Nitpickin queen

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Oh my God! Is anyone else suffering from temporary bipolar disorder right now? Am I the only one? I have had a lot of experience with bipolar patients in the last 20+ years and I feel like this must be what it is like. The shelter in place quarantine got me “buggin.”….and I am not actually in it all the time! I am still going to work every day! Believe it or not, as an obgyn, pelvic exams and c sections do not translate well to telehealth….unless you wanna get busted for porn…lol Seriously, that was just a joke. Anyway, moving on. Let me preface what I am about to say by first clarifying that I am GRATEFUL for my health, my family, my life situation and everything that I have. Ok, having gotten that out of the way, I feel the need to state that some days I am about to go crazy! My moods are all over the place. I expect some of this with menopause and all, but I am really overachieving here at the moment.

The days that I get to go to work, I am totally grateful to be able to go to work and help patients. It is a real bummer that I cannot practice any aesthetics right now since it is not considered essential. That stuff was really helping to keep the lights on….and it is fun and the patients are healthy and happy to be there. Oh well. We will still be ready to serve when quarantine is over. It is not a part of the key big picture right now. I get that. It is still really hard to see my women who were relying on us for hair removal go right back to feeling self conscious in public, but there is nothing I can do about it right now. So, having the option to work is good. I am glad to still be able to help people. It is hard on the staff because they are having to take turns leaving the office early, but I am at least able to offer them unemployment for reduced hours. I still have our bonus systems in place and they still can get a percentage of that, even though the opportunities are less right now. It’s the best I can do at the moment. Even though work is overall good right now, everybody’s emotions are still wacked out. We snap at each other over little things without meaning to. Little things become big things. Add to that recipe the fact that we have an office full of women and presto! It’s potentially like adding gasoline to a fire. It’s just human nature. We misdirect our stress and project it onto whatever is in front of us, even when we don’t mean to.

So, I hang in there all day at work and try to keep everything on an even keel. I have taken on the emotional correction of the world at large like some kind of sacred mission with positive posts, encouragement, extra compliments and disseminating accurate information. It is exhausting but so worth it. Somebody has to do it.

But then, it is time to go home. I get super excited to go home, anxious to see my kids and my pets. I get in the car and I am all pumped up to go home, strip down, wash my clothes immediately, streak past my kids as they scream ewww to get to my room to change.

Then, something happens to me. I am still in the car and I get the overwhelming urge to call my kids and ” ask” them about their day. They either don’t answer or when they do answer, they do not provide the answers to my satisfaction and suddenly, the innocent phone call I had planned morphs into something entirely different. I come storming into the house and immediately begin screaming their names to get their attention, all the while looking all around the house for any evidence of what they didn’t accomplish. Was their room clean? Did they do their laundry? Did they finish their homeschool tasks for the day? Did they attend the 20 million free online classes that are available right now…all in one day? NO! WHAAAAAT?! Now I am really pissed! All my nervous energy that has built up during the day of the things that I would like to be finishing releases and the kids are my first target. Whoa! Then I find myself reminding myself that I need to slow down. What the hell just happened? The kids are not the enemy…..are they? I try to then back up and be really sweet and ask them what they would like for dinner and what fun at home activity would they like to do. Usually by this point, they have already put up the carefully crafted tune out mom wall ( since this scenario probably repeats on a daily occurrence) and can’t even register that the nice version of me has come out. I find myself trying to coax them out of their rooms so that we can spend some time together and they are surprisingly passive aggressive and unwilling. I mean c’mon. Who doesn’t immediately want to come downstairs and throw their arms around my version of Mommy Dearest? Yeah I get it. No one. OMG why does this happen? Why can’t I stop it?

I truly am enjoying the extra hunker down time. I promise that I am. I am just having a hard time not projecting my own need to still accomplish projects without driving(lol) onto my kids. I think there are still reasonable expectations to be had. I mean let’s face it. They have an unprecedented amount of free time to fit in a lot of stuff. That is just fact. I should be able to expect them to do their school work, do some basic stuff around the house, and at least try to keep themselves mentally and physically healthy with my help. I would still be pissed if they didn’t unload the dishwasher or were living like pigs even if we weren’t on quarantine. Just sayin. Some things haven’t changed. And if I am being honest, I am not the only one suffering from a temporary mood disorder. They are all volleying back and forth from bickering and yelling to hanging out like besties on any given day. It is getting harder to keep track one minute to the next who is fighting and who is friendly. So, I am not alone here. I just need to find a way to keep reminding myself that quarantine did not magically transform my kids into the best self-starters on the planet and that our motivation levels were not equal even before everything went a bit nutty. The struggle for balance is real! Lately I have taken to giving myself a small time out in the car before I even go into the house. Sometimes this helps. Sometimes this doesn’t. But, at least I am trying. Hang in there people! Remember, this is only temporary.

Dr. Katz

A migraine is not “just a headache.”

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The audacity of some people! To call a migraine just a headache is almost a type of blasphemy. Millions of people suffer from debilitating migraines every year. Just like fibromyalgia and other conditions that have no outwardly visible effects, it is difficult for people to understand just how awful they are. Let me enlighten you.

A migraine is a type of vascular headache that causes severe throbbing pain or a pulsing sensation, often on one side of the head. The headache often comes with nausea, vomiting, and photophobia and phonophobia (sensitivity to light and sound). An attack can last for hours to days in some cases. The symptoms can be so severe that they can completely shut a person down for days. No garden variety simple headache can do that. This is why a migraine episode is often referred to as a migraine attack. It literally feels like you are under attack.

Let’s go through the possible stages of a migraine attack. The four stages are prodrome, aura, attack and post-drome.

Prodrome occurs one or two days before a migraine. Consider it like a sort of heads up or warning that a migraine is coming. Some symptoms you might experience are constipation, mood changes( depression to euphoria), food cravings, neck stiffness, increased thirst and urination, and frequent yawning.

Aura is something that might happen before or even during a migraine. The symptoms of an aura are reversible neurological symptoms. Usually they are visual symptoms like seeing various shapes, seeing bright spots, seeing flashes of light, loss of vision or tunnel vision. Sometimes a person feels pins and needles in an arm or leg. Sometimes there is weakness or numbness in the face or one side of the body. Some people get aphasia or difficulty speaking. Some people hear noises or music and have uncontrollable jerking or other body movements. Most often these symptoms appear and develop gradually and last for 20 to 60 minutes before the actual headache begins. These symptoms can be truly terrifying, especially if the person does not realize they are about to suffer from a migraine. Think about it. what actually differentiates these symptoms from possible stroke symptoms for example? Yup! Scary stuff. I can remember my first migraine at age 18. I was in college. I can remember suddenly losing vision in my left eye, tingling in my arm and then I had trouble speaking. I could not find a word to say my life without a struggle, if at all. I remember trying to call my mother and not actually being able to speak, which just terrified the both of us. My friends dragged me to the ER, but by the time I got seen several hours later( apparently an 18 year old with stroke symptoms was not concerning), the symptoms were gone and they sent me home…without any real information or guidance. This is how it goes for many patients during their first migraine attack.

The attack of headache itself usually lasts from four to 72 hours if untreated. During the attack, patient feels pain in one or both sides of the head. It usually throbs or pulses. There is intense sensitivity to light and sound. Aaaand let’s not forget nausea and vomiting. Only the best for migraine sufferers

The post drome consists of fatigue and feeling drained and even confused for up to a day. Your head feels sore almost. Even the slightest movement can bring the pain back. It is sometimes referred to as the migraine hangover.

