Tidings of comfort and joy. Be of good cheer. Have a holly jolly Christmas. May your days be merry and bright. It is the season of giving thanks. We hear these sentiments almost daily this time of the year. Too often we fail to realize that the holidays are a difficult time for many people. Life situations, like those listed below can influence how happy our holidays will be. Loss or death of a loved one Estrangement from family Financial difficulties Life stressors (even happy ones like moving, starting a new job, or getting married) Too often in today’s cyber world, the words sadness and depression fill our phone screens, especially this time of year. Everyone has an opinion, a similar story, or a recommendation. "See a therapist." "Go talk to someone." "Get some meds for your depression." Unfortunately, share a problem or an ailment on Facebook and everyone becomes a doctor or a therapist. The IHCRC Behavioral Health team does their best to help people understand when therapy or medication management is necessary. Having strong emotions is not necessarily a bad thing. Emotions are helpful in navigating the world because they provide feedback about activities to engage in more often and activities to engage in less often. Emotions can help people experience things like empathy. Some emotional reactions are reasonable responses to situational factors, such as those included in the list above. Bottom line, there are situations where having strong emotions do not necessarily mean that therapy is needed. Not all emotional reactions require psychotherapy or medication management. Grief is a natural response to loss. Stress is a natural response to financial difficulties. Emotions sometimes simply mean that we are alive. And sometimes, emotions become so strong that we need to seek the help of a professional. You might need to see a therapist if you have….. Suicidal thoughts Been depressed for a long time and no longer finding any joy in life Uncontrollable crying Panic attacks Feelings that your life is meaningless Trouble completing daily tasks Feelings of hopelessness and helplessness Addictive behaviors, drinking more or gambling Lack of self-care (not bathing or getting dressed for example) Been withdrawing from social interactions Been hearing voices that frighten you We are always here to help, to guide, and to listen. Instead of posting publicly on social media, why not contact someone privately who can truly help you determine if therapy is right for you #holiday #depression #therapy #sadness #medication #emotions

National Stalking Awareness Month is observed on Tuesday, January 1st, 2019. It has been observed the month of January since 2004. Did You Know 7.5 million people are stalked in one year in the United States. 15% of women and 6% of men have experienced stalking victimization at some point during their lifetime in which they felt very fearful or believed that they or someone close to them would be harmed or killed. The average length of partner stalking is approximately 2.2 years (which is longer than the average of just over one year for non-intimate partner cases) 81% of women who were stalked by a current or former husband or cohabitating partner were also physically assaulted by that partner. 57% of stalking victims were stalked during the relationship. Most Commonly Reported Stalker Tactics by Both Female and Male Victims of Stalking Approaching the victim or showing up in places when the victim didn’t want them to be there Making unwanted telephone calls Leaving the victim unwanted messages (text or voice) Watching or following the victim from a distance Spying on the victim with a listening device, camera, or global positioning system Time of Greatest Risk for Violence Any stalking case can escalate into violence. The risk of violence is heightened when the stalker Issues direct threats of violence Expresses jealousy of the victim’s relationships with others during the relationship Uses illegal drugs Impact of Stalking on Victims 46% of stalking victims fear not knowing what will happen next. 29% of stalking victims fear the stalking will never stop. 1 in 8 employed stalking victims lose time from work as a result of their victimization and more than half lose 5 days of work or more. 1 in 7 stalking victims move as a result of their victimization. The prevalence of anxiety, insomnia, social dysfunction, and severe depression is much higher among stalking victims than the general population, especially if the stalking involves be­ing followed or having one’s property destroyed. Things You Can Do If you are in immediate danger, call 911 Develop a safety plan, including things like changing your routine, arranging a place to stay, and having a friend or relative go places with you. Also, decide in advance what to do if the stalker shows up at your home, work, school, or somewhere else. Tell people how they can help you. Contact a crisis hotline, victim services agency, or a domestic violence or rape crisis program Keep evidence of the stalking Contact the police. Every state has stalking laws. The stalker may also have broken other laws by doing things like assaulting you or stealing or destroying your property. Consider getting a court order that tells the stalker to stay away from you. Tell family, friends, roommates, and co-workers about the stalking and seek their support. Tell security staff at your job or school. Ask them to help watch out for your safety. Resources Call Rape/Tulsa Rape Crisis Call Rape is a 24hr information and crisis line that can assist with Stalking, Sexual Assault, Domestic Violence, and Teen Dating Violence. They offer services 24-hours a day by calling their hotline at (918) 743-5763 The