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How to Safely Get Children Outside During the COVID-19 Pandemic

How to Safely Get Children Outside During the COVID-19 Pandemic

By | General Information
How to Safely Get Children Outside During the COVID-19 Pandemic

We all know how important sunshine and outdoor activities are for our children. The recent emergence of the coronavirus pandemic has caused significant fear for many families causing them to avoid venturing out of the house. has outlined some specific ways parents can encourage outdoor play while keeping children safe.

  • Allowing children to build nature sculptures with twigs, leaves, cones, rocks and other things naturally found outdoors can stimulate their creativity and improve fine motor skills. Don’t forget to apply sunscreen before heading out!
  • If you’re able, biking is a wonderful way to get outdoors with the family. Lubbock has several parks that are bike friendly, just be sure each child has a properly fitted helmet
  • Encourage imaginary play by letting children use old pots and utensils to make their own kitchen outdoors and prepare mud pies and mud cakes.
  • A nature scavenger hunt is a great way to continue learning away from the kitchen table. Consider encouraging children to create a nature journal of trees and/or animals they see along the way. They can even do some research on that gorgeous cardinal they spotted! My youngest son loves to collect acorns on our walks, so we have started carrying a Ziplock bag for him to carry them. They can be left in a container outside for the squirrels.
  • Enjoy some ball time outside. Kick the soccer ball back and forth, play catch with a football, softball, tennis ball, etc. You don’t need a net to play volleyball, draw a chalk-line net on the concrete.
  • If you choose to play on outdoor equipment at a park test the temperature first, it may be very hot if it is in the sun. I recommend carrying Clorox wipes to wipe down equipment before and after play.

Outdoor play is very important for children, teens and adults. It improves physical and mental well-being, increases focus and engagement in learning and is a great mood-booster. Any parent of a toddler will tell you if he’s fussy, take him outside! The same is true for children, teens and adults alike.

Tanya Russell MSN, RN, CPNP is now offering pediatric urgent care at Grace Clinic® Mondays-Thursdays 8 am – Noon. Learn more about Tanya Russell or call 806-744-7223 to book an appointment.

Anterior Lumbar Interbody Fusion (ALIF)

Anterior Lumbar Interbody Fusion (ALIF)

By | Nesterenko
Anterior Lumbar Interbody Fusion (ALIF)


Anterior lumbar interbody fusion is a surgical procedure done through the abdomen to remove a diseased intervertebral disc and replace it with a spacer, thus restoring the disc height, decompressing the nerves, correcting deformity and fusing the vertebrae together in the corrected position.  



Three main indications for ALIF:

  • Degenerative disc disease causing disc collapse with compression of the nerves and back pain
  • Spondylolisthesis, which is instability between the spine bones, when two vertebrae shift next to each other
  • Recurrent disc herniation

What are the goals of ALIF?

There are three main goals:

  • Restore height of the disc space and remove pressure from the surrounding nerves
  • Correct alignment of the bones
  • Remove abnormal movement by fusing the bones together


Backpack Safety Awareness Day

National Backpack Awareness Day

By | Nejat

With school back in session the importance of backpack safety should be top of mind. Adults and children need to be aware of the consequences of carrying a backpack incorrectly. There are some basic guidelines to follow when wearing a backpack. Carrying a backpack incorrectly can cause back pain and damage to the spine. The guidelines below will help in preventing damage and pain from occurring.

  • Make sure your child’s backpack weighs no more than 5 to 10 percent of his or her body weight. A heavier backpack will cause your child to bend forward in an attempt to support the weight on his or her back, rather than on the shoulders, by the straps.
  • The backpack should never hang more than four inches below the waistline. A backpack that hangs too low increases the weight on the shoulders, causing your child to lean forward when walking.
  • A backpack with individualized compartments helps in positioning the contents most effectively. Make sure that pointy or bulky objects are packed away from the area that will rest on your child’s back.
  • Bigger is not necessarily better. The more room there is in a backpack, the more your child will carry-and the heavier the backpack will be.
  • Urge your child to wear both shoulder straps. Lugging the backpack around by one strap can cause the disproportionate shift of weight to one side, leading to neck and muscle spasms, as well as low-back pain.
  • Wide, padded straps are very important. Non-padded straps are uncomfortable, and can dig into your child’s shoulders.
  • The shoulder straps should be adjustable so the backpack can be fitted to your child’s body. Straps that are too loose can cause the backpack to dangle uncomfortably and cause spinal misalignment and pain.
  • If the backpack is still too heavy, talk to your child’s teacher. Ask if your child could leave the heaviest books at school, and bring home only lighter hand-out materials or workbooks.
  • Although the use of rollerpacks – or backpacks on wheels – has become popular in recent years, we are now recommending that they be used cautiously and on a limited basis by only those students who are not physically able to carry a backpack. Some school districts have begun banning the use of rollerpacks because they clutter hallways, resulting in dangerous trips and falls.
Polycystic Ovarian Syndrom (PCOS)

PCOS: Metabolic Disorder vs. Gynecological Disorder

By | Devani
Polycystic Ovarian Syndrom (PCOS)

It is likely that you or someone you know has Polycystic Ovarian Syndrome (PCOS), as it is becoming more and more prevalent among women of all ages. In fact, it is estimated that up to 20% of women (1 in 5 women) have this disorder. The sheer mention of PCOS comes hand in hand in the context of challenges that are highly distressing, such as becoming pregnant or having signs of excess male hormones (androgens), producing unwanted hair growth or acne, for instance.

Historically, PCOS was described as mostly a reproductive problem. The first mentions of this syndrome in current medical literature came from Stein and Leventhal, who described the classical triad of polycystic ovaries (or multiple cysts on the ovaries), hirsutism (signs of excess androgens) and oligo-amenorrhea (having too few or no menstrual cycles).