So, we just finished talking about all the phases and the similarity to stroke symptoms. How do you know when to take it more seriously and see a doctor? Obviously, it is a good idea to see a doctor if you are experiencing chronic headaches with any kind of symptoms, just to be safe. When you go to the doctor, it is a great idea to keep a headache diary of all your episodes and symptoms and any triggers you have been able to determine. This will help the doctor get your diagnosis established more quickly and get you the help that you need that much sooner.

You should also see a doctor or go to the ER right away if you have any of the following symptoms: 1) An abrupt, severe headache almost light a thunderclap in your head, 2) A headache accompanied by fever, stiff neck, seizures, mental confusion, double vision, weakness, numbness or trouble speaking, 3) A headache or worsening headache after a head injury, 4) A chronic headache that is worse after coughing or straining or sudden movement, 5) A brain new kind of headache after the age of 50. Yes, there are some of these symptoms that can also occur with a migraine as well, so it can still be confusing. I would say err on the side of caution whenever your symptoms seem new or not consistent with your usual migraine. If you’re wrong, great. It’s a migraine only. If you are not wrong and you ignore it, you could actually be suffering from a stroke, meningitis, a brain tumor, a hematoma or worse.

So, what causes migraines? They aren’t fully understood yet, but we think that genetics and environmental factors might play a role. Researchers have studies changes in the brainstem and it’s interactions with the trigeminal nerve. The trigeminal nerve is a major pain pathway in the body. The trigeminal nerve is also called the fifth cranial nerve. It has branches that go along the temple, along the cheek, and along the jaw line. It is responsible for sensation int he face and motor functions like biting and chewing. Researchers are also studying the role of serotonin imbalances in migraine sufferers. This make sense since serotonin helps regulate pain in the nervous system. They are also lookig at the role of other neurotransmitters like calcitonin gene-related peptide. Stay tuned!

Now let’s look at some migraine triggers. These are just some common ones. They can be different for everybody. Hormonal changes in women are a trigger, especially fluctuations in estrogen before, during or after menses, pregnancy, and menopause. This is where that migraine diary I was referring to earlier comes in very handy. This type of migraine is sometimes referred to as a menstrual migraine because of it’s relationship to hormone changes. Sometimes oral contraceptives or hormone replacement therapy can make migraines worse. There is also some data that suggests that combined oral contraceptives and hormone replacement therapy may not be a good idea in migraine patients anyway because of possible stroke risk. There is other data that suggests hormone modulation may be very helpful. Other times women say that they feel better on these medications. There is not really a good way to determine ahead of time which group your patient will be in. There is some trial and error involved. Having said that, and just to add to the confusion, one of the best treatments that I have found for menstrual migraines is to have a patient put on an estrogen patch two days before their anticipated menses and wear it for several days into their period until the usual point when symptoms would resolve on their own. I have found that, in the right patient, I can eliminate the menstrual migraine almost immediately.

Other possible migraine triggers are drinks that contain alcohol, wine, and too much caffeine. Since migraines are vascular headaches, they may be triggered by things that affect our vasculature. Alcohol causes vasodilation ( dilation of blood vessels) . Caffeine causes vasoconstriction ( stricture of blood vessels). Interestingly, caffeine can become kind of a vicious cycle in migraine patients because it can sometimes ward off a headache in the early stages….and then it can also cause both migraines and caffeine withdrawal headaches. Caffeine is a tricky one. I try to counsel my patients to avoid it all together in the first place if possible. Remember that caffeine is found is several different sources: pop, coffee, chocolate, tea, and dairy products with added sweetener.

Stress is definitely a migraine trigger. This refers to any kind of stress at home or at work. Even stress from illness can trigger migraines. This is why it is important for migraine patients to discover stress relief techniques that work for them.

Sensory stimuli can be migraine triggers. Bright lights, sun glare, and loud sounds can trigger migraines. Strong smells like perfume, paint thinner, second hand smoke and others can trigger migraines. At our office, we have a scent free policy for all patients and vendors. People who show up with any kind of strong scent will be rescheduled. We have too many employees, myself included, that will be down for the count if they smell the wrong thing and then everybody will have to be rescheduled anyway. I wish people wouldn’t fight it so much. You don’t need to take a bath in perfume and then go to the doctor. I won’t be offended if you don’t smell like flowers, cakes, or pie. I promise!

Sleep changes can trigger migraines. Sleep changes refer to insufficient sleep, interrupted sleep, or jet lag

There are certain physical factors that can trigger migraines. Intense physical exertion can trigger migraines in some people. There is a phenomenon called post-climactic migraine as well. Some unfortunate patients get migraines immediately after sexual climax. Talk about unfair!

Weather changes that cause a change in barometric pressure can also cause migraines. This seems to be particularly evident with big changes in temperature or sudden changes like a storm that brews up quickly.

We talked about oral contraceptives and migraines earlier. Essentially, any medications that cause vasodilation can also trigger migraines. This includes medications like nitroglycerin, minoxidil, ACE inhibitors and hydralazine.

Certain foods can possibly trigger migraines like aged cheese, salt, or processed foods. Ironically, most of my migraine patients crave these exact foods. Remember when I talked earlier about cravings preceding a migraine? I think this relationship needs further exploration. I think it is possible, at least with regard to the cheese, that eating it might trigger some sort of histamine release since it is made of mold, almost like an allergic response. Histamine release can cause vasodilation and vasodilation can trigger migraines. This is just my theory at this point. Certain food additives like aspartame and MSG can also trigger migraines. I can image that it is because these additives also have salt. High levels of salt impair the function of the endothelium (lining of the wall) in our blood vessels. Once again, anything that affects the blood vessels can trigger migraines.

What are some risk factors for developing migraines? Family history is one. If you have a family member that gets migraines, you are more at risk for developing them too. Have we found the migraine gene yet? No. But, I am willing to bet that we will some day. Age is a factor as well. Most migraines begin in adolescence, seem to peak in the 30s and then slowly become less severe. This is not true for all patients however. Mine took a turn for the worse not the better in perimenopause, but then seem to be settling down again. Being female seems to be a risk factor for migraines. women are three times more likely to have migraines than men. I am assuming that is related to the whole fluctuating hormones issue.

Now lets talk about how to diagnose a migraine. For the most part, it consists of ruling out everything else. You go to see a doctor specializing in headaches, usually a neurologist. They take your history, family history, mediation history, etc and do a neurological exam. If everything they find is consistent with migraines, they diagnose you with migraines. If you have any unusual symptoms like I listed earlier, they may order an MRI or a CT scan to rule out other serious conditions like stroke, tumor, multiple sclerosis, etc.

What are some treatment options for migraines? They basically fall into two categories: non medication and medication therapies. A migraine diary is essential as the first component to pinpointing effective treatment. It can help to identify triggers and patterns. The first thing that I do with patients is to talk about trigger avoidance and lifestyle changes like avoiding caffeine and getting good sleep, etc. Some of my patients have also benefited from other options like acupuncture and cranio-sacral therapy. These methods are controversial to say the least. However, I am of the opinion that, if an option has not been shown to be harmful, you bet I am going to offer it to a patient.

