When the pandemic began, companies across the U.S. abruptly closed their offices, asking employees to work from home. One year later, millions of people are still working remotely, many facing the additional challenges of juggling child care and remote schooling.
The boundary between our work lives and personal lives has become blurred, leading many to ask: "Am I working from home, or living at work?"
Host, Jonathan Fialkow, M.D. welcomed a panel of experts for a discussion about the physical and mental effects of working from home, and what we can do to keep ourselves healthy in this new paradigm.
Guests on this episode are:
· Justin Thottam, D.O., back and neck pain physician at Baptist Health’s Miami Neuroscience Institute
· Maria Ordonez, M.D., family medicine physician with Baptist Health Primary Care.
· Amy Exum, LMHC, psychotherapist with Baptist Health’s Community Health & Wellness
When the pandemic began, companies across the U.S. abruptly closed their offices, asking employees to work from home. One year later, millions of people are still working remotely, many facing the additional challenges of juggling child care and remote schooling.
The boundary between our work lives and personal lives has become blurred, leading many to ask: "Am I working from home, or living at work?"
Host, Jonathan Fialkow, M.D. welcomed a panel of experts for a discussion about the physical and mental effects of working from home, and what we can do to keep ourselves healthy in this new paradigm.
Guests on this episode are:
· Justin Thottam, D.O., back and neck pain physician at Baptist Health’s Miami Neuroscience Institute
· Maria Ordonez, M.D., family medicine physician with Baptist Health Primary Care.
· Amy Exum, LMHC, psychotherapist with Baptist Health’s Community Health & Wellness
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Dr. Fialkow: Welcome, Baptist HealthTalk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health's miami cardiac and vascular institute, as well as chief of cardiology at Baptist Hospital and the chief population health officer at Baptist Health.
When the pandemic began, companies across the U.S. abruptly closed their offices, asking employees to work from home. One year later, millions of people are still working remotely, many facing the additional challenges of juggling child care and remote schooling.
The boundary between our work lives and personal lives has become blurred, leading many to ask: am i working from home, or living at work?
In a recent episode of Baptist Health’s resource live program, I spoke with 3 experts about the physical and mental effects of this past year of working from home, and what we can do to keep ourselves healthy in this new paradigm.
My guests were:
· Amy Exum, a psychotherapist with Baptist Health’s community health and wellness team,
· Dr. Justin Thottam, a back and neck pain physician at Baptist Health’s Miami Neuroscience Institute
· And Dr. Maria Ordonez, a family medicine physician with Baptist Health Primary Care.
Let’s listen in……
Dr. Fialkow: So, Amy let's start with you, let's kick it off. When we work from home every day, activities like just getting out of our pajamas, brushing our hair, aren't really necessary anymore. Should we develop a routine? Is it healthy to break out when everybody looks the same. Do we, should we who would pay attention to how we look? And how we manage ourselves?
Amy Exum: So, thanks. Thanks for that question. Many of us have probably experienced a day or two where we may have stayed in our pajamas or not done our typical daily hygiene. But just so you know, routine can be a good thing. It brings certainty at a time where most things are uncertain and there's a lot of changes that will continue to happen. Routine also alleviates our need to make decisions. So, as we've gone through this pandemic we've had to make so many different decisions each day, just what it looks like to go drop our kids off at school, what it looks like to run to the store. If we have a routine, we already know what time we're gonna eat lunch what we're gonna have for lunch. And it's able to reduce those stress levels, that we're probably all feeling right now. On top of that it helps us maintain a lot of our healthy habits.
But what we've been experiencing this pandemic is a lack of any kind of new, interesting, fun experiences. So, if we take that lack of new experiences in combination with a set routine, our lives can seem pretty monotonous. We wanna be able to balance out having a routine while also trying out new things. I know we're in a pandemic, so we're still limited but it doesn't mean that we can't change up things. We can't try a new place to grab food on the go or try a new spice in our meal. Pick up the phone and call somebody that we haven't talked to in a while. Or try a new hobby. J ust because we're working from home and practicing safe, social distance doesn't mean that we can't have fun and try out new things.
