St. Joe’s Oakland Chief Medical Officer addresses vaccine hesitancy and socio-economic barriers to getting vaccinated

Fabian Fregoli, chief medical officer of St. Joseph Mercy Oakland, recently spoke with iHeart Radio about the need to remove barriers of care for socio-economically challenged individuals living in our community.  Doing so, he said, can help people access a COVID-19 vaccine if they want one.  He also addressed vaccine hesitancy among some and the ongoing efforts of Saint Joseph Mercy Health System to provide support and education to the community.

Living with Type 2 Diabetes?

Five Tips for Staying Comfortable and Healthy During Warmer Weather

According to the CDC National Diabetes Statistic Report 2020, in 2018 (most recent statistics), an estimated 7.3 million U.S. adults aged 18 years or older (2.8 percent) had undiagnosed diabetes and 88 million adults (34.5 percent) had pre-diabetes. It was also estimated that 26.8 million U.S. adults (10.2%) had diagnosed diabetes. Of those 26.6 million, 90-95 percent had the most common type of diabetes: type 2 diabetes.

In type 2 diabetes, the body becomes resistant to insulin that is produced by the pancreas. The pancreas compensates for this resistance by producing even more insulin. Eventually the pancreas creates as much insulin as it can, but the resistance increases. Insulin resistance leads to high blood sugars.

Once a patient has high blood sugars that are untreated, those blood sugars damage blood vessels, particularly the small vessels that supply glands and tissues. The organs most affected are eyes, kidneys, nerves and heart.

While there can be a genetic component to type 2 diabetes, there is a correlation with weight gain and specifically abdominal fat. Trying to stay lean will help most people avoid issues with blood sugar control. Losing weight can help improve the health of a person with diabetes.

If you are living with type 2 diabetes, there are simple steps you can take to stay comfortable and healthy during the warm summer months.

Stay Hydrated

When a person’s blood sugars are high, body fluids can shift. In the warmer weather, diabetic patients can become even more dehydrated than others, so it is essential to remain hydrated with water. Water is the best choice — not sports drinks, pop, juices, coffee, or tea. Be sure to drink about eight glasses of water during the course of each day.

Continue to Exercise

With type 2 diabetes in particular, we encourage people to stay physically active. Whether you walk or participate in another sport, be sure you have well fitting, comfortable, supportive shoes. We do not recommend going barefoot or wearing sandals. It is best to wear shoes that offer support, protection and coverage.

Eat More Locally Grown Fresh Fruits and Vegetables

Processed foods tend to be higher in simple sugars and carbs that could raise your blood sugars even more. Unprocessed foods are better because your body has to work harder to metabolize their sugars. Following an average healthful diet, such as the Mediterranean diet, is a good place to start. Depending on your diabetes, you may want to be mindful of eating fruits and vegetables with a higher glycemic index. As an example, bananas, carrots, and corn are foods with a higher glycemic index that can be absorbed more quickly than other vegetables and fruits.

Get a Good Night’s Sleep

With the longer hours of daylight, it is still important to pay attention to your sleep environment so that it promotes quality sleep. Find a cool, dark and quiet place to sleep. Sleep apnea can occur among patients with type 2 diabetes. If you have sleep apnea, consult a sleep specialist to help promote better sleep.

Protect Injectable Medications

If you use injectable medication for your diabetes, it is important to remember that the medication needs to remain at room temperature, which is about 70 degrees Fahrenheit. During warmer months, keeping your injectable medication in your car or outdoors could reduce its effectiveness by allowing it to reach a higher temperature.


If you are living with diabetes or caring for a person with it, it is good to remember that diabetes is a chronic medical condition: There will be good days and bad days. Be gentle with yourself if you falter. No one is perfect. Tomorrow is another day, so pick yourself up, and do your best to follow guidelines that can improve your health.

Learn more about St. Joe’s diabetes education and diabetes prevention programs.

Pediatric Mental Health

As we head into the summer months, the effects of the COVID-19 vaccine surround us as life begins to feel more normal. For many children and adolescents, it’s a time to get back to sports and activities, hang out with friends and family, and soon return to school. Unfortunately, re-entry into “normal” is not as easy as it may seem for many youth in our community. Fifteen months of social isolation during the pandemic has magnified issues in children and adolescents who have struggled with anxiety and depression.

