“Nothing compares to the simple pleasure of a bike ride.” – John F. Kennedy

A few months back, the snow started to melt and we headed out to the Erie Canal for our family walk/bike ride. My son, Matthew, asked if I wanted to ride his bike for a few miles so he could rest.

I laughed at the idea.

A bike? Me?

At age 42, I hadn’t been on a bike since I was 16 – no, that isn’t true. I was on a bike while at the boardwalk in Ocean City, Maryland a few years ago, but it was one of those beach bikes that holds four people and has a basket in front. Does that even count?

Anyway, I agreed. I got on the bike and wobbled a little at first. But then after about a mile, I realized… I love this feeling!

And this is how my biking obsession began. I worked out the details to purchase nice bikes for my husband and me that we could use on the roads and trails near our home in Chittenango, and within days we had our very own Trek bikes.

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Bike riding: I’m not alone

What I have learned since that day in March is that I’m one of many people who have this love for the freeing, stress relieving qualities of riding a bike.

As I take to the roads and trails every day with my husband and children, we pass dozens of biking enthusiasts. Some are sporting fancy gear and riding the cream-of-the-crop bikes, others are simply wearing their protective helmet and peddling a not-so-fancy bike like mine.

Take my friend and coworker Erika Gruszewski, from Monroe County, for instance. Since the pandemic started, she, her husband and their daughter have gone bike riding together as a family, which is a fun way to explore their neighborhood and get some activity at the end of the day.

“We also have a push-along trike for my toddler – she can’t reach the pedals yet, but she loves ringing her bell and wearing her helmet,” Erika said. “Pushing her around the neighborhood in the trike or the stroller is an almost daily activity for us. Getting out and moving in the fresh air always improves my mood!”

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As many people, especially families like Erika’s with young children at home, are looking for lockdown-compliant ways to get outside and keep everyone as healthy and happy as possible, we’re all enjoying this physical activity, outside in the fresh air.

In fact, research shows that a growing wave of New Yorkers are embracing cycling and that it’s a booming method of exercise and transportation in larger cities. According to PeopleForBikes Foundation, “affordable recreational bikes and practical models for commuting and errands are in high demand right now.” During May and June of 2020, bike sales throughout the nation were up substantially from last year — 65 percent greater than year-to-date 2019.

A Bicycle Built for Sunday Funday

Lilac Inthavong-McEvoy, who resides in Monroe County, said it’s easy to understand why the popularity of cycling has grown.

“It’s a fun, easy way to get outside, spend time with others, and get exercise,” she explained. Lilac spends her Sundays traveling bike trails and roads throughout Rochester with her coworkers at Excellus BlueCross BlueShield on what she calls “Sunday Funday.”

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“On any given Sunday, we could have as many as 16 people – coworkers, their spouses, their kids – who meet and ride,” she said. “It’s a way to be together and spend quality time in a safe, socially distanced way.”

Connect, Reflect, and Recharge

Co-worker and friend, Melissa Gardner, who also resides in Monroe County, has benefited from Lilac’s cycling Sundays.

“In most aspects of my life I am an introverted person who is very self-motivated to accomplish any goal I set,” Melissa said. “That isn’t true for fitness, though. Any time I missed a goal or broke a fitness streak, I would borderline give up and allow too much time to pass before picking back up healthy habits.”

For someone like Melissa, who wasn’t a fan of group fitness classes or anything that felt competitive, cycling has given her the outlet she needed to connect with others, reflect and recharge.

On the weekly rides, Melissa says she enjoys the fact that she “can meet-up with riders for great energy and be completely by myself – all while burning calories and exploring our community.”

Benefits of getting on a bike and peddling

Not only do biking and other forms of outdoor activity allow families to get exercise, they also provide valuable peace of mind during stressful times, said Nicholas Massa, MD, medical director at Excellus BlueCross BlueShield.

“Being able to go outside and spend quality time with the family, while getting the physical activity that we all need makes getting on a bike an easy solution to maintaining your health.”

According to Massa, we should follow these physical activity guidelines for Americans.

