From My Frontal Lobe @drjeff - Tumblr Blog

So You Think You Have COVID-19?

There is plenty of anxiety. And many patients have made appointments with a request to be tested. But the answers they have been getting are confusing and often frustrating as well. What should you do if you think you have COVID-19 (the disease caused by the novel coronavirus aka SARS-CoV-2)?

The first step is figuring out if you need to go to the emergency department. If you are feeling short of breath and/or having trouble breathing, this is definitely an indication (or a reason) to go to your nearest emergency department for evaluation. Having low oxygen saturation (or hypoxia) may necessitate supplemental oxygen usually being provided by a nasal cannula.

The second step is to call your primary physician and check with your county’s Department of Public Health. These two resources should help you understand the testing capabilities of your locale and unfortunately this will be a big determinant of who can get tested if they are not “sick enough” to require hospitalization.

Many of my visits have involved advising patients about the realities of our situation and lack of adequate testing. I have had to advise patients that have symptoms that they ought to stay at home and assume they have COVID-19 and self quarantine at home. The reasoning for this is that we assume many people who have COVID-19 will be in the spectrum from asymptomatic to mild/moderate disease that does not require admission to the hospital. If people who are well enough NOT to require a hospital admission, then the information obtained from testing will not change the treatment (self quarantining and treating the symptoms).

What symptoms should one look out for? That question is tricky. As we learn more about the disease we are seeing more and more symptoms that can be caused by COVID-19. For example, early on we advised patients to be on the lookout for a new cough, fever, or shortness of breath. However there have been reports of other symptoms including diarrhea, loss of taste/smell, etc. As this is changing, I would recommend the following sources:

CDC – https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

WHO – https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

*This post is for informational purposes only. As advised above, please contact your primary care physician if you believe you have COVID19.

#covid #covid19 #pandemic #medblr #medtumblr #cdc #who #coronavirus

Yeah, I just did reblog myself...

drjeff

I’m Baaack

This week I returned to work after needed to stay off and isolated for the last week. While I didn’t come to work, I wouldn’t consider it a vacation. My days were filled with taking care of the toddler (3 year old) while my wife worked from home. In one word, it was exhausting.

As far as recovering goes, I noticed improvement almost each day in terms of the severity of my cough. I was coughing less frequently each day. I never developed a fever. I also never developed any shortness of breath or difficulty breathing.

And so, here I am, back at work.

Stay safe and healthy, everyone.

drjeff

To be clear, I had a cough. I don’t know if I had COVID19. I did not get tested. My time off was to protect those around me in case I did actually have COVID19.

I’m Baaack

And so, here I am, back at work.

Stay safe and healthy, everyone.

#medblr #medtumblr #covid #covid19 #coronavirus #doctor #physician

I’ve been relatively insulated thus far. Though I have been seeing patients, most of my encounters are video or telephone.

Tomorrow my little sister starts her month rotation in ED. (She’s a family medicine resident).

Now I’ll be paranoid for her.

#covid19 #pandemic #medblr #medtumblr #medicine #doctor #physician

harritudur

i just discovered this wilkinson sword ad, and it is basically #myaesthetic 😘

versatilememes

I’m too bi for this ad

cipheramnesia

bi-swordsual

saint-batrick

are…are they gonna bone down on that glass covered bed?

flaming-fruitcake-deactivated20

Honestly I’m glad I wasn’t the only one concerned about the glass.

lastchancefancy

Swordplay is foreplay

shoelace-and-friends

…Swords have ads?????

aqueerkettleofish

Wilkinson Sword is a razor company. But… damn…. damn…. whoah….

@hypno-sandwich

A-HEM!

Oh hey it came back.

Omg

I suppose thats a good reason for martial arts training...

I have crossed the 7 day threshold.

I “get” to go back to work on Monday.

Paid Leave

I have seen that a few companies are offering paid leave if their workers test positive for COVID19. In theory this is great. In reality, this is bogus.

Policies are worded very specifically. Most of the statements I have seen that list paid leave are for patients that TEST positive for COVID19.

The problem is we do not have enough tests!

