Letter for February 8, 2022

Hostility towards healthcare workers. Early signs of pancreatic cancer. The city is safer than the burbs? Omicron update. Meditate now, when you don't need to. Eyeglasses...or drops? Guacamole.

Human [resisting trends that diminish us]

A lot of normal social guardrails have been damaged over the past several years. Civility in how we treat each other has been eroded by political parties as tribes, mass irritability from the pandemic, and the group consequences of individual choices. We’ve felt it in the hospitals and in the offices. The vast majority of people are great during their visits, but there is certainly a minority that comes preloaded with hostility towards healthcare providers. Nurses, doctors, and support staff have been insulted, shouted at, and physically assaulted at rates that have become alarming. Negative, unhinged reviews are showing up online about us when we try to do the right thing by our patients, if not what is demanded of us. Our pandemic fatigue only makes these attacks more hurtful.

The CEO of our health system recently wrote an Op-Ed about this phenomenon. I commend him. I think awareness of the problem is part of the solution. To restore the social contract between patients and healthcare providers - in which we work hard, sacrifice much in terms of training and debt, and now contend with infection risks for ourselves and families, in exchange for the appreciation, social privilege, and respect we get for doing our jobs - we need to turn down the volume of criticism. We all need feedback when not doing a good job. But healthcare workers are not part of any conspiracy to harm. It’s quite the opposite.

Our hospitals and clinics are deploying signs that read:

Kindness and patience are good for your health.

Take a deep breath or take it outside, just don’t take it out on our staff.

It is incredible that it has come to this. Thank you for making that evening noise of appreciation two years ago, for us and all the other essential workers. As I write this 2,500-3,000 Americans are still dying of Covid each day, with millions more dealing with whatever hand of disease symptoms they were dealt. We need that mutual respect right now, actually, more than the paycheck. We need it just like the teachers, retail workers, restaurant workers, grocery store workers... Keep paying it forward, as they say, and thank you for already doing this.

Fading street art, corner of South and Taney Streets, Philly

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Alive [longevity and an ounce of prevention]

* Pancreatic cancer is often found in late stages. Even though it is not one of the most common cancers, because of how aggressive it can be, it is projected to be the 2nd most common cause of death from cancer by 2040. Among the early warning signs, the new onset of diabetes might herald an underlying malignancy. The vast majority of new diabetes cases, however, are not accompanied by pancreatic cancer. For example, up to 12% of Americans have diabetes. But an article in The NYT summarizes a few red flags that might make us extra vigilant:

... a patient’s glucose level is rising rapidly and is difficult to control with diabetes medication; patients with diabetes are losing weight with no explanation like a change in diet or exercise; or if patients have been fine for years and then suddenly in their early 70s get diabetes and it’s not clear why.

People with diabetes have a higher risk of developing pancreatic cancer, and so studies are ongoing to see if more aggressive screenings like blood tests and imaging might make a difference in this population.

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* More mask mandates are going to be eased soon, for better and mostly worse, especially for vulnerable populations.

I live in the city. I also like the burbs and the country, and during the early suffocating days of the lock down, I dreamed of having a green yard and some fresh air. Living in the city with an airborne pathogen felt like being stuck inside an abscessed wound, while the rest of the burbs and countryside just had cellulitis.

But Philly is still built on neighborhoods and community, and despite what we see on the evening news in which it seems like a murderous war zone, most of my experience here has been nothing but old fashioned neighborly stuff. We talk with each other on our stoops as we walk to the grocery store, or pick up some incredible food cooked by an acclaimed Thai chef or Italian family, or watch our kids ride bikes and run around during a blocked off street party.

And people have been wearing masks in stores and schools. When the rates are high, it has been a mandate. We’re pretty well vaccinated and boosted.

Compare Ocean County, NJ, spread out and green. At the beginning of this mess I would have traded for a house there. But 2 years in, 1 out of every 200 or so residents there has died of Covid. In Philly, where we are living on top of one another by comparison, 1 out of every 360 people have died. I haven’t studied math in a long time, but I think that’s an 80% greater risk of dying of Covid.

I do wish I had a proper garden though.

And some chickens.

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Aware [commentary on key news]

Covid updates:

• A study out of Scotland showed that pregnant women who were unvaccinated had 5 times the rates of hospitalization when compared to vaccinated pregnant women.

• Kids can get quite sick with Covid, and a body-wide inflammatory condition called MIS-C can be a quite serious complication. Post-vaccination monitoring of children who received the Pfizer vaccinations has shown a 90% reduced chance of developing MIS-C.

