ACP Internist Blog


Thursday, September 10, 2020

Behind the mask: school days

Reopening our schools during the COVID-19 pandemic is on everyone's minds, and the outlines of the conflict are at this point clear to many: not just safety for kids, parents, teachers, and staff, but also for surrounding communities. Decisions may reinforce inequity.

Specific statistical models are available for estimating the risk that a gathering of N people includes at least one person with COVID-19; other models estimate the influence of airflow and other aspects of building design.

The above depend on local factors: who is likely to be infected, and how many; how much contact (or what “mixing,” as epidemiologists call it) is prevalent in a community; what the local schools are like.

But so much isn't known. We lack consistent regimes of testing, tracing, and isolation. Only 14 states make their tracing data public; So many cases (such a basic number!) are not found or included. And those who aren't included are likely to be in the out-of-the-way corners that are too easy to ignore (underpasses, prisons, streets; entire neighborhoods).

Living under uncertainty is its own psychological trauma, but having at the same time to include in all our calculations considerations of who might be forgotten is a tougher job still, whether we are calculating statistics or merely jotting up risks and benefits on our pads or in our heads.

Yet the forgotten are always closer than one thinks.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.
Monday, July 6, 2020

With wellness habits: something is always better than nothing

The philosophy of “something is always better than nothing” is one of the most useful things to remember when it comes to lifestyle medicine and incorporating better habits into our daily routines. I've found that for many people, especially those right at the start of their health and well-being journey, the task ahead may seem very daunting and intimidating. You may eat a load of junk food, have no regular exercise routine, or have a ton of weight you want to lose. Such a big mountain to climb.

A very important thing to remember, is that we don't need to start off with huge changes immediately. There are always little, often tiny, things we can do to keep stepping in the right direction. If you've eaten a fast food meal, why not have an apple or a handful of blueberries afterwards? If you're eating a pizza full of carbs and loaded with cheese (something that you know will be terrible!), why not make an extra effort to put some vegetables on it as well? Do you find yourself sedentary in your desk job for most of the day? Then get up and ascend a few flights of stairs for a few minutes! If you know there's no way you can work out for 30 minutes to an hour because you're so busy—then just have a five-minute workout instead!

These little things add up very fast, soon become normal, and a series of habits that you're regularly engaging in, especially as you start feeling better about yourself in general. “I must eat an apple today,” “I have to have some vegetables with that,” “I need to get up and move around.” I know because this is how I started my wellness journey several years ago. Miniscule changes evolved over time to a regular ingrained pattern that has left me in better shape and feeling more energetic and happier too. I'm not going back!

This doesn't just apply to people initiating lifestyle change for the first time in their lives, it can even apply to seasoned enthusiasts. We all have days of indulging and a lack of exercise. No matter where we are … if we just keep doing those little good things every day … it soon adds up and magnifies.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.
Friday, July 3, 2020

I have perhaps 5 good years left, and don't want to live like this

I recently heard the following viewpoint from a very active person in their mid-70s:

Before the pandemic, I was in the golden years of my life. I used to enjoy gathering with all my family and friends, and was traveling the world seeing new places I've always wanted to see. The last couple of months has been horrible, I'm a scientist by training, and understand the initial need to flatten the curve and stop the spread. I don't mind spending several weeks or months living under this lockdown with these restrictions, but if we're talking years—count me out. I'm a social person, want to be able to see my family and friends regularly, and don't want my remaining years devoid of this, and the ability to travel. I know the statistics well, and the mortality rate is less than 10% in my age group, maybe much lower, and less than 1% in younger, healthier people. My age group is the one that supposedly needs the most protection, and I understand the risk. But nobody has asked me, or anyone else my age, and we have no voice in the media. To be honest, I'd rather take my chances than let my remaining years be in isolation at home—waiting for an effective vaccine or treatment which may never come. I understand the need to protect people, and by all means anyone who wants to socially isolate completely, can do so—but I don't want to live like this for the remaining few good years of my life.

What do people think of this viewpoint? Is it reasonable or selfish?

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.
Friday, June 26, 2020

3 natural things you can do to immediately boost your immunity

Engaging in healthy habits to boost your immunity, is a great idea during the best of times, let alone during a pandemic. Microbes are ubiquitous, and the human body has been engaged in a fight with them, since the beginning of time. They are going nowhere, and will still continue to threaten you, even if coronavirus disappears off the face of the earth. No matter what your age, there are always things that you can do to help make your immune system as strong as possible. Here are 3 particular health habits that you should be focusing on:

1. Eating plenty of fruits and vegetables, especially those high in anti-oxidants and vitamin C
I cannot over-emphasize the mantra of “5-a-day” enough when it comes to vegetables and fruits. If you have that in your head all the time and do it consistently, the benefits to your health are enormous. Focus on some superstars including blueberries (or any type of berry), citrus fruits, peppers, and dark green leafy vegetables.

An idea: start your morning of with a handful of blueberries and a banana, which will already give you almost half of your daily quota!

2. Get outdoors and exercise
Exercise serves a massive boost to your body, and it's an extra benefit if you can do this outdoors (also think Vitamin D, which is further linked to immunity). Minimum recommendations are for 75 minutes of vigorous intensity a week and/or 150 minutes of moderate activity a week, but feel free to do much more than just the bare minimum. This, along with diet, is obviously linked with maintaining a healthy weight. Obesity, aside from age and having pre-existing medical conditions, is one of the worst risk factors for getting extremely sick from infections.

3. Get enough sleep every night
Research suggests that almost half of adults do not get enough sleep every night. We have all probably had it drummed into us from a young age that when we sleep, our bodies heal and regenerate. It's true. If you don't get enough continuous restful sleep every night, it will serve as a huge drag on your body. Ever developed a viral illness when you are tired and sleep deprived? Probably. How much should you get? Studies suggest the optimal amount is between 6 to 8 hours for most adults every night. You probably know your own sweet spot (mine is about 6.5 hours).

If you want to give yourself a natural immunity boost and have your best chance of fighting off any infection, these three natural things done consistently will help you in more ways than you can imagine.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.