However, as we have made significant strides in understanding this disorder, we are understanding that PCOS is better described as an endocrine or metabolic disorder, and that PCOS is more of a harbinger of endocrine diseases like Type 2 Diabetes and metabolic syndrome, rather than the originating disease itself.

Some now consider insulin resistance as central to the origins of this condition. As a result of insulin resistance, insulin levels rise and sex hormone-binding globulin (SHBG) made by the liver decrease, resulting in an increase in bioavailable, active androgens. Insulin may also increase appetite, contributing to weight gain. This leads to a number of downstream effects, such as metabolic syndrome, nonalcoholic fatty liver disease and sleep apnea. Furthermore, PCOS sufferers are more likely to have depression and anxiety and experience miscarriages or other pregnancy complications.

Unfortunately, PCOS is to this day, highly underdiagnosed.

We are finding that PCOS can present itself clinically in a variety of ways. For instance, while phenotype A has the classical high androgen, low ovulation and polycystic morphology, other phenotypes may not include any one of these criteria. Thus, women with PCOS may endure a variety of symptoms, including, but not limited to:

  • infertility
  • irregular periods, including more frequent periods
  • long lapses between periods
  • acne
  • weight gain
  • unwanted hair on the upper lip, chin, neck, upper chest, abdomen, back, arms and thighs
  • hair loss on the temporal regions of the scalp
  • thinning of hair or hair loss
  • darkening of the skin around the armpits, groin or back of the neck

Further, testing results are highly variable. Testing may include a number of lab tests, such as testosterone levels, thyroid hormone levels, progesterone levels and an oral glucose challenge test; however, it is not necessary to have abnormal results of bloodwork or imaging, like ultrasounds.

That being said, all is not so grim in the world of PCOS. There are real, actionable things a woman can do, in regard to their health. As a physician who strongly believes in a holistic approach, I first encourage all PCOS patients to take their diet and lifestyle into account. Insulin resistance being central to this syndrome, it is important to work at this level.

We know that weight loss can be highly impactful. Shedding as little as 5% of the initial body weight can regulate menstrual cycles and ovulation and potentially even improve SHBG levels. Diet is critical to a holistic approach to PCOS, particularly eating a whole food, non-processed diet. Many foods can contribute to inflammation in the body, and inflammation certainly contributes to insulin resistance. It is important to eat a diet similar to a low-glycemic, Mediterranean diet that is high in fibrous vegetables, high-quality fats, legumes and whole grains. I also work with certain supplements, such as those from the inositol family or bitter melon, when extra help is needed. Lastly, we cannot talk about healthy living without talking about stress. Excess stress leads to increased cortisol levels, which also causes insulin resistance. I work with patients to find their anchor that they can do regularly as their daily exercise to stave off stress.

When all of these fail, we luckily have other options, such as hormonal methods and antiandrogen medications.

The bottom line is that there ARE solutions that work. Speak to your physician about your concerns, and together, find a plan that works best for you.

Vrinda Devani is a board-certified Obstetrician and Gynecologist practicing at Grace Clinic®. Learn more about Dr. Devani or call 806-744-7223 to book an appointment.

Learn more about Dr. Vrinda Devani

Living On Your Own - Grace Gertiatrics

Living On Your Own – Grace Geriatrics

By | Malhotra
Living On Your Own - Grace Gertiatrics

As of July 2017, 12% of the Lubbock county population was over the age of 65 years. This comes out to be almost 36,627 people. A large number of these older people reside in community living settings such as residential homes, assisted living facilities and nursing homes. However, many older people continue to live in their own homes, sometimes facing several challenges.

Challenges of Living at Home

The challenges older people face when living at home could be several. Difficulty in carrying out day to day activities like cleaning the house, transport issues when not driving, difficulty being able to obtain or prepare meals, trouble navigating stairs, struggle getting into tubs to take showers and requiring help getting dressed are some of their daily predicaments. Faced with these troubles, many finally relent against their wishes and give up their homes to go live in a community living place. Sometimes it is a choice made to avoid loneliness and boredom, when their friends and family are living far or pass away.

Transitioning to Community Living

This transition to a community living can be a welcome change for some, where they now enjoy their housekeeping, cooking, and transport needs being taken care of. However, some residents miss the spaciousness of their homes, their neighbours and friends, and the independence and privacy they had in their independent houses. Depression after such a move is a common problem that continues to ail some for years. Living in a community setting is like living in a world of its own. Not only does the outside world start to slowly forget them, but they too get more and more drawn into their new world and new friends, that sooner or later they forget their old lives.

If you are getting older, and some of the above seems inevitable, then there are some things you could do to continue living in your home as long as possible.
  • Enlist the help of your children and grandchildren in assisting you with your needs at home.
  • Seek help from home health agencies in the area, who can send help to your house on an hourly basis for assisting with housekeeping needs, showers, dressing etc
  • Exercise daily to keep yourself functional and fit for longer.
  • Participate regularly in social activities such as church, senior centres, hobby groups.
  • Volunteer or work part-time to increase socialization, and keep mentally active.
  • Use services such as Meals on Wheels if unable to prepare your own meals.
  • Modify your home to avoid stairs, have a walk-in-shower, grab bars, and raised toilet seats.

If leaving your home does become necessary, remember that the transition may be hard, but with time, patience, and preparation you will soon be happy and contented in your new world.

Keya Malhotra is an Internal Medicine and Geriatric physician practicing at Grace Clinic®. Learn more about Dr. Malhotra or call 806-744-7223 to book an appointment.

Learn more about Dr. Keya Malhotra