COVID19 Vaccine Update

Plans for increasing distribution of the COVID19 vaccine are rapidly evolving.

While getting the vaccine is a very personal decision, I would encourage the vast majority of you to get it. Those who are high risk for COVID19 complications (more than half the population) and those who are regularly exposed to anyone in this high risk category should especially consider getting the vaccine. The only group of people who are recommended to perhaps not to get the vaccine are those who have experienced severe vaccine-related reactions in the past.

Last week at our monthly Zoom office hours, I talked about the two vaccines and my thoughts on them. You can access the recording of that meeting here to have many of your questions anwered!

Where and When to get the Vaccine!
It looks like starting January 19th we will be able to start making appointments for the COVID vaccine at OhioHealth vaccine clinics. Starting Tuesday, January 19, those 80 years and older, will be eligible for the COVID-19 vaccine. Each week following, the eligibility age increases by five years:
January 25: age 75 and older, and those with specific high-risk conditions
February 1: age 70 and older and school personnel
February 8: age 65 and older.

COVID-19 vaccines will also be offered through other healthcare system clinics, in the local health departments' vaccine clinics and likely in pharmacies too. Those individuals haven't released their plans quite yet - or at least not to me.

Ohio Department of Health COVID-19 Vaccine info is located here including links to local health department information and CDC vaccine-related information.

Columbus Health Department COVID-19 and Vaccine information is located here including links to other local health departments if you fall outside of the Columbus area.

Keep Getting These Emails
Make sure to add drpaige@drpaige.com to your email contacts list to make sure you continue to receive our weekly emails as we will continue to send updates. Keep in mind this email is not monitored for patient questions.

Next week, we will be accepting requests to make COVID-19 vaccine appointments. Please look for our email on Monday January 18th with instructions on the best way to get signed up for the vaccine!

Invite Friends and Family to Get These Updates
If you would like me to update friends and family who aren't current patients, feel free to send this link to them and we will include them in future updates: www.drpaige.com/tips. (The first email will be the COVID19 Tip Sheet.)

How to Make Sure your COVID Vaccine is the Safest and Most Comfortable Possible
When the time comes, keep these things in mind.
The day of:
-Hydrate and eat before you go
-Relax before and after receiving the vaccine. Deep breaths!
-Be monitored afterwards for a full 30 minutes (even if you are told 15!)
-Be proud of yourself! : )
-Continue to hydrate, move your body that day to get blood pumping, sleep well.
-Use tylenol as needed for soreness, but not necessarily as prevention.

The most common normal effects of the immune response are fatigue, soreness in the injection muscle, headache and a low grade fever. Most are very mild and prevented by taking good care of yourself. Rest assured that these are signs that your body is creating an immune response that will be helpful for you in the future.

You'll do great! I'll be back in touch soon!

Best,
Dr. Paige

Vitamin D Season is Here!

Studies show that the majority of Americans have suboptimal levels of Vitamin D3 all year round, but especially during the upcoming winter months.  Our bodies can make vitamin D with safe levels of sun exposure, but most of us don't get that. Whether you live in an area of the country that doesn’t get a lot of sun or don’t spend as much time outside as you would like, it is very likely your body isn’t producing as much as you need.

Most laboratory ranges consider 30mg/dL and above normal. Optimal ranges start at 50mg/dL. If you have never had your levels checked, please do! Most physicians include this (or should!) as a standard part of annual wellness blood testing.

Vitamin D3 has many roles in bodily function. In fact, it acts more like a foundational hormone than a true vitamin. Vitamin D3 is involved in bone and muscle metabolism, nueurotransmitter balance, immune system regulation, gene regulation related to risk of cancer, and the list goes on and on.  

Symptoms of vitamin D3 deficiency are often not present until levels get very low and can be very subtle even then.  Fatigue, aches and pains, mood changes, hair and nail changes, slow wound healing, tendency for frequent infection are all associated with low vitamin D. Many people don’t notice any symptoms, unless AFTER they supplement and realize the improvement they feel.

In addition to being difficult to get through safe sun exposure, vitamin D can be difficult to get through food as well.  There aren’t many natural sources of vitamin D in food and it is somewhat difficult to absorb. Natural sources of vitamin D in food can be found in fatty fish, eggs, and cheese.  It is often added to processed foods such as cereals and milk also.  Rather than depend on vitamin D being added to foods, I recommend that everyone consider adding a high quality supplement.  

Check out more Vitamin D3 clinical info here and resources for quality supplements here.

What We Are Learning Right Now

As a physician committed to the health and safety of our community, I can’t help but notice some things that we are learning right now.  When I say learning, of course, I don’t mean that these are brand new revelations or that everyone has learned these. I mean we as a community are leaning further into these concepts and growing. Tough times spur on growth, so nothing like two pandemics to make us look at our health.  We know that our Whole Health is more than just our body. It also honors the influence of our relationships, resources and physical environment. All of those are being affected right now! Some of what we are learning:

1. Empathy is a learned skill, not a trait.  While you can’t literally step into someone else’s shoes, you can relate to them and find common ground. One of the most powerful things to consider is that you don’t have to have a common experience with someone to relate to them.  You have to have a common feeling with them.  So if you have ever felt sad, anxious, scared, grief-stricken, ignored, devalued, unheard, disrespected, etc., you can relate to someone who is experiencing those feelings to a certain degree.  Here’s the kicker though. In order to know how someone is feeling, you have to talk to them. You have to listen to them.  Ask thoughtful questions with a background of compassion and then listen.

2. We can do more than one thing at a time and care about more than one thing at a time.  This is a tough one.  Sometimes you can be tempted to think that if you care about COVID19 safety precautions, then you don’t care about financial health for example.  There are tough continuums of risks and benefits and complex mechanisms all over this world that require our attention with varying degrees of intensity.  We won’t always agree in the grey zone, but if we continue to see things as black and white, we are assured to never agree.  When I focus on your chest pain, it doesn’t mean I don’t care about your changing mole on your arm. I can make a plan that honors the urgency and risks of your chest pain AND the urgency and risks of your mole.  It requires conversation, exploration of priorities, values, fears.  It’s a challenge, but we can do it.    

3. We can focus on one thing at a time, without disparaging another or being distracted by another.  This sounds contradictory and the same as number one all at one time.  It’s really not. Hear me out.  Sometimes when you hear “black lives matter.” you may be tempted to think well “all lives matter.” Sometimes when you hear “COVID19 has killed more than one hundred thousand people in the US.” you may think “Well heart disease is the biggest killer nationwide and in my family. Why aren’t we talking about that?”   It’s natural for the brain to drift to what is familiar and comfortable.  It again goes back to the point that there are tough continuums of risks and benefits and complex mechanisms all over this world that require our attention with varying degrees of intensity.  Imagine your child comes up to you bleeding after having tripped on a toy and you turn your attention to tend to them.  The younger child says “Oh I don’t matter to you now?”  You would gently explain that their sibling needs your attention right now.  When that hurting child says “Mom, I need attention!” your first response wouldn’t be “Well, sweetie, really ALL children need attention now don’t they.”  When that bleeding child comes up to you, your first response wouldn’t be, “Well the real issue is, you should’ve been watching what you were doing. Let’s talk about your focus issue.” before stopping the bleeding.  Let’s not let uncomfortable feelings distract us from addressing one issue by changing the subject to a different issue.  

