Life is Short and Precious

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.
It happened in an instant. Unimaginable horror and tragedy stunned a community and, indeed, the world.  The collapse of a condominium building in Surfside, Florida, at 1:38 A.M. instantly changed the lives and focus of thousands of people in the U.S., Israel, and South America.

Hundreds of people have been working around the clock, under brutal and treacherous conditions, to save a single life.  Rescuers of every race and background are feverishly trying to find even one survivor of any race or background.  Brave, skilled, and dedicated heroes are doing what brave, skilled, and dedicated heroes always do:  They sacrifice their own safety and well-being to help others.  Rescue personnel, regardless of their color or politics, must be pulled off their shift against their will.  Trying to save another human being is their sole focus. They work together selflessly as a unified team to save life.

This is not shocking to anyone who has ever worked in an ER, an OR, or an ICU.  It’s not a mystery to veterans who have served in combat or police officers who have saved countless lived in emergency situations.  However, too many individuals in the realm of politics, the media, academia, and the corporate world remain baffled by genuine courage and devotion in others.  Since the beginning of our species, ill-intended people have tried to sow division and strife.  Pitting people against one another is malicious, but it has always created an opportunity for power-hungry individuals to seize control.  Teaching children and young adults to be suspicious and resentful of others based on race, gender, or any other physical — therefore superficial — characteristic is a form of cultural rot.  It is a poisoning of the mind.

The tragic collapse of a condominium complex in Surfside, Florida, shows how misguided our priorities can be.  Life is short and precious.  There is never a good reason to promote hatred.  There is more than enough heartache in life without deliberate nastiness. We should never permit ourselves to be focused on race.  We have every reason to keep our focus on grace.

Perspective, Humanity and Common Sense

Posted Posted in Brain Science, Elder Care, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s been a year now.  Several hundred thousand frail, elderly people have died in hospitals and nursing homes alone, confused — and no doubt — feeling abandoned.  Tens of thousands of people have lost their businesses and livelihoods.  Children and teens deprived of normal schooling, sports, and other activities are suffering from anxiety, depression, insecurity, and loneliness.  Poor and disadvantaged children and those with learning disabilities are falling behind rapidly.  Online absenteeism is staggering, and grades are sinking.  The frustration and loneliness are excruciating for millions of innocents.

Politicians and bureaucrats are not lonely, however.  Their lives have not been destroyed.  If they want to dine out, work, socialize, or travel they do.  After all, they’re special.  They are enlightened elites.  We have heard the elites preach “science” to us for over a year.  The question is which science?

Medicine involves many sciences — chemistry, biology, mathematics, physics, statistics, genetics, physiology, pathology, epidemiology, and microbiology.  And that’s only a partial list.  Medicine, however, is also an art.  Sadly, over the past year, too many people have forgotten that.  Individual nurses, doctors, and other professionals have worked heroically to save lives and to be kind — under impossible circumstances — to patients.  But bureaucrats and politicians, with rare exceptions, cannot fathom the art of caring for seriously ill or dying patients — deprived of even a loved one — to hold their hand.  Once they taste control over others, they will not relinquish it willingly.

Human beings are social creatures.  We need contact, communication, and — perish the thought — touch.  Throughout human history exile, isolation, or solitary confinement has been considered painfully harsh punishment.  Yet this is precisely what has been inflicted on young children, the frail elderly, and millions of people in-between — all in the name of “science.”

The point of medicine is to relieve pain and suffering, it is not to control behavior.  Elderly people giving up hope and dying alone, and young people committing suicide were entirely predictable.  Some of us warned about an epidemic of anxiety, depression, addiction, abuse, and suicide a year ago.  These concerns were largely dismissed.  Histrionic media types and “officials” had millions of people convinced that COVID was a veritable death sentence for everyone. 

In reality, 99.7 percent of people who test positive for COVID survive.  Children are not vectors for this illness.  This virus attaches to human cells via angiotensin, converting enzyme receptors in the nasal mucosa and respiratory passages.  Children have very low levels of these receptors.  This is not difficult “science.”

