Category Archives: Medical

Not worth 0500

Holly Doyne Posted on by

One of the downsides of living on the US West coast involves time zones. What may seem like a perfectly reasonable time to you, in London, Geneva, or Copenhagen is not all that great from my point of view. Especially this morning,  which is why I am whining. The Global Health Program out of University of Copenhagen has a regular webinar series named the Nordic Global Health Talks. These, in the past, has been both interesting and informative. The topics have ranged over a wide variety of key public health topics and the presentations have been excellent. 

Not so this morning. Ok, from their point of view it was 1400. Early afternoon and no one should be suffering from post-prandial fatigue. But from my point of view – with an alarm sounding off at 0447 so that I was logged on by 0500 – it was dark. And quiet. And a bit on the chilly side.

And yes, I am working my way around to the whine. Last. month the discussion involved the issue of global health and society wellbeing as reflected by the state of migrant health. The speaker was knowledgeable and informative. The topic today was the result of a doctoral dissertation on clinical guidelines for labor and delivery compared to on the ground realities in Tanzania.  What started out as a comparison of actual workload at one location in Zanzibar with clinical guidelines turned into an extended rant about how the guidelines weren’t useful or locally relevant. Ok – but 20 minutes on how poorly the WHO guidelines functioned in practice (low resource settings) was a bit much as she never presented a comparison of those guidelines with the ones locally developed, or how they went about the process of developing guidelines or ….

You get the idea. Not organized, not informative after the first five minutes and didn’t give me much information on what could be done to improve the situation.

I gave up before the end of the hour and went back to bed.

——————– 8- < ——– – – – – – – – – —

Alex is home. He has dogs for company.  His pain meds are working.

And the dogs – they are still trying to dig up that gopher who is too stupid to relocate.

It might be funny

Holly Doyne Posted on by

if the whole thing wasn’t so appalling. Talking about Alex and his broken leg. Last Friday night just to jog your memory. And then the insurance people. The order of events is about as follows:

  1. ER visit on Friday night. Splinted and told to see Ortho on Tues
  2. Monday attempt to contact Ortho.
  3. Tuesday – Insurance manager states: ER referral not good enough, you need a primary care doctor to refer you to Ortho
  4. Wednesday – Alex sees a primary care doc who says “This is insane, of course a broken leg needs to be cared for by Ortho.” and expedites the referral
  5. Thursday – insurance manager informs that “urgent referrals” can take up to 72 hours to process. And we have heard nothing by 2000 which is apparently as late as they work

 

If anyone needed a demonstration of how broken the US Health Care system is – I refer you to the above list. Yes, as a family physician in a rural area, I might have splinted, then casted a simple tip-fib fracture. But not in a complicated patient. Not in someone with previous surgery or fractures in that leg. It is just asking for trouble.

In their assumption that everyone is trying to get unauthorized care and spend their precious money (so that it doesn’t land in the senior executives’ pockets), the rigid protocols decrease quality of care and actually increase cost.

During my residency, before all the “managed care improvements” we would have splinted someone like Alex, admitted him for overnight evaluation and let Ortho take care of his leg during normal daylight hours. Or, in a rational society, he would have been routinely scheduled and seen on Tuesday when the Ortho person who saw him in the ER said he needed to be seen.

It will be interesting to see if we get what I expect – which is a phone call late Friday saying “yes, he needs his Ortho follow up.” Which means that he will be seen a week AFTER Ortho said he needed to be seen. Still with his leg in a splint.  Still with the unresolved question of whether or not he needs surgery to stabilize his ankle, still in a lot of pain.

George quietly informed the person on the phone that, should Alex have problems or complications that would not have occurred had he been treated early as directed, he was going to hold everyone who delayed the care personally responsible.

No, he doesn’t practice law in California, but he knows people who do. There are also various people in the state government who are going to hear about how their “managed care” is managing to not deliver care.

I stitched. I needed it!