4. We evaluate the world based on our own beliefs which are formed by our experiences.  If we are not actively seeking different information from a variety of perspectives, we’re getting a very distorted picture.  This is a huge topic that deserves more than a little blurb of course, but consider these examples.  If you are young and healthy and always recovered from illness quickly, you naturally consider the threat of a new virus differently than someone you know who “always tends to catch whatever is going around.”  If you have grown up having had a few positive, respectful interactions with police officers and that is what you’ve seen others experience, you have a sense of comfort and trust with authority and may be quick to defend against anything that changes that belief. If you have grown up having been pulled over an average of 3-4 times a year for minor violations, had a gun pulled on you by one of them when you reached for your wallet after asking permission and knew multiple people with the same experience, you would think differently.  Just because we haven’t had a certain experience doesn’t mean that it doesn’t exist.    

5. It’s hard to not be triggered.  I am a firm believer that we are in control of our responses.  Our circumstances do not have to dictate our responses. If we let the stresses around us throw us off our game, then we are constantly at the mercy of changing external forces. But #HARD!  Our brain leads us in the direction of comfort and certainty and, in times that seem uncertain (spoiler alert-all times are uncertain), that reflex is even stronger.  Sometimes this happens so quickly, we have little chance to avoid being triggered.  Our only hope is how we respond after that trigger.  Notice when you feel this way and pause to respond rather than instinctively react. Example for me.  There are words that don’t feel good - white fragility, white supremacy, white privilege.  I don’t consider myself fragile.  I don’t walk around thinking I’m better than everybody.  But we can pause and dig into the meaning of these words.  They don’t have to trigger guilt, sadness, shame or defensiveness in me when I understand their systemic context.  I can actively not take on a position of discomfort talking about race.  I can acknowledge that I am more likely to get a quick respectful encounter at a traffic stop or not be pulled over at all as a white female. I can acknowledge that I’ve never thought twice about putting up my hood and scuffling swiftly away from a store in the rain.  I can look at that experience and use it for good for others.

I am in no way an expert on race relations specifically, so why am I talking about all this to you?  I am charged with helping people in my community be healthy and happy.  Anything that affects your health and happiness is in my purview.  Racism is a public health issue.  Racism is a pandemic.  Just as I am willing to step forward to share how COVID19 affects you and the community, I am willing to share how racism affects you and the community.  I could share statistics about the increased incidence of infant death, hypertension, diabetes and heart disease in the black population.  I could share statistics about the decreased rate of breastfed babies, vaccination, preventive healthcare and opportunities for healthy behaviors.  I could also tell you unfortunate data regarding patients lack of comfort and trust in the medical system due to historical breaches of that trust and, unfortunately, continued poor patient experiences with non-Black healthcare professionals.   But the most powerful is a physiologic connection that is more at the root cause of many of these phenomena and more directly related to racism itself.  If one is not afforded a baseline sense of comfort and safety in this world and consistently feel unaccepted, your sympathetic nervous system will be on overdrive way more than it is designed to be.  That fight or flight response is not meant to be activated to the degree that the stress of systemic racism causes.  When we consider our Whole Health...remember our biochemistry, structure, mindset is affected by our environment (our relationships, resources and physical environment). Racism influences Our Whole entire Health. 

So while I do not come to you as an expert, I am a huge fan of learning to be better.  I try to know what I know and what I don’t know. And I know how to find and distill good information.  And of course when I have good information, I am committed to sharing it with you!  I humbly offer you this information that may be helpful without judgement, assumptions of where you are or where you need to go.  Consider it, sit with it. Take what you see fit and leave what you do not.  While I write this from the perspective or a white woman whose community is majority white, I also offer this information to my friends of color: I honor you and stand with you. Thank you for the grace that you continue to show in sharing your stories.

And I must say that this process is not specific to race relations. You can fill in the blank with just about any topic or area of life. Humans are put on this Earth to learn, grow and serve in all areas! 

How can you actively diversify your environment, learn more and be anti-racist?

-If you feel yourself not wanting to talk about racial injustices, but you feel comfortable speaking out against other issues (climate change, metoo movement, animal cruelty, etc.), stop and ask yourself why.

-Reflect on your childhood and your experience with racist remarks, situations, opinions around you and consider how that may have affected how you relate to the world currently.  Do they still apply to the current environment?  Is there new data to take into account?

-Learn about the history of systemic oppression and privilege with an adult lens rather than our learned lens and consider how that plays a role in today’s society.  Racism can be overt or covert, intentional or unintentional as it is baked into many passive systems we often don’t stop to consider.

-Notice if you feel triggered by words like white privilege or white supremacy. Most people do and it takes some time to realize that these are not personal attacks or even conscious biases. There are simply historic and enduring systems that confer advantages, big and small.  When we stop taking them personally, we can move into understanding others’ perspectives.  

-Stay aware. Follow a variety of resources that are as level-headed as possible.  Reconciliation and justice doesn’t have to be inflammatory.

-Listen and  learn about the experiences and perspectives of people of color, recognizing that it’s not up to them to teach you about racism.  Recognize that this is an especially traumatizing time for everyone and these conversations need to happen on their time and interest.

-Don’t be shy about calling out colleagues, friends and family when they say something racist.  Coming from a posture of curiosity can help keep resistance down. Why do they think what they think/ say what they say?  

-As respectful as you may be, don’t be surprised when your call-outs meet resistance. People may become defensive or try to shift focus from the issue.  Forge on.  You are only responsible for you.

-Learn, learn, learn. You don’t have to agree with everything you learn, but if you feel like you may have room to expand your knowledge related to others’ experiences, there are great resources. Books like White Fragilty, How to be an Anti-Racist or Let it Shine, Separate is Never Equal for kids or Netflix shows like Explained: The Racial Wealth Gap or When They See Us.  Follow people online that you relate to...Emmanuel Acho, OfficialMillennialBlack, Rachel.Cargle, Nicole Walters.

-Support. Everyone is called to growth in various ways. It may be doing some thought on your own during this time. It may be having conversations with your friends and family and supporting them. It may be making a donation to CampaignZero or the American Civil Liberties Union.  It may simply be befriending new people at your church or in your community. It may be shopping at new stores or inviting new people to your business.

If I know one thing about your health, it is that it is NEVER stagnant. Our thinking and mindset is not meant to be stagnant; our physiology is not stagnant; our body structure is not stagnant.  We are meant for growth and adaptation and I lovingly urge you to explore your personal opportunities for growth!  What is your best next step?

What is your plan? Put the plan in plan demic.

I have been asked many times to respond to the issues brought forth in the video “Plandemic.” In a previous post, I talked about how it saddens me to see it throwing people into a tizzy, when I believe we benefit most from focusing on health-building activities right now. Though I have watched it and reflected on it, I just couldn’t bring myself to take the time and energy to counteract all the misinformation, but am thankful to my colleagues that have and will pass along some of their thoughts that I agree with.

In some ways conversations like these are analogous to debating the philosophy of fire, the risks and benefits of fire, who starts fires, proper place to burn fires, etc. WHILE a wildfire is still burning. This obviously detracts from the important education about how to protect yourself from fire, where and how big the fire is and what to do if you catch on fire. But for that very reason, I have gathered some information to help you have some balanced information.

