Category: coronavirus

Cleansing

Joanne Dragun, M.D.

Last evening Jacksonville, Florida opened its beaches. Couples and families piled into jeeps with surf boards and bikes and raced out of my neighborhood (just 5 miles from the beach) at 4:30. Crowds jostled toward the surf at 5 PM on the dot as if they had just escaped from prison. There was a collective sigh of relief, not always hidden by a face mask,  but the exuberance and joy was evident everywhere. It isn’t even warm enough to surf or jump in the waves but people wanted a cleansing for themselves not just door knobs. Its been a month of fear, frustration, lack of schooling and loss of income and as children played in the sand, couples walked hand in hand, surfers tried to keep a distance, the sense of community said “Enough!” Many think, “If I get Covid so be it. I will take the risk that there may not be a ventilator for me.” The farther along we are with the management (there is no treatment yet) we realize ventilators are often not the answer. My responsible comment is to say, “Please stay home until its safe as to not overwhelm the system”.

The stay at home orders and shutting down of all elective surgeries and medical care resulted in hospitals now half full. Everyone is waiting for the surge, terrified of what happened in population- dense New York. It will not happen everywhere, but an outbreak in South Dakota shutting down a meat plant, demonstrates how infectious this disease is and insidious. A football player who never left the house gets infected but an ICU nurse with inadequate PPE does not. It seems so random. We do however, need to have a sense of caution. We also need to stop hiding in fear. In 5 days we will know if the Jacksonville experiment was safe or a disaster.

So how will we proceed ? I like to take a page from our patients. They are some of the most vulnerable yet they behave as if there is no risk. After all, the real threat is a cancer they are managing and treating. They do not have the energy to battle everything or the luxury of staying home. They show up everyday and teach us how to handle a crisis.

We all have friends and family with cancer who for years have walked boldly out the door to face the unknown, maybe with a scarf on the head, a badge of courage over the porta cath, a bag of knitting or work laptop for time in the chemo chair. They are not afraid. They come for toxic, scary, debilitating therapy and say, “Bring it on!” Cancer is also an unseen demon that took up residence in them without warning. No Clorox or Lysol can make them immune. They cannot wash their hands of it. If they hunker down at home in fear and sadness, they miss their chance for improvement or cure. And so they show up again and again. Our patients teach us about self care and recovery. Although some of us have not been exposed to this virus,  they are a reminder that we have been exposed to courageousness, fearlessness, determination, even fierceness. These are contagious too.

These brave individuals give us hope. They teach us that the real cleansing we all need is refreshing our minds. This fear will not be sprayed or wiped away. Cleansing our thoughts of worry and fear is therapeutic. Open the doors and windows and let the fresh air circulate to reduce the virus and “wash” the air.  Shut off the TV which is stealing our comfort and peace- the “news” is a threat we have allowed into our homes and is like a virus itself. Open your environment to a new way of thinking. Read a good book, dance to music, take a course on line, write a journal, tend a garden, do yoga, spend time in the sun which seems to kill this virus (thank goodness). Recovery on every level from this pandemic will take much more than testing and tracing. It will be personal for each of us. It will require us to face the unknown just as my patients do everyday. Trust that you will leave your home and venture forth with deliberate bravery.

Cleansing your spirit is a first step.  Welcome in the joy of freedom with each breath and prepare yourself to go out and face a bright future. It will require a mask, social distancing, honoring our immunocompromised and elders to keep them safe, washing our hands and not touching our faces, but you’ve got this down by now. Cleansing is a way of life. You are well prepared to take back our world!

 

THE RISING

Joanne Dragun, M.D.

We have all been instilled with amazing grace. We each have internal fortitude beyond what our thoughts can bring to awareness. Human history is defined by suffering, but it is our own personal pain and persecution that can seem so unbearable. There will be prayers passing over and Easter Resurrection this week and in each, the collective religions and universal humanity will offer up this new suffering in hopes of rebirth.

Now more than ever we must draw strength from the generations before us. Money, food, jobs, even health have been forever changed. Isn’t that true for the Jews protecting their firstborn in the passing over?  Jesus’ disciples being persecuted? More recently the grandfathers who went to the city dump to find shoes for their children in the great depression?  The parents who fought for years, not a few months, in WWII and the men and women who battled in Vietnam and mid-east? Weren’t there times when the pain and suffering was so great that the world as they knew it ended?

We are here today because they did not give up. We do not have all the answers- not for cancer- not for this virus and not for the economic challenge ahead. Neither did they. But every one of us can get up, reach out, pray, plan, and be strong for those to follow. A friend is sending videos of her new grandchild getting ready to crawl. She pushes back and forth in what looks like pushups with such anticipation and energy. She will get there, she will bring hope and light because she has a beautiful future.

