In March, following the stay-at-home order, I went on a final grocery run, checked in with family by phone, and settled in at home. I told myself, “There’s plenty I can do at home, it’ll be fine.” I planned for my needs and, despite harrowing news from friends abroad, I felt secure. One month later, many of us have been laid off and are fighting for unemployment benefits while others are working increased hours as essential staff. Retirees are strategizing for their daily needs, children are adjusting to on-line school. Parents working from home, juggling job duties and childcare and technology challenges. Many of us are feeling waves of exhaustion, frustration, overwhelm. How do we make sense of these feelings? How do we grieve our lost routines with the uncertainty of the path ahead? We can turn to Elizabeth Kubler-Ross’s famous ‘Stages of Grief’ model to organize ourselves for this journey. It is important to remember the stages are not linear; we don’t walk through them sequentially.

Denial: Denial can serve a helpful purpose in getting us through the first few days and weeks following loss. In the midst of COVID-19, denial can show up when we think, “This is just a flu and I don’t get sick, I’ll be fine.” Denial can push us to busy ourselves in work, or find other constant distractions. As time passes, denial often dissolves and gives rise to other stages.

Bargaining: When things are beyond our control, as with grief and COVID-19, bargaining is a way to regain a sense of authority. “I’ll stay home for now, but this better be over by June” or “If I stay home, everything will be fine by my birthday in August.” Recognizing that we can’t bargain our way to a better situation is a step towards resolution.

Anger: In the midst of COVID-19, much anger has been expressed at government leaders, international travelers, entire cultures. Anger is a valid emotion and worth exploring, but it is not okay to take it out on those around us.

Sadness/Depression: For many of us the sadness of our circumstances is becoming undeniable. We feel the sadness o missed graduations, birthdays and holidays; we long for contact with friends and loved ones. Missing everyday milestones can be heartbreaking and lead to increased feelings of loneliness and depression. It’s okay to be sad right now.

Acceptance: Originally identified as the final stage of grief, acceptance is when we recognize the reality of our circumstances: we are in a pandemic, we are socially distancing and staying home in order to protect one another, and we don’t know when this will end. Acceptance of the present moment, no matter the pain, is where we find some
emotional freedom.

Meaning-Making: In the sixth stage of grief, introduced by Davis Kessler and endorsed by Kubler-Ross, we discover meaning-making as a byproduct of acceptance — once we accept our reality, we can make something out of it. When we create meaning, we are able to see our struggles in new ways. Meaning-making does not eliminate pain, but it can
give it purpose.

There are endless ways of making meaning of this time. By connecting with friends and spiritual communities online, we can explore a new side of relationships and new textures to our faith. When we advocate for equity in healthcare and unemployment benefits, we give our anger a voice for change. Trips to the grocery store for neighbors in higher risk categories connects us with others in a valuable way. When we spend reflective time by ourselves, we remember our needs and values, and tune into our deeper selves. When we find enjoyment in the often-tedious task of cooking, mealtimes become creative activities. Noticing endearing quirks in our pets can fill us with gratitude for the ways they enrich our lives. Listening to music reminds us to move, dance, play. Spending time outside can help us connect with nature, appreciate rural life, enjoy songbirds and notice signs of spring. Through these practices, both great and small, we can find value.

In the coming months, as leadership and health professionals adjust our current restrictions, we will dance between stages — we might revisit denial, move directly towards anger, wade back into bargaining. At each stage, we can meet ourselves with compassion, remembering this grief process and, again, move gently towards meaning-making.

AUTHOR: Terra Marzano, Licensed Clinical Social Worker, Rinehart Clinic

For more local health and wellness information, follow Tillamook County Wellness on Facebook, Instagram and Twitter.

For the past decade, the County Health Rankings have taken the pulse of the nation, showing us how where we live matters to our health. Tillamook County Public Health is pleased to report that our county has seen an intriguing trend, moving from an overall ranking of 26^th, out of a total of 34 Oregon counties included in 2016, to an impressive 10^th place ranking out of 35 Oregon counties included in 2020. According to Marlene Putman, Public Health Administrator, “Health indicator data is just one measure we use to drive investments to improve community health and well-being. This trend shows that the hard work and collaboration of our community partners is moving us in a positive direction.”

This report compares the health of counties within states. We know that not everyone has the same opportunities to be healthy where they live. Good health allows people to fulfill their potential and thrive. Looking at these measures can help a community better understand what systems are supporting health and well-being and where there might be room for improvement.

The Health Rankings make it clear that good health is influenced by many factors beyond medical care such as access to physical activity and healthy foods, factors that Tillamook County partners can do something about. All counties can take action to improve their health, no matter where they rank. It’s not a race to the top. It is about making steady progress toward building communities where people feel connected and supported to live healthier lives.

The Health Rankings report is well worth celebrating. There are many incredible actions taken by leaders and organizations in Tillamook County in the past five years that contributed to this positive trend, and we congratulate all our community members for this success. It is also worth noting that the “Year of Wellness” was launched in 2016 and continues to build momentum as Tillamook County Wellness into 2020 and beyond. More than 46 community partner organizations, and nearly 100 individuals, have made a commitment to work collectively to reduce risk for type 2 diabetes. This collective action is changing our community and it is changing people’s lives for the better.
County Commissioner Bill Baertlein has been instrumental in many of these efforts, demonstrating true leadership. When asked about the County Health Rankings report, Commissioner Baertlein said, “I’m really pleased with everything that has happened. It has really exceeded all my expectations and I think this report will add fuel to existing efforts. I’m excited to see where we go from here.”

