As I run through my daily regiment wondering where I may have slipped up a tad on this recent diagnosis of Endrometerial Hyperplasia, I couldn't help but notice my water intake.  Sadly, I've been a bit laxed on my stringent routine due to COVID-19.  It's enough dealing with this whole online working system let alone remembering what I'm supposed to do to keep my health optimal every minute of the day.  

Don't get me wrong, I never deviate too far from my diet.  I am a firm believer this is what has kept me in a decent corner today.  It's not 100% by any means.  But, if I can run at 85% I can get through a normal day.

This syndrome of fibromyalgia can have a huge impact on how you lead your life on a day-to-day basis. A range of treatments are usually prescribed for long term management of fibromyalgia pain including physical therapy, psychological therapy, and drugs. And, of course, we all need support to continue.  But daily food and beverage intake is right up there on the top of the pyramid for folks like us. 

That clear liquid we take for granted every day can actually help to relieve the symptoms of fibromyalgia. Did you know that fatigue and headaches can be caused by dehydration? Our adult bodies are made up of approximately 70% water which evaporates through breathing, sweating and other natural bodily functions. Drinking water helps to flush all the toxins through your liver and kidneys and out of the body. Aim for at least 8 glasses each day – being hydrated will help to fight off fatigue. If you don’t like plain water try a squeeze of lemon juice or lime to add some flavor.

Water is the most underutilized tool when it comes to your health. From hydrating skin and helping with headaches to giving you an endless supply of energy, simply drinking enough H2O each day can pay off in a big way.

"Proper hydration is key not only to making sure we stay alert and energized, but also to keeping everything functioning in our bodies," says Jaclyn London, MS, RD, CDN, Nutrition Director at Good Housekeeping Institute. "Most of us need to drink between 8-10 cups (as a general rule of thumb) of water per day — and much more when we factor in heat, sweat, medications, and humidity shifts."

Yes, remembering to carry much less sip on a water bottle throughout the day can feel like a challenge, but drinking enough water is essential for your wellbeing. How much is enough? Well, much like calories, the amount of water each person needs depends on a few different factors. Read on to calculate how much water you should be drinking each day based on your own unique needs.

I, for one, have been searching for a more specific calculation for my own personal water needs.  I'm going to share it with you.  Upon immediate calculation, I configured this into my Fitbit to ensure I can begin step one of my latest quest to better health. 

​If you want to determine the exact amount you should drink according to your body weight, you can follow these steps:

1. Take your weight (in pounds) and divide that by 2.2.
2. Multiply that number depending on your age: If you're younger than 30, multiply by 40. If you're between 30-55, multiply by 35. If you're older than 55, multiply by 30.
3. Divide that sum by 28.3.
4. Your total is how many ounces of water you should drink each day. Divide that number by 8 to see your result in cups.
5. Go grab that to go cup and start filling! 
   
   
   
   

Bleeding post menopause will rile up anyone's day.  Nothing worse than feeling the onset of cramping, that hasn't been experienced in years, accompanied by bleeding.  One's first precaution is to dive into the internet to see if you are not being afflicted with the big "C".  Step two is to call your GYN and ensure you are not harboring a mass of some sort. 

It's not that fibromyalgia offers a myriad of nuances as it is, try adding a bit of cramping, fatigue, and deviant emotions to your day that you haven't experienced for 15 years.  Yet, according to a recent study in NICHD titled, "Women with Endometriosis Have Higher Rates of Some Diseases," researchers found that woman who suffer from Fibromyalgia or Chronic Fatigue Syndrome have a higher risk for issues such as endometrial hyperplasia. That is due to this disease involving pain in the muscles, tendons, and ligaments.

Endometrial hyperplasia is a condition in which the endometrium (the lining of the uterus) becomes abnormally thick. Although endometrial hyperplasia is not cancer, it can lead to uterine cancer in some women.

Endometrial hyperplasia is usually caused by an excess of estrogen without progesterone (female hormones). The progesterone is not made and the lining of the uterus is not shed if ovulation does not occur. This means that the endometrium may continue to grow in response to the production of estrogen. The cells of the endometrium may abnormally crowd (hyperplasia), which may lead to the cancer of the uterus.

What is atypical endometrial hyperplasia?

