Dr. Eleanor Glass is seeing an alarming number of exhausted women coming through her practice.
At Integrated Family Care
(IFC), which she co-found with Dr. Amy Mechley, they are just beginning to see patients for well checks again, after the staff was vaccinated. Prior to that, they were only seeing sick patients.
“We started seeing people fall behind,” she says. “Well visits — that’s when some of the important things come up. It’s not just well care. That’s when somebody finally admits they’re depressed; that’s when you notice if a kid is struggling.”
“There are these secondary and tertiary and quaternary pandemics happening — isolation, financial devastation, and domestic violence that we need to be here to catch,” she continues.
A little over a year into the pandemic, some people — particularly mothers and working mothers — are struggling more than they were at the beginning.
But the doctors at IFC are ready. Instead of chastising people for weight — or habits — gained during the pandemic, they’re working with patients to help them slowly improve their quality of life.
“I always remind people that what they say in the doctor’s office is confidential,” says Dr. Glass. I try to use modeling statements. I try to remind them that a lot of people are using things that they didn’t rely on in the past, like alcohol or marijuana.” Then she asks: “Has that been part of the picture for you?”
She pointed to a trend of “alcohol overuse:” People drinking more at home this year out of boredom, loneliness, exhaustion, and fear. *
Both Dr. Glass and Dr. Mechley practice “motivational interviewing,” which recognizes that each patient is different and has different needs, despite possibly experiencing the same problems. This helps identify individual roadblocks and what motivates each person as well as what’s holding them back.
Dr. Glass gives the example of weight gain during the winter of 2020-2021, which was especially rough at the end.
“We might have two people who have gone through very similar things this winter and the solutions are totally different,” she says. “For one person it could be introducing exercise, for another it could be therapy to address emotional eating.”
This level of care is possible because of IFC’s monthly fee
, which covers everything from visits to deeply discounted lab work. And although the doctors recommend having some kind of health insurance for catastrophic situations, it’s the ideal model for the uninsured as well.
Or for women in crisis.*
Dr. Glass hasn’t heard from many of her female patients this year. Some are single mothers dealing with work, life, and remote learning; others are women who are in dangerous situations at home. She tries to check in when she can, but she doesn’t always hear back.
“What’s concerning [is] that I haven’t seen them or heard from them, which makes me fear that many of them are in crisis,” she says.
And when women do reach out, it tends to be because symptoms of exhaustion have gotten so bad that patients think there is something seriously wrong or previously undiagnosed.
Dr. Glass explains that fatigue is biological. When we’re tired, our frontal brains, which is the part that handles emotional regulation and other cognitive abilities, we can’t think or speak clearly, and we move into our more basal-level brain — our mammalian brain — that lives in a world of fight or flight. When you live in that world, only the necessities become critical, like food, sleep, and safety. All other higher-cognitive functions — like managing finances, a child’s curriculum, and work take a back seat.
“We’re like toddlers,” she says. “When we’re exhausted we can’t regulate our emotions.” This leads to forgetfulness, panic attacks, and other issues that keep people from functioning well.
“You can’t think straight when you’re tired and you definitely can’t eat well when you’re tired, she continues. “That’s also mammalian. When you live in fight or flight, your body naturally craves carbs because it literally thinks it’s going to need to run from a lion, tiger, or bear. So I try to reassure women, [by saying] ‘You come by that honestly.’ Millions of years of evolution have led you to eating more pizza and pastries than you had intended during winter of 2020–2021.”
But if all those carbs led to weight gain during the pandemic, Dr. Glass stresses that this is not the time to explore some major new dietary trend. It’s the year to go back to the basics: Have you had five servings of fruits and vegetables today? Enough water? An adequate amount of sleep? And — she says again — be careful with substances.
“I remind people that their habits mean more to me than the numbers,” she says. “Instead of a goal of losing 10 pounds, try adding three veggies into your diet every day. Have small, measurable, reasonable goals that encourage habits rather than numerical weight loss.”
