Another Anti-Vaccination Myth Put to Rest. Pregnant Women Can Safely Take the Flu Shot

Vaccinations have been blamed for causing autism in children and used as an excuse to permit school age children to opt out of receiving vaccinations and immunizations but still attend school. The result has been a reemergence of measles and other preventable childhood illnesses in multiple areas of the world.

Anti-vaccination advocates have extended their arguments to claim pregnant women receiving the flu shot are increasing their off springs’ chance of developing a disease on the autism spectrum. To study this question Jonas F. Ludviggson, MD, PhD of the Karolinka Institute in Stockholm, Sweden explored this question. They followed large numbers of pregnant women in Sweden during the 2009-2010 influenza season and then followed their newborns for almost seven more years. Over 39,000 pregnant moms were vaccinated with the standard inactivated flu vaccine that season. Only 1% of their children, 394, had developed illnesses on the autism spectrum by 2016. Conversely, over 29,000 moms did not receive the flu shot that season and 394, or 1.1%, of their offspring developed diseases on the autism spectrum. There was NO statistical difference in the groups. Their research paper was published in the Annals of Internal Medicine Journal.

As we head into influenza immunization season; the voices of scientists, public health experts and physicians will be encouraging everyone to take a flu shot. The voices of those who believe these vaccinations will cause harm will also be loud.

Look at the data and scientific evidence and please take your flu shot this season. It certainly is not a perfect preventive treatment but it reduces symptoms and severity in those unfortunate enough to catch it. Call your doctor and make an appointment to receive your flu shot.

Pandemic Cabin Fever and Risk Tolerance

It’s Labor Day and I am so grateful to be alive and have my family tell me they are healthy and well. As part of the COVID-19 pandemic, my wife and I have been isolating since February.

Our major risk of disease transmission is I go to work and see patients face to face. I dread the thought of being the one to pick up the coronavirus and sicken my loved ones. I often feel like a quick change artist changing into special scrubs, masks, gloves, face shield and gown or lab coat to see patients . My pants, shirt, tie and belt get hung up and my shoes and socks get put into a plastic bag. My sneakers never leave the office. In between patients, while my staff clean the exam room, I am shedding one outfit and changing into another. The used one goes into a netted laundry bag which gets washed on the hot cycle each evening.

My wife and I have not been to restaurants. We pay for shoppers picking up supplies and bringing them to our front door. We have a receiving decontamination process by our front door. We bring in no prepared meals. Trips for haircuts, nail and toe trimming and even some non-critical physician visits have been put on hold. The goal is to stay alive until a vaccine or treatment makes the risk less.

We miss our friends greatly. We are all over 65 years old and considered high risk for COVID complications. There have been no socially distanced meals or gatherings. We talk on FaceTime or Skype. Our regular Friday night dinner with family friends for 30 plus years is on hold for now. Our schedule is structured and revolves around work responsibilities, pet care responsibilities, exercise to keep the mind and body fit and home cleaning responsibilities. We speak to our adult kids and their kids daily.

We are more fortunate than most having a daughter and her family an hour away south of Miami in the “ 305.” She has been pregnant during the pandemic, preparing to deliver shortly so she is high risk too. We respect her protective bubble and when we drive down we stay more than socially distant, all with N95 masks on surpressing the urge to pick up our toddler grandson, hug him and smother him in love and kisses. In the pandemic with his brother or sister in utero, being able to visibly see him, smell him and see his growth is enough to refill our tanks and maintain our COVID plan.

Many of my friends and patients believe we are crazy for being so isolated. I see the wives go out to lunch with the girls, go for hair coloring and cuts. They tell me how safe and clean it is at the site they are visiting until I get the phone call about the fever spike, the dry cough, the headache, the diarrhea. Then the frantic quest for accurate and reliable testing begins for individuals.

At times it is the golf game, or tennis and a meal “ at the club.” I always get a lecture from them on just how many precautions “the board“ put in place to protect them. That is, until it doesn’t and they too are sick with COVID.

