HER HEALTH: Weighing In On Winter Wellness

Featured Sliders / Health & Fitness / Stories / November 14, 2017


Everyone loves the holidays, but they often come with some baggage – preparing massive feasts for family and friends, stretching the budget for gift shopping and having the house taken over by guests.

Add other wintertime elements like grieving the recent loss of a loved one, depression or contracting the flu, common cold or pneumonia into the mix, and a doctor’s visit will be at the top of the holiday “to-do” list.

SSM Health Medical Group nurse practitioners Jillynn Hull, Julie Miller, Ashley Sandbothe and Kassie Maasen (from left as pictured) deal with a lot of these issues every day, and have shared information, education and preventative measures that help everyone get on the path to better health and wellness, especially during the winter and holiday months.

Find out more information at SSMHealthMidMo.com


HER: With flu season approaching, is there any new information about the flu shot that the public needs to be aware of? Please discuss the flu shot currently available.

Jillynn Hull: The CDC (Center for Disease Control) shows that the 2017-18 flu shot will have two strands of influenza A (H1N1 and H3N2 or the Hong Kong flu virus) and two strands of B, which are in the flu shot this year. A common misconception is it is always the same shot, but it is different every year. They are two years behind … so they are going by serology that was from 2015. It takes that long to isolate and to produce. … Even though they are different strains, the symptoms are the same. Everybody wants to know what strain it is … but, the bottom line is they are sick. Now, we don’t know if you are going to have H1N1 because if we test you for influenza A and you are positive, it could be H1N1 or H3N2. It is still just a viral strain. … It is also recommended that anyone 6 months and older has a flu shot yearly. It used to be for high risk or (those with) respiratory problems, but with the strains now every person should get one. The recent guidelines show for children … 6 months to 8 years old who have not received at least two doses of seasonal flu shots should get two flu shots instead of one.

HER: What flu symptoms are signs an individual should see a healthcare provider?

Kassie Maasen: Influenza symptoms can be similar to a cold, but more severe. Symptoms can include cough, sore throat, nasal drainage/congestion, fatigue, headache, body aches, chills and fever. Those who are high-risk are at increased risk of complications from influenza and should see a doctor if they are experiencing these symptoms.

Julie Miller: A tell-tale sign for influenza is when a patient says, “I started feeling sick at 12:15 on Friday, and it hit me like a ton of bricks.” They know the time and they say, “I hurt all over.” That is influenza.

HER: What are common misconceptions about the flu, the flu shot and wintertime illnesses? 

Hull: My favorite is, I don’t get the flu shot because I don’t get sick.

Ashley Sandbothe: Or, I won’t get the flu shot because it makes me sick.

Hull: Just because you are not going to get a flu shot and say I’ve never been sick or had the flu, you may be right and may not. If you have a sniffle and don’t think you have symptoms you know of, and stand next to someone in the grocery store that has immunocompromised disease processes, just sneezing could get them deathly ill. It is not even that you should get the flu shot for yourself. We, as a community, should all protect each other and keep using those preventive measures.

Sandbothe: Another one is don’t go outside without a coat, you are going to get sick. … That is not going to happen. Flu is caused from a virus, pneumonia is caused by viruses or bacteria. Being cold is not going to give you a virus.

Hull: Another one is that every time they get the flu shot they get the flu. It is not live (or an active virus). That might have been true back in the day … but the shot that we give now is not live, so it is really not possible.

HER: Has there been an increase in pneumonia?

Sandbothe: Pneumonia circulates year-round, it is not seasonal like the flu is. It is a bacteria, most of them are viral. It is a bug that circulates year-round; it doesn’t have to be cold for it. We have been seeing a lot of pneumonia lately.

Hull: People 65 and older should also get their pneumonia shots. There are two different vaccines that we can give people as well. They can get the pneumococcal PCV13 and a year later get the Pneumovax (PPSV23).

HER: What are the best wintertime illness prevention tips can you offer?