Atypical endometrial hyperplasia is a premalignant condition of the endometrium. It occurs when there is an overgrowth of abnormal cells, or it may develop from endometrial hyperplasia. In some cases, polyps (tumors) in the uterus can lead to atypical endometrial hyperplasia.

Who is at risk for developing atypical endometrial hyperplasia?

Atypical endometrial hyperplasia usually develops in older women (after menopause). But it can develop in younger women if they do not ovulate or are obese.

What are the causes of atypical endometrial hyperplasia?

Atypical endometrial hyperplasia develops when there is no balance between the female hormones, estrogen and progesterone. This imbalance is called unopposed estrogen and it may be caused by a number of factors including:

• Hormone changes during menopause (cessation of menstrual period)
• Estrogen-hormone replacement therapy
• Breast cancer treatment, using drugs such as tamoxifen (Nolvadex®, Tamofen®)

What are the symptoms of atypical endometrial hyperplasia?

Abnormal vaginal bleeding is the most common symptom of atypical endometrial hyperplasia. Less common symptoms include abnormal vaginal discharges or an abnormal Pap test result.

An interesting comment my doctor asked first was, "Have you been sick recently?" 

"No," I replied

"Have you been under any stress lately?" he asked.

"Well, yes, but nothing out of the ordinary," I answered.

"Because stress plays a vital role in disrupting your hormone levels," he concluded.

You can bet i will be on another adventure here, offering you vital information on this topic upcoming.  He also prescribed progesterone therapy to regain my hormonal balance.  

​Memoirs of a Geisha is a historical fiction novel by American author Arthur Golden, published in 1997. The novel, told in first person perspective, tells the story of a fictional geisha working in Kyoto, Japan, before, during and after World War II and ends with her being relocated to New York City.

​In the 1950s, truck driver Frank Sheeran gets involved with Russell Bufalino and his Pennsylvania crime family. As Sheeran climbs the ranks to become a top hit man, he also goes to work for Jimmy Hoffa -- a powerful Teamster tied to organized crime.

​Arizona motorcycle cop Frank Shankwitz meets a terminally ill boy named Michael and is inspired to change his life, leading to the creation of the Make-A-Wish foundation.

​Emilio, his daughter, and his granddaughter embark on a crazy journey to find the love of his youth before he succumbs to Alzheimer's disease.

​A highly regarded child psychologist, Dr. Carter Nix (John Lithgow) has shown signs of being unstable, but he completely snaps when he discovers that his wife, Jenny (Lolita Davidovich), is having an affair. Nix's mental breakdown leads to the emergence of various other personalities, including a ruthless thug and a scared little boy. Nix's descent into madness involves murder, revenge and even the abduction of his own daughter, resulting in a suspenseful web of intrigue.

​The new coronavirus — or COVID-19 — is spreading across the United States. Health officials are working to understand how to contain it. The Centers for Disease Control and Prevention (CDC) now recommends that everyone in the general public wear a cloth mask in addition to continuing to follow social distancing guidelines when they must go out into public.

Path to improved health

At first, the CDC said not to wear a mask. Why do we now need to wear cloth masks?

As we receive more data about COVID-19, we are learning more about how it spreads. Data shows that many people already have the virus who do not know that they have it. They are asymptomatic, or not showing symptoms. It can take up to 14 days for a person who has been infected to develop symptoms. That means that when these people go to places like grocery stores and cough or sneeze, they are unintentionally spreading the virus.

The new CDC recommendation is not intended to prevent you from getting COVID-19; it is to protect other people. In order to flatten the curve or slow the rate of spread of the virus in your community, assume that you already have the virus. Wearing a cloth mask will help to contain your own germs should you cough or sneeze in a public place. It will help to prevent you from giving COVID-19 to other people.

Should I try to buy a surgical mask or an N95 respirator?

No. Only health care professionals should wear surgical masks or N95 respirators. We are currently experiencing shortages of proper personal protective equipment (PPE) for the doctors, nurses, and other health care professionals who are working to fight COVID-19. Do not use a surgical mask or N95 respirator if you are not a health care professional. If you already have some of these in your home, you can donate them to a local hospital or health care facility.

Do I still need to practice social distancing?

