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So You Have IBD During a Pandemic

Hey!

What's going on? Been pretty boring over here in Chicago.

Ok I don't need to elaborate on what the hell is going on in the world. We are being bombarded with information - some accurate, a lot inaccurate - about this pandemic. It's very easy to become completely overwhelmed by it all. We've been forced, pretty damn quickly, to completely overhaul our way of life for the greater good. To reduce the strain on our healthcare system of the sick and dying. And us humans are generally bad with rapid, monumental change that we really don't have a lot of say in. Our little reptilian brains do what they're supposed to do (prime us for fight or flight or freeze) but our advanced "thinking" parts of our brain have to interject with all sorts of unhelpful thoughts, thereby sending some of us off the rails.

Before we start, turn off the news. Seriously. In the days following 9-11 we found people who consumed more 24-hour news channel information were more likely to have symptoms of post-traumatic stress disorder (PTSD). Even if they didn't live in New York City. Turn it off, please.

Ok, back to this "How To Cope During a Pandemic" thing.

Thankfully, I was able to shift my practice to 100% tele-psych pretty fast since I have been using video chat for a while with patients. I talked to 14 people last week and every single session was about COVID-19. I mean it'd be kinda weird if it wasn't, right?

Since most of my patients have a chronic medical illness, there was obvious concern about getting sick. Those on immune-suppression medications were most concerned. But there seemed to be less concern about the prospect of "sheltering in place" or "stay at home" orders. Why can't we pick a universal term, government people? They seemed less concerned because many have had lengthy hospital stays, or have had to limit their social lives due to a particularly bad disease flare. My IBD patients seemed the least fazed by not having to go out for a while.

With that being said, we know social distancing and isolation can cause problems, psychologically, in the long term. And it looks like we're in this for a while. So I'm going to provide a list of tips on how to cope through COVID-19.

I really like the resources from Dr. Ali Mattu (@AliMattu), who runs a wonderful YouTube channel on various topics in psychology. So instead of recreating the wheel, I highly highly recommend you watch his stuff.

For example, he has some great tips on coping with the coronavirus pandemic:
https://www.youtube.com/watch?v=mwrMtJ3DYXg

What else can you do? Leverage the antidotes to anxiety and depression. And there are many. It's about figuring out what are the best ones for you.

What are the antidotes to anxiety?

  • Recognize your running thoughts in your head so you can evaluate their usefulness.
  • Answer "what ifs" versus simply stating them and jumping to the next "what if" question.
  • Realistically evaluate your ability to get through the situation. You've been through a LOT in life, why is this situation any different? 
  • Exercise. Yes. Exercise.
  • Keep a routine.
  • Write down your worries each day for 15-20 minutes.
  • Relaxation time. Whatever works for you. Meditation, deep breathing, yoga, stretching, listening to music, making music, making art. Whatever, it doesn't matter as long as it works for you.
  • Get one of those adult coloring books, preferably with the swear words in it. But any kind is fine. Color a page a day.
  • Pay attention to your shoulders. Are they up by your ears? You're tense. Take a minute to relax.
  • Acceptance. We can't control most of this. And that's ok. Do you really want to be responsible for managing a global pandemic? Let it go. Focus on what you can control.
  • Turn off the news. Seriously. 5-10 minutes tops at any time. Then go do something else.
  • Turn off Facebook or other social media if it's just making you scared or tense or angry. 
  • Only use information from reputable sources. What's a reputable source? The World Health Organization.
Excellent resources on coping with anxiety, not COVID specific:

How to get through immediate anxiety: 
How to get into mindfulness (not your usual exercises):
How to do deep breathing:

What are the antidotes to depression?
  • Keep a routine. Take a shower. 
  • Use technology to stay connected to your loved ones. 
  • Engage in "meaningful activities." There's no right or wrong answer to this, rather what feels good to you. Clean your closet. Knit a hat. Paint your toenails.
  • While TV is a lovely escape, don't spend the whole day on Netflix. Take breaks to get up and move. 
  • Go for a walk outside, just keep your distance and don't congregate.
  • Exercise. Yes. Exercise.
  • Turn off the news except for 30 minutes total a day done in short 5-10 increments.
  • Turn off social media as much as possible. Limit your time on any platform to 20 minute increments unless you're engaged in meaningful connection to others. 
  • Recognize your thoughts and evaluate their usefulness.
  • Limit alcohol consumption.
Tips for working through depression:

Specific to people with IBD and other conditions where you may be on medications that suppress your immune system - this includes me. I am immune-suppressed.
  • DON'T STOP YOUR MEDICATIONS UNLESS YOUR DOCTOR TELLS YOU TO. Yes I'm yelling. And I don't mean Dr. Google. Or Dr. Oz. Your prescribing doctor is your sole source of information on this right now. 
  • Be flexible and patient. My gastroenterologist's office has converted to tele-medicine and canceled any elective procedures. This is to protect health care workers, save on supplies, and reduce your risk of exposure.
  • Use your patient portal to communicate (if you have access to one) but don't blow up your doctor's inbox. They're already stressed. Be concise in your message and patient as you wait for a reply.
  • Pharmacies will stay open no matter how "locked down" we become. There may be shortages of certain medications, so refill as early as you can versus waiting until you have 1 dose left. 
  • Maintain a healthy diet. I know I've been eating less than optimally the past week and need to get back to my usual routine. If you have foods you know cause your gut unhappiness, avoid them for now.
Right now, if I have to pick from the psychology concepts and strategies I use with my patients, by far Acceptance and Commitment Therapy is where it's at to help with life in the era of COVID-19. I will write more in the coming days on this, but for now here are some good resources on how to accept we're in a shit show, and it's going to be weird and tough and scary, but that's ok.

Turn off the struggle switch:
https://www.youtube.com/watch?v=rCp1l16GCXI
The sushi train exercise:
https://www.youtube.com/watch?v=tzUoXJVI0wo
The unwanted party guest exercise:
https://www.youtube.com/watch?v=VYht-guymF4

If you've never done any of the stuff I've written or shared, know it's going to be hard to implement right away. Don't give up, though. Give it at least a few weeks before you decide it's not working for you. Be consistent in your practice. Like you were when you were a kid, learning to ride a bike.

It'll be ok. Or it won't. Either way, you can deal with this.

-T2

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