Dr. Fialkow: So the uncertainty of this whole situation could be balanced a little bit by creating that routine. You could at least control what you can control which is your own personal hygiene and some components of your day. I certainly could agree with that, but elaborate a little bit more on those changing up the things that you can do. We're clearly limited to some degree in what we can do. So, what are those recommendations specifically? We talk about how we have a workforce that's close together, talks all the time, the old in my generation water cooler discussion about the funny TV show that happened over the weekend. How can we? How can we have these the social engagement with coworkers? When we're not physically in each other's company on a regular basis.
Amy Exum: It's one of the things that I miss most about going into work, are those little conversations. Those coffee breaks, that lunch hour that we get to spend with our colleagues. Never would have guessed that I would miss having that passing conversation in front of the copier or a photo, the the water cooler as you had mentioned. So it's really important right now that we make an effort to reach out. We are physically disconnected from people, and so it takes a little extra effort than if we just had some of those casual interactions. I know it's not ideal but we can have a Zoom lunch with our colleagues. It's not the best, but it's something that we can supplement with until we're able to have those more in-person comfortable interactions. You can also do things like schedule that coffee break with your colleagues. Sometimes I have 15 minutes, I'll text my colleagues on Microsoft and say, Hey, do you have 15 minutes where we can just chat and have a cup of coffee together? And we all get on. You can also connect through group chats where you can send pictures to each other, make sure that you're keeping in touch that way.
Also know that some of your colleagues are gonna be a little bit busier than others, because they have some of those home responsibilities teaching their children from while also doing their own work. So if they don't respond, don't take it personally, we are all busy. And then I'd ask everyone to capitalize on those little interactions that we have outside of the home. We don't get them in the workplace anymore but if you go to the store and you pick up something, say hello to the cashier, say hello to the person in line, how are you doing? We don't have to have these long drawn out conversations but just those little interactions really help keep us emotionally and socially healthy.
Dr. Fialkow: I think that's really great point. The social isolation can be, could be recognized and combated with little type of things like that. We even started a Zoom meeting this morning, and the first thing was I went through the room about everyone, say a little bit what you did over the weekend and start a little dialogue. And granted you have to have the time and the right people to do it. The other part I wanna emphasize and I've seen this with my family, as well is if someone does not wanna participate in that conversation or they don't sign in for a video social engagement, don't judge them. They may be busy, they may have-- appreciate that free time whether they're just gonna be embarrassed with as well. So, the new world of not passing judgment, how we all handle these experiences. That's great information.
Dr. Fialkow: Justin, I want to talk a little bit more about medical and ergonomic issues. So, home offices across the country makes we've made these matrix workstations, people working at the kitchen, couch, even beds with laptops, they may be cozy, but they take a toll on one's body. My daughter who's intimately worked at home has a terrible posture, sits at the laptop. I always think she probably lays there to an excuse me to give her a neck massage at night, but there are real consequences to this. So, what are the kinds of injuries and health issues you've seen spike over the past year because these people having to improvise and working at home. What are the medical conditions? Then we'll follow up with whatever recommendations you can make, for people to avoid those types of injuries.
Dr. Thottam: Sure, Jonathan. Yeah, so, we're seeing a lot of increase in neck and back pain and issues. Again, like you said people are kind of making makeshift workstations. So where people had work ergonomic chairs and standing-up desks, they don't have that anymore. So they're using their kitchen countertops and couches and beds. And I'm sure also with a lot of patients having children a lot of the office space is kind of taken up. So you're kind of a, you kind of give up everything for your children and a lot of patients do. And then you end up kind of sacrificing your own health.
So we've been seeing a lot of musculoskeletal problems, arthritic pain, herniated disc, and it a lot of it is from poor posture, increased sitting also is kind of causing problems that people take for granted even driving to work. You're kind of getting out, walking to your car, going, sometimes you'll stop at the coffee shop, walking through the parking lot. Those are all kind of exercises that we were doing before that a lot of people don't have anymore. So kind of contributing to a lot of the symptoms that we're seeing. And also because of the pandemic, I think a lot of people were afraid to be seen or were kind of delaying, delaying, delaying until it became pretty severe where we were seeing an increase in in herniated disc and severe pain.
Dr. Fialkow: So I think the key point is you've always seen those injuries, but you're clearly saying more frequent of more people coming in with those consequences. When, to the best of your ability of, for these purposes? When would you recommend someone who has a little neck soreness? Or the low back hurts a little bit, when should they see a doctor about it? When should they seek medical care?