 

another Saturday, more needles

Holly Doyne Posted on by  

I was part of the team at Allen Temple Baptist Church again today. Officially our hours are 1000-1400 which means a good couple hours ahead of time for set up and perhaps time afterwards for tear down. This location is about as far south in Alameda County that I want to drive. Nothing against the other areas, but getting to some of the more southern locations proves to be a nightmare.

Or rather, it isn’t getting there, it is getting home at high traffic. And trust me, the traffic was horrible pre-pandemic and much worse since then. Way too many people who never had cars before are now out on the freeway creating havoc.

Anyway – I went, I stuck needles into people, I came home and stitched. I should’ve done some sewing, or cleaning. Instead – I spent time on Aquarius & the Fox.

Why am I up

Holly Doyne Posted on by  

sometimes I think I am insane, and other times I know it. THis morning was totally and completely a case in point. I enjoy staying educated, up to date, and informed on the public health issues that were part of my job for decades. One of those duties involved dealing with various WHO agencies, committees, and programs.

So, to make an even longer story short, I received an email notice from WHO about a Webinar this morning relating to Neglected Tropical Diseases. It is interesting (for me) to learn the current status of guinea worm, leprosy, and other diseases that I saw in Africa but are not exactly common in the developed countries.  

The Webinar was not what I expected. It was a long, long announcement with bits and bobs from here and there as the opening sally for a Congress and World whatever day. Now, I like singing and people making speeches (not) as well as the next person. But seriously, I would not have gotten on line at 0500 (GMT-7) for a listen. Yes, I understand that 1400 in Geneva is about as good as one is going to get in terms of time zone fairness for the maximum number of people world wide.

But I am going to be a lot more cautious about agreeing to anything that early in the morning. 

Ouch

Holly Doyne Posted on by

And I thought yesterday was a disorganized disaster – today trumped that in spades then ran the table (ok, mixing metaphors here, but you get the idea). And, as attempt to write this for the third time, the fun has simply not ended. Safest if I take my shivering self to bed.

Let me explain: today was supposed to be a pair of quick check-ups at the VA. And this is the Med Center on the far end of San Francisco – yes Virginia, you can practically toss a stone in the Pacific from the back picnic tables – the only way I would be driving any further would involve a trip to Travis AFB or the Sacramento VA. Those 21 miles seem to take forever and involve city streets, stoplights, stop signs, interstate freeways, the Bay Bridge and a circuitous route through SF itself.

Anyway. First up – I failed to set an alarm so woke up 20 minutes late. The only positive thing I can say about starting late was that Peet’s had just opened so there might be coffee – at least if there wasn’t a line of 10 people. At 0530 in the morning?  It took 20 minutes to get my coffee and I was starting to get even more panicky. Obviously, I am not someone who takes being late well at all.

So there I go, Down Vine street, left on MLK, right on University heading toward the Interstate. But wait, something feels wrong when I start driving. A slub-dup that has just started. I pull over and check. Left rear tire is now flat. ARGH! A block further on the left, there is a filling station with parking spaces. Carefully crawling the car across two lanes and turning left, I ease the car into a side space. The absolutely wonderful man working in the station says it is fine to park the car for a couple of hours if someone is going to be coming to get it as he agrees that driving on a flat tire is stupid.

I call and wake George up and leave him with the challenge of calling AAA and getting the tire changed. I would do it if I had time, it wasn’t dark, and I wasn’t freezing cold. All of them together? Nuts – that is why we pay for AAA right?

I call a Lyft as there is no way I can make it on public transport in the time I have left. 10 minutes later, my driver pulls up. She quietly, efficiently, and without the use of GPS takes me to the VA by the same route I would use, Through screening and up to the waiting room.

I have my dental appointment, followed by my next appointment. I am fine, but since on the last checkup I had zero antibodies against COVID in-spite of 2 immunizations and an augmentation dose, my doc thinks a booster is in order, Otherwise, back in 3 months. Over to the immunization clinic. They inform me I am 8 days too early for a dose. Back to my doc. He puts the requirement for the early dose in my record. Back to the immunization clinic where they do the whole information and consent thing before sticking me.

