Tag: vaccine

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.

The confession

Joanne Dragun, M.D.

Our center has started a new therapy with an injectable radionuclide that targets GEP-NET tumors in the bowel- often metastatic to liver. Patient have therapy for years that just controls symptoms, but this is the first targeted agent that can reduce tumors. The injection is IV and requires hours of amino acids infused to protect kidneys from the radiation damage as the drug is excreted. Patients come for 4 doses 8 weeks apart. They sit in a chair for about 6 hours. I personally infuse the radiation part of the therapy for 30 minutes. During these sessions we get to know the patient very well. These lengthy episodes lead to all sorts of discussions. There is no pain and little if any side effects so patients are not put to sleep like with benadryl for chemo or hyped up on steroids to avoid issues. What happened this week is worth sharing.

“Doc, I don’t know why I am doing this”. I knew Lou didn’t need more instruction about the treatment so I waited. “I am really here for my wife”. Lou is widowed 4 years- we found that out the last treatment. “It’s crazy but I find myself doing alot of things because of her. I pick up my clothes even though she fussed at me for years. I load the dishwasher her way. I get the dog groomed, I even go to church.  There is so much I rebelled against when she was alive. I criticized her cooking or made fun of some things she didn’t understand. Now Doc I am not proud about any of this. Maybe this is just time for confession”. I offered, “Lou, getting cancer treatment can be an emotional time and its not unusual for people to reflect on their lives as they are trying to save them. Its perfectly normal, but I am impressed that your wife lives in your mind. It must have been a great marriage”. Oh, Doc, No. Sometimes it was the worst! I am not easy to live with- just ask the dog, but I realize I did love her and wish I behaved better toward her.”

Not sure how to ease Lou’s mind and heart, I just said, “Lou, you wouldn’t be here now if not for her, so I’d say she would be proud and probably forgive you”. His eyes brightened behind the mask. “You really think so?” I was surprised at this need for validation. “Lou, do you really think you came up with this whole confession thing on your own? I doubt it- she’s here with you for sure. Frankly you are not that self aware”, I teased him. We both chuckled and he settled back with a sigh. I don’t know which therapy was the most effective for Lou today.

PS: Very often our actions, as with Lou, are for others. Surprised there is still a need, I want to plead with you on behalf of so many doctor, nurse and hospital colleagues who battle everyday, for the patients, our loved ones and friends who have passed, for other cancer patients who now are restricted from getting biopsies and surgeries due to overwhelmed hospitals (yes all non-emergent procedures that require an overnight stay are on hold.) Please be sure that you and your family are vaccinated. That is a small but incredibly critical part for you to play in our world of wellness. Thank you.

Incentives

Joanne Dragun, M.D.

As if the new directive rolled out by the CDC yesterday isn’t enough: “If fully vaccinated you no longer need to wear a mask!!” we now have competition for our deltoids: A chance at $1 million, free doughnuts, free beer! After months of queuing up, frustrating hours to find shots in at least a nearby county, people in cars for hours, wearing diapers, others flying to Florida to grab a dose. We now find ourselves begging the non- vaxers to get the shot. We had a call from a doc down the hall yesterday that they had extras doses if anyone still needed one, and I still could not talk a few patients into going. I will tell you now, have faith in the vaccine. I have said it for months. I have advised you to get the first available, It is safe. And for those of us who did, the sense of relief is indescribable.

Charlie is only considering now because of the free beer, but Rosie says absolutely not- there isn’t enough data. What?? People who never even used the word before are holding it up as a banner. Stop it. I mean it.

Of the hundreds of people I have seen this year, those who died with or from covid did so before vaccination. We have not seen one single person die of covid here in my practice since the vaccines are done. Unfortunately we are seeing life ended because people didn’t get screened, cared for or are in a back log for primary care visits.