Across the country we are seeing dramatic declines in case numbers, hospitalizations, and deaths.  In all likelihood, millions more people have antibodies to COVID than we realize.  They were simply never sick enough to be tested.  Millions more have been and are being vaccinated.  When 80 percent or so of the population has antibodies (either from infection or vaccination), we will have herd immunity.  There is no need to compromise the physical, social, psychological, and academic well-being of children and teens for one more day.  There is no need to refuse grandparents a hug.  We are rapidly losing any sense of perspective, humanity, or common sense.  We have developed a penchant for panic.  But panic is not policy.  Paranoia is not policy.  We must never again permit the self-serving notions of so few to dictate the misery and destruction of so many.

On Leadership, Science, and Happiness

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

It’s safe to say we’ll all be happy to see this year come to an end.  Fifty years from now people will still be studying the pandemic of 2020, catastrophic hurricanes, tornadoes, wildfires, riots, a controversial election, and the Nashville bombing.  We have reasons to be exhausted.

Despite all these dreadful events, or perhaps because of them, there is much to be learned.  It could easily fill a book, but for now, a few thoughts will suffice:

On Leadership

  • The people who are trying to frighten you are trying to control you.  Ignore them. Good leaders inspire confidence and optimism, not despair.
  • There is never a place for panic in leadership. There is never a place for panic in public policy.
  • Good leaders actually do what they ask others to do. They do not exempt themselves from difficult, inconvenient, or unpleasant tasks.
  • True leaders respect others.  They do not harbor disdain for others.
  • Tyrants (false leaders) often succeed because cowardice is so common.  Show some spine when bullies arise, and remember, no politician or bureaucrat has missed a paycheck in 2020.
  • When in the course of human events, it becomes clear that what you’re doing isn’t working, it’s time to change what you’re doing — especially in a crisis.

On Science

  • Genuine science requires brutal honesty, discipline, openness, acceptance of uncertainty, and humility.  Real science always has been and always will be a work in progress.  When people scream, “Follow the science,” all too often they mean, “Do as I say.”
  • The main point of science is to help us overcome problems and adapt to difficult circumstances. Creative people in every domain have learned to adapt to massive challenges over the years. The Year 2020 was no exception.  In a crisis people need practical advice and suggestions, not domination and suppression.

On Happiness

  • Most of us still have much for which to be grateful, and there is no happiness without gratitude. Take nothing for granted. Many of us now miss things as simple as family, friends, hugs, and handshakes.
  • There are plenty of unkind people in the world. Don’t be one of them.  Kindness and happiness go hand in hand.
  • Don’t believe anyone who insists our darkest days lie ahead.  Such people do not understand the wonders of the human spirit.  It is never time to give up, despair, or cower in a corner.

Fear not.  We’ve learned a great deal in 2020, and we will build on that knowledge.  Be focused.  Be engaged.  Stay informed (not indoctrinated).  No matter what happens in 2021, do not relinquish your right to engage in independent thought and speech.  The future depends on it.

Happy New Year to All.

The Greatest Enemies of Freedom

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Election Day.  Veteran’s Day.  Pearl Harbor Day.  Do these days have anything in common?  They do — more than most of us might think.  The catastrophic attack on Pearl Harbor on December 7, 1941, shocked the nation into unprecedented action.  Millions of people who had ignored the war in Europe and Asia could no longer remain unaware or uninvolved.  Massive numbers of people rushed to enlist or pitch in on the home front to defend freedom itself.  People willingly sacrificed everything from gasoline, to meat and sugar, to fabrics and metals for the sake of the war effort.  Discipline and sacrifice were a given.