Finally back home, I find that George came to the gas station (in Dani’s car) saw to the tire change. Drove it to the tire place. Walked back (3 km) and drove home. This was after getting Dani to work and Alex out to the new place to oversee the upgrade on the back yard fence.

It is now almost 2200. It is cold upstairs, at least that is what I am blaming for my chills and tremors. Couldn’t possibly be the vaccine now could it? The day has sucked. If the past is any indication, I may well spend tomorrow feeling sorry for myself.

Just glad I didn’t sign up to work any clinics for the rest of the week.

(not spell checked or edited – sorry about that…….

a normal Saturday

Holly Doyne Posted on by

Our vaccination site was moved for today, on rather short notice as it turns out. My best guess is that the church where we normally hold the clinic had a funeral and didn’t want to mix the mourners with those coming in for immunizations, much less the chaos created by parking. I attempted to look on time, but gave it up for a bad cause.

What I did learn was that FEMA (Federal Emergency Management ….) started providing financial assistance for funeral expenses related to COVID-19 deaths starting in Jan 2020. (link here). I have never seen a reference to this in the press or on any news programs. But then FEMA, under the previous US Administration, seemed to be much more about not providing services than making it easy for anyone to access their claims services.

Back to East Oakland Youth Center which is where we were. It is located only a few blocks from our regular site. Parking was insane (just saying). Since this was a new location, we had the challenge of a completely new set-up which started out with unloading the vans and ended, I am sure, at the end of the day with complete tear-down.

Because we are still seeing a lot of Omicron in our area, masking and distancing were strictly enforced. Lots of Pfizer and Moderna today – and not that many kids. Again, I had a couple of people who wanted Janssen so that they would be work eligible in 2 weeks. Also, a lot of those who originally received J&J are in for boosters. We are using Moderna because we have more of it.

By 1330, the line had dwindled to just about no one, so I got an early release (and skipped the teardown).

Spent the rest of the day in a little bit of clean up, a lot of stitching, and a Zoom call with a stitching group based in Australia.

Masks work

Holly Doyne Posted on by 2

We have had a bit of insanity behind the scenes over the weekend.  Dani received a call from work on Saturday informing her that a work colleague had just reported a + COVID test. Further, this was someone with whom she had worked closely with all day Tues & Wed.

Note – this was Saturday. New Year’s Day. She and Alex had been up for dinner on Friday evening (so count that as four additional people at the table). Plus, she had spent Thursday and part of Friday a bit north of here at a dog show.

So there we go – quarantine time. And scramble to find testing. Work told her she is on “Covid Leave” till she has test results (this is good – she gets paid). There is no testing available on Sunday. In fact, hours spent attempting to book a test have the earliest opportunity being Thursday (this is 8 days later… on a variant that is likely 2-5 days incubation. Even if she caught it, testing + 8 days later would be a stretch.). Shana found her a walk-in location for Monday. Hours in line (seriously, more than 3 hours) before it was her turn.

Results today came back negative and she will be back at work tomorrow.

I can only truly believe that careful mask wearing, good hand hygiene and not sharing a lunch table paid off in both her safety. And prevented the risk to the rest of the family.

Otherwise, I did no cleaning or laundry today, but I did finish the last two sections of that Fairy Tale piece + finished up the Frame. Completed the last two houses in the Seasonal Skies Sal, leaving only ~85% of the frame to stitch. Worked a bit on the full coverage piece. And just because that wasn’t enough confusion, I have stitched  a whole lot of black in the frame for this year’s ShipsManor SAL. Total of 1283 stitches for the day.

I think I need to sleep…

Back to Allen Temple

Holly Doyne Posted on by 2

and it was out the door early with a quick stop at Peet’s before heading to San Leandro and today’s Alameda County POD. Whatever had tied up the parking lot early this fall had cleared so off-street parking felt a bit more comfortable. I have worked here at least half-a-dozen times before. And, as it turned out, I knew at least 3/4 of the people on the lines today.

