This Holiday season has been challenging as family members chose whether or not to travel and spend time together after months of time apart.   

Many family and friends have different comfort levels of what works for them in terms of safe practices during a pandemic.  The key to navigating this time and making your self-care a priority is to be clear with yourself and others what your vision of a safe and peaceful holiday looks like and communicate that plan unapologetically and confidently.

This year after being apart from many family members for what will be a year next month, we made the decision to stay home for Thanksgiving and not travel.  While in my heart I wanted to spend time with family and friends I immediately felt anxious and uncomfortable at the thought of several families coming together under one roof to spend time together and share a meal.

What I have learned personally and professionally is that the path of peace is always the path that will be right for you.  Do not let yourself be guilted or manipulated into veering off the path of peace to accommodate someone else’s agenda.  Choosing to people please over peace of mind will always leave you feeling emotionally hungover in every way.

I often get asked by clients, “Isn’t that selfish to not see family and friends, don’t you think that is harsh?” Pandemic or not, self-care should be what you honor above all else.  What is selfish is someone giving you a hard time and using guilt as a way to get what they want.

Self-care sounds like this, “I’m really feeling overwhelmed and tired not to mention anxious about numbers rising again, what works for me this year is to limit contact outside to those I only live with and lay low.  While I would love to see everyone, I need to honor what I feel comfortable with.  I appreciate your understanding.”

Selfish sounds like this, “I can’t believe you won’t be coming over for Christmas, everyone is really upset and we all miss you so much, I just don’t see the harm in stopping by for dessert, what’s the big deal?

Self-care sounds like this, “I am disappointed too and for me this is what works this year.  When things settle down and are less risky, we can talk about getting together.”  End conversation and don’t take the bait of guilt.

A person who respects your boundaries would respond like this, “While we will miss seeing you this year, I understand how you feel and would not want you to feel anxious or uncomfortable about getting together.” No guilt, no manipulation, no drama and no emotional hangover.  Clean and direct.

2020 has brought us many lessons; perhaps the one we can practice this month is to continue to honor our boundaries and to communicate in a clean, direct way leaving no room to be bullied into serving someone else’s agenda.

These are lessons and styles of communication that we have to practice regularly in order to build up the muscle of confidence and ease in communicating our needs.  Once you practice this it gets easier and easier and the fear of conflict or a negative reaction begins to diminish.

I work with individuals who are working on this in their late teen years and others who are in their eighties. It’s never too late to learn how to honor what works for you.

YOU ARE WORTH IT!

Meghan Fritz is a psychotherapist practicing at Fritz, Stanger & Associates. Telehealth appointments are available, visit www.fritzstanger.com for more information. 

Imagine in February of 2020, if I had asked you about your ‘maskne.’ How would you have responded? 

However, in November 2020, the majority of people are familiar with this portmanteau of mask plus acne that has been added to our coronavirus lexicon to describe acne breakouts, dry skin and irritation caused by chronic mask use. The ubiquitous fashion accessory of 2020 has come with some unexpected side effects. In the dental office we are seeing an explosion of complications arising from mask usage and while the most common complaint is bad breath, the more serious concerns are increased dental decay, gum disease, temporomandibular joint (TMJ) dysfunction, facial pain and bruxism (tooth grinding).  

‘Mask Mouth’ is the new term being given to the associated dental diseases arising from chronic mask wearing.  The Center for Disease Control (CDC) acknowledges the efficacy of face masks in blocking the release of small respiratory droplets that may contain the COVID-19 virus and therefore the use of face coverings is essential to help curb the spread of this virus.  The three most common types of masks are cloth masks, surgical masks and respirators like the n95 or kn95’s, more commonly worn by healthcare providers.  While the importance of mask use is indisputable, acknowledging the side effects and planning accordingly will help limit potential damage.

HALITOSIS (BAD BREATH)
Bad breath has been the most common complaint from wearing a mask.  The bacteria in our mouth produce a sulfurous compound called methyl mercaptan.  This is often described as smelling like cabbage or rotting eggs and is believed to be responsible for halitosis.  When you are wearing a mask many people breathe through their mouth instead of through their nose.  This leads to a decrease in saliva and dry mouth (xerostomia).  Saliva is responsible for washing away the build-up of bacteria that forms a biofilm on the teeth.  Saliva also contains antimicrobial agents that help reduce the bacterial population and contains an abundance of minerals necessary for remineralizing enamel.  Dry mouth increases your bad breath by allowing far more bacteria to populate.  In addition to mouth breathing and dry mouth, people are drinking far less water because it is often cumbersome to remove the mask; this is especially true for those of us working in the healthcare field where donning and doffing (applying and removal) of personal protective equipment can be quite a chore.  This increased difficulty decreases water intake throughout the day leading to further dehydration.  Lastly, during the pandemic we have seen an increase in coffee and alcohol consumption, both of which worsen dehydration and lead to increased dry mouth. 