First as a family physician and medical educator, I have to say that I do not purport to be an expert in infectious disease, epidemiology or political theory. I do have very solid medical training and I am an expert in knowing what I don’t know, seeking up to date information from a multitude of sources and analyzing that data to have a well-informed opinion. I am first and foremost an advocate for personalized excellent medical care for every patient. I am part of a community of physicians world-wide who do the same in their various areas. In the setting of an unprecedented global pandemic, physicians and scientists with no political agenda have banded together to share information and best practices related to a novel virus that is behaving both in the population and individuals differently than we have seen in the past. There is no algorithm for the prevention and management of COVID19 and I don’t expect one. I am open to novel treatments, holistic treatments and pharmacologic treatments and make the best judgments based on the knowledge of how the body works, previous experiences that can be safely extrapolated and evolving data.

Much of the below is taken with permission from a colleague who actually turned her privacy settings back on because the conversations in her comments were getting nasty. I also would direct you to a YouTube video by Dr. Mike entitled “Doctor Fact-Checks PLANDEMIC Conspiracy” which is a thoughtful exploration. I trust that we can share viewpoints and ask questions from a place of respect in this feed.

“Plandemic”... A well-produced, well-lit film depicts now-discredited former researcher Judy Mikovits who shares a plausible-sounding narrative about the current pandemic in the setting of her new book coming out. It uses many well-known techniques of the power of persuasion and marketing to set a scene of trust that unfortunately is misused. Nearly all of her scientific statements are demonstrably false or at best misapplied.

- She states “There is no vaccine for any RNA virus that works." Incorrect: Polio, hepatitis A, measles, to name a few. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763971/)

- Her retracted paper was actually not about vaccines at all, even though she insinuates that it was. (Here is the article: https://www.ncbi.nlm.nih.gov/pubmed/19815723)

- She states that Ebola could not infect humans until it was engineered to do so in her laboratory. This is false. (Here is an article describing an outbreak of Ebola in 1976, long before Dr. Mikovits was conducting research: https://academic.oup.com/jid/article/214/suppl_3/S93/2388104 )

- Likewise, many other zoonotic viruses have been shown to gain mutations that allow them to infect humans. This would not be some kind of new, crazy idea. We actually predicted it years ago: we just didn’t know exactly which virus or when it would occur. (Here is an article from 2015 discussing the likely emergence of future coronavirus pandemics: https://virologyj.biomedcentral.com/…/10.…/s12985-015-0422-1 )

- She states that the US was working with Wuhan to study coronaviruses years ago, like it’s a “gotcha” moment: yes, of course we were doing this – Wuhan is a coronavirus hotspot and it makes sense to study this family of viruses where it naturally occurs. (Same article as above: https://virologyj.biomedcentral.com/…/10.…/s12985-015-0422-1 )

- She states that COPD lungs are identical to COVID-19 lungs. Any practicing physician would be able to tell COPD from COVID-19, both clinically and histologically. (One article discussing an overview of tools for diagnosing COVID19 https://pubs.acs.org/doi/10.1021/acsnano.0c02624, one about CT specifically https://www.tandfonline.com/…/full/10…/22221751.2020.1750307, and one about histology specifically https://academic.oup.com/ajcp/article/153/6/725/5818922)

- The statement taken out of context from the CDC death certificate recommendation reads in full “In cases where a definitive diagnosis of COVID-19 cannot be made, but is suspected or likely (the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID-19 on a death certificate as “probable” or “presumed”. In these instances, certifiers should use their best judgment in determining if a COVID-19 diagnosis was likely. Testing for COVID-19 should be conducted whenever possible.”. My physician colleagues are not being pressured to put COVID-19 on death certificates when it should not be there. This is the same process we always follow. (Here is the actual document with instructions for

filling out death certificates from the CDC: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf )

- The idea that physicians are incorrectly diagnosing COVID-19 due to financial incentive is also ridiculous. Medicare sometimes bundles payments for some conditions (i.e. if you have a heart attack, medicare may pay XX for your treatment) – it’s possible the hospital could get paid $13,000 for your COVID-19 admission, but do you know what that’s based on? The fact that the average cost of a hospital admission for a respiratory condition is $13,297. This is actually a cost savings to patients oftentimes. The reason physicians and hospitals get paid more to diagnose COVID19 is because they spend more time, resources, talent and risk to treat it. (I can’t post a scientific study here, since this isn’t a scientific fact, but this article describes the procedure in detail: https://www.usatoday.com/…/fact-check-medicare-…/3000638001/ )

- She states that hydroxychloroquine has been “extensively studied in this family of viruses” – in fact, it has not been studied well in coronaviruses. It HAS been studied in malaria, which is not a virus. (Here is the one study that was performed that people like to cite, and it is an in vitro study (not in humans), of SARS (not COVID-19), and chloroquine (not hydroxychloroquine): https://virologyj.biomedcentral.com/…/10.1186/1743-422X-2-69 ). And yes, it is considered an essential medicine for the treatment of malaria. Not for coronaviruses.

- Furthermore, the data on hydroxychloroquine are much weaker than they originally appeared: the small study that was highly publicized was not a randomized controlled trial, and the only patients who died were those who received hydroxychloroquine (and these were EXCLUDED FROM ANALYSIS!). This is terrible science. Even so, we want to investigate all possible treatments, so controlled trials are being conducted on hydroxychloroquine right now. (Current recommendations and summary of research: https://www.cebm.net/…/hydroxychloroquine-for-covid-19-wha…/ ; One study published on May 7 shows no benefit to using hydroxychloroquine https://www.nejm.org/doi/pdf/10.1056/NEJMoa2012410… )

- She insinuates that there is a hydroxychloroquine shortage as a result of reduced production. In fact, the shortage has resulted from an increase in demand: people who take this medication regularly are writing extended prescriptions and because physicians are using it for COVID19 patients because they have nothing else to try. (https://jamanetwork.com/c…/health-forum/fullarticle/2764607…).

- “All flu vaccines contain coronaviruses”. Nope, absolutely false. (In fact, it’s so false based on the way vaccines are made that there are no studies specifically stating this claim. It would be like trying to conduct a study to examine whether humans can live with zero oxygen. Nope, we can’t. No study needed.)

- The idea that sheltering in place somehow harms your immune system is really far fetched. There are plenty of viruses and bacteria all around us that keep our immune system busy. Your GI system doesn’t wither away when you eat less food. Your immune system is fine. A YouTube video by Dr. Mike (Doctor Fact-Checks PLANDEMIC Conspiracy) gives good info on this in more detail.

-That you may reactivate a virus in yourself by wearing a mask have been thoroughly debunked in other posts and I won’t get into the details here. Both national societies of emergency medicine have condemned the statements of these doctors, one of whom is not board-certified. Masks indeed need to be donned carefully so as not to spread droplets that may be on the mask though.

- Lastly, private companies removing false information from their platforms does not represent repression or promotion of propaganda. We have the right to free speech indeed, but we don’t have the right to spread misinformation on private companies’ platforms. I personally regret that taking down the message seems to have helped it gain steam, but it’s not our right to speak on someone else’s turf.