It was a bit insane as we were offering Pfizer (1st, 2nd, Booster) for adults, Pfizer for Peds (5-11) and Pfizer (1st&2nd) fo the 12-17, and Moderna (1st, 2nd, Booster, Augmentation dose) for adults, Janssen as well for adults.  We pretty much split up the workload, all the syringes were clearly labeled and we picked them up one at a time as a client plopped themselves into the chair.

(the obvious idea being to avoid wrong vaccine, wrong dose).

I was “lucky” enough to spend most of the day on the Pediatric line. Next time, I will happily do anything else. I don’t expect kids to be happy. What I do expect is responsible behavior out of parents that acknowledges what a child is/isn’t capable of doing at any particular age. None of mine particularly enjoyed being stuck with needles, I would be concerned about any child who was!

I missed the Cal Women’s Basketball Game. but watched first Minnesota overcome Michigan before watching the Cal Men’s win. I will spare you my rant about the lack of coverage and respect for women’s sports.

I managed just a bit of stitching and will provide the roundup tomorrow… I am even going to see if I can sleep past 0200 in the morning!

 

Measles and Ft McCoy

Holly Doyne Posted on by

When I spent part of summer there, it was Camp McCoy. July and August in Wisconsin can be humid on top of being hot. There were fields all around us. I was there as a doc, part of my annual time as a reservist. The reason my unit was there? The year was 1980 and we were dealing with another set of refugees – that time from Cuba.

Now why anyone would decide that Wisconsin – not near water, not near many Spanish speakers and certainly not a camp in great condition was a good place to temporarily house 10,000 male refuges is beyond me. Then, unlike now, there was a positive attitude toward the refugees and a definite dislike of Castro’s Cuban government much of which was regularly briefed by the earlier Cuban refugee population which. for the most part, had settled in Florida.

I was at Camp McCoy to provide medical care for the Military Police Battalion deployed from Kansas which was providing security for the site. In addition, we an an Air Borne reserve unit or so out of Chicago that came every supper to hang out and get in their jumps.

I am mentioning all of this because that summer our issue wasn’t measles (as is the problem with the current Afghan refugees) but rather STIs (sexually transmitted infections). By the time my unit (5501st USAH) showed up many of the other challenges had been overcome. The refugees were down to spoons, and plastic at that, due to the amount of violence (prisoner on prisoner – excuse me – refugee on refugee) that can be perpetrated by turning even plastic knives and forks into shivs. Most of the window no longer had glass for the same reason.

The US Public Health Service was providing the health care for the refugees. The two nurse practitioners were excellent as was the PA. Their supervising doc was out of his depth and apparently spent his time drunk in his bunk. That was the rumor. I never even met the man. End result is that of the four of us on our side (one pathologist, me, one PA, one NP) I became the go-to doc for everyone when a doc was needed due to clinic issue, emergency transport, medical issue, or common sense. 

If I could deal with 10,000 men who kept passing around various STIs because of a stupid policy. Some [idiot]  had decreed that treatment should be given only to those with positive penile cultures. The lab had been told not to process rectal cultures. Contact tracing was almost impossible. Solution? Literally butt loads of penicillin. I signed off the meds for the PA and NPs and they started aggressively treating anyone with a problem and all mentioned buddies. [Of note, besides those who wanted to leave, Castro also tossed out a lot of prisoners, mental health patients and every gay man that was identified. Which is how we would up with such an interesting collection of individuals. In August, in Wisconsin, during haying season. Did I mention a lot of steroid dependent asthmatics?)

Anyway  I see no reason why we should be stopping the flow of refugees for measles. Yes there may be a few contagious individuals. So send a team to Ramstein Air Base with a load of MMR and solve the problem. Identify all contacts so far, isolate as you can. And realize that getting everyone to the US will ensure that health care will be provided to those who really get ill. Under the current conditions the transmission chain is going to keep going . There is a reason that most refugee camps run by MSF and other NGOs in low income countries provide measles vaccine to all children on entry to the camp. Wisconsin had decent immunization of children. And Ft McCoy? Out in the middle of nowhere. 