Family Safety Center 600 Civic Center, Main Floor Police Courts Building Tulsa, OK 74103 Phone: 918-742-7480 Domestic Violence Intervention Services, Inc. Phone: (918) 743-5763 Tulsa Police Department The Tulsa Police Department investigates reports of crimes that were committed off-campus in Tulsa. Their non-emergency number is 918-596-9222. Heartline Crisis Line Dial 2-1-1 – or text your ZIP code to 898-211– for a free and confidential helpline that can connect you with resources in your area. If you’re struggling with thoughts of suicide and would like to speak with someone call (800) 273-8255 Oklahoma Coalition Against Domestic Violence and Sexual Assault OCADVSA provides advocacy and support related to Sexual Assault, Domestic Violence, and Stalking. For information and services across the state, call (405) 524-0700 Domestic Violence Hotline The National Domestic Violence Hotline has been the vital link to safety for women, men, children, and families affected by domestic violence. With the help of dedicated advocates and staff, they respond to calls 24/7, 365 days a year #stalking #nationalstalkingawarenessmonth

High blood pressure, also called hypertension, is when the pressure in your arteries is higher than it should be. When your blood pushes against the sides of the arteries this creates a force. The force of this pushing is called your blood pressure. Blood pressure is written as a fraction. The top (systolic) number represents the pressure when your heart beats. The bottom (diastolic) number represents the pressure when your heart rest between beats. Almost half of people in the United States who are over the age of twenty have high blood pressure. It is important to know your blood pressure and have it checked on a regular basis. High blood pressure usually has no signs or symptoms, but can lead to heart disease, stroke, kidney disease, blindness and more. So how does someone know if they are at risk for developing high blood pressure? Risk factors are divided into two groups. The first group includes the factors we do not have control over. These include: getting older, family history of hypertension, race/ethnicity, having kidney disease and having obstructive sleep apnea. Men also are at higher risk than women. The second group of risk factors are things we do have control over. These include the following: smoking tobacco, being overweight or obese, high cholesterol, uncontrolled diabetes, not getting enough exercise. Also eating an unhealthy diet that is high in sodium, low in potassium and drinking too much alcohol increase your risk for high blood pressure. For adults, normal blood pressure is below 120/80 mm Hg. Elevated blood pressure is when your top (systolic) number is between 120-129 and your bottom (diastolic) number is less than 80. High blood pressure is when your numbers read 130/80 or higher. If your blood pressure is in this category, it is definitely time to pay attention. It is a myth that a person can tell if they have high blood pressure just by how they feel. Many people think that having high blood pressure has symptoms such as nervousness, sweating, or having flushing of the face. However, many times people have no symptoms at all. This is why hypertension is known as the “Silent Killer”. If you have high blood pressure, it can be causing damage to you heart, arteries, eyes, kidneys and other organs. Prevention is key to keep blood pressure under control. Start by not smoking. If you already smoke, do everything in your power to quit. Get active. Aim for at least 150 minutes each week of aerobic activity. This is exercise using your large muscle groups. The goal is to get your heart rate up high enough so you are breathing harder than at rest, but able to still carry on a conversation. Some examples of aerobic activity include walking, riding bikes, swimming and dancing. If you are overweight or obese, lose weight. Limit alcohol intake. Women should have no more than 1 drink per day and men no more than 2 drinks per day. Limit sodium. Aim to consume less than 1500 milligrams of dietary sodium a day. This includes all forms of salt that you cook with. This also means it is important to read labels at the grocery store and choose lower sodium options. Be aware that the highest foods containing sodium include; breads and rolls, pizza, soup, lunch meats and cured meats (ham, bacon, sausage), rotisserie chicken and sandwiches. A low sodium food usually contains no more than 140 mg of sodium per serving. Lastly, if you are prescribed medicine to lower your blood pressure, take your medication exactly as prescribed. There are several categories of medicines for managing blood pressure. Many people are on more than one type of BP medication because the medicines work in different ways. Do not stop taking you medicines just because your blood pressure improves. It can be very helpful to track your blood pressure at home. Keep a log of your readings if your doctor requests you too and bring your log with you to your appointments for review. So, know your blood pressure. If it is well controlled, maintain a healthy lifestyle to keep it there. If it is 130/80 or higher, see your provider and ask to see an educator in the Health and Wellness department. #bloodpresssure #heartdiease #hypertension #highbloodpressure