There is nothing wrong with taking in a variety of sources of information. I encourage it! Stay open. Know your biases. #bealeader to yourself first and foremost and then to your loved ones and community. My hope is that where you focus your emotional, intellectual and physical energy is benefiting you and not distracting you from what you would be better served focusing on.

You cannot steer a storm, but you can steer your own boat! What is YOUR plan to move forward in one area of your Whole Health - mind, body, spirit … life!

Update on Office Practice and Healthy at Home!

Hello!

I hope this finds you well. Some updates as the Stay Safe at Home order is extended through May 29th for many activities…

1. I continue to be available to you for both in-person and telehealth visits (text, phone, video chat via our Spruce app).

2. I continue to be available to work with you to create the healthcare experience that is the safest and most comfortable for you.  I also can serve as your advocate and advisor for your work environment and other activities.  Your health decisions need to be personalized to you and balance your Whole Health - mind, body, spirit...and life!  Please don’t hesitate to have those conversations!

3. As always, I encourage you to contact me with any new symptoms that you have questions about and keep me up to date with any changing or progressing symptoms.  If you don’t already have medical equipment at home, you may want to consider investing in a thermometer, a blood pressure cuff and a pulse oximeter as monitoring tools for your family. 

4. I encourage you to take advantage of our telehealth platform (text, phone and video chat via our Spruce app) as a primary resource (ask if you aren’t already connected!).  I know it’s hard to wrap our heads around at first, but a lot of care can safely take place via these technologies while decreasing your risk of exposures.  This is especially important for those at higher risk (age 65 and over, those with obesity, diabetes, lung, heart, liver or kidney disease or other immunocompromised states).

5. Even though telehealth is prefered for most, don’t hesitate to specifically request an in person visit so we can discuss and make the decision that is right for you.  Following CDC and Ohio department of Health best practices for in-person visits:

   1. A virtual history will always be taken (by phone, video and/or questionnaire) to solidify best next steps.

   2. Children or visitors should not come to the office unless prior arrangements are made. One patient assistant (for help navigating the office or relaying information) is always permitted as long as they are well.

   3. Before coming to the office, everyone (patients and assistants) should check their temperature at home and report a temp of 99 or above and any ill symptoms before coming to the office.

   4. Please arrive on time or let us know if you are running early or late, so that we can safely minimize your exposure to others.

   5. Please wear a face covering or shield while in office if you have any ill symptoms or if you don’t have symptoms and are comfortable doing so.  We commit to do the same for you.  Use hand sanitizer before you come and/or when you arrive and avoid touching high-touch surfaces when possible.  

   6. Please maintain 6 foot distancing when possible in the office. 

6. Don’t fall behind on your check-ups and preventive care!  Even when we may use telehealth as a primary resource, we can still touch base on how you are feeling (physically and emotionally!).  “Virtual check-ups” in this time to keep medication up to date, talk about how you are doing, share vitals that you can take at home (blood pressure, temperature, pulse, pulse ox and blood sugar for some), arrange for blood testing and imaging at low contact locations and other helpful care recommendations can still happen. So even if you prefer to stay home, feel free to have your regular “check-up” virtually!

7. Don’t hesitate to keep up with (or start!) your counseling appointments. Kevin is seeing clients in person and virtually while respecting physical distancing. We all need support during this time and talking with a professional is a key way to help you adapt, cope and thrive during tough times!  Call or text 614-710-0075 to schedule with him.

8. Thank you to everyone who has been joining our Wednesday 1pm Online Office Hours via Zoom. It’s a casual drop-in environment to share information and ask questions and is open to patients and friends, so feel free to pass along the invite. These will continue in the month of May. Join Zoom Meeting: Meeting ID: 280 157 653 Password: Signature

9. I want to know how you are doing!  If you are not due for a checkup and not having a concern that needs evaluated, just shoot me a note to say hi and give me an update on life!   : ) I have been thinking about you!

Best, 

Dr. Paige

PS - There’s a lot of talk about “Stay at Home” but I am more concerned about being HEALTHY at home (and out and about if you need or choose to be of course).  As we navigate living in a community that will continue to have concerns about infectious disease, let’s turn our focus to HEALTH. 

When we create physical and emotional health, we naturally become more resilient to infections AND the effects of social changes all around us.  Much more info to come about how we can support each other with this!

Stepping Back Into 'Normal' Life

There are many emotions around the opening up of our everyday lives again. Here are my thoughts.

The most common question I get is “Is ___ safe?” or “Will ___ be safe in the ___?”  It’s a complex question to answer because it involves both a respect for public health recommendations and orders and your individual health status and tolerance for risk.  So that is the process that I walk patients through to come to a decision.  We often tend to see things as black and white and there is nothing black and white about personal and public health. There are no absolutes.  

When you think about it, you have likely experienced this method of thinking in other decisions when it comes to your personal health.  Your blood sugar is above range. What are the risks/benefits to using medication now vs working on diet & exercises vs doing nothing?  What do you decide to do?  You broke your arm.  What are the chances of it healing on its own vs using a surgically placed pin?  What do you decide to do?  We have scientific knowledge of how the body works and scientific data on the effects of various interventions to guide us, but we don’t have absolute certainty on our individual  outcome.

But there is added complexity here.  We are not simply considering a treatment for a condition we know you already have. We are also considering your risk of getting it, the risk of other people in your community getting it from you and the health and viability of the entire healthcare system.  Because of the novelty of COVID19, we don’t have the level of scientific data that we would prefer related to treatment options and outcomes.  We haven’t had the testing and tracking at the population level, so we don’t have a good estimate on what your personal risk is of contracting it at any given time.  And from a population health perspective, we have to consider not only your outcome, but the outcome of others in the community and our ability to treat a given population for any health concern with a functional healthcare system.    

No wonder it’s a complicated topic!  And when things get complicated, sometimes we are tempted to try to oversimplify.  When the stress of uncertainty or fear sets in, we are tempted to oversimplify.  The reality is that this is a constantly evolving situation that will continue to evolve based on the nature of the virus, your individual health decisions and population-based control measures.  Some things to keep in mind…

Social distancing was never meant to eliminate the spread of the virus. It was simply meant to slow the spread.  A main goal of this was to give the hospital system time to prepare for higher numbers of sick individuals, increase testing so that we can track risk better and increase protection supplies to help slow spread.  This has been done to varying degrees in various areas. 

There is no doubt that when reopening happens, we will experience an increase in cases proportionate to the level of additional exposures.  Until enough people develop a natural immunity (get the virus and recover) or get a vaccine (a long way off), this will be the case.  

There is no one way to eliminate risk. Even now you have some level of risk.  Our continued goals are to keep our personal level of risk at a personally acceptable level and the population’s level of risk at a culturally acceptable level.  We individually determine our personal risk tolerance with wise counsel.  Our leaders determine our population’s acceptable level of risk based on wise counsel.