Veteran’s Day (originally called Armistice Day) honors the end of World War I. Few of us can even begin to fathom the anguish, misery, and suffering endured by the troops in Europe.  The horrors of trench warfare, malnutrition, hideous infectious disease, nerve gas, and deprivation of every sort took a terrible toll.  Nearly half of U.S. troops who died succumbed to complications of the Spanish Flu.  A hundred years ago, there were no antiviral drugs and no antibiotics to treat secondary bacterial pneumonia or meningitis.  Curiously, President Wilson never even gave a speech about the flu pandemic.

In World War I and World War II, the hardships of sacrifices endured by so many millions of people were intense.  But how does that relate to Election Day 2020?  It’s not that strange or complex.  The two greatest enemies of freedom are apathy and cowardice.  It’s been that way for thousands of years.  We are in a time of great conflict and uncertainty.  Angry, jealous, controlling people are everywhere.  Remember, if someone is trying to frighten you, he or she is trying to control you.  Don’t be intimidated.  Don’t be demoralized.  Observe, think, and vote.  Apathy and cowardice have dreadful consequences.

This Too Shall Pass

Posted Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Raging wildfires, hurricanes, flooding, tornadoes, riots, arson, violence, lockdowns, pandemic fears, economic upheaval, and political turmoil.  If you’re not stressed out at this point you may be in a medically-induced coma.

Nearly everyone is dealing with some degree of anxiety, sleeplessness, weight gain, tension, irritability, frustration, and/or depression.  There are some constructive strategies we all know and have even advised patients to follow.  But we’re in “Physician, heal thyself” mode these days, so here are a few reminders:

  • Avoid people who are chronically angry and, if possible, don’t be one of them.
  •  Don’t obsess about things you cannot control, including the behavior of other people.
  • Re-invent some aspect of yourself — invest in a new hobby or resurrect an old one that used to give you joy.
  • Freshen up your work space or home. A pleasant, cheerful, clean, de-cluttered environment can really boost morale.
  • Move more.  Sitting at a computer or in front of a TV for hours on end is not healthy physically or emotionally
  • Take a good look at yourself and your appearance.  It may be time to kick it up a notch, if only for your own mental health.
  • Limit your exposure to negative, nasty, snide, snarky people on TV — that means 95% of the “news.”
  • Let yourself have 30 minutes of total silence every day.  It might feel like withdrawal if you’re addicted to noise and devices.
  • Make an effort to compliment someone — about anything.  It may turn around your entire day and theirs.
  • Go out of your way to be kind to a patient, colleague, neighbor, stranger, or — this is shocking — relative.  Acts of kindness boost levels of endorphins, serotonin, and Immunoglobulin A in everyone involved.
  • Get your minimum daily dose of uplifting inspirational reading, prayer, and meditation.  Human beings are more than bodies.
  • Don’t be difficult.  Being pleasant and cooperative is a gift to the people around you.  As we read in the Book of Proverbs, “A merry heart doeth good like a medicine.”

Cheer up.  Do some good for others.  This too shall pass.

Deconstructing Anxiety: Finding the True Source of Fear for Profound Healing

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Pain, Psychology

By Todd E. Pressman, Ph.D.

Fear and fulfillment. These are the prime movers of our life, the two great forces that drive the human experience.

Fear is a constant companion. It whispers in our ears of lurking dangers and impending catastrophes. Fulfillment is our high purpose, that which calls us from our most secret places and compels us to discover a freedom and wholeness far beyond what we had thought possible.

These two forces engage in a constant battle. If we forgo our fulfillment and succumb to fear, we are never fully satisfied. But, fear warns us, if we venture forth, we risk the unknown; we are sure to encounter all sorts of perils and should, instead, “play it safe”.

A STRANGE PHENOMENON

Our solution, as a humanity, is to try to satisfy both drives. This results in a strange phenomenon: we convince ourselves that fear is the best strategy for finding and securing fulfillment. We have an impulse for fulfillment—a desire to connect with someone or an urge for creative expression—and immediately consult our fear to negotiate the terms. Fear becomes our provocateur, rooting out from dark corners anything that might signal danger. It becomes our warning device for taking the actions that will protect our fulfillment.

