Acknowledge what you’ve lost

Dr. Boulos says first- and second-year post-secondary students have missed a lot of the typical high school and college experiences such as sports and clubs, graduation, and frosh activities. This could create some mixed emotions about starting classes this year.

“Recognize that there is some grieving,” says Dr. Boulos. Lack of enthusiasm, boredom, as well as anxiety with starting back in person could indicate there are some feelings that need to be addressed.

“Think about how this year was different. What were the things you feel that you’ve missed, and then when [you’re] able to identify what [you’ve] missed, you can grieve it,” she says. “If you don’t know why you’re feeling like this, it’s hard to grieve.”

Remember what you’ve already been through

The pandemic continues to create a lot of uncertainty for post-secondary students heading into this school year, and that too can create anxiety. But Dr. Boulos says it can be helpful for students to remind themselves that uncertainty isn’t new.

“You’ve already gone through a lot of this uncertainty in the last 17, 18 months. You’ve managed it,” she says, pointing to adjusting to wearing masks in school, learning online, ending high school or starting post-secondary differently than they thought they would.

“Remember, you have rolled with it already, you’ve gone through these things, and you will adapt,” she says. “You know that it’s possible.”

Set expectations

Students can manage their anxiety around uncertainty by focusing on what they can control, Dr. Boulos says. She suggests, for example, setting expectations with roommates beforehand, and if you’ll be far away from your support system of family and friends, making plans ahead of time on how you’ll stay in touch. It’s also important to establish routines for exercise and sleep.

“Those things [you] can control. Everyone is going to be having uncertainty, so what you do is you work with what you can control,” Dr. Boulos says.

Anxiety in social situations

She also says there will be students who are facing social anxiety as they go back to in-person classes, and possibly events, for the first time in two years.

“Social anxiety’s going to be there, that’s to be expected,” she says.

She suggests students struggling with social anxiety focus on “gradual, repeated exposure.” Start small and build up. For example, if you have a social activity, you could attend for a short period of time. You can leave if it becomes overwhelming, but it’s important to keep trying.

“You can always go back to your residence. But then, try it again,” she says. “If you start avoiding, it may get worse.”

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In his early elementary school years Andrew’s performance had been okay, though never stellar. In retrospect, he probably cruised because he was smart, the demands were low and the structure and supervision were high. In higher grades, teachers expected him to be more self-directed. Testing in Grade 3 had found him to be in the gifted range of intellectual functioning. This only made the problem feel worse in later years – he was underachieving terribly relative to his potential, just coasting along aimlessly, a sad waste of natural talent in his parents’ eyes.

It’s not that he had no intellectual interests at all. He would briefly become excited about a topic beyond the school curriculum – like the time he had watched a Steven Hawking documentary on the Discovery Channel, or when his family went on a tour of WWI battlefields in France. He would start to read up on science or history, but he would quickly lose interest. He seemed perpetually bored, lazy and lacking persistence, focus or self-discipline. He could not apply himself to long-term goals involving delayed rewards. He had recently become a fairly regular marijuana user, but probably not heavy enough to really account for his lack of motivation, and the lack of motivation had long predated this habit.

In my assessment of Andrew, he did not have enough specific and persisting depressive symptoms to meet criteria for a Major Depressive Disorder. Besides, there was no clear onset or change from his usual baseline. Rather, he seemed to have just slowly drifted into a state of increasing aimlessness and low motivation over a period of years. He did not feel a sense of hopelessness or profound pointlessness about his life and the future, but neither could he see any clear purpose for himself in life. He lacked any career goals, let alone ambition.

One thing stood out in my questioning of Andrew and his parents: he had a short attention span – especially for tasks requiring sustained effortful focus. He had a longstanding frequent tendency to zone out in class and to be more easily distracted compared with most of his peers.  He would quickly become bored and restless. His parents had been aware of this, but they had always assumed that his lack of focus was the result of his lack of interest and motivation, rather than the other way round. He also lacked organizational systems for his work, despite his parents’ attempts to help him set these up. And his time management was atrocious.