It is not like we aren’t already dealing with SARS-COV2. Much rather deal with someone escaping from a war-torn country than someone who denies science while demanding medical care as their oxygen level tanks.

 

 

Returning to Our Lady of the Rosary

Holly Doyne Posted on by  

POD (point of distribution – thank you very much) which is in Union City – for those of us who have no clue about anything in Alameda County or the East Bay other than Oakland and Berkeley. Trust me, Union City is about as far as one can get from our house and still be in the same county. Driving there is easy since our operations hours are 1500-1900.

Leaving just after lunch lets me skip the traffic, drive calmly and arrive early enough to sit in the car and stitch for an hour or so prior set up.  The days are starting to get shorter and this is an outside set up, so I am really glad we aren’t open later since I detest the East Bay freeways in general and after dark in particular.

As it turns out, once again we are offering all three US available vaccines. Since the majority of who are now coming in are school aged, most immunizations are Pfizer. As it turns out, it is mostly young men. Something to do with wanting to play sports. What impresses me is that more than a few are also dragging along older siblings or parents.

And I am the vaccinator. Three vaccines? Three separate immunization stations. We have everything color coded and have the client head to the correct table. Absolutely no way do any of us want a med error. So I bop between tables as required.

I enjoy working with this crew. It is a mix of county employees, contract employees and volunteers. And any day that we provide more vaccines than workers is a great day.

I am home by 2030 and not completely wiped out.

There are times

Holly Doyne Posted on by  

when the truth should be avoided.

remember what I said about fever and chills Saturday? Well, my fun lasted through to yesterday morning. So there I am, checking in at the Oakland Outpatient VA facility. They ask me if I have been exposed to COVID.

No. Ill? No. Fever or chills in the last 2 weeks?

And I mention that I had a normal reaction to my booster.

Stupid, stupid, stupid. The screening person then informs me that I can’t be seen.

Why? I don’t have COVID, I haven’t been exposed. I had a normal reaction to a booster, same reaction as I had last February.

She calls the nurse. Nurse says no.

I very quietly and firmly insist on speaking directly to the nurse. I don’t have a choice about today’s visit. I am out of an essential medication.

After 20 minutes, one of the nurses comes down. I carefully explain, and suggest that they talk to my doctor since I will need medication in any case. He wanders back upstairs. Another 15 minutes pass and he comes back to say that I can be seen after all.

It is now five minutes before my appointment time.

Turns out, this appointment was worth it. This particular physician grew up and trained in NYC. He landed here on the West Coast because of a fellowship at UC Davis. Late 50s, he just shook his head over my hassles with the SFVA staff, reminding me that as a teaching facility, they put more stock in tests and less in patient’s experience. Lab? My lab from July is fine (this is the lab that I thought was ok but was refused as “off” by the teaching staff earlier this month). He isn’t worried. I can have my refills.

I am even willing to drop back in five months. I appreciate consideration and kindness.

Ouch

Holly Doyne Posted on by  

“this post is being released a couple weeks after I wrote it.”

I worked a shift yesterday at one of the Union City PODs. Since we had all three US available vaccines, I went ahead and got my “augmentation” shot as recommended by my Oncologist. Moderna as it happens to be.

Perhaps you might remember my whines last Feb when I received my second shot and felt like cr*p for a couple of days? Well, guess what? Even though the blood tests had come back flat – no immunity here folks – my personal immune system had a different reaction when challenged. I was very glad one of my co-workers had offered to cover my shift at Eden Community Center.  By 2130 last night, I was sure that I didn’t want to work today.

This morning? Ugh. I am with it for the moment, but not sure it is going to last. (Shall we just leave it at fever and chills?) But, as I keep reminding everyone – it is soooo much better than getting SARS-COV2 and landing in the hospital.