“Adults need at least 150 to 300 minutes of moderate physical activity each week,” he explained. “Adults also need to engage in strength-based activities (lifting weights, push-ups) at least 2 days each week. Following these guidelines can improve overall health and decrease the risk of chronic diseases such as heart disease, cancer or diabetes.

There are also physical activity guidelines for children age 17 and under:

• Children ages six to 17 need at least one hour of moderate-to-vigorous activity every day. They should also include both aerobic activity (biking, walking, running) and strength-based activities (climbing on the playground, jumping rope).
• Preschool-aged children should be active for at least 3 hours per day to support growth and development.

Tips and Tricks for a Safe Bike Ride:

• Wear a helmet.
• Be seen. Dress like a fluorescent peacock—wear bright colors and reflective clothing, especially in the early morning, late at night, or on cloudy days.
• Protect yourself from the sun. Wear sunscreen, especially on the back of your neck, and sunglasses
• Know the weather forecast. Wear waterproof gear as needed.
• Be alert. Never ride with headphones or an earpiece. You need to hear everything you possibly can.
• Ride with a buddy. Two cyclists will be more visible than one. Plus, if something happens to you, your buddy may be able to facilitate the emergency response process (and vice versa).
• Get creative with your route. Choose roads that are extremely wide or have dedicated bike lanes. Opt for quieter neighborhood roads over high-traffic ones.
• Always carry a patch kit. Learning to patch up your own flat tire can prevent you from being stranded in an unsafe or remote location.
• Carry a cell phone and ID. If you don’t have a patch kit and need a ride, your cell phone will come in handy.
• Bring drinking water for longer rides.
• Ride with traffic, never against it.
• Always be ready to yield. What you can do is go slowly enough that you could stop or give the right of way at a moment’s notice.
• Be vigilant at intersections. When coming to a stop, hang left in the lane so the drivers behind and in front of you can see you.
• Be on the lookout for loose gravel, ice, sand, puddles, and other road hazards.
  
• Take bike-specific trails, whenever possible; follow the rules of the road; use bike line if there is one.
• Don’t share water bottles.
• Practice good cough etiquette by coughing and sneezing into your arm, not your hand.
• Wash hands with soap and water after any possible contamination, before eating and after using the bathroom (or use alcohol-based hand sanitizer if soap and water are unavailable).
• Consider bringing hand sanitizer or wipes to use after portable toilets.

As medical practices open for patient visits, it’s time to reconnect with your doctor to discuss care or screenings you may have postponed. That includes screenings for breast, cervical, and prostate cancers. But those aren’t the only screenings to check on.

Colon Cancer

Colon cancer is the third leading cause of cancer death in New York state. There are about 9,000 new cases of colon cancer each year in our state and about 3,000 deaths.

Colonoscopy is the most thorough screening test and is proven to prevent the disease. Removing benign or pre-cancerous polyps found during colonoscopy can not only prevent colon cancer, but also can reduce deaths from the disease for years.

Learn about Lynn’s colon cancer story by watching the video below:

Prediabetes

Prediabetes is serious, common, and reversible with lifestyle changes. One in three adults has prediabetes, but 90 percent don’t know it because there aren’t always symptoms. A simple blood sugar test can show if someone has prediabetes. African Americans, Hispanic and Latino Americans, American Indians and Native Alaskans are at higher risk for having elevated blood sugar levels.

Learn more about prediabetes by watching the video below:

 

Skin Cancer

Skin cancer is the most common cancer in the U.S., according to the Centers for Disease Control and Prevention. The current estimate is that one in five Americans will develop skin cancer in their lifetime.  More than five sunburns in a lifetime can double a person’s risk for melanoma.

According to the American Academy of Dermatology, Caucasians and men older than 50 have a higher risk of developing melanoma than the general population. However, skin cancer can affect anyone. Skin cancer in persons of color is often diagnosed in its later stages, when it’s more difficult to treat.

The American Academy of Dermatology encourages everyone to perform regular skin self-exams to check for signs of skin cancer, including new and changing moles. Individuals with a history of melanoma should have a full-body exam by a board-certified dermatologist at least annually.

Learn more about preventing skin cancer below:

Screening Saves Lives

The best option for medical care is to see you provider in person. With many practices now welcoming patients, it’s time to reconnect with your provider to discuss care or screenings you may have postponed. Screenings save lives!