Andrew had many of the typical characteristics of Attention Deficit Disorder. ADD is a diagnosis applied to children or adults with very short attention spans. It also involves relative deficits of what is referred to as executive functioning, or cognitive control (simply put: the ability to control one’s thoughts and actions – the basis of ‘will power’; these higher mental functions are closely related to, and to some degree dependent on, the ability to focus). Attention and motivation are integrally linked and mutually dependent, but it is often the case that attention is the more primary and fundamental function, influencing motivation.

Needless to say, there are very many possible explanations for lack of motivation. ADD is just one of them, albeit a fairly common one. Unfortunately and obviously, psychiatric assessment and treatment is not the answer for all unmotivated teens.

ADD is common. If we include slightly milder cases, about 5–10 per cent of the population have these characteristics. Think of ADD as one end of a normal continuum rather than a true disorder in a category distinct from normality. It’s just the way some people are—it’s part of who they are, not a ‘thing’ that they have or an illness they are afflicted by. As with most psychiatric disorders, the line separating a disorder from normality is determined (imprecisely) by the particular trait/s causing significant impairment of functioning in relation to the demands of the individual’s environment. There are evolutionary reasons for this diversity of traits in a population. Our modern environment tends to favour people who are focused, so these otherwise normal traits can be a liability in many settings.

The brains of people with ADD traits can in a sense be thought of as less internally stimulated than average brains – their brains require higher levels of external stimulation to engage them. So these people find unstimulating activities that require patient mental effort to be completely unengaging and intolerably boring. They need activities that are more stimulating, exciting, rewarding, novel or varying (video games are designed to meet these criteria). These relatively ‘under-stimulated’ brains are thought to have lower activity levels of the neurotransmitter dopamine. Dopamine plays a central role in attention and reinforcement of behaviour. When dopamine is activated in our brains by a particular stimulus or action, it is nature’s way of ‘telling’ us that something is important or good for us—it marks a stimulus as salient (noteworthy) and it reinforces an action so that it is more likely to be repeated. Dopamine activation thereby directs our attention and motivates us to persist in a behaviour. Medications that improve attention are called stimulants (caffeine is in this category). They increase dopamine activation, among other chemical effects.

I spoke with Andrew and his parents about strategies for reducing distraction, optimizing focus, improving organization, and leveraging incentives to increase his motivation. We discussed medication as an additional option, with a careful discussion of the pros and cons (side effects, risks). I was careful to emphasize that medications don’t work for everyone. Some people understandably have reservations about medications for ADD, but Andrew’s parents, being doctors, were quite interested in considering the medication options, and Andrew was willing to give it a try.

I started him on an attention stimulant medication, which he could take on days when he needed to be focused and motivated. Fortunately, he had an excellent response to the drug, and no side effects. He found school much more interesting and engaging when he was on the medication, and was much more persistent and productive on those days. He said he felt on those days like his attention “locked onto” the task at hand, and he felt a strong urge to keep doing whatever he was busy with. He even felt annoyed if he was interrupted from his task. He didn’t take the medication on days when he didn’t need to concentrate as much, because he didn’t want to feel so intense all the time.

Andrew’s marks improved impressively over the next few months. This greatly boosted his morale and his motivation more generally. There was some spill-over effect of his motivation in that he tried harder to apply himself to his work even on days when he was not on the medication, but his focus was consistently better on the days when he was on it.

I have followed Andrew for several years now. He still loves playing video games, and he still gets to bed too late at night (smoking a joint – just one, he assures me – “to settle my mind and help me sleep”). But he is close to completing a tough degree in engineering, and he is now well on the way toward achieving the clear, attainable long term career goals that he has set for himself.

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Daphna Steinberg, registered dietitian, has some tips for back-to-school lunches that are nutritious and delicious.

