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The Truth About Drug Addiction Overdose and Recovery

The Truth About Drug Addiction Overdose and Recovery

September is National Recovery Month. It’s a time to bring awareness to the importance of recovery from a drug or alcohol addiction or a mental health trauma. 

Why Addiction Recovery and Overdose Awareness is Important for Everyone

Since 1999, nearly 841,000 people have died from a drug overdose. In 2019 alone, over 70,500 overdose deaths occurred in the United States. That number continues to increase each year and our country hasn’t experienced a significant decrease in overdose deaths in many years.

If these numbers aren’t reason enough to care about drug addiction overdoses and recovery, perhaps understanding that drug addiction can affect any person from any walk of life will get your attention. That’s right, you and your family members are not exempt from experiencing drug or alcohol addiction no matter how good of a lifestyle you try to live. It can and does happen to all types of people.

Drug overdoses are a leading cause of injury death in the US among people ages 25 to 64. Adults aren’t the only ones at risk, however. More than 4,770 teens also died from a drug overdose in 2019. Nearly 3,320 teenage boys passed away from a drug overdose that year while just under 1,500 teen girls also died from the same cause. The overwhelming majority of these deaths were caused by opioids. 

What You Need to Know About Opioids and Overdoses

Opioids, especially synthetic opioids, are the number one cause of overdose deaths in the United States. Synthetic opioids, excluding methadone, accounted for nearly 73% of opioid-related overdose deaths in 2019. In total, opioids were involved in nearly 50,000 overdose deaths that same year. 

Overdoses typically occur within 1-3 hours of using the drug and despite what many falsely believe, an overdose can happen the very first time you use a substance like opioids or amphetamines. Mixing opiate drugs with other depressants like alcohol or benzodiazepines greatly increases the risk of an overdose death as does combining them with a psychostimulant like methamphetamine. Using pure heroin after regularly using heroin that has been “cut” with another substance like sugar can also lead to an overdose.

The Truth About Recovery and Overdosing

Relapsing after spending time not using your drug of choice also increases your risk of overdose death. That’s why support during recovery from drug addiction or alcoholism is so important to success. Addicts are more likely to relapse if they feel they lack a support system or are still receiving criticism for their past choices from those who should be lending their support. 

Addicts are considered in remission from substance addiction five years after addiction recovery begins. If you relapse and survive, don’t let your recurrence be a reason to wallow in your addiction. Recurrence is normal for most addicts but doesn’t mean they aren’t capable of staying sober. It can take time for an addict to adjust to their new life post-addiction. The important thing to remember is not to give up hope no matter if you are an addict or a loved one of an addict.

Like with other health conditions, early intervention can lead to earlier remission from addiction. If you or someone you love has recently started a new drug addiction, there is still time to get on the path to a faster recovery. 

You should know that there is no one perfect path to recovery. Many addicts find pharmacological, social, and psychological treatments to be helpful while some are able to recover without formal help. Any of these options are acceptable as long as they truly lead to remission. 

Addiction treatment and counseling is one of several behavioral health services we offer at Mantachie Rural Health Care. For more information or to make an appointment, click here.

Should You Discuss Your Mental Health Struggles with Your Boss?

Mental health is a hot topic these days and many patients are more open about their mental health struggles than ever before. (Read about why tennis star Naomi Osaka decided to open up about her mental health here.) However, many people still find it difficult to open up about their mental health in their workplace. As understandable as this is, everyone has a right to privacy, but in some circumstances, you may benefit from discussing your mental health struggles with your boss. 

How to Decide if You Should Talk with Your Boss About Your Mental Health

Deciding if you should talk with your boss about your mental health depends on your relationship with them. Do they know you well and are you comfortable discussing private matters with them? Or do you work in a company in which you rarely see your boss and you are sure they don’t know your name? Knowing who you are working for is extremely important.

If your mental health is impacting your job in any way, even if it creates a problem with a co-worker, it may be time to discuss your mental health. If you still don’t feel comfortable, you have some rights as an employee to protect yourself. Ask your mental health provider to complete an FMLA form (Family Medical Leave Act) to protect yourself in case you need to take time off for treatment. Your HR department is obligated to protect your privacy and will not disclose your medical information to anyone, including your boss. If your company has 15 or more employees, you are also protected under the Americans with Disabilities Act (ADA).

