does not have COVID-19. For a nasopharyngeal swab, it appears to only catch 63% of those that have the disease. This is all the more reason why we keep EVERYONE who is even mildly sick at home.


At this point, we must all act as if we had the disease and could spread it.


That means:


  • Staying at home. Limiting visits to grocery stores, gas stations, etc, and cleaning your hands thoroughly after any outing.

  • Cleaning and disinfecting all surfaces frequently, including countertops, doorknobs, light switches, and devices.

  • Being careful not to touch your face while you are at work or out. Remember this virus is mainly spread by contact, so wash your hands often.

  • Sneezing or coughing into your elbow, even if you are not sick


I hope this give you a better picture of how we are handling the situation. As always our patients have access to us by phone, email, text, and video chat, if necessary. We are seeing patients in the office for emergencies only. Please call us first before you visit our office.


Kissi Blackwell, MD

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  • Kissi Rosabel Blackwell, MD

During a press conference with Mayor Santellana this morning, it was announced that the first case of COVID-19 has been diagnosed in Wichita County. The only thing we know is that this person traveled to Budapest and Hungary and came through DFW airport and drove straight home from Dallas. This person and their spouse self-quarantined right away and alerted their doctor's office before making a visit to the office and being tested. They drove straight home and did not visit any other locales in Wichita county, per the report. We hope this means that this case has been isolated and contained. The news report can be found here

Please make sure that you are not making any unnecessary trips outside your home.

-- Try not to visit public places if at all possible except to buy food and supplies, go to doctor's appointments, or pick up prescriptions.

-- If you can work from home, please do so. If you must be at work, try to stay at least 6 feet from others and clean your hands and your work station frequently.

-- If you are sick, STAY HOME. No matter how much you think they can't do without you at work, it is not worth spreading this disease. Even if YOU don't feel that bad, you may spread it to someone who could die from it. Once again, if you feel sick, DO NOT walk- in to the office without calling us first. If you are mildly ill, we will keep you at home to avoid exposing others and ask you to check in with us daily. If you are seriously ill with shortness of breath, fever, and dry cough, please call us and we will initiate a video call or phone call to help guide you. Any visits we have with sick patients will occur in the parking lot. This situation is changing daily and we will try to keep you abreast of everything that is evolving in our community and nation. If you have any questions or concerns at all about what is happening please don't hesitate to call me. THIS is why access to your physician is important and why we do what we do. We are lucky that we are prepared for just such an emergency. Stay well! Dr. Kissi Blackwell Clarity Direct Care


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(940) 441--CARE (2273)

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