Think outside of the two slices of bread

Does your kid like to graze rather than eat a sandwich everyday? Pack a bento box style lunch of veggies and hummus or white bean dip, cheese and crackers and a fruit salad. Throw in some edamame, soy nuts or pumpkin seeds.

Pack some protein

Your child needs protein to keep going throughout the school day. Meat, mini cans of tuna or other fish, eggs and cottage cheese are good sources of protein. Baked chickpeas pack a crunch and some protein.

Get a good Thermos

Pack a Thermos with leftovers from last night’s dinner: soups, chilis, pasta make great Thermos leftovers.

Reimagine leftovers

If you’ve got leftover chicken, cut it up and add it to a salad (put the salad dressing on the bottom of the container, put in hard veggies like red peppers and mini tomatoes then add the lettuce so it doesn’t get soggy). Or, cook up some extra pasta noodles during dinnertime and turn them into a Greek pasta salad with tomatoes, cucumbers, feta cheese and olives, with a little olive oil and vinegar dressing. If you child doesn’t mind eating the same thing a few days in a row, you can make a big batch of pasta salad and keep it in the fridge for up to 3 days.

Spice up your sandwiches

Forget the bread and jam. Try something new and exciting. Sprouts (wash them really well), herbs or hummus can help liven up a boring old sandwich.

Don’t forget an ice pack, and a water bottle or milk. Be sure to double-check the no-good foods for your child’s classroom. (And remember, adults can take a bagged lunch too, and these ideas can work for us as well!)

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Family physician Dr. Sharon Domb says it’s not too early to start thinking about easing the transition back to school for your children to ensure you are both ready to face the new year. “There are some things we can do to help set our kids and teens up for success,” she says.

Check on vaccines

Be sure your child’s vaccinations are up-to-date (even teens as they go off to college). You can find a list of vaccinations on Toronto Public Health.

Sometimes it’s hard to keep track of who got vaccinated and when, as vaccines are given in multiple places – at the doctor’s office, at school by public health nurses (in grades 7 and 8), and sometimes at travel or other clinics. The family doctor does not receive a record of those done outside of the office, so it’s up to you to keep track. If grade 7/8 vaccines have been missed, you can visit a Public Health clinic to receive them free of charge. In addition to the routine vaccines, you may want to discuss additional optional vaccines with your physician.

Get eyes checked

It’s important to have your child’s eyes checked by an eye doctor when they are starting school. Your child may not realize they aren’t seeing distances far away until they have to stare at the chalkboard (or Smart board).

Watch your back

It seems like kids and teens are staying the same, but backpacks get bigger and bigger! Is there a way to reduce what’s in that sack to help avoid injury or pain? Here are some tips for choosing a backpack.

Revisit eating and exercise

It’s a great time of year to check in on your eating and exercise habits, Dr. Domb says. Talk to your children about healthy eating choices, and involve them in planning school lunches and after-school snacks. Get your child involved in making the lunches too. Check Canada’s Food Guide and make sure your child is getting the recommended nutrients. If you think your child is having trouble getting those nutrients, whether due to a modified diet, pickiness or low appetite, speak to your family doctor. Talk with your child about being active and help find activities they enjoy (not everyone likes team sports. Is there another physical activity your child enjoys?)

Set new rules and limits

September is a good month to check in on family rules and limits. Is your child now old enough to get added responsibilities, like emptying the dishwasher or making lunches? Screen time and bedtimes sometimes change over the summer – is it time to reset TV and video game limits? Is the summertime bedtime OK to keep up through the school year, or should your kid or teen hit the hay a little earlier now that school is starting?

Lessons learned?

Reflect on last year. Were there issues at school that should be addressed before a new school year begins? Did your child struggle academically? Were there behavioural issues that should be dealt with? Make an appointment with your child’s school if there are unaddressed issues so that you can touch base with them early in the school year and set your child up for success. Does your child struggle socially? Take some time before school starts to talk about strategies he/she can try this year.