Preparing to Talk with Your Boss About Your Mental Health

If you’ve decided to talk with your boss, there are a few things you can do to prepare. Making a list of discussion topics to cover can help ease your anxiety and help your thoughts stay organized during your meeting. You should also know your rights as an employee before any discussion begins. Mental health costs employers a whopping $225.8 billion a year. Even if you don’t know your employer well it is still in their best interest, as well as yours, to listen. 

Your mental health provider can also help you prepare for your meeting. They can help you decide what to share with your employer, and they can help you prepare mentally for any anxiety or stress you are feeling about the meeting. 

Is your mental health impacting your job and other areas of your life? Don’t struggle alone. Talk with your mental health provider as soon as possible. The providers at our behavioral health clinic are highly experienced and caring providers who want their patients to succeed. Request an appointment today at 662-282-4226. 

Naomi Osaka’s Battle with Depression

Naomi Osaka is a 23-year-old tennis rock star who has won four major titles and is second in the world of female tennis competitors. She’s also the highest-paid female athlete in the world, bringing in a whopping $55 million in endorsements and prize money in 2020. But she made headlines in June 2021 when she withdrew from competing in the French Open after playing only one match. Her reason for withdrawing from the competition? To focus on Osaka’s battle with depression.

That’s right. You can be one of the top tennis stars in the world and still suffer from mental illness. 

Before the French Open began, Osaka announced that she would not participate in post-match interviews in an effort to safeguard her mental health. Staying true to her word, Osaka skipped out on interviews following her first and only match at the 2021 French Open. This decision drew sharp criticism from reporters and others who felt that she should have participated in interviews like the other athletes. Osaka was also fined $15,000 and received a threat from French Open officials to suspend her from the competition. In turn, Osaka decided to withdraw from the Open. 

Osaka’s Battle with Depression

Osaka told officials that she had been suffering from long bouts of depression since winning the US Open in 2018. Since withdrawing from the French Open, Osaka has also withdrawn from competing in the German and Australian Opens. 

Depression is characterized by sadness and disinterest in doing normal, everyday things. As you can see, it can affect anyone of any age, no matter their talents, popularity, athletic ability, or financial status. 

Despite initial criticism, Osaka has since received praise and support from fans. Many even find her decision to withdraw from these competitions to be inspiring for others who are suffering from a mental health condition. 

It’s important to know that praise and support are not enough to “cure” Osaka’s depression. Although depression patients find more success in treatment when they have the support of family and friends, depression is a real health condition that needs treatment from medical and mental health professionals. 

If you are suffering from depression symptoms, don’t keep fighting alone. Mantachie Rural Healthcare offers behavioral health services by licensed and highly experienced mental health professionals who truly care about their patients and the patient’s success. To schedule an appointment with one of our providers, dial 662-282-4226. 

What is Social Pain and Why It’s More Common Than Ever

Social pain isn’t a term one hears often. But in the last year, the number of people suffering from social pain is greater than ever due to the effects of the pandemic. Social distancing, unexpected deaths from covid-19, canceled events and plans, and political unrest are just a few contributors to the increased number of people experiencing social pain. 

What is Social Pain?

Social pain refers to the painful emotions caused by situations involving other people. Emotions include but are not limited to feeling rejected, alone, ostracized, devalued, abandoned, disconnected, and grief. A study by the University of Sao Paulo suggests the pandemic has caused a substantial spike in social pain. Social pain is often a reaction to the loss of relationships by way of rejection, abandonment, moving away, death, etc. Social distancing and quarantining has increased the negative emotions associated with social pain due to the lack of contact with people whose relationships we value. 

The Benefit of Social Pain

Like physical pain, the function of social pain is to alert us to threats to our social well-being. In turn, these emotions will deter us from doing things that undermine our relationships. Social pain often leads us to make more effort to maintain intact relationships.

How to Cope with Social Pain

Social pain is not unmanageable. In fact, most steps taken to treat these negative emotions are done at home. The first step to managing social pain is to accept that what you are feeling is real. These feelings are completely normal but do not indicate something is wrong with you. However, these emotions may mean your social connections are not where you want them to be. 

Managing your thoughts is the next step. Learning to train your thoughts away from the source of your pain keeps you from wallowing in your feelings. Find an interesting distraction like a hobby, music, reading, working out, or even watching a compelling movie or television show. Practicing meditation is another way to train your mind to control your thoughts. 