February is usually thought of as the month of love and hearts. It is also a time to focus on the darker side of relationships though. February is National Teen Dating Violence Awareness Month. Information about teen dating violence is shocking. Did you know that probably 1 in 3 high school students will face some type of dating violence? Think about that: 1 in 3 teenagers will go through some form of relationship abuse before the age of 18. Yet, 81% of parents believe teen dating violence is not an issue or they say they don’t know about the problem. [1] More studies suggest that American Indians are 2.5 times more likely to be sexually assaulted than people of other races, and 1 in 3 Indian women report having been raped. [2] So, What Does Dating Abuse Actually Look Like? Physical Abuse: Any force used to cause fear or injury, like hitting, shoving, biting, strangling, kicking or using a weapon. Verbal or Emotional Abuse: Non-physical behaviors such as threats, insults, always knowing what someone is doing or who they are talking to, shaming, bullying, separation from others or stalking. Sexual Abuse: Any action that causes a person to lose control of their sexual activity or the situations in which sexual activity occurs, including rape, coercion or restricting access to birth control. Digital Abuse: Using social media to bully, harass or threaten a current or ex-boyfriend, girlfriend, husband, or wife. Demanding passwords, checking cell phones, cyberbullying, unwanted sexting, too many texts or threatening texts or stalking on social media. Stalking: Being watched, followed, or harassed. Stalking can occur online or in person, and may or may not include giving unwanted gifts. [3] Common warning signs of dating abuse: Checking cell phones, emails or social networks without permission Being very jealous or insecure Always being put-down Removing self from family and friends Physically causing pain or hurt in any way Being controlling 3 Ways to Help and Stop Teen Dating Abuse Teach youth what teen dating violence looks like. Have open talks with youth about teen dating violence and the warning signs of abuse. Also, discuss what healthy limits are and how this helps relationships. Promote and teach youth about what healthy relationships look like.During the teenage years, young people are learning skills they need to create positive relationships with others. This is the perfect time to push for healthy relationships and prevent patterns of dating violence that can last as an adult. Know what places or who is available to help. In Oklahoma Indian Health Care Resource Center of Tulsa - 918-382-1241 Muscogee Creek Nation- Tania Bardin - tbardin@mcn-nsn.gov Domestic Violence Intervention Services - 918.743.5763 Across the United States National Domestic Violence Hotline 1-800-799-SAFE (7233) When teens need help, they can reach out to peer advocates for one-on-one support by texting “loveis” to or calling National Sexual Assault Hotline- 1-800-656-HOPE (4673) References Break the Cycle. (n.d.). Learn About Dating Abuse. Retrieved from https://www.breakthecycle.org/learn-about-dating-abuse Tjaden, P & Thoennes, N. (2000). Department of Justice Break the Cycle. (n.d.). Warning Signs. Retrieved from https://www.breakthecycle.org/warning-signs #teendatingviolence

The holidays are stressful enough without all the requests to donate money and adopt children. As the Development Director for IHCRC and a donor myself, I know how much stress this can add to an already financially stressful time of year. Why yesterday alone I must have received 30 to 40 requests for donations. I gave once and felt good about it instead of feeling bad about the 39 other organizations who did not get my money. So, I thought I would share a few tips on how to keep yourself saying "Happy Holidays" instead of "Bah Humbug." Care for Yourself First - You and your family are MOST important. Do not feel bad for focusing on your family. Set a Donation Limit: We all want to give during the holiday season. Set a limit for yourself and stick to it. Remember every little bit helps whether it be $1 or $100. Give Up One Important Thing: Do you buy a soda or a coffee every day? Do you eat lunch out? Do you grab a candy bar when you buy gas? What about your favorite donut on Saturday morning? Give up ONE just ONE during the holiday season and give that money to a cause. Decide What is Important to You: Speaking of causes, decide what is important to you. Is it an organization who has helped your family? Did the story they told tug on your heart strings? Is it a cause dear to your heart, for example dogs in need of homes? Were you asked by someone close to you? Bottom line - it's your bottom line. Give because you WANT to give NOT because you feel you MUST. The Holidays are Not the Only Time People are in Need: You want to give but you just can't this holiday season. Give when you can. Trust me - the need is ALWAYS there. Feel Good About What You Have Done: Giving makes us feel good. That is a fact. Concentrate on what you gave and who you helped NOT on the 39 organizations who did not receive your money. It's Not Always About Money: Sometimes Holiday giving is really about sharing what you have with others. Invite someone you know will be alone to eat with your family. Bake an extra batch of cookies. Donate used coats or scarfs to the homeless. Sing carols for your neighbors. Write a poem or letter to cheer someone's day. Visit a friend who cannot leave home or lives alone. Share a decoration with someone in a nursing home. Brighten someone's Bah Humbug day with a smile. There are a million ways to give even when you don't have money. #givingduringtheholidays #donation #holidaycheer

