According to the Centers for Disease Control and Prevention (CDC), 1 in 13 people have asthma so about 25 million Americans have asthma.  Asthma is a chronic lung disease that causes airway congestion and tightness. Symptoms can include cough, shortness of breath or chest tightness.    It is important to know when your asthma is not controlled, what your triggers are and the two basic types of medications used to treat asthma. 
 
Do you know the “Rule of Two’s”?
Do you have asthma symptoms or use your quick relief inhaler more than two times a week? 
Do you wake up at night with asthma symptoms more than two times a month? 
Do you fill a canister of your quick relief medication more than two times per year?
If you are answered yes to any of these or if you are unsure, it is time to involve your doctor to discuss asthma control. 

Do you know your triggers or how to manage them?
Many asthmatics can be allergic to weeds, trees, grass, mold, dust, dog or cat allergens.   If you have never been tested, speak to your doctor about getting tested for allergies so that you can better understand your triggers.  Allergies are typically treated with Medications, Modification of the environment and Modification of your immune system with immunotherapy or ‘allergy shots’.    
Now during the peak pollen season, if you feel triggered, take the medications that your doctor has recommended. If you are allergic to pollen, wear a mask when outdoors, and shower or wash your face after coming indoors.  
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Indoor allergens such as dust mites can be reduced by stepping up cleaning, and by keeping humidity indoors to less 55%.  You can do this with a dehumidifier.  

Know the differences between 
your medications.
There are two basic types of medications that can be helpful for people who have asthma.  The first is a rescue inhaler such as albuterol. The rescue inhaler can help to open the airways and can be used for cough, shortness of breath and wheezing.    The second medication is a controller medication, and this one should be used daily even if you are feeling well.   

Since the Covid-19 pandemic has coincided with the peak pollen season, it is important to control your allergy and asthma symptoms to avoid confusion over Covid-19 since some symptoms overlap. Take your medications as instructed by your doctor.  Follow your Asthma Action Plan. If you do not have a plan, now is the time to speak to your doctor.   Keeping your asthma under control can help you to be your best self, and lead to a healthier and more active lifestyle. 

by Diana Brummer
​Owner, Good Mental Health, LLC

As we enter the 3 phase transition plan for reopening our society following the COVID-19 pandemic, many of us are excitedly anticipating a return to “normal life.” With a safe reopening weeks away, once it does arrive, it will be a totally new normal we are returning to. Going forward, we will refer to this experience as “before and after." COVID-19 has challenged us and changed us, creating disruption in our routines, and uncertainty about the future.

Letting Go with Compassion
During this time of lockdown and social distancing, vital experiences have been missed. Students have spent their fourth quarter of the school year away from their campus, teachers, friends, and activities. Seniors have missed important events and opportunities such as prom, grad bash, and spring sports. It remains to be seen whether postponed graduation ceremonies will be able to safely proceed as the summer unfolds.
Non-essential businesses shut their doors and risked their financial solvency to keep the community safe. Essential workers continued to report to work, risking their personal health so that their neighbors could access the vital services they provide. We have begun wearing masks.
We have all been asked to give up pieces of ourselves during the COVID-19 pandemic. Whether you were a greeter at church, a school volunteer, a little league coach, or the social organizer for your friend group, we have all experienced the loss of the roles we once held before life changed.

And with loss comes grief

Processing Grief
Grief expresses itself in many ways. It can feel like anxiety, depression, fatigue, and stress. It can display as sadness, anger, ambivalence, or a combination of these.  Behaviorally, we may withdraw from, or lash out at, those close to us. We may be drinking too much, exercising too little, sleeping too much or not enough. It may be difficult to stick to a daily routine or find joy in the activities that are available to us right now. It may be hard to connect to the people we need most.
We may compare our situation to others, and decide we don't have it as bad as those in other parts of the world. We begin to deny the validity of our difficult emotions and feel shame or guilt for having them at all. By denying that our grief exists, we deny ourselves the opportunity to grieve what's been lost and to ultimately heal.

The New Normal
Human beings are resilient creatures. We can bounce back from extraordinarily difficult things. But in order to do that, we have to allow ourselves space and grace to process our difficult emotions. We do that by acknowledging they exist, allowing ourselves to feel them, and speaking them out loud to a trusted friend, support person, or to ourselves in the safe pages of a journal or in our own minds while we reflect.