Happy Back-to-School! Do you have any other yearly routines to help you get ready?

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1) Protect your skin

Heading to a patio for a long lunch or mid-afternoon drinks? It’s actually the most important time of day to pay attention to your sun exposure. The sun causes the most harm to the skin when it’s overhead, from 11 a.m. to 3 p.m. between April and September in Canada. At those times, the sun’s rays travel through less atmosphere, making them especially intense.

To be safe, seek shade, avoid direct sunlight during peak UV periods and wear a broad-spectrum sunscreen. An SPF 30 will protect you from about 97% of harmful UV rays. Just make sure you apply enough. You’ll need about a shot glass full to cover your body adequately.

2) Keep your eyes safe

The sun poses a significant risk to the eyes even when it’s low in the sky. In fact, the lower angle gives the sun’s rays a direct pathway into the eyeball. Think of how hard it is to drive on the highway when you’re heading into the rising or setting sun. Furthermore, UV rays can penetrate clouds and reflect off many different surfaces such as snow, sand and water.

Research has shown that to protect your eyes, you should be wearing sunglasses, day-long, year-round and even when it’s cloudy. The best protection is provided by close fitting, wrap-around sunglasses that also block sunlight from the sides. When you’re picking sunglasses, you will want to find a pair that shields against both UV rays and blue light. Wearing a wide-brimmed hat also helps to keep the sun out of the eyes.

3) Stay hydrated

Dehydration can cause a variety of problems from simple thirst to low blood pressure and increased heart rate. At extremes, dehydration can affect your kidneys, which can be dangerous. Water or other calorie free drinks are the best choices if you are trying stay hydrated. Make sure your water glass is replenished often, to remind yourself to keep drinking it.

If you’re planning on drinking alcoholic beverages, it’s recommended that women drink no more than 3 drinks on a single occasion, and that men drink no more than 4 drinks. Following these guidelines will reduce your risk of injury or harm. And if you do drink, arrange for a safe way to get home- don’t get behind the wheel.

4) Pass on the chicken fingers and fries

If you’re heading to a patio, you’re probably going to end up ordering something to eat. Don’t starve yourself all day- have a healthy snack low in sugar and fat before you arrive at the restaurant to avoid overeating. And when it comes to choosing something from the menu, avoid ordering high fat, fried or greasy foods.

5) Clean your hands

Make sure to clean your hands before eating, drinking, or preparing food, and after using the washroom or touching high traffic surfaces like doorknobs. If you can get to a sink, use warm water and rub the soap in your hands for at least 15 seconds. Using very hot or very cold water makes it less likely that you’ll wash your hands for long enough. Remember, the action of rubbing soap on your hands is what lifts dirt and bacteria off your hands, which is then rinsed away by the water. You’re not going to ‘kill’ any bacteria by using scalding hot water to wash your hands!

If you can’t get to a sink with running water and soap, use an alcohol-based hand sanitizer instead. You’ll still need to rub the sanitizer into your hands for 15 seconds to ensure your hands are properly cleaned.

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Joanne Dorion, a physiotherapist in Sunnybrook’s Occupational Health & Safety Department, has seen many injuries that develop over time from poor desk setup and posture. “We frequently see people with forearm pain including tennis elbow, when the muscles on the back of the forearm are strained from poor hand and wrist positioning on the keyboard. Shoulder and rotator cuff injuries are also common, which can be caused over time by holding your arms too far out to the side and forward while typing,” says Dorion.

Dorion has seven easy adjustments you can make to your workspace to make it as comfortable (and safe) as possible:

Raise or lower your keyboard tray

When you’re typing, your elbows should have an L-shaped (90 degree) bend and be at the same height as the keyboard. “Your arms and elbows should be by your side, with your arms bent at about 90 degrees and with straight wrists,” says Dorion. Don’t have a keyboard tray? Raise or lower your chair instead to allow your arms to naturally settle into a 90 degree position.

