Category: covid

Gifting

Joanne Dragun, M.D.

A lovely patient has been busy through chemo and radiation sewing beautiful masks. The fabrics are fun and fanciful yet keep toxic inhalations at bay. She even included some college teams. Her gift of love is extended not only to our staff and fellow patients, but she is mailing to Texas, Ohio and other cities in Florida. It is a great way to share the “we’re in this the together” time. Another patient is making meals she shares with an elderly neighbor. He helped her through her drama of diagnosis with his own strength with cancer history. Mrs. Charles gifts a large pack of precious toilet paper to another patient, Mrs. Evans who is in a wheelchair and unable to go anywhere except this therapy. The gifting and kindnesses go on and on (as is usual with cancer patients anyway) but more so now. This lifts everyone’s spirits.”Doc, its never about me- everything I do, even this therapy is for my family” Hank says. Malinda is a substitute teacher, unemployed. She is “manning up” accepting the risk  helping at the church to make food bags for children- her heart is breaking for them more than her need to feel safe.

What is it with these cancer patients? They are such a fierce group. “Doc, you concern yourself with my treatment but let me live how I need to”. Maybe these gifts from the heart are what is keeping them going- being needed, which is a prime motivator for life. So these feisty cancer patients and survivors are changing my own dialogue. I want to say “be safe, stay home until there is a better way to manage this disease, don’t put yourself at risk (there are patients who have lost the battle not from cancer but the virus). But instead they teach me everyday. I now think: Be strong, don’t cower, push back, remain tough as you had to for treatment, don’t be bullied, spread love which boosts the immune system like nothing else can.

So a new message is evolving: Continue to gift your spirit- even  with a phone call. There is so much rescuing to do. The pain will only heal with human kindness- not a vaccine or drug.

There will be a time when our formerly self-centered lives return to a new normal. But the break in our focus is so dramatic, devastating and gut wrenching that we will all be changed. People are waiting hours in line for food (“Doc, I’ve worked everyday since I was 14 now I can’t afford gas to come for treatment”.) There is no way this won’t have a lasting impact.

If you feel compelled and are able to help, I will not direct that you cower to the threat. Of course I want you to stay safe which may mean staying home. But we know that you are fearless and unlikely to listen to caution after these past months of peeking through the blinds.  Instead I encourage you to live that life of sacrifice and strength that helps you to fight this cancer battle and continue to be unafraid. You are needed. (Just wash your hands and wear a mask).

Super Spreaders

Joanne Dragun, M.D.

Hands washed. Check. Wipes in the car. Check. Sanitizer in the small purse. Check. Keys and credits card handy so no routing around. Check. MASK ON. CHECK! Heading out the door today for any endeavor takes some planning that has now become habit. With numbers increasing in Jacksonville, it remains wise to continue precautions. (Even the RNC canceled. The President’s need for adoring fans is like a need for air- just not this air!)

“Blah,blah,blah!!!!” I hear it across the store aisles. A woman is tossing things into a cart while on the phone- no mask. Not even tucked like so many under her chin as if she had a chin lift (you do realize there is no point of entry there). She is shattering my peace. It is smart to get in and out or buy online and when you can’t, then make your trips quick, efficient, and distanced. The reason I was appalled is that she didn’t distance, talking like that spreads,  and she seems insistent on avoiding responsibility. If someone has a medical condition enough to avoid a mask, stay home please. Like a bee you cannot avoid (well, more like a murder hornet)  she kept following me, so eventually I overheard her conversation.

It was a tirade of complaints from one thing to the next. Her “chi” was very disruptive and brought to mind Peanuts’ “Pig Pen”. I wondered who cared enough to let her whine. It dawned on me that she is a super spreader of hot mess. People who complain constantly, or just want to hear their own voices and not listen, are infectious too. It was noxious stimuli for me.

I rushed out to the safety of my calm, peaceful clinic. I thanked God that demoralizing and aggressive chatter does not happen in my sheltered space. Here, people have every right to be disenchanted with their circumstances. They may be too ill to care for themselves and need to move from home, concerned for the children who may lose a parent, fearful of cancer and it’s treatment now adding to COVID job loss and money woes, so many issues surrounding this insult that vary with each individual and family.