There are several steps you can take to help prevent dry mouth and improve your bad breath.  First drink more water throughout the day and try to decrease your coffee and alcohol intake.  Set a schedule for water consumption throughout the day if necessary.  Try a humidifier while sleeping to increase the ambient moisture.  Use an alcohol-free mouth rinse and a tongue scraper to help decrease the bacterial load and increase the frequency of your professional dental cleanings. Lastly, there are excellent over-the-counter oral health care products, such as Biotene, that have been specifically designed to help with xerostomia.

TOOTH DECAY AND GUM DISEASE
While bad breath may be the number one concern for the patients, tooth decay and gum disease are far more concerning to your dentist.  The decrease in salivary flow from dehydration and dry mouth allows for a build-up of bacteria, particularly around the gum line of your teeth.  Since the root surface of your tooth lacks the hard-protective enamel coating it is much more prone to decay and that decay spreads much faster.  Your saliva is a natural buffer, neutralizing acid from food and bacteria, as well as being supersaturated with minerals like calcium that help to mitigate the damage from the acidic challenge produced by these bacteria.  Dry mouth will also allow food particles normally swept away to stay stuck around and between the teeth serving as a food source to the adherent bacteria, increasing the likelihood of decay.

Additionally, without saliva to help lubricate and wash away the bacteria, it will begin to harden on the tooth surface converting from plaque to tartar or calculus.  This hardened build-up of bacteria on the tooth will cause irritation and inflammation of the tissue and underlying bone.  If this build-up is left untreated it can lead to an irreversible loss of the supporting structures known as periodontal disease or loss of the protective keratinized tissue around the tooth, known as gingival recession.  In addition, the inflammation caused by periodontal disease has been associated with multiple systemic conditions including heart disease and diabetes.  While gum disease is painless in the early stage, bleeding gums when you brush and floss is a good indication that the inflammation is progressing. 

Chronic mask usage may also be responsible for making the bacteria in your mouth more aggressive.  There has been some misinformation regarding the use of cloth or even surgical masks, implying their use can cause a decrease in blood oxygen (hypoxia) or a build-up of carbon dioxide in the blood (hypercapnia).  While this has been shown to be false, there remains some debate as to whether the extended use of masks, particularly a respirator-style like an n95, may result in a slight carbon dioxide increase over time.  Now while this build-up is thought to be so low that it doesn’t affect the general health of the wearer, any increase in carbon dioxide in the mouth would favor the proliferation of more virulent and aggressive anaerobic bacteria.  This could worsen the potential for decay and gum disease over an extended period of time. 

TMJ DYSFUNCTION, FACIAL PAIN AND HEADACHES
TMJ dysfunction, facial pain and headaches are an unexpected side effect of chronic mask use and have proven to be a real problem for many people.  Dentists have seen a significant increase in the number of patients presenting with joint and jaw pain, headaches and facial pain. 

The temporomandibular joint is a sliding hinge joint that connects the jawbone (mandible) to your skull.  It is positioned anteriorly or in front of your ears and you can feel the joint move as you open and close your jaw by lightly positioning your fingers just in front of the tragus of your ear.  Temporomandibular joint disorders (TMD) are characterized by pain in the jaw joint and in the muscles associated with jaw movement. 

Often times, TMD is believed to arise in patients who are prone to clenching, grinding and nocturnal bruxism.  These habits are often associated with anxiety, stress and emotional disturbances. The coronavirus pandemic has certainly made anxiety, stress and emotional disturbances a common problem for many, many Americans, leading to significant increases in TMD. These problems are being mistakenly identified as sinus issues, toothaches, neck pain, facial neuralgias and headaches leaving those suffering without any relief. 

Why are masks hurting our jaw joints and causing so many complications? Many people are uncomfortable wearing a mask.  Often, the wearer will tense the jaw and jaw muscles to help hold the mask in place. It results in increased small jaw movements as people attempt to move the mask away from their face and mouth, or attempt to reposition the mask to keep it in place or release the tension on the bridge of the nose or the face. It is this constant muscle tension and movement that fatigue and overwork the muscles of mastication leading to pain. 

Many people protrude the lower jaw in an effort to ‘tent’ the mask away from their face.  This is especially common in children or those suffering from conditions that make them especially sensitive to touch or texture, such as Autism. Others subconsciously protrude the lower jaw to open their airway and increase breathing efficacy. This is especially common with geriatric patients and those patients with breathing issues.  Protruding the lower jaw will help increase airflow while mouth breathing to help overcome the resistance to airflow caused by the mask.  This is especially true in the healthcare environment and those wearing respirators and high-level surgical masks.

An additional cause of headaches from masks can be from the ear loops, which apply pressure to the auriculotemporal nerve (a branch of the trigeminal nerve) which runs just in front and above the ear into the scalp.  Compression in this area from tight ear straps can cause facial pain and headaches.  Using ‘ear savers’ or mask extenders allow you to eliminate the pulling or compression caused by the ear loops on most masks.