Social pain responds to sensorial experiences which means doing something as simple as moving your body or resting can take your mind off your pain. Looking at beautiful and colorful things, listening to music, taking a warm bath or shower, and even grabbing a hug from a loved one or pet living in your home can ease feelings of social pain. 

Finding ways to connect with others is also essential. The more personal and direct the communication is, the better it works to treat social pain. Video chats and phone calls work best but email and texts are better than nothing at all. Reminiscing with old photos, letters, or messages as well as thinking about positive memories of your loved one can also take away negative feelings. 

Of course, if your social pain lasts longer than two weeks or more with no relief, seek help from your healthcare provider. Mantachie Rural Health Care provides both medical and mental health care and can help you get over the hump of social pain. Click here to request an appointment now. 

ADHD During a Pandemic: How to Help Your Child Stay on Task

ADHD During a Pandemic: How to Help Your Child Stay on Task

ADHD, or attention deficit hyperactivity disorder, is more common than ever among schoolchildren. Children with ADHD are easily distracted, impulsive, often fidget, and struggle to pay attention or focus on the task at hand, such as listening to a class lesson or completing an assignment. Over the last few decades, great strides have been taken to help children with ADHD improve their symptoms and perform better in the classroom. However, the recent pandemic has seen an upswing in children who are again struggling to keep up with school work. 

What causes ADHD?

ADHD is a result of less activity in the part of the brain that controls attention or imbalances in brain chemicals known as neurotransmitters. Children with ADHD are either predominantly hyperactive/impulsive or predominantly inattentive. Predominantly hyperactive/impulsive children display more fidgety or disruptive behaviors while predominantly inattentive children simply struggle to focus attention. 

ADHD Treatments

Providers treat ADHD by two different methods–medication and therapy. The most successful treatment of ADHD combines both medicine and therapy. Stimulant medications are the most commonly prescribed and best medicinal treatment for ADHD. Certain non-stimulant medicines are also sometimes used but are believed to carry a higher risk for the patient. Talk therapy and support therapies such as social skills therapy can help children with ADHD learn how to cope with struggles. It may also boost their self-esteem, as well as teach them how to get along well socially. 

The role of the parent or guardian is as crucial in the treatment of ADHD as therapy and medication. Parents or guardians can help their ADHD child stay on task with the implementation of a daily written schedule or routine. This schedule should include all tasks to be completed from the time they wake up to bedtime. Tasks include basic daily activities such as eating breakfast, brushing teeth and hair, and getting dressed, as well as any home tasks such as chores or homework. 

Parents are also their children’s biggest advocate at school. They should ensure the school treats their child’s ADHD virtually through special education and modifications to help the child stay on task. IEPs and 504s should be in place for any student with ADHD.

ADHD and Coronavirus Pandemic

ADHD doesn’t place your child at a greater risk for contracting coronavirus. However, the pandemic could still affect their condition. Behavioral health experts have seen a rise in ADHD children who are struggling to keep up with schoolwork due to distance learning and other hurdles caused by the pandemic. Luckily, parents and children can implement a number of measures to help ease ADHD struggles.

  • Create a new daily schedule/clear routine for distance learning. Work with your child’s teacher or teachers to create the best schedule to manage their ADHD during the pandemic. Ensure the schedule includes breaks that detail activities for the child to do to unwind. 
  • Make sure teachers continue to implement learning modifications and adjusted them to fit distance learning. 
  • Create one space for everything. Students are using a plethora of learning and streaming programs for distance learning. A child with ADHD may become overwhelmed by the various links and programs they must access each day. They may benefit from consolidating links and schedules all in one place. Consider using a Google Document since Google Classroom is a commonly used program among schools. Parents should work with the child’s teacher to create this designated starting place.
  • Develop daily/weekly checklists and scheduled check-ins. Again, parents and teachers should work together to create daily and weekly checklists to help children with ADHD stay on top of school tasks and assignments. Ask to schedule regular check-ins between the child and their teachers to give them opportunities to address problems or questions.
  • Ask for non-screen work. It’s no secret that too much screen time is detrimental especially to children who are already struggling with attention or learning disabilities. Parents should talk with their child’s school or teachers to find out if paper assignments are available to complete and return to the school to help reduce screen time. 
  • Use tools like text-to-speech to help children stay on task. ADDitude Magazine offers a great list of assistive technology apps and extensions to help students struggling with schoolwork.