Let's allow ourselves to grieve what was, then imagine what our new normal might be. We can harvest the good from this difficult experience-increased time with our families, learning we are capable of (and maybe enjoy!) working and learning remotely, witnessing the solidarity of the human race as we truly are all in this together but separately. Let’s perhaps recalibrate our priorities based on a new appreciation of the fragility of life and design a vision for our future that is not only different but better than before.

If you are struggling emotionally during this difficult time, please visit our website at www.GoodMentalHealthLLC.com for access to relevant blog posts, local resources, or to schedule an appointment. For the safety of our community, all upcoming appointments will take place by phone or online via video chat.

by Diana Brummer, 
MSW, LCSW
www.GoodMentalHealthLLC.com
Office: 904-325-6105
Mobile: 904-419-7435

We are experiencing an unprecedented global health crisis. In a world that feels largely out of control, what can we do to stay calm while facing so much uncertainty? 


First and foremost, we must recognize that we are human and it is a normal human reaction to feel anxious and worried at a time like this. Whatever your style of coping, recognize that you are doing the best you can in a difficult situation. That being said, the following are a few techniques you may also find helpful.  

Challenge negative thinking:

Our interpretation of a situation will create our experience of that situation. The reasons we are socially distancing are serious and scary, however, the experience of social distancing doesn’t have to be. Reframe this experience by giving yourself permission to enjoy this mandatory time out. Experience being at home, spend more time with family, brainstorm creative ways to connect with others without physically meeting up.  We have the option to view this situation as a crisis as well as an opportunity. I would offer that most situations in life can be viewed, and treated, as both. 

Be mindful of your focus: 

Is a global pandemic terrifying? Yes. 
Is the divinely inspired human race amazing and resilient and brilliant when we work together for a common goal? Also, yes. 

As quickly as a crisis can manifest, it can also resolve. When our minds drift to worry about the future and the safety of our loved ones, we can affirm that there are brilliant minds around the world pooling their talents, skills, training, and abilities to identify a solution to this problem. By working together, we can and will overcome this problem.  

Ask, what’s in my control? 

We have been given a mission: practice social distancing. Limit non-essential travel. Work from home if we can. Wash our hands. Self-isolate if we experience symptoms of illness. These are the things we can control. Just as we can remind ourselves that a solution is on it’s way to us, we can also remind ourselves that, by doing our part, we are helping to bring that solution more quickly into reality. We must focus on what we can control, and then commit to doing it. We move forward with faith that the rest, which is not in our control, is also in progress by others who are capable and inspired to solve this problem.


Denying difficult emotions does not prevent us from having them. Doing so, we bottle them up, stuff them down, and let them accumulate until they erupt in unhealthy ways and at inopportune times. Grounding is a skill that becomes stronger with practice. It begins when we give ourselves space and grace to feel difficult emotions. It works by challenging our unproductive, negative thoughts and reframing them with more helpful, productive thoughts instead. What we focus on increases so let's make sure we are focusing on the magic that is possible versus the fear that it's not.


If you are experiencing increased anxiety during this difficult time, please visit our website at www.GoodMentalHealthLLC.com for access to relevant blog posts, local resources, or to schedule an appointment. For the safety of our community, all upcoming appointments will take place by phone or online via video chat. 

by Dr Kathleen Deckard
​Pets R Family

​COVD-19 is at the forefront of everyone’s minds right now so I want to address some common questions about whether your pet may be affected by this virus.

What is COVID-19?
While coronaviruses are common, COVID-19 is a new strain of coronavirus that had previously not been identified in humans. The key features of COVID-19 are respiratory symptoms with a fever and cough. Like all new infections, understanding COVID-19 is important with details coming in rapidly.
Coronaviruses in pets have been around for a very long time.  It is important to know that the coronavirus of infected dogs and cats cannot affect humans.  Cats get their own coronavirus that typically causes either no clinical signs or very mild diarrhea. The feline coronavirus is also associated with another disease called feline infectious peritonitis, which is very serious.  Similarly, dogs have their own coronavirus that can cause diarrhea, lethargy, and reduced appetite, but most dogs recover uneventfully with supportive care.  Simply stated, cat and dog coronaviruses are very different than COVID-19. 