Other times it is the younger adult families with school age kids traveling out of state to the mountains with “safe and responsible friends” only to end up COVID positive, survive and be dragging six weeks later with new EKG changes a health conscious 40-year old did not have pre-COVID. When I get the patient call from the high-risk individual now positive with COVID 19 there is little I can do other than pray and root for them. Knowing the multi system diseases these individuals must overcome I suppress the urge to just cry. Yes fluids, Tylenol, rest and cough syrup are available but not much else unless they get much sicker and hopefully that won’t occur.

When they get worse it’s off to the hospital where the COVID team armed with not much more (steroids, convalescent plasma, remdesevir for some) does the same. When the patient thankfully does not get worse, and should be grateful, instead they complain foolishly about “why am I here if you are not doing anything for me?”

A vaccine is closer than further. Treatments with monoclonal antibodies and possibly prevention are closer than further. With the opening of in-person schools, in-person college attendance and our Governor pushing safe air travel and tourism, I expect the infection numbers to climb in late September early October.

Putting our lives on hold may be extreme and overreacting. I will continue that plan and advise you to suck it up, tough it out and do the same. I pray that my efforts and family’s efforts continue to keep them well and healthy. Even with their efforts there are no guarantees – just our prayers.

Conversations Overcome Concerns & Strengthen Relationships

When I organized my medical practice, I tried to find individuals with great customer service skills plus the medical knowledge to work in an internal medicine practice. We all do our best to meet the needs of our patients but sometimes, even with the best of efforts, we fall short.

For example, a patient requested a large quantity of a medication as a refill early one morning. I saw the fax as I walked in the door, picked it up, signed it and returned it to the pharmacy for the refill. It only took about five minutes to send it to the pharmacy.

When the pharmacy received the refill authorization, they did not have the quantity of the medication the patient requested. When the patient went to pick up the medication, they were given a 90-day supple, not requested 180 days.

The pharmacy incorrectly told the patient we only ordered 90 tablets. Angry, the patient called the office and was abrasive – not giving my staff a chance to investigate the matter to see if it could be settled to her expectations. Unfortunately, the pharmacy never told the patient their supply of that medicine was short.

The angry patient left our receptionist in tears and our office manager flustered. It takes a great deal to fluster our office manager, given her background. I tried to call the patient, but she did not take the call.

Having a personal conversation is the preferred way to understand and overcome concerns, issues or complaints. Email is too impersonal and rarely conveys the tone properly and a handwritten letter is less personal than a face-to-face meeting.

The same applies to those unexpected release of records forms you receive from patients requesting their records be sent to another internal medicine or family practice. You never want to learn your patient has left your practice without knowing why. How do you fix a problem and prevent it from happening in the future if you were never made aware of it in the first place?

I encourage my patients to contact me if they are unhappy with me, my staff or the way I provide care so we can address their concerns. Better communication makes for better care – even if the original message is unpleasant.

Give us a chance to hear your point of view and address the issue. That is what relationships are all about.

Although this article is based on my patient experiences, I encourage everyone to have a conversation with their doctor to share their concerns.

A Perfect Storm Brewing: Flu Season Plus A COVID-19 Resurgence

I was asked by a colleague what I thought influenza seasonal infections coupled with a predicted second wave of COVID-19 would look like locally? Influenza A arrives locally around Thanksgiving and peaks the last two weeks in January and first two weeks in February. I suspect it is fueled by seasonal visitors coming to Florida bringing the disease from their home locales. We see a low level of influenza B year- round in our pediatric population.

A full-page ad appeared in all Florida newspapers today sponsored by every major health system in the state including Baptist, Tenet, HCA, Cleveland Clinic, Broward Health, Jackson, U M Health, Memorial Health and others. It stressed wearing masks, social distancing and frequent hand washing.

If you get sick with mild symptoms, they encourage remote telehealth care. If you have moderate symptoms, they suggest going to their urgent care facilities. For severe symptoms call 911 or go to the ER. At no time did they suggest calling one of their employed physician offices or visiting your private doctor which is all consistent with CDC recommendations. Private independent and employed physicians just don’t have the ventilation systems, sanitizing systems, personal protective equipment or trained staff to see potential COVID patients in their offices. If a patient is positive, or a staff member converts, what is their responsibility to the next patient or to the other tenants of their building? Is a 14-day quarantine in order?