At my practice (a large, tertiary, University-based clinic in Southern California), we are operating under the assumption that most people who contract COVID19 will have a mild form of the disease that will not require a hospital admission. However, they will need to be off work for the duration to limit the spread and prevent a high-risk patient from contracting it and needing a hospital stay.

So the majority of my patients who develop fever and cough (in cold/flu season) are told to stay off work and to act/behave as if they have COVID19 but they do not have a confirmed positive test to support the diagnosis.

Are these people going to be able to claim benefits? I don’t know the answer to this. But if not, it will be a huge disincentive for people to follow recommendations and stay home when sick.

#covid19 #pandemic #medblr #medtumblr #physician #doctor #internal medicine #primary care

Hello, I would like to know how your system is dealing with medical students who are still in the pre-clinical phase ? Are they having online courses ? How about the on-field training ? Im sorry to ask in such a blunt way but I live in a third world country and would like to know how developped countries are dealing with this issue. Thank you !

I heard that the 1st and 2nd year medical students are doing online courses. I am not sure what the 3rd and 4th year medical students are doing at this time.

The LCME, the national accrediting body for medical schools in the US, issued guidance on this: https://www.medscape.com/viewarticle/927614

Most of what I am hearing right now is hearsay since I am no longer officially part of our clerkship.

Waiting

I’ve been watching and waiting each day. I’ve been following the advice I give to my patients who had cough or fever and otherwise were healthy enough to stay at home.

Last night I felt warm. I got up and checked my temperature and it read 100.3. I froze. I did it two more times but the subsequent temperatures were 99 or less. I breathed a sigh of relief. My wife (RN) took my temperature too and I didn’t have a fever.

There was a slight moment of panic, I’ll admit, when I looked at the 100.3. I’m 5 days from when I first noticed the cough. I thought everything was improving each day since then.

This morning I haven’t had much of a cough at all. I had a normal temperature as well.

Will continue to watch and wait.

#coronavirus #covid19 #medblr #medtumblr #doctor #physician #quarantine #lockdown #isolation

Banned From Work

This week has started off oddly. I am at home. I am not on vacation. I wish I were. Instead, I am at home in a sort of self-quarantine.

Last week, as I was getting ready to go to work I noticed that I was coughing. Initially I thought that I was had a tickle in my throat and that I just needed to clear it. But the cough persisted.

At our institution our outpatient faculty clinics had already instituted a strict screening policy. All visitors to the building were funneled to the main entrance. There, two people screen any person entering regardless of whether they are visitor or employee.

The questions each day were the same. Have you had a new fever? Have you had a new cough? Any shortness of breath? Any contact with known COVID19 patient? If all questions were answered with a negative, they would hand you a sticker that said “Cleared” and a face mask.

I knew that I would fail the screening. I also knew we had a shortage of tests. I would not be eligible for testing. And, the institutional policy for returning to work with new symptoms would require me to wait a minimum of 7 days.

So here I am. At home. Avoiding contact not only with patients but with my co-workers. I understand the reason for the policy. With the pandemic we must do everything we can to minimize spread of this COVID-19 disease.

Each day I have checked my temperature. Each day I have not had a fever. My cough has improved each day. And on National Doctor’s Day, while this pandemic rages, and my healthcare colleagues continue the fight, I sit and I wait.

#medblr #medtumblr #doctor #physician #covid19 #quarantine #nationaldoctorday #nationaldoctorsday

Cross posting today some things I posted to my JeffreyMD.com blog.

Will likely continue cross-posting.

Rationing Tests?

Rationing tests? In the U.S.A.? It may sound strange to hear that in the land of plenty we are rationing tests. But here we are, ill prepared for a global pandemic.

One of the most difficult things to say to patients who are having symptoms of cough and/or fever during this pandemic is that they need to stay home and act as if they had COVID-19. Testing, for the most part, is being reserved for the patients sick enough to require a hospital admission. I don't think it helps that many people keep seeing things in the news touting how people can get tested without fully explaining the limitations we have. Or maybe my region of the country is the abnormality?

Ideally we could swab anyone who had symptoms. But since we cannot, maybe this will help:

With a limited supply of testing supplies, we should only test those in which testing will change the management or treatment.