Patients are sitting in front of me daily who have every right to cry, kick and scream their shock, fear, and anger. Instead what I do see is a serenity that is ethereal. It’s not all acceptance; they are here to fight or at least learn. At every turn there is hope and always the love and concern for others come through loud and clear. Above their masks, the eyes tell me all I need to know. Wide eyes, a crinkle of smile, a soft tear- all at the same time in this sacred space.

You will encounter thoughtless people like that shopper many times now. I hope we all remember that many many more of us are being brave in the face of challenge, far beyond a capability we thought was within us. Positive, uplifting words are necessary now more than ever. Gentleness, a loving spirit, and show of courage are also contagious. Let us all be super-spreaders of the very best kind.

Getting Testy

Joanne Dragun, M.D.

Could we have a few weeks without Covid in the blog? Nope! With increased cases, many are wondering if, when, how to get tested. Just remember even if you do, it just proves you are not positive now- not tomorrow, and it doesn’t protect or show if you’ve had it and recovered (that is an antibody test). More important than tests is getting care quickly when needed.  Immunocompromised people (diabetes, cancer, heart disease, COPD, asthma, kidney disease, hypertension are all at increased risk for severe inflammation and hospitalization. Let’s look at symptoms, signs and provide advice with each:

GO to the HOSPITAL (do not fear – they are better at testing, triaging, and treating now.

No need to wait for doc visit or test. Time is of the essence so go quickly with: change in mental status, speech or vision changes, severe headache, confusion (strokes and meningitis), lack of oxygen, or blood clots are serious. Doesn’t matter if you are covid positive you need care.

Chest pain, shortness of breath, worsening cough with pneumonia, faces or lips blue.

Covid fingers or toes can be signs of blood clots (red or purple) represent a lack of blood flow and risk for lung, kidney, and brain clots. High fever. Don’t sit and watch- go, especially if you are in the high-risk group.

Call Your Doctor:

Sore throat, runny nose, congestion (virus enters through the nose so masks up!) Nausea, vomiting, diarrhea, especially with fever. Doc may send you for testing. Do not let anyone dismiss you by saying you have a cold or allergies. If you think you’ve been exposed inform doc and get tested.

Fever over 100.5 especially with fatigue “can’t get out of bed”, feels like flu, body aches, malaise. Do not wait weeks for an appointment. Tell them you are concerned and they will send you for the test.

The virus is ubiquitous in the community and the body. It is highly infectious and spread by aerosol. If you have symptoms, isolate. Call your doc and get the test.

The roll-out of testing and care is confusing. Added to that is how infective asymptomatic people are. That is the reason for masks, hand washing, distancing, avoiding crowds. Stay home with a fever. Respect distance with seniors ( elderly… but also those high school and college partiers!). The learning curve is steep. Most cases will be mild. Keep your own immune system healthy: eat well, hydrate, exercise, go outdoors, refresh the air in the house, wipe surfaces (Lysol kills in 2 minutes), use saline nasal spray or lavage. Take Vitamin C, D, zinc. Gargle mouthwash with cetylpyridinium (under study).

Most important: continue to send love to family and friends- the absolutely proven immune system defense!

Smile

Joanne Dragun, M.D.

Not much to smile about lately? It has been a rough patch. Everyone is anticipating a return to normalcy…. Then Dr. Fauci informs us there may not be an effective vaccine, treatments are not proven, even if you have had Covid-19, immunity may not be sustained. It’s a hot mess. We can hide behind the masks so that no one sees our scowl. Unfortunately, we can also miss the real brain change that occurs when we smile- it is all neurons and stimulus so consider smiling- right now as you read on.

Interactions are so weird right now. I am used to smiling and putting patients at ease when we meet, but a starched white coat and N95 mask hides the gentle, caring assurance they need from me.  In the cancer center, I have come to break our mask rule for those first moments. I stand at the door and greet the patient with a smile so they can see my face, then mask up for the discussion and exam. It helps a little I hope.

