Tag: pandemic

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“We’re running low.”

Last week while on service in the hospital, one of the respiratory therapists said: “We are out of High flow nasal cannulas.” This struck fear in my heart. Let me explain what that means and why this is so terrifying. For me, for you, for everyone you know.

In the past 3 weeks, COVID19 admissions in my hospital have risen, and the majority of those patients requiring oxygen, and sometimes intubation, have been between 30-50 years old. For my followers, that’s probably you.

The equipment in which we use to support a person’s oxygenation range from nasal cannula (#1 on the graphic) to intubation (#6). You want to try to avoid #6 at all costs because there are, more often than not, long-term consequences to having a tube placed down your airway for even a few days. And we want to avoid the risk that the tube will never come out at all.

In the graphic, notice that HFNC (high flow nasal cannula) is #4. That means that, because supplies are running low or are out altogether, we are losing one of the most important intermediary steps to supporting patients who cannot breathe without oxygen support. In sum, you are one step closer to intubation and death from COVID-19 without the intermediary step of HFNC.

My hospital has since replenished our stores, but we are still running low. The whole country is running low because we have so many Covid19 patients that are using them. And if infections keep rising at this rate, we may not have one for you or your loved one when you/they are hospitalized, whether with COVID-19 or another illness. This, to someone who wants to be able to save you, is terrifying.

But don’t panic. There is a solution. Save the high flow nasal cannulas. Save your body from being intubated. Wear a mask. Wash your hands. Socially distance!

Thanks for listening and I hope you stay safe and healthy.

Love, Dr. Yang

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“Medicine is not a job, it is a calling.”

The other day, I was interviewed by the U.S. News and World report regarding why someone would make the financial decision to become a physician. My best answer was: “You don’t go into medicine to become rich, or famous, and definitely not to be well-rested. You go into medicine because it is a calling.”

12 years ago, I left my law practice to start the long, arduous journey of becoming a physician. Making the decision to leave law (a lucrative path at that!) to pursue medicine was an incredibly difficult one. If I had continued as an IP lawyer, I would be able to retire in the next 5 years, and enjoy a very comfortable retirement. But I would’ve lived only for my own comfort and the accumulation of wealth. But now, I am the person that is there for people on the worst day of their lives, and to me, there is nothing more meaningful.

If you start working as a plumber at 18yo, you will save more for retirement than if you become a doctor. With 12+ years of training, 8 of which you are paying into the system, and another 4+ of residency where you are barely paid enough to cover rent, the numbers don’t add up for doctors. But rationality has little to do with the decision to go into medicine. We make this decision because medicine is a calling. Because you can’t imagine doing anything else other than caring for those who are suffering. Because you have been so close to the human condition that you just want to alleviate other’s suffering. And any other life than that would be unsatisfactory.

I sometimes joke around that if I had stayed in law, I could be relaxing on my yacht on weekends, rather than working extra moonlighting shifts to pay down a mountain of loans. But life isn’t about dying with the most money, it’s about living in alignment with your values with the most meaning. There is a saying: “You may love medicine, but medicine will never love you back.” Whether or not medicine loves me back doesn’t matter to me. Medicine has taught me so much about being a compassionate, selfless, giving, empathetic human. And in that vein, medicine has given me so much than I will ever give to it.

Yes, it’s hard. Yes, it lends meaning to life. Yes, it’s worth it.

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Keep your pulmonary system healthy with this technique of diaphragmatic breathing

Did you know that we have pulmonary vagal irritant receptors? Irritant receptors lie between airway epithelial cells and are stimulated by noxious gases, cold, and inhaled dusts. Once activated, they send action potentials via the vagus nerve leading to bronchoconstriction (which can lead to cough) and increased respiratory rate. When stretched, these receptors also increase production of pulmonary surfactant, which allows our alveoli in the lungs to be more flexible and compliant. Our treatment, when these irritant receptors are activated is supplemental oxygen and airway clearance. You can do this yourself! Just take a long, deep, deliberate breath – right now! That brings in more oxygen into your lungs (supplemental oxygen), and helps to clear your airway with the prolonged exhalation.

Keep your pulmonary system healthy, avoid cough, and your vagus nerve toned during these times in the pandemic with this technique of slow, diaphragmatic breathing. Keeping the pulmonary vagal irritant receptors inactivated and at rest!

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We are in this together – COVID-19

 

*The beaches are closed. The parks are closed. But our hearts must stay open.*

 

Today, the US now has more confirmed COVID-19 cases than any other nation. That is over 82,000 confirmed infections across the country. And this is despite having performed a paucity of testing. Without question, there are tens of thousands (if not, hundreds of thousands) more cases that were not reported simply because we were not prepared to test this many people.

 

Slowly, each state is enacting Stay Home orders… But I am so fearful we have done too little, too late. Each day’s delay in stopping human contact creates more hot spots, none of which can be identified until about a week or two later, when the people infected start falling ill. The weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy and our lives to restart.  The death toll in the U.S. has quadrupled over the last week and I am devastated. And this will only get worse from here. Please, let’s do your part in slowing this virus down. Taking what feels like extreme actions now will allow us to have a quicker recovery when this crisis is over.