If you believe you’re suffering from TMD, headaches or facial pain associated with mask usage there are several steps you can take to help. Try to keep your jaw relaxed while wearing the mask, your teeth should not be touching, lips slightly apart and tongue resting lightly on the floor of your mouth. Try not to clench your jaws or protrude/push your lower jaw forward while wearing your mask. My other recommendation is something I call ‘M & M’ therapy. Unfortunately, it doesn’t mean you get to indulge in delicious candy-coated chocolates.  It stands for, Moist heat, Massage, Motion, Motrin (or any anti-inflammatory, such as ibuprofen), Mush diet, Mouthguard and Muscle relaxer. You want to treat early TMD symptoms with simple physical therapy; moist heat, massage and motion to help relieve muscle tension, use an anti-inflammatory to reduce swelling and pain in the joint, limit hard and tough foods (especially gum chewing), use a night guard to reduce further pressure on the joint and a muscle relaxer to help spasm.  If you’re not getting relief, you may need to consult your dentist.

ANXIETY, DEPRESSION, ISOLATION AND FACIAL PAIN
This time has been one of the most unique, scary, isolating, and depressing times anyone can remember.  It has tested the emotional constitution of many people and many of us have been forced to find different methods to cope with the isolation and stress.  Physicians and pharmacies are reporting significant increases in the number of prescriptions written and dispensed for antidepressant and anxiety medications during 2020. 

Many of the medications prescribed for the treatment of depression, anxiety and emotional distress are in a class of medications known as SSRI’s or selective serotonin reuptake inhibitors. SSRI’s block the reabsorption (reuptake) of serotonin into the neurons in the brain. Serotonin is a key hormone that stabilizes our mood, and promotes a feeling of well-being and happiness. Serotonin generally makes humans happier and less stressed.  Unfortunately, SSRI’s have a common side effect, they increase clenching and grinding. 

Reports have chronicled patients suffering with symptoms of bruxism, including jaw clenching, headaches, tooth grinding, and broken teeth after they began treatment for relief of depression and anxiety with common SSRI’s.  These medications include, Fluoxetine (Prozac), Seratraline (Zoloft), Venlafaxine (Effexor), Escitalopram (Lexapro), Paroxetine (Paxil) and many others.   

It seems counter intuitive that medications designed to make you feel better, less depressed and less stressed will paradoxically increase your clenching, grinding and nocturnal bruxism, leading to facial pain and even broken teeth.  It’s important as dentists that we recognize this problem and identify our patients that might be suffering so that we may take steps to mitigate this side effect and help our patients to a better quality of life. 

This year has been proven to be difficult in so many different and unexpected ways.  It is important that we take the necessary steps to protect ourselves and each other so that we may all get through this together.  It is also necessary that we, as medical and dental professionals, recognize the new challenges that face us during this time.  Mask wearing is important but it comes with consequences.  It is important to talk with your physician or dentist if you believe you are experiencing any of these symptoms.Stronger together. 

The end of another year is rapidly approaching, and just as you cross items off your checklist and prepare your home for the winter, it’s also important to complete maintenance items to prepare your finances to close-out 2020.

The first piece of financial housekeeping will be to begin to gather documents you’ll be needing just after the new year to prepare your taxes. Compile receipts for medical bills, tuition payments, child care and charitable contributions, among others.

While many of us will no longer be able to itemize deductions due to recent tax law changes, there are credits for things like child care and education expenses which you may still be eligible for. For those with large medical bills, mortgage interest, or who have been particularly philanthropic this year, you may still be able to itemize, so it is important to have those receipts handy.

When it comes to planning for your retirement, this is the perfect time to evaluate your contribution levels to your retirement plans at work. If you have the ability, and you’re not yet contributing to the maximum levels allowed, consider topping these accounts off to take advantage of the possible tax deduction this year, as well as the ability to simply squirrel as much away for the future as possible. Even if you can’t contribute to the maximum, be sure to at least contribute enough to take advantage of any employer matching contributions. 

You may not be aware, but once you reach age 50, you are eligible for higher contribution levels than in prior years. So, if you’ve turned 50 this year, consider increasing your contributions. For 401(k) and 403(b) plans, you can contribute an additional $6,000 to a max of $25,500 from $19,500 for those under 50. For SIMPLE plans, you get to contribute an additional $3,000, up to a new max of $16,500. Take advantage of this opportunity to catch-up on contributions you may not have been able to make when you were younger. 

On the subject of milestone birthdays, if you turned 72 in 2020, you would normally have to start having to take withdrawals from IRAs and certain company sponsored retirement plans. These are called Required Minimum Distributions (RMDs). Your contributions to these accounts have been allowed to grow tax-deferred all this time, and now Uncle Sam wants his share. This age limit was increased from 70 ½ by the SECURE Act in late 2019. However, due to COVID and the resulting CARES Act, you won’t need to take an RMD for 2020. RMDs from inherited IRAs have also been suspended for this year, but you should expect both to resume in 2021.

Even if you can’t itemize charitable contributions on your taxes, you may still be able to make those contributions on a pre-tax basis! If you direct distributions to be paid directly from your IRA to your charity of choice, you won’t be taxed on that portion of the distribution. This is a great option if you are subject to the standard deduction.

The end of the year is a perfect time to review your various forms of insurance, including your home and auto. Take note of various coverage limits and deductibles. If you can, consider a higher deductible in order to save on premium expenses. 