For Arthur, we have an added issue. He is deaf and lip-reads. I considered a plastic see-through mask just for these occasions but plastic over nose and mouth doesn’t seem like a good idea- No one wants their doc passing out in front of them.  Standing 6 feet away, I present him with the information and resume the mask as he takes his off for the exam. Then I see his smile too. It is comforting for us both. We are missing so much in giving up that simple interaction. People love engagement, crave it and many need it more now than ever. Another long time patient Marlene arrives. She has had a partial facelift, blepharoplasty, lots of injectables, and if I hold her initial picture up from 8 years ago, she looks like a different person entirely. It was her way of dealing with the changes cancer brought. “Doc I am going to get botox next week.” I am reminded of a video a few months ago from south Florida with a doc poking his head into the car windows of patients and injecting women in masks with botox. Doing anything to keep the office open. “Marlene, don’t be ridiculous. People can only see your eyes- with injections you will have no expression at all. Wait until masks are not mandatory and people can see your beautiful smile again.”

At a time when personal interaction and proximity are limited, a smile could go a long way. My recommendation for us all is to find ways to express our concern, kindness and joy behind the mask. Wear your heart on your sleeve- say it with words or a nod of the head or wave of the hand to others. Everyone is eager to engage- you just might (if it’s not Marlene) see their eyes crinkle a bit in response. When you smile behind your own mask, your brain will respond and your open heart will cheer you, which is just what you need now too.


Continue reading “Smile” →

Big

Joanne Dragun, M.D.

We all recall the wonder-filled upbeat movie “Big” with Tom Hanks. The title reflected transforming into his grown-up body while still a child. The concept of living big with a child-like wonder can inspire us all. Dancing on the keyboard, falling for the pretty girl, though shy, making bold and wild ideas come to life in toys… living big! Lately, we’ve been doing the opposite. I listened to a meditation recently. The guide had many suggestions to keep things simple and contemplate small, taking time instead of just barreling through life. I am not having any of it. We are done living a scared, tight, small existence. We only get one life and while a virus has upended our peace, we can still be bold.

When Norman came to see me this week, the tattooed motorcycle rider was used to living in a big, gregarious way. The new diagnosis of cancer at only 45 years knocked him over. His whole perspective on life changed with one scan. There is a disconnect between his activities, travels, work, family, and friends, and this new threat. “Shoot me now, Doc! I guess I am dying. How’d you like that for a kick in the head??” This lifestyle change is more than he bargained for so early in life.

 I remind Norman that he didn’t ride his Harley cross country until he practiced around the block. Ramping up to “big” takes effort. “Norman I want that life for you as well. You can still live large, unafraid, fearless. Right now we need to manage the confusion and terror. You can’t get out of the rain until you build a roof, so let’s get started on therapy to protect you”. No one, regardless how tough is not afraid of cancer- double negatives for emphasis. During therapy, Norman needs hope for the future. Eventually, he will improve and there will come changes but he will have time to acclimate to them.

Lives have changed everywhere this year. Every one is not getting back to normal with covid either- there are jobs, businesses, and health changes for many- even psychological stress. Our child-like wonder has vanished. So its time to think of new normals and give ourselves the chance to be fierce and excited about our futures again. We are not here to live small, mousy insignificant lives. No matter the stressors- you are in this life to make a difference, love your family and friends, engage with passion and deliberateness.

The next day Norman came for the simulation to start the planning for radiation. He rode his Harley, walked in the door as if he owned the place. Gone was the downward cast eyes and quiet frightened demeanor. He was big, bold and brash and I loved it. “Bring it on,” his attitude said. That power will give him strength for the battle and surely impact his immune system. If he succeeds it will be all him and he will go on to live and love a big life.

Thanks Norman. You were just the shot in the arm we all need now. You will inspire others and we will all embrace a full future without timidness or fear. It’s important for us to live big lives in honor of those who miss having those years. Let’s all make the most of rejuvenation after the recent months of fear, and engage big and expect bigger.

See No Evil

Joanne Dragun, M.D.

The great thing about murder hornets (oh come on Joanne) is that we know what they are and we know what they do. There is even video of them ripping off the heads of bees- not good. However, I respect them. They are not hiding in plain sight, waiting to wreak havoc by the careless rub of the eye or scratch of the nose. (Yes, keep washing hands).