 

We are one day shy of a week into our compulsory stay at home order in California. The beaches are closed. The parks are closed. But our hearts must stay open. We are all in this together.

 

I know this has been hard – on all of us. I talk a lot about how connection is what defines us as humans. And this severing of physical connection has worn us all down. But I ask you to stay strong. Start to enjoy your alone time, because soon enough, it will be busy again. Spend this time reflecting on your life, your goals, the connections you want to continue to cultivate in life. The ones that are meaningful to you. This is a novel virus, and also a novel time. Enjoy the novelty of your solitude and time for reflection. Embrace it – you never know how long it will last; and if it is like anything else in life, it will be fleeting.

 

“When ‘I’ is replaced with ‘we,’ even illness becomes wellness.” – Malcolm X

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The importance of stretching

Getting antsy during your self-isolation? It’s time to roll out the yoga mat that you bought at Target 8 years ago! (that may or may not still be in its original wrapping)…  During this period of isolation, this is your chance reconnect with the physical and mental exercise that for thousands of years have hooked yoga practitioners around the world. Stretching is essential because it helps maintain flexibility. And if anyone of us need anything right now to stay sane, its flexibility in our bodies and our minds. The Mayo Clinic recommends that stretch at least two to three times a week. And you should hold each stretch for 30 seconds for most areas and up to 60 seconds for sore or problem areas. The beauty of yoga, specifically, is that it stretches the body, the mind, and the heart. I think we all need to open our hearts in this moment and make them bigger. We all could make space in our hearts for those that are suffering. Whether you are young or old, overweight or fit, yoga has the power to calm the mind and strengthen the body. Yoga really is for everyone. So in this time of self-isolation, find some space to connect back with yourself through yoga. Maybe find more space and openness if your heart for love. And send it out there. Love, great love. The world is indeed full of peril, and in it there are many dark places; but still there is much that is fair, and though in all lands love is now mingled with grief, [love] grows perhaps the greater.” ― J.R.R. Tolkien

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Community in Immunity – go for that run!

Community in Immunity.

Just a reminder to keep up your immunity up by exercising and eating right. I made myself a green juice with lots of ginger. Whether or not ginger actually boosts my immune system, it made me happy. And there’s plenty of scientific evidence that the happier you are, the more robust your immune system. So, do what makes you happy. Go outside. Get some exercise. You can take care of yourself in COVID-19 isolation.

Trying to preserve some sense of normalcy is really important for your wellbeing. Maintaining a routine like getting up and getting dressed, can positively affect mental health. *And good mental health promotes good physical health.*  For me, exercise is my catharsis in times of stress. Every little bit of movement counts, so even when confined to our homes, the key is to move. The American Heart Association recommends adults engage in at least 150 minutes (2.5 hours) per week of moderate-intensity aerobic activity, or 75 min/week of vigorous activity. So, next time you watch TV, do some squats during the commercials. Heel raises when you’re washing dishes. Lunges when you’re doing laundry. Knock out some push-ups when you’re waiting for water to boil. Dancing is also a great way to move your body. Turn on some music and boogie with your partner or kids.

A good rule to follow is to make sure you get your heart rate up, multiple times a day. Stairs can be your cardiovascular best friend and if you have access to stairs in your home or apartment, going up and down those stairs is a great way to get your blood pumping.

We are following shelter in place orders here in California, but you can still go for a walk or run if you stay close to home, as long as you’re able to maintain a reasonable amount of distance and you’re being good about hand hygiene. What counts is that you’re moving your body.

So get up. Go for that run. Do some squats. And stay strong for our community in immunity! I’ll be back tomorrow with some yoga stretches and exercises to keep that immune system strong!

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National Doctor’s Day

It’s March 30, 2020, and it’s national doctor’s day. But this year is unlike any other. It has been trying times recently for physicians. Even before the pandemic, burnout was 46% and the physician suicide rate is the highest of any profession. Physicians have been frustrated trying to shuffle paperwork, and serve hospital systems and insurance companies when all we really want to do is take care of patients.

Now our situation has shifted. In a pandemic, we no longer have time to worry about our failing American health system—we have to act. And physicians everywhere are acting. They are stepping up to take care of the surges of people with COVID-19 in our communities.

As a hospitalist on this Doctor’s Day, I start a string of shifts caring for patients infected with COVID-19. Every physician I know caring for COVID-19 patients is experiencing higher levels of stress ever (and we know stress). But we also feel more alone than ever as we distance ourselves from our families, friends and colleagues in order to protect them.

What can you do to support physicians for Doctor’s Day 2020?
1. Just reach out and connect. It means so much to us to hear from you, and to remember we are working for YOU.
2. Donate PPE if you have any. We can’t take care of you if we are ill ourselves.
3. Stay home. PLEASE. I am literally begging. The chant “We go to work for you. Please stay home for us” are just as much for as it is for us. There are only so many beds. Don’t make us choose who gets them.
4. Remember all of this when it’s over. Because this will end… and after the pandemic has subsided, please remember that physicians were there. Despite personal anxiety and concerns for our own safety and our families, we keep showing up to take care of you. So sometimes we have bad days too. We, like you, are human, and we’re doing our very best.
As for me, I will approach Doctor’s Day more seriously than ever. Some of my colleagues have died from COVID-19, and we will lose more before we’re through. I will continue to use Doctor’s Day as a time to reflect on my place in this calling. I hope we all remember—not just on Doctor’s Day—the sacrifices physicians make. . . . .