There are migraine medications available as well. They can basically be divided into two categories: pain relief and prevention. The pain relief drugs are taken during attacks and help stop symptoms. the preventative medications are taking regularly, often on a daily basis to reduce the frequency and severity of migraines.

The pain reliever options fall into seven main options: straight pain relievers, triptans, dihydroergotamines, Reyvow, Ubrelvy, opioids, and anti-nausea drugs.

1) Straight pain relievers are over the counter or prescription medications like aspirin, ibuprofen or Excedrin. You have to be careful and not take these for a prolonged period of time because they can cause other problems like medication overuse headaches, ulcers and gastrointestinal bleeding.

2) Triptans are another category of medications that block pain pathways in the brain. They bind directly to 5ht1D/1B receptors in the intracranial vessels in the brain. They come in pills, nasal sprays, or shots. They are most effective when taken immediately upon onset of prodrome or attack. These are meds like Imitrex, Tosymra, and Maxalt. They may not be safe to use in patients who are at risk for stroke or heart attack.

3) Dihydroergotamines like D.H.E or Migranal are another category of medications. These medications are migraine-specific serotonin agonists that bind to multiple receptors in the brain. Remember how we talked about how important serotonin is in pain perception and transmission? These are most effective when taken shortly after start of symptoms for migraines that tend to last over 24 hours. They can have unpleasant side effects like worsening of migraine-induced vomiting and nausea. They come in nasal spray or injection. Just like triptans, they should be avoided in people with coronary artery disease, high blood pressure, kidney disease, or liver disease.

4) Lasmiditan(Reyvow) is in its own category. It binds to a different serotonin receptor in the brain, 5HT-1F. The exact mechanism is not known, but we assume it has an agonist effect. It is approved for migraine with or without aura. So far it has been great for improving pain, nausea, and sensitivity to light and sound. It is also unique because it is an oral medication. Patients have to be extra careful with this medication because it can cause drowsiness and sleepiness. It also shouldn’t be taken with alcohol or other central nervous system depressants.

5) Ubrogepant(Ubrelvy) is also in its own category. This is an oral calcitonin gene-related peptide antagonist. It is approved for acute migraine with or without aura in adults. It is the first drug of it’s type. So far it is very effective in reducing nausea, pain, and sensitivity to light and sound within two hours. Side effects include nausea, excessive sleepiness, and dry mouth. You cannot take Ubrelvy is you take other CYP3A4 inhibitor drugs like amiodarone ( blood pressure med), itaconazole ( anti-fungal), and clarithromycin (antibiotic).

6) Opioid medications are another category. Some people cannot take other migraine medications as we already discussed because of other medications or health conditions. These address pain only and have the side effects of drowsiness and are highly addictive. They should only be used if there is no other alternative.

7) Anti-nausea drugs are the last category. These are usually taken in combination with pain control medications and can help with nausea and vomiting. These are medicine like Reglan, Compro, Zofran, and Chlorpromazine.

Preventative medications fall into five main categories: blood pressure-lowering medications, antidepressants, anti-seizure drugs, botox, and calcitonin gene-related peptide monoclonal antibodies.

  1. Blood pressure-lowering medications include beta blockers like propranolol and metoprolol. They also include calcium channel blockers like verapamil. These are good at preventing migraine with aura. Side effects include drowsiness, dizziness, dry mouth, and cold hands
  2. Antidepressants are another category. Tricyclic antidepressants like amitryptiline ( Elavil) are good in treating chronic pain and are good in preventing migraine by increasing serotonin levels which then constricts intracranial blood vessels and helps stop a migraine from starting. The side effects include sleepiness and weight gain however.
  3. Anti-seizure drugs are another category. Migraine activity in the brain has been compared to seizure activity so it makes sense that anti-seizure meds could be helpful. Topamax and Depakote have been used. There are significant side effects with these medications like dizziness, weight changes, nausea, psychosis, etc. They can also cause seizures during the weaning process if a patient decides to go off of them. They are definitely not my favorite first line option.
  4. Botox injections are yet another category. Botox can be injected every 12 weeks in the areas around the eyes, nose, forehead and neck. This is successful in preventing migraines in some patients. Let’s remember that Botox comes from botulinum toxin, a toxin that causes flaccid paralysis and death. In the proper hands, it can causes minute, targeted, temporary relaxation in the desired muscles. In the wrong hands, side effects could be very serious.
  5. Last but not least comes the potential holy grail trio of medication options,: the calcitonin gene-related peptide monoclonal antibodies. This group of drugs include Almovig, Ajovy, and Emgality. They are all available in monthly injection. So far, they have been nothing short of amazing in patients with chronic migraine. I have had patients with daily migraines for years reduced to none at all! These medications have truly been lifesavers so far. So far, the most common side effect has been a possible reaction at the injection site. The only drawback at this point that I can appreciate is their considerable expense to the patient and the sometimes lengthy prior authorization process. Unfortunately, that always seems to be the case with a newer medication that is truly effective.

Last but not least, let’s talk about some alternative medicine options for migraines. Acupuncture is one option that we talked about earlier already. Biofeedback also seems to be effective in relieving migraine pain. It teaches the patient how to monitor and control certain involuntary physical responses ( like muscle clenching) to negative stimuli. The negative responses are monitored and the patient is taught how to recognize them and reverse them. There is some argument for cognitive behavioral therapy as well. This type of therapy teaches patients how behaviors and thoughts affect how they perceive pain. Herbs ,vitamins and minerals also play a role in migraine prevention and symptom reduction. Feverfew has been shown to potentially prevent migraines. Butterbur was recommended in the past, but now not so much because of safety concerns. Vitamin B2 (riboflavin)may be helpful in migration prevention and severity. There is some possible data on Coenzyme Q10, but more information is needed. Some research suggests that magnesium levels are low in migraine patients so magnesium supplements have been tried. The results are mixed so far.

Well, that was probably more than you ever wanted to know about migraines. I am sure there is a lot more to know in the future, but that’s all I have for now. I hope this was helpful and that you are now convinced that a migraine is not “just a headache.”

Dr. Katz

Fibromyalgia is a real pain in my…..everything!

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Ah fibromyalgia! So often maligned as a bullshit, all in your head disease. Patients are placated, symptoms downplayed as just being overemotional or “making yourself sick” or dismissed all together. Seeing is believing when it comes to diseases right? If you can’t see anything on the outside of a person, they must be OK right? Wrong! Did you know that some physicians feel so strongly that fibromyalgia is baloney that they will refuse to see patients that have that on their history list. How do I know? Because I am one of them!

Ok, now that I am semi-finished with that initial rant, let me educate you a bit about fibromyalgia. I feel like it is time, as I am sitting here in full flare, probably brought on by the itty bitty amount of stress around me in the world today…lol

Let’s start out with some diagrams about fibromyalgia and all that it affects

Now let’s talk about fibromyalgia. We are not going to be able to discuss everything in the diagrams above, but we are going to hit some of the key points. The following information regarding fibromyalgia comes from a mix of two sources: my own experience and the Mayo Clinic. I figured that it would probably mean more to pull out a big gun like the mayo to help convince the dubious of this crappy disease’s validity. Well, here goes. Fibromyalgia is a real beast. Did you know that fibromyalgia is one of the most common chronic pain conditions in the world. It affects about 10 million people in the United States alone, according to the National Fibromyalgia Association. It is a disorder that is characterized by widespread musculoskeletal pain and fatigue. It does not cause joint damage per say, but the musculoskeletal pain is still quite severe. It also affects sleep, memory and mood. YAY! There is research that suggests that fibromyalgia amplifies painful sensations by affecting the way the brain processes pain signals. Huh? What? For example, a typical person might find light stroking on their arm(“arm tickles”) pleasurable on any given day. For a person with fibromyalgia on a flare day, they might perceive those light arm tickles as a person literally digging into their arm with hot pokers, which is about the furthest from a pleasurable sensation that you can get. This can definitely get in the way of a good episode of hugging or snuggling.