There have been studies regarding the relationship between loneliness and mental health in healthy children and adolescents. We know social isolation and loneliness can increase the risk of depression even a decade later. Throughout the country, pediatricians are concerned that the loneliness experienced during the COVID-19 pandemic will likely affect the future mental health of our youth.

Patrick Gaulier, Senior Clinical Social Worker at IHA WestArbor Pediatrics, notes that “many adolescent patients have talked about feeling isolated and separated from their friends and other supportive groups.” Children and teens have turned to social media as their primary source of maintaining a connection with their peers. In many cases, this online-only environment has ended friendships which, in turn, causes many adolescents to become reluctant to return to in-person learning. During a recent appointment, Patrick recalls a 10-year-old describing deeply disliking in-person learning because he “doesn’t know anyone anymore” and worries he will not be able to make friends again.  

What to look for

With the return to activities, symptoms of anxiety or depression could show up at any point. Some children may initially seem fine, with parents noticing signs several weeks later. Other children will exhibit symptoms right away. Not all children will be able to express their feelings of depression or anxiety in an obvious way. Instead, they will show complaints of physical symptoms or behavior changes. Parents and guardians should learn to recognize signs of mental illness, as it isn’t always obvious. Children and adolescents may express their worries through behaviors such as withdrawal from family and friends, irritability, argumentativeness, and aggression. Some may try to avoid activities that they previously enjoyed. Or, they may show physical symptoms like stomach aches or headaches. 

How to help the children and teens in your life

Checking in with kids about their mental health may be one of the most important things we do to help our youth out of the COVID-19 pandemic. Sometimes, it’s as easy as saying, “Hey, I see you are having a hard day today. Is something making you worried?” 

Encouraging children and adolescents to participate in physical activities and spend time outdoors with peers is an excellent step in helping improve physical and mental health. Kids will experience positive emotional benefits with increased safe socialization as we continue to vaccinate and cases continue to decrease. 

Of course, when in doubt, you should always reach out to your child’s pediatrician. Pediatricians routinely evaluate patients for mental health concerns. They can make recommendations such as healthy lifestyle changes or connect you with a mental health professional who has experience and expertise in treating children. 

We cannot ignore the negative impacts on mental health on the development of children and adolescents during the COVID-19 pandemic. We know that parents, family, friends, pediatricians, and therapists can all help address the mental health needs of children and adolescents. The earlier we intervene for our youth, the better chance we have of making a positive impact. If you would like to speak to a pediatrician about your child’s mental health, IHA Pediatrics is available for same or next-day appointments in-person or via video to determine the next steps. More information can be found online at http://www.ihacares.com/pediatrics. 

“Handy” Tips to Stay Safe While Working in the Garden

Gardening is a great outdoor activity that allows you to grow beautiful flowers or nutritious foods for your family to enjoy.   All the digging, planting and weeding is good exercise, but it can also cause injury in your hands, wrists and arms if you’re not careful.

Because gardening involves a lot of repetitive motions, people who enjoy this hobby are susceptible to overuse injuries. These injuries typically develop over time and may affect the hand, wrist or elbow. The pain is often ignored when minor, which sometimes causes mild injuries to develop into more serious problems

Common Types of Gardening Injuries

Trigger Finger/Thumb

Most gardeners do a lot of pruning without realizing that the continual opening and closing of shears and pruners can lead to a painful locking of the fingers or thumbs.  When this occurs, pain develops in the palm, or you can experience a locked finger pointing downward, forcing you to use your other hand to “unlock” it. 

Gamekeeper’s Thumb

This is a chronic condition caused by repetitive motion and stress on the ligament located on the inside of the thumb.  Repeatedly opening and closing hand tools and clippers can cause chronic weakening of the ligament.

Wrist Tendinitis

Repeated movement of the wrist can result in chronic pain.  Friction occurs when the tendons in the wrist rub together.  This friction can cause swelling, irritation and inflammation.  Gardeners commonly experience this either near the base of the thumb or further up the forearm.