Ensure that your homeowners coverage amounts reflect the value of your home. Your home has probably appreciated since you purchased it, but have you increased your coverage limits to keep pace? 

An often-overlooked task is to review your beneficiary declarations each year. Families grow, as new members are added, and shrink with death and divorce, which means that beneficiary and Transfer-on-Death declarations can easily become outdated and no longer reflect your true wishes. 

Since these declarations are a matter of contract, they will overrule what your Will may say. So, even if you’ve updated your will to exclude an ex-spouse, but you left them as beneficiary on your IRA, your new spouse won’t be able to inherit those assets, but the ex will, and it can’t be challenged in probate.

Your Certified Financial Planner® professional is perfectly suited to help you mark most of these items off your list. Review your beneficiaries, gather tax documents, maximize funding of your various retirement plans, take required distributions, and review your insurance coverage with your advisor each year, to help ensure that your financial plan is well-tuned as you prepare to turn the page on 2020.

Stephen Kyne CFP® is a Partner at Sterling Manor Financial, LLC in Saratoga Springs and Rhinebeck, NY.Securities offered through Cadaret, Grant & Co., Inc. Member FINRA/SIPC. Advisory services offered through Sterling Manor Financial, LLC, or Cadaret Grant & Co., Inc., SEC registered investment advisors. Sterling Manor Financial and Cadaret, Grant are separate entities.

It happens every year.

The days get shorter, the weather gets colder, the time changes and all of the sudden you’re heading home from work in the dark.  For some people it’s no big deal, but many others may find themselves drained of energy and feeling a little blue.  It is possible that you may be experiencing symptoms of Seasonal Affective Disorder (SAD), a form of seasonal depression.  The good news is, there are steps you can take to help combat these winter blues

1. Stick to a schedule:
• Maintaining a regular routine can help you stay on track and prevent disruption of your circadian rhythms.
• Making sure you get adequate sleep helps maintain energy levels and eating at regular intervals helps to maintain a healthy diet. 

2. Exercise:
Physical exercise helps to release serotonin in the brain, improving your mood and giving you a boost of energy.

3. Get outside:
Take advantage of what sunlight there is.  Bundle up and take a walk around the block at lunch when the sun is brightest.

4. Light  Therapy:
Sometimes our schedules or the weather just don’t allow for an opportunity to get outside and enjoy the natural sunlight.  Light boxes, which give off light that mimics the sun, are a great alternative. Spending 30 minutes per day, especially in the morning, can help regulate circadian rhythms and suppress release of excess melatonin

5. Increase Vitamin D intake:
Studies have shown that an alarming large percentage of people, particularly those living in the Northeast, suffer from insufficient levels of vitamin D.  Vitamin D deficiency has been linked to depression, fatigue, muscle pain and a weakened immune system. 

6. Socialize:
During the winter months, the urge to hunker down and stay at home can result in fewer social interactions. Keeping an active social schedule and having a strong support network will help keep you engaged and give you things to look forward to.

7. Talk  to your doctor:
It is important to note that SAD is a form of depression and is best diagnosed by a mental health professional.  Talking to a doctor can help determine if what you are experiencing is in fact symptoms of seasonal or other forms of depression and whether or not you may benefit from additional treatments such as medications or therapy.

Dr. Kevy Smith Minogue is a chiropractor in Saratoga Springs providing non-surgical treatment of spinal disorders and sports-related injuries. For more information, please visit MySaratogaChiropractor.com or call 518-587-2064.

It is often difficult to start the estate planning process. We all know that there are certain documents we should likely have in place. We all know that we should talk to family and friends to seek input and assistance on important decisions. We all know that we should likely obtain the help of professionals in getting a proper plan together.

Despite knowing all this, how do we even begin the process? The questions and answers below are designed to start a conversation about the key issues in your estate planning. With the help of family, friends, and the appropriate professionals, that initial conversation will hopefully lead to the establishment of an estate plan that works for you.

How do I transfer my assets to my loved ones after my death?
There are three basic ways to transfer your assets after your death. First, you can direct the transfer in a Last Will and Testament. Second, you can create a Lifetime Trust, transfer the property to the Trust, and then direct the property distribution in the Trust. Third, you can make the property automatically go to others by beneficiary designations, transfer on death provisions, joint ownership, or similar arrangements that take effect upon your death. Whether you should have a Will, a Trust, or establish automatic transfer on death arrangements is something you should discuss with an estate planning attorney. Based on a variety of considerations, you may want to use one or more of these techniques to ensure your property is transferred as you wish.

What steps should I take to plan for my potential incapacity?
In order to plan for your potential incapacity, you should have a Power of Attorney and a Health Care Proxy in place. The Power of Attorney will designate an agent who can handle your financial affairs if you are no longer able to do so. The Health Care Proxy will designate an agent who can handle your health care decision making after you no longer are able to do so. The Health Care Proxy can also be paired with a Living Will, which is an expression of your wishes with regard to your medical care.