So, why does it hurt? We think that this abnormal processing of pain signals in fibromyalgia patients is due to abnormal levels of the neurotransmitters in the brain, spinal cord, and nerves. We have seen that repeated nerve stimulation in fibromyalgia patients actually causes changes in the brain and abnormally increases these neurotransmitters. On top of that, the pain receptors in the brains of fibromyalgia patients then go on to develop a type of pain memory and become even more sensitive. This results in the receptor “overreacting” to any pain signals.

We really do not know for sure what causes fibromyalgia. It is said that fibromyalgia symptoms can begin after a physical trauma, surgery, infection or significant psychological stress. However, there are other patients with fibromyalgia that gradually develop symptoms over time with no triggering event. Family history also seems to play a role in fibromyalgia. A patient is more likely to develop fibromyalgia if they have a relative who has it. I have seen this myself over the years. In my particular case, I can check off several of those boxes. I am blessed to have survived some horrendous car accidents. I have experienced lifetime movie-worthy psychological stress, in addition to multiple surgeries and I have family members who suffer from fibromyalgia.

The part about the correlation to psychological stress is what really gives fibromyalgia a bad name and it’s victims a lot of discrimination. This fact just makes it easier for people to label those patients as psychosomatic or treat them as if their pain is not real. Trust me the pain is real! The flares are real! I am very fortunate that I do not get flares that often, but when I do, I experience a multitude of symptoms including diffuse hot pain, especially in my neck, back and shoulders. All my sensations are off. I could scratch an itch on my arm and swear I just accidentally burned myself with a hot drill. My head hurts. I feel feverish. I am exhausted. Sometimes I even feel dizzy. My TMJ acts up. I get temporary irritable bowel symptoms. It just really adds up to a super fun day. I will admit that there is a correlation between stress, emotions, and symptoms. The symptoms are definitely worse when I am stressed, but then sometimes I have symptoms even when there is no stress and then I become stressed out because I feel so shitty. It can really be a vicious cycle. I am not sure that anyone can truly understand what a person with fibromyalgia goes through unless they have actually experienced it. We tend to judge people and their disease severity by outward appearances. It’s like we can’t believe something is real until we can “see it with our own eyes.” Well folks, there is nothing to see here and I guarantee you it is very real!

Let’s break down these symptoms a bit more: widespread pain, fatigue, and cognitive difficulties. Fibromyalgia pain is often described as constant dull aching that has lasted at least intermittently for at least three months. It has to occur on both sides of your body and above and below your waist to be considered widespread. As far as fatigue, fibromyalgia patients often wake up exhausted, no matter how long they have slept. Their sleep is often interrupted by pain and other sleep disorders like restless leg syndrome and sleep apnea, just to add to the fun. “Fibro fog” is a term that is used to describe the cognitive troubles like impaired ability to focus, pay attention and concentrate. I get it, fibro fog sounds made up, but it is very real as well. There are times when my level of discomfort really does get in the way of finishing a thought at that moment.

Fibromyalgia likes to hang out with a multitude of other painful diseases like migraines, irritable bowel syndrome, migraines and other headaches, interstitial cystitis( painful bladder syndrome) and TMJ. It’s almost as if all the fibromyalgia components aren’t enough by themselves. It’s like a domino effect with other body systems falling in line with altered pain perception with emotional component. The patients that have more than one of these pain syndromes truly have the capacity to suffer without some compassionate help.

Did you know that women are more likely to develop fibromyalgia than men? According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, women are eight to nine times more likely than men to have fibromyalgia. It has been suggested that women could be more at risk for fibromyalgia in part due to the role that hormones play in the perception of pain. Fluctuating estrogen and progesterone levels during the menstrual cycle seem to correlate with severity of fibromyalgia symptoms in some women. This fact of course leads to more discrimination as women are often thought of as the more emotional sex to begin with. This is consistent with the misguided thinking that fibromyalgia ORIGINATES from emotions and emotional triggers rather than the more accurate fibromyalgia is AFFECTED by or ACCELERATED by emotional triggers. There is a difference.

How is fibromyalgia diagnosed? Back in the good old days, doctors would put a patient through an 18 point pain exam. This exam consisted of a physician pressing firmly on 18 different points on a person’s body to see if any of them were painful. Nowadays we do not put patients through the tender point exam. Now doctors diagnose fibromyalgia based on the patient’s symptoms and if a person has had widespread pain( both sides of the body and above and below the waist) for more than three months with no underlying medical condition that also causes pain. There are no specific blood tests or x rays to diagnose fibromyalgia. But, doctors will probably draw a complete bood count, sed rate, ccp, rheumatoid factor and thyroid function tests to rule out other underlying disease.

So, how do we treat it? Is there any hope? The best option for fibromyalgia treatment is a combination of medication and self care. I am a fan of the multidisclipinary approach, emphasizing good physical and mental heath, along with management of pain to increase quality of life. As far as medications, the U.S Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. Two of these drugs alter serotinin and norepinephrine levels to help control pain: Cymbalta and Savella. There are some older drugs that affect these same neurotransmitters as well like Elavil and Flexeril that can also be helpful. The third drug approved to treat fibromyalgia is Lyrica. Lyrica works by blocking the overactivity of nerve cells that are involved in the transmission of pain. Neurontin works in a similar way and is also sometimes used. Over the counter pain relievers like Tylenol, Motrin, and Alleve can also be helpful. Narcotics and opioids are not a good idea for fibromyalgia because they can lead to dependence and even worsen pain over time a a result. In addition, the side effect of sleepiness would only accentuate the baseline fatigue that fibromyalgia patients already suffer with.

There are non drug therapies as well. Physical exercise is the most effective treatment for fibromyalgia and should be used in addition to any drug therapy. Patients benefit the most from regular aerobic exercise or other body-based therapies like Tai Chi and yoga. Let me be clear, I am not saying anything about it being EASY to exercise with fibromyalgia. More often than not, I am usually cursing like a sailor when I first get started, especially if I am having a bad day and am hurting. The good news is that, even if a patient is in pain, low impact physical exercise will not cause any harm. I have to admit that, even if I am hurting at first, I usually feel better when I am done and I definitely feel better day to day if I keep up an exercise regimen. Physical therapy is also a good option because the therapist can individualize exercises for strength, flexibility and stamina. Water based exercises are very helpful as well. My motto is it’s ok to keep cursing, as long as you keep moving.

Acupuncture has also been suggested as an option for Fibromyalgia. Acupuncture involves the insertion of very thin needles through your skin at particular points on your body. It has been a key component of Chinese medicine for thousands of years. The Chinese use it to balance the flow of energy or life force (chi) that flows through the meridians( pathways) in your body. They believe that inserting these needles will re-balance the energy flow. In Western medicine, the acupuncture points are viewed as places to stimulate nerves, muscles and connective tissue. By stimulating these points, your body’s natural painkillers are stimulated like substance P, endorphins, and met-enkephalin. This stimulation of natural painkillers can possibly help with fibromyalgia pain.