Our best means of decreasing individual exposure/infection that we can layer on top of one another to gain confidence in our safety are:

1 - Physical distancing (6 feet or more), either electively or by order

2 - Not touching contaminated surfaces, frequently washing shared surfaces

3 - Washing your hands frequently

4 - Not touching your face (eyes, nose, mouth)

5 - Wearing a mask with proper handling

Our best way of decreasing the population risk are:

1 - More testing (identifying current and past cases)

2 - Isolation of sick individuals 

3 - Tracking and quarantining of exposed individuals

4 - Collective voluntary agreement or policies to order any of the above individual measures

So now we are back to the punchline...how you proceed revolves around a respect for public health recommendations and orders and your individual health status and tolerance for risk.  

1 - Government orders are usually a minimal safe standard based on population status. Your decision may be more extreme. (Could be less also, but that would have ramifications of course.)

2 - Government health recommendations may be a higher safety standard. Your decision may be more or less extreme based on your Whole Health considerations - emotional, physical, spiritual, financial, relational, community concern, environment.

3 - Your individual health status and tolerance for risk. This requires that careful conversation about the status of your Whole Health and what your best efforts can be.  

Does your physical health put you at higher risk for complications (based on age over 65), obesity, diabetes, lung, heart, kidney or liver disease immunocompromised status)? 

Is your emotional health struggling despite your best attempts to adapt?  

Financial health - What is the status of your basic resources - shelter, food, finances - and how is that affecting other areas?  

Relational health - How much is your current level of connection with friends or family affecting your overall health? What is your level of concern for vulnerable populations in your community?   

Is your current environment safe?

These are just some of the questions that might guide your decisions.  The most important thing is to judge the situation from a place of calm wisdom - not fear, anger or rebellion.  Seek wise counsel on what is best for you if you are struggling.  

Be your best self - whatever that is.

Every single one of us has the same basic human concerns. Your Whole Health priorities are not necessarily the same as others, but everyone has these concerns.  We truly are in this together, even though everyone’s individual situation is different. 

Yes, there are basic governmental regulations that must be followed. Yes, our efforts affect those around us.  But there is much freedom in what is best for you.  You will see a lot of variation in how individuals, families, businesses and communities conduct themselves and that is okay!  

You may not feel comfortable going back to work and choose to take a leave based on your risk status.

You may choose to add your siblings family into your “pod” of exposure, but continue as is otherwise.

You may return to work and commit to take extra protection and self-monitoring precautions when you are there and when you come home.

You may see your family doctor via telehealth, but see your counselor in person.

You may choose to continue to meet with your church group virtually, but meet a friend for coffee on the patio.

You may go into the grocery for the first time in six weeks with a mask. You may continue curbside pick up. 

Whatever you choose today might change in two weeks or tomorrow and that is okay. The situation is evolving. Your best effort is evolving. Your resilience is evolving. Your confidence is evolving. Your wisdom is evolving. Your creativity is evolving. 

Be your best self - whatever that is. 

Stressed, tired, overwhelmed, overweight and uncertain?

Okay this has been on my mind for the past month! SO much to share with you...

I talk a lot about Whole Health - mind, body, spirit...and life!  During times like this every aspect of our Whole Health is being affected.  It’s more obvious than ever before how intertwined our physical and emotional health is with our life circumstances. But there is great news!  We have the ability to thrive despite our life circumstances.  Human beings are resilient. We are made to adapt, get scrappy and come out on top!   

It is so very normal to feel all over the place right now. In times of uncertainty, our brains search for answers that either aren’t there or are ever changing.  Naturally this creates major emotional unrest - truly traumatic unrest which can cause all sorts of fight or flight-like and grief-like reactions. But I won’t get too nerdy sciencey on you.  The real question is, how in the world can we get through this? I’ve got you!

MAJOR disclaimer for my overachievers out there...this is not a “to do” list. More is not necessarily better.  This is a list of possibilities. Pick ONE thing to start with. Pick the thing that feels the best - there is no one “right” thing for you. In fact the thing that feels best to you is automatically the right thing.  You are wise. Your body is wise. You can be your own doctor here and “Self-Rx” the one thing that feels like a go, commit to do it, do it, be proud of yourself for it. Repeat. : ) More at the end...

Whole Health Hacks for this time (and all times)!

1. Form a loose routine. Start with bedtime. Set a timer on your phone for 30 minutes before you want to be asleep that says “bedtime routine.” When it goes off, tell the toddler in your brain (we’ve all got one!) that it’s bedtime and then start a relaxing bedtime routine that helps you wind down.  See below on using your senses to sooth.  

2. Build on that bedtime and set yourself up for success the next day during that bedtime routine.  Think of one thing that you want to do the next day - something that you are excited about and will be proud of yourself for.  Commit to do it. Consider even writing it down, so when you check it off the next day, you get that good ol’ dopamine rush of accomplishment.  Bonus points if you even set yourself up for success by making it easier to do (ie-filling up your water bottle.)   

3. Be intentional about waking up.  Okay I know that sounds odd, but energy doesn’t come from the sky. Your body creates energy.  And it needs some basics to do it - air, water, movement, stimulation to your brain (thinking, light, sound, etc.).  Use that to your advantage and get up, take some deep breaths, drink some water, get your body moving and have a plan for what you’re going to do.

4. Develop anchors within your day as much as you can. Bedtime and wake time are good ones to start with.  The idea is not to feel like everything is regimented, but rather to maintain some things on a schedule so that your brain is calmed by having an expectation and meeting it. Realize that even anchors have to have flexibility sometimes.  Some things that can serve as anchors: wake time, dressed and ready to roll time, meal times, school start time, outside time, midday rest time, fun time, tech free time, call a friend time, TV time, bedtime routine time, lights out time.

5. “Put on a li’l lipstick. You’ll be fine!” My mom was famous for saying this when she wanted to speed up the teenagers' getting ready process.  It’s priceless advice. Part of caring for your body is caring for the “esthetic of self.” You don’t have to impress anyone but yourself and when you put in a little effort you will be impressed. Some ideas: shave, dress up even if you’re not leaving, paint your nails, put on pants with buttons (not elastic. lol), do your brows, try a new lipstick, try out that Texas big hair, wash, exfoliate and moisturize, use a face mask, wear different jewelry, choose a bright color in your outfit, figure out how to fold that scarf you got for Christmas last year.

6. Fresh air don’t care.  Get some fresh air every day, ideally multiple times per day.  I don’t care if it’s too cold, too hot, too rainy, too dry, too humid, too whatever. Sometimes I feel a little wimpy because Ohio weather is frequently too <something> and then I realize that is an excuse.  Some ideas: open a window, sit on the porch and take some deep breaths, play in the backyard, go for a walk, go to a park for a trail walk. (You can safely do this while maintaining physical distance from others and wearing a mask can further protect.)

7. Enjoy your inside time too.  This is a good time to renew your pride in your home. Spring cleaning is therapeutic in and of itself, but an organized environment can feel calming.  Have fun with changing up decor, rearranging furniture, building a fort. Try to have an area where people in your home can go to have some down time on their own and respect their need for that.  This isn’t always possible, but even a quiet corner or a walk in closet can be soothing. Everything in moderation though. Try not to over obsess about cleanliness or tidyness. 