What do I need to do to make sure my final wishes are honored?
Many people rely on their family to handle their funeral arrangements and costs after they die. As an alternative, you may want to consider pre-planning for those arrangements and costs. By doing so, you will relieve your family from many challenging decisions and the associated cost burden. If you wish, you can also sign an Appointment of Agent to Control Disposition of Remains, which is a form usually drafted by an attorney. That form designates who is in charge of your remains after you pass away, and it includes provisions regarding your particular wishes.

How can I provide for family members that I leave behind?
You can obviously leave your assets to your family members, however, if those assets are potentially insufficient to care for those you leave behind, you may want to consider purchasing life insurance. This is especially so for young families with children. Term life insurance for younger, healthy people with children is generally affordable and can provide potentially significant funds for children who need support if one or both of their parents die unexpectedly.

What provisions can I make to pay for nursing home costs?
Nursing home costs can be paid for in one of three ways: through your own private funds, with long term care insurance, or by Medicaid coverage. By discussing your options with a financial planner or attorney, you can develop a plan that works for you.

What can I do to make it easier for someone to handle my affairs if I die or become incapacitated?
If you die, your estate fiduciary or your trustee will take over your affairs. If you become incapacitated, your power of attorney agent and health care proxy agent will be able to act for you. In either case, it would be very helpful to put together a list of your assets, along with contact numbers for all the appropriate professionals, i.e. attorneys, accountants, financial advisors, etc. With this information in hand, the people taking over after your death or incapacity will have a reasonable place to start their work.

What plan should I have in place for my residence?
Although most of us would like to age in place, we must be realistic about the level of care we might need as we grow older and what resources may be necessary to provide that care. As a result, you should develop a plan to provide for in home care or consider alternatives for moving your residence to a facility that can provide the care you will need. Discussions with your family and friends about alternatives like assisted living facilities or adult homes need not wait until after that level of care is needed. In fact, the discussions are often most helpful in advance of the actual need for services.

Hopefully, by working through these questions, it will start a conversation about your estate planning. That conversation should include family, friends, and the appropriate professionals, i.e. attorneys, accountants, and financial advisors. The end goal is to develop an estate plan that meets your needs and provides for the ones you love. 

Matthew J. Dorsey, Esq. is a Partner with O’Connell and Aronowitz, 1 Court St., Saratoga Springs. Over his twenty-three years of practice, he has focused in the areas of elder law, estate planning, and estate administration. Mr. Dorsey can be reached at 518-584-5205, mdorsey@oalaw.com, and www.oalaw.com.

Everyone hates changing the clocks, right?
I’ve found it to be so hard on the little ones—for a solid week after the time change, my little boys tend to be not tired when they should be or they’re very tired and I’m trying to keep them up for just one more hour. It messes with naptime and bedtime and the morning routine, and I’m always grateful when that week comes to an end, because we’re usually all back on track by that time.

But one thing I really love about the time change in the fall is the early darkness. We have quiet time until around 5 p.m. (naptime for the baby and a snooze on the couch for myself as well; quiet play and/or a movie for the middle kids; homework for the big kids), and by that time, after the Fall Behind, the house has darkened, and the first I thing I do when I get up from the couch is pull the curtains, turn the lights on, and heat up a cup of coffee to get me through dinner and bedtime. I sit back on the couch with my hot mug, and little boys snuggle with me while we all reanimate after our cozy quiet time. 

More than just the increased coziness of the lights being turned on and the curtains being closed is the lovely feeling of securing us all in for the night. I’ve always loved when all of us are finally home after our day of busyness, and the relief of changing into pajamas for the rest of the evening since we’re done going and doing and seeing other people. It feels safe, and like a sigh of relief. It’s different in the spring and summer—the evenings still hold possibility with their late sunsets and warm temperatures—but the cold and dark of the fall and winter lend itself to hunkering down. Do you know that word “hygge”? That’s what fall and winter evenings at home are for me after we’ve locked our door for the night—warmth, coziness, contentment.

Not to say that our evenings are always calm and serene—there are the evenings when everyone behaves while I’m making dinner and then they get caught up in quiet activities after dinner like Legos, reading, and homework, and those are the very best (in fact, life never seems more perfect than those times), but more often (much more often) the boys are amped up because they’re hungry and then Dad gets home and even with full bellies after dinner it seems like the perfect time to wrestle and annoy each other. I don’t sigh with relief at this time of day because everyone is calm and quiet, but rather because I love the feeling that we’ve met our outside-the-house requirements for the day and we’re well within reason to decide we’re done until tomorrow.

I should also mention that I don’t hate evening activities—trick or treating, high school basketball games, holiday dinners with friends and family, checking out the city’s Christmas lights, going out for evening snow shoveling and playing, heading out in the dark to pick up the boys from friends’ houses or school functions are all things I think of when this time of year comes around, and I look forward to them all! But on those days, as much as I love those activities, I still feel such a welcome “unwinding” when we’re finally all home for the night.