For more information and resources to help you reconnect with your provider, visit ExcellusBCBS.com/reconnect.

You’ve likely heard this before: staying connected is important for our health.  But have you really thought about why and how, especially during this time of physical distancing?

“We are wired for social connection,” said Amy Hernandez Gamboa, BSW, a medical services care management trainer with Excellus BlueCross BlueShield. “Our new way of living has tested our ability to go long periods of time without seeing friends, family, being able to hug, or enjoy physical gatherings,” Amy said.

That lack of social connection can have a negative impact on how we feel both physically and mentally. “Right now we are feeling the barriers that are getting in the way of the benefits,” Amy said.

The Benefits of Social Connection

Science backs up the importance of social connection. In fact, social ties might be the single most important predictor of wellbeing.

Some of the positive impacts of social connection on physical health:

• Strengthens the immune system;
• Quicker recovery from disease;
• Increases longevity;
• Sharper memory;
• Can help reduce stress and blood pressure when pregnant

There are mental health benefits of social connection as well:

• Lower rates of anxiety and depression;
• Higher self-esteem;
• Greater sense of empathy;
• Improved mood;
• Increased trust and cooperation;
• Increased ability to support others

Quality, Not Quantity

Social connection looks different for everyone, but there are four key elements, according to Amy:

1. Having meaningful relationships. It’s about quality of relationships, not quantity.
2. Making regular connections. For some, that may be a daily connection and for others, it is less often.
3. Feeling a sense of belonging. Have you heard the expression “find your tribe?”
4. Having shared experiences. Sharing experiences with others can enhance that feeling of connection.

5 Ways to Encourage Connection

“If you’re like me, you may find yourself missing your connections and needing to find creative ways to stay connected,” Amy said. “Social connection can occur without physical connection.”

Amy recommends five themes and thought-provoking questions to consider in order to encourage connection:

1. Grace – be forgiving of yourself and others. Find time and make it a priority to stay connected. Social connection is going to look different today than in the past. Ask yourself: how can I let go of prior expectations and create space for myself and others to connect today? What are my one to two priorities today?
2. Technology – it allows us to go places we may not have been able to go before via virtual tours, such as museums and zoos. Use social apps to connect for a virtual book club or virtual walk with a friend. Ask yourself: where do I want to ‘go’ today? When can I set up a video chat with a friend or relative today? Technology helps us break through the barrier of physical distance.
3. Intention – be intentional in your connections. Who do you want to connect with and how today? Determine how you’re going to spend your time.  This can help address any barriers you may have. Think about a one-word intention that can help you strengthen connections this week, maybe it is “gentle” or “try.”
4. Creativity – think outside the box. What creative idea can you share with a friend or family member today?  What inspires you today?
5. Generosity – socially connect by thinking about others. Ask yourself: who might need to hear from me today or how can I support others?

Choose Your Own adventure

Choose to make your social connections an adventure.  This is especially helpful if negative thoughts begin to take up too much thought.  You can:

• Remember the past. Reminisce on fun, shared experiences with friends or go through mementos.
• Embrace the present. This allows you to appreciate today. A fun idea shared by Amy is to meet up for ice cream with a friend and enjoy from the safe distance of your cars.
• Plan for the future. Make a bucket list. Think of all the future holds for you!

What ways have you stayed in touch while staying apart?

Share your tips in the comments section below.

Sources:

• https://greatergood.berkeley.edu/topic/social_connection/definition#what-is-social-connection
• https://depts.washington.edu/uwcssc/content/basic-understanding-social-connection#overlay-context=content/current-research
• Arewasiporn, A., Sturgeon, J., & Zautra, A. Sharing Positive Experiences Boosts Resilient Thinking. October 8, 2018.
• Cacioppo, John T., Patrick, William. Lonelieness: Human Nature and the Need for Social Connection. New York   London, NW.W. Norton & Company. August 17, 2008.
• https://greatergood.berkeley.edu/article/item/why_are_we_so_wired_to_connect
• https://www.psychologytoday.com/us/blog/the-athletes-way/201309/the-love-hormone-drives-human-urge-social-connection
• https://greatergood.berkeley.edu/topic/social_connection/definition#why-practice-social-connection
• https://greatergood.berkeley.edu/article/item/social_connections_keep_pregnant_moms_healthy

 

Most people who are near the end of life lack the ability to make their own decisions about the life-sustaining medical treatments they wish to receive or avoid. For patients with advanced illness and frailty, the most important means of ensuring their preferences are honored is to have a properly completed and accurate electronic version of Medical Orders for Life-Sustaining Treatment (eMOLST) available in their electronic medical records through connections with the New York state eMOLST Registry.