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Be a hero today.

“History will not forgive us for waiting an hour more,” said San Jose Mayor Sam Liccardo. “This is our generation’s great test, our moment to stand tougher as a community. Amid our collective fears, we will find our uncommon courage.” This past week that I have been working in the hospital, friends and followers have applauded me for putting myself at risk to help the sick and frail. But you can be a hero, too. Even if you are too selfish to self-isolate for the elderly and immuno-compromised, then be selfish enough to do so for yourself, because young people get severely ill with COVID-19 and they die from this virus as well. I get it. This is hard. I hope no one in your family, or no one you know, dies because of this. Because that’s what we’re trying to accomplish. Minimizing needless deaths.

Part of the reason this is scary is because so many people are dying, and there are so many unknowns for this disease. We are still finding out the characteristics but what we know is that this virus likely lives on surfaces for 2-3 days. It loves banisters, bar tops, tables, chairs, etc. We know that it is susceptible to drying out, UV bleach, detergent and disinfectants. And if it lives for 2-3 days, that means it can die off in 2-3 days. Every virus needs a host, so don’t be it’s host!

If you have been self-isolating, I am here to applaud you. You don’t have to be a nurse or doctor on the front lines to be a hero. You, too, can save someone’s life today by staying away from public places. Wash your hands. Disinfect. Stay in. Self-isolate. Today, save someone’s life. Be their hero.

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I stayed at work for you, will you stay at home for us?

9 years ago, I recited the Hippocratic Oath, and two sections have always stuck with me:

“Into whatsoever houses I enter, I will enter to help the sick” and “I will respect the hard-won scientific gains of those physicians in whose steps I walk.”

 

The events over the last couple of weeks have affected me deeply.  Of course, I’m concerned about a novel virus that killing patients.  But, I’ve been more distraught over the reaction of the people, the response of the state and federal governments, the blatant disregard of science/epidemiology, and the warnings of physicians in other countries on the front lines.

Most of us will get this virus and be OK.  But slowing it down is 100 percent vital. Why? Because our health care system has limited resources. We only have so many hospital beds in this country and, only 62,000 ventilators. If the forecasted numbers of infected Americans reach the projected numbers, we will have no choice but to ration those resources. This means a physician will forced to choose who gets a chance to live and who does not. This is the reality in other countries right now.

I was lucky enough to have trained at a wonderful hospital, loved my ICU months as a resident, and learned from the best critical care doctors out there.  I will enter this fight with guns blazing.  But, I will do so with a heavy heart, because it will be because people didn’t want to change their routines. I will risk my health, life, and family because people didn’t want to be inconvenienced to cancel their play dates, parties, weddings, bar hopping, travel, date nights, workouts … the list goes on.

Last night, Gov Newsom finally announced a shelter in place in California. Stay home, I entreat you, America. For the sake of us all. Even if your state is not restricting your movement, please stay home. This is not for the long term.  This is not an infringement on your rights.  This is a pandemic, plain and simple. This is an international crisis. This is a moment in humanity that we are all in together. Will you rise to the occasion?

I stayed at work for you, will you stay at home for us?

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#covid19 #medicaldoctor #covid19medicalopinion #doctor #physician #washyourhands #socialdistancing #pandemic #askadoctor

 

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COVID-19

I think it’s about time that I weigh in on COVID-19. I apologize for being MIA on this matter – I have been on the front lines in the hospital this week, admitting and caring for patients. First and foremost: Yes, this is serious. Should you panic? Absolutely not. Should you follow some sensible guidelines? Please do. Up until now, Americans have not been taking this pandemic seriously enough. We cannot be so arrogant and cavalier as to believe that we are above becoming infected with COVID-19 like the rest of human civilization in other countries. Let’s be serious and respectful. Gathering in groups is selfish and reckless during this pandemic. It will speed up the spread of the virus, increasing the suffering for older and vulnerable people and for the medical workers caring for them.

The best way to protect yourself and others remains common-sense guidelines including hand-washing and “social distancing” (ex: work from home). For those who are 60+ and with comorbid diseases, take extra precautions, including avoiding crowds and nonessential travel. And then follow these remaining rules:

*Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
*Avoid touching your eyes, nose and mouth with unwashed hands.
*Avoid close contact with people, generally, and those especially who are sick.
*The average incubation is 5 days, so you could be asymptomatic and still spreading the virus. This is, again, why it is imperative that we social distance at this time.
*Stay home when you are sick, especially if experiencing a fever or respiratory symptoms.
*Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Follow by washing your hands.
*Clean and disinfect frequently touched objects and surfaces.

I’ll be in the hospital this next week…. We are on the front lines, setting up fever tents and bracing for the fall. Stay updated on my Story. See you soon and stay safe