It’s no surprise to me that I’m feeling this all more profoundly right now, when being outside the house and among other people—even loved ones—represents an increased risk of spreading sickness, which is stressful in and of itself, even when the risk is necessary and worth it (church, grocery store, school, the family and friends in our “bubble”). And of course, with the stress and contention of election season and even now in the wake of Election Day, “outside the house” especially includes social media, which is harder to shut out, but so worth trying to do—a virtual “turning off the porch light” if you will. I like the quote attributed to William J. Bennett: “Home is a shelter from storms—all sorts of storms.” I guess that’s what I’m getting at, in my usual wordy way. 

One of my very dearest hopes is that when the clocks change again in the spring, the longer days and increased sunshine run parallel to increased hope in regards to the pandemic, increased safety outside the house, decreased social unrest, and less of a desire to hole up and hibernate at home. In the meantime, I’m so grateful for days that end with cozy nights at home with my loved ones, and I hope for the same for you all. Happy Thanksgiving to you and yours!

Kate and her husband have seven sons ages 16, 14, 12, 10, 8, 6, and 2. Follow her at facebook.com/kmtowne23, or email her at kmtowne23@gmail.com.

Seven-in-ten retirees will need some form of long-term care, which means that, for couples, there is a 91% chance of one spouse needing care. 

November is Long-Term Care Awareness Month. Let’s talk about how you can provide for your care, while protecting your family and assets from the risks associated with long-term care. This is an issue that will affect nearly everyone.

People generally plan for their long-term care for two reasons. First, they want to make sure that they receive the best care available, by qualified caregivers. Second, they want to make sure that their assets are protected so that their spouse will be able to continue his/her standard of living. The average widow outlives her husband by twelve years – what will those years look like if the couple’s nest egg was spent on her husband’s long-term care?

In this part of New York, long-term care can cost upwards of $10,000/month.  With an average nursing home stay of more than 2.5 years, you can see how quickly assets can be depleted. So, what is a person to do?

Some people are adamant that they will take care of their spouse in the event they need care. This strategy is well-intentioned, but generally not the best. Often care begins with one spouse providing it, but the needs can quickly outpace the spouse’s ability or skill level.  Could your spouse pull you out of a bathtub today? Could they do it twenty years from now? Are they the most qualified person to provide care?   What if your spouse pre-deceases you? Who will take care of your spouse after you die?

Gifting and trusts used to be a popular way to protect assets, however uncertainty in the legal landscape makes this a risky strategy. There is currently a five-year look back period for gifts, and it’s very possible that period could be extended. Will you know when you’re five years from needing care? What if the look back goes to ten years? Today, we see this type of planning used when a more effective strategy isn’t available. 

Bar-none, the most effective strategy for planning for the day your health changes is private long-term care insurance. Insurance can provide the flexibility of receiving care from a qualified professional caregiver in your home, an assisted living facility, or a nursing home, or in all three setting as your needs change. This means that you can still be surrounded by your loved-ones, without burdening them with your care.  We feel the prime age range for securing coverage is in your mid- to late-50s, while you’re still healthy enough to qualify, although your needs may differ.

Here’s what to look for in a long-term care policy:

1. A good insurance policy should include an inflation protection component, so that the policy’s benefit will increase as the cost of care increases. These inflation protection benefits are generally available with between 3% and 5% annual increases. 
2. A policy should allow you to receive care where and how you like: in your home, an assisted living facility, or a nursing home, as your needs demand.
3. Many policies will offer a cash benefit; a portion of your benefit paid directly to you rather than to your care provider. This benefit can be used for in-home modifications and other expenses related to your needs.
4. Your policy should provide a daily benefit large enough to cover the cost of care in the region you plan to receive it. Remember that any shortfall will have to be paid out-of-pocket.
5. Make sure your carrier has a high credit rating. Since any guarantees are based on the claims-paying ability of the carrier, you’ll want to be confident your carrier will still be around when it comes time to pay for your care. 

When you’re young and providing for a family, the risk to your family is that you’ll die prematurely. Once you’re retired, the risk is often no longer death, but the day your health changes.  Do you have a plan to provide for your care? Long-term care insurance is not the only way to plan for your care and associated expenses, but it is the most foolproof.  If you don’t qualify for insurance, then trust work or gifting may be necessary. 

At the very least, you should be discussing your needs with your family and your Certified Financial Planner® professional to ensure that you know your options, and are able to make an informed decision on a strategy.  Your advisor is the best person to educate you about the options, based on their understanding of your unique circumstances.

 Stephen Kyne, CFP® is a Partner at Sterling Manor Financial, LLC in Saratoga Springs and Rhinebeck.

COVID fatigue is an inevitable consequence of the undue stress of this pandemic. People are really struggling with no reprieve from kids, from bills, from being cooped up inside the same four walls. Some people are tossing their masks—risking infection for themselves and their community—simply because they can’t take it anymore.  

Undue stress is an understatement for 2020. The pandemic has brought wholesale change to all of us, including fear and grief for lost loved ones, lost jobs, and lost way of life. But more than that, we’ve also had a year of divisive politics, racial tensions, civil unrest, a fluctuating economy, and angry rhetoric in social media. 