Can my pet get it?
On February 27, 2020, news broke of a Pomeranian in Hong Kong that tested weak positive for COVID-19 from swabs obtained from the nose and mouth.  It is important to note that it is highly unlikely that your pet would be able to harbor the virus on their fur since it is porous and fibrous.  Veterinarians and human health officials have decided after many tests, that the affected dog had a low-level of infection that was likely to be a case of human-to-animal transmission.  
To be cautious, the dog was quarantined, but has never had clinical signs of illness. Based on currently available information, both the US Centers for Disease Control (CDC) and World Health Organization (WHO) report there is no evidence cats or dogs can spread COVID-19. Furthermore, there is also no evidence pets get sick from COVID-19. 
One of the world’s leading veterinary diagnostics firms tested thousands of dogs and cats for the new coronavirus, and not a single case came back positive. This backs up the theory that pets cannot catch or spread Covid-19.

How Covid-19 could have an impact on available pet medications.
According to the American Veterinary Medical Association, 32 animal drug companies either make their drugs or obtain ingredients for their drugs from China. The Food & Drug Administration (FDA) contacted all of these companies, and to date, none of them have reported drug shortages however shortages are anticipated in the future.

What should I do?
Although research is underway, there is no vaccine against COVID-19 currently available. Until we have an effective vaccine, we all need to exercise some common sense, including:

Don’t panic! 
Stay informed – read unfiltered information from veterinarians as more data becomes available
Thoroughly wash your hands with soap and water, including after handling / petting animals. This recommendation isn’t specific for COVID-19 – hand washing helps reduce the transmission of multiple infectious diseases! 

If you have COVID-19, restrict contact with pets and other animals. According to the American Veterinary Medical Association (AVMA), sick individuals should “avoid contact with animals, including petting, snuggling, being kissed or licked, and sharing food.” Another family member or friend should care for animals in the household whenever possible.

The take-away message about 
COVID-19 and pets…
The novel coronavirus COVID-19 is not thought to cause clinical disease in companion animals.  As we learn more about this virus, you should keep abreast of any new information that is learned about the virus.  
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Most veterinarians are staying open as essential providers of care for our pets and are taking proper precautions to limit person to person contact.  These precautions include curbside service, shipment of medication to the home, delivery of food and medications, drop off appointments, telemedicine and phone consultations.  Do not delay your pet’s care during this time.  Contact your veterinarian for how they can help care for your pet during this challenging time.

The holiday season is upon us!  This is the time of year that brings families together. It can also be the time of year that reminds us why we might choose to spend time apart. Why is it that we can walk through the door of our parents' homes and immediately feel like we're ten years old again? If you find yourself anxious at the thought of spending quality time with your extended family this holiday season, taking a look at family roles and the feelings these roles can trigger may be a reason why.
    As children growing up in a family system, we are often unconsciously assigned roles to fill. Were you the high-achieving hero who diligently lived up to your parents' expectations and who continues to keep things running smoothly to this day? Or perhaps the scapegoat, an example of how to not fit in with the rest of the family? Maybe you were the mascot who provided comic relief when tensions ran high? Or the lost child, fading into the background with your nose in a book, someone who no one really got to know at all?
    Gathering again with aging parents and adult siblings, we may feel the uncomfortable pull of someone else's expectations for us. Those unresolved feelings from childhood and the sense of guilt, obligation, and sometimes disappointment they can trigger are what can make us uncomfortable in these situations.
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The following tips are part of my Family Holiday Survival Guide that can help our quality time feel more enjoyable for all:

1. Recognize your triggers.     Realize that old childhood roles and expectations no longer have to be part of your adult experience and don't allow yourself to react to them as if they are. Recognizing and then interrupting our own dysfunctional behavior pattern is the first step toward changing our relationships for the better.


2. Establish a time limit before you arrive     If two hours is the length of time you feel comfortable spending with the extended family, determine an exit strategy within that two hour window. No need to stay all day if you know from past experience that inhibitions lower and hurtful things are more likely to be said the longer you are together. Traveling from out of town? Renting a hotel room to allow yourself a place to unwind and recharge is often money well spent.