Florida is lifting restrictions quickly and as ‘stay at home’ is over this week, many are having to find their shoes and squeeze into something other than sweats. Release from captivity comes with responsibility. Respect that someone you encounter could be immunocompromised or lives with someone who is. Just because we cannot see this virus doesn’t mean we can be complacent. All along I have been in favor of living strong and brave but wise.

The virus is a lot like cancer in its surreptitious way. Skin cancer we can see, but the million of other cancers per year hide under that beautiful exterior, wreaking their own havoc on unsuspecting organs. Patients are always fascinated, if not horrified, when we review scans and can actually see inside the body. It helps them to arm for the battle.

This week’s literature tells us people are avoiding hospitals, procedures and screenings. Physicians are concerned people will miss the chance to get care early in disease stages when curable. Healthcare centers are safe and have every protection so have no fear. What isn’t safe is this cancer risk because of covid, 30-50% of cancer will go undiagnosed this year. Survive the pandemic to have an uncontrolled cancer? Don’t do it- be smart.

Pandemics end in 2 ways- they kill everything and then have no hosts or they mutate, become less lethal and highly infective (like this one) and we learn to live with them. Don’t wait for a vaccine- it may never come. So please take control of your life and get the care that you need. 99.97% will not be impacted by this virus but 2 million will be diagnosed with cancer in 2020 (better news- there are 18 million cancer survivors). Lets focus on what needs attention.  Let the murder hornets and virus go- it is time to take care of yourself. Continue to be smart when you go out and now maybe even add some non-toxic bug spray.

Source http://www.cdc.gov/cancer

Mothers

Joanne Dragun, M.D.

You may expect a warm and glowing blog post about Mother’s Day.  We all love our mothers and many of us miss them. This post however, is in honor of Mothers for a different reason. It’s to give homage to the “I told you so” thought that every mother on earth and above is thinking right now.

“Didn’t I tell you not to touch your face? Don’t pick your nose. Stop rubbing your eyes. Don’t spit or farmers blow. Clean under your fingernails. Wash your hands!!! Cover your mouth when you cough. Use a tissue when you sneeze”. She was brilliant wasn’t she? She didn’t need Dr. Fauci- it was intuitive. She knew this pandemic was coming and tried to train our habits. AAH if we only listened. Was she dismayed when she looked in your room and closet? “Clean up! This place is a mess. You’ll get bugs or an infection” or something to that effect. How right she was. Now you pull out all your mother’s teachings to clean surfaces, disinfect and sanitize. As Jimmy Fallon said in his thank you notes “Thank you doorknobs for reminding me to clean you- which I never have”. Mom probably did.

How is it that Mom is always right? My Mom was compulsively neat and clean so we learned at an early age. Fastidious as Mom was, heaven forbid the “orderliness … you know ‘next to Godliness’ on the report card was not an “A”  She never used the word “data”. As annoying as it was, I respect this now. Have you found yourself looking up utube videos for how to clean various objects and surfaces? Trust me- bleach can make a mess.

So this Mother’s Day let’s salute the women who birthed us, raised us, taught us, or for the men, married us, are sisters and friends to us and remember they have a God-given mission in life- to love us and keep us safe. If you really want to give a gift forget the flowers and cards. If you are blessed to still have her, call and just say, “Mom, you were right.” She’ll know. Now go wash your hands. Thank you.

Happy Mother’s Day to all those who gift their wisdom and strength everyday. God Bless you.

 

 

Red Light -Green Light

Joanne Dragun, M.D.

We’ve tired of  the “Simon Says”  game I recalled a few weeks ago. Next up: Red Light Green Light: Go- don’t go. Stay- go with care. Go now because you may not go next fall or winter. Or ever. Our heads are spinning. Some scientists are holding onto the directives as if those alone will cure us. They resist giving us permission because they do not have all the data. The parochial nature of investigations has paralyzed us but they are unwilling to give into loosening or lose credibility. The scientists working on a cure, control, studying data, and researchers on every front are all feeding their families. They have the luxury of holding everyone hostage until their tracing, testing and insatiable need for data is satisfied.  Many news reporters “tut-tut-tut” about states opening (again they all are working).  We gave the scientists our devotion and attention.  They, not us were reckless. They were erroneously telling us in January “the US had nothing to be concerned about,” and they had to revise broken CDC tests, then these same scientists required a double check while the cases were exploding limiting contact tracing.