The S.H.I.N.E protocol has also been suggested as a holistic approach to treating fibromyalgia and chronic fatigue syndrome. S stands for sleep. Get adequate sleep to replenish your energy and muscle repair. H stands for hormones. Correct any underlying hormone imbalances such as estrogen, progesterone, testosterone, or thyroid hormones. I stands for immunity and infections. Looks for underlying viral, bacterial, bowel, sinus or yeast infections and treat them. N stands for nutrition. Make sure that your vitamins and minerals are in optimal balance. E stands for exercise as able. Don’t overdo it and cause undue fatigue. Gradually increase exercise as tolerable.

It is very important to keep yourself mentally healthy with fibromyalgia. All that pain can really drag you down. Patients with fibromyalgia have a high percentage of anxiety and depression. Some of them had anxiety and depression before developing fibromyalgia. Some develop anxiety and depression after fibromyalgia. I think that chicken or the egg question can never be answered with certainty. I always recommend regular counselling to my fibromyalgia patients and I use it myself as well. A counsellor can be a fabulous resource for stress management strategies which can help lessen flares. In addition, a counsellor can help get at the root of any psychological trauma the patient may not have processed yet.

Last, but not least, I think it is important with fibromyalgia to take an active hand in developing your own strategy for how to deal with flares, keep moving and increase your own quality of life. I have noticed over the years that the biggest predictor of quality of life in my fibromyalgia patients is whether the patient is actively seeking ways to feel better and be captain of their own ship or if they have given up, resigned to be a victim forever. I have some patients who are in a wheel chair and on disability and I have some patients, like myself, who are active with jobs and living their lives. I really do believe that there is a mental game that must be played and won with fibromyalgia in order to not let it rule your life. I know that for myself, I have to get up every day and will myself to keep plugging and keep going, even if I don’t feel like it. I am not successful every time. There are some days when I am having a flare that is so ridiculous that I have to stay home, drink tons of water and wear an ice helmet around my head and neck. I have to force myself to go for a walk or workout because I don’t always feel like it and it hurts when I do it sometimes, but I know it is essential to keeping me moving I have to come up with ways to manage pain that still allow me to function during the day. My favorite pain management so far is to use some daily turmeric as a supplement, do some kind of workout every day, use Motrin when I have to, and drink tons of water to help me clear whatever inflammatory lactic acid that I have built up in my muscles. Massage is great too, when I can get to an appointment. I try to manage stress the best that I can, but I would be lying to say that I am perfect at it. Stress is unavoidable in my line of work…and The point is, that I have developed some strategies that are working for me..most of the time. Everybody is different. This disease sucks, but it is not life-threatening. We need to own it and work hard to find whatever strategy works for us. You are not going to cure it, but you need to find a way to live with it. That’s all for now.

Dr. Katz

NOW she doesn’t want to use social media?! ( Or, thank you Corona?)

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You know how we are constantly struggling to get our teens off of social media, ever searching for that blissful few seconds of direct eye contact? You know what I mean right? The nagging to put the phones away at the table, the desperate attempts to have conversation in the car, the fitful calls up the stairs to try and get their attention while they have locked themselves in their rooms doing who knows what on Face Time? We have all been there. I know we have. You can admit it. It’s ok.

Guess what?! The tables have turned! Now, we are relying on social media and computers for everything! We have to with this quarantine business. Now they have to be on the computer for homeschooling. They have to use their phone or Face Time to talk to friends, or anyone for that matter because they aren’t allowed to see anybody in person, except for the beloved family members that they live with. Wouldn’t you think that this would be a dream come true for them? Of course, I am not suggesting that being cut off from all of their activities, school, and boyfriends/girlfriends is fantastic or anything. I know that it’s not. I just thought that the endless opportunities for social media interaction without me nagging might soften the blow somehow. Weirdly, I think it has made it worse. In my mind, the unprecedented amount of free classes and online activities sounds like a goldmine of opportunity and I would be taking full advantage of it, plus the enhanced freedom of the current schedule. Just think of the stuff you could fit in that you normally couldn’t! Yeah. That is not how my kids are taking it. They are depressed. They are nesting in their beds more than ever. They are missing their friends. They are missing going to class. They are missing going to competitions. They are missing interacting with people besides me! It’s weird. It’s as if being able to see their friends and do their activities in an unlimited fashion on a screen only is now finally driving the point home of how much better it is to see people and do things in person! I did not see this coming! I have been trying to drive this point home for years! Who knew that I needed a pandemic with a side of home quarantine to finally get this done for me?! It feels weird to say this out loud, but thank you Coronavirus? For this one thing?

Dr. Katz

How’re we doin?

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Hi everybody! Shelter in place day 1. How’re we doin? I am feelin the panic from everyone. I even felt a little creeped out last night when I went for my walk and suddenly my phone was overtaken by a reminder of the executive order…complete with a notice about unnecessary travel being prohibited. It literally gave me the chills for a second, like I was in one of those weird future dystopia movies or something. Then, I shook it off. You know why? Because it is not really any different than what we were supposed to be doing anyway! I know what you’re going to say. Hey! Before we could still get take out and go to the mall, etc. Hey! This is even a bigger crush on small business. Yes. Yes. All that is true. My business is being severely affected too. I can’t do any surgery, unless it’s an absolute emergency. I can’t see any people that are sick who actually need me. They have to go through the ER or stay at home. I can basically only see well patients or OB patients, if I can even get them to come in. I am not immune to this process. The scary flipside is, that I also have to risk exposure to COVID everyday. If a COVID positive OB patient comes in, we still have to figure out how to deliver them safely with the least exposure to the least amount of people and keep their newborns safe as well.

However, if you think about it, we were already supposed to be restricting unnecessary trips and travel. We really should have been following our social distancing, not going to restaurants, not going to the movies, not going to the mall anyway. There was no dire need to get our nails done or go to the tanning salon. These are not basic life needs. Before you get all ruffly, let me explain what I mean about basic life needs. They are things that are life or death dependent. Your life or death does not depend on how brown you are or how good your nails look or if you got that extra candle or how gray your hair is ( Trust me, I am battling that one as we speak). It just doesn’t, if we are being honest. I am of the opinion that if we were truly following instructions in the first place, there would have been no need to issue an executive order. (Having said that, I also get that a politician’s need to appear like they are actively doing something in a crisis may, in fact, supersede the actual need for action.) If we hadn’t panicked and hoarded all paper products, in reaction to a virus whose main symptoms are NOT GI symptoms, except for a small percentage, those of us that have been working like crazy might have had an option to wipe our asses besides the wipe with the left, eat and shake hands with the right method. C’mon people! I am looking at all the fear-mongering, crazy Facebook posts. They are unnecessary. They are not helpful. They are not helping anyone get through this thing.