Unfortunately, the strategy backfires; it is impossible to be fulfilled while we are in fear. Not only does fear keep our attention on danger, but we know we can never truly prevent all potential threats. Our response to this is to dig in more deeply, devoting ourselves to an even greater control over danger. We fool ourselves into believing we are working toward the day when we will finally achieve the safety we seek, free to get about the business of fulfillment.  Of course, that day never comes. As the Chinese proverb states, “We are always preparing to live.”

This is the human drama that has been playing out in every culture of every age. Our first and greatest drive is for fulfillment—we know this experience whenever we watch a child filled with the joy of being—and we will not be satisfied until we reach it. Our soul rattles its cage not just for relief from anxiety but to actively create our good.

But the seduction of fear is powerful. We can’t really afford to dwell in the joy of the moment, it tells us. We must keep our eye on looming dangers or the possibility of a sneak attack. So we make the decision to take care of fear first, somehow hoping to get things under control in a complete and permanent way.

When we look around at our current state of affairs, the tragic effects of this strategy are all too evident. Security is the overwhelming goal for most of us, with fulfillment often postponed to the point of being forgotten. It has us live in ever-more-constricted ways, squeezing our once expansive, exuberant selves into a very narrow psychic territory.

We learn to delay gratification, taking care of responsibilities and handling problems, before we can get around to what makes life really worthwhile. There seems to be always one more thing to handle, and then one more and one more. Again and again we tolerate the frustration of postponing our fulfillment until we become rigidified in a posture of waiting. When this goes on long enough, we can indeed forget our original goal.

The great irony of our approach to fulfillment, using fear as our guide, is that it is precisely the approach that will keep us from it. Over a lifetime of such practice, we see our opportunity for fulfillment slipping by. We become stunned by how hard life can be, how much we’ve lost, how far we have fallen from the dreams and high expectations of our early ideals. Because we have sought to get control over a fulfillment that never comes, the futility of the effort catches up with us and we find either that we never did have control or that it wasn’t truly fulfilling after all.

WHAT’S MISSING?

What makes fear so compelling? Why have we become so entrenched in its strategy to secure fulfillment, even when we see that it isn’t working and can make us miserable? If we consider clinical anxiety as simply an exaggerated form of the fear we all struggle with*, the problem can truly be said to be epidemic, the need universal.  How does anxiety co-opt the brain to become so maddeningly fixed and unyielding? What are we missing in our understanding?

The problem, I propose, is that we have not yet fully deconstructed anxiety. We have not yet achieved a successful analysis of precisely how it works—the exact mechanisms that create it, maintain it, give it its power, and make it so intractable. Our paradigms have been incomplete. We need a comprehensive model for understanding and working with the fear at the root of our difficulties, a Rosetta Stone for cracking its code.

Such a model would not only unravel the mystery of anxiety but would illuminate its secret gift. For, as we have said in a previous article**, finding fear’s cure reveals the path to transcending suffering in general, providing a map to deep fulfillment, healthy relationships, and a more functional world.

And why has this been so elusive? Why are we only sometimes successful in our treatments for anxiety? Simply put, whenever a therapeutic intervention fails to produce the desired results, it is because it has not yet fully deconstructed fear in these ways. Fear’s trickery depends upon its ability to convince us not to look at it deeply.  In clinical language, we say fear is hallmarked by avoidance behaviors. We seem to be reflexively wired to respond to fear with these avoidance behaviors.

THE FEAR OF LOOKING AT FEAR

Since the beginnings of psychotherapy, we have understood the importance of reversing this avoidance response, whether through insight into the unconscious, cognitive transformations, various types of exposure therapy, etc. Yet this wiring is powerful, our defenses are resistant, and we still have not explored the nature of fear in a complete enough way. Even if we think we are intimately familiar with it, many of the fast and fleeting thoughts behind the scenes will slip by unexamined. In truth, this is because we are subtly afraid to look at them and discover all they have to teach us. We don’t want to look at them because we know they will require a complete paradigmatic shift in our understanding of who we are and how we deal with life.

