Friday, June 26, 2020

Drowning Prevention: Appoint a Water Guardian!

Drowning Prevention: Appoint a Water Guardian!
Somehow it is already summer. This year feels so different, but many families are figuring out how to do a bit of traveling even in the midst of the Covid virus. As long as you take reasonable precautions, getting a change of scenery can be a wonderful thing. Anytime you are away from home, there are a range of safety issues that can arise. When you get to your vacation destination, do a basic assessment as soon as you arrive. Are there smoke and carbon monoxide detectors? Do you know where the fire extinguisher is? If you are visiting older relatives, are any of their medications safety out of reach? Are any unfamiliar pets comfortable with children? Have you asked to make certain that there are no unsecured firearms?
Think like a toddler. What type of trouble can they get into? Can they open the doors on their own?
Water danger is one of the more essential considerations. If you are going anywhere that has a pool or is near water of any sort, you need to be aware that drowning can happen in just a few inches of water and it can happen quickly!!! According to the CDC drowning is now the most common cause of death in children under the age of four (excluding congenital issues)
Here is a true story from one of my patients. Several adults and children were enjoying a day at a friend's pool in the East bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed, and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone.  Just this week my friend Dr. Ted from Oath Pediatrics, fresh from his overnight shift in the hospital, was telling me about a close call, near drowning from a family pool in Walnut Creek. Just a moment of taking their eyes off of the kids almost led to tragedy. Sometimes having a lot of adults around lends a false sense of security. If kids are near a pool, the adults must take turns being on a shift as the designated lifeguard.
It is so important to be aware that a person who is drowning usually does not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged on watching them like a hawk while they are in the water.
When I sent this post a couple of years ago, I became aware of Levi's Legacy and I am going to continue to do my part to spread the word. Many parents are doing a good job of staying on high alert when they are actively at a poolside but the danger doesn’t end when you leave the pool area.
Levi's Legacy tells a heartbreaking story of a child who slipped out of the vacation home, made it out to the pool and drowned as the parents were busy doing some preparation for a family evening outing.
The important message here is that the lifeguard shift does NOT end when you go inside.
If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present. Hotels or apartments with fountains need to be treated with caution as well. If you do have pool access, there are a variety of pool alarms and safety monitors on the market. Some devices are little gadgets that your child wears around their wrist. Alarms and monitors may add a layer of safety but nothing takes the place of direct supervision. Someone needs to be on duty. Take turns. Appoint a water guardian. On duty mean no distractions (that means your cell phone. Put it down, you can do it.)

Friday, June 19, 2020

Decisions about how to ease out of quarantine restrictions

Decisions/ Decisions
Being isolated is HARD!

We have been in quarantine for three months, give or take 100 years. With talk about things starting to open up, I have gotten many questions from friends and patients asking for my counsel about how to make a good decision about their personal “opening up”. People need to figure out work, childcare and/or seeing their family and friends. Some schools are reopening. I have some friends who are busting to hold their grandchildren and haven’t been able to. Others have made creative quarantine schedules to allow visits. How and when to normalize is on everyone’s mind. As much as we wish we could wave a magic wand, this virus is not going away anytime soon. Staying inside is not realistic for another year. We need to find the crucial balance. At the same time, watching other states reopen and have numbers surging is an uncomfortable situation.

During the past couple of months, many people made individual choices about how much they would actively isolate.
Here is an important fact - you can be as careful as can be, but if you are living with someone who is not taking adequate precautions, then you may be wasting your efforts.

Some people have created an absolute bubble. They have had no in-person contact with anyone. All of their food is delivered and decontaminated before they touch it. If we are assigning grades, they get an A+.

Other people I know have been making more relaxed choices.
Folks with a wide social circle, who congregate but keep their masks on are probably a C+. If they go out without a mask, they get an F. (How masks became a political football is beyond me; it is a simple action. It broadcasts that you have an awareness and are taking an action that is in your control.)

I will assign myself the grade of an A-. I have been very careful about who I see. I have done some safely distanced walks outside with other friends who are also at least an A-. I have gone into some supermarkets, but not when they were crowded and I did a full scrub when finished. I always have a mask with me and put it on when I am within 6 feet of anyone outside my home.

