Tag: covid 19

Greek to me

Joanne Dragun, M.D.

As a college freshman sorority pledge, upperclassman would randomly stop and demand that you rattle off the Greek alphabet. Never knew it would come in handy. Skipping over “XI” to avoid a variant name for the Chinese president brings us to Omicron. As we all know, “virus gonna virus”. Researchers research and so they make tweaks to the vaccines and therapies and frankly, we do not need to know all the boring and frightening details. Presently, in vaccinated adults, Omicron seems to cause two days of fatigue, in fact the flu is now worse. (get your shot)

Viruses that are exceptionally lethal like Ebola die out because there is no one left to transmit. Covid had a remarkable run the first year with catastrophic impact until vaccines. As long as mutations stay within certain parameters, vaccines will offer protection. We are not surprised that the new variant is more contagious. That’s how viruses survive. They can mutate thousands of times. Your protection is to get vaxed, get boosted and prepare to be boosted again.

At the medical staff meeting this week, the presentation on covid sums it up: Over 1700 cases, but not one fatality at that hospital in a vaccinated person. Unlike 2020, hospitals can currently manage cases and are not overwhelmed. So imagine physicians’ dismay over New York state instituting preemptively a ban on all elective procedures again. This is why we are finding patients with extensive cancers now instead of smaller, curable disease. The delay in diagnosis has been tremendous. Data suggests there are over 700,000 cancers that have gone undiagnosed or untreated due to delays. I am seeing it everyday.

What’s my recommendation? Live your life. If in a group, mask (even vaxed can transmit), be up to date with vaccines, don’t delay. If you need medical evaluation, see your doc in person for best exam. You cannot telehealth breast and prostate exams, colonoscopies (all the most common cancers), derm checks, MRI, PET and CT scans, endoscopies, I cannot palpate lymph nodes over the internet.

Alice was in this week, “Doc remember when no one would see me- but you examined and found my breast cancer?” Joan “saw” by telehealth her primary for Medicare yearly check. When she called to say something wasn’t right, I examined her in person and detected a loud wheeze and a CT found a lung cancer lurking. We cannot make up for the months missed caring for other diseases at the alter of covid. Too many people lived a terrible life these past almost two years and they weren’t even sick. We are sick of being told we are sick.

Bottom line: get seen, get care, get vaxed, get help, get back to a real unafraid, unsheltered life. We are not naive pledges. We are intelligent savvy grownups who will not be intimidated. We need to take back control. I promise you that no bureaucrat is smarter than you or knows what is best for you (look how they designed a vaccine card you must carry but doesn’t fit in the wallet- stupid). Covid is continuing to be an excuse for a power grab and enough is enough.

Incognito

Joanne Dragun, M.D.

After 48 treatments, we got to know Jack fairly well. I met his wife of 56 years, saw pictures of his great grandchildren, knew about his past career and “retirement career” of 25 years. There wasn’t much Jack didn’t share in our weekly visits. He sailed through therapy and the final day came new year’s eve. The staff gathered in the lobby- we were all masked up and distanced and other patients hadn’t arrived yet. It was a big day for this octogenarian who thought at one point he had lived all he had to do until his wife encouraged one more effort to keep him well. The cancer won’t be a problem for him and even behind the mask I could see the big smile.

What came next surprised me. Jack asked to have a video of him ringing the bell and without asking permission, he swiftly removed his mask so we could see his smile. I stared. After months of “togetherness” here in the center, if I ran into him on the street I wouldn’t know him at all. Jack had a nice big toothy smile and a goatee that was salt and pepper. I realized how for ten months, unless I needed to examine the head and neck area, I had no facial recognition for my masked patients. I have literally seen hundreds of people and have little idea of how they look. Cosmetic surgeons must be suffering. Now people won’t even want injectables with the threat of them swelling with the Moderna vax ( inflammation against the foreign substance.. can you imagine?!).