Much depends on unknown factors. How effective will this year’s flu shot be? In my area, the chain pharmacies already received their supply of influenza vaccine and have shamelessly been pushing it on customers since July. Scientific research shows that in senior citizens the flu shot immunity begins to subside 90 days after you receive the shot. Given that, if your pharmacy tech gives you the flu shot in September, then how much immunity will you have by the time the flu arrives around Thanksgiving?

Quick, accurate and inexpensive testing availability for flu and COVID 19 is an important factor as well. We have had a quick influenza test for years requiring a nasopharyngeal swab. A similar test for COVID -19 has just been released by Abbott Labs and received Emergency Utilization Authorization from the FDA. That means Abbot Labs researchers say it works and the FDA takes them at their word. This test, called “a game changer” by many, will be available in October.

When $15 per hour medical assistants start performing the test rapidly, in volume, I hope the accuracy results are similar to Abbots claims. Our health and lives depend on that. At the same time a finger stick blood drop test is heading to market to quickly detect flu and COVID -19 on the same test card. Finnish scientists and Israeli researchers have quick breathalyzer tests coming soon as well. I hope they work and get here soon. I will test everyone at the door as will restaurants, theaters, sports arenas and most businesses.

All of this information really skirts the issue. With no treatment and vaccines available yet, I expect this flu COVID-19 season to be a human health disaster. With no national plan in place and no close coordination with state and local elected and public health officials, I see the fall and winter as a time of continued disease surges and deaths while the political influence on disease treatment supersedes scientific research and public health realities. Without a coordinated program of PPE and medication distribution, coordination of testing availability and results with contact tracing and specific shutdowns of hot spots without challenges related to loss of freedoms the outlook is grim.

Protecting senior facilities without a coordinated program and funding for it will not work for residents or employees. Opening schools and day care without similar precautions, training and funding for materials and tracing will lead to hotspots as well. There are members of the student population such as special needs children who need to return too, in person, learning safely and creatively. Others need to learn remotely or be given a chance to catch up later when safe return to in person learning is possible.

Without a plan to assist renters, homeowners, landlords, small business owners, farmers, restaurateurs, etc.; any shutdown for disease will be met with overwhelming resistance. I see a bleak and dangerous health picture developing in the fall/winter creating a perfect influenza/COVID storm.  I hope I am wrong but, if right, the disease surge will overwhelm ERs and hospitals.

Safety for Patients First

In the heat of the ongoing pandemic, my associate and I suspended in-person routine office visits for the safety of our patients. To get to our office, patients walk through a revolving glass door into a common lobby and then take a small elevator up to the second floor. There are stairs which are well hidden and not easily accessible. A sign is posted next to the elevator suggesting facial covering, but not requiring it, despite an executive order in Palm Beach County mandating their use.

This is a multiuse building with numerous offices. Many of the other tenants do not social distance or wear masks routinely. There have been multiple tenants who have tested positive for COVID. For this reason, we participated in telehealth visits exclusively to protect our older, chronically ill and vulnerable patient population. It was safer to keep them in their home than bring them into our practice. We were willing to forego practice revenue and income to do so. Our first priority is the safety of our patients.

The office has been open daily, answering calls, refilling prescriptions, filling out forms and scheduling telehealth visits. The criticism from patients for doing this has been scathing. The worst criticism has been from those requesting blood draws for visits to other doctors. We performed this as a courtesy in Pre- COVID days but believe the risks far outweigh the benefits for non-ill individuals at this time.

The COVID-19 hospitalization rate and percentage positive rate locally have declined to a level that is allowing us to begin safely seeing patients again in our office. The building management still will not enforce the Palm Beach County mask mandate so we urge you to social distance and wear your mask.

Do not enter the elevator unless it is empty. Wait for the next one to ensure safety. Hope to see you soon. Call with any questions.

Caregivers & Health Care Aides are Underpaid & Underappreciated

It’s been years since I lost my mom and retired as a hands-on personal caregiver. The care I provided her was supervisory, not physical, and it was exhausting.

As a physician caring for my patients who end up in a skilled nursing facility for post hospital rehab, I have always been amazed at how under paid, under trained and overworked these well-meaning caregivers and aides truly are. It’s easy to see why burnout is common amongst them and turnover is ranges from 50% – 100 % annually with these jobs.