Sandbothe: Wash your hands, sneeze into your elbow. … Avoid high prone areas when the flu is very prominent, because you don’t know what somebody else is going to do. There is a reason why those wipes are there; wipe down your cart at Walmart or the grocery store.

Hull: Get plenty of sleep. If you get plenty of sleep at night, your immune system will work better. … I also read a study out of Canada recently that Vitamin D, getting 10,000 units a week … can reduce your risk of the common cold, flu and pneumonia by 40 percent. … Take a multi-vitamin to help combat the cold, flu and pneumonia.


HER: What is seasonal depression and how prevalent is it locally? 

Sandbothe: It is a type of depression that occurs … usually more prominently seen in the winter/fall when our days are shorter and we’re not getting near as much sunshine. Sunlight gives us a lot of different chemicals in our brains; serotonin is the main one. The decrease in sunlight decreases your synthesis for Vitamin D, melatonin and other things that make you feel happy. … It is dark when you leave for work, it is dark when you get home and that just sucks.

Miller: I think depression is very prevalent, whether it is seasonal or not … The statistic that I saw … one in four women in their 40s and 50s are taking some sort of antidepressant, and I would concur with that in what I’ve seen in several years of practice (in mid-Missouri).

Maasen: It will take people years to come see us, they will wait and wait and wait and often they are finally to that breaking point when they see us. Seasonal depression is a real diagnosis, if experiencing symptoms of depression, you should not just brush it off and think it is just the “winter blues” or that you just have to tough it out until winter is over. Don’t wait years, see a health care provider.

HER: What are treatments and methods used at SSM Health? How can a person get help and relief? 

Sandbothe: At SSM, we have certain questions we do for a generalized depression screening. If they score high on that, we will ask a series of other questions. Somebody can score just fine on that and still be depressed. We definitely watch for symptoms as we are talking to them.

Hull: Eye contact is a sign. You can totally tell if something is wrong, especially if you have seen them before. You may not know everything about them and they don’t know everything about you. But when you come back and see me, the last time you were here you were very apt to tell me anything and now you are giving yes and no answers. … We can’t be afraid to ask those questions, and they can’t be afraid to give those answers.

Sandbothe: That is a really important reason you need to establish care with a primary care provider. Don’t just skip around to different urgent cares or ER’s, because those people are not going to know you. You need that not just for anxiety or depression, but for every aspect of your health.

Miller: Our medical records also allow comprehensive care across the SSM continuum. I 100 percent agree with what Ashley just said. I can see a patient for the first time today and know that they have seen Kassie, know what they talked about the last time with Kassie, saw (Dr. Paul Burris) in Urgent Care and went to the emergency department. That does not negate the establishing of the primary care physician. That is the best, but the second best is being able to see a comprehensive medical record, which is a great asset to SSM.

HER: In your professional opinion, what triggers severe grief/depression for individuals who have lost a close loved one around the holiday season?

Sandbothe: I think it is normal for that depression to come up during the holidays or subsequent holidays after losing a loved one. You start thinking of your past holidays, ‘Hey my dad is not going to be here this Christmas.’ You start thinking we are not going to be able to carry on that tradition we’ve done for years; we will have to carry on new traditions but they are not going include him. It is kind of a vicious cycle because your mind recirculates and tries to learn how to cope without that person there.

HER: When should a grieving person seek professional medical help, and what services does SSM Health provide to assist that individual?

Maasen: The majority of grieving people will pass through the stages of grieving without needing professional medical help, but those experiencing serious or long-lasting symptoms of depression should seek professional medical help. This includes, but not limited to, depression that is interfering with one’s daily life, persistent feelings of worthlessness or/and suicidal ideation. 

Hull: The biggest thing is letting them know they are not alone, and they don’t have to go through it alone. That goes with anybody with depression, especially somebody during the holidays that’s grieving. There are so many groups … and different community efforts. It’s about getting them out and seeing there are other people dealing with the same things they are.