Dr. Thottam: That's a great question. I mean, honestly, I would do it as soon as possible. If you have pain for more than three to five days I would start see, I would try to see somebody. 'Cause the faster you can see one of us we can kind of give you a layout on and do an exam make sure everything's appropriate and no red flags are coming up. But if there is no problem, we can always start you on some exercise program to kind of prevent it from getting worse and improve it before it gets severe.
Dr. Fialkow: So the early assessments worthwhile, I'm sure, as you said you worked with them on strength and they get exercise and we can get to that. What about the ergonomics aspect? What do you actually see? And what are the components? That you would tell someone to try and avoid those neck and spine type of injuries or strains from the home workstation environment.
Dr. Thottam: Yeah, so a lot of times when you're at home, essentially you wanna kind of have a chair that's good and has spinal curves to kind of emphasize a good posture. You also wanna kind of pay attention, all of us, including myself after, half an hour, an hour on the computer, everybody starts to slouch and then it's kind of a force of nature. But at the same time, if you're aware of it, you can kind of keep it in your mind to keep your posture. Even getting up every hour or so and stretching doing the exercise, it can go a long way. Having appropriate height for the chair. So a lot of times you want your knees to be at the same height as your hip with your feet flat. You wanna make sure if you're at a desk, your knees can fit appropriately underneath the desk with some ample space there. Having a foot rest, maybe beneficial kind of has. Sometimes you can have like something that pivots. So you kind of, even though you're sitting, you're moving your legs, getting circulation going, you're stretching out the muscles that way. In terms of the mouse, you want your wrist to be neutral. Sometimes you can even put a little cushion there to kind of help and take some of the stress off of the wrist. Your chair arm height should be to appropriate so that you're not stressing your shoulders. Those are just a few things that and your computer screen should be essentially at eye level or a little bit lower just so you're not stressing the neck.
Dr. Fialkow: Right. Here's a question that hopefully it's a fair one. So if someone's sitting at their desk or in their couch or at their couch or at the kitchen table and they feel a little lower back strain, do they get up and walk around? Or do they lie take pressure up off their back?
Dr. Thottam: I would actually get up and stretch. Sometimes it's just the posture of, hey, you're slogging forward and you're kind of stressing all of those ligaments and muscles as well as putting some strain onto those joints of the back. So getting up stretching, I think will go a long way. Laying down and having a flat surface with your knees up can also be beneficial, that's more for arthritic pain, but can be beneficial in stretching out the low back as well. But I think majority of the time, it's the standing and walking, stretching that helps you more than the laying down and keeping it flat.
Dr. Fialkow: That's great. So Maria, we've really teed it up for you. Some people sitting at their desk for hours when you're sitting with a patient and you're recognizing this bad posture or the bad work situation, Justin went into the ergonomics the arms at the right level with the mouse and the screen at the right level to avoid flexing your neck or extending your neck. What are the actual kinds of things you tell people to do physically? Whether be, what are the kinds of exercises? Or what are the kinds of things you actually tell them to do?
Dr. Ordonez: What ---- Justin was saying in terms of standing up and stretching, I like to tell patients every couple, maybe 40 minutes or to an hour to get up and stretch and walk around. But then also since now we're all working from home to take advantage of that and kind of like alluding to what Amy was saying to like build it into their routine, right. To build it into their routine. And I tell them go online and find maybe five to 10 minute videos of, core exercises or lumbar back, or neck exercises, upper back, right. And just do that like five minutes, five to 10 minutes. There's really short ones that you can incorporate. So, okay, maybe that coffee break every day or maybe when you're gonna have lunch before lunch just do like a five to 10 minute video. If it's even five to 10 minutes it makes a difference if you do it every day. And if you can incorporate it into your routine then you'll see the difference in your back.
Dr. Fialkow: I think that's the main point. You don't need to join a gym. You don't need to go out for 45 minutes of heavy exercise, a few minutes, five minutes, twice a day is 10 minutes.
Dr. Ordonez: Right.
Dr. Fialkow: And you really don't have to find a lot of time to incorporate this but it has significant medical benefits as you're describing. Amy, we're talking about how we separate work and our personal life. And, we said you can throw a load of laundry in between phone calls or take the dog for a walk, speak about, the focus of [inaudible] and separating work from your personal life.