I make a conscious choice to not judge anyone else's decisions. I give full respect to people that will avoid me because I am not an A+. I give my understanding to the people who have a lower grade. Some of those have no options. They have to work or deal with childcare. While I don’t question their choices, I maintain my own boundaries. Being over 60, I have tried hard to keep people out of my orbit unless I am comfortable that they “make the grade.” Understand that these grades are arbitrary and are made up on a scale that is only found in my brain. You all get to create your own scale.

Remember, your grade is only as high as the people you are with. Or in other words, you are only as safe as your weakest link. If I spend time with a B-, then my grade goes down to a B-.

I am not privy to any special inside scoop, but I am good at problem solving. This is all about risk vs. benefit. 
What do I mean by that? Here is an example that my husband Sandy uses.

He had to do a personal risk assessment regarding resuming activities after major orthopedic surgery, and his surgeon taught him how to think about it. In 1990 he tore his anterior cruciate ligament playing basketball; he also participated in a variety of other sports, but this was his passion. This was the dark ages of orthopedic surgery and there was no such thing as arthroscopic surgery for this injury back then. So, he had almost 7 hours of surgery, with 4-6 inch scars on both sides of his knee. He was in the hospital for 6 days and non-weight bearing for 8 weeks; This was going on while I was quite pregnant with our second daughter. His rehab was excruciating and took a full year. When his doctor told him he was free to resume an active sports life, he expressed serious reservations, because he never wanted to go through this again, and he was fearful of tearing it again. So the doctor asked him a series of questions – how would he feel if he ended up back in his office after tearing it playing softball? Sandy said he would regret it and believe it to have been a waste. How about if he ended back there after skiing? Sandy said he liked skiing but also would not feel it was worth another surgery and rehab. What about basketball? And here Sandy said yes, it would be ok if he injured it again playing basketball because he loved it that much. So the doctor said – ok, there’s your answer. Go out and play basketball! And he did! But what he first had to do was weigh the consequences of a number of potential activities against the benefit he would derive from each, and only one met that hurdle. Unfortunately, Sandy got a real-world test of his analysis 8 years later when he tore his other ACL. But he had no regrets, even before seeing the same surgeon. As luck would have it, arthroscopic repair had become the standard for this surgery; he was in the hospital one night, weight bearing the day after surgery, and back on the basketball courts in 4 months, where he continued to play for many years.

So all of you need to play the risk/ benefit game for your family. No one has the exact same situation.

So, how do we approach these very complicated choices that have potential ramifications that go beyond the risk of knee injury.
Simplify it as much as you can by marking down all of the important considerations. What are the benefits of the action you're considering? And what price are you willing to pay to do it?

Make a list. Writing it all down might help you get clarity.
Start with contemplating your risk tolerance. Kids are generally not getting very ill from this, and the young adults are not as safe as once thought, but if someone in your quarantine bubble is over 60 or has any preexisting conditions, that needs to be taken into consideration.

Where are you located? That is an incredibly important factor. Keep an eye on the numbers in your city. They are likely changing weekly. Keep your finger on the pulse. In San Francisco, the numbers are relatively low and flat compared to other large cities. Find a database that you trust and keep checking it. I do a daily look at the US and world counts here:

Another excellent source are the tweets of Bob Wachter, Chief of Medicine at UCSF:

Keep in mind that all life activities involve risk. Just getting in a car or crossing the street involves some risk.

So, what is it that you want to do?
For instance, going to a movie theatre right now would seem like a silly choice right now; you can watch a movie from home. That is an easy one. Pedicure? Paint your own toenails.

Questions like childcare are a bit more complicated.
Who might be coming into your orbit? What is their grade?

Are you contemplating a visit with family or friends who have not been as careful as you are? Have a serious and civil conversation. Perhaps they are willing to do a week of clean living to raise their grade in order to accommodate you. Of course we don’t know if a week is adequate. Two weeks would be safer. Come up with a solution that feels right for all of you.
One of my cousins has planned an Air BnB get away with her kids. She has been an A+. Her daughter has been a B, but is going to spend a very careful week or so raising her grade before joining her parents for what will surely be a wonderful getaway. Their son has been going to a lot of protests in NYC. He wears a mask, but is not going to change his lifestyle to get his grade up high enough. He won’t be joining the rest of the family. They all love each other and completely respect each other's choices.