In the mean time, the world took control and managed the care needed by the thousands of critically ill. The virus will not change. The response is what changed – the armamentarium of management and care to the rescue. Working on therapy and vaccines is critical but as long as we can rescue or manage the majority (99.97%) we should be about living while they research.

Every doctor’s background is science. I cannot turn the radiation beam on without documented evidence of safety and efficacy for every type and stage of cancer. We do not put patients on the table and deliver light therapy. We respect that all science leads treatment. But we are seeing millions of people forced to give up livelihoods by the government until the scientists advise otherwise. Control of the masses. Some from  the ivory towers are now cautiously whispering that the testing and tracing won’t work and the vaccine may never be found. The deaths are tragic. Lives are changed forever, families broken, loved ones lost and as a world there is grieving. The inertia must however end.

I am already seeing the patients who bravely waited at home- tumor growing right in front of them and perhaps now not curable. Who is liable for this? The greater good is served by freedom and taking responsibility not by letting criminals go free and arresting mothers on the beach. Where is our common sense? We are not invincible, but we are smart and usually cautious. Covid is not the plague, cholera or Ebola. It is not wiping out everything in its path. Yes the toll is tragic as with other diseases and infections. Surely it will continue to infect millions. Cancer patients are at higher risk and must be guarded. The elderly and nursing homes must be protected. I am among many physicians saying that whatever path we are on now for children and the masses cannot be sustained- and even more so maybe it isn’t necessary.

I wrote weeks ago about opening the house to air. I am now saying open the doors and we will accept the outcome.

Addendum: Thank you Gov. DeSantis my patients can now have testing and procedures starting Monday. Remember, even when the stay at home expires, if you are at risk, use judgment and protect yourself. The government doesn’t need to do it for you.

 

Stop the World

Joanne Dragun, M.D.1 Comment

My father loved to sing and some favorite tunes came from a Broadway play,” Stop the World- I Want to Get Off” (1966) with Anthony Newley. I wonder what he would make of this pandemic which has actually stopped the entire world. But we cannot jump off; we have to find a way to be right here and now. Clarity is lacking.  The overarching directive is: everybody stay at home until we figure this out.

Sure we hope there will be a vaccine eventually and a treatment that rescues those at risk. Perhaps we’ve already blown past the testing and contact tracing that may have been helpful early. We are finding just this week that the virus was here and contagious long before expected and millions are probably already exposed. Can we really expect the luxury of studying thoroughly before engaging? No.

We are impatient now- we did the work of stopping our lives for the 6 weeks needed to ramp up requirements to care for the critically ill. Hospitals were built, the military involved, the all hands on deck efforts have succeeded. Hospitals and ICU’s are waiting for the surge. Nursing homes are under more scrutiny.  Taking the first baby steps back into the world is becoming necessary.

Unfortunately, this selfish virus and the impact of devotion to it, will have unintended consequences.  We are ignoring the health and wellbeing of our patients while waiting for control of this virus. Well, life cannot wait for a cure or vaccine. After forty years, there never was a vaccine or cure for HIV-Aids. There is no cure for the common cold either (a coronavirus) so we need to be realistic. These discussions are happening in all specialties. We can no longer ignore and stand by. Collectively all healthcare is ready to get back to caring for you.

If you have an issue, concern, lump, bump, a need to be seen and your physician’s office is closed, then call a cancer center. They are open and ready to help. If we use safety measures, we can get back to the business of saving lives. That’s living. We cannot stay distracted with inertia. We must help you to stay well. We are here for you and ready to be champions for your care.

We all are ready to step out into this new world. Paralysis is no longer a healthy option. Some habits remain: washing hands, avoiding crowds and elderly at risk, wearing masks, wiping high touch surfaces at home and car, getting sunshine and fresh air. As we look around like hibernating bears, we hardly recognize ourselves- I’m not talking about the crazy hair or sweats. Getting back into the world finds us more thoughtful. We can see more clearly what we always knew, what is really important- the love of family and friends. As we re-engage we will all be more loving and devoted. That’s the clarity that will cure us.  The world may have stopped but you and I believe, as well as my physician colleagues around the globe, that we have the power to give it a push to start turning again.

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!