General Wellness

Good Monday morning,

The problem with going off line for a few days is that everything changes.
And not just a little bit.
Here are a few things out there.

1) Does exposure provide future protection (ie will antibodies protect us and will a vaccine work)? There have been a few uncorroborated reports out of China of people previously infected with COv-SARS-2, getting reinfected and getting sick again. It’s hard to make anything of this, especially in light of improvements we have seen in some patients improved in the US by getting convalescent serum from previously infected donors. Time will tell.

2) Resurgence after re-opening. Even in S. Korea, arguably the country which dealt with this the best and has had the lowest death rates, there was a resurgence in cases after some loosening of restrictions were implemented. They tightened back up again. I think by the weekend, we will see the result of the “Georgia Experiment” where they started loosening last week. A week later, we will see what happens in all the other states where loosening was allowed this last weekend. It’s inevitable that we move in a measured manner but it is inevitable that people will get sick and some die. Yale epidemiologist Dr. Katz, who by the way promotes a vegan diet, is one of the rational voices out of those who do think that we must start opening things up but also concedes that people will get sick and die. He says that “flattening the curve” does not mean that people won’t die, it just changes the date.

3) NEW SYMPTOMS. Some kids have developed massive inflammatory responses to the virus, similar to a well established inflammatory condition called Kawasaki’s Disease. DON’T PANIC. Most kids who get allergy symptoms actually have allergies. Some with headaches are just stressed. Skin rashes can come from many things. I think that the basic three symptoms have now been expanded with a few additional ones. If you have these or combinations of them, contact your doctor:
a) Fever
b) Cough
c) Shortness of breath. Add to these three the following
d) Sore throat
e) GI symptoms like stomach pain or diarrhea
f) Unexplained isolated changes in smell and taste.
g) Unexplained skin rashes. (Covid toes).

In the midst of all this uncertainty, there are some cornerstones.

• We need each other.
• We need to get as healthy as possible to weather whatever the future holds for us.
• We need to be smart. Going to a birthday party without social distancing now is crazy. An outbreak in California was directly linked to just such an unwise choice. Wear your mask. Socially distance. It may not absolutely guarantee you won’t get sick, but I do think that some degree of social distancing may be in our future in one form our another, independent of this particular virus.
• We need to stay as active as possible.

If you are interested, Fareed Zacharia had a great editorial on his CNN show yesterday. Worth a listen, espetially his closing comments. Essentially, we can’t continue to live the way we have and expect this type of global even not to happen. It’s hard however to listen to such well spoken people and then have to suffer through a pharmaceutical add or Jimmy Dean commercial about how a processed meal of eggs, bacon and biscuits is part of a great breakfast! 🤮

As for our office, we are starting to open up slowly, practicing as much safety and social distancing as possible. We’ll see.

Have a great week.

Stay safe and be well.

AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷

A More Surgical Strategy
— Read on mailchi.mp/richroll/dr-david-katz-517

PERSPECTIVE AND THE IMPORTANCE OF OVERALL HEALTH

We are bombarded with news, mostly negative, through various media sources. Today, it is understandably almost exclusively focused on the Covid-19 worldwide pandemic, how to prevent it, deal with it, move on with it, how we’ve messed up managing it, how many have died from it… The constant barrage is not helping much. There is no question that this is a major issue, especially for our elders as well as for those who have chronic illnesses. They need to be protected. People do get sick and some die but the vast majority do just fine, maybe not even experiencing any symptoms. And we need to focus more on that as well as more important, general health issues.

We have learned a tremendous amount about this virus and the disease it causes in a very short time. There are almost daily changes and new findings. The various presentations, lab findings, treatment protocols… An interesting example is that just a few weeks ago, a patient presenting with severe respiratory issues to an ER may have been immediately intubated (put on a ventilator). The stats are grim. If you needed a ventilator, the chances of dying were between 50 and 70% depending on location and other co-morbid factors. Now, the approach is a little more measured with oxygen, frequent re-positining to help move the fluid in the lungs around and various medications including anticoagulants and over the next few hours, some patients improve, not needing to be on a ventilator. In fact, it appears that putting a patient on a ventilator too soon actually damages some of the healthier lung tissues, allowing the virus to infect more cells.

There is also now even some suggestion that some people may have innate immunity, meaning something about their immune system, possibly a previous infection even with a different coronavirus, which protects them. As an example, cruise ships, arguably enclosed petri dishes, have had outbreaks, but the worst case had only 20% of the people on board getting infected, and most other cruise ships having significantly lower rates of infection. Examining the spread in other areas where there is reliable data, seems to be consistent in that only about 20% of people exposed to the virus get sick but of those that do, 95-99% get over it just fine.

I do think that we still need to take this very seriously and protect ourselves however I also think that this will probably affect everyone eventually. The key is to stay as healthy as possible so we can weather the storm better.

But let’s keep the overall health of the population in mind as well. Every single day, today, a year ago, 20 years ago, more than 1800 people a day die from heart disease. That’s over 600,000 people a year. Just in the US alone. That’s more than double of all the Covid-19 deaths worldwide! Over 80,000 die every year from diabetes complications other than the vascular ones. That’s more than have died from Covid in the US. Both of these conditions, vascular disease and diabetes, along with obesity, are the most significant risk factors for having a more severe, if not lethal case of Covid-19. All three are preventable and reversible!

But it’s like the frog in a pot of water. Throw it in when it’s hot (it hurts my heart just to think about that) and it jumps out. Put it in when the water is cold and turn up the heat slowly, it won’t get out because its body acclimates to the heat, until it can’t, and it dies. Chronic diseases slowly simmer in the background. Our bodies have an amazing way to compensate for the damage we subject it to.  You don’t appreciate that damage until the poop 💩 (my favorite emoji) really hits the fan and you start having complications. A perfect example is dementia. At epidemic levels in the world today, the damage to the brain starts to occur 20-30 years before the first symptoms develop. Sadly, dementia is the only chronic disease which is not reversible nor do we have any effective medical treatment. Prevention is the key. By the way, dementia-related complications make dementia at least in the top 5 causes of death in the US today. Some put it at #3.

The bottom line is MANY more people die every day from diseases that are almost 100% related to our lifestyle choices, primarily our terrible diet. Of course lack of exercise and other lifestyle factors are important but diet is the most important.

Let’s make sure we ride out this pandemic as safely as possible, which also includes opening things up responsibly so that our economy doesn’t completely collapse. This means not only governmental guidance and responsibility but more importantly, personal responsibility. Distance, wear a mask, wash your hands, be responsible. But let’s also start to pay attention to the elephant in the room. Reversible, lifestyle-related chronic disease has killed, and will continue to kill many, many more people than Covid-19 ever will. Take better care of yourself, starting with a healthier diet. Move more. Stress less. Care for those around you. And by the way, this will also help save the planet.

I am sharing a link to a great interview with Dr. David Katz from Yale. He speaks very intelligently about how we need to start opening things up, but doing so in a measured manner. He is also a big advocate for “food as medicine”.

I’m taking a break from all the tech early this week. I feel like I’m spending all day and night staring at a screen. Virtual/video office visits with patients included. Zoom meetings. Lectures, updates…, it’s a bit much.

Have a great weekend.

Happy Mother’s Day to all the amazing women in our lives. Mothers, grandmothers, aunts, wives… Thanks for doing what you do so that we can do all that we do. ❤️ 

Stay safe and be well. 

AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