Has your child been struggling with ADHD-like behaviors for longer than six months? It could be more than just struggles of learning during a pandemic that are causing your child to have problems. At Mantachie Rural Healthcare, we diagnose and treat ADHD with combined work between your child’s healthcare provider and our behavioral health specialists. Don’t let your child struggle through another semester when help is just a call away. Request an evaluation appointment today at 662-282-4226 or through our website.

Teens Active in Extracurriculars Have Stronger Mental Health

Teens Active in Extracurriculars Have Stronger Mental Health

Teens who participate in extracurricular activities tend to have better mental health than those who do not, according to a recent study published in the journal Preventive Medicine. The study, conducted among more than 28,000 seventh grade students across 365 schools in British Columbia, found that those who played sports or participated in the arts had fewer mental health issues than students who spent their free time behind a screen. 

This should come as no surprise. Physical activity and practicing a hobby or art are known to boost teens’ mental health. But in a pandemic year when many activities have been greatly altered or sidelined altogether, teens must get more creative and independent with keeping themselves busy and off the screens. 

How to Maintain Extracurricular Activities During the Pandemic

Many sports and activities have managed to continue in some capacity this year while others haven’t fared as well. Whether your child is participating in an extracurricular that is active this year or holding out for next year, it’s important to keep them on track and in practice for their chosen outlet. 

Encourage them in any way you can. Be a listening ear when they are practicing their music scales or volunteer to play the catcher when they want to practice their curveball. If your budget allows, spring for socially distanced lessons to help them improve their chosen sport or art. If not, check out the many free resources online including YouTube. Yes, we know this means putting your teen behind a screen. However, this counts as productive screen time and you can monitor their progress and lessons to ensure they’re not getting distracted. 

Limited Screen Time is Key to Teens Mental Health

The British Columbian study found that boys and girls overall fared far better mentally with less than two hours of screen time in addition to participating in extracurriculars. Even if your child can’t attend a band practice or art lesson, you can still limit their screen time. And you can encourage other productive activities like reading or learning a life skill. 

We know that limiting screen time during a pandemic is harder than usual. But we and other medical experts believe that making this sacrifice will ultimately reward you and your children in the long run. If your teen is struggling to stay strong mentally, we can help. Mantachie students can begin seeking help at our school-based clinic and continue treatment at our main clinic. Dial 662-282-4226 or request an appointment online to learn more. 

Depression Myths and the Truths Behind Them

Depression Myths and the Truths Behind Them

Depression is one of the most common mental health disorders in the United States. However, we encounter many misconceptions about depression and what it is and is not. Today we are taking a look at the most common myths surrounding depression and revealing the truth behind them.

Myth #1:  Depression isn’t a real disease.

Depression is a very real, complex illness impacted by psychology, sociology, and biology.  Anyone can get depression regardless of your family history. Contrary to popular belief, depression doesn’t just affect your emotional health but it can also negatively impact your physical health as well.

Myth #2: Antidepressants are a cure-all for depression.

Although antidepressants are a very powerful and effective treatment for depression in most instances, they aren’t always enough.  Psychotherapy or talk therapy often successfully treats depression.

Myth #3: You can snap out of your depression on your own.

Depression is not the same as sadness. Just like any other medical condition, depression requires proper diagnosis and professionally prescribed treatment. People who are depressed cannot talk themselves out of it one day. If you have battled depression for months or even years, it’s time to talk to your provider about treatment.

Myth: 4 Depression is caused by trauma.

Unhappiness or sadness are completely normal emotions following a sad or traumatic event but this is not the same as depression. Depression causes feelings of sadness, emptiness, or loneliness at any time even if things are going relatively well. These feelings typically last for long periods and often have no cause.

Myth #5: If you have a family history of depression, you will get it, too.

Depression is more common in people who have a family history of the condition. However, family history does not guarantee that you will be affected by the illness, too. 

Myth #6: Only women get depressed.

This simply is not true. Men experience depression, too, but they may not be as likely to talk about it as women. In fact, the number of men in the US who die by suicide each year is four times that of women. Another reason we urge men to reach out more about their emotional health. Your provider’s office is a safe place to find help.

