wellness – Tarrant County Physician Online

The Winter Blues

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the March/April 2026 issue of Tarrant County Physician.

As I was first writing this article, we were facing our usual “once a winter” storm with freezing temperatures, snow, and ice. Despite our best preparations, Texas just does not have the infrastructure to maintain business as usual during significant winter storms. Honestly, up to this point, it seemed like a pretty mild winter. And then the front came through with howling winds, record low temperatures, freezing rain that turned to sleet, and barely any snow, though some did fall. People stayed indoors in the warmth, but many I am sure enjoyed some “winter sports” with sledding on trash can lids and attempts to build snowmen.

However, it didn’t take long before people started feeling cooped up and wanting to get out. Thanks to telehealth, my clinic was able to provide care for patients during the following week while we awaited sunnier days and above-freezing temperatures. Patients were already mentioning that they felt a dip in their mood and lower motivation. Friends, family, and acquaintances over the years have sometimes mentioned things like this when the winter sets in. It happens only now and again, when people may want to stay home but still are interested in their usual activities. This is not seasonal affective disorder, a serious variant of clinical depression that often requires professional treatment. This is a fairly well-known phenomenon called “winter blues.” NIH-funded researchers have been studying both of these conditions for decades.

Patients were . . . mentioning that they felt a dip in their mood and lower motivation. Friends, family, and acquaintances over the years have sometimes mentioned things like this when the winter sets it. . . . This is a fairly well-known phenomenon called “winter blues.”

The winter blues tend to occur in colder and more northern (or southern if south of the equator) areas because it is a reaction to reduced sunlight and the changes of the season. Yet it can happen anywhere when the weather turns “dark and dreary.” According to the University of California-Davis Health, people still continue to function while experiencing a mood dip, minimal sadness, fatigue, and less motivation.¹ These feelings are usually mild and temporary, which is different from seasonal affective disorder. According to Dr. Matthew Rudorfer, an NIH mental health expert, the winter blues can be linked to something specific, like holiday stress or loss.²

What should we do or recommend if we or those around us have the snowy doldrums? It may seem obvious, but simple things like getting outside (dress appropriately!), opening your blinds/curtains for more ambient light, being social, and getting physical (the Jane Fonda kind, not the Mike Tyson kind) are all ways to get past this. The kids have it right—go sledding, have snowball fights, make a snow (or ice) man . . . and enjoy some hot cocoa when it’s time to relax. Because the seasons always change, and spring is on the way! Well, technically, in Texas, it’s already here.

References:

UC Davis Health, “Seasonal Affective Disorder, Winter Blues and Self-Care Tips to Get Ahead of Symptoms,” Cultivating Health (UC Davis Health Blog), November 29, 2023, https://health.ucdavis.edu/blog/cultivating-health/seasonal-affective-disorder-winter-blues-and-self-care-tips-to-get-ahead-of-symptoms/2023/11.
“Beating the Winter Blues,” NIH News in Health, January 2013, https://newsinhealth.nih.gov/2013/01/beating-winter-blues.

TCMS Committees and Programs Review: Find Your Passion and Join Us in Making a Difference in Medicine

Feature Article

By TCMS Staff

This article was originally published in the January/February 2026 issue of Tarrant County Physician.

There are a variety of reasons that doctors choose to join TCMS; usually, new members will point to one defining thing that encouraged them to get involved. Perhaps they view our advocacy as critical, or they believe that we provide important networking opportunities. Maybe they wanted help with billing or more extensive chances for leadership roles. But whatever reason brought them here, when doctors choose to actively participate in the society, they find there are many more reasons to be part of TCMS than the one that drew them in the first place.

So here is our committees and programs review, your chance to learn of the opportunities that lie before you. We have a number of specialty committees and programs you can participate in, and we encourage you to join the one you find most compelling to use it as a springboard for upping your impact on medicine.

Allied Health Scholarship Committee
TCMS and its members, in partnership with TCMS Alliance, have an exciting opportunity to support the education access of allied health students through the Allied Health Scholarship Committee. This committee awards scholarships to qualified undergraduate students in Tarrant County who are actively enrolled in allied health training programs. It meets three times a year to discuss the applications received, choose the preliminary interviewers, interview the chosen candidates, and then decide on what amount is given to each final scholarship recipient. A student is also chosen to receive the Murphy Award—the largest monetary amount of all the scholarships offered—named after the donor, James A. Murphy, MD.