Yes. Wearing a mask should not take the place of social distancing. You should still stay at least 6 feet away from other people when you go out in public. A cloth mask may help to prevent you from giving the virus to others, but it does not protect you (the wearer). It is still important that you stay home as much as possible and continue to properly wash your hands.
What makes an effective cloth mask?An effective cloth mask should:

• Cover the nose and mouth and fit snugly against the sides of the face.
• Be secured to the ear with ties or loops.
• Include multiple layers of fabric.
• Allow for breathing without restriction.
• Be machine washable and dryable without losings its shape or fit.

How do I make my own cloth mask?

The CDC has posted instructions for how to make your own cloth mask from materials you may already have at home. You can use a t-shirt or a bandana to make your own cloth mask. See instructions from the CDC.

Things to consider

When you wear a mask, it is important to know how to wear it properly. When using a mask, you should:

• Wash your hands with soap and water before putting on the mask. If you do not have soap and water available, used an alcohol-based hand rub.
• Cover your mouth and nose with the mask. Make sure it is snug to your face.
• Do not touch the mask while using it. Do not touch any other areas of your face.
• As soon as you return home, take the mask off and put it in the wash.
• Remove the mask by touching it from behind. Do not touch the front of the mask. Throw it in the washing machine and wash your hands immediately.

Click Below for Walmart Masks 50 for $11.60

With the advent of many businesses reopening it is normal to feel a bit of excitement as we begin to transition to normalcy.  

But this is not a time to let your guard down just yet.  Rather it's time to renew pertinent information as we head down the road of another month.

COVID-19, short for coronavirus disease 2019, is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a newly identified pathogen that has not previously been seen in humans and is highly contagious.

Although it belongs to the same category of viruses as SARS coronavirus (SARS-CoV) and influenza viruses, SARS-CoV-2 is a different strain with its own characteristics. 

COVID-19 was first reported in Wuhan, China, in December 2019, and the outbreak has spread quickly across the world, prompting the World Health Organization (WHO) to declare COVID-19 a pandemic.
How does COVID-19 spread?Because COVID-19 is a new virus, nobody has prior immunity to it, meaning the entire human population is prone to infection.

It primarily spreads via respiratory droplets when people cough or sneeze. Scientists have yet to understand how easily and sustainably the disease can spread among people. Based on available evidence, researchers do not think airborne spread is a major transmission route. 

Individuals over age 60 are at the highest risk of developing a severe case of COVID-19, while children do not seem to be at a higher risk than adults.

There are currently no reports about how susceptible pregnant women may be to COVID-19 or about transmission of the virus through breast milk.

What are the symptoms of COVID-19?

Common symptoms of COVID-19 begin two to 14 days after exposure. They include fever, tiredness, and dry cough. Other symptoms include sputum production, shortness of breath, sore throat, headache, myalgia (muscle pain) or arthralgia (joint pain), chills, vomiting, and nasal congestion. Less frequent symptoms include diarrhea, hemoptysis (coughing up blood from the respiratory tract), and conjunctival congestion.

Most of these symptoms are usually mild, and about 80% of people who get the virus will typically recover without needing any special treatment. However, about 1 in 6 patients become seriously ill and develop breathing difficulties.

What general preventive measures should people take?

The following simple preventive measures can help minimize the spread of COVID-19: 

• Wash your hands often with soap, lathering both the front and the back of the hands and fingers for at least 15 to 20 seconds. If soap is not available, use a hand sanitizer that contains at least 60% alcohol. The European Centre for Disease Prevention and Control produced a poster detailing effective handwashing.
• Avoid close contact with someone who is ill. (Maintain a distance of at least 6 feet, or 1.8 meters).
• Stay at home if you are sick.
• Use a tissue to cover your mouth and nose if you cough or sneeze and dispose of it properly afterward.
• Disinfect surfaces and objects you touch frequently. 
• Avoid touching your eyes, nose, and mouth with unwashed hands.

​

The U.S. Centers for Disease Control (CDC) does not recommend that healthy people wear a face mask.

But as a measure of precaution, it is always best to go out with a mask, preferably an N95.

Is there any specific advice for fibromyalgia patients take?

Because fibromyalgia is not an autoimmune disease, patients are not thought to be more at risk of COVID-19 than someone without the disease. People with fibromyalgia should follow the advice provided for the general population.