While you do your figuring, here are some things we know about contracting the virus. Some of these factors carry more weight than others.

  • It is much more about the air that we share, than catching something from touching something.

  • Outdoors is significantly safer than indoors.

  • >6 ft is safer than <6 ft. 

  • Masks are safer than no masks. Of course the masks also need to be worn properly.

  • Short exposures (<10 min) are safer than longer ones. 

Regardless of whether or not you are inside or outside, the risk goes up if you are around people who are coughing or sneezing, but it also goes up if people are shouting or singing. There was a church choir that was severely impacted early on in this pandemic.
If you have wandered outside the safety of your home, washing your hands for at least 20 seconds and avoiding touching your face are the most protective actions that you can take. Hand sanitizer is useful but you need to use at least a dime sized dollop and then after generously spreading it, allow it to dry. Once you get back to a sink, do an extra wash with soap and water.

In the unlikely event that the virus has landed somewhere and is actually still alive, shiny surfaces are riskier than rough ones.
There was a story in the news this week about toilet seats.. Oy, I am not even going to go there. Just please wash your hands.

Looking at the above information, it stands to reason that taking a walk outside while wearing a mask is probably pretty safe. Being inside the corner fruit store for 5 minutes and washing your hands before you touch your face, probably okay too.
Singing duets inside a building for an extended period with someone who is not usually in your bubble, is quite a bit riskier.

Whatever happens...accept that you made the best choice you could in the circumstances.
Parents it is essential that you work as a team here. There can be no finger pointing if things don’t go as planned. Whatever plan you cobble together, shake on it (and then go wash your hands!) You are in this together. This is all a guessing game. Put thought into the process and do the best you can. No beating yourself up.
This will pass at some point. We will find some kind of new normal that doesn’t feel as restrictive. Scientists are actively working on improving testing, tracking and working on vaccines, but I am not optimistic that we will have true answers this year.

We need to carefully balance safety with the need to resume some normalcy.

Friday, June 12, 2020

Stop feeling guilty for finding moments of joy

Have you ever gone from laughing to crying and then back again in a single breath? I know I have.

Emotions don’t follow rules. They jumble in all at once. It is perfectly normal to be able to host more than one emotion at the same time. Why am I paying attention to this now? 
Because, these days, when I ask someone how they are doing, the response is usually a protracted sigh. Many people feel guilt or shame if they are among the population that is actually doing somewhat okay during these tumultuous times.
People seem reluctant to admit that they are intact. I think I will start changing my question. Instead of the broad, “How are you?”, I will amend it to “How are things in your tiny little corner of the universe?”

By no means should we afford ourselves the luxury of ignoring what is happening to the state of the world these days. It is essential to listen, pay attention, learn and support others who are fighting real battles with health and/or racial injustice. If you need to feel some heartache over current events, allow it, but if you can, put some limits on it. As my daughter Alana says about a tricky emotion, “invite it in for tea, but don’t let it stay for too long”. 

In order to continue to live well, we also need to invite the joy in. Think of it as your oxygen mask. You need to take care of your mental health so that you can then tend to the needs of others. If your immediate friends and family are intact, then as a family you can reach out further and put positive energy out in the world. It starts with you. Joy is everywhere. You just have to notice it. 

I frequently walk up to the top of twin peaks. It is currently closed to cars, I confess that I will have mixed feelings when it opens back up. There is joy in looking at the flowers, hearing the birds, smiling at the children who are busy making chalk drawings on the sidewalks. I give a greeting to all the waggy dogs. There is joy in the sweet clear air when I sneak my mask down below my nose for a few moments. I am thrilled that my body graces me with the ability to get up there without passing out. And then there is the spectacular view which is a reward all by itself.

How can I feel contentment when the world is in so much turmoil? How can any of us? Because we must. I had recently been chatting with some patients who had new babies. They were exhausted, but euphoric. The discussion was about how they had mixed feelings of sharing their happiness with others. You don’t need to hide. The world needs that joy! 

Friday, June 5, 2020

In memory of Uncle Landshark

In Memory of Uncle Landshark
I do much of my writing at night when I am in bed trying to fall asleep. Words and sentences swirl through my head. This world is hurting so much right now. There is a lot to grapple with.