In 2025, the committee awarded $49,400 to students based on financial need and scholastic achievement. This was divided between 17 students from four different Tarrant County colleges and universities—all of whom we believe will make a big impact on the patients of Tarrant County with their future careers! We look forward to 2026 and the opportunity to meet and connect with even more schools, shaping the future for allied health students in our county. To get involved or get more information, contact Melody Briggs at mbriggs@tcms.org.

Board of Advisors
Each month, our executive committee meets to discuss the highlights of the healthcare community, the progress on TCMS projects, and goals for the future. When you participate with the Board of Advisors, you have a chance to get a full picture of TCMS and its role in Tarrant County, including its partnership with public health, emergency services, medical schools, residency training programs, charitable organizations, and local community leaders. This gives you a front-row seat in the efforts made to advocate on behalf of physicians
This monthly gathering is open to member physicians, residents, students, and other healthcare personnel. For more information on attending, email Melody Briggs at mbriggs@tcms.org.

Ethics Consortium
The Ethics Consortium meets monthly and is a diverse, non-partisan group of people interested in healthcare and ethics. Its mission is to improve the health and well-being of the diverse communities that make up North Texas by assisting in the application of ethical values to current healthcare issues through educational programming and advocacy efforts that encourage civil conversation and dialogue.

Healthcare in a Civil Society is an annual forum that seeks to engage leaders of varying perspectives in a civil conversation that focuses on the healthcare issues that are important to our community and is devoid of the rhetoric that often undermines these conversations in the media. This year’s event focuses on caring for the whole patient and takes a close look at where spirituality and the delivery of care intersect. The event will include a breakout session for audience participation and engagement and a panel discussion featuring leaders from various sectors to further the conversation. If you are interested in joining or would like more information on the Ethics Consortium, call TCMS at (817) 732-2825.

Legislative Committee
The Legislative Committee works to build the critical relationships necessary for effective medical advocacy. Though the committee certainly participates in the First Tuesdays at the Capitol events during the legislative session, it is also committed to fostering relationships with legislators and educating them on the issues year-round. In addition, for physicians who would like to get involved but feel unsure about talking to legislators themselves, it’s a great opportunity to build the knowledge and skillset to be a powerful advocate on behalf of your patients and your practice. You are surrounded by expert advocates! Members of the committee also make up a ready response team for issues that may arise between sessions, allowing TCMS to quickly navigate legislative challenges. For more information about the Legislative Committee and its goals, contact Brian Swift at bswift@tcms.org.

Committee on Physician Health and Wellness
The TCMS Committee on Physician Health and Wellness (PHW) promotes the health and well-being of physicians, recognizing that physicians are at least as vulnerable, if not more, to issues of substance abuse (including alcoholism) and mental disorders as their patients. The committee supports the early recognition, evaluation, and treatment of physicians with these conditions, and their monitored recovery. As part of this, the committee supports the work and activities of the Texas Physician Health Program and the Texas Medical Board.
The function of the PHW Committee is three-fold: 1) to promote physician health and well-being; 2) to ensure safe patient care by identifying physicians who may have potentially impairing conditions; and 3) to advocate for physicians while maintaining confidentiality and the highest ethical standards.

As advocates, the committee members help with interventions, referrals for evaluation and treatment, if necessary, and monitor attendees upon their return from treatment. It supports widespread education for physicians, family members, and support staff regarding possible impairments.

Through the TMA PHW Assistance Fund, financial assistance is available to physicians who cannot afford treatment for depression, chemical dependency, or other problems or whose families need short-term living expenses while a physician receives treatment. Donations to the fund are appreciated and are tax-deductible.

Our local committee consists of physicians who have special interest and experience in supporting those who are struggling, and it is available to consult with individuals and institutions locally that have questions or problems in this area. For more information about how you can participate or receive assistance, contact Kathryn Keaton at kkeaton@tcms.org.

Project Access Tarrant County
Project Access was formed in 2011 to facilitate surgical and specialty care to low-income, uninsured residents of Tarrant County who do not qualify for county or other resources. Since then, PATC has coordinated over $22 million in donated healthcare services, helping thousands of patients access life-changing and life-saving treatment.

