Infectious diseases have been a part of my entire adult life and I have always been proud of the work performed at the Centers for Disease Control and Prevention and the National Institutes of Health — all paid for by the people of the United States for the good of all humankind.

I first heard of the COVID19 outbreak in December 2019. At the time I and most healthcare professionals believed it was just another infectious disease, no more dangerous than most. I did worry that our more connected world in the year 2020 might let this virus spread further than previous outbreaks, but I was confident that the CDC, NIH, and WHO would use their combined expertise to control this virus, just as they have always done so in the past.

By February 2020 I began to realize that something was amiss with our response to the COVID19 outbreak. Backchannels monitored by me and many academic health professionals were curiously quiet, with little being said about the work being done to contain the virus, study its genetics, and determine its rate and mode of transmission.

This is pretty standard stuff and, like in many professions, chat rooms, podcasts, and informal conference calls always spring up when something out of the ordinary is happening. By March I was beginning to really become concerned, and I started cautioning friends and family to cancel travel plans and to ready themselves for some drastic public health measures.

By the end of March and into early April, my worst fears were realized as New York and New Jersey followed Oregon with massive outbreaks of COVID19. To help, I set to work designing and manufacturing a HEPA filter face mask, the first designs of which were worked out by a team at Rutgers University during the last Ebola outbreak, and distributed, free of charge, over 1,100 masks to healthcare and nursing facilities across New York and New Jersey.

I also helped set up in-house testing facilities at the University Hospital in Newark. One of my sons is a biomedical research technician and he volunteered to help run these PCR-based tests, working three times per week from mid-April to the end of July in the Newark facility, testing the healthcare workers working at the University Hospital.

The worst part of this pandemic for me is that any competent physician or public health doctor could (and did) predict what was going to happen if different steps weren’t taken at different times during the past year. The United States taught the rest of the world how to handle infectious disease outbreaks, and it saddens me that we are, by far, the hardest hit by COVID-19 and the least effective in containing its spread.

There is nothing political or sinister about the steps needed to contain this pandemic. It is science, pure and simple, and all we need to do is listen to the experts.

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I rushed to the ER and was met by the trauma team, which included the on-call third-year surgical resident, a medical student, trauma nurses, a respiratory therapist, an on-call anesthesia resident, and two ER technicians. The patient arrived on a backboard, intubated, with a neck collar in place. There was a large, blood-soaked bandage on the patient’s right lower chest. The head EMT called out his report:

Victim is a 20-year-old college football player with no significant past medical history who was walking to a party in a nearby town when a stray bullet struck him in the back, exiting at the right costal margin (edge of the ribcage near the right flank). This took place at approximately 10:40 PM and we arrived on the scene at 10:50 PM. The event was witnessed, and the victim supposedly sunk slowly to the ground without further trauma. The patient was alert and talking when we first arrived but quickly lost consciousness and was intubated. He had a large wound on his right that was packed with dry, sterile gauze. His vital signs have been variable but mainly stable. We have placed a 14 gauge IV in each arm, and have started normal saline wide open.

I was in charge and after the patient was transferred to the ER stretcher, I ordered a lateral neck x-ray, had the medical student insert a Foley catheter, and I and the third-year resident did our initial examination. The patient had good peripheral pulses, his blood pressure was 100/50, and his heart rate was 150 beats per minute. We turned him to examine the entrance wound, which was just to the right of the spine between the 4th and 5th ribs and 1 inch in diameter.

The exit wound was at the right costal margin and was 8 inches across with perfuse bleeding from the intercostal vessels and the surface of the liver. I re-packed the wound, ordered 4 units of O- blood STAT, and had the nursing staff call the on-call attending surgeon to tell him to come in.

He was 30 minutes out, so I decided to attempt to over sew the bleeding vessels in the exit wound while the blood was being infused. I had the third-year resident load up a 2–0 silk on a needle driver and as I pulled the bandages back, I told her to tie off the vessels that came into view. After two failed attempts, and with her hands now visibly shaking, I told her to get it right this time or I’d do it myself.

Visibly steeling herself she was able to get the bleeding vessels over sewn within 10 minutes. At this point, the patient began to become unstable with dropping blood pressure and his heart going into a rapid flutter pattern. This happened so suddenly that everyone froze in place for a second before I yelled “CALL A CODE” and began to get the defibrillator ready. We gave the patient bicarb, epinephrine, and lidocaine but he quickly went into atrial fibrillation.

I shocked him 5 times, with further doses of epinephrine and bicarb in between, but after 10 minutes the patient became asystolic and I stopped the code. I had the nurses call the attending to head back home, and I went to confront the patient’s family with the news. After telling them that their son/brother had died of his wounds, I next asked them to donate his organs so others might live. They agreed and I called the transplant team who arrived within 15 minutes.

I went back to the trauma bay and found my third-year resident sitting on the floor quietly crying. I sat next to her, silent for a few minutes. She was training to be a surgeon and I knew the last thing I should do is try and comfort her. So, after a few minutes of silence, I said, “So, what did you learn tonight?” Without missing a beat, she blurted out “that I’m not going to be a god-damn trauma surgeon!”