The devastation created by COVID-19 at senior care facilities brought this all into sharp focus. These poor employees living in multi-generational homes, and not having the luxury of working remotely, have suffered staggering losses due to this disease. With no quick accurate test for this virus available, they show up at work not knowing if they are infecting their elderly patients inadvertently or being infected and bringing it home to their loved ones. There has certainly been no organized program on a national or state level to protect the patients or the caregivers.

With lockdowns in place at these facilities, these hardworking aides are now functioning to some degree as mental health counselors as well.  But it’s the physical nature of their work that amazes me – routinely lifting and grooming men and women weighing a hundred or more pounds.

My poor little 24-pound rescue pug suffered a neurological catastrophe last weekend with an embolus to her spine leaving her paralyzed in her rear legs. I have a harness and soft belt to support her so she can walk on her front paws and squat to void and defecate. If I don’t hold her up high enough, she scrapes the skin off her knuckled rear paws and they bleed. She hates the booties I tried to protect her with.

The canine neurologist asked that we don’t use the rear rollers you see paralyzed animals use for mobility because she wants her to walk again or at least give her a chance. Once a day I go into the pool with her and support her midsection while she paddles away with her front paws and I move the rear legs through their normal range of motion. Lifting those 24 pounds is exhausting for this 70-year old but she is making progress pushing back now against my hand in those previously flaccid limbs.

I do this out of love. I can’t imagine how difficult it would be to lug a 100+ pound person around all day while risking COVID-19 exposure, all for $15 per hour.  I tip my hat to these health aide angels who are the glue that keeps elder care together in a dreadful profit driven system.  They do it to give their loved ones a roof over their heads, food on the table and a chance at a better future.

As the U.S. population ages, we need to find a way to compensate them fairly and appropriately to show our appreciation for what they do and recognize how difficult and dangerous their essential work is.

Chocolate and the Risk of Coronary Artery Disease

Chayakrit Krittanawong, MD, of the Baylor College of Medicine, was part of a group of physician scientists conducting an observational study involving regular chocolate consumption and the risk of developing coronary artery disease. Their research was recently published in the European Journal of Preventive Cardiology. In what was called “a systematic review and meta-analysis” they analyzed data from 336, 289 participants, participating in six studies, looking at chocolate consumption, coronary artery disease, acute coronary syndrome and acute myocardial infarction.

If you consumed chocolate 3.5 times or more a month, or more than one time per week, you were considered a high chocolate consumer. High chocolate consumers turned out to have a lower risk of coronary artery disease of about 8%.

This is great news for chocolate lovers. However, readers must remember this is an observational study and cannot link cause and effect. It did not factor in obesity, lipid levels, presence of diabetes, cigarette smoking history, activity level, family history of premature coronary artery disease or other dietary habits.

Is it possible that chocolate lovers eat more fruits and vegetables than non-chocolate consumers? Could it be that chocolate lovers eat a healthy Mediterranean Diet more frequently than non-chocolate consumers?

This study clearly didn’t answer those questions. What it does say to me is that if you reduce your cardiovascular risk factors, as best you can, eating chocolate occasionally may not hurt.

Time for Some Positive News

I drove home from my medical office, walking through the building with my N-95 respirator mask and wiped my hands with Purell as I entered my vehicle. I turned on the sports radio talk show only to learn how many of my baseball, football, hockey, basketball and soccer teams were curtailing practices due to COVID-19 infections while they question whether their season would start. Arriving home, I entered through my garage with my pandemic routine of rigorous hand washing, clothes worn outside go right into the washing machine and find a fresh mask in case I need it on my community dog walk.

“Hi honey, how are you and what’s on the agenda tonight?” My wife was keeping her distance because on one of my office medical staff stayed home after her dad tested positive for coronavirus. The practice staff were all near her and now we are all on 14-day self-quarantine while we await our COVID-19 test results.