Physician volunteers partner with PATC by seeing a limited number of patients in the comfort of their own office and in the course of their normal clinic day. Volunteers determine how many patients they are able to accept each year, and surgery is scheduled at facilities where volunteers have existing privileges. All care coordination including hospital and ancillary services is provided by Project Access staff so the physicians can focus on providing care.

PATC’s highest areas of need are general surgery, breast surgery, gynecology, orthopedic surgery (hips and knees), and pulmonology; although all specialties are always welcome. By volunteering with PATC, physicians play a critical role in improving health outcomes for patients who would otherwise go without care, while strengthening the health and well-being of our local community.
You are invited to learn more about how your expertise can make a meaningful difference—on your terms, within your existing practice, and with full support from the experienced PATC team. To learn more, contact Kathryn Keaton at kkeaton@tcms.org.

Publications Committee
The Publications Committee meets bimonthly to review submissions for TCMS’s journal, the Tarrant County Physician. All TCMS members are welcome to submit articles for consideration. The committee is devoted to selecting content that is meaningful to our readers—the medical community throughout Tarrant County.

We are incredibly grateful not only for our bimonthly authors, but also for those who write feature articles. From topics spanning the practice of medicine and legislative issues to anecdotes about historical figures and unique excursions, many TCMS members have shared their interests through articles that were published in the journal. The committee members give a resounding “Thank you!” to all contributors, and they have two requests: send in more submissions and consider joining the committee. The only way the journal can successfully represent all TCMS physicians is if members from different backgrounds and experiences write about the things that are meaningful to them, and joining the team that reviews content allows you to augment the voice of your fellow physicians in a powerful way. If you are interested in joining the Publications Committee or submitting an article for review, please contact Allison Hunter at editor@tcms.org.

Women in Medicine Committee
The TCMS Women in Medicine Committee’s goal is to promote networking and collegiality and present ideas and solutions for issues specifically affecting female physicians in Tarrant County. Now several years into its formation, the committee’s events have provided platforms for empowering and educational speakers, round tables, and CMEs. And from time to time, mixers, soap making, and yoga have made the itinerary! To join the think-tank behind these events, contact Brian Swift at bswift@tcms.org.

We hope you found one or more groups that grabbed your attention. And if you’re still unsure, don’t worry! Click this link, mark the topics you find interesting, and we will send you more information about committees or programs where you can make a difference doing the things you care about.

The Last Word

Lifestyle Modifications

By Hujefa Vora, MD, Publications Committee Chair

This article was originally published in the September/October 2025 issue of Tarrant County Physician.

With your annual physical last week, we drew annual labs. We’ve got to discuss these results today. Your cholesterols need better control. Your total cholesterol is greater than 200 mg/dL, but to really understand these results, we’ve got to look at the breakdown. Your HDL, your “good” cholesterol, should be higher than 40 mg/dL. It looks like we have some work to do on this.

No, you don’t need to increase your cholesterol intake. To raise your HDL level, you need to increase your aerobic exercise. You need to make some lifestyle modifications. Your LDL, your “bad” cholesterol, is markedly elevated, and this is not a good thing. This combination of low HDL and high LDL can dramatically increase your risk for cardiovascular disease. I want to finish reviewing these lab reports, and then we will take a few minutes to circle back to this issue. Let’s see here. Your kidney and liver function tests are normal. Your fasting blood sugar is a little higher than expected. Your blood counts, red blood cells, white blood cells, platelets—all look good, which means your inner factory is working. The implication here is that your nutritional status is good. Your body has all of the raw materials it needs to produce all of these cell lines. Your thyroid appears to be functioning at normal levels. Finally, and most importantly, there is the matter of your glycosylated hemoglobin level. This has nothing to do with the blood counts and hemoglobin we reviewed earlier. It is actually also called hemoglobin A1c. This is a measure of your average blood sugar level over the past three months. And your A1c is just a tad on the higher side here. The World Health Organization defines diabetes as an A1c of 6.5 percent or greater. Your numbers landed in the prediabetes range. So now we’ve really got some more issues to talk about.

Alright, no time to panic. I want us to relax and really understand what it is we are talking about here. Prediabetes is like a warning shot. Your body is telling us that if we don’t take action in the here and now, then you are at significant risk of developing diabetes.