• Pfizer announced that they are planning to seek an Emergency Use Authorization for children under age 5 for vaccination. The dosage being used is a small 3 mcg (compared to the adult 30 mcg dose). Preliminary data already released has shown this dosage to be very safe, with good antibody levels detected in children under age 2, but with disappointing antibody levels in the 2-5 yo cohort. More information is coming on this decision, and the various agencies and advisory councils will be hard at work.

  Pfizer is testing a third 3 mcg dose in the same 2-5 year olds to see if that gives better antibody levels. Instead of waiting months for this information, Pfizer is probably thinking: (1) the vaccine looks very safe, (2) antibody levels are not the only way the vaccines work, (3) vaccinated adults and older children with waning antibody levels are still benefiting from T-cell immunity to avoid getting severe illness, (and 4) day cares have been a real problem this winter. Plus many parents rightly want the vaccine for their children under 5 already. Child care centers have been their usual petri dishes, despite good efforts.

• A sublineage of Omicron called BA.2 is spreading now. It seems to be more contagious than the original, but vaccination/boosters might be a bit more protective against BA.2. The evolution of the Omicron variant is another reason why I would like to get an Omicron-specific booster if offered in the near future. Not freaking out about BA.2 at this time.

• Compared with 6 European countries, the U.S. has suffered 2-7 times more deaths, 2-8 times more hospital admissions per capita, is 10-20% less vaccinated, and up to 65% less boosted.

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Well [ideas and studies that promote better health]

It wouldn’t be a surprise if I told you that meditation is good for your mind and body. There is a lot of science supporting this, and thousands of years of human intuition. I was discussing this with someone during a visit Wednesday night, and we came to the conclusion that meditation, like exercise, is best done consistently. When you are really stressed, anxious, and in need of some help, meditation does not always provide a quick fix. It can still help, but the regular practice of meditation and mindfulness has been shown to restructure the brain in ways that help us respond to distress instead of reacting to it, or worse, trying to deny it.

I am guilty of not making time for this when things are going well. But I do have two resources to recommend. The first is a site called Meditation Oasis. Many of the guided meditations are free, or you can purchase the app for like $5 and download a bunch of great sessions. Some have themes like coping with pandemic stress, or chronic pain, or insomnia. I also like the mindfulness program that you can do in person or over video, run by Jefferson University’s Myrna Brind Center for Mindfulness. A couple years ago I participated in a one day class, and was so relaxed by the end of the day that I developed a splitting headache! Kind of like how the body might feel if we suddenly decide to run 15 miles without training, and an indicator that we need to practice more frequent self care - even when we are feeling good.

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Happy [in the pursuit of contentment]

If you wear glasses, do you remember being happy to pick out your first pair? Did you find some joy in trying out different styles, looking at your reflection as your frames lent you an instant persona - bookish, sporty, fashionable? I have not yet had that pleasure, although in my mid 40’s I am experiencing presbyopia. I can’t focus on the details of an object if held within 10 inches of my eyes. I kind of want to get some readers, if only to express myself and experience another rite of passage into adulthood. But now there are prescription eye drops (newly approved by the FDA) that we can prescribe that temporarily correct our vision for close up objects.

The drops are branded as Vuity, and not covered by insurance. I think it costs about $100 for a month supply. They can only be used once a day, and last up to 6 hours. Apparently they do work, allowing the user to focus once again on the fine details right in front of them - without glasses. Possible side effects listed include headache, blurred vision (!), redness of the eyes, and ocular irritation to name a few.

I suppose there might be situations when not having to wear readers would be preferable, but I think for many people, wearing glasses has become part of their persona.

Ben, inventor of the bifocal, looking brilliant for the ages

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And finally, have fun watching the Super Bowl, or the Winter Olympics. If you do have a watching party, remember that rapid antigen tests reduce the risk of asymptomatic spread, and are free once reimbursed by your health insurance. Keep those receipts, and don’t feel awkward incorporating safety. Coronavirus rates are still very high, although on their way down.

I see a lot of gout attacks after the Super Bowl, so be reasonable with those wings and beer. Fortunately for heart attack risk reduction, neither the Eagles nor the Cowboys are playing. And yes, guacamole is health food.

P.S. Have you seen Kamila Valieva land a quadruple jump on skates? [Addendum: this story just got a bit more complicated in terms of performance enhancing medication, ethics of little girls being pushed in sports, abusive coaching… hopefully a Simone Biles moment of reckoning for the sport of figure skating?]