Hand Infections

Some gardeners are unaware of Rose Thorn Disease (Sporotrichosis).  A fungus found in soil and in rose thorns can enter your bloodstream through a simple rose thorn prick.  It can take months to show any symptoms.  At first there will be a purple or pink painless lesion which can spread up the arm as ulcers or open sores.  Other bacteria or fungus can be introduced with even the smallest cut, running the risk of developing into a major hand infection.

Simple Precautions to Prevent Hand Injuries

According to the Consumer Product Safety Commission, emergency rooms treat more than 400,000 outdoor garden tool-related accidents each year.  With proper safety techniques you can stay away from the hospital and avoid becoming a statistic.

Always wear gloves. Use thick leather gloves when working with roses.  Latex or rubber gloves are best when gripping tools or when working in the soil.  Proper gloves will not only reduce blistering but will also protect your skin from fertilizers, pesticides, bacteria and fungus. 

Vary your activities and take breaks.  Don’t stay on one repetitive task too long.  When raking, trimming hedges, pulling weeds, pruning bushes or planting bulbs, move from one job to another every 15 minutes with a brief rest in between.   Be sure to take breaks regularly.

There is a tool for everything so use it. Avoid using your hands to do jobs a tool can do better and faster.  Select tools that are lightweight and include thick rubber handles to reduce stress on the fingers when gripping.  Ergonomic gardening tools can significantly decrease grip force and reduce any inflammation

Check Your Posture

Posture includes whole body position but also includes the angle of your wrist while using hand tools.  Grip strength is maximized when the wrist is in a relaxed, neutral position.

Connect with an expert when you need help.

If you have a hand, wrist or arm injury, connect with a hand specialist. Dr. Caroline Wurtzel is a St. Joseph Mercy Chelsea physician who specializes in hand, upper extremity and microvascular surgery. Her office is located in suite 302 of the St. Joseph Mercy Chelsea Professional Office Building at 855-450-2020.

Five Things to Know about your COVID-19 Vaccine Card

Many providers are offering fun “I’ve been vaccinated” stickers or buttons for patients to share their excitement and encourage others to get their COVID-19 vaccine. But there’s only one official document you’ll receive after getting your vaccine and that is the COVID-19 Vaccination Record Card.

  • What is a COVID-19 Vaccination Record Card?

Your vaccination card is a record of what COVID-19 vaccine you received, the date you received it, and where you received it. It’s your personal COVID-19 vaccination record. While it’s not a legal document, and not the only record of your vaccination, having this information at your fingertips will save you a trip to your vaccine provider or local health department.

  • What if I didn’t get a card from my provider?

If you didn’t get a card after you were vaccinated, the Centers for Disease Control and Prevention (CDC) recommends contacting the vaccination provider site where you received your vaccine or your state health department to find out how you can get a card.

  • What should I do if I lost my card?

Information about your COVID-19 vaccine is available in your electronic health record or from your vaccination provider (the location where you received your vaccine).

If you received your vaccine at a St. Joe’s or IHA vaccination site, your vaccination details are available in your MyChart patient portal. To access, click the menu button and scroll down to the “My Record” section. Select “Health Summary” and then the “Immunizations” tab. If you do not have a MyChart account, sign up for one today.

If you do not have access to your electronic health record or cannot contact your vaccination provider directly, contact your state’s health department. If you enrolled in either the V-SAFE or VaxText program after your vaccine, you can access your information via those tools.

  • Should I be concerned about fraudulent vaccine cards?

Since the Centers for Disease Control and Prevention (CDC) updated its guidelines to allow fully vaccinated people to go without a mask in most public places, worries around fraudulent COVID-19 vaccine record cards are growing around the country.

As business begin to reopen, some may require employees and customers to show proof they’ve been vaccinated. An easy way to do so is to offer up a COVID-19 vaccination card, which has caused a spike in internet searches for and website listings offering fake vaccination cards. In response, the FBI has shared a warning for the public on the making or purchasing of false vaccination cards stating people who do so are breaking the law.