What should sick individuals do?If symptoms are present and a COVID-19 diagnosis is confirmed, patients should follow these steps to prevent the spread of the infection:

• Stay at home, preferably in a separate room not shared with others, and isolate themselves, with the exception of getting medical care.
• Avoid public areas and public transport.
• Limit contact with pets and animals.
• Avoid sharing personal items.
• Cover coughs and sneezes with tissues and dispose of them properly.
• Sanitize hands regularly. 
• Disinfect surfaces such as phones, keyboards, toilets, and tables.

People should call ahead before visiting the hospital for an appointment. This way, the hospital can take necessary steps to prevent the spread of the infection.

Patients who have confirmed COVID-19 should wear face masks when going out. The WHO’s website has a resource explaining the proper use of a face mask. 

What tests are available?  

Many tests for the detection of COVID-19 have been made available under the FDA’s emergency use authorization, including rapid tests that are being developed to detect the presence of the virus within minutes.

The Foundation for Innovative New Diagnostics provides an up-to-date list of different manual and automated tests that are available or currently in development.

Is there a treatment?

There are currently no vaccines available for human coronaviruses including COVID-19. This makes the prevention and containment of the virus very important.

Oxygen therapy is the major treatment intervention for patients with severe disease. Mechanical ventilation may be necessary in cases of respiratory failure.

Are there any new treatments in development?

Several clinical trials have been launched or are being planned to test a variety of potential treatments and vaccines for COVID-19. A complete list of all ongoing clinical trials pertaining to the virus is available here. by Fibromyalgia News Today
​

​Living with fibromyalgia means coping with a number of symptoms: widespread muscle pain (myalgia), extreme tenderness in many areas of the body, sleep disturbances, fatigue, headaches, and mood issues like depression and anxiety. But how does having fibromyalgia impact your risk of COVID-19 and ability to manage these symptoms while staying at home? Here’s what our experts want fibromyalgia patients to know about navigating the coronavirus pandemic.

Does Fibromyalgia Make You High-Risk for Coronavirus?

The answer depends on whether you have primary or secondary fibromyalgia, says Petros Efithimiou, MD, FACR, a rheumatologist who practices in New York City.

Primary fibromyalgia, which is the most common form, is a chronic pain syndrome in which the body and brain process pain and stimuli differently, explains Dr. Efithimiou. Importantly: “There is no immunosuppression.”

Since fibromyalgia doesn’t compromise your immune system, there is “no increased risk for acquiring COVID-19 nor increased risk for mortality from that disease,” says Frederick Wolfe, MD, a rheumatologist and fibromyalgia expert in Wichita, Kansas.

“People with a diagnosis of fibromyalgia should follow the suggestions of medical authorities for ordinary citizens,” he says, including proper hand-washing, practicing social distancing, and avoiding unnecessary travel and close contact with other people if you need to go to work or run an essential errand.

Secondary fibromyalgia, on the other hand, often occurs in patients with immune system disorders like lupus, rheumatoid arthritis, and axial spondyloarthritis. In this case, your immune system can be suppressed and you would be considered high risk for COVID-19.

Knowing the difference is crucial.

“People might think that fibromyalgia is an autoimmune disease since they are often referred to and treated by rheumatologists, and some of their symptoms may mimic those of lupus or other rheumatology patients,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas.

But fibromyalgia is not an autoimmune disease, which occurs when the body’s immune system mistakenly attacks your own cells and tissues.

Do Fibromyalgia Medications Suppress the Immune System?There is not necessarily a straightforward or universal way to treat fibromyalgia. Your medication options will depend on your most concerning symptoms as well as if you have any co-occurring conditions. Drugs used to treat primary fibromyalgia may include antidepressants, anti-seizure drugs, and non-steroidal anti-inflammatory drugs (NSAIDs):

• Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), cyclobenzaprine (Flexeril)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta) or milnacipran (Savella)
• Selective serotine-reuptake inhibitors (SSRIs): fluoxetine (Prozac) or paroxetine (Paxil, Pexeva)
• Anti-seizure drugs: gabapentin (Neurontin), pregabalin (Lyrica)
• Non-steroidal anti-inflammatory drugs (NSAIDs): Advil or naproxen

If you develop COVID-19 symptoms, it’s probably best to avoid NSAIDs like ibuprofen (Advil) or naproxen (Aleve); you’re better off taking acetaminophen (Tylenol). According to a well-publicized article in British Medical Journal, “prolonged illness or the complications of respiratory illness or the complications of respiratory infections may be more common when NSAIDs are used — both respiratory or septic [blood infection] complications and cardiovascular complications,” said Paul Little, MD, professor of primary care research at the University of Southhampton in the UK.