If you have a problem and cannot get to see a doc, call a cancer center, we have been open every single day through covid. Tele-medicine doesn’t work in this field. We will see you, work up the problem and care for you asap. Today when Marsha said she came in because she can’t get to her primary care for another 6 weeks, but has had symptoms for a year, the cancer needs attention now. Unfortunately, that is what I have seen this week. Patients with late stage diagnosis.

Take your life back. You don’t need a donut. You have a million incentives to be strong and healthy. If you are vaxed, the next step is getting your routine visits. I know that I am also late for my 10 year colonoscopy, medicare visit and mammogram so I will be there with you. Let’s do this. The incentive for each of us is a long, happy, healthy life. No sense ending the mask mandate if we have to wear a respirator. I am not kidding. Get the vax, get your kids vaxed (remember that Jonas Salk founded polio vaccine and tested it on himself and family first, there were no thousands in a trial) Today we rarely ever see polio.

Be strong and brave and encourage your loved ones. Offer to buy them a doughnut, beer or lottery ticket if that’s what it takes. We are over this; lets move on with being healthy. Too many succumbed to this horrible virus. Too many children are without parents and grandparents. You owe it to them to live your best life. Now take off that mask and lets see your smile!

Party on

Joanne Dragun, M.D.

Bored? Isolated? Well check out how the other half is living, or should I say living it up? Spring break may be over but covid break is on. My husband took me to Ft. Lauderdale last weekend and I couldn’t believe my eyes. Happy, smiling, partying faces everywhere. I wasn’t dismayed, I was delighted. No one was singing happy birthday twice while washing hands or wiping door knobs. They were dancing in the pool with frothy drinks and living out loud. Jet skiis hummed, boats roared, bachlorettes and birthdays partied and I thought I was on another planet. People dying for vacation for a year, now vaxed will not be dying from vacation. If having fun is in your DNA, take your life back.

Maris just wants to see her grandson play ball, probably for the last year. Jim has been called back to work and even with my release from cancer perspective, can’t go with two children remote learning. One year in a young life is forever- we need to get back. Docs are saying stop the regulations smothering our children.

Even New York is ready to put on the show- a surprise to everyone! You do not have to dance to the DJ to participate. Look for opportunities to tip toe out the door. You may also be surprised what you find. Have faith in the vaccine.* It is a life changer. All mandates are off in Florida. Is the virus different here? Surprise to everyone that cases are not increasing. It was fascinating for me to see people expressing their rights and making their own choices. The quick visit looked like another world and inspires hope. It was as different as a foreign country. You can find freedom if you choose.

I met a young Canadian living with friends at the hotel, working remote for the past nine months. They are so thrilled with how their experience of the pandemic is wildly different from what could have been. Get ready. If NY is pushing back, it will happen quickly. Make plans to dig out those party shoes or swim trunks.

Navigating cancer and covid has made for a crushing year. When Beverly finished her journey and rang the bell this week, we both giggled as I said three words: “Now get out!”

*CDC: of 92 million fully vaccinated the infection rate is .0001%

Patience

Joanne Dragun, M.D.

It’s toilet paper all over again. Are you still working down your stock of paper supplies acquired 6 months ago in a frenzy? Did you know that there is plenty on the shelves now….. and probably at less cost? Don’t be embarrassed, we all did it. What I refuse to do however is playing out currently, queuing up for hours for the vaccine. On new years day the local news showed a line of cars down Route 1 in St. Augustine that started 4:30 AM. It goes for miles and at 9 AM they haven’t started vaccinating yet. Are diapers involved? A friend thought he was clever and went on Sunday at 4 AM but there were hundreds of cars ahead of him and they ran out before getting to him.  A “deputy” from the health dept was interviewed- obviously from her home yesterday who said that since sitting on the phone for hours wasn’t working they would roll out an email sign up.. duh. Obviously that is bust and they decided to just vaccinate first come, hence the line up of hopeful recipients. Of course, if you know me, I’ve written to the Governor, Senators and health depts several days ago. A plan tor success needs to hatch- NOT the flat footed “health depts” working from home in a dither. Bring in the military, send the vaccines to hospitals for storage, provide staff to jab the needle into arms and let’s get this show on the road.