Another stitching day

Holly Doyne Posted on by  

Except for an exercise class – can’t forget about self torture – I quietly spent the day listening to an audio book and stitching. I am not sure about my original plan …

Oh, right – it had to do with getting up for an NIH sponsored conference that started at 1000 EDT (which means 0700 for me) on the subject of the Neurological and Psychiatric consequences of COVID-  especially Long Haul COVID. (A side note – CDC and NIH are desperately trying to rename the syndrome/s to something more “official.” It is not working. As one of the speakers said – Long Haul came from the trucking world where heavy loads are hauled over long distances. It really suits, And why shouldn’t those dealing with the subsequent problems get to name their condition? – end digression)

Besides all the usual scientific mumbo-jumbo which all amounted to – we don’t really have a clue – there were some interesting and clear presentations. I will post links for anyone interested once the webinar recordings are placed on line.

Otherwise –

I worked on Part 6 of Owl Forest’s Alice –

se Part 6

which includes the flowers below the table, Alice, mouse, border, the “eat me” cake, and the top of the sock which leads into a shoe (remaining to be stitched). Some of this was actually completed yesterday.

Then I moved on to Claire Bray’s Solar System – The Sun is actually from May but I decided the 3k+ stitches would be easier to follow in Pattern Keeper and got around to loading it this morning. I have two planets on the list for tomorrow…

the start

end of the day

which amounted to about 1700 stitches. That is a lot of oranges….. and I still have 600+ to go…

Mindless cozy mysteries make for good audiobook listening. Of course, Audible is having yet another sale…

Home Early

Holly Doyne Posted on by  

For the last several years (several being defined as a couple of months after finishing R-CHOP in summer of 2017) I ventured across the Bay Bridge to the SFVA for follow up every couple of months. That follow up consisted of a check-up with my wonderful oncologist, a boat load of lab tests, and maintenance infusion (with assorted medicines accompanied by pre&post chasers).

The study information (you have to love those involved in academic medicine) supported a regime of 12 doses (q2months) of maintenance meds which resulted in an average of 48 months of disease free existence. The jury is still out as to whether or not going beyond that made any difference. [side note – for anyone paying for medical care out of their pocket, this would be a considerable expense just to get the first 24 months of extended treatment. HMOs don’t normally offer the option of continuing after those 24 moths. The VA, stupid on somethings, doesn’t have those limits on its physicians. While not anywhere near as expensive as George’s stem cell transplant, the cost would be a consideration for many].

Anyway – I have made it to my 48 months without any sign of recurrence. I could continue on the therapy but SARS-COV2 is impacting my decisions. Nothing like an infusion to kill off all CD-20 related white cells every two months. CD-20 is on the B cell lymphocyte line. The line that, among other things leads to plasma cells (which produce antibodies). See where I am going? Nothing like wiping out my immune system every couple of months. With COVID-19 expressing new and more infectious variants.

Right.

I have done fine so far through the last year +, but I don’t have a problem wearing a mask and staying away from crowds. But with Delta, plus all those who don’t want to be immunized to protect themselves and everyone else much less wear masks – I don’t think the risk is going to be worth it.

The end result? Rather than get home at 1600 or later, I was home before 1100, complete with a stop at the bakery for fresh peach turnovers… yummm

POD closure

Holly Doyne Posted on by 2

and I know that POD stands for something, but what? Escapes me at the moment. But POD is the name for the Alameda County run community immunization sites. Starting in January, Fremont Highs School on Foothill Blvd in Oakland was the first of such sites. Open Thurs-Sat, the location was picked for a number of reasons. The area around the high school is one of the lowest income areas in the county. And, as should not be surprising, had one of the highest attack rates of COVID-19 along with not insignificant death rate.

The area has a high immigrant population with Spanish, Vietnamese, Cantonese, Mam, all being more prevalent than English.