Standing there as I changed into some clean clothes, I heard my wife say, “Dinner is a salad, steamed broccoli and reheating last night’s leftovers. I have us set up to watch Ozark, Breaking Bad, and House of Cards after you watch the half hour national news.” These were all brilliantly written shows we had missed seeing when they came out, with not one character you could root for or say they are a good person. The shows are smart but negative – about flawed people exhibiting more negative than positive character traits. The evening news was not much better covering the unchecked spread of the coronavirus, brawls about wearing a mask, financially strapped small businesses looking at closing up shop for good and one more look at the death of George Floyd in Minnesota.

I decided my best option was to look for some positives, so I found some. Yesterday we sent my 71-year-old patient with bilateral pneumonia from COVID-19 home from the hospital on his road to recovery. With heart disease, obesity, chronic lung disease and multiple intrabdominal abscesses as a complication of emergency surgery; he should not have survived. He did not require oxygen, or convalescent plasma, or remdesevir, which isn’t even currently available in Florida, or dexamethasone which is also in short supply. He should not have lived but he did!

On the same day Regeneron announced that its antiviral monoclonal antibody cocktail called REGN-COV2 was moving into human phase 2 and 3 trials at multiple sites in the US, Mexico, Brazil and Chile. Regeneron believes this medication can be used to treat sick COVID-19 patients and to prevent infection. If this phase goes well, they are prepared to introduce the product to patients in late August or early September.

This was followed by the news that the vaccine being developed in the UK at Oxford and the vaccine being developed in the USA at Moderna had both produced antibody responses in human volunteers at multiple dosage levels and they too are moving into phase 3 trials in humans . Both companies are so sure their product will be successful they are producing it for distribution now. Late fall or early winter are their target dates for distribution.

There is a light at the end of a dark pandemic tunnel. Our job is to stay healthy physically and mentally and do what we can to protect ourselves and others. Wear your mask, social distance, wash your hands frequently, stay home, be kinder to everyone else who is stressed out, worried and lonely. Call your physician and make sure you a get a flu shot this fall. We can get through this together and build a better world!

Volunteering for the COVID-19 Vaccine Trials

My civic-minded daughter in California asked me what I thought about her volunteering for one of the drug trials or vaccine trials involving COVID-19. She asked me if I knew how they found volunteers for these research studies. I told her I had no idea, but I would investigate it.

The Center for Disease Control and Prevention (CDC) and the National Institute of Health (NIH) websites directed me to a volunteer network formed to find volunteers to test treatments for HIV disease. I was directed to a website being run by the Fred Hutchinson Cancer Institute in the Midwest.

Mr. Hutchinson was a former major league baseball player and the manager of the great Cincinnati Reds baseball team that lost to my beloved New York Yankees in a World Series in the 1960’s. Fred had contracted cancer and been involved in philanthropic works in cancer research. After his death, the center took on his name. It is a first-class extraordinary cancer research and care facility. They are supervising the COVID-19 Trials Prevention Network.

If you access the site at http://www.coronaviruspreventionnetwork.org you have an opportunity to volunteer for prevention and treatment studies. There is a short questionnaire to fill out asking you about your health, height, weight, exposure to COVID-19 and contact information. If you are selected for a trial, you will be contacted and at that point have a chance to review what is being studied and what the risks and benefits are for your participation.

Filling out the form does not obligate you to participate but does put you in the pool of individuals willing to consider participating in a prevention or treatment trial.

Good Advice and Quality Care Is Not A Negotiation!

In this era of the “Art of the Deal” many in my patient population seem to believe that dealing with science, math and physical laws of nature is a negotiation.  They seem to believe as it’s the same as if you hired a contractor to work on your home and he wants a 20% down payment when you sign the contract and you only want to pay 5%.

I’ referring particularly to the laws of transmission of respiratory viruses, droplet particles and aerosolized viral particles. We are supposed to be wearing masks or facial coverings when indoors or when we are within a few feet of each other (six feet or less). We are supposed to stay six feet or more apart.

If exposed to the coronavirus or COVID-19 you are supposed to go home, stay home and self-quarantine for 14 days. You can contact your physician and discuss the circumstances and ask for advice.

What you are not supposed to do is go home, get anxious and agitated and spend hours on the phone trying to get tested immediately. The tests are only about 70% accurate (nasopharyngeal swabs via PCR). The quick tests, with turnaround times of hours, are wrong 48% of the time.

