Traditionally, it seems that most patients do not view their physicians as actual, potentially flawed human beings. It’s just too uncomfortable a concept. If patients viewed their doctors as humans, that would mean that they would have to acknowledge the fact that they can make mistakes, have emotions, have physical ailments, and emergencies as well. To most patients, that is an untenable thought. Their doctors need to be superhuman, infallible, and infinitely available at a moment’s notice. This kind of thinking allows patients to engage in demanding, unreasonable, and entitled behavior at times and puts a significant burden on the doctor patient relationship.
Interestingly, this seems to have turned around somewhat now in the time of COVID. Now it seems like patients are attaching themselves more to doctors who are showing their human side. The videos I post of myself at home in regular clothes or talking about how I finally figured out how to do my nails by myself get tons of views. Patients are listening with baited breath to see how I might be struggling with all of these changes. It’s as if listening to me is giving them tacit consent that it’s ok not to be ok right now. I feel like giving them a glimpse into me as a person is actually helpful right now. I can potentially help guide them through the proverbial tunnel to the other side of this thing. I get excited when I post my Facebook live daily video in the morning and all those people tune in. Knowing that I am able to reach all those people in a positive way helps me too. Personally I am loving it. If I can be myself with patients and still help them at the same time, I am all in! I would prefer to be that way all the time, within reason of course. I still stand by what I have said in previous blogs. Patients who are suffering or have just been given a terrible diagnosis do not necessarily care how I am feeling at the moment. Common sense still has to reign supreme here. I guess what I am really saying is that I hope the compassion doesn’t die out when the pandemic does. Have a great day everybody!
I saw a meme the other day with a woman straddling a lap top computer and it read: The new face of gynecology. At first I totally laughed out loud, carefully distancing myself safely into the ” That’s so ridiculous.” response category. Then, I stopped and realized whoa? Are we that far off from that right now? The struggle to get on the list of essential businesses right now is real and we all want to get there, but who decides what is essential and what isn’t? There are some things that are black and white in regards to this decision…..or are they? Ice cream shops are not essential, unless you have that sudden, overwhelming craving or you are a pregnant woman and nothing else will do to go with your pickles. Paint shops are not essential, unless you were trying to finish painting your wall and ran out just prior to reaching the last quarter panel. Movie theaters are not essential, unless you are on your last nerve with multiple bored children and seeing a movie is literally the only thing that they are able to reach a consensus on. I realize that these examples are somewhat facetious, but you get what I mean about perspective right? I totally agree with social distancing and restricting interactions to essential ones to help flatten the curve and decrease the spread of this awful virus. I am just not sure that we are all on the same page regarding what is essential and what isn’t.
I hear lately that gynecology is not essential and that obgyns should only be seeing ob patients or patients with infections. WHAT?! HEH?! I guess that seeing ob patients is more of a black and white call since there are two humans involved and we cannot monitor them over the phone or perform ultrasounds…..or c sections, but why isn’t gynecology essential? Why aren’t vaginas important? I am living in fear of fines or getting reported right now as I continue to see gynecology patients( with a zillion precautions of course) that I deem to be essential. It’s all I know how to do. Gynecology patients still need care, COVID or no COVID. The key to the relatively high success rate of cure in gynecology is timely, proactive, and preventative diagnosis and we are removing that advantage all together by denoting gynecology as non-essential.
I have heard patients say that they were turned down by other offices when they called to make an appointment because they were having abnormal bleeding. I confess, I got them right in! To me, bleeding is essential! I have had to turn down multiple patients whose incontinence I am treating with our awesome in-office options because that is not considered essential. I am sorry, but not peeing on yourself uncontrollably seems very essential to me. I am not allowed to do gyn surgeries for right now unless life or limb is imminently threatened or cancer staging is affected. Well, how am I supposed to know if cancer staging is going to be affected if I can’t go in and look with hysteroscopy in the first place? I can’t make that call without all the information. What if doing that surgery would make a life or death difference and I just don’t realize it? In addition to that, if I wait until someone is bleeding to death( life or limb risk), it may be kinda too late to do anything about it. Just sayin. If we get a bad outcome in the end because of delay in care due to COVID, are we going to be able to use the COVID-19 defense in court? Do we think that patients will care that we had to hide behind COVID restrictions if they lose their own lives or the life of a loved one? I feel confident that the answer is no when this is all said and done. I feel like all of these delays are just a tiny sample of the reality of the socialized healthcare that people think they want because it sounds good on paper. Just something to think about. Have a great day everybody.