The billion dollar industry, from makeup to surgeries, to antiaging everything, how different it is today. A reminder that it does not matter how we look to others. If we share our hearts, thoughts, ideas, dreams, experiences and communicate with our eyes which can still smile, we aren’t missing a thing.

Telemedicine

Joanne Dragun, M.D.1 Comment

Have you tried this yet? Telehealth has been around for about ten years and a quick service for minor issues.  We have never used this for radiation therapy cancer visits but engaging with patients who do not require an in– person exam reduces their risk during the pandemic. What I am finding is that sometimes it’s a hoot!

“Doctor! You don’t look sick! How come I gotta talk to you on the phone? They say I can’t come because I might catch a virus.”  I am sitting at a computer in an exam room. Dalia is in front of me on her phone with facetime.  At 83 she needs to be protected but doesn’t fully understand how staying away from the doctor is better for her health. Her face is covered with a mask. “Dalia, is anyone with you?” She assures me no one- “Dalia, I am far away from you on the computer so you don’t need to wear a mask. We both giggle. “Doc, this is the craziest thing! I just want to come in and see you- how are you gonna examine me?” We review the reports I have but I agree this is profoundly limited.  We  set a time in a month for a “real visit”.  

Larry was in this week for a check up. At 87 he is having none of it. “Doc, if I am gonna die, you gotta give me a hug. I might not make it next year.” He always brings a smile. “Larry, your mother lived til 101 and your cancer is controlled, so no hug today, stay home and we will see you next year!”

Ginny is newly diagnosed, has several procedures this week and is frankly terrified. “Doc, I just need your comfort and strength.” You don’t get that from a computer. Mickey came in for a followup. “We could have talked over the computer” I say. She shakes her head, “Doc I live with my 96 year old mother, I was dying to get out for the morning!”. Harvey is happy to call it in and escape the prostate exam. Olive tries to stick her foot in the camera so I can see the swelling. We laugh about her being a contortionist. Mike is shy but finally turns around to show me a rash on the buttock that looks like shingles and needs treatment immediately. Understanding that cancer patients are frequently immunocompromised keeping them safe at home is important but limited.

The laying on of hands is a revered part of doctoring. I recall the first time we examined each other as med students, the scientific learning took a real turn. I have always felt that the bond formed when a physician examines a patient is a force. I never take for granted no matter the years, that you have placed your trust in me to use my skill for your benefit. It is always an honor and a sacred trust. It is never haphazard or routine. Touching another person for an exam has healing properties and the impression that telemedicine can replace is a fallacy.

If your doctor’s visit is set up for telehealth, go in prepared before you hit face time or Zoom. Make a list of your concerns and questions. Since you are not physically examined, this visit is unlike most and involves talking with your doc and they can only help if you provide real information. They are there to help in spite of the circumstances- we all know it isn’t thorough but it can be efficient and safe.

 I will see anyone who refuses medical care over a computer. My patients have a fearless spirit. They know that the virus isn’t seeping under their doors, tracking them down. They have learned to avoid risky behavior.

You and the USA have seen tough situations and prevailed. We will again. I will hug my patients again, I will give up telemedicine for the hand to hold and the touch to calm. I will be there for you and you will be there for others. Let’s be unafraid together.

 

Hearth and home

Joanne Dragun, M.D.

One exception to the six-foot “social” distancing rule is the toilet paper aisle. If congress wants to really help with a rescue package, they could just give each family toilet paper and the viral load would decrease.

Fear is filling the void of activity and working. Yesterday we received word from the governor that all elective healthcare procedures are cancelled. All hands on deck for the virus now. At this point there are two directives for everyone everywhere: Wash your hands and stay the heck home. Period. You may walk in your yard or in nature away from others which I encourage.

If you are actively undergoing treatments, we are making every effort to sanitize and keep you safe in the cancer center. Today we are starting telemedicine (Thank you Seema Verma).