Because the cards are made of cardboard, they may be easily replicated, but the information they contain is also easily verified. Information about a patient’s COVID-19 vaccine status is available in their electronic health record, from their vaccination provider (the location where they received the vaccine) or from the state health department.

The FBI recommends anyone who encounters suspicious activity contact “the appropriate government agency” in their local jurisdiction or state, the U.S. Department of Health and Human Services at 1-800-HHS-TIPS or the FBI Internet Crime Complaint Center.

  • What’s the best way to keep my card safe?

Because the cards are made of paper and could easily get dirty or damaged, it’s important to keep your vaccination card in a safe place. You can put your vaccination card away with other important personal documentation in a safe or file cabinet.

Some office supply stores are offering lamination of vaccination cards. While it’s a great idea to protect them, if the cards have stickers affixed to them the heat involved in the lamination process can make them unreadable by turning them black. It all depends on how they were printed.

The Centers for Disease Control and Prevention (CDC) recommends taking a photo of your card as a backup copy but avoid the temptation of taking a selfie with it and posting it on social media. You might put your personal information at risk, according to the Federal Trade Commission.

Michael Davis lost 183 pounds

After college, Michael’s weight was at an all-time high and he knew something needed to be done. As a former athlete, he was used to being active and knew he was losing his quality of life.

Michael has a few close friends and family that had bariatric surgery, so he decided to make an appointment with MBI. “From the first appointment, I knew this was the solution for me,” said Michael. He underwent bariatric
surgery in February 2020. Michael learned that bariatric surgery is a tool, and this was start of his journey. He had support from his family and the MBI team to guide him through each step.

Now, he can do everything he wanted to do before; run, jog, outdoor activities and keep up with the kids. “Thanks to MBI, I have my life back and it’s the best thing I could have ever imagined,” said Michael

Wendy Bemis lost 138 pound

Wendy felt like she had tried everything; diets, programs, exercise and nothing seeming to work. She was 320 pounds and didn’t have the energy to participate in outings with her children and family.

Wendy’s doctor suggested she make an appointment with MBI and she had bariatric surgery in July 2019. Bariatric surgery was a huge lifestyle change for Wendy. “I learned how to cook healthy food and to eat the correct portions,” said Wendy. The MBI dieticians helped her to customize a plan that included food she liked and fit within her lifestyle.

Now, Wendy is 182 pounds and is off all her medications, has less anxiety and is sleeping better. “I wake up in the morning feeling like I have energy to tackle the day now,” said Wendy. She looks forward to going to sporting events, on road trips and spending more time with her family.

The COVID-19 Vaccine and Pregnancy: What You Need to Know

As an OB/GYN physician, my patients ask me many questions about how to protect the health of their pregnancy.  It is common to have discussions in the office about what medications are safe, what environmental exposures they should avoid, and what is required for a safe delivery.  Over the last year, patients have had to ask another list of questions about the effects of COVID-19 on their pregnancy.  And although the answers are still evolving, we are gaining more information each day about the virus’ effect on mom and baby. 

When it comes to COVID-19, we know that pregnancy is classified as a high-risk condition by the Center for Disease Control and Prevention (CDC).  This means that pregnant women are more likely to get severely ill (hospitalized, admitted to ICU, and intubated) from diseases or other viruses, including COVID-19 compared to non-pregnant women. Due to this risk, it is important that we protect pregnant women from getting the virus.  Protective measures include masking, physical distancing, and vaccination. 

Is Vaccination Safe in Pregnancy? 

Currently, there are vaccine studies underway enrolling pregnant patients. Research has shown that pregnant and lactating women that receive the vaccination produce a comparable immune response to nonpregnant people.  Also, COVID-19 antibodies have been detected in the umbilical cord blood and breastmilk after maternal vaccination.      