I took it upon myself to break down the governor’s executive order announcement into a less than five minute summary. I will do the same right now for you. Here are the main bullet points. Stay at home whenever possible. If you have an essential job (defined on the website), you can go to and from work. Essential businesses are still open. You can go to get gas for your car. You can go to the pharmacy or grocery store. You can still get money. You can still go to the doctor or to the hospital if you need to. You can still go outside. You can still go for a walk. Maintain your social distance of 6 feet at all times. No crowds. Have meetings remotely. All your basic needs can still be met. Amazon is not shutting down like rumors have said.(JK, she didn’t really address that…lol..but it is true.) Don’t panic. Don’t hoard. That is it in nutshell…in two minutes or less. Let’s just all screw our heads back on properly and dig into our common sense reserves and we will get through this together! Have a fantastic day everyone!

Dr. Katz

COVID-19 and Pregnancy

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Hi everybody! We have been doing so many updates about all aspects of this virus and it’s effects lately. It seems to be all we can talk about. However, I feel like we have forgotten about the preggies. It’s time to review a little bit about what we know about COVID and pregnancy. Please keep in mind that whatever I explain right now this minute could still change tomorrow. The following is a break down of the recent commentary about COVID and pregnancy in the journal Obstetrics and Gynecology.

First, let’s keep in mind that the WHO only declared a global pandemic as of March 11th, so there hasn’t been a ton of time or pregnant women to study since then. Let’s go over what we do know and what we have seen. Keep in mind that this situation is changing rapidly. As of March 17th, more than 189,000 people have been diagnosed with COVID globally with more than 7,500 deaths and more than 150 countries involved. Realistically, this is probably just the tip of the iceberg because of the limitations of testing so far. We know the common symptoms of dry cough, fever, and fatigue. We know that the incubation period is up to two weeks. We know some of the findings on chest x-ray and in lab tests that can occur with COVID and we are working on a serum test instead of the nasal swab. We also know that there are multiple very similar coronaviruses that have been around since the 1980s! Hmm. How new is this thing really? I am asking for purely academic interest only I promise. Has it really been around all this time in bats like the other viruses and somebody just finally ate the right/wrong bat in a soup so it could make the jump to humans?

Ok. I am getting distracted. I was supposed to talk about COVID and pregnancy. So, what do we know about the preggies anyway? So far, there have been three case series for a total of 31 pregnancies affected by COVID that have been published. We also have a WHO report from China with some limited information on 147 pregnancies. We also have reviews looking at features of other coronaviruses like SARS(Severe Acute Respiratory Syndrome-Associated Coronavirus) and MERS( Middle East Respiratory Syndrome-Related Coronavirus) in pregnancy. The American College of Obgyn has already published guidelines for pregnancy and the CDC has posted answers to frequently asked questions about COVID and pregnancy, but there is still a lot we do not know for sure right now.

So, what are the answers and what are the questions? One of the biggest questions is the case-related fatality of the disease in pregnancy. It is hard to sort through the data on the fatalities because the fatality rate really depends on the co-morbidities of the patients, the quality of the health care provided and the age and health of the patients affected. It’s not just straight numbers. So far, rates around the world have been reported in a range from .9% to 9%. But remember, these rates are overall rates, not adjusted for the variables mentioned above. Plus, mild or asymptomatic cases can be missed so the fatality numbers can actually be overestimated. We don’t fully know the fatality rate in the United States yet and as of yesterday, we do not have any fatalities reported in pregnant women that I am aware of.

We still have questions about all the routes of transmission of COVID as well. We are still looking at how long the virus survives on surfaces. So far, 9 days is the magic number, depending on the surface and the particular coronavirus. We are still looking at whether asymptomatic people can transmit the virus. For a pregnant woman, the biggest question if there is vertical transmission of the virus. Vertical transmission refers to transmission of the virus from a pregnant woman to her fetus. We really haven’t had enough pregnant women yet to compare to nonpregnant women of similar age. There was a small study comparing SARS in similar aged pregnant and non-pregnant women that suggested that pregnant women may have a greater incidence of severe disease and death, but we are not seeing that so far with COVID.

As far as vertical transmission, we really don’t know the answer yet. SO FAR, we have not seen it yet in the small number of COVID pregnancies reported up until this point. This sounds great, but I don’t think we can count on this just yet. I am going to hang on to this bit of potential good news anyway for now. I will say that the in the group of pregnancies studied so far, the vast majority of women were infected in the third trimester and most of them had delivery by c section. We don’t really have any pregnancies to refer to at this point where the women were infected in the first or second trimester.

There is a question about pregnant health care workers and COVID. Should they be given special consideration? In the past, the CDC has recommend different guidelines for different viruses. For H1N1, they recommended that pregnant workers follow the same precautions as other workers, but maybe avoid any procedures that could generate aerosols( infected respiratory droplets). A different systemic review of 1862 publications rated the following as the aerosol-inducing procedures with the highest risk of infection transmission of SARS: tracheal intubation, tracheotomy care, airway care, and cardiac resuscitation, non-invasive ventilation and manual ventilation before intubation. Results were mixed as far as nebulizer treatments. With Ebola, the CDC recommended that pregnant workers not even care for those patients. We just don’t have enough data yet to make specific recommendations for pregnant workers and COVID.

Currently, hospitals are recommending immediate separation of newborns from COVID positive mothers postpartum. At our hospital currently, COVID positive mothers will remain in negative airborne isolation throughout their stay. Immediately after birth, the neonate is put into an isolette, separated from the mother and moved into the nursery under negative airborne isolation. Those mothers that choose to have their infants remain in the room for bonding must wear PPE( personal protective equipment) and the infant must stay in the mother’s room throughout the entire stay. Remember that so far, we have not seen vertical transmission (mother to fetus in the womb), but the neonate could still get infected after exposure to the mother after birth. Luckily, so far, it looks like children in general are mildly affected by COVID, but we really don’t know about neonates.

So, where does that leave breastfeeding? We have a very small amount of data that suggests that SARS is not transmitted through breastmilk, but we really don’t know about COVID. Even the SARS data is too limited to apply on a broad scale.

I get it. I just basically said that we really don’t know anything solid about COVID and pregnancy. The situation is just evolving too fast. We do have some possibly good news about the lack of vertical transmission but we need to keep watching. At this point, the best thing to do regarding pregnancy and COVID is to keep using the same methods that we already are to prevent the spread of other viruses like the flu. Tell patients to not go around known ill persons. Tell them to wash their hands frequently and not touch their face. Tell them to cover their coughs and sneezes and not just blast into the open air. Screen pregnant patients for upper respiratory symptoms, travel, cough and fever and triage accordingly. Separate ill patients from well patients. Limit visitors to labor and delivery and postpartum. Cancel mass gatherings and concerts. Maintain social distance. The reality is that pregnancy care does not truly lend itself to telehealth as a rule. These patients need regular visits. We need to take every universal precaution, like we should anyway. Give patients copies of their records frequently in case their care gets disrupted.

Basically, this situation is going to keep changing until it runs it’s course. This is the best info we have available right now. Until we have more data on more pregnant women, this is all I have to offer you right now. I think the key for now is to use common sense and universal precautions and to stay tuned for more updates as they arise. Hang in there and try to have a great day.

Dr. Katz

Listen to the WHO

Hey everybody! Show of hands…who is stressed out right now?…..Ok yes. I see all of your hands….and that is perfectly NORMAL right now. We just don’t want to convert that stress into panic and do something stupid. So, let’s look at some advice on how to not let that happen. The WHO(World Health Organization) Director-General Tedros Adhanom Ghebreyesus said it best during a daily press briefing on COVID-19 at the WHO headquarters in Geneva on March 11th. He was giving out tips on how to stay physically and mentally healthy while living under quarantine. His advice was simple and did not involve any rocket science….Don’t smoke, limit alcohol, exercise and try not to watch too much news!