We have become so invested in our fear-based ways of negotiating the world that we will not easily give them up. Most of us resist looking at fear as much as possible. But even those who pursue a deeper exploration of the psyche can get lost in its meandering catacombs, missing the ways in which fear is distorting their compass. The fear of looking at fear is the first obstacle to overcome in our search for freedom and fulfillment. It is the source of our human predicament and that which preserves it as well.

Our existing strategies for dealing with fear fall short of real change in direct proportion to the extent that they do not look at and deconstruct the fear fully.  We need an approach that reliably digs up the fear at the bedrock of our suffering with insight into what gives rise to the suffering in the first place.

Those who have sought out this answer, intrepid explorers of consciousness, have demonstrated enormous courage to bring back maps of the terrain they traveled. Freud at one point thought he was going crazy as he conducted his own self-analysis. Jung had to acknowledge his “shadow” in order to deal with it effectively. The Buddha determined he would sit under the Bodhi tree until he either reached enlightenment or died trying. Their courage, and that of others, has paved a way for the rest of us, showing that we must look at and examine fear, digging it up fully, if we are to become free. The hero’s journey, the dark night of the soul, and the death-rebirth archetype all describe the same path: we must confront and move through fear all the way in order to find our higher good.

Facing fear fully, in safe and manageable ways but wholly without reservation, then, becomes the key to finding the true source of suffering and opening a path to freedom. And resolving the fear of facing fear is the first essential step in this process.  We must be willing to follow fear to its most subterranean hideout. But when finally there, standing resolutely in the face of that from which we have been running our entire life, we may at last come to know our true “enemy,” shake hands with it, and even befriend it. With this, we reveal the gift it held, discovering what it was calling for all along and satisfying its need in a new and more fulfilling way.

In traveling this path, we will come to see that the whole of humanity has been engaged in an endless cycle of fear built upon a faulty strategy for securing fulfillment. But seeing the problem clearly like this makes transformation possible.  No longer are we merely a figure caught in a play. When we take hold of the fear that has been directing from behind the scenes, we can rewrite the script in more fulfilling ways. Finding the anxiety at the root of things gives us a sort of X-ray vision where we see through our automatic assumptions about life and reveal the truth they were hiding. Like discovering the “man behind the curtain” in The Wizard of Oz, we lose our fear when we understand its source.

Our task, then, is to fully deconstruct anxiety, learning how to navigate through the subterfuges of fear and, ultimately, how to design a life lived from free choice. Rather than being twisted and distorted by the ways of fear, such a life reaches for a transcendent truth, one that has the potential for resolving suffering at its source and restoring us to our original fulfillment.

In future blog posts, we will begin to lay out exactly how the Deconstructing Anxiety model takes up this task.

————————————————————————-
*In these blog posts, the word “fear” is considered as synonymous with “anxiety”, as per the Buddhist concept that the anxiety created by anticipating a future event has the same effect in the mind as the fear experienced by an imminent threat.

**See Deconstructing Anxiety: The Journey from Fear to Fulfillment
_______________________________________________________________________

This is an edited excerpt adapted from Todd Pressman’s Deconstructing Anxiety: The Journey from Fear to Fulfillment (2019), published with permission from Rowman and Littlefield Publishing.  All rights reserved.

Copyright 2020 by Todd Pressman

COVID-19: Scary Graphics

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

Quick.  What’s the clinical definition of a “spike”?  You’re not sure, are you.  Don’t feel bad.  No one knows what the clinical definition of a “spike” is.  But the all-knowing bureaucrats and media types toss the word around with abandon.  It serves their purpose, which is to keep as many people as possible afraid and, therefore, controlled, especially in the age of COVID-19.