No, you are not diabetic. I understand that you feel fine, that you don’t feel diabetic. The thought I want to stress to you is that this is a preventative visit. Our goal is to prevent the complications of low HDL, high LDL, and borderline hemoglobin A1c. Those complications include heart attacks, strokes, kidney disease, vision disturbances, all ultimately negatively affecting your quality of life, possibly even your quantity of life.

No, these levels are not fatal, but if we let these things go long enough without addressing their root cause, the complications can be detrimental to your overall health. The most effective ways to lower your risk of developing diabetes when you are prediabetic are by losing weight, increasing physical activity, and eating a healthy, well-balanced diet. I don’t expect you to go out and run a marathon (although that would be amazing!) but rather just make some modest lifestyle modifications. If you are able to effectively make lifestyle modifications, then we may be able to avoid full-blown diabetes. We may not necessarily need to prescribe medications right off. Lifestyle modifications most certainly can help to decrease your risk of heart attacks and strokes.

Lifestyle modifications. That’s a buzzword that we talk about in our offices all the time. I’m going to give you some food for thought at this point. Lose excess weight. For people who are overweight, losing just 5 percent to 7 percent of your body weight can reduce your risk of developing type 2 diabetes by over 50 percent.¹ Increase physical activity. The CDC recommends getting at least 150 minutes of moderate-intensity aerobic exercise per week.² This can include activities like brisk walking, cycling, or water aerobics. Regular exercise helps your body use insulin more effectively. Combine cardio with strength training. Incorporating strength training for all major muscle groups at least two days a week further improves insulin sensitivity and glycemic control.² Quit smoking. Smoking can increase insulin resistance, making it harder for your body to manage blood sugar. Get enough sleep. Poor sleep is linked to insulin resistance and weight gain. Aim for seven to nine hours of quality sleep per night. Manage stress. Chronic stress can increase blood sugar levels. Find healthy ways to cope, such as meditation, yoga, or deep breathing exercises.

Lifestyle modifications also include making dietary changes. Focus on whole foods. Emphasize a balanced diet rich in vegetables, fruits, whole grains, and lean proteins and low in saturated and trans fats. Choose high-fiber foods. Fiber-rich foods, such as vegetables, fruits, and whole grains, slow down digestion and prevent rapid blood sugar spikes. Limit refined carbohydrates, processed foods, and added sugars. Avoid or limit sugary drinks, processed foods, and refined carbohydrates like white bread and pasta, which can cause blood sugar levels to spike. Drink more water. Water is the best choice for hydration and helps to maintain healthy blood glucose levels.

In the American medical system, we don’t emphasize preventative medicine as much as we emphasize reactionary medicine. We are taught to take care of the problems, treat the complications of underlying symptom-free subclinical metabolic issues. As primary care physicians, our role is to work to prevent disease, keeping you healthy so as to avoid illness. Most of what I discuss with my patients in clinic was not given to me through books in medical school but rather acquired through years of experiential learning, caring for the healthy, and teaching them to avoid disease. Lifestyle modifications don’t always get into our medicine textbooks but they should. The point of my diatribe today? Make sure that all of you are going to see your primary care physicians. Make sure that you are taking care of your health, so that all of us can better understand and serve our patients. My name is Hujefa Vora, MD, and this is my Last Word.

References:

“Diabetes Prevention: 5 Tips for Taking Control,” Mayo Clinic, March 12, 2025, https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639.
U.S. Afsheen Syeda et al., “The Importance of Exercise for Glycemic Control in Type 2 Diabetes,” American Journal of Medicine Open 9 (June 2023): 100031, https://doi.org/10.1016/j.ajmo.2023.100031.

The Poison, the Clouds, and the Clearing: Mindfulness in Medicine

BY SETU SHIROYA, MS-II TCU , WITH NEHA SOOGOOR, MS-II TCU; EDITED BY JAYESH SHARMA, MS-II TCU

Breathe in. Breathe out.

It is my first day in the clinic. My heart is racing in my white coat that I have little confidence wearing. My anxiety skyrockets, as do my feelings of not belonging.

What if my attending doesn’t like me? What if I make a mistake? What if my patient starts crying? How do I do a lung auscultation again? What does losartan do?

I can’t remember. I can’t think.

Breathe in. Breathe out.

I have been studying the whole day, my career-defining board exam is in one week, my head is throbbing, my eyelids are drooping. I am clicking through flashcards but nothing sticks. The days are merging into one; someone asked me for the day of the week, and I came up blank.