In war, as my husband says, its not the country you fight for its the man beside you. So let us fight for each other. Let’s be strong together. While in this pandemic, governments can help, but no government has ever saved. For that we need higher power. We need to pray boldly and be unafraid. We must believe that this pain will Passover. We should believe in the Resurrection and for ourselves. Belief is necessary for the future and  no one has power over what you believe. We are in our own (literally) trenches. I believe the pain will pass. I believe the suffering will diminish. I believe that this pandemic and trials will define a generation and history will find we were resilient and strong. I believe if we pray as one voice we are heard. I believe you have within you every cell of compassion, hope, and strength to survive this and that we will each find our way to thrive again.

Your personal Resurrection is coming, just believe it. Jesus may have opened the way but His followers found hope, persevered and spread His teaching not for a generation but world wide for over 2000 years. This virus may be highly contagious but you have weapons against it- Belief is contagious, courage in battle is contagious, strength is contagious, laughing, positive attitude, joy, empathy,  and gratitude are all contagious. Let’s open our hearts to hope together.

Now put on a mask or scarf and go out for that walk, knowing that you are not alone. You are in a family and a community of believers.

God Bless you this Passover and Easter season. Have faith that we will all hug our loved ones soon.

 

Do this – not that

Joanne Dragun, M.D.

Recall the simple child’s game “Simon Says”? Your friends would have you do the craziest things and then everyone would giggle at the silliness. No one is giggling now, and yet we find ourselves in the midst of another crazy game. This COVID creep has crept into our lives with these seemingly random “Simon says do this- not that” directives. For all the independence we espouse, how quickly did we all adjust every aspect of our lives, stay behind the line, follow the rules in the hope of salvation? There is however, a sense of comfort that we are all facing this together. Many of us can recall a time we were challenged by a trial, sickness, cancer, injury, or fear and were forced to manage alone.  This pandemic, while physically pushing us apart, is bringing families, friends and even countries together.

We are eager to get it right and so we are complying with one way aisles in Walmart, washing plastic packaging, singing happy birthday (twice), not wearing a mask, oops now wearing a mask, and so many “Simon says” type actions. We wonder if the slightest mis-step will endanger us or a loved one.

Here is a recap this week of information and info that explains these random directives (Johns Hopkins*):

The virus is not a living organism like bacteria. It is a protein (DNA covered by fat) When it gets into your mucus membranes (eyes, nose, mouth) it mutates and multiplies. It isn’t killed but decays on its own. It is fragile so if you can cut the fat (foam, scrubbing 20 seconds with soap) the protein breaks down.

Other ways to disrupt the molecule: heat over 77 F for washing, clothing, alcohol over 65% dissolves fat (not vodka), 1 part bleach/15 parts water dissolves the protein from the inside. Pure hydrogen peroxide works but burns the skin. Vinegar doesn’t break down fat.

Don’t shake clothing and bedding. The protein will disintegrate on porous surfaces in 3-4 hrs, 24 hrs cardboard, 42 hrs metal, 72 hrs plastic (so wipe down products you receive or bring into the home.) Wash hands after touching everything and keep nails short. The virus likes to hide in cracks.

Dry, warm, bright environments break it down faster (warm, wet are worse) so air out your house and car. The more confined the space-  the more concentrated the virus. Limit time physically together especially in enclosed spaces. Think ‘under 6 feet away keep under 6 seconds’. The likelihood of infection in a quick transaction is very low- always wash hands afterward and don’t touch the face.

So now you know how to protect and why-  social distance, wash hands, don’t put magnets up your nose (unbelievable from an astrophysicist no less), stay home for now. Wear a mask if you must go out (don’t keep readjusting, that’s just touching your face again)  You can do this. You can be safe and well.

This little ball with the fancy red hooks isn’t tracking you- it is just looking for a place to replicate. Don’t give those deceivingly cute projections a place to latch onto. Do go out for a walk (again, Doc you are a pain about this!) Yes, but it keeps your mind and spirit up and improves your well being for every major disease including cancer, and fresh moving air has less virus. Share your funny memes, talk with friends and family, enjoy peaceful meditation every day.