I explain this to concerned individuals and try to soothe their fears but the negotiations begin. I am flattered by the degree of confidence and power they believe I have but just because you want me to say something contrary to what the scientific facts show, doesn’t mean it is correct or good advice.

Sometimes my patients try and make me feel like I am a priest in a Catholic Church during confession, but I have neither the training nor the connections with the good Lord. Sometimes they try and make me feel like the supreme leader who can grant them a special dispensation. I am not that powerful or good and this is Mother Nature we are dealing with and laws of science.

As an example of what I mean, let me use a personal situation as an illustration. My daughter, son-in-law and 2.5-year-old grandson live south of Miami in Dade County in an affluent community of young well-educated individuals called Palmetto Bay. They both work full-time and have been working from home due to the COVID-19 pandemic. My grandson is cared for, watched, taught, loved and instructed during the day by his loving grandmothers so the kids are free to work without incurring childcare expenses.

Both grandmas’ have master’s level early childhood teaching degrees and one is a psychologist who recently retired from the Dade County School system. Seeing my grandson grow up with his grandmothers doing what they love to do most is a joy. When COVID-19 raged in March, they closed the pre-school my grandson attended. Unexpected exposure to others resulted in both grandmothers having to avoid my children because they are both older with chronic illnesses and considered high risk for COVID-19.

The pre-school sessions resumed a few weeks ago bringing joy to my wife and grandson. My daughter’s neighbors show little or no respect for the coronavirus. When I last visited three weeks ago there was a party going on next door and four adult men in their thirties or early forties were out on the lawn without masks or social distancing puffing away on cigars while a band of young children intermingled on the lawn. We all waved hello but kept our distance.

Two days later my son-in-law left his home through a side door to take a stroller out of his SUV parked 30 yards deep in his driveway without a mask. The neighbors five-year-old, playing freely on her lawn saw him and ran over to say hello while his back was to the child. He turned around and this well-meaning child was right there in his face. He jumped back, thought nothing of it because they were outside, and he is three feet taller but realized that the close encounter was worrisome. Two hours later they received a phone call from the neighbor saying that unfortunately they had just been informed that all their friends who visited over the weekend were now ill and tested positive for COVID-19. The neighbor was concerned about the encounter between my son-in-law and her child because my daughter happens to be pregnant.

My daughter called her obstetrician who told her what I tell my patients. Your husband needs to self-distance and self-quarantine for 14 days. When my daughter said they had been in contact several times since the incident, the obstetrician repeated the original advice. They all went into self-quarantine for 14 days. The grandma nanny visits stopped. I received a frantic phone call that night after my daughter spoke to her OB and supported the advice she had been given.

Living in Dade County they tried to get tested beginning five days after exposure, but the lines were horrible, and supplies ran out while waiting several times. With no symptoms, they did not need the test. The strain of working full-time from home and caring for a toddler was an issue once the grandma’s stopped helping because they were afraid of catching the disease if the kids were exposed. They tried multiple times to negotiate another route or plan with the OB, with me and with their mothers. I finally said, “This is not a negotiation. These are the facts. These are the suggestions of the World Health Organization, the Center for Disease Control and your own doctors.“

On Day 15, the grandmas agreed to return. The neighbor’s child never tested COVID-19 positive nor did the child’s parents.

Missing your loved ones is a terrible price to pay for the unchecked virus. I feel horrible for those in quarantine who miss their loved ones dearly.

However, I cannot give you a “Get Out of Jail Free” card like they have in Monopoly. I cannot tell you that if you are recovering from a lymphoproliferative cancer it is safe to pass through an airport, take a commercial airliner and visit your kids or folks if it really isn’t. I cannot safely tell you after arriving it is fine to not self-quarantine for 14 days before seeing high risk relatives. I cannot tell you the same-day quick COVID-19 test they are performing at the local private walk-in center or your community board is providing is fully accurate when in fact science shows it is not.

I will discuss with you the facts and if asked for an opinion give you an honest opinion based on science and data. I will not negotiate however so please don’t ask me to anymore! As a famous detective said on a famous black and white TV show , “Just the facts.“ is what I will tell you because it is best for you even if it is not what you want to hear.