Myth #7: Once you’re on antidepressants, you’re on them for life.

Some people will need prescribed medication for depression for the rest of their lives. However, not every depression patient fits that description. Each case of depression is different which is why there isn’t one perfect cure-all for the disease. Many patients are able to successfully wean off of medication with their doctor’s help after a certain period of successful treatment. 

Are you struggling with depression or have depression symptoms? Don’t suffer alone. Mantachie Rural Health Care offers behavioral and medical help for depression. Click here to request your appointment now. 

A New Blood Test to Diagnose Alzheimer’s is Being Studied with Promising Results

A New Blood Test to Diagnose Alzheimer's is Being Studied with Promising Results

Experts have long believed that earlier treatment of Alzheimer’s disease is the key to slowing or stopping the disease. Now, a new blood test for Alzheimer’s is being studied. It demonstrates promising results that could lead to early diagnosis and treatment. 

A study presented virtually at the Alzheimer’s Association International Conference 2020 and in the JAMA medical journal revealed promising results for those fighting to cure dementia and Alzheimer’s disease. The new blood test–which still likely won’t be available for several years–detects different types of tau protein, a hallmark of Alzheimer’s disease. 

How the New Blood Test for Alzheimer’s Works

The new test works by focusing on the specific subtypes of tau protein. This key protein becomes abnormal as Alzheimer’s disease changes the brain. Initial results found Alzheimer’s patients exhibit more of a particular subtype, a modified tau protein called p-tau217, than healthy patients who participated in the study. 

Studies of the blood test have shown its results to be as accurate as a spinal tap or PET scan. The blood test can also distinguish Alzheimer’s disease from Parkinson’s disease and other types of dementia with 89% to 98% accuracy. What’s more, the test could differentiate between the different types of cognitive dementia and flag early signs of Alzheimer’s. 

Experts say earlier detection of dementia could lead to testing current treatments for these diseases at a much earlier stage. Earlier treatment could result in slowing or completely stopping the progression of dementia. 

Just how early can this new blood test detect Alzheimer’s? Possibly up to 20 years before the first symptoms occur by measuring p-tau217 levels. 

As you can read, exciting moves are being made in the quest to cure Alzheimer’s and dementia. Though we may still be several years away from seeing these new tests become available for patients, we’re confident the treatments for these terrible diseases are going to improve greatly and change the lives of patients and their families. Learn more about the new blood test study here.

Your Right to Request a Referral to a Specialist

Our doctor and nurse practitioners are family care providers. That means they have experience and are highly educated in a wide range of medical conditions. Most of our patients find that experience and knowledge to be exactly what they need in a time of illness. For some patients with chronic illness or advanced illness, we need to refer them to a specialist. But your health isn’t just in our hands. You can (and should) take an active role in your health. If you think it’s time to see a specialist, ask us for a referral.

When to Ask for a Referral

Some illnesses are easy to diagnose on the first visit. A very sore throat with a fever can be diagnosed and treated as strep throat with a quick test. Other illnesses aren’t that clear. Many diseases and chronic illnesses have similar symptoms. Our providers listen to your symptoms, ask questions, and order tests in an effort to single out the cause of your illness. That means some problems may take more than one visit to get a diagnosis. 

If you’ve visited with your provider more than three times for the same issue and still don’t feel like you’re getting any closer to finding answers, it’s time to talk to your doctor about a specialist referral. Your primary care provider is a partner in your health. We want to see you feel better. Sometimes a doctor with specialised care in a specific area can provide new insight.

What to do Before Requesting a Referral

Before you ask your doctor for a referral, check with your insurance. Most insurance companies have a list of specialists they prefer. You’ll also want to know if seeing that specialist requires a referral. You can check out the potential providers and have an idea of who you’d like to request before your visit.

How to Request a Referral

It can feel awkward asking your doctor to refer you to someone else. Don’t let that stand in the way of better health for you. Your provider wants the best for your health. As a primary care provider they will continue to be involved in your health decisions even if you seek care from a specialist. 

During your visit with your provider, ask if they think it’s time for you to see a specialist or let your doctor know you’re ready to see a specialist. Ask for your doctor’s recommendation of who to see and why that’s their preferred referral. They may have insight into your health history and the specialist’s knowledge that an internet search or your Aunt Clara’s recommendation doesn’t have. If you do not want to see the specialist your doctor recommends, let them know who is covered by your insurance and who you would like to see.