Our location was in the brand new gym of the high school – which is home to the Fremont High School Tigers

The Tiger mural watching us

 

I started working there in February and put in more than a dozen shifts during Feb/March. Starting in April, most of my shifts were at the Ashland-Cherryland site.  The Alameda Country Public Health staff worked all the sites, so one saw the same people no matter the location.  But anyway. …

Over the course of about five months, this one particular site (on three days a week) fully vaccinated over 26,000 individuals. Before anyone who has gone to a mass vaccination site scoffs – this location was set to support those who were local, didn’t have transpiration. So everyone walked (or was wheeled) into the POD.

I am mentioning all of this because today was the final day at this location. In addition to those working today a number of the rest of us who had put in a lot of time were invited to celebrate. There was cake

the cake

as well as food.

It was good to have a chance to say thank you and good-bye to many of those with whom I have been working these last five months. I am currently not signed up for anymore shifts as there are plenty of volunteers and most individuals who want immunizations have received them. If it comes to boosters this fall – then I will probably volunteer to work again.

Out of the past

Holly Doyne Posted on by  

A long time ago (ok, more than 40 years ago), George & I lived in St Paul (MN). I had a small family practice mostly focused on OB and well babies. George was working for Legal Aid. I mentioning this background because connections extend over time, distance, and space. (no, not at Star Trek reference).

I have several lovely Lebküchen tins from our time in Germany. Three of them have been sitting on top of the dining room built in cupboards for several years as indicated by the definite coating of dust. There are family photos inside. Shana has been asking about her baby book; it is somewhere and I will find it. Figuring one way to quell my guilt would be to offer a selection of photos from her infancy and childhood.

Among them, I found pictures from a birthday party she attended when not quite a year old. I looked at the photos, twins. I remembered them, their older brother, and their parents quite clearly. On a whim, I decided to see if I could locate either of the twins. The boy of the two had a fairly unique first name and I located him on a simple search. As a faculty member, his university kindly provided a contact email.

So off went an email. Several days passed; I received a reply. No, he obviously didn’t remember (I don’t know anyone who remembers their first birthday party). but his parents immediately knew who I was. In fact, he was at their house, as were his siblings, and everyone’s spouses and offspring. I emailed off a set of the pictures. They were much appreciated, I was assured.

And I am thinking that sometimes it is alright to be reminded of the times when our hair wasn’t grey (or that we had hair…)

But I am not there

Holly Doyne Posted on by 2

In an ordinary year, with ordinary things going on – I would be at CISTM 17 in Kuala Lumpur for the bi-annual meeting. I haven’t missed one since 2005. I even made CISTM 15 in Barcelona in the middle of chemo and two years ago in Washington DC. There was a program that I was running (passed off to a colleague who had a bit more time – or at least is a lot more organized).

I had thought, after the five day meeting, to go on to Australia; perhaps first cruising the Mekong Delta.

But noooooo. We have a pandemic and are making due with conferences on line. While being on line lets those from around the world in the Travel Med community participate without having to spend large amounts of money on travel and hotels, it has the definite disadvantage of time zones. No matter what time zone the organizers chose for the base, someone is going to lose sleep. In this case,  it is both those of us on the US West and those in Australia/New Zealand.

This morning’s start was 0800 EDT (GMT-5) which put it at 0500 here and 2200 Melbourne.

Tomorrow my start is 0345. So not fun.

on other fronts –

I managed to finish another section on Aster’s Amazing Adventure

 

 

and the next section of LittleDove’s Wizard of Oz (I am leaving the backstitching and the glitter to the end – wand/crown & faces…)

Follow the Yellow Brick Road – Part 2

Ouch

Holly Doyne Posted on by 3

I am sure that I forgot to mention that I received a call last Saturday from the San Bernardino SFVA call center. This lovely woman identified herself and asked if I would be interested in being scheduled for a COVID-19 shot at the SFVA.

Oh, duh. YES! and was scheduled for 0800 this morning.