Peace of Mind For Those With Advanced Illness

eMOLST is for patients with serious health conditions who want to receive or avoid any or all life-sustaining treatment, who reside in a long-term care facility or require long-term care services, and/or who might die within the coming year. In New York state, eMOLST, and its predecessor, the hard copy MOLST, are the only authorized ways to legally document both nonhospital Do Not Resuscitate (DNR) and Do Not Intubate (DNI) orders that Emergency Medical Services can follow. eMOLST also documents additional specific medical orders that are recognized and honored in all health care settings, including preferences regarding hospitalization. In hospitals, hospice, nursing homes, and the community, eMOLST is used to issue orders concerning preferences for resuscitation and life-sustaining treatment.

COVID-19’s impact on the frail elderly illustrates the important role eMOLST has in the way preferences for care, recorded as medical orders, are communicated. The importance will be intensified if predictions for a second and third wave of the virus are realized. eMOLST allows frail older adults to write their own final chapter and relieve loved ones of any anxiety that comes with making end-of-life health care decisions on their behalf.

eMOLST is not intended for healthy people, or for people who have a chronic condition or multiple chronic conditions but have a long life expectancy. Those individuals should complete a health care proxy and discuss their wishes for care with family and loved ones.

How to Complete eMOLST

Patients should ask their providers if eMOLST is right for them, and if so, complete the electronic form. If a hard copy MOLST already exists, the COVID-19 crisis would dictate that it be reviewed and updated and converted to eMOLST so that it is in the registry. If a patient lacks the ability to make end-of-life decisions, the health care agent or surrogate should speak with the provider. The tools and features in the eMOLST system ensure that a standardized process is used for conversations, and the completed eMOLST is 100 percent accurate.

Licensed physicians and nurse practitioners have the authority and accountability for accurate completion of MOLST and eMOLST under the Public Health Law. As of June 17, 2020, physician assistants also will have that authority and accountability. Only licensed physicians can complete MOLST and eMOLST orders for patients with intellectual or developmental disabilities who lack capacity to make medical decisions and cannot complete a health care proxy.

When an authorized health care practitioner signs the eMOLST, a copy of the medical orders and the discussion automatically become part of the statewide eMOLST Registry that is available as a public health service in all settings, as patients move from one care setting to another across New York. The physician, nurse practitioner, or physician assistant also will print a copy of the eMOLST on prominent, bright pink paper that will physically travel with the patient.

Additional Resources and Education

Excellus BlueCross BlueShield led the development of two free community websites.  CompassionAndSupport.org has information on advance care planning, free downloadable health care proxy forms and instructional videos. MOLST.org has COVID-19 guidance on MOLST, how to have thoughtful MOLST discussions, and instructions for obtaining urgent access to eMOLST.

It was while I was lying awake at 3:00 a.m. again that I realized something was not right.  I am usually an early riser, but 3:00 a.m. is really early, even for me! The pandemic had brought about a lot of changes to my life, including a significant reduction in sleep!

A Vicious Cycle

I work as a Workplace Wellness Coordinator at Excellus BlueCross BlueShield. My job is to educate others on the importance of sleep, but I am not immune to having issues myself.  I know how detrimental inadequate sleep can be, with problems ranging from impaired memory, to obesity, to greater likelihood of car accidents. That knowledge only raised my stress levels! And like a vicious cycle, the more I stressed about not sleeping, the less I slept.

I decided to get help

One night, stuck in another vicious cycle of not sleeping, I decided to get help. I was already registered with MDLIVE, the telemedicine service affiliated with my health insurance. I decided to schedule an appointment with a Licensed Social Worker, who was available within a couple of days.