I had several subjects that I was considering writing about this week - big topics, such as talking to your children about race and how to teach them to value differences. Health issues such as the fact that standard vaccinations rates are going down. Or perhaps writing about more tips on keeping sane during the quarantine….but then this weekend my family and I experienced a more personal loss. That is the subject that won the battle. Thank you for indulging me as I put my memories onto paper.

We lost our uncle Steve this week. My kids called him uncle Landshark because of a game he played with them when they were children. He was one of the good guys on this planet.
Steve was my husband's uncle, but since I have known him since I was 17, we were closely connected. I chatted with him at least every week or so. It wasn’t uncommon for calls to go into voicemail. He took turns ignoring his cell or his landline, depending on which was getting more spam calls that month. It also wasn’t unusual for him to take a few days before calling me back.

This past week, after a few days of leaving messages, not hearing back from him, and a “feeling in my gut that something was not okay,” Sandy called the police in his little town in Ohio and asked them to do a welfare check. They broke into the house and found that he had died. I had been nagging him to get one of those life alerts, but he was stubborn. He was just shy of turning 80, and with a 91 year old older brother down in Florida who is doing well, I hadn’t pushed the ‘younger’ uncle on it, beyond bringing it up occasionally.

For those of you who like my tales of the “things that are hard to explain” here is one. Steve was married to Aunt Millie. She and I were also very close.

Several years ago when I was at work, my phone started to turn off and restart. It continued this cycle repeatedly. Other people watched and witnessed, no one could figure it out. I called Sandy and told him what was going on. He "knew" why this was happening but instead said it might be time for a new phone. He sounded a bit odd and told me that we could figure it out later. The phone continued to be “possessed” for the entire day. When I got home, Sandy broke the news to me that Millie had died, fairly suddenly. The phone stopped acting strangely. The message had been delivered.

This week, before we actually knew there was anything wrong, both my phone and my daughter Alana's started acting wonky. Our phones were making calls to each other without any instigation from us. Not butt calls - the phone would be on a surface, not being touched and would start dialing. Also, the Alexa device in our house was randomly having conversations. There was a disturbance in the force. Now we know. The devices are now behaving just fine again.

How to capture his essence in just a few words…..  

Steve spent most of his life in the air force as a communications expert. For much of his career he was stationed at Cape Kennedy, assigned to NASA. Yes, along with the astronauts, he drove a Corvette while there! He was actively involved with all the Apollo missions. While not officially licensed, since he was already aloft as part of the team, when not busy he would occasionally pilot the converted C130 plane used to communicate with the lunar missions; he just missed seeing this recent launch. Once retired, he volunteered for the Red Cross as a radio and communications expert, assigned to emergency response teams that were sent to different disaster areas to lend a hand.

On every birthday Steve and Millie would call family members, armed with pots and pans, whistles and other noise makers. We would get a clanking, cacophonous rendition of a very off-key happy birthday that is hard to describe.

He loved all animals and until that last year or so, always had an assortment of rescued animals that found their way to him. 
When Steve came to visit he liked to fix and repair things. He also woke up in the middle of the night and baked delicious mandel bread. I remember the first time he did that, I woke up at 3 am to the most amazing aroma, went down to explore and found him busy in the kitchen. The recipe was his secret. As far as we know, he took it with him (maybe he can figure out a way to text it to me.)

He hated butter. He was that person who would interview the servers at every restaurant for at least five minutes about the importance of making sure that no butter was involved in the preparation of his food. As much as he hated butter, he loved extremely spicy food and lived for sushi. A good day could include sushi for breakfast, lunch and dinner. I kid you not.

I allowed myself a solid day to beat myself up for not acting on my uneasiness that first moment when he didn’t call me back. Of course I know perfectly well that it may well not have made a difference. I am human and had to play the woulda-shoulda-coulda game. I can’t change this story, but I can perhaps change somebody else's.

Do you have people in your life who live alone? Quarantine is tricky for people who live by themselves. How long does it take for someone to notice that there might be something wrong?
Please institute a daily check-in system with the people in your life. 

Do people have “in case of emergency instructions” left in a place where others can find them? Unfortunately, we have now learned that uncle Steve did not. Get that taken care of. It might not be an easy conversation, but it is an important one