I was up early for a conference originating out of Geneva. It turned out to be worth a lot less that the time involved so I was on the road with coffee from Peet’s in hand by 0630. Traffic wasn’t particular friendly going in as the marine layer (aka FOG) was blanketing the Bay Bridge, slowing everyone down to a crawl.

I finally managed to wend my way to the parking garage, get checked in through the outdoor screening process and hiked up the stairs to the first floor (the one above street level for those not familiar with the European norm of floor naming).

There were no signs. None. Not a one. I finally found someone at 0755 at the medical clinic who could point me in the correct direction. Not Building 200 – Building 1. And outside the auditorium for check in.

Ok, I can do that, arriving just as the clock rolled to 0800 and got in line. And waited, and waited. About 15 minutes later, one of the staff came out to apologize for the  delay, citing personnel turn over due to illness. Ok, if someone is sick, I really don’t want them administering shots.

As it turns out, the line was a mix of employees returning for shot #2, employees showing up for shot #1 and about 5% veterans mixed in just for good measure. The actual process went quickly, I hardly felt the needle going in. The immunization was recorded in both my electronic medical record and on a card placed in my hot little hand. As soon as my 15 minutes was up, I headed out the door, through the city and back across the Bay Bridge.

I even made a stop at Acme Bakery  as a reward for myself since there wasn’t a line.

By evening I had the expected sore arm.

The well dressed dentist

Holly Doyne Posted on by  

Since I had to be at the SFVA anyway – I thought I would check to see if the dental clinic might just have an opening. Dental, like the Infusion Center and all the other procedure driven clinics requires a negative COVID test within 3 days. (Not that I enjoy getting a swab jammed up my nose, but it makes sense to maximize the amount of goodness I can get out of that particular bit of uncomfortableness.   My dentist’s afternoon patient hadn’t show up, so she was willing to haul me in for a short exam. 

Which will lead to me returning tomorrow – the only patient for the morning. I scored both a cleaning and a repair to a broken filling. 

The VA is taking good care of its dental staff – they have full protective equipment including PAPR’s (portable air purifying respirators). If you are not familiar with this particular bit of fun, it is a pump worn on the back of the belt. Sucking in room air, it filters it prior to blowing it into the hood. No matter how much aerosol is generated during a dental procedure, it doesn’t wind up in the dentist’s or dental assistant’s breathing zone.

protection +

Not quite space aliens……

or empty heads

Holly Doyne Posted on by 2

Since most of them are not exactly sweet (the politicians, that is)…

And, as Pat reminds me (oh, it is sooo nice to have friends who are medical librarians…) ..

Except … that original marshmallow study? Was later shown to be flawed, badly. It turns out what it was actually testing was not executive function or self-indulgence, but social determinants/influencers of health. Kids who were raised in scarcity, poverty, with a lack of resources had learned to not trust adults who said they could have more later, and figured a bird in the hand is worth two in the bush. 
 
 
Of course, that doesn’t mean that it still doesn’t apply to the situation. I wonder what would have happened if the study had continued on for a year, and the poor kids gradually learned they could trust the researchers, and the rich kids decided they were bored with waiting, their parents will buy all the marshmallows they want at home. 

Or, those with reasonable knowledge in science are able to figure out that ignoring the rules for five days is not going to improve their lives in the long run.

As one of the members of Island Knitters commented last night – “Is getting the family together this year important enough that you are willing to take the risk that some of them will be dead next year?”

It is not rich or poor in the case pretending the virus is also going to go on holiday … wait! The virus is going on holiday, but not as taking a break but happily going along to enjoy new locations, new groups of people, and overwhelming even more city, town, and rural health care systems.

There will be an excellent discussion today from UCSF Medical Grand Rounds at 1200 (PDT) on schools, vaccines distribution – link here. If you read this later, you can find the recording on YouTube under UCSF Grand Rounds.

Yes, we all need to make decisions on our own health and sanity. But also be aware that those decisions have far reaching ramifications on our families, our community, and our society affecting both those we know and individuals that we have never met.