During my appointment, she explained that I was feeling so stressed that my brain was too “busy” to shut down and sleep properly.  She gave me some activities to try such as meditation and breathing techniques.  She told me to work to make small improvements, even an extra 20 minutes at night is a start.

6 Habits for Better Sleep

Sleep problems are common, according to Greg Carnevale, M.D., chief medical officer and sleep specialist with Excellus BlueCross BlueShield. “There are 50-70 million people in the U.S. that suffer from one or several sleep disorders that result likely in not getting enough sleep. The cause and solution can vary for each person,” Carnevale said. Health experts recommend getting at least seven hours of sleep each night.

“As a society, we need to recognize the dangers of trying to get by with fewer hours of sleep and wake up to the health benefits of a good night’s rest,” Carnevale said. He offers the following tips for improved sleep:

• Keep bedroom quiet, dark and cool.
• Avoid large meals, caffeine, nicotine and alcohol before bed.
• Stick to a consistent sleep schedule, including on weekends.
• Exercise regularly.
• Establish a relaxing bedtime routine.
• Turn off electronic devices at least 30 minutes before bed.

Seek Help When You Need It

I’ve been listening to the advice of the social worker and thankfully, it is helping. I really wish I had called sooner. But, it is never too late to seek help.

“There are sometimes very easy and simple steps to improve on your sleep, and sometimes you need a professional, such as your doctor, to help,” Carnevale said. “Trying to navigate the misinformation out there alone can have deleterious effects to you and your health.  Don’t wait to seek help,” he added.

View and download an Excellus BlueCross BlueShield infographic on ways to improve sleep at ExcellusBCBS.com. For more help with sleep, talk with your doctor or sleep specialist.

The COVID-19 pandemic is shedding new light on the often-abstract concept of advance care planning. Advance care planning is where individuals document what matters most to them, and then select the right health care agent to make decisions on their behalf if they are unable to speak for themselves. During this pandemic, many people have had the heartbreaking experience of making medical decisions for loved ones who were unable to communicate.

Advance care planning gives patients peace of mind in knowing that health care decisions will be made on their behalf by a person they trust. For the person selected to be someone’s health care agent, advance care planning gives them the confidence to make decisions based on their loved one’s stated values and beliefs.

Advance Care Planning: For all Adults Ages 18 and Older

All adults ages 18 and older should start advance care planning conversations with their health care providers, family members and trusted friends. Then, they should complete a health care proxy to formally name a health care agent.

Completing or updating a health care proxy can be done at an office visit to the individual’s physician, nurse practitioner, or physician assistant. The practice of social distancing may require this to be done with a telehealth visit via telephone or by using video conferencing technology such as Skype.

The health care proxy form requires two witnesses to the signature. This can be accomplished in person, or by using video conferencing technology. A photo of the signed health care proxy can be mailed to the health care provider or uploaded to the medical practice’s secure patient portal. Individuals also should email a copy to family members.

If video conferencing is unavailable, speak with your health care provider about the process for verbal consent.

Read special considerations on how to complete a health care proxy during the pandemic by visiting CompassionandSupport.org.

MOLST: For those with an advanced illness

Individuals with an advanced illness or advanced frailty are advised to reach out to their physician or nurse practitioner to discuss the Medical Orders for Life-Sustaining Treatment (MOLST). MOLST reflects a patient’s preferences for treatment, including resuscitation, respiratory support on a ventilator, and hospitalization. It is based on a thoughtful discussion  about the patient’s current health status, prognosis and goals for care.

MOLST is not an advance directive and is not for healthy people. It is a set of medical orders signed by a physician or nurse practitioner that must be followed.

Learn More and Start The Conversation

Excellus BlueCross BlueShield led the development of a free community website, CompassionAndSupport.org, that includes information on advance care planning, free downloadable forms and instructional videos. MOLST.org has COVID-19 guidance on MOLST, eMOLST, and how to have thoughtful MOLST discussions.

An educational poster “Who Will Speak For You If You Can’t Make Your Own Health Care Decisions?” is available to download at ExcellusBCBS.com.