We are gathering data from a “V-Safe Pregnancy Registry” about outcomes from women vaccinated during pregnancy.  As of May 17, 2021, over 4,900 pregnant people have enrolled.  To date, there have been no safety concerns and side effects were similar in the pregnant and nonpregnant populations.  Vaccinated pregnant people did not have an increased risk of miscarriage, preterm labor, stillbirth or congenital anomalies.  This data is very reassuring, and we encourage all patients vaccinated in pregnancy to join the registry.  (vsafe.cdc.gov)

Making an Informed Decision

The American Congress of OB/GYN (ACOG) and the Society for Maternal Fetal Medicine (SMFM) both recommend giving pregnant women access to the COVID-19 vaccine.  Also, The Academy of Breastfeeding Medicine states that the vaccine does not affect the safety of breastmilk and thus supports vaccination for lactating people.  

Pregnant people should make a shared decision with their OB/GYN provider after discussing the risks and benefits of COVID-19 vaccines in pregnancy.  They should also be supported if they choose not to get vaccinated and special emphasis should then be placed on interventions that are safe and proven to work – handwashing, masking and physical distancing.

Improved vaccination rates are key to us returning to life as normal.  If you are pregnant, considering pregnancy or breastfeeding, talk to your doctor about getting the COVID-19 vaccine. 

Delicious, Nutritious Kitchen Gardens are a Growing Trend

Flavors and aromas from fresh herbs and veggies make meals treasured experiences that inspire the senses. The good news is that everyone can enjoy this simple, restorative pleasure by setting up a kitchen/small container garden that takes little space, but significantly enhances the quality of life. “People know more than they think about growing food – instincts kick in very quickly,” said Laura Meisler, St. Joe’s Farm Education Coordinator and a lifelong gardener. “In gardening there are no failures, only experiments that teach lessons. Plus you may discover a new favorite flavor.”

While many people avoid gardening after accidently killing a few innocent house plants, it’s important to remember that herbs and veggies are often more hardy and forgiving than ferns. Also they’re far more tasty. But first things first…

The set up

If your space is limited, smaller decorative containers can be used as indoor herb gardens providing classic, but diverse cooking herbs such as Basil (Genovese is popular); Oregano; Rosemary, Thyme and Cilantro. When harvesting indoor or outdoor herbs, clip from the side and your plants will keep producing. If you love Oregano and brussels sprouts, try this easy, yet delicious recipe below.

If you have a deck or porch, larger containers such as 3-5 gallon planters can be used to grow some veggies. Or if you’re frugal, make friends with your local restaurant owner and grab five-gallon pickle buckets for free. These large buckets are perfect for a range of plants.

Once you have the containers, drill about 10 3/8″ holes in the bottom of each, then deposit some gravel.  Now comes the dirt.  For a few, larger outdoor containers, you’ll want to get three or four 40lb bags of organic potting soil and one bag of peat.  (The peat will help the soil retain moisture, in case you want to go away for the weekend or you just forget to water the plants.) Mix about three-parts potting soil to one-part peat. 

Now you’re ready, what should you plant?

Fortunately, there’s a lot of options for container gardens that produce plenty of wonderful food throughout the season. Here’s a few recommendations:

  • Greens – Lettuces aren’t just ice-berg any more. Plus the names are way more cool. Today’s greens provide a range of nutritious, incredible flavors that if you selectively harvest (like your herbs) will provide meals through the season. Laura recommends heirloom greens – grow varieties not found in stores: Flashy troutback lettuce is a beautiful red and green variety and seeds are easily found.  Mizuna is fantastic green that you can also boil/blanch like spinach.  Speaking of spinach, there’s nothing better either in a salad, or tossed into a pasta dish. Purple kale is another tried and true green along with Swiss chard, that produces stalks that can be eaten like celery.  Plus kale and chard can be used for delicious juices with apples and fresh ginger root. Lastly, butter-crunch-bib lettuce is container friendly and has a very mild, sweet flavor.  Sun Needs – many greens do better in indirect sunlight, so if you have a shady part of the deck, that’s perfect for your greens.  
  • Herbs, again – In addition to the classics we already covered, Sage and Rosemary can be grown outdoors and then brought in for the winter. In addition to gracing your home with an incredible aroma, these woody herbs are essential for a wide range of recipes. Sun Needs – Most herbs, like greens do better with indirect sun.
  • Tomatoes – Of course we couldn’t do a container gardening story without talking about tomatoes. You’ll want a larger container (Those five-gallon pickle buckets are perfect) and consider cherry tomatoes. These do great in containers and many of the newer “monster” cherry tomatoes are very flavorful. Sun gold cherry tomatoes are one variety that produces a beautiful orange veggie that will add a splash of summer color to your patio or deck. Tomatoes’ root systems are dense and aggressive, so stick to one plant per bucket.  Invest in round, metal trellises that will let the plants climb and stay healthy, plus the trellises can be reused for the next growing season. Other larger tomato varieties such as Beefsteak, Best Boy or Goliath (as the name implies, they’re massive) are best left free range – they will quickly become root-bound in containers and not produce. Sun Needs – Tomatoes love full sun.
  • Veggies – Green or yellow garden beans can be grown in containers, but the trick is to not over plant.  Three, maybe four plants per five-gallon bucket should do it. Put in a few stakes to let beans grow up strong toward the sun.  Bell peppers (green, gold or red) are not only delicious, but the plants are pretty. Two plants per bucket is the maximum.   Sun Needs – Full sun