If you were fortunate enough to have had a good education and some training in critical thinking, you know you must define your terms. It’s the essential starting point for any serious discussion or debate.  You cannot make up terms or definitions on a whim.  This, of course, is distressing to those who worship their notions and emotions. Today, that means millions of people. Reality (or a “spike,”) is whatever people say it is.

Announcing that “the country is seeing a worrisome spike in COVID-19 cases” is misleading.  Defining the terms is not only critical for any measure of professional or intellectual integrity, it is essential for a prudent response.  Sadly, in far too many cases, a lack of intellectual integrity can be easily used to promote paranoia.  Today, nearly anyone can create scary graphics splashed with “worrywart red” ink.  This is done routinely to exaggerate the threat of anything from a virus to a thunderstorm.  Be afraid. Be very, very afraid.

No. Do not be afraid.  Understand what is happening:

  • There is exponentially more testing being done now compared with six weeks ago (as of late June 2020).
  • The criteria for COVID-19 testing have evolved tremendously over the past three months.In March, elderly people with obvious respiratory symptoms were told to stay at home and avoid the emergency room.  They were advised they did not need to be tested.  Today, in much of the country, many people can be tested on demand.
  • Greater numbers of young people are being tested.Naturally, more positive tests will be reported.  Most of these individuals are asymptomatic and will remain so.  Consider this — no one could walk into a clinic or makeshift roadside testing site and simply demand a test for flu, strep, hepatitis, or mono because he or she felt like it.  Medically speaking, what’s going on now is odd.
  • Deaths from COVID-19 have declined by 40% across the U.S. over the last two weeks.This is crucial for understanding what is really happening.  The mortality rate for COVID-19 here is around 0.05% (and probably lower).  Contrast this with what we were told initially.  Italy had a mortality rate around 10-11% and in the U.S. we expected a mortality rate between 3-4%.  That’s quite a difference.
  • Our focus should not be on the number of positive tests, but on hospitalization and mortality rates.There will be regional fluctuations in both.

COVID-19 is new.  Patterns of transmission, virulence, and regional penetrance will change gradually.  Our understanding of the best ways to treat seriously ill patients will change.  This has happened throughout history.  For now, don’t overreact to “worrywart red” on TV graphics.  Steady as she goes, America.  Steady as she goes.

 

Help for the Helpers on the Frontlines of COVID-19

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Dr. Jennifer L. Abel

Many healthcare workers on the COVID-19 frontlines are overwhelmed and traumatized. In addition to putting your lives on the line, many of you are quarantined from your family and some have insufficient PPE. Many are having to make multiple difficult decisions daily and have see an unprecedented number of people suffer and die; sometimes even colleagues.

You are amazing! You are also human! So, it is crucial that you express your emotions: cry in the restroom, cry on the way home, go outside for 10 minutes to shed tears or blow off steam. Angry at a co-worker, administrator, or politician? Pay attention to your driving, but imagine they are in the passenger seat and express your feelings.

Keeping your body relaxed is very important to help with immune function and to survive emotionally.  “How can I possibly relax? I have no time and am way too stressed to relax” are common thoughts on the front lines of COVID-19. Fortunately, relaxation strategies need not take any time at all and can be done without stopping your work activity. Test it out! Because most of you are standing or walking most of the day, stand or walk now while engaging in your favorite strategy simultaneously. Now pretend. Go through the motions of a common work activity while engaging in your strategy. The exception is you can’t do breathing strategies while talking.

It’s easy to get distracted and forget to use your coping strategies. Try to get into the habit of using strategies every time a machine starts beeping, each time you switch rooms, someone calls your name, or when you change tasks. Put up sticky note reminders when possible. Change the wallpaper on your phone or change the ringtone and text-tones. Each time you experience the reminder, engage in your strategy.

No doubt you’re exhausted. When you experience one of your reminders, ask yourself “do I need all this energy” or “what’s the least amount of energy I can use while doing this procedure? Writing notes? Walking down the hall?” Follow with your favorite word, like soft, loose, or relaxed.