It is accepted that there is a spectrum of presentation of COVID-19. Some patients may have zero symptoms. Some patients may have mild symptoms. Some patients will need extra support that requires treatment in a hospital (like supplemental oxygen, mechanical ventilation, etc.)

If patients are stable enough that they are breathing comfortably, they should stay home and act like they have COVID-19. They should treat symptoms and self quarantine to avoid spreading it others who might develop more severe disease.

Patients who have symptoms that include shortness of breath or trouble breathing should go to the Emergency Department to be evaluated. They may be hypoxic (have low oxygen saturation) and need additional support. These patients who are sick enough that they require care in a hospital should be tested.

Again, it isn't a perfect system. We don't have an infinite number of testing kits/supplies. We don't even have enough test everyone we suspect of having COVID-19. But this is why testing is being limited.

Needless to say, this post is not intended to be medical advice. If you have questions about your particular case, please contact your primary care physician.

#covid19 #pandemic #isolation #medicine #doctor #physician #medtumblr #medblr

Pandemic!

It is painful to watch the amount of distrust or disbelief amongst the public – even among those who are in healthcare. Last week I saw an article about young people still going on about their usual life, not willing to put things on hold. One of the people interviewed was a nurse.

I saw another article from this week that beaches remain open in Florida for spring break. Parties were just told that they must keep their groups to 10 or less. However, the article also showed a picture taken on a Florida beach in Clearwater that showed apretty crowded situations (the picture was taken on 3/27/2020).

Sometimes I just want to face palm.

#covid19 #medicine #physician #quarantine #social distancing

I tumble less

I tumble less now that in the past.

But I am not more coordinated or put together.

I just have found my life to be a busy mess.

fullhalalalchemist

🚨🚨🚨

today is Nov. 15. the FCC, under chairman Ajit Pai, will not listen to the public despite millions of comments in support of net neutrality. They are going to try their hardest to kill net neutrality, which in turn will kill the internet, which in turn will help eradicate democracy. it won’t just affect Americans, it has the potential to affect the entire internet, something we ALL use daily. you can bet your ass other countries will see america doing this, and use it as an excuse to do it in their own countries.

this is what buying a plan without net neutrality looks like there:

you have to pay MORE for features you’re already guaranteed to have under net neutrality. and in america, you already know how expensive everything is.

democrats AND republicans both want net neutrality. advocacy groups in touch with congress have said that if your members of congress receive calls from you, they are more encouraged and more likely to take action to stop Pai’s plan to gut net neutrality. after Nov. 22, it will be MUCH HARDER to convince your member of congress.

please, call them. call them daily.

https://www.battleforthenet.com/

fullhalalalchemist

hey guys, please reblog this version and don’t forget to call!!! if you are nervous about calling, you can use resistbot to send faxes to your reps and the stance app to pre-record your message so you won’t have to speak to anyone. (available in both google play and app store)

unexpectedyarns

CALL

On Writing

There was a time when I thought the idea of earning a living by writing was absolutely magical.

I remember when writing (whether here on tumblr, or JeffreyMD.com, or for Medscape) was cathartic. It allowed me to process the raw emotions of the roller coaster that was medical school. It was truly a therapeutic release.

But these days, my writing is mostly done in patient charts in the form of progress notes documenting my patient encounters. I write about how the patient is feeling overall in short fragmented bullets. I write more detailed assessments and plans. And I thoroughly detail tough discussions with patients and/or family members -- especially when there is disagreement. These days, the writing I do is forced. It is borne out of the necessity of my job -- in order to support my billing and cover my butt.

In the still, quiet moments when my mind begins to wander, I remember thinking about what it would like seeing a novel on display at the local bookstore. I once thought I could prolifically write novel after novel, best-seller after best-seller.

These aspirations, if I may call them that, linger still. Though, these days, the pull is much weaker. I find myself struggling with words. Years of training myself to document precisely and concisely have not served as good practice for the creative word-smithing side of my brain. When I sit down to write something non-medical, I have to fight the urge to write in bullet point. Perhaps that’s just how I think nowadays.

I should continue practicing.

I’ll continue trying to flex that creative side of my brain.

Maybe one day, I’ll smile as I walk into Barnes & Nobles and notice my debut novel on display.

But for now, forgive this verbal vomit and thought diarrhea of mine.

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