Staying Well During the COVID-19 Pandemic Crisis

SGO Board of Directors Member Marcela G. del Carmen, MD, MPH, from Massachusetts General Hospital in Boston, provides cognitive behavioral strategies to manage anxiety and tools to build resilience in the current COVID-19 pandemic crisis.

Maintaining Wellness During COVID-19

The practice of Gynecologic Oncology is already fraught with emotion, stress, and burnout, yet balanced with a high sense of purpose and fulfillment [1]. The COVID-19 pandemic has brought a heightened level of stress, anxiety, fear, and panic to our personal and professional lives. The SGO Wellness Task Force has compiled this list of resources as an E-A-S-Y guide for managing pandemic panic. E-A-S-Y: eat, activity, sleep, and you [2].

EAT

• Make sure you are eating and eating well (plenty of fruits and vegetables) [3]
• Be aware that stress eating may occur, and a temporary weight gain can become permanent [4]
• Be aware of how much alcohol you are consuming – we are a profession already at risk of alcohol and addiction problems [5]
• Stay hydrated

ACTIVITY

• Set a routine, in times of crisis we crave structure even more
• Don’t forget to shower and brush your teeth
• While many at home are growing a beard, now may be the time to shave if you don’t have access to a PAPR
• Working from home can turn into an all-day pajama party, but be mindful of what you’re wearing (or not wearing) for your Zoom conference call [6]
• Contact your local Red Cross to schedule an appointment to donate blood
• Stay active, ideally outside
• If you have an internet connection, there are endless options for low- or high-impact exercise, yoga, etc.
• Connect online with Strava, Zwift, Peloton, or online classes from your gym
• Start a new hobby
• Learn to play an instrument (or just enjoy some music)
• Start journaling
• Finish that home DIY project (but avoid activities that might land you in the ER – stay off the ladder, the gutter can get cleaned later)
• How do you practice mindfulness? Do you meditate? Adults who suffer moderate to severe anxiety may be at risk for dementia – and meditation can help [7,8]
• You can find free meditation apps on your phone
• Headspace is offering to waive the membership fee, just provide your NPI
• The Chopra Center (Deepak Chopra) has made it’s 21-day meditation program free (thanks, Oprah!)
• Judson Brewer, PhD, taught Anderson Cooper to meditate, and now offers a Coronavirus Anxiety Update video on YouTube
• Ten Percent Happier is currently free to healthcare workers, but also offers a free Coronavirus Sanity Guide
• Let’s talk about….Coronavirus and Sex: Questions Answered, by Dr. Jen Gunter

SLEEP

• Now, more than ever, make sure you are getting GOOD sleep [9]
• Avoid using electronics for 30 minutes before bed
• Keep your bedroom quiet, relaxing, and cool
• Go to bed early enough to get at least 7 hours
• Keep a consistent sleep schedule, even on weekends
• Several apps have sleep-enhancing features (e.g. Calm, Brain.fm)

YOU

• Take time for YOU
• Take a break from the news
• Connect with others (Zoom chats, FaceTime, a good old fashioned phone call)
• Get your affairs in order, seriously – update your will, touch base with your financial planner, be prepared [10]
• The Coronavirus Aid, Relief, and Economic Security (CARES) Act and new guidance from CMS both contain provisions to provide financial support to qualified providers
• Take a moment to appreciate what you have (keep a daily gratitude journal)
• Take a moment to appreciate the acts of kindness in your community
• Don’t forget to keep your sense of humor, it helps [11]

“You may not control all the events that happen to you, but you can decide not to be reduced by them.” –Maya Angelou

Additional Resources:

• National Suicide Hotline: 1-800-273-8255
• National Domestic Violence Hotline: 1-800-799-723
• Childhelp National Child Abuse Hotline: 1-800-422-4453
• National Center on Elder Abuse
• SAMHSA’s (Substance Abuse and Mental Health Services Administration) National Helpline – 1-800-662-HELP (4357)
• Strategies to Support the Health and Well-Being of Clinicians During COVID-19, National Academy of Medicine
• Coronavirus Anxiety Daily Update #1: March 16, 2020 by Judson Brewer, PhD, Brown University
• Protecting Your Family From COVID-19 by Dr. David Price. 27 Mar 2020, Weill Cornell Hospital
• Curtis JR, Kross EK, Stapleton RD. The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA. 2020 Mar 27. doi: 10.1001/jama.2020.4894.
• The Four Things That Matter Most: A Book About Living by Ira Byock, MD, https://irabyock.org
• Gossage, Lucy. “Coronavirus means difficult, life-changing decisions for me and my cancer patients”. The Guardian. Thu 19 Mar 2020.
• Laucis, Anna. We Cannot Lose Another Oncologist to Burnout: Encouraging a Path Towards Wellness. ASCO Connection, 24 Mar, 2020.
• Coronavirus: What People with Cancer Should Know
• The Johns Hopkins Guide to Psychological First Aid (George S. Everly Jr. and Jeffrey M. Lating)
• Stronger: Develop the Resilience You Need to Succeed (George S. Everly Jr.)
• Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors.
• Practicing Self-Care 2.0 During These Stressful Times (Texas Medical Association,Dr. Lois Ramondetta)
• For the Frontlines: Free Crisis Counseling & Toolkit

References:

1. Vetter MH, Vetter MK, Fowler J. Resilience, hope and flourishing are inversely associated with burnout among members of the Society for Gynecologic Oncology. Gynecol Oncol Rep. 2018 Jun 8;25:52-55.
2. EASY method, adapted from E.A.S.Y. parenting routine from “The Baby Whisperer Solves All Your Problems” by Tracy Hogg, 2005.
3. Bittman, Mark. What’s Wrong With What We Eat. TED.com. Dec 2007. h
4. Aamodt, Sandra. Why Dieting Doesn’t Usually work. TED.com. June 2013.
5. Brewer, Judson. A simple way to break a bad habit. TED.com. Nov 2015.
6. A Etiquette Primer For Zoom And Other Videoconferencing Services. NPR All Things Considered. 25 Mar 2020.
7. Daviglus ML, Bell CC, Berrettini W, et al. NIH state-of-the-science conference statement: Preventing Alzheimer’s disease and cognitive decline. NIH Consens State Sci Statements. 2010 Apr 28;27(4):1-30.
8. Russell-Williams J, Jaroudi W, Perich T, et al. Mindfulness and meditation: treating cognitive impairment and reducing stress in dementia. Rev Neurosci. 2018 Sep 25;29(7):791-804.
9. Health Sleep Habits. American Academy of Sleep Medicine. Feb. 2017.
10. Simon, Scott. How To Make Your Estate Plan Amid The Coronavirus Pandemic. NPR Weekend Edition. 28 Mar 2020.
11. Spencer R, Alexander V, Eickhoff J et al. A digital media attention diversion improves mood and fear in patients receiving chemotherapy for recurrent gynecologic malignancies: results of a randomized trial. Int J Gynecol Cancer. 2020 Mar 1. pii: ijgc-2019-001185.