Miller: SSM has a behavioral health care continuum. I’m not saying that sadness over the holidays needs an inpatient stay, but we do have continuum of care for behavioral health. All communities are underserved for behavioral health, but we just got a new provider. St. Mary’s is taking great efforts to keep us staffed with psychiatrists, especially when there are not many out there to be had. Depression and anxiety is treated first with cognitive behavior therapy, before any medications. That is the best treatment. (In addition, the SSM Health staff said the health system also sponsors grief seminars during the holiday season, with details available at SSMHealthMidMo.com.)


HER: Food is a big part of holiday celebrations for many Americans. In your own words, what does overeating do to your body physically, particularly for those who have a regular, balanced diet? How can it trigger other long-term medical issues? 

Hull: We do see a lot of people who gain a lot of weight during or after the holidays. They eat more, and when you eat more your blood pressure goes up. Overeating causes fatigue. Your body has to work harder to get rid of the calories. You are putting more stress on your body. … Your body can only compensate so much and work a certain way. When we put more on it, it just doesn’t know what to do.

HER: What are some helpful tips to enjoy holiday feasts while remaining healthy?

Hull: If you are going to have a whole variety of food, take little bits of everything. You don’t have to make four plates; put it on one plate and sample everything. Moderation is key.

Miller: I think the biggest challenge is for people to stay active through the winter months. I am a runner and it’s tough. It is dark, it’s cold and the bed feels so much better. That’s when your body needs it the most. I love to eat, but I exercise to stay healthy. Taste everything, enjoy the holidays, don’t stress about it, but find something that keeps you moving. If I’m going to overeat today, I want to relieve myself of those toxins with a run tomorrow and feel so much better.


(Photo by Mikala Compton) From left, nurse practitioners Jillyn Hull, Ashley Sandbothe, Julie Miller and Kassie Maasen are pictured at SSM Health St. Mary’s Hospital in Jefferson City.

Jillynn Hull, NP-C, is a nurse practitioner at SSM Health Medical Group – Family Medicine at 2511 W. Edgewood, Ste. G in Jefferson City. Originally from Florida, Hull received her associate’s in nursing from Columbia College, a bachelor’s degree in nursing from Central Methodist University in 2010 and a master’s degree from Maryville College in St. Louis, becoming a nurse practitioner in 2015. She lives in Eldon with her husband and three children.

Ashley Sandbothe, FNP, is a nurse practitioner at SSM Health Medical Group – Family Medicine at 140 Northstar in Holts Summit. Growing up in Liberal, Missouri, Sandbothe received her bachelor’s degree in nursing from Missouri Southern State University and master’s degree in nursing from St. Louis University. College is where she met her husband, who is a Taos native and in the active U.S. Army, and the couple has two children. Prior experience for Sandbothe includes working at an orthopedics clinic and in pediatrics.

Julie Miller, DNP, FNP, is a family nurse practitioner at SSM Health Medical Group – Family Medicine at 2511 W. Edgewood, Ste. G, and she works part-time at the SSM Health Medical Group Urgent Care, also on W. Edgewood. Miller was born at the old St. Mary’s Hospital and grew up in California, Missouri. She earned her bachelor’s, master’s and doctorate degrees from the University of Missouri in Columbia, where she recently became an adjunct faculty member. She and her husband have two daughters and live in her hometown.

Kassie Maasen, FNP, is a nurse practitioner at SSM Health Medical Group – Family Medicine at 3527 W. Truman Blvd. in Jefferson City. From Westphalia, Maasen received her associate’s and bachelor’s degrees in nursing from Lincoln University. Maasen has worked at the ICU step-down unit at Capital Region Medical Center, and in surgery, as a circulating nurse and on the open heart team in Illinois. She received her master’s degree in nursing from Maryville College, working at SSM Health for nearly five years and became a nurse practitioner.

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November 14, 2017