After that, she dried her eyes, and we began to discuss what happened. The patient was stable, the bleeding was under control, and he was conscious and talking at 10:50 PM. By 11:40 PM he was dead and there was nothing we could do to stop that. We discussed what might have happened and in the end, she was calm enough to head back to do the paperwork.

Later I found out that the bullet that struck the patient was a 5.56 high-velocity round fired from an AR15 over 200 yards from the victim. The shock wave caused by the bullet passing thought the victim literally “cooked” the right ventricle of his heart and the only reason he didn’t die at the scene was that he was an NCAA-level athlete and his damaged heart was able to keep functioning for almost an hour.

The third-year resident went on to become a very successful transplant surgeon in Boston, and I became a cancer surgeon.

The victim’s family was informed that 22 people benefited from their son’s sacrifice and their generous donation of his organs. The State of Connecticut passed one of the first anti-assault weapon bans in the country the following year.

That one night in 1992 changed a lot of lives. I still have occasional nightmares about it, though it did make me and the third-year resident better physicians and surgeons.

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Breast cancer is the most commonly diagnosed cancer in women worldwide. While more commonly associated with women, it can also affect men, given the presence of breast tissue in both sexes. Diagnosis rates vary, but it is something to which both biological sexes are potentially vulnerable. It is imperative, therefore, that everyone understands how to conduct regular self-checks to help increase the detection of potential concerns. Early detection of cancer can help increase options for treatment, and subsequently improve long-term survival rates.

Conducting self-checks for breast cancer is important for everyone. Self-checks for women are recommended, in addition to regular screening. Great resources from the CDC help to explain breast cancer in men, and symptoms to look out for.

Early detection can be enhanced via conducting regular self-checks, as well as regular examinations by a medical professional. The frequency of recommended checkups may vary from person to person, based upon a number of factors. These include personal and family history of cancer, genetic predisposition, and other considerations. For example, for those persons who are known to have BRCA gene variants, it is often recommended that they conduct more frequent checkups to monitor breast, ovarian, and other health.

Although breast cancer awareness month only comes one month a year, its mission is one worth carrying out year-round. Raising awareness — to help improve detection, increase access to treatment, to improve support for patients and caregivers — each of these initiatives requires consistent attention.

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One of the most common concerns of a breast cancer survivor following successful treatment is recurrence. Breast cancer survivors can be subject to a myriad of different medical concerns following their diagnosis, but the threat of additional cancer remains a looming one for many. A second breast cancer is the most common second cancer for survivors. This includes cancer in the same breast for those who opted for a breast-conserving lumpectomy, as well as the development of cancer in the breast opposite the one originally diagnosed. However, breast cancer survivors are also at an increased risk for several other cancers, including melanoma, colon cancer, sarcomas, thyroid cancer, and others.

Some of these cancers can be linked to radiation treatment, including lung cancer. Several studies have shown a longitudinal link between radiation therapy for breast cancer and an increased predisposition to lung cancer. However, it is important to note that, for many, radiation therapy helped to increase life expectancy as well. Understanding the potential costs and benefits of different treatment options can be complex. It is important, as always, to speak with your doctor(s) about the available options in order to understand the dynamics involved. Weighing the options is an important decision, and it should be an informed one.

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It is consistently working to improve the delivery of medical care, as well as better understand issues pertaining to public health, as evidenced by its work to maintain the International Classification of Diseases (ICD), a diagnostic tool for epidemiology and disease classification. Similar to other diagnostic tools such as the DSM, it is one that has been frequently updated over the years to reflect the latest research.

One of the more recent updates to the ICD saw a more thorough classification of the concept of ‘burnout’, for example. It is now recognized as a syndrome, resultant from “chronic workplace stress that has not been successfully managed”. It is important to note that this applies explicitly to an occupational context. Burnout is something that can be seen across a wide array of industries; however, physician burnout is one that is of increasing concern in the wake of the pandemic.

As many states and cities across the globe are seeing new surges in coronavirus cases, hospitals and healthcare providers continue to grapple with the dynamics of the pandemic. Many are facing shortages of essential Personal Protective Equipment (PPE) and other medical supplies, despite being months into the pandemic.

Although some supply chains for different goods have adjusted, the healthcare industry is still plagued by deficiencies. This has critical implications. Without the needed supplies, healthcare providers risk unnecessary exposure for themselves, their patients, and their families. This, coupled with the increased amount of patients, is a recipe for stress, and eventual burnout, for many physicians.

Medscape’s 2020 ‘National Physician Burnout & Suicide Report’ found that 42% of the 15,000 physicians surveyed reported being burned out. Half of those surveyed said they would give up at least $20,000 in annual income to reduce their working hours. This was released in January, just months before the WHO had declared the novel coronavirus a global pandemic. The situation has only become worse, as hospitals are often understaffed or otherwise ill-equipped to handle the new demands on the healthcare system as a result of COVID-19.