8. Lend a hand.  Stress makes us very self-centered. There’s no shame in it - it’s a natural protective mechanism, but we have to fight against that. There’s nothing that gets us away from worrying about our own situation more than helping someone we appreciate. Some ideas: send a cheerful text/email/phone call/video chat, write a well wishing card to a nursing home, write a thank you note to someone in an essential line of work, do a chore for someone in your household, pay for the person behind you in the drive-thru, post something encouraging on social media, hug your kiddos extra, play an undistracted game with your household members, share these tips and other encouraging information with your crew.

9. Be a little self-centered. Ironic huh?  Do something that you like to do. Don’t be afraid to ask for some alone time in a kind way or you get to pick the show on TV. Some ideas:  lay down and daydream, write in a journal, read a juicy book, do a craft, color, knit, sing, dance, go for a drive, take a bath, light a candle, watch your favorite show, you pick the board game the family plays.

10. Do something for your biochemistry each day.  Okay we can consider that something for your belly as well as I tell my girls.  Our body is fed via nutrition and hydration. Some ideas: pick a water intake goal, pick a fruit/veggie intake goal, commit to eating at the table only, commit to take your supplements/medications on time, try a new healthier recipe, set the table for a fancy slow enjoyable dinner.

11. Do something for your body each day.  I’m not talking about a workout program. I’m talking about something that is meant to make your body structure feel good!  Some ideas: stretch from head to toe as you get out of bed, before going to bed or during commercials; go for a walk, have a dance party, do an online workout, use resistance bands or weights for strength training, try a plank challenge, wear a pedometer and set a steps goal, walk around the house, go up and down stairs.

10. Soothe yourself. I talk a lot about soothing through your senses.  Our brain gets messages through all of our senses, so stands to reason that if we want a calmer or happier output then we can start with a more positive input. Think in terms of what you are seeing, hearing, smelling, touching, tasting, how you’re moving and design opportunities for you and your family to give yourself what you need. Some ideas: looking out the window, enjoying nature views, designing a neat area of your home (clutter makes us more anxious), looking through old photo albums, listening to happy or relaxing music and shows, turning off negative news or conversations, aromatherapy through candles, essential oils (lavender is calming, citrus or eucalyptus is energizing), cuddling up with your favorite blanket, scarf, comfy pants, lovey, bear, eating slowly and intentionally to enjoy the flavor of your foods, eating different and more naturally flavorful foods (citrus, spicey), movement through traditionally calming activities like dance, coloring, sewing, knitting, running, skating, skipping rope. 

12. Let others do their thing. Everyone is going through a tough time and needs a little extra grace. This is not the time to hold big ones and or little ones to a standard of perfection.  Emotions may seem hard to understand, reactions may seem exaggerated. This is a time to practice grace and let things roll off your back a little more. (I have to insert here though that there is no grace for a lack of safety. If you are in an unsafe environment, please reach out for help. Don’t look the other way either - if someone you know if not safe, please speak out to protect those who can’t protect themselves. You can text LOVEis to 22522 or call 800.799.7233.) 

13. Practice a self-coaching mindset.  You are the police(wo)man of your mind and our thoughts lead to our feelings. Read that again because it’s hard to swallow sometimes. Our thoughts determine our feelings, not our circumstances. It is possible to be in total chaos and be calm as a cucumber.  The only way to get there is to monitor our thoughts and reroute the ones that don’t serve us well.  Literally practice coaching yourself in a kind way. What is a good coach? A coach sees the best in us, she holds us accountable, she pushes us, she knows our edge, she knows when we need to recover, she doesn't let us get away with the BS (that’s toddler talk), but she doesn’t shame or belittle us (that’s mean girl talk).  If you find yourself going down a rabbit hole, think “What would the coach say?”

14. When you are sick of the coach, listen to the cheerleaders. Sometimes you gotta be your own hypesquad. When you are down by 5 with 1:34 on the clock and the crowd is silent, the cheerleaders are still doing their thing.  The reality is you are a survivor. You are resilient. You are creative. You are scrappy. You have survived 100% of your hardest days and you are going to be okay. It may not look how you would prefer, but you got this!

15. It is what it is.  I have a love hate relationship with this sentence.  It is one of the most overused victim-mindset-ridden phrases in some circumstances. However, it also has wisdom.  Accepting where we are without judgement of ourselves and others is huge...and hard. It’s kind of mind-blowing to think about, but it is possible to totally love and care for yourself with grace and acceptance and still seek growth and improvement.  You don’t have to do your best. To be integrity with yourself, you do need to try your best and accept that your best effort will vary day to day hour to hour minute to minute sometimes.  Control what you can control...your focus, attitude and your effort are the top ones. I may not know when quarantine is over, but I sure can hang these shirts up in rainbow order, call for better rates on my telephone bill and tell my kids how proud I am of them.

16. How is this happening for me?  Have you ever gone through a really rocky time - breakup, death of a loved one, abuse, job loss, health crisis and felt like your world was crashing down only to later realize that in some ways it was “the best thing that’s ever happened to you.”  Looking back you see the doors that were opened, the wisdom you gained, the friendships that were solidified, the confidence you grew. What if we could see those blessings right in the eye of the storm? #easiersaidthandone We can practice it though.  What are we learning in this? Where are there opportunities in this? How is this helping us define a new normal? What is this changing in me and in my life that needed to change?

17. Create a blessing. If that one was difficult, you may have to manufacture your own blessing right now. You may have to pick something to learn or create a positive activity to get you through this.  Think of something so that later on you can say “Remember that crazy time back in 2020 when I was stuck inside and drive y’all crazy learning to speak Spanish from the internet?” Some ideas: new language, calligraphy, sewing, cooking, huge puzzles, writing a business plan, painting the house, building furniture, singing lessons, playing an instrument, reading the entire book series, watching the entire TV series, finishing the Bible, taking an online course, researching a side hustle.

18. Equal playing time.  In the spirit of everyone gets a trophy, I’m not asking you to be Susie Sunshine all the time.  I’m just asking you to strive for equal playing time.  Our brain is perfectly designed to protect us. Notice I said protect - not make us happy.  That’s why anticipating the negative is so easy for us. It’s a pretty strong default. So if our brain is going to spend all that time going down rabbit holes of creating hypothetical doomsday scenarios for you to freak out about, then I just simply ask it to give equal playing time creating hypothetical positive scenarios for you to get excited about. Intentionally think of positive things that could happen. Intentionally see positive things happening.  You’ll feel silly, but it works.    

19. The opposite of sadness is funny.  If you are having a hard time giving equal playing time to positive scenarios, you may have to hack this one a little.  You can also balance sadness with humor. Have you ever noticed how people say the most inappropriately funny things in the most stressful of times? I am the queen of it personally.  Laughter breaks tension, anger, sorrow, all the headless horsemen. Some ideas: joke books, tell Alexa/Siri to tell you a joke, stand-up comedians on TV, Funniest Home Videos, blooper videos on youtube, funny movies. If you can’t think of anything else, google “runway model fails” videos. I dare you.

20. Anticipation.  One of the strongest ways to improve our happiness is to have something to look forward to.  Have you ever been more excited planning that dream vacation than you were actually on it? Heck yes!  (Especially if you have kids. lol) Use this to your advantage. Think of what you are looking forward to both day by day and in the future. You don’t even have to know exactly when it’s going to happen to benefit from it!  