Areas where we continue to improve include people’s perceptions of their personal health and well-being, smoking rates have gone down, and we have a lot of access to places to be physically active, especially outdoors. Health issues needing improvement include obesity rates and sedentary behavior, as well as people not getting enough sleep. All these factors influence risk for chronic disease. Other areas we hope to see improvements include flu vaccination rates, number of children in poverty, college attainment, teen birth rates, and premature deaths, including those that are drug or alcohol related, as well as suicides. As positive as our trajectory is, there is still a lot of work to do to support individual and community health.

The expression, “It takes a village,” is true. We improve these areas together as a community. And the inverse is true too. We are always moving in a direction. Collectively, we decide what that looks like and how we can invest our energy and resources to make things better. It takes everyone working toward a common goal, supporting one another and making a commitment to do things in a new way. Together, we are Making Healthy Happen.

For more local health and wellness information,  follow Tillamook County Wellness on Facebook, Instagram and Twitter.

Leslie Manners has always taken her health and fitness seriously. The 42 year-old mother of two boys, Max and Body, was a regular at the Tillamook YMCA, often working-out five days a week. She ate healthy foods and gently pushed her fishing guide husband, “Big Dave,” of Big Dave’s Fishing Adventures, to also make positive eating choices. So, when she noticed blood in her stool two years ago, she didn’t think much of it. At her annual OB-GYN check-up, she mentioned it and was referred to a gastrointestinal specialist for follow-up.   Because of a family history of polyps in Leslie’s family history, a colonoscopy was also scheduled.

“I scheduled it for three months later in September, when my husband would be back from fishing in Alaska,” Manners said. It was during that screening that a large tumor was found in her rectum. Doctors told Leslie that surgery to remove the tumor would be necessary, but a biopsy would be completed before they scheduled the surgery. “A few days later, the results came back as non-cancerous.” Yet, that seemingly positive prognosis was short lived.

Doctors scheduled a pre-operation lower endoscopy and Leslie had a friend drive her to the appointment, thinking it would be another routine procedure. “When I woke up from the screening, the doctor came and told me that it was cancer and that the roots of the tumor had penetrated into the colon wall.” In addition to surgery to remove the tumor, Leslie was told she would also need radiation and chemotherapy. As expected, the diagnosis was devastating. “I was in complete shock. I was doing everything I thought I should be doing – I didn’t eat red meat, spent five days a week at the gym – it didn’t make sense.” Leslie began praying every day for help and guidance.

A CAT scan revealed that Leslie had Stage 3 colon cancer and it had spread to two of her lymph nodes. A PET scan then showed Leslie had a nodule in her thyroid which was stage 1 cancer, but curable. “I remember asking, why me? But then I said, why not me? At the time, it didn’t make sense, but later, you think, maybe there is a reason for it.” And with that, the fight was on.

Chemotherapy, radiation, Western medicine, Eastern medicine, supplements, genetic testing, medication trials, naturopathic therapies – nothing was off the table. Leslie was determined to do everything she could to fight the cancer and felt fortunate to have the ability to pursue multiple treatment options – if not just for her, then for her family. “I went to a practitioner of Chinese medicine. I switched to a plant-based organic diet and I juiced everyday, spending more for organic veggies and vitamin C IV therapy and mistletoe injections.” Leslie’s battle would be financially taxing, but the family pressed on. “Insurance doesn’t cover holistic treatments at this time.” Leslie’s journey provides an important reminder that early detection and prevention is key to saving money and lives.

It is recommended that, with any colorectal cancer diagnosis, other family members also get screened. Leslie was advised that her family members should be screened 10 years prior to the age Leslie was at her diagnosis. In what seems to be a recurring theme in colorectal cancer diagnoses, screening often does more than just save one life, and with Leslie’s story, this rings true. “My sister Julie had turned 50. She got screened and they found three polyps. One of them was Stage 1 cancer and was treatable. My screening and diagnosis saved my sister’s life.”

The side effects of the chemo and radiation can be brutal. However, Leslie credits her full-court press on her cancer – the homeopathic therapies, acupuncture, massage, yoga, the diet and exercise regime, traditional medical interventions, her faith and cancer support group – as a huge influence on her being alive today. “At one point during chemotherapy, the oncologist said to me, ‘You are the healthiest cancer patient that I have right now.” As with any health challenge, maintaining a positive outlook and having a network of support are tied to better outcomes.

The battle continues for Leslie, but her determination has only grown stronger. “In October I had a CT scan which was clear. My colonoscopy in December was also clear.” Leslie believes that talking about colorectal cancer screening is important, and that with knowledge, you are much better equipped to deal with a diagnosis if it ever occurs.

“I would say, slow down. You didn’t get it overnight. Change your diet immediately, then network, research and look outside the box. Have the will and have faith. And get screened, because screening is easy, and early screening saved my life.”

Colorectal cancer is the 2^nd leading cause of cancer deaths. And it is the most preventable. Any person, age 50-75, should be screened. Contact your healthcare provider to schedule your screening and to find out if you are eligible for a $25.00 gift card*.

*For individuals that are currently due for screenings or have never been screened. Screening must be completed by May 31, 2020. Gift cards will be mailed upon verification of completion of screening.

AUTHOR: Paul Fournier

For more local health and wellness information,  follow Tillamook County Wellness on Facebook, Instagram and Twitter.