Amy Exum: So I'm smiling because that's a little bit of what my day looks like with the laundry and the dogs. This question has been going on for quite some time of how do we separate work and life. Ever since we've had the development of these lovely cell phones and laptops work has really started to encroach on our free time. I was talking about this pre-pandemic, and now that many of us have our offices in our home, it just gets tougher, right? So one thing that we can do is the way that we look at it is gonna be different. We're gonna really look at this from an integration standpoint that work and personal life are just integrated. Think about how many times we have to take a phone call from our children's school because something happened or we have to make a phone call to the vet during work hours, and then vice versa in the evening when we're supposed to be spending time with our family, we may have a work emergency.
So we have to have some of that flexibility especially with the world that we live in today. Things that can help though, are that routine that we talked about and figuring out two different styles. So one style is if, and if my employer allows me right, to work a couple hours, then take a break do some personal things, work another couple of hours do some personal things, really integrate that throughout the day that may work well for some of you. The other approach is to really be a little bit stricter with your schedule and say, okay, I'm really allocating these hours of my day to focus on work give or take anything that happens in between. And then I'm gonna really disconnect and shut down from working during my personal hours.
I'll say that pre-pandemic, I really liked the integration of doing some work, doing some stuff at home doing some work since the pandemic, because I'm always home now, I actually like the second technique. I'm much stricter with my time because for some of you, you might find that, Oh it's so easy to keep working past your normal hours. As you mentioned before, Jonathan, we were work, many of us are working a lot. And so some things that I suggest are to turn off the computer, actually shut it down, put it in away in a cabinet or a drawer where you cannot see it, if it's a different room, close the door. So it's not that reminder on top of it turn off those notifications from your phone. If you have a position where you can do that. And then for the other set of people who have a tough time doing work during those work hours it's a little bit of holding ourselves accountable setting our own deadlines, asking our colleagues to help us out and check in with us to make sure that we're staying on track. Because when we're stressed, when we're tired, it's really easy to turn on the TV or start to scroll through social media. Working from home takes a whole lot more discipline than it does when we go into the office.
Dr. Fialkow:
Maria, to that point where, the work and personal time becomes blurred, let's talk about some of the health-related aspects of it, not just the psychological aspects. Microsoft released a study on remote work phenomenon. They found that our work week has gotten longer by three to four hours a week because we're always accessible and we're not really having finding that down time. How does this affect our work? Our health, how is it? How does it affect your health? To not have that shut down time?
Dr. Ordonez: So I think one is the stress levels being higher, right. Anxiety being on the rise and with all of that comes a lot of risks, right. Cardiovascular, we're doing less exercise. And so I think it's important to keep a balance like Amy was saying, right. Maybe having that schedule to put your phone away and then maybe going for a walk, right. That way, decreasing your stress levels, right. Increasing your exercise, decreasing your risks of disease. Also, addressing your anxiety because that will help lower your anxiety. Spending time with family too, right. Getting to spend time with loved ones. So being able to unplug, right, if you're outside where you gonna get more vitamin D. So it's so important to be able to try to reduce our stress levels and our anxiety which is at least from my sample, what I've seen along with the back pain, from the pandemic a lot of increased like anxiety, depression stressors from everything that's going on, right in the pandemic. So I think what Amy was saying and all the pointers are really, spot on.
Dr. Fialkow: Great. I’m going to take some questions. I'm gonna ask Amy, I'm sorry, Maria this. Can looking at my computer screen for long periods of time have an adverse effect on my concentration or vision?
Dr. Ordonez: That's actually a common question, I get here in clinic right now in pandemic people are asking a lot and the answer is yes, it can have an effect on you and then also on your eyes. A lot of eye fatigue right now that we're, prolong exposure to screens, right. Because there's a lot of glare and our eyes have to strain a little bit and we have to focus like this close focus attention. So it's hard to, for the eyes then to adjust to seeing a distance, which is in the short-term. So for people I also say not only taking the physical breaks but also like take a break and look at the, they say like 20 feet away. So like at a distant object to relax your eyes. Also, a lot of people are having dry, irritated eyes. So to use, some drops to moisturize the eyes like over-the-counter drops. And then the other one is with circadian rhythms, right? So at nights staring at the Blue light and staring at the computer or the phone, right. 'Cause we're catching up on things. So it can also disturb our sleep. So I tell people, try to have like that point where you're not looking at the phone anymore, or if you do need to then to put the night mode or maybe, Blue light glasses, if you can to, so that he doesn't interfere with your sleep. So those are some of the common things.