3. Choose a safe word (and share it with a safe person).      Choose a unique word or phrase and share it with your significant other or another "safe" family member. If you find yourself becoming triggered or upset, use your safe word to make a fast get away. Something as simple as a walk around the block is often enough to deescalate a situation and give all parties time to clear their heads.


    Wishing you all a safe, joyful, and emotionally healthy holiday season! For more information on building, strengthening, and healing family relationships, please visit our blog at GoodMentalHealthLLC.com.

by Michael L. Duncan, Esq.
Duncan Trial & Family Law
11512 Lake Mead Ave., Suite 301
Jacksonville, FL 32256

If you are divorced with children, then you are never completely separated from your ex. This is because you and your ex are connected through your children and will be throughout life.  And, irrespective of what you think about your former partner, you have a job to do, which is to do the best job you can in raising your children.
    Thanksgiving is almost here, and the Christmas and New Year holiday season is right around the corner. These holidays are very special for many people and their families, and dealing with them during and after divorce can be challenging.  Here are my top tips for helping your children have the best holiday season possible despite your divorce:


1. GET IN THE SPIRIT OF THE SEASON - The holiday season is a time for being thankful, for giving, and for new beginnings.  Teach your children to truly appreciate Thanksgiving and be grateful for the love you share with them. You can show them how to appreciate the Christmas season by being giving to others and each other.  And, through your example, you can show them how the New Year can be one of healthy, fresh starts.


2. COMMUNICATE & COORDINATE:  Communicate and coordinate with your children's other parent.  Look, it is understandable if you find this to be a challenge.  But a brief email, text message, or conversation can help make certain that everyone’s plans for the holidays work out well. Work out exactly where and with whom your children will be during what times, and when, where, and how exchanges will occur.  Timely and properly detailed communications in advance can help to avoid frustration and confusion for you, your children’s other parent, and your children. A few minutes now can spare you days, weeks or months of frustration and anger (not to mention attorney’s fees) down the road.


3. TIME & ATTENTION ARE THE GREATEST GIFTS:  Being able to lavish gifts upon our children can feel great.  But always remember that love means far more than money and material things.  Your love, time, attention, and emotional support are much more important to your children than any material possessions.


4. PLAN IN ADVANCE FOR NEXT YEAR:  Avoid last-minute juggling of schedules and the agony of 11th-hour negotiations in years to come and set up a plan for next year now if possible. Even if you simply begin the dialogue with your ex now, starting the conversation now can save you a lot of stress later.  And, begin planning now with your own extended family to help make this process even easier.  Everyone will be happier knowing what is coming, and you can avoid conflict for next year’s holidays.


5.  ESTABLISH AND MAINTAIN TRADITIONS WITH YOUR CHILDREN:  Holiday traditions are an important way in which we build memories that can last a lifetime. Whether it is the continuation of past rituals, or creating new ones, these traditions can give your children something to look forward to as they spend time with you during the upcoming holiday season.


6.  ENCOURAGE YOUR CHILDREN TO ENJOY TIME WITH YOUR EX:  Encourage your children to enjoy their time with their other parent – no matter your feelings about your ex, put your children first.  Your children will enjoy the greatest stability when they can feel free to enjoy enriching relationships with each of their parents.

by Stephanie Hall,
​Coordinator at The Skin & Body Center

​Self Care is a word that gets thrown around a lot lately.  I’m a Mom of 3 boys and I have this conversation with other Moms a lot.  Self care…sounds great, but when am I going to find the time to practice this mystery art?  We know we should take the time to take care of ourselves because when we do, it overflows to our children, our significant other, our jobs, etc.  Unfortunately, it can become a constant cycle of I should, I will, maybe tomorrow, definitely next week…

The reality is, the struggle is real.   We are huge advocates at the spa of self-care because we give so much to those around us, we need to replenish ourselves so I asked the staff at Skin & Body Center for their favorite Self Care Rituals.  

MASSAGE  - The benefits of massage are amazing and research shows regular massage reduces stress and anxiety and helps you to sleep.  

YOGA - Yes, I know you love to wear your yoga pants but actually DOING yoga is really good for you too! 

DRY BRUSHING – It increases blood circulation, improves skin and drives toxins out of the body.  It simply feels good and only takes a few minutes. 

FINDING JUST A FEW MINUTES OF ME TIME – this could mean savoring a cup of tea or taking a bath with oils and scrubs. 
 