You may wonder if you need to line up at a testing tent. Please do not. If you have been exposed or have symptoms, call your primary care physician who needs to write an order first and determine if you qualify. Some test sites then have appointments. The test will not keep you safe. It is not curative or protective. It is information, which if positive, reinforces your need for isolation even within your own home. If a fever and shortness of breath worsens then you should be seen at the hospital.

Since there is a lot of mis-information and the news media has a selfish need to keep you enthralled, limit your exposure to that as well. If do want valid recommendations, tune into Sirius 110 Langone Medical Center doctor radio which is converted to constant corona and has panels of experts answering questions. You can listen on your computer https://player.siriusxm.com/public-service.

You may wonder how you can help. If you have a neighbor or friend who is being treated for cancer, check on them and volunteer help. Use your own strength for good. Make a meal for someone who is working a necessary job, putting themselves at risk daily and leave on the porch. If you sew, make masks (any kind is appreciated) and drop off at the front desk (not ER) of your hospital. Doctors are reusing one disposable mask for a week. If you have supplies, share.

We are in this battle together. We are altruistic at heart and this crisis is bringing out our best. The pioneer Louis Pasteur said, “Chance favors the prepared mind” (when you prepare yourself for life, chances are often in your favor). You are prepared for this. You are bringing amazing fortitude, strength, wisdom and determination to this battle.

Often doctors say to each other “Be well” we are all now saying. “Be safe”. To you, my friend, be safe, be smart and unafraid. Now, shake it all off and go out and take a walk!

Endemic

Joanne Dragun, M.D.

The WHO has now declared the Covid 19 virus a pandemic. The US is under a state of emergency. Brilliance will be required to control this new threat. Enter Dr. Ian Lipkin from Columbia U., Director of Infection and Immunology. Studies are being performed with Dr. Lipkin’s involvement using blood plasma antibodies from patients who have recovered from Covid 19. This could be a very fast way of rescuing people since there is no cure. Dr. Lipkin, a renowned virologist is suggesting that one person’s strength and recovery can be infused to aid another. Its quite a concept. As with cancer- new therapy is all about immune system so this process would enhance those who are without defense and most vulnerable.

If you or a loved one has had cancer or any major life threatening event or disease, however, pandemic panic is a yawn. Examples are small pox or TB, H1N1 flu, Spanish flu, HIV/Aids. Are you frightened by any of these? No. They have been managed and even if these diseases had deadly consequences, somehow the world has survived. The concept of injecting someone else’s immunity into another is a novel thought. We certainly would not inject HIV or TB but it’s a new world and there is a new hope.

Let us tap into other’s strength to find calm in this storm. Endemic to cancer patients is bravery. They’ve met that demon and have overcome. This week I met Gerry. After reviewing her scans with a large lung cancer, she lifted her chin, looked me in the eye and said, “Bring it on Doc!” No wimps here. People facing down the dragon cannot be intimidated. What are they going to do, worry about toilet paper? Ridiculous.

This invisible virus cannot defeat you. No pandemic will frighten you or destroy what you have achieved. If you have a loved one who passed from cancer remember how strong you both were and fearless.

Endemic to those battling cancer or a chronic disease or injury is a strength that lifts the rest of us. We look to you for peace and calm. We honor your fight and refuse to give into fear and panic because that would be an insult to you. We haven’t faced your fear so we may think this new chaos has merit. You teach us. We owe a debt of gratitude to you for demonstrating how fierce the human spirit is. We are not going to fall apart because there is a threat. We are going to arm ourselves and take this on- head on. We owe it to you not to shrink and be bullied by an infection. We would be shamed in front of your power.

As with the plasma infusion, your strength can infuse us with hope for recovery from suffering. There were times you leaned on us. Times we lifted your spirit, loved your heart, took your hand and guided. Now it is your turn. We look to you to guide us and to believe in ourselves the way that you do- everyday. Thank you. Your inspiration will keep us safe.