“The medication patients take for pain and fibromyalgia, such as gabapentin (Neurontin) and pregabalin (Lyrica) do not decrease the ability of the immune system,” says Dr. Efithimiou.

Additionally, antidepressants do not affect the immune system, says Dr. Bose, and “you should continue these medications to avoid flares.” Before stopping a medication, contact your physician over the phone or using a telehealth system to come up with a plan.

Distinguishing Fibromyalgia Symptoms from Coronavirus Symptoms

Many of the symptoms you may experience with fibromyalgia — including chest pain, body aches, fatigue, and malaise — can also be symptoms of COVID-19. But experts say you’ll be able to tell the difference.

“We tell our patients, if you feel any drastic changes — such as feeling out of breath or sharp pains in your chest — or feel different than your baseline, you need to tell us,” says Dr. Efithimiou. “We ask them to evaluate the intensity and character of symptoms. People are quite anxious, but they should stay away from the hospital.”

Anxiety and depression can cause physical symptoms, including body aches, fatigue, and chest pain. “The best way to tell the difference between potential COVID-19 symptoms and those of your chronic condition is to seek professional medical advice through an office visit or telehealth, which is available at many locations,” says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.

Managing Symptoms of Fibromyalgia Under Quarantine

Fibromyalgia symptoms like pain and stiffness, fatigue, disrupted sleep, anxiety, and depression may feel intensified right now. “It’s a two-way street,” says Dr. Efithimiou. “The more you can control anxiety, the better symptoms are going to be.”

We asked rheumatologists and psychologist John S. Fry, PhD, a former member of the National Fibromyalgia Association, what you can do to manage these symptoms during the COVID-19 pandemic.

Exercise

Many people find that exercise helps ease their fibromyalgia symptoms and quality of life. The coronavirus shouldn’t stop you from moving. Go for a walk, walk your dog, try online yoga, tai chi, or strength-training classes. Pace yourself and give yourself plenty of rest between sessions.

Practice relaxation techniques

It’s important for people with chronic pain and fatigue to learn how to relax their bodies by meditating, doing yoga, or practicing deep breathing or progressive muscle relaxation. While there are apps available to walk you through these strategies, telemental health can help you hone these and other pain management skills, says Dr. Fry, who is licensed to practice in California.

Lean on loved ones

Dr. Fry believes it should be called “spatial distancing” not “social distancing,” especially since it’s so important for people living with chronic illness to have social support from friends and loved ones right now. Make sure to carve out time to connect with others, whether that’s calling a friend, FaceTiming or Skyping, or arranging a Zoom meeting with family and friends, says Dr. Fry. And take advantage of those loved ones who are around you 24/7; don’t hesitate to ask for a gentle massage or help with household chores, he adds.

“Many fibro patients may have underlying depression and/or anxiety or a history of past trauma. It is important to broaden your safety net during the pandemic,” says Lenore Brancato, MD, clinical assistant professor in the division of rheumatology at NYU Langone Health in New York City. “With constant solemn news in the media and necessary isolation from family and friends, it can stoke anxiety for everyone, especially patients with fibro.”

Create a schedule

Whether you plan out a detailed schedule of your day or jot down a To-Do list every morning, creating a routine for yourself will help alleviate feelings of isolation and create some normalcy as you follow shelter-in-place orders. As you complete your tasks, “take a few seconds to savor the fact that you got it done,” Dr. Fry says.

Shift your self-talk

Self-talk can make a huge difference in how you manage your anxiety, which is likely causing you to catastrophize and think in black and white, explains Dr. Fry. Instead of saying to yourself something like: “Coronavirus is everywhere. I’m trying to protect myself. I’m scared. I’m going to get it — and if I do no one will be there for me,” say to yourself something like:  “I might get the coronavirus, but I might not if I’m careful.”