21. Savoring.  Another big bang for our buck comes from savoring.  It’s a little hard to explain, but if you picture that fancy wine connoisseur you get the idea.  They enjoy everything about that moment through as many of their senses as possible. Pick something - anything - and savor the moment with it.  Experience it with every bit of mindfulness you can muster. It could be a sunrise, a kid’s laugh, a hug, a meal, a dance, anything!  

22. Gratitude. Oprah made it cool, let’s be honest. There’s so much neuroscience behind this.  When you reflect back on something in your life that you are thankful for, your brain shoots off little fireworks. Truth.  Writing down a few things that you are grateful for every day makes those fireworks even bigger. Bonus points if those things are small, specific and unique day to day.

23. Don’t keep that gratitude to yourself.  Part of connecting with others is expressing appreciation.  Saying thank you for the littlest of everyday things, even the things they are “supposed to be doing anyway” is huge!  Giving compliments, writing thank you notes, buying or making small gifts are other great ways to spread gratitude.

24. One day at a time. I know it sounds corny.  Have you ever been running and thought to yourself “Just run to that mailbox.” And then when you get to the mailbox, you say “Okay, just to that stop sign and then you can stop.” And then when you get to the stop sign “You’re almost home; just make it home.”  We don’t necessarily know when we’ll be able to stop running, but we know that these stressors are temporary. They are difficult. They are stressful, but they will indeed pass. Do not focus on the finish line. We can’t see that quite yet. Focus on this minute, this hours, this day, this week. Set small goals and then reset them.  Be obsessed with the process of living your life, not the results of living your life.

25. Lean on me...when you’re not strong. I’ll be there… Remember that song? This is not the time to fly solo.  Lean on trusted counselors, friends and family that are setting a good example of the direction you want to go. I’m asking you to fiercely guard your mindset and that means not everyone gets to speak into your life right now.  But it also means that you need to have support. Sometimes in times of stress, we tend to “turtle in” way too much. Maybe we think we don’t want to bother people. Maybe we are just hoping things will get better on their own. It’s great to be positive, but hope is not a strategy.  Stay connected or get connected to help as you need it...they can be counselors, doctors, therapists, teachers, tutors, financial advisors, friends, mentors, family members. We are pack animals. We’re not meant to ride this one alone.

26. Lean on Him.  No matter what your faith, times like this make it very obvious that we are part of something bigger.  I personally believe that God is always beside us. God always has our best interest in mind. God always has His purpose in mind. We may not understand the why’s, the how’s and the what’s, but we are loved and we are taken care. We also are put on earth to grow and fully express our God-given gifts and talents for His purpose the best we can. It is not lost on me that I am editing this the night before Easter, a season of trial, persecution, but most of all of new beginnings.  I am so thankful for my faith, for those who walk in faith with me and support me without judgement. We are truly in this together - both this crisis - and life!    

 Okay, that was A LOT!  Does that trigger the over-achiever in you?  (I am a recovering overachiever myself.) Remember what I said in the beginning, I want you to do one thing. I don’t want you to feel guilty because you think you should be doing more. This is not just one thing or that you only did one thing. This is an intentional hack to literally start to stabilize your brain chemistry in chaotic and uncertain times.  And it’s the first step in a coaching process you can follow to gradually navigate growth going forward.  

One thing is so powerful because:

1 - You promote yourself to the status of being your own best doctor and self assess what you need. 

Promotions are good right? They create reward.

2 - You honor your intuition and Self-Rx that thing that feels like a go. 

Honoring yourself is good right? It promotes trust and security.

3 - You make a commitment to yourself to complete that “prescription” and get excited for it.

Keeping your word to yourself is good right? It promotes trust and security.

4 - You do it and savor it.

Mindfully experiencing this action is great right? It promotes a realization that “everything is okay.”

5 - You celebrate and express gratitude to yourself for doing it.

Celebration and positive reflection helps you re-experience that “everything’s okay” feeling and rewards you with a sense of accomplishment. 

#ididonethingtoday today. What did you do that made you proud of yourself today? Share with me on social or here!

@drpaigedo on Facebook and Instagram

Wise Tactical Grocery Shopping Tips

Seeking food is indeed an essential activity, so how can we do this the safest?

1. Don’t go...seriously consider, “Is this really necessary or can I make do with what I have and batch what’s on my list until next trip?”  Next to not going, best to use the drive up pick up services. Skip ahead to number 7 if you do.

2. Batch your trip...plan to buy what you need for 2-3 weeks if at all possible. Don’t hoard, but limit the number of trips as much as possible.  Use frozen items in addition to fresh to make supply last longer.

3. Go when and where it’s not crowded...if you have to pass a store and go to another one, do it.

4. Masks - given the shortage of masks needed by sick people, caregivers and medical personnel and the potential for them to increase your risk is mishandled, these are not recommended. Homemade masks, scarves, bandanas can provide some protection if you are in a place where you have to come within six feet of people.  Just be sure not to touch them or your face!

5. Gloves - gloves only work if they are used for one contact/exposure and then discarded. Otherwise you are little germ collectors just like your hands and provide a false sense of reassurance that ends up with increased spread of germs.  Better to treat your hands as contaminated when they are, don’t touch your face or unnecessary items and thoroughly wash your hands after. 

6. Navigate the store like a well-choreographed dance.  Make a list and get what you need as you go, being aware of what and who is around you. Avoid an aisle that is crowded and circle back if needed. The six foot rule applies even when in businesses that are essential.

7. Don’t touch other people’s stuff and don’t let people touch your stuff whenever possible. If stuff has been touched, consider it contaminated.  Remember the “if you break it you buy it rule”? Now use the “if you touch it you buy it” if at all possible. Bring only what you need with you - perhaps two credit cards, your ID and a list in your pocket as opposed to a purse.  Wipe down anything you need to touch and/or wipe your hands down after you touch it (example-wipe the grocery cart handle, do your shopping, wipe down your credits cards, sanitize hands when you leave).

8. When you get home...your home is your sanctuary so make it as safe as possible by not letting contaminated things beyond the entryway or have one place where you unload things that are contaminated.  Have hand sanitizer by the door, all shoes come off at the door. Consider letting anything that doesn’t need refrigeration in the car for a few hours (virus dies on most surfaces in that time). Consider wiping down items that come into the house (plastic, glass, metal especially where the virus lives longer).  Wash fresh produce. Wash your hands and the surfaces that “dirty” items came into contact with. Retrace your steps and clean your way backwards and leave any contaminated items in the garage/entryway. Consider changing clothes and/or showering when you are done (more due to potential contact with humans than contaminated food items).    

Be well!

COVID-19 Update 3.31.2020 FAQs and an Invite

Hi my friend!

I think everyone is going through the “stages of quarantine” right now.  There are stages of realization of the importance of physical distancing that everyone will go through.  It is my hope that my information served to help you be an early adopter and that you are doing your absolute best to limit contact with anyone except your immediate pod (and advocating for others to do the same).  There are also stages of responses to this whole situation and those will feel fairly up and down. It’s okay to have good days and bad days. Just not okay to stay in the blah. : )

Reminder that our online office hours are every Wednesday at 1pm.  Join us and bring your questions! Kevin Malarkey, our licensed family counselor, will be joining us this Wednesday to talk about our emotional health and coping during this time. You can click here if you need the link.