Every brilliant mind and company is working feverishly to find treatments and vaccines. I participated in a conference call today, “Lessons from the front”  for physicians across America with all the major government leaders (Dr. Birx, Dr. Hahn FDA, Seema Verma, CMS and physicians from New York to Washington to Nebraska and Atlanta) all in the heat of the battle. Every question and answer leads to a sharing of ideas and best advice. Even discussions about every type of therapy, what has been learned on the front lines for others to prepare, (like treating patients prone, setting up triage tents to keep people from crushing ER’s and ICU’s, and in NY, having 911 calls directed to telemedicine docs to triage) as well as some of the seemingly smallest to overwhelming issues they have faced. It is a national group think tank. Trust me and them, we will get to the other side.

*For outstanding information go to: https://www.coronavirus.jhu.edu

Addendum on masks: Wear a mask when you are out of your home and especially if you are undergoing treatment for cancer or are immunocompromised.  Barriers do help. We are now told that you can breathe this airborne virus in, hence remember to distance yourself. Oh and send some virtual love to that nerd you were too cool to hang with in high school because they are getting us out of this mess. Be grateful some people didn’t aspire to be influencers. Their brilliance will save us all.

 

 

 

 

Cancer and covid

Joanne Dragun, M.D.

After 9/11 we witnessed the disruption in travel and the loss of innocence. We gave in and believed if we line up at the airport, put security and barriers around everything we would be safe. There are many similarities this week with the new threat. If we allow, it will be all-consuming and steal our money, entertainment, family and friends interactions even toilet paper. For cancer patients, it may even steal their cure.

Jeanine starts her therapy this week. “Doc, shouldn’t I just wait until this all blows over? I don’t want to get sick” I express to this frightened patient that as long as she is careful (you know the drill: hand washing, no touching the face, avoid others, stay home) we should treat the disease she has, not the one causing fear. The common flu is ubiquitous and deadly* but we don’t stop our lives. We live, we manage, we are brave and not giving into this. Not to be brazen and unwise, just to maintain control. Being anxious, fearful and paralyzed does nothing to contribute to our wellness.

This virus is not seeking us out. It isn’t tracking us down and attacking us in our beds. It’s all in the way the information is approached. We never ever had this level of tracking with other non-curable viruses that caused tens of thousands of deaths. You probably barely recall the bird flu, the swine flu, H1N1. You still worked and lived your life and although many people did succumb to the infection, the world and your own life didn’t stop unless you were directly affected.

In oncology, I actually do have a recommended answer for Jeanine. Medicare (CMS) has come up with suggestions for treatment. Low-risk cancer can wait a few months, medium risk are at the doctor’s and patient’s discretion and high risk should move into care. Cancer centers are well equipped with the ability to sanitize and care for very ill patients. What arrogance this virus has to make us postpone our own well being. In some cancer cases, months are short- should we just abdicate the time we have?

So what are my recommendations after hundreds of hours researching and reading, seeking counsel and advising? If you are well, do not seek healthcare at all. No followup routine visits, no testing, keep yourself away from the ill and frail for your sake and theirs. If you have started therapy or are of moderate or high risk (check with your oncologist) go full steam ahead. If you are newly diagnosed and low risk consider waiting a few months.

This virus isn’t going away but over 90% of us will survive it and even the elderly frail at risk survive 85%. If you venture out you won’t know until up to two weeks after if that was a mistake. But do go out for a walk in nature- the runs to the supermarket or home depot are over for now. A new dynamic has been birthed making communing with nature more precious. Taking a break from our busy lives is something we rarely do so enjoy the peace and solitude. Then be ready to jump back in, hopefully soon. We cannot wait 18 months until there is a vaccine to live. We should be determined to survive and thrive in spite of this virus.

I am going to be strong with you. I am not going to be still hoping a cure will rescue me or a drug will treat me. If that happens fine, but the news would have you believe it is the only way. Make your own way. Don’t be careless but don’t be frightened. Fear didn’t keep cancer away so there really isn’t any therapeutic value in it. You have the power to handle anything that comes your way.

For up to date information: http://www.cdc.gov                                                                                                     *note (hopkinsmedicine.org): flu, 1 billion cases worldwide, up to 646,000 deaths. Up to 60,000 deaths US.

Addendum: The $2 Trillion rescue plan was passed by a self-centered congress yesterday. They laughed and patted each other on the back (hubris ignores social distancing.) While we the people take out an enormous loan for politicians’ special interests, let us pray that my colleagues on the front line will receive the equipment they need and not find it necessary to wear trash bags and bandanas. Doctors, nurses, EMTs are naive- we don’t catch diseases like cancer, heart attacks, strokes, and so they jump in and rescue no matter the thought for their own safety- always. They believe they are invincible even in the face of this invisible pathogen. May God bless their bravery and provide.