EXERCISE – walking, running, group exercise, dancing. 
 
MEDITATION/QUIET TIME – take advantage of the early morning.  Get up a few minutes early and have a quick meditation and set the day’s intention.

READING FOR PLEASURE – it allows you to unplug from work, social media, stress and remain focused. 

GET OUTSIDE - gardening, working outside and going to beach are all things that can help you to relax and decompress.  Just don’t forget the sunscreen!  

SKIN CARE RITUAL – you have to wash your face, so why not make it part of your self care ritual?  Find skin care products that you love how they feel and smell.  Breathe and take a few extra moments.  
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SPEND TIME WITH A GOOD FRIEND – Your friendships are so essential to your spirit.  Take the time to nurture those relationships.  

Bottom line is make time.  Do little things every day that take care of you because you deserve it! 

January is such a wonderful month. It’s full of the freshness of a New Year; the excitement of new goals to accomplish and the anticipation of experiences yet to be had. It’s a time to plan for what’s coming next and a time to reflect on what has already passed.


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But as much as January is famously full of hope and promise, it can also be infamously full of disappointment and frustration. Especially when the opposite of accomplishing your goals is not accomplishing your goals and the opposite of anticipating new experiences is not having new experiences to anticipate.


Reflecting on last year’s goals and realizing you haven’t yet achieved them can be difficult. Even more difficult is setting the same goals year after year and never achieving the results you desire. What are your new goals for this New Year? And what goals have you rolled over from 2017?   
Whether it’s to “lose ten pounds,” or “communicate better with my partner,” or “make more money,” or “spend more time with the kids,” we all have areas of our lives we’d like to improve. What are you planning to do differently in 2018 to move past the limitations that have been holding you back? What tools and skills do you need in order to create the life and relationships you desire?
The first step in any transformation process is to change the story we tell ourselves, about ourselves. We must change our thinking in order to change our lives. Until we can identify as someone who is capable of being physically fit, or a good communicator, or deserving of wealth, or a more attentive parent, we will continuously fail to be those things because we won’t behave in a manner that allows us to achieve those goals.   

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Life isn’t about finding yourself, it’s about creating yourself. So, this year, let’s embrace our New Year’s resolutions with the intention of creating the lives, relationships, and experiences we have always hoped for. It’s never too late to become the person you were meant to be.

​According to the American Physical Therapy Association (APTA) 2012 survey, low back pain affects the daily function of 69% of Americans. Furthermore, in a survey conducted in 1999, 60% of orthopedists reported back and shoulder pain in children due to heavy backpacks. Overall, non-traumatic low back pain develops due to poor posture and muscle strain. Wearing heavy backpacks and wearing them improperly can lead to back pain, shoulder and neck pain.  

There are no studies yet that address the long term affect of back pain from backpacks, but in my 14 years as an orthopedic physical therapist, I have seen postural faults and low back pain beginning in youth manifesting into chronicity in adult life. Why risk long term muscular imbalances and spinal degeneration if prevention is a choice?  The way a heavy backpack affects a young developing spine is simple. Weight is distributed unevenly on one shoulder, causing the child to compensate and shift the hips and upper back over center line to counterbalance the load.  This causes improper muscle activation and non-activation on one side of the spine and the other, causing a “scoliotic-like” spine that can cause stress and pain in the joints and muscles.  Posture is severely affected not only with this sideways shift as in one shoulder backpack carrying, but also with carrying a heavy backpack on both shoulders with rounded shoulders, forward head, severe front lean, and a flattened low back. Growing tweens and teens already have a battle with holding themselves in proper posture. The last thing they need is a heavy back pack worsening things. 

The APTA recommends limiting backpack weight to 10-15% of the body weight of the child. The American Academy of Pediatrics (AAP) recommends a lightweight backpack such as canvas with two wide, padded shoulder straps because narrow straps can dig into shoulders. A safe backpack should also have a padded back, which is comfortable and protects kids from being injured by sharp objects such as scissors, pens, wire notebooks. A waist belt and multiple compartments can also help distribute the weight more evenly.