The struggle is real! I have discovered yet another snarky perk of the war against COVID 19: chronic mask-wearing acne! It is a beast that is not likely to be tamed any time soon…lol Our skin is under attack from chronic suffocation, bacteria and the extra dry environment under our masks. Who knew we would be fighting a blemish war too! I did not sign up for this. Having said that, would I rather battle a pimple than a life-threatening respiratory infection? Yes ma’am I would. There are things we can do to try to save our skin for now. There is nothing we can do if we die from COVID 19 so, in terms of the big picture, the war on acne is decidedly less important. However, I just don’t need one more thing to frustrate me when I look in the mirror in the morning and neither do you so here are a few tips. Personally, I have stepped up my skin regimen to include three times a day face washing with my Neutrogena Cooling Gel Scrub: once in the morning before I put the mask on, the second I take it off when I get home, and again before bed. I have also added cleocin wipes twice per day for the bacteria that are now allowed to lay on my face all day. To combat the additional dryness, I am adding a little bit of Neutrogena Oil Free Moisturizer. Now, if you are not experiencing dryness, please don’t add the moisturizer. It will only make things worse.
Now that I am done complaining about my skin, let me start out by saying that I believe in almost all of the precautions that we are taking lately to help prevent the spread of COVID. Or, at least let me say that I understand them all, but I still have mixed feelings about some of them. We need to wear the masks when we are around people and patients and have to go to the store. We need to practice social distancing of at least six feet. Yup I get it. I have to admit that I am still not sure about the limiting going between two houses and the not being able to paint or plant part. I understand that if you are going to your cottage you probably also have to go to the gas station and grocery store, but if you want people to distance, what better place to do that than their cabin in the woods? The same kind of goes with painting and planting…..unless people are throwing plant and paint group events. So, the store is open, but the parts of the store that people could use to stay at home and do home projects to keep themselves busy is not. Hmm. I can understand people’s frustration with that one. I think that if you are asking people to do necessary self-quarantine and social distancing, why not facilitate it being easier to do so? But, keep in mind that the government is just trying to keep us safe and that restrictions are necessary. Also keep in mind that some people would take these extra allowances and run with them and forget social distancing all together and put us all at risk. I guess it is a balancing game: potentially over calling restrictions to balance out risk for the people that would abuse the extra allowances and cost thousands of extra lives. It is an incredibly difficult game to play and I do not envy the government officials at all. The responsibility of just caring for my family and my patients is a lot to take on at times. The responsibility for a whole nation must be overwhelming to say the least. I don’t think I could handle it. Could you?
Yes I said it. Easter was still good. I saw everybody posting in despair about not being able to see family members. Umm. Unless you live alone, you still saw some family members right? Or, even if you do live alone, there is still skype, facetime, zoom, etc. You can still see people that way. Yes, you can’t hug or touch them, but we are not supposed to right now anyway remember? It’s a saving lives thing? So, even if you were able to get close enough to see them, it would still be like a tease because you couldn’t go up an grab ’em like you want so what would be the point?
Anyway, moving on. Like I said, Easter was still good. We still had good food. We still enjoyed the company of just the four of us: my husband, myself, and our two daughters. We ate at the dining room table with no cell phones. My husband did all the cooking! We formed a group chat with the relatives. We still had an Easter egg hunt. I still left baskets out for my teenagers with chocolate and goodies….and autographed pictures of the Easter Bunny of course. We still decorated eggs. We still stopped to remember what the day is really about and gave appropriate thanks. No, we did not attend a live church service. No, we did not go to a big family party. We just laid low. It was a great excuse to not wear a bra and stay in pajamas all day. I don’t think I even showered as a matter of fact, not because I was depressed about COVID or angry at the Governor, but because I just didn’t have anywhere to go. The pressure was off. That’s a plus in my book.
On a side note, we groomed the dogs out of desperation. That really just reminded me of how indispensable our groomer really is and how much I respect her for keeping safety in mind and also laying low right now. Both are dogs now look like a five year old took the kindergarten scissors to them with no supervision. Hey I tried ok? I mean, they don’t seem upset about it. I didn’t cut anything I wasn’t supposed to. There was no biting, blood, or whining. As a matter of fact, at one point they just laid down and surrendered because I think they realize that all other options had been exhausted. So, I am gonna take that as a win…for now. But the second the groomer is back in business I will be begging at her door and bringing bribes…lol.
I think the thing that I enjoyed the most is that the four of us were together all day long. My 16 year old even made an appearance instead of lurking in her room. We had great conversations. We admired our own handiwork in literally every room of the house that is now organized and purged for the first time in like seven years. Whoo! I took the time to just look at my kids and my husband and listen to them and soak up every minute. These things seem so small and trivial, but I treasured every one of them. They all remind me of how precious and wonderful life is and how we should never take even the smallest thing for granted. Hope everyone had a meaningful and happy Easter!
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.
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.
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?..lol) 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!