Watering and fertilizer – less is much more

The most common mistake new and experienced gardeners make is over watering. Check with your finger-tip, about ½ inch into the soil…if it’s still damp, don’t water yet.  If it’s going to rain, hold off because that fresh water will invigorate your plants. While there are a lot of products on the market to improve yield, rather than using chemical fertilizer, it’s better to go organic using a good compost and natural fertilizer such as fish emulsion but, most importantly, find joy on the growing journey.

“Gardening is not a chore or a task to get done. It’s a way to put down the phone and unplug, slow down and reconnect with life… even it’s just taking a few minutes to check the plants,” said Laura. “Caring for something that also provides us with wonderful food recharges people and restores balance.”  

Not ready to start your own garden?  No problem. The Farm at St. Joe’s, our hospital-based farm located on the St. Joe’s Ann Arbor – and now St. Joe’s Oakland campus – has an option where people can enjoy the freshest produce through the St. Joe’s Farm Share in Oakland and Ann Arbor. Think of it as an affordable subscription for seasonal produce that also supports sustainable, local growers. As part of our commitment to fighting food insecurity, The Farm in Ann Arbor offers Farm Share assistance  and The Farm in Oakland also provides help for vulnerable community members to obtain fresh produce.  

If you are interested in donating or volunteering at The Farm, please see these opportunities: The Farm at St. Joe’s Ann Arbor and The Farm at St. Joe’s Oakland.

Browned Brussels Sprouts with Oregano Dressing 

Serves 4 as a side dish 

Prep time: 10 minutes Cook time: 8 minutes 

Many of us are familiar with oregano as an ingredient in Italian and Mexican cuisine; this simple recipe brings oregano’s warm, aromatic flavor to protein-rich Brussels Sprouts. The Oregano Dressing also goes well with grilled vegetables and cold pasta dishes. 

Ingredients: 

1 ½ -2 pounds fresh Brussels sprouts 

2 Tablespoons olive oil 

Salt 

For the dressing: 

¾ cup olive oil 

¼ cup fresh oregano, leaves removed from stems 

¼ cup fresh parsley, chopped 

1 large or 2 small cloves garlic 

¼ cup salt 

¼ cup sliced almonds, toasted   

Directions: 

Place olive oil, oregano, parsley, garlic and salt in a food processor or blender; pulse until herbs are finely chopped. Add more salt to taste as desired. 

Wash Brussels sprouts, trim stem ends, and cut in half lengthwise. Toss in a bowl with 1 Tablespoon olive oil to coat. 

Heat an additional Tablespoon of olive oil in a large skillet over medium heat. Place sprouts in the skillet cut side down, sprinkle with a couple of pinches of salt, cover and cook until sprouts begin to brown (about five minutes). Test sprouts for tenderness; keep covered and cook until desired tenderness is reached. Turn up heat and cook uncovered until sprouts are brown and caramelized; toss a couple of times with a spatula to cook round sides. 

Remove from heat and toss with Oregano Dressing to taste; add nuts and serve immediately.