People in helping professions are great at taking care of others, but aren’t nearly as good at taking care of themselves. Now is the time for you to finally ask for what you need, or even want, from others. And take time to self-nurture.

I heard today that people wearing scrubs are being discriminated against out of fear they’re carrying the virus. Some have been mugged or antagonized because they are known to have a job. Please know that the majority of us, not just patients and their families, are very appreciative of your sacrifices.  Know in your heart that having a purpose is a positive predictor of happiness, even though you probably aren’t feeling particularly happy right now. Similarly remember that even when you feel helpless, you are still helping!

Thank you very much for all the help you are providing, especially if you are putting your life at risk and/or isolating from your family to help!


Dr. Jennifer L. Abel is an expert in worry and the author of three books and two card decks including Resistant Anxiety, Worry, & Panic.

COVID-19: Complications

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

We knew this was coming, or at least we should have known. Several subsets of patients with complex reactions to COVID-19 (the disease from the coronavirus infection) are being recognized.  The very young, the very old, and the very sick may be predisposed to rare and intense immune responses to infection with this coronavirus.  Here is what we know so far:

  • “Cytokine Storm” can be a dire consequence of COVID-19 especially in older patients with several underlying illnesses.  Cytokines are polypeptides or proteins secreted by immune cells coming into contact with bacterial or viral antigens and/or endotoxins.  Cytokines can also be synthesized by adipose cells (one of the reasons overweight patients are at serious risk).  Cytokines include chemokines, interleukins, interferons, and tumor necrosis factors among others.  Simply put, cytokines influence the magnitude of an inflammatory immune response.  Multiple genetic factors seem to play a role.  Clinically, an older, chronically-ill patient with COVID-19 (or other infections, such as influenza) can deteriorate dramatically over 6-12 hours. Vital signs become unstable, O2 saturation drops, respiratory distress intensifies, and inflammatory markers like C-reactive protein rise.  Cardiac function is seriously compromised and liver, kidney, and neurologic function decline rapidly.  Severe clotting disorders may develop.

The outcome is poor, but aggressive efforts to suppress the massive autoimmune inflammatory response may help if initiated at the earliest stages.

  • Toxic Shock Syndrome:  This is an acute, serious, systemic illness triggered by a response to exotoxins produced by staph or strep bacteria. It was first noted in young women in the early 1980s and was linked to tampons, diaphragms, or contraceptive sponges left in the vagina.  It can occur after childbirth, abortion, or surgery.  Symptoms include a high fever, diffuse red rash resembling scalded or burned skin, hypotension and multi-organ system failure leading to shock.  Prompt and aggressive treatment involves removal of foreign bodies, debridement of incisions or wounds, IV fluids, and IV antibiotics (clindamycin and vancomycin).  IV immunoglobulin can be used.

Several patients in the New York area, who tested positive for COVID-19, have presented with symptoms similar to Toxic Shock Syndrome.

  • Kawasaki Disease:  This is a childhood illness with a dramatic presentation and complications related to vasculitis, probably of an autoimmune nature.  Each year in the U.S. there are between 3,000 to 5,000 cases, mostly in children under the age of five years.  Rare cases occur in young infants, teens, or young adults.  Occasional community clusters occur, especially in late winter and spring, without clear evidence of person-to-person transmission.  Diagnosis requires the presence of four out of five clinical findings after fever lasting five or more days.
    • Bilateral conjunctivitis — injection or intense redness without exudate, drainage, or crusting.
    • Mucocutaneous injection of the lips, tongue, and oral mucosa. Lips are red, raw, dry, cracked, and fissured.  The tongue is enlarged, red, and possibly tender.  The classic description is “strawberry tongue.”
    • Skin changes involving the hands and feet.  There is pronounced edema and erythema especially on the palms, soles, and nail beds.  Full-thickness desquamation or sloughing off of skin on the fingers, palms, soles, and toes leaves the underlying denuded skin red, raw, and tender. These changes typically begin around Day 10.
    • Polymorphous rash over the trunk may resemble measles, scarlet fever, hives, or erythema multiform.  The perineal area is often involved.
    • Cervical lymphadenopathy with at least one lymph node in the neck ≥ 1.5 cm in diameter.