Breathe in. Breathe out. Breathe in. Breathe out.

Only one year into medical school, and everything feels like a dream. I’ve made it so far, yet the future seems so daunting. I love my life but also fear it at the same time. I want to keep going. I’m excited, but I’m nervous. Where am I in my life? Do I even belong here? Am I the only one thinking this?

Breathe in. Breathe out.

I say it to myself over and over again—my thoughts have been spiraling for days. I need to breathe. I need to calm down.

Breathe in. Breathe out.

I do belong here. I’ve made it so far in this journey; the hard work, the endless hours were not in vain. There is so much more to go and I remind myself that I am excited. I just need to take it one step at a time.

Breathe in. Breathe out.

I am going to be present for patients. I will be a doctor. One step at a time.

Breathe in. Breathe out.

The rampaging thoughts settle, my mind clears, and I open my eyes.

It’s going to be okay.

The morning alarm rings, and my first thought is always the same: “Can I sleep for five more minutes and not think about the long day ahead?” I have stressful exams to take and sometimes dread the workload awaiting me. It feels like the only quiet time I get is in the morning, when I am drinking coffee, working out, or just embracing the quietness. I try to find time to relax, but burnout feels like it is always looming over my shoulder. However, mindfulness and meditation have helped me reorient myself and develop a healthy way to process these feelings.

What does it truly mean to be mindful? To me, mindfulness is staying grounded to what is in the present moment. It can be easy to think of the past or try to anticipate the future. However, the only inevitability we hold is this present moment. Not a second before, not a second after.

How can we practice this? Mindfulness comes in many forms; some find relief in running or weightlifting, making it a point to have a constant regimen at the gym. Others find it through meditation, focusing on breathing and relaxing the mind. These share one commonality: a mental space we create where we stop thinking about the past or trying to anticipate the future, focusing instead on what is present within and around us. There isn’t one answer to seeking mindfulness; the greatest difficulty lies in knowing where to begin.

As medical students and future doctors we are expected to quickly calm ourselves after these stressful moments and proceed. Sadhguru, a guru who is the founder of the Isha Foundation, states: “Fear, anger, resentment, and stress are poisons you create in your mind. If you take charge of your mind, you can create a chemistry of blissfulness”.1 It is especially easy in a hectic and high-paced environment or period of life to get lost in our thoughts about the stressors we experience. Our thoughts are like clouds. We can either let them pass, or we can dive into them. Taking control of our mind to let the clouds pass, helping our mind become still and focus on the present, is difficult.

This is where meditation techniques can help train our mind. Meditation techniques often involve bringing awareness to a single action or sound. For example, they can be used to bring awareness to your breathing or the repetition of a few words. One method I use is called “4-7- 8 breathing.” Close your eyes. Breathe in for four seconds through your nose. Hold your breath for seven seconds. Breathe out for eight seconds through your mouth. As you inhale, stay aware of how the air flows through your body, from the tip of your nose to your navel. As you exhale, follow the air out from your navel to your mouth. Repeat this about two to three times.

At TCU Burnett School of Medicine, our Meditation and Mindfulness Student Interest Group aims to educate medical students about techniques such as 4-7-8 breathing and help them stay engaged in healthy mindful practices to avoid burnout. Our goal is to cultivate a supportive student community dedicated to mindfulness, fostering connection through monthly meditation sessions, inspiring physician guest speakers, and meaningful community volunteering.

It is going to be okay.

My mother always told me, “Take it one step at a time, one day at a time.” As medical students, we’re often exposed to patients and situations that can take an emotional toll on our mental well-being; times such as witnessing a patient’s death or delivering a life-shattering diagnosis. Before we can process what we’ve witnessed, we’re often thrown back into a fast-paced environment without a moment to rest. In such a high intensity life, grounding ourselves with activities that bring comfort and ease becomes crucial to our mental well-being. My hope is that we future physicians can practice mindfulness early, so that we can be present for our patients. In turn, we can help our patients be mindful as we work together throughout our most difficult moments to maintain healthy behaviors.

References:

1. Sadhguru Quotes – Fear, anger, resentment, and stress are poisons you create. If you take charge, you can create a chemistry of blissfulness within yourself. Accessed February 13, 2025. https://isha.sadhguru.org/en/wisdom/quotes/date/december-06-2021