Sometimes a physician to physician referral can result in a faster appointment time. This is not always the case, but it can be a benefit of having your doctor put in the call. Also, if your provider makes the referral, they will know the protocol to ensure your medical records are shared with the specialist. 

Before Your Specialist Appointment

Double-check with your primary care provider’s office to ensure they sent your medical records to the specialist’s office. Also, make sure the new doctor is still covered by your insurance. Make sure you have a list of medications to take with you to the new appointment and check online to fill out any forms ahead of time.

After Your Specialist Appointment

Your primary care provider is still available for all your health needs, even if you’re seeing a specialist for a specific issue. Your doctor should have records of your visits with the specialist so they can make notes in your chart. If you’re seeing a gastroenterologist for a stomach problem, your primary care physician will still be your go-to for acute care illnesses like sinus infections or other chronic diseases like high blood pressure.

Remember, we’re a partner in your health journey, but your true responsibility for your health remains with you. Being open and honest with your provider not only about your health, but about your desire to see a specialist may save time and help you find a diagnosis faster.

Managing the Effects of Social Distancing on Mental Illness

Managing the Effects of Social Distancing on Mental Illness

Social distancing is important to slow the spread of the coronavirus. However, it can have unintended mental health consequences. We as humans are designed to be social, to interact with one another, and even to respond to positive touch. While we don’t have a lot of studies surrounding quarantine and isolation, the few studies conducted following the 2004 SARS outbreak show an increase in anxiety and depression. As social distancing drags on, we can expect to see more people suffering from mental illness.

If we could squash the coronavirus and end social distancing today, we would. We would have ended it a month ago if that was in our power, but it’s not. We can, however, recognize what’s happening around us and take steps to care for our mental health and the health of others around us every day.

Admit the truth about our new world

Almost everyone feels a bit “off” right now. We’ve all been affected whether by losing a job, being sent home to telecommute, not being able to find the supplies we need in stores, or being directly exposed to or sick with the virus. Nothing about this situation is okay, and the first step to managing our mental health is to admit it.

Our emotions can range from fear and anxiety to depression and boredom to anger. Admit your emotions and give yourself permission to say this situation isn’t okay. Then think about what parts of the situation you can control.

Stay connected

While we may not be able to hang out with friends after work or have dinner with our extended family, we can take advantage of technology to stay connected. Plan a virtual happy hour with friends online. Video chat with family members. Text friends and check in with them on a daily basis. 

Pay particular attention to friends or family members who have suffered from anxiety, depression or loneliness in the past and older adults who live alone. These groups tend to have the hardest time managing the anxiety and depression that comes along with social distancing.

Temper your expectations

Gwyneth Paltrow suggests we use this time away from school and work to learn a new language, pick up an instrument or read a book. Those expectations set the bar pretty high. If you’re doing good to keep up your kids’ homeschool assignments while managing your telecommuting work let that be enough. Taking up a new hobby that doesn’t include monitoring the news every fifteen minutes is a great way to pass the time, but don’t expect your piano skills to be ready for Carnegie Hall in four weeks.

Creating unrealistic expectations for yourself during this time only increases your stress levels.

Create a routine

Routines won’t cure everything, but they place something back into your control. Include time for exercise and being outdoors if you can manage it while observing social distancing rules. Luckily in Mississippi, most of us can.

Staying busy keeps our minds off the news and the fears about job security, paying the bills, and access supplies.

Limit news access

Just because news is available 24/7 doesn’t mean we need to consume it during all those hours. Increased news and social media consumption lead to increased anxiety and depression. Set specific times each day that you’ll check the news and select reputable news sources.

We wish improving and protecting your mental health during these days of uncertainty was as easy as following a few bullet points. We know it’s not. These points can help you find a clear path to managing the anxiety and fear that lives among almost all of us right now. The one thing we ask you not to do is numb your emotions using drugs and alcohol.

If your depression, anxiety, or other mental health concerns are affecting your everyday life, it’s time to get some help. Call our mental health clinic at 662-282-4359 to talk to a counselor about options available for you. Don’t suffer alone. Ask for help.

For additional suggestions on managing fear and anxiety during the days ahead check out this article from PSYCOM.


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