Overall, be an advocate for your child and look for signs and symptoms of back stress. Ask your child if his/her back is sore or achy.  Perform a visual inspection before you send your child off to school and see if your child’s posture is affected by the backpack. Conference with the teacher to ensure that there is enough time in between classes to return to lockers and exchange books.
If pain in the back, neck and shoulders persist even after proper measurements have been taken. Seek the medical help of a physical therapist. Chances are pain can be reversed with proper muscular strengthening, stretching, and manual therapy.  Your therapist will include home exercises to treat muscle and postural imbalances. Such as the cat/cow stretch, hamstring stretch, mid-back stretch and upper trapezius stretch. Strengthening will include rows, scapular stabilization, and core strengthening.  Manual therapy will reduce abnormal tissue tightness relieve stress on the spine bones.  Apply ice for 10 minutes for new onset, intense pain because the cause is most likely inflammation. Use heat sparingly as heat can increase inflammation and therefore increase pain. Only use heat as a contrast to treat the inflammation. The contrast is applied with 10 minutes heat and 10 minutes ice immediately afterwards.  This contrast technique will help “pump” the swelling out of the tissue.  
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I am a firm believer that if you keep adding micro stress on a joint or muscle over time, the muscle and joint complex will break down. Just as a butter knife cutting away at a 6 inch thick climbing rope will eventually cause the fibers to fray and fracture. 

​by Dr.  Raquel Watkins, Allergist
Watkins Allergy & Asthma Clinic

        ​The common cold and chickenpox aren’t the only ailments parents should worry about this back-to-school season. Allergy and asthma are the most chronic illnesses in children, and are a leading cause of missed school days in the United States.  Asthma accounts for 10.5 million missed school days annually.  Symptoms of these conditions can also interfere with nightly sleep, concentration in the classroom and cause learning disruptions.
          According to the American College of Allergy, Asthma and Immunology (ACAAI), 28 million American children have allergies and 7.1 million suffer from asthma. There can often be many more allergy and asthma triggers in the classroom than in the home environment, causing children’s immune systems to over respond.

​         With schools commonly known as being a petri dish of germs and viruses that get passed around from child to child, parents shouldn’t just chalk up breathing difficulties and runny noses to yet another cold. Both can be signs of something more serious, such as allergies and asthma.
          To help parents understand if their child is at risk for missing school days due to allergy and asthma, Dr. Raquel Watkins, Jacksonville’s board certified allergist and the ACAAI offer the following tips.

Know what Triggers Symptoms – There are a number of inhalants in schools that can trigger allergy and asthma symptoms, such as the classroom pet, pollen and dust that has settled in the school which can contain mouse allergens. Peers with a pet at home can also trigger an allergic reaction in your little one, since these allergens can be transferred to school via clothing and backpacks. If a child says they are coughing, having difficulty breathing, have a rash, runny nose, or are sneezing, these could all be signs they are allergic to something in school. 

Know the Difference – It is easy to mistake a cough and a runny nose as signs of a common cold or respiratory infection. If symptoms are persistent, lasting more than two weeks, it’s likely due to allergies. Colds evolve, usually starting with a stuffy nose, throat irritation and low grade fever. Next comes the sneezing and a runny nose, with thickening mucus that often turns yellow or green.  Trouble breathing, wheezing, chest tightening and often a cough that won’t stop are signs of asthma.
Find Relief – Parents should make an appointment with a  board- certified allergist to have their child tested, diagnosed and treated for allergies and asthma. An allergist can also help a child understand what is causing their symptoms and how to avoid triggers. For children with particularly bothersome allergies, an allergist may prescribe immunotherapy (allergy shots) which can modify and prevent allergy development. Patients under the care of an allergist also have a 77 percent reduction in lost time from school.
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Inform, Educate and Carry – A child’s school, teachers and coaches should all be informed of any allergy and asthma conditions and have medications available. But the education shouldn’t stop there. Children should understand what triggers their symptoms and any warning signs to watch out for. If they are prescribed life-saving treatments, such as a rescue inhaler and epinephrine, they should know how to use their medication. Many schools allow students to carry medication, making communication between parents and the school the key to a healthier child.

Dr.  Raquel Watkins is a Board-Certified Allergist who treats infants, children and adults with asthma and allergies to pollen, pets, and insects as well as skin allergies.   Her office is centrally located in Bartram  Office Park, 13241 Bartram Park Blvd, Suite 2601 Jacksonville Fl 32258 http://www.watkinsclinic.com/