Diabetes and exercise go hand in hand. Exercise is an important part of your diabetes management plan. It can help improve your blood sugar, increase your overall fitness, lower your blood pressure and cholesterol, and lower you risk of heart and blood vessel disease and stroke. Whether you already work out at a vigorous level or are just getting started, exercise is a must have in your diabetes self-management tool box. Before getting started there are some important steps to take before beginning a new exercise regimen. First talk to your doctor about any risk factors you have that may limit certain types of exercise. Find out what types of exercise are appropriate for you. If you have been inactive for a long time, your doctor may want to check the condition of your heart before giving you recommendations. Most people benefit from a combination of aerobic exercise and muscle strengthening exercise. Keep an exercise journal to determine the best time of day for you to exercise so that your exercise is coordinated with your meals and medications. Always test your blood sugar before, during and after your workout. Safety is your first priority. If your blood sugar is below 100 mg/dl, it may be too low to work out safely. Most people need to have a small to moderate size carbohydrate snack before exercise to keep them from experiencing hypoglycemia. This is a good topic for one to discuss with his or her diabetes educator. The American Diabetes Association recommends that adults with diabetes get 30 minutes of moderate level intensity aerobic physical activity at least five days a week. If someone is wanting to lose weight, typically a person will need to exercise for sixty minutes five days a week. Whether it is Spring, Summer or the cold of Winter make a plan to get more active and help keep your diabetes well controlled. For more information, IHCRC has a nationally accredited diabetes education program with educators whom are available to patients. Referrals to the program can be made through your primary care provider at the clinic.

Diabetes is a complex disease that is often hard to understand. There are different types of diabetes, but today I want to talk about Type 2 Diabetes Mellitus (T2DM). Common causes of T2DM include a combination of overweight and obesity, a lack of physical activity, and consuming too many calories. Family history can also play a role. This upsets the overall balance of glucose (sugar) and insulin within the body. First, let’s start with the risk factors for T2DM. Risk factors fall into two different categories; the ones we have no control over and the ones we do. Risk factors that we have no control over include: family history of Type 2 Diabetes; race/ethnicity, age, and having a history of gestational diabetes for women. If you are American Indian/Alaska Native you are at higher risk for diabetes. The risk of developing Type 2 diabetes increases as one gets older. If you have a parent, grandparent, or sibling with T2DM you are also at higher risk. If someone has both parents with diabetes, that person has a 75% risk of developing the disease. Type diabetes has become an epidemic in the United States and around the world today. Did you know that there are currently 26 million people who have diabetes in the U.S alone? Even more concerning is that 7 million of those individuals have no idea that they have diabetes at this very moment. Did you know that insulin is a hormone? I like to think of insulin as the key that unlocks the door to our body’s cells that lets sugar in. Without insulin, we keep too much glucose floating around in our blood stream and it turns our blood from a nice thin watery consistency to a thick syrup. Of course, syrup doesn’t flow as well as water. That thick blood has a hard time getting through our blood vessels and this can lead to damage throughout our system. There is a lab test known as the Hemoglobin A1c that can be done with a finger stick which can determine if a person has prediabetes or diabetes. This test measures how much sugar (glucose) that is in the blood stream. When an A1c is 6.5% or higher, then we know a that person has diabetes. Often people do not get tested for diabetes and by the time they are diagnosed, they have already had the disease for as long as 5-7 years. Science shows with an A1c of just 6.5%, the pancreas has already lost 80% of the cells that make insulin. Early diagnosis and treatment is the key to preserving the remaining cells in the pancreas that make insulin. So what does all this mean anyway? The more weight we gain and the more inactive we become, the higher risk we have for developing Type 2 diabetes. This is because we will have more glucose in the body, which means the pancreas will be working overtime to lower our blood sugar. T2DM can develop, which then requires one to make lifestyle changes and often take medication in order prevent complications. Making lifestyle changes before developing Type 2 Diabetes is the best way to prevent the disease. The most important steps we can take include exercise and healthy eating along with losing weight if needed. One may be able to delay or prevent Type 2 diabetes altogether. Choose a healthy eating plan that includes lean meats and dairy options, whole grains, fruits and vegetables. Limit, or better yet, eliminate all sugary beverages from the diet. Drinking one regular soda each day has been shown to increase one’s risk for developing type 2 diabetes. Get physically active if you aren’t already. The American Diabetes Association recommends 30 minutes of exercise at least 5 days a week. This means doing aerobic activities such as walking, cycling, or swimming in order to get your heart rate up which is good for the waistline and heart health too. If you don’t exercise now, begin with just ten minutes a day, 2-3 days a week and work your way up. Often losing 7-10% of your body weight can significantly lower your risk of developing diabetes. As a community, we can work together to support each other in developing long-term healthy lifestyle habits that can prevent or delay this disease.