It’s no wonder that we find ourselves snapping at each other over everything from spilt milk to unpaid bills and everything in between. Some families and friends have even stopped speaking to each other. 

There’s no silver bullet to resolve COVID fatigue. No one-size-fits-all solution to healing the pain we cause each other when angry or unable to resolve differences of opinion. But there are several things we can do to try healing the rift or prevent one from occurring in the first place. 

Keep perspective. Thankfully, we have access to 21st century medicine and can be confident that this pandemic is temporary. It’s just one year, maybe two, which is hard, but doable in the grand scheme of things. It’s all temporary. 

Have compassion for yourself. Don’t beat yourself up for feeling angry, hopeless, or terrified. These are normal feelings for the times, and you are not alone. Be forgiving of yourself and those around you.

Shift to gratitude. You can choose how you interpret what is happening around you. Feeling gratitude will help you not sweat the small stuff and strengthen you when facing something more serious. 

Prepare for anger. You are going to feel angry. Everyone does. So, think about what you can proactively do to manage those feelings. In the gap between the impulse to act on your anger and the action itself, you have choices. What do you want to do the next time you feel angry? 

Recognize the signs of anger. Notice the changes in your body that precedes an outburst of anger. You might feel tension in your jaw, heat in your face, or tightness in your gut. If you pay attention to these cues, you can step back and take a breath. Walk away. Don’t send that email until the next day. It is much harder to walk back impulsive words and repair their damage than to not say them at all. 

Resist self-medicating. Anger is impulsive, often born of feeling powerless and helpless about the situation around you. Be mindful about self-medicating with alcohol or drugs, overeating, or spending too much money to manage those feelings. In the long run, they can make things worse.

Look beneath the anger. Your anger may be masking underlying depression, sadness, anxiety, or other emotion. Perhaps you are upset that you can’t visit your new grandchild in another state. Or you need time off from work, a day trip away, or some other kind of reprieve. Ask yourself what else you are feeling and why.   

Clear the air. Cold-shouldering isn’t good for you, and it isn’t good for anyone in the household or office. Perhaps the other person wants to make up, too, and doesn’t know how. If you feel safe to do so, then be the first to apologize. Not for your opinion, but for how you expressed it. 

Take responsibility. Use “I” statements when communicating. (I’m sorry. I want to get along with you. I value our relationship.) Don’t try to explain or rationalize the way you behaved. Own your part without any expectation that the other person will own theirs. 

Practice good communication. Difficult subjects should not be discussed through texts and emails. Face-to-face is best because much of what we communicate is nonverbal. Together, decide on ground rules for discussing topics where you differ, like politics. Dialogue to share points of view, not to change minds. Keep things constructive, not personal or threatening. Listen thoughtfully and respectfully. 

Seek help. The counterbalance to anger and frustration is cultivating positive reactions, such as patience, focus, and compassion. Sometimes that is easier said than done. It’s okay to ask for help through therapy, couples counseling, or your primary care doctor, to name a few. 

We are living through a momentous year of hardship and perseverance that will appear in school textbooks one day. It is normal to feel angry and afraid. But remember, we are also resilient and resourceful. We can do hard things.

A vaccine will come. Until then, we can resist the temptation to lower our guard. We can wear masks, social distance, and avoid gathering in groups for another year if necessary. We’re in a worldwide marathon to beat this virus. As long as we support and truly connect with each other, we can reach the finish line and show future generations how it’s done. 

Saratoga Hospital offers behavioral health services through our Primary Care practices, medication management and counseling at Saratoga Community Health Center, Inpatient Mental Health services (for those at risk of harming themselves or others), as well as substance abuse and behavioral health counseling through our Addiction Medicine services. Learn more at SaratogaHospital.org.

If your stress or anxiety is keeping you from getting through your day for longer than a week, or you cannot shake serious feelings of sadness and depression, call your healthcare provider right away. You can also call:

• SAMHSA Disaster Distress Helpline: 1-800-985-5990
• Substance Abuse & Mental   Health Services Helpline: 1-800-662-HELP (4357)
• Suicide Prevention Coalition of Saratoga County: 1-800-273-8255
• Saratoga County Crisis Line Hotline: 1-518-584-9030
• Wellspring Domestic Violence Hotline: 518-584-8188
• NYS Child Abuse Hotline: 1-800-342-3720
• National Suicide Prevention Hotline:1-800-273-8225
• NYS Domestic Violence Hotline: 1-800-942-6906
• Samaritans Suicide Prevention Center Hotline: 1-518- 689-4673

With winter coming and climbing numbers of COVID-19 cases, we’re facing the prospect of several more months of isolation during this pandemic in order to protect our communities and flatten the curve. Unfortunately, isolation and loneliness can take a demanding physical and emotional toll. Loneliness is linked to a 29% greater risk of heart disease, 32% greater risk of stroke, 50% greater risk of dementia, and increased rates of depression, anxiety, and suicide.  

Long-term social isolation is a serious concern, and while it has been hard on everyone, it’s been especially distressing for older adults. Even before COVID-19, nearly one-fourth of Americans 65 and older were considered socially isolated. Now, with so many seniors staying home, away from family and friends because of the pandemic, that number is rising—and so are the health risks to an already vulnerable population. 