Instead of trying to force people to change, Dr. Glass encourages people to develop one healthy habit a day. Maybe it’s listening to five minutes of a meditation app in the morning or taking a very quick walk in the evening.
“Creating a habit takes 21 days, so if you can commit to this change for 21 days,” she says. “On day 22, your brain will expect it. That empowers people to realize that they can effectively create change in their lives and also decreases some of the stress and turmoil that leads to some of the substance usage.”
Dr. Glass explains that we all have a mental health toolbox, whether we realize it or not. When she meets with patients, she draws a picture of a toolbox and asks them to add the “tools.”
Things like exercise, spending time in nature or with a close friend or family member (making meaningful connections), eating healthy, yoga, and having a sense of purpose at work all count as tools.
But, she adds, “The pandemic has taken away a lot of those for people.”
“We need to really consciously add some additional tools to your toolbox right now,” she tells patients. “You may have depression, you may have anxiety, you may have ADHD. I don’t know but clearly whatever tools you were using to cope and to avoid sinking into this thing, you need some additional tools.”
That could be medication, recommitting to some form of exercise, or signing up for counseling until it’s safe to meet with friends and family again.
What about the kids?
Dr. Glass is seeing an uptick in anxious and depressed children. She stresses the importance of sending a message that their social/emotional health is more important than their grades right now.
Lately, she works with more and more kids who show signs of ADHD but are likely just struggling with online learning.
“It’s very difficult to make a mental health diagnosis of a child during a pandemic,” she says.
And while she shies away from medication — preferring to focus instead on counseling and breathing exercises — sometimes it becomes necessary to temporarily medicate just to make it through.
She also lets kids know that their priorities — like getting good grades — can be different right now, and encourages everyone to maintain a daily rhythm.
“You need feel some get up and go in the morning and some put it aside and rest in the evening,” she says. “Otherwise, you just feel sluggish all day.”
She recommends going to sleep and waking up at the same time at least five days a week, along with getting outside first thing in the morning. If that’s not possible, try a sun lamp. And, at least an hour or two before bedtime, put the screens away.
“Having a positive attitude about this is critical,” says Dr. Glass. “To show our children that we can be champions for masking. I know we’re tired — it’s hard to be a champion for your kids — but to be a champion for the cause and say that we are all in this together, and we need to help each other get out of this by protecting our loved ones and doing cautious acts of kindness to support others, I think, is a big part of what our kids will remember if we teach it to them.”
She notes that as hard as it is for working parents to keep all the balls in the air, our kids are much more likely to remember the adaptations we made instead of our perceived failures.
Dr. Glass can’t speculate on how long we’ll be masking and distancing, but she does predict that some changes will stay, like doctors wearing masks during cold and flu season and children being sent home from school with the slightest sniffle.
“We’ve been encouraging the middle ground,” she says of her practice. “When vaccinated we’re still going to wear masks, wash our hands, maintain distance but we are going to start doing activities that we wouldn’t have done before the vaccine (like movies, crowded parks, and visiting vaccinated family and friends). The risks of continued isolation outweigh the risks of covid transmission in vaccinated people.”
The big things that need to change — the systemic problems that have been present in our society for generations — were brought to light during the pandemic.
“You go up against this rock solid truth — at least in my perspective — that we have to have comprehensive sick leave mandates for all workers in America and we have to have better family and medical leave protections, and for the really little ones, we have to have access to childcare,” says Dr. Glass. “We can’t move forward as a society, and women, especially, can’t help move the economy forward without that.”
* Dr. Glass stresses the importance of recognizing the difference between “alcohol overuse” and substance abuse. She also notes that women in crisis are used to coping and don’t often reach out for help. If you or someone you know is experiencing addiction, mental health issues, or domestic violence, she recommends these organizations: Women Helping Women, NAMI of Southwest Ohio, and 1N5.