Keep your feet flat on the ground

If they aren’t, use a footrest, or grab a box or phonebook

Pull your keyboard toward you

Your keyboard should be close to the edge of your desk. “Doing this will naturally bring your posture in to a good position,” says Dorion.

Mind the position of your mouse

The mouse should be placed next to (and at the same height as) the keyboard

Adjust the height of your monitor

Your eyes should be in line with the top one-third of your computer monitor. “This will help to keep you sitting tall in your chair,” says Dorion

Get your monitor distance just right

The screen should be about one arm’s length (40-74 cm) away. If it’s too close, you’ll strain your eyes; too far, and you’ll bend forward, affecting your posture. “Poking your chin out puts a lot of strain on your neck,” says Dorion

Pay attention to your back and shoulders

Your back should be well supported, and your shoulders should be relaxed at all times

What if you spend most of your time on a laptop? Laptops are tricky because the screen and keyboard are close together, so you can’t get into a proper position. Dorion recommends changing the positioning of your laptop often, so as not to spend too long in one position. Type with the laptop near the edge of the table, which is better for the arms and wrists. While keeping the laptop further away is easier on your eyes, it is very hard on your arms and neck. “If you find your eyes fatiguing, look away from the screen on a regular basis to let the eyes rest,” says Dorion. If using a laptop away from a desk, prop it up on your lap with cushions to reduce the strain on the neck.

An even better solution to the laptop problem? If you can’t get a separate monitor, “get yourself a wireless keyboard and mouse. It will make a huge difference,” says Dorion.

After making the adjustments listed above, even if you do find a very comfortable position, it’s not a good idea to stay like that all day. “Change your position often, do some gentle stretches for tense muscles and take short breaks to stand up and walk around, “says Dorion.

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Yes, it could be.

Texting thumb is also known as ‘Gamer’s thumb’ or by its technical term “DeQuervain’s syndrome.”

There have been increased incidences of this thumb issue noted with use of smart phones and computerized hand held games. A recent study in the American Journal of Physical Medicine and Rehabilitation found that increased texting led to an increased rate of issues with the thumbs, especially on the dominant side.

It occurs when two tendons on the back of the thumb and near the wrist become inflamed and the tissue starts to thicken. Over time, this gets worse and causes pain with movement and gripping. Eventually, movement and strength become limited.

So what can you do to prevent texting thumb?

• Ice 5-10 minutes and rest after a lot of texting, emailing or gaming.
• Use voice activated texting and emailing to rest the thumbs.
• Alternate by using index fingers to carry out the tasks.
• You may require a resting splint and some therapy to help reduce inflammation and increase range of motion and strength. Talk to a therapist or your health care provider.

Other health conditions can cause sore thumbs – speak to your health-care provider for a proper diagnosis.

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To the healthy individual, the term “flu season” may sound abstract, perhaps irrelevant. But the flu, or influenza, kills about 3500 Canadians every year, and causes about 12,200 of us to be hospitalized due to the illness itself or related complications.

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1. Use a supportive chair when sitting for an extended period of time. Sit with your back firmly against the chair
2. If reading from a textbook on a table, it’s helpful to have it propped up. Prop it on another book, so that the neck doesn’t have to bend as much
3. Take frequent breaks. Even the most ideal position should be changed periodically. This is especially important when using the computer (desk top or laptop) or mobile device.
4. When using tablet for prolonged periods, try to have it supported on something, for instance a tablet stand. If using it away from desk and seated, use some cushions on your lap to support your arms.
5. Stretch muscles that are getting sore or cramped from prolonged positions or repetitive computer work. Take a few deep breaths and then try the following stretches:

• Roll shoulders forward and back;
• Turn neck from side to side;
• Bend and straighten wrist; open and close the hand.

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