Some FAQ’s that I wanted to cover now:

I want to help care for someone who is at high risk. What can I do to protect them?

Very good question!  The most important thing is to limit the number of people you are exposed to. So if you are caring for a high risk individual, you should not be around many other people at all and the people you’re around shouldn’t be around a lot of people.  (So basically if you are an essential worker or live with an essential worker, you may not be the ideal caregiver) Some tips: go to the grocery very infrequently, use drive up pick up services and/or delivery, consider using a mask, in general don’t let them touch your stuff and try not to touch their stuff as much as possible. No hand to hand touching. Do as much at a distance as possible. Wash your hands when you arrive and frequently.

Not knowing is so hard.  How do I deal with that?

Well in the tough love category, the not knowing is not new. We have never known what the future holds. We have never been in control.  All of our efforts to fool ourselves into thinking so were false before. This is an opportunity to work on taking wise decisive preventive action to the best of your ability and release the rest to faith. That is the only way to see the lessons in this, gain a sense of calm and enjoy your life. 

When do I think this will be over?

Good question!  What I do know is that this is not something that is going to be over and we snap back to the “way things were.” This is a time that everyone’s life needs to adapt and change and we will take many of those adaptations forward to a new normal - a normal that can actually be better!  The estimated peek is mid-May, but is changing depending on how well we respond to physical distancing recommendations. The response will also depend on the amount of testing we get access to. The more testing we have the more we can target the isolations. Once the peak subsides, we will gradually unravel the limitations. There is also a possibility that if another peak develops, we may need to reinstate stay at home.

I wonder if I already had it. How will I know?

We know that first cases in China were late December and the first people from China into the US (and Ohio) were early January. At that point quarantines were expected, but it is possible that there has been spread since January.  They are working on a blood test that shows some level of immunity and that will be a great addition to our tools. Do keep in mind though that multiple strains can continue to develop and there has been evidence of reinfection in some, so we can’t assume complete protection.

Is there a testing update?

Testing is still limited to hospitalized individuals, high risk individuals with significant symptoms and healthcare workers. Assume you have the virus and act accordingly (isolation, self care per my previous posts).  Contact me if you have any questions!

What’s the deal with hydroxychoroquine and azithromycin as a treatment for COVID19?

There was a very small study out of France that showed improvement with these two medications and studies are currently underway. Those with severe symptoms are eligible to take these medications even before they are FDA approved. These medicines aren’t without risk though. When used together there is a risk of dangerous heart rhythm disturbances, so they must be used carefully.

PS—If you are feeling like you want to help in some way and not sure what to do, check out these t-shirts. We designed them to inspire you and THANK YOU for all you are doing to keep your community and yourself healthy!

Checking in with YOU!

I have so much to say!

SO much going on.

SO much to consider.

SO much to share to keep you healthy and happy.

But honestly I don’t just want to be that chatty older sister with all the advice giving. lol. And this is hard for me because I have advice to share. And opinions. And suggestions. And…

I want to pause to listen for a minute…HOW ARE YOU?

What is on your mind? What questions do you have for me?

Shoot me a note via this link!

Talk to you soon.

Dr. Paige

COVID-19 Update 3.18.2020

An update from my previous posts for you.  Be sure to check the previous information too if you haven’t seen it. 

I hope all of you are staying well and paying attention to what I call your Whole Health - emotional, spiritual, physical, intellectual, relational, financial, environmental.  Everyone is affected in one or many of those health dimensions and we need each other’s support to cope and adapt.  

Some updates:

1. Social distancing 

   1. My recommendation for everyone at this time is what San Francisco is calling “shelter in place.”  While this may sound alarming, it really is no different than what has been communicated before for many. It’s just more important now.  If it is not essential, don’t leave home for it.  

   2. Essential things include: to seek non-elective healthcare, to seek and deliver a reasonable food supply for your family or someone who is isolated due to illness, suspected illness or higher than average risk, to exercise outside at a six foot distance from anyone not within your family (backyard play, walks, nature trails, biking, etc..), to go to work if you are an essential employee.  

   3. All nonessential employees should be working from home. If you are considered an essential employee, you should be provided the maximum opportunity to physically distance yourself from others, have access to handwashing/hand sanitizer, have your temperature taken daily and have the opportunity to self quarantine if you have symptoms.  Advocate for yourself and your fellow employees referencing this communication and the Ohio Department of Health communications.

   4. Pods - Consider the concept of living life within a small “pod” or tribe as Dr. Acton references.  Everyone has a small pod of people that they have accepted the risk of being around. Keep in mind that you have the risk of exposure to them AND everyone who they are around. If one person in the pod becomes ill, everyone should conduct themselves as though they are ill.  SO very important to keep that pod small and, have commitment of pod members to physical distancing when they are not around you and be doing what you can to minimize risk even within the pod. My pod = kiddos, daddy, babysitter, nurse friend that we are sharing childcare with and her child, nurse and patients who I can't treat via telemedicine. My pod is bigger than I would like it to be. Do better than me!

2. If you have any symptoms:

   1. If you have any symptoms of illness You should not be around anyone other than people who live in your house and you should be cautious about minimizing contact with those people (handwashing, covering mouth and nose, not sharing food, utensils, physical separation as able, etc.).  You should check your own temperature every day to monitor for symptoms.      

   2. If you have mild symptoms, be aggressive with self care: increase fluids, rest, have Tylenol (Acetaminophen) available to manage fevers if uncomfortable (1000mg three times a day). Recent study suggests that ibuprofen/antiinflammatories might not be ideal for this particular virus, so stick with acetaminophen if possible. Take guaifenesin/mucinex over the counter, consider integrative techniques like taking intentional big deep breaths hourly to expand lung passages, increasing/supplementing Vit C, Vit D, Zinc.  Some study suggests that Echinacea and Elderberry might not be ideal for treatment of this active viral illness, so you may want to avoid these at least if you have significant symptoms.  Hot steam shower/humidifier with Eucalyptus/Vicks, honey/teal/lemon/cough drops.

   3. Call for high fever, deep/productive cough, or shortness of breath. I can do video visits for mild symptoms, but if the symptoms are significant you should be seen here or in urgent care. If you have severe symptoms like shortness of breath, chest pain or confusion, go to the ER. 

   4. Testing: Corona virus testing is still limited to those with severe symptoms or in some cases healthcare workers.  Testing is recommended only to be done in designated testing facilities and hospitals. The reality is you should not expect to be tested and you should not need to be tested because if you develop any symptoms, you are expected to isolate yourself right away.

3. Could I have already had this?  The earliest potential infection in Ohio could have been as early as January. It is possible that you could have already had this and recovered, BUT it is absolutely impossible for you to know if you have or not. You should have no reassurance that you have developed any immunity to this from speculation.  The symptoms of this virus and other cold viruses, flu viruses and other infections overlap too much to assume this. Furthermore, more than one strain of this has been identified and the possibility of reinfection has been confirmed.  

4. Our office - Nothing has changed about our procedures. Everyone will have a phone consultation to determine the best way to treat you.  At every possible opportunity, you will be treated by phone or video chat. Instances where you need to be seen in person, you will be served at a time and in a manner that decreases exposure of contagious from noncontagious persons.

Stay well!

Dr. Paige