Actually, he broke it down even further. Let’s go over it. Remember this is right from the WHO so I feel like we can trust it. I will add some of my personal touches as well.

Eat healthy to boost your immune system. Now is not the time to max out on junk food in a nervous binge. I have been fighting this myself. I have also turned to my favorite Amazing Grass Immunity Blend for a little extra immune support.

Limit alcohol and sugary drinks. Particularly avoid sugar alcohols like maltitol. Your body cannot really digest most of them. With regard to alcohol, you have to remember that your body reacts to it essentially as a toxin and devotes all it’s energy into getting rid of it. You just don’t need the extra stress on your body right now. Ok. I get it. Drinking some alcohol may be part of your stress reduction plan right now, but I would advise you to at least keep it in moderation ( A drink or two at most). The term sugary drinks refers to any beverage with added sugar or other sweetener like high fructose corn syrup, sucrose, etc. This includes soda, pop, cola, fruit punch, lemonade, powdered drinks and sports drinks. According to the T Chan School of Public Health at Harvard University, these add calories only and increase your risk of type 2 diabetes, heart disease and other chronic disease. Really, your body does not need the extra stress right now. Save money! Drink water!

Don’t smoke. It can make COVID symptoms worse and increase your chances of getting really sick. I get it. The number of nicotine addicts in the world has not suddenly decreased and this may not be realistic for everybody, but try your best. This includes vaping and Juuling btw.

Exercise at least 30 minutes a day for adults and an hour a day for kids. Make sure it gets your heart rate up and your blood pumping. Physical activity can hep flush bacteria and viruses out of the lungs more quickly. Exercise causes changes in white blood cells and antibodies. These are key elements in fighting infection. The brief rise in body temperature during and right after exercise may help fight bacteria. This is similar to what happens when you have a fever. Also, exercise slows the release of stress hormones.

If you are allowed outside, go for a walk, go for a run or go for a bike ride…remember to keep a safe distance from others ( 6 feet is the magic number for now). Social distancing is very important right now. The concept of social distancing is deliberately increasing the physical space between people to avoid spreading illness. Staying at least six feet away from other people decreases your chances of catching COVID. Remember that the biggest reason for trying to practice preventative measures now is to decrease the spread of the virus and hopefully not overwhelm the healthcare system to the point that we have to turn away people for treatment like other countries have had to do.

If you are not allowed outside, run the stairs, dance, do some yoga. I am going to add pull out an ancient exercise dvd or the Wii and get playing! There are a startling amount of free exercise and dance classes on the internet right now. Take advantage of it! They won’t be free forever.

Attention to everybody working from home! Don’t sit too long in one position. Get up every 30 minutes or so and stretch and change position to keep your circulation moving.

Take a 3 minute break every 30 minutes…and I don’t mean a 30 minute break to watch the news!

Get your mind off of all this crisis. Find your spot of zen. Listen to music. Read a book. Play a game. Light a candle. Meditate. You are probably saying right now meditate? I don’t know how to meditate! Let me let you in on a little secret. There is no right or wrong way to meditate. The definition of meditation is to think deeply or focus one’s mind for a period of time, in silence or with the aid of chanting, for religious or spiritual purposes or as a method of relaxation. If you are finding yourself too much a newbie to get started, may I suggest the apps Calm or Headspace. They are pretty amazing.

Be aware of what is going on in the world, enough to know what restrictions etc are necessary, but don’t watch the news incessantly enough to freak yourself out. If you do tune it for an update, tune in to a reliable source like the WHO or the CDC, not your neighbor or the latest Facebook messenger forward that you cannot verify. I have gotten countless forwards from unverifiable sources. These are all from well-meaning people just passing it on, but really all they are doing are making me more anxious. Tedros suggests that you check in maybe once or twice a day, again, only to reliable sources.

I just wanted to put together some ideas and include the reasoning behind them. I think that too often lately we are just barking out instructions and people are either listening to them or balking at them, but not really understanding the “whys.” Hopefully, this will help. I often find that it is easier to follow through with something if you understand why you are doing it.

Dr. Katz

Just sittin at home

I actually have a day off today. There were no patients scheduled for me at the office. At first I was frustrated by this, then I realized this day came just in time. I am exhausted, emotionally and physically. I have been working non-stop, both in literal hours and in hours spent trying to assuage panic and keep a good face. All of that is very worthwhile, but very tiring nonetheless. I am going to try to embrace this day as my little break and not worry about what is going on in the world around me. I am going to go outside on my deck and feel the wind and look at the birds and enjoy the sunshine. I am officially giving myself permission to relax, which is something I don’t do very often, to tell you the truth. I am going to seek out my own little spot of zen like I posted about last night.

As I started making plans to do just that, I got an email alert on my computer from a marketing company. It was titled something like “How to market in this time of crisis” or something like that. Ok, curiosity got the better of me and I opened it. The whole thing was about making patients believe that your services were essential and making them think they needed you, especially now. I get where they were going with it. They were trying to be helpful and find strategies to help you recruit patients and not have to go bankrupt until Corona Virus blows over…which is a real possibility…..However, it just came out all wrong and somehow selfish. That is just my take on it, of course. I get that now is a time of survival in all senses…physically, emotionally and economically and I am struggling a bit to find that perfect balance of altruism and self-preservation. We all are. But, I am not going to spend my time distracting patients and spa clients and making them think that they need me if they truly don’t right now. Yes, I have plenty of fun spa services to offer in addition to my regular obgyn services. It’s true. It is also true that the spa services are part of what is keeping the lights on right now in the midst of all the panic. Yes, they are relaxing in the sense that the patient is doing something just for them. Sometimes, getting to do that one thing for yourself is the thing that keeps the scale from tipping even further toward anxiety and panic. There is also the reality that the hospital is screening patients at the door so that anyone who even seems slightly ill cannot even get in. If you think about it, your chance of exposure is a lot less in that regard. Still, there is a part of me that feels selfish about advertising right now. So, I have really toned it down not up at this time. What I really want patients to be concentrating on is taking this whole thing seriously, following guidelines, staying home if possible, and keeping themselves healthy so we can be done with this whole thing and resume life as usual. For the patients that do need or want to come in, we welcome them with open arms and universal precautions. Have a fantastic day everyone!