As a physician who specializes in geriatric care, I see the change in older patients who no longer have regular in-person contact with loved ones, and it’s heartbreaking. The situation is especially difficult for those with dementia, who don’t understand why they no longer have visitors. 

There are several simple things we can do for the active seniors in our lives, but relieving the loneliness of older seniors who may have a myriad of conditions has been very challenging for families. For seniors who are open to it, video chat platforms offer creative ways to enjoy each other’s company. Families and friends are playing board games, knitting, and watching the same television programs together in real time. 

Even before the pandemic, letters, phone calls, children’s drawings and photographs have always been important reminders to seniors that someone cares. Regular communication of any kind helps make your family member or neighbor feel included, heard, and valued. Such contact can mitigate feelings of isolation, worry, and loneliness for both of you.

The same level of interaction is not possible with adults who have a cognitive impairment or are declining. They may not be able to distinguish a face on a screen or understand who is on the other end of the phone call. These are adults who often respond best to someone holding their hand or singing softly near their bedside. Physically separating to protect these family members from infection is changing the quality of life for all involved and can feel painful for families. 

There is no one-fits-all solution to these situations. A good start is to sit down with your family, the physician, and caregivers involved to discuss options. Some families are choosing a single, designated person to be physically present regularly with their senior, taking extraordinary precautions. Others look for alternatives, such as music and headphones, or life-like toy pets for company. Some are recording their own voices, to help their loved ones feel close, such as with Simulated Presence Therapy. Caring for this population of adults is currently a national conversation that may inspire more solutions in the months ahead.   

We know the safest thing to do during this pandemic is to stay home, but that doesn’t mean we have to give up enjoying the company of our family, friends, and neighbors. While social distancing protects against infection, it doesn’t protect us from the consequences of being isolated for weeks and months at a time. Pick up the phone. Write a letter. Talk with your senior’s caregiver about options for increasing personal connection. We can make the pandemic a little easier to bear by staying as emotionally close as possible.

If you have any concerns that your family member or neighbor is more than lonely, perhaps experiencing depression, encourage them to call their primary care provider. Our primary care practices through Saratoga Hospital Medical Group offer behavioral health screenings, now, through telemedicine visits. 

Learn more about our primary care and behavioral health services at SaratogaHospital.org. 

We are several months into the pandemic, and there is no end in sight—yet. Substance-related overdoses and alcohol intoxication incidents have been on the rise, nationally and locally, throughout 2020.  

A recent RAND Corporation survey highlighted a dramatic increase in alcohol consumption since the start of the COVID-19 shutdown. There were 30 overdose incidents on a single day, May 21, in the Capital Region, and Saratoga Hospital’s Emergency Department has seen an unusually high number of opiate-related cases this year. 

In such an environment, there may be someone you know who is struggling to get through the day. If you are concerned about someone who may be abusing drugs or alcohol: 

• Take time to educate yourself about addiction. 
• Don’t judge or lecture. Listen, encourage them to seek help, but know they must make the call.
• Be realistic in your expectations. This is a lifelong disease.
• Seek support. It may be helpful to get counseling for yourself. 
• Learn CPR and, when possible, get NARCAN training. 

Being prepared is the best thing you can do to protect your family, friends, neighbors, and co-workers. NARCAN® Nasal Spray is a prescription medicine used for the treatment of a known or suspected opioid overdose emergency with signs of breathing problems and severe sleepiness or not being able to respond. If you are interested in attending a future NARCAN® training, please email Saratoga Hospital Community Wellness Programs at communityed@saratogahospital.org.

I want to acknowledge the courage and resolve of everyone in recovery from alcohol and substance abuse. These are people who have already overcome much adversity, and many are facing the current pandemic challenges from a place of strength. 

But it’s the isolation that has taken a toll. Recovery is not something to take on alone, which is why we emphasize virtual support groups and mentoring. Our Addiction Medicine program has had a tremendously positive response from patients using its telehealth services, and the good news is that MANY OF OUR current Addiction Medicine patients are doing well, showing great resiliency in the face of the pandemic.

With our COVID-19 protocols that keep patients safe, we continue to deliver the high-quality treatment and support that builds that needed sense of connection, including stress-relieving alternatives to substance use that work specifically for you. We also offer several non-controlled anxiety medications as well.

If you are struggling with addiction and would like to get help, please call the Addiction Medicine team at 518-886-5600. Our program provides high-quality care without judgement, in an environment where you can receive comprehensive, personalized, and respectful treatment, including medication management and counseling. 

We all know these are difficult times, and we don’t know when it will end. The cumulative stress of it all is more than we have ever experienced. But you are not alone. There is a great deal of strength and comfort to be had from the bonding and sharing experience of group support. 

To learn more about our programs, please visit SaratogaCommunityHealthCenter.org. For additional resources, please visit SaratogaHospital.org. As always, in case of emergency, call 9-1-1.
Addiction Medicine Program at Saratoga Community Health Center: 518-886-5600