The cardiac complications of Kawasaki Disease include coronary artery aneurysms, myocarditis, pericarditis, and valvular disease.  EKG and echocardiogram are indicated at the time of diagnosis and in regular follow-up visits for at least a year.  Treatment involves high-dose aspirin and IV immune globulin.  Approximately 85 children in the New York area who are COVID-19 positive are being evaluated for this condition, now called “Pediatric Multisystem Inflammatory Syndrome.”

Cytokine storm, Toxic Shock Syndrome, and Kawasaki Disease are rare in their original forms or as complications of COVID-19.  The overwhelming majority (over 82 percent) of patients testing positive for COVID-19 remain asymptomatic or mildly ill.  The survival rate in the U.S. (rarely mentioned) is over 99.5%.

Those of us in health care must always be aware of unusual or rare complications of any illness.  But perspective is crucial, a concept lost on many in the realms of media and politics.  After all, the best way to control people is to keep them afraid.

Knowledge, perspective, and prudence:  not fun, but essential.

homestudy

Coronavirus (COVID-19): We’ll Learn To Cope

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Enough.  Enough with the panic, paranoia, and power grabs.  Enough with the hysteria, hoarding, and hyperbole.  Enough with the melodramatic funeral music between commercial breaks on TV.  Fear, malaise, and resignation cannot become a permanent feature of life. This is not the end of the world, and this must not be tolerated as the “new normal.”

One of the most effective antidotes to fear is perspective.  Many of us had loved ones who endured far worse situations during the Spanish Influenza of 1918.  In those days, there were no ventilators or even the ability to deliver nasal oxygen.  There were no ICUs, cardiac monitors, or even TVs.  Antibiotics, antivirals, bronchodilators, anti-inflammatory medications, and corticosteroids did not exist.  There was no such thing as a Respiratory Therapist.  It was bleak.

Ten years later, during the beginning of the Great Depression, socio-economic conditions were equally bleak.  There were no social safety nets.  Social Security, unemployment Insurance, Medicare, Medicaid, welfare, food assistance, personal and small business rescue programs were nonexistent.  Soup kitchens and bread lines were the measures of last resort.

There is another major difference between the present day and 1918, and it revolves around the media.  In 1918, people had newspapers.  Radio was in its infancy.  There were no narcissistic TV “personalities” promoting an agenda 24 hours a day.  Enough is enough.  We don’t need any more people in the media selling panic for profit.  We need facts.  We need reason.  We need sensible, constructive solutions to a serious, infectious disease.  But we cannot sit on our hands for 18 months when a vaccine may or may not save the day.

Anyone telling us we have no choice but to lock down everything is misguided.  We always have choices.  Life constantly presents us with potential risks and benefits.  People can learn how to function with reasonable safety once they have the facts.  We are not helpless, clueless children who must be grounded “for our own good.”

Death is a certainty at some point — for each of us.  It always has been.  What matters is living a life that is good, honorable, and uplifting to others.  We are told no one should determine who lives and who dies.  Yet politicians and bureaucrats proclaim which “workers” (a Marxist term) are essential and which ones are not.  That reflects a stunning level of arrogance.  The only “non-essential” job or business is the one you didn’t pour your heart and soul into.  A handful of officials (where jobs, paychecks, and pensions are secure) is destroying the lives and futures of tens of millions of other people.

We’ve learned how to cope with tuberculosis and terrorism, the Great Dust Bowl and diphtheria, threats of nuclear war, and natural disasters.  We’ll learn how to cope with COVID-19, not through fear, not through paralysis, but through prudent, innovative, courageous action.  Enough with the panic.

Let’s get on with it.