Dr. Fialkow: That's true, the light from the actual screens can turn off certain sleep drivers so it can affect your quality of life and your sleeping. I'm gonna ask each of you this question and we ask each of you to answer it to your own specialty and your own knowledge. And the question is what's the effect of caffeine? And the effect of alcohol? On our mental and physical health during this pandemic. Amy, do you wanna tackle that first?
Amy Exum: Sure. So I'll start with the caffeine, right? Caffeine is a stimulant. I'm sure the other physicians can talk to that. But if I'm already experiencing some anxiety that stimulation is going to increase my anxiety. So we really wanna be mindful of how much caffeine we're taking in and what form as well, what time of the day we're consuming the caffeine because if we have trouble sleeping probably not a good idea to have caffeine after noon. So being mindful of that. When it comes to the alcohol, know alcohol is a depressant and sometimes people think, well, you know what? I'll just have a nightcap or something to put me to sleep. And it's true. Alcohol will cause you to, will suppress you so that you do become more sleepy but it does interfere with your sleep cycles. And so when we have any issues with sleep with anxiety and it can also, by the way, increase your anxiety, if you've been drinking enough alcohol and then you stop. So it can really impact the way that we feel emotionally and physically. And so it's important to monitor how much of each substance I'm consuming, whether it's caffeine whether it's alcohol or anything else that I might be consuming. How does that impact me? How does it make me feel? I often ask my patients, what do you feel like? Before you have that cup of coffee or you have that drink, what do you feel like afterwards? And then how do you even feel the next day? Because we have a lot of emotions and a lot of mixed feelings that can happen after we've drank too much coffee or we've drank too much alcohol as well. So there's physical effects, mental health effects as well. Any kind of mental health diagnosis that you have really wanna be cautious with consuming any kind of substances.
Dr. Fialkow: That's great. Justin anything you wanna add to that?
Dr. Thottam: Yeah, I mean, just to kind of add on even to those two was as well as even smoking is also something that, you probably will probably see more of especially as people have more stress and again it can have adverse effects to all of our systems. So you wanna just be careful specifically for the spine too, with smoking, we've seen that it can adversely affect like even healing times and it's total spine health.
Dr. Fialkow: What are the signs people should look for in themselves? To say, hey, wait a minute, I might be going down this path. And if they feel that what would you recommend they can do about it?
Amy Exum: Sure. So I just wanna say first that most of us are feeling pretty tired, if not exhausted. It has been over a year of this and our bodies and our minds just were not built to sustain this level of emergency mode. Now, if I notice that I am not, I'm feeling very unmotivated, I'm not getting joy out of the things that I used to enjoy. As Maria mentioned, spending time with family. If I used to love and look forward to spending time with family, and that's just not the case anymore, this is a flag for me. If I'm finding that I'm having more health issues that is also a red flag for me. Some of us manifest our mental health and our physical health and it's very intertwined as well. So lack of motivation, maybe sleeping more or sleeping much less, drastic changes in appetite levels or how we eat. Or really looking at anything that is out of our norm. And I know again, that's tough right now because everything is out of our norm as we speak but you really know yourself best. And when you start feeling pretty down or extremely anxious and that's starting to interfere with your ability to go to work, spend time with people you love, to laugh, to learn new things, that's when it's time to reach out to a professional. You can reach out to your primary care physician, you can reach out to a mental health professional such as myself and encourage you to keep and write down the phone number two, one, one, it's a helpline that anyone has access to. You just dial it from any touch-tone phone. And then we at Baptist Health also have resources. We have the Recovery Village at Baptist Health where they can help support your mental health. It's important to not feel alone during these times which is really easy to do when we're working from home. So again, mentioning that reaching out for your wellbeing and for other's wellbeing. If you know that you haven't seen someone in a while you haven't heard from them, go ahead and reach out and see how they're doing. You can also call that two, one, one number, if you're worried about somebody else now is a time better than ever to reach out to a professional, prevention truly is the best medicine when it comes to our physical health and our mental health.
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And if you have any comments or suggestions for future topics, you can email us at BaptistHealthTalk@baptisthealth.net. That's BaptistHealthTalk@baptisthealth.net. We'd love to hear from you. Thanks for listening. Until next time, stay safe and mask up.
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