Remind yourself that you’re not alone. You likely have friends and family members and reaching out to them does not make you a burden. Think about the last time a friend called you for emotional support. After you hung up the phone, did you think it was a burden? Helping others is a behavior that’s been proven through research to make people happy, says Dr. Fry.

Find a healthy distraction

As you stay at home as much as possible, home in on hobbies and activities to help exacerbate feelings of anxiety and social isolation. Whether you paint, garden, color, scrapbook, or catchup on a Netflix series, it’s important to get into things that give you pleasure.

Prioritize sleep

When you live with fibromyalgia, getting quality sleep is a struggle. Unrelenting pain can disrupt sleep, which can lead to increased achiness and fatigue, creating a vicious cycle. Anxiety over the coronavirus can make it even harder to fall asleep or stay asleep all night. Now’s the time to make an extra effort to shut off those worries before shut-eye and change your perspective. “Before bed, write down three good things that happened, even if it’s been a horrible day,” says Dr. Fry. “Even if they’re little things: my dog licked my hand, I saw a pretty hummingbird, a friend called me today. This too shall pass.”

“Facilitating restorative sleep, which can be difficult during the best of times for fibro patients, requires attention,” says Dr. Brancato. “Sleep hygiene and  sleep rituals, such as legs up the wall or simple inversions and meditation practice may be helpful. Daily exercises (even seated biceps curls or leg lifts)can help reduce pain and relieve stress. Exercise can also foster improved sleep.” - Creaky Joints

Dietary surveys in the US and elsewhere show that most people are consuming diets that do not meet national guidelines—often because of availability or cost—and such diets may not provide optimal quantities of essential vitamins and minerals. Currently, the ongoing COVID-19 pandemic is likely to put many more individuals at risk of food insecurity and make consuming a healthy diet even more difficult. This becomes increasingly likely if the infection risk-mitigation strategies do not include approaches to ensure essential supplies are effectively distributed and accessible, or if the pandemic affects productivity of the agricultural sector.

1 lb sausage, uncooked
1 oz. package cream cheese, softened
1¼ egg
1/2 cup shredded cheddar cheese

Preheat oven to 400ºF.

Mix all ingredients until well combined. 

Roll into 1-inch balls and place on a rimmed baking sheet.
​
Bake for 18 –- 22 minutes, or until brown.

We have known for a long time that nutrition is intricately linked to immunity and to the risk and severity of infections. Poorly nourished individuals are at a greater risk of various bacterial, viral, and other infections. Conversely, chronic or severe infections lead to nutritional disorders or worsen the nutritional status of affected people. Therefore, it is imperative for all of us to pay attention to our diet and nutritional status during the ongoing COVID-19 pandemic. Furthermore, the clinical course of COVID-19 disease tends to be more severe among older individuals and among people with chronic conditions, such as diabetes, hypertension and cancer that are partly related to nutrition. [1] Although data are not yet available, co-infections, such as HIV/AIDS, may also be associated with more severe outcomes, and optimal nutrition plays an important role in maintaining health among people with such infections.

24 large mushrooms, stems removed, or more as needed
1 pound bulk hot Italian sausage
1 onion, diced
4 ounces grated Parmesan cheese, divided
1/4 cup Italian bread crumbs
1 teaspoon minced garlic
1 teaspoon chopped fresh parsley

Preheat oven to 350 degrees F (175 degrees C).

Hollow out each mushroom cap, reserving scrapings.

Heat a skillet over medium-high heat. Cook and stir sausage, onion, and reserved mushroom scrapings in hot skillet until sausage is browned and cooked through, 4 to 6 minutes. Drain and discard grease; return sausage mixture to skillet.

Stir 3 ounces Parmesan cheese, bread crumbs, garlic, and parsley into sausage mixture. Cook and stir until heated through, 3 to 5 minutes.

Stuff each mushroom cap with sausage mixture and place on a baking sheet.
​
Bake stuffed mushrooms in the preheated oven for 12 minutes. Sprinkle remaining 1 ounce Parmesan cheese over mushrooms and bake until mushrooms are cooked through and cheese is melted and bubbling, about 3 minutes.