The vaccine is sitting waiting for the roll out that is stuck. So that’s my crank today- you are not surprised at my ire for poor performance are you? So here’s the deal. Please don’t sit for hours in your car lined up in the hopes when they get to you there is still a dose. Let things settle down and when the pharmacies get it and more sights are involved it will be smooth. It’s not as if you are headed on a cruise as soon as you are inoculated. After dose 1 you will be about 50% protected in 12 days, then 90% about 2 weeks after the second dose so we are still talking a few months.

 Patience is required, so as I said a few weeks ago- you got this, just from going to Disney. But you don’t have to rush to be first in line next week because frankly they haven’t figured it out. (PEOPLE GET OUT OF THE TUB AND GO TO WORK!). Ugh. Today I asked the Governor to get the military involved.

When I did call the health depts , they said everything is closed til Monday- sure take a break for the holiday its not as if there is a pandemic. 8th grade computer wiz kids would have had this knocked out quickly. In spite of my disgruntled tone, I am still preaching patience. If you are over 65 expect to sign up in the next month. If you are undergoing active cancer treatment, check with your oncologist. Many patients on chemo should not get the vaccine while their immune system is compromised, and so the medical oncologist needs to advise you. Hopefully you’ve already gotten the flu shot for the year because you need a few weeks between the vaccinations- you can’t get them together.

The good news is that it is in the government’s interest to get you vaccinated and so they will work out a system and as more companies are approved and produce, you will get vaccinated….. don’t be an anti vaxer please; if you read this you actually care about yourself and loved ones and know that good health and strength do not come from osmosis. The effort is worth it. It’s just not necessary to sit in your car for five hours. Have faith. You and your loved ones will get the vaccine and in a few more months life will improve… I didn’t say return to normal and your patience will be rewarded. Keep calm. Help is on the way.

PS: When you do get the vaccine avoid alcohol since it reduces the immune system and the vaccine may be less effective!

Free will

Joanne Dragun, M.D.

Traffic is flying past me on the busy highways. What’s the urgency when we are supposed to be sitting on our sofas? People are willing to take risks whether driving or interacting. Parties, travel, get togethers show that many are ignoring recommendations. Why? We are weary and change isn’t coming fast enough- even though today’s approval by FDA (thank you Chief Steve Hahn, MD also a radiation oncologist) happened at warp speed.

Beatrice was in today for a check up and is detailing her own plans. “Hey Doc, I’m 80 years old. I have cancer and they tell me to stop living for my own good! How do people think I got to be this old? It sure wasn’t by being a wimp. Damn if I’m gonna sit out this Christmas- it may be my last!” I remind her, “Beatrice, you are at a high risk”. She smirks, “Yeah so’s driving in Jacksonville!” True.

Covid really complicates things in the center and patience is required. But for Beatrice I give in, “Go live your life. Wash your hands, wear a mask and don’t engage too much”. She pretends she hasn’t heard me, “What? don’t drink too much?” When did we get to the point when we allowed others to decide how we live- not for the first few weeks or months, but almost a year now! After I describe how to be safe and try to stay outdoors, I need to consider adding, “Please live your life and if it is shorter because of your freedom of choice accept that”.

Beatrice teaches me in her senior wisdom. “Doc, everyone cannot be saved, not from the cancer or an infection. You can just do your best and we do ours, but at least we decide”. I don’t push people to get treated for cancer and I don’t punish them if they decline today then come back in a year to get them out of trouble.

Overreach is everywhere and it is not good for us, our children or our country. It has become a virus in itself. Power grab has become infectious. We are sick of being protected from becoming sick. Today I say, honor your free will. You can certainly stay sheltered. If you wish, however, put that ugly Christmas sweater on (along with your mask) and go live your life. We don’t get a second chance and there is no re-gifting time lost.