Dr. Katz

Just when I thought I could stop being anxious

I saw the news today celebrating no new corona virus cases in Wuhan. Whoohoo! That means there is an end to this thing at some point, right? It sounds good doesn’t it? Now take a quick step back and remember that this cycle took several months….that we know of. Also consider that China was months ahead of us. This means we are not done with this for awhile folks. This means it is more important than ever to listen to the EXPERTS like the CDC…not google…not your friends( unless they are healthcare workers on the front lines maybe)…not your chiropractor or the kid at the grocery store. Pay attention to Dr. Anthony Fauci! Who is Dr. Anthony Fauci? He is the director of the National Institute of Allergy and Infectious Diseases. If he starts talking, be quiet and listen for a minute. He says think twice before you get on a plane. He says we have to take this seriously. He says that there are no PROVEN safe and effective therapies for the Corona Virus yet. That does not mean that possible treatments are not being looked at. He doesn’t say to panic, but he does say that we all need to do our part to stay at home when possible, not to make unnecessary trips and to stay away from crowds to decrease the chances of spread. Every time I see the latest beach vacation pic lately with hundreds of people in sunny Florida, defiantly partying, I just scratch my head in bewilderment and disgust. What the heck do people think they are doing? Have we become so egocentric that we think that nothing can permeate our own little bubbles? Do we think our actions have no consequences? Newsflash! There are no bubbles right now! Every single unnecessary exposure just puts more people at risk like gigantic ripples on the ocean. I can’t help looking at those pictures with some resentment as I am going straight home from work and then straight back to work the following day. I think about the vacations that are now cancelled and everything my kids are missing. But guess what? All those things are survivable and worth it! I realize that the government is not just trying to ” control” me or “mess with me.” They are trying to take what steps they can to stop the spread of this thing. Believe it or not, the same folks that are defying the guidelines while complaining about being controlled are the same folks that are taking the one element that we can control( social distancing) and throwing it to the wayside, unilaterally deciding for all of us how the course of this virus will go. I had to go to the store today for the first time in awhile. I was standing in line and these two people stumbled up next to me, obviously under the influence of something and were making out in line. Then they decided to plunk their items down almost on top of mine and then snatch them back, run back to the aisle and pick out something else and then plunk that down on top of my purchases. They were also both coughing with no attempt to cover whatsoever. I looked at the guy and said,” What are you doing? Now is not the time for that.” They just stared at me, shocked, as if it completely escaped them that I would not want to be coughed on, bumped against, watch them slobber over each other, or have our purchases hang out together like some kind of slumber party in the middle of a pandemic! Imagine that! To be honest, I wouldn’t enjoy any of those behaviors even if there were no pandemic, but who’s It is just this kind of ignorant and belligerent behavior that is going to get us all into trouble, make this pandemic last longer and completely close the small window of opportunity for us to get back to our normal lives a little sooner. Please people. We have to do better. It won’t kill us to stay in our houses more, cook at home, stop making unnecessary trips or avoid crowds. Life will go on temporarily without trips, festivals and concerts, but if we don’t try a little harder to follow these temporary guidelines, we will end up having to forcibly surrender all of the autonomy that we thought we were fighting for in the first place.

Dr. Katz

Pandemic has panic right in the title

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Hi everybody! I get, more than anybody, how scary the world seems right now. We hear crazy reports on the news everyday, which are then contrasted with reports that we hear from doctors so then we are not sure what to believe. We have politicians trying to float conspiracy theories. Is it just a conspiracy? No! This is serious business. Let’s be honest. There really isn’t anything worthwhile for anyone to gain by making this up! We are on the brink of a national shutdown because of how quickly and efficiently this latest Corona Virus can spread and mutate and we are scratching our heads trying to think of whatever we can do to help stop it in it’s tracks. We have gone from a free and independent lifestyle of choice to being confined to our homes for work and homeschooling. We can’t dine in at a restaurant anymore. All “non-essential events” have been cancelled like band festivals, concerts, sporting events, etc. I would have to argue that the definition of a non-essential event is definitely in the eye of the beholder. I think that the government is defining them as events that do not affect a life or death outcome. Ok I get that. However, cancelling graduation or the last season of sports for a high school senior is potentially devastating. Those kids have worked hard for 12 years to get to that point, only to have their finale taken away. I am not suggesting that these guidelines are not necessary, I just think that we all have to have a little patience and realize just how different the impact is from person to person. Most teenagers are just reaching the point of beginning to think outside of themselves and are not really ready to handle that kind of setback…at least not easily and not without some adult guidance regarding ” the big picture” of it all. It is our job to help them through this as well and explain why it is not a good idea to use this time to head out and party.

People are panicking in all different ways. Some are buying up all the toilet paper in the free world, even though gastrointestinal symptoms are not traditionally associated with this virus. ( I would love to know how that rumor got started. ) People are hoarding. People are picking fights and defying the government’s current recommendations for home confinement. People are becoming belligerent and focusing too much on the ” no one can tell me what to do” aspect of all these latest guidelines. People that is not the point. No one is trying to focus on controlling you or crushing your business. We are trying to prevent as many controllable methods of spread of the virus as possible and it makes the most sense to start with keeping people from interacting in large crowds or confined spaces if possible. You have to stop thinking of yourself as a single, untouchable entity. It is just not the case in this situation. Every action by every person has consequences and it won’t take much to tip this situation quickly out of control. If we can find it in ourselves to try our best to go along with these recommendations, maybe we don’t have to get to the point of a national shutdown like other parts of the world. Maybe if we pay attention, hunker down a bit, use our common sense, stay educated, try to focus on accurate information, we can shorten the course of this virus’ impact and get back to our lives sooner.

I don’t have the luxury of staying at home because I am a health care worker. Those babies are not going to deliver themselves and last time I checked, my patients can’t perform their own c sections. Alas, I am stuck going to work. Really, I am kidding. I don’t feel like I am stuck. Yes the hours have gotten longer and the restrictions more inhibiting. We cannot do elective surgeries any more. I have had to disappoint patients and reschedule things. But, it is part of my job. I love caring for people. I consider it my duty to stay calm and focus on disseminating accurate information and getting patients the help that they need in the safest manner. I have a goal to be the calm in the storm if at all possible.

It is hard sometimes not to fall into the panicky mindset. I find myself laying awake at night wondering about every little symptom I might have or overthinking the decisions I made that day. God forbid I cough like one time. Even though I know better, I start pondering all the possibilities all over again. People are so freaked out by a single cough nowadays that I found myself prophylactically throwing a throat lozenge in my mouth before going to the grocery store today because I don’t want to start a panic in the produce aisle. I did let out a single sneeze today when a man with a ton of cologne walked past me. I got death stares as if I just stabbed somebody.

I have heard a lot of criticism of the medical community lately for making jokes during this time. Lighten up everybody. We are dealing with this everyday with countless people. We are still going to work and trying to figure out how to manage the new normal in our homes. Do you really think that we think this whole Corona Virus situation is funny? Hell no! It’s called a coping mechanism! Would you rather that we panicked and freaked out and acted like morons? I think not. Humor is one of many ways of dealing with a tough situation. Sometimes it is the only thing that gets us through what have been some of the toughest days of some of our careers lately. It’s definitely not keeping us from doing our jobs I promise you. Please. Let us have our humor and try not to be offended. When Meredith Grey makes a joke, does it stop you from watching Grey’s Anatomy because it seems too inappropriate?

The more I think about this, the more I think that we got this people. We are capable of buckling down, adjusting to our new normal, putting our routines on hold so we can get through this. It will be economically challenging. It will be frustrating, sure. But, I know we can do it. Panic and belligerence are not the answer. Let’s try something different. Use this crazy twist of fate and epidemiology as an opportunity to bond with your family! Dig out those board games that have an inch of dust on them. Play cards. TALK. Make some tik toks together. Sit down to family dinner together. Have a music jam. Play the Wii. ( Does anyone still have one of those? Pay more attention to the family pets. Rediscover a hobby that you put by the wayside long ago. For me personally, it has been an opportunity to clean the shit out of my house, which was crazy overdue by the way. It may seem insignificant, but there are gains to be had with this forced closeness. You just have to switch your perspective a bit. I know we got this. Good luck and stay strong everybody!

Dr. Katz