Physicians are combatting the novel coronavirus, as well as fighting for their mental wellness. It is essential that we raise awareness of mental health for everyone, especially for those upon whom we all rely on our well-being. Doctors around the world are thankfully taking notes and researching ways to help provide interventions to help ease the burden. For the sake of all providers and their patients, let us hope this sheds more light on the issue and leads to actionable change.

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White coat syndrome, or ‘white coat hypertension’, is a phenomenon whereby patients experience elevated blood pressure when they are in the presence of a medical professional or when their blood pressure is being measured at a medical office.

When not in the presence of a medical professional or ‘white coat’, these same patients exhibit normative blood pressure levels. The presence of the ‘white coat’ triggers the physiological response of a subsequent rise in blood pressure. Essentially, it is a conditioned response by the body to react in response to the stimulus of the white coat. It is not unlike the renowned Pavlov’s Dog findings — except, instead of salivating when you hear a bell, your blood pressure rises when you’re in a medical setting.

If we consider that one of the criteria for white coat hypertension dictates that a patient’s blood pressure is otherwise normal outside of the medical environment, some may assume it is a minor problem. But research suggests this is not the case.

Patients with white coat hypertension are at a greater risk for heart disease when compared to others with normative blood pressure. For those that are aware of their white coat hypertension, and/or experience anxiety in response to a medical setting, it is not unusual for patients to avoid the medical environment altogether.

Conscious awareness isn’t always needed, of course. It is often the human tendency to simply avoid what we don’t like. This can spell trouble in a myriad of different ways, from a decrease in regular checkups to missed medical tests.

Double trouble — viral exposure concerns & hypertension

The challenges of white coat syndrome coupled with those of the novel coronavirus create a double threat. At the beginning of the pandemic, the National Syndromic Surveillance Program (NSSP) discovered a 42% decline in Emergency Department visits. A similar decline was seen in ER visits for heart attack, stroke, and uncontrolled high blood pressure. Some medical professionals have reported patients declining organ transplants due to fears of exposure to COVID-19 or because they cannot have a family member with them in the hospital. For persons with white coat hypertension, these effects may be amplified.

Unfortunately, heart attacks don’t stop just because we are in the middle of a global pandemic.

It is still important to get regular checkups and undergo any procedures which are essential to maintaining health. As we continue to navigate these uncertain waters, it is important that we do not allow fear to prevent us from taking care of our health.

Staying healthy during a pandemic means being your own advocate. Listen to your doctor and do your own research. Explore options for telemedicine, which can make healthcare more accessible whilst mitigating risks of in-person visits. One of the most important things you can do is to be mindful of your own health. In these uncertain times, being your own advocate is one of the few things you can control.

The post Why ‘White Coat Syndrome’ and The Pandemic Are A Double Threat appeared first on Medika Life.

Not unlike how the Internet we use today outpaced dialup. But if you work in the medical field in America, chances are fairly likely that even if you haven’t used a fax machine yourself in the last decade, that you have at least walked past one on your daily rounds.

If you’re asking yourself why that is, you’re not alone. It is a question that has asked by many over the decade. Especially if we consider the massive evolutions in medicine in the past few years, such as using computer vision to detect melanoma or Artificial Intelligence to diagnose breast cancer, it is reasonable to wonder why these emerging technologies co-exist with ones that have been gathering dust in other industries.

The benefits outweigh the costs of going digital.

Depending on who you ask, the fax machine is still relevant in medicine for a number of reasons — from IT security to HIPAA compliance and other regulations. The same argument could be made for going back to paper for all medical records. While it may be a lot harder to conduct a widespread ‘hack’ of a patient’s paper records than an Electronic Medical Record (EMR), it is safe to say that the benefits have outweighed the costs of going digital.

No system is perfect, of course, but the introduction of Electronic Health Records (EHRs) and EMRs has provided numerous benefits to both medical professionals and patients. EHRs help support improved patient outcomes — from improved safety to error reduction, the gains are many. A survey of medical providers found that 94% found that EHRs make records more readily available. The survey of patients found further benefits in improved care, from increased access to medical care to a reduction in prescription error.

For all of the arguments in favor of fax as a more ‘secure’ and ‘private’ means of transferring clinical data, there are probably as many points of evidence pointing to the flaws in the system. The list of data breaches associated with medical records being sent to the wrong fax number, for example, probably outnumbers the number of pages in the fax machine at your local provider.

Legacy systems are still en vogue in the healthcare sector in the United States and may still be for some time. Regulatory systems and the judicial system advance at a much slower rate than the fast-paced industry that is technology. However, given the recent constraints on the medical field brought on by the pandemic, we are overdue for the widespread adoption of newer technology.

Telemedicine makes medicine more accessible for Doctors and their patients. It is important we utilize technology, of course, after accounting for the potential risks and doing our due diligence to mitigate them. This is no easy task, but its one we must undertake to help improve the industry, for everyone’s sake.

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