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Picture of Ayden celebrating his last day of Elementary school.  For those of you that have been around here long enough know that at 2 or 3 years old doctors were telling us that if Ayden survived he

Yesterday we were so.bleseed to celebrate the graduation of my oldest son from college.  He graduated in 3 years,  played baseball and graduated with honors. 3.75 GPA and starts Grad school to become

I am negative for covid. Thanks for the well wishes. Whatever I had kicked my butt worse than any flu I have ever had. But no covid!

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3 hours ago, tdhoosier said:

I can't access the article so I'm not sure how this paragraph was used in context; thus not directing anything at you Reacher or necessarily the article. But I'm finding it strange when people try to pad the blow of increasing cases with the response: "well, we are testing more". No s*** Sherlock! This is the most obvious thing that some (saw multiple people on the news pushing this narrative the last few days) try to make trivial. 

Naturally when cases rise, more people feel symptoms and then more people get tested. So, of course there will be more testing. And even if there were less tests, it doesn't mean that the virus disappears....it just means that cases are spiking and we don't know about it, which doesn't sound like a good thing because it makes it harder to identify clusters and take necessary precautions. Ignorance is not bliss, especially when you are dealing with a highly infectious virus. 

A couple follow on points, more widespread testing will detect more mild and or asymptomatic cases. I hear college kids are getting tested multiple times / week. 

Didn't include this in my earlier post-  the percentage of those tests that are positive, known as the positivity rate, has also been rising, climbing to 5.6% Wednesday from 4.6% about a month ago. That figure is expected to fall as testing expands.

If 90%+ getting tested are negative, many of those must be employees / students being forced to vs those with obvious symptoms.  I'm all for testing and would like to see more widespread antibody testing as well.

Lastly, I'm finally personally seeing / hearing about people getting the virus which I wasn't in the spring. In the last week, heard of two that got it. 1 girl in her 20s. Had no symptoms. Another women in her 40s. Only had a mild cough. 

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14 hours ago, mrflynn03 said:

I honestly feel a bit guilty about how I feel. I'm doing fine financially, but mentally so,so at the moment.

Many more have suffered so much more than I have. Wether it be mental, physical, or monetary.

If I remember right you adopted a cat recently?

How is that going?

I have a very difficult problem of saying no to my wife so we have 2 12 week old kittens creating Havoc!! I held them In the the palm of my hand on day 1 back in June.

They grow so fast.  

There’s the rub, we are also doing well financially. Two sources of income with no interruption. And our immediate families are healthy so far. But that doesn’t mean that we are not just exhausted by the news cycle (COVID and non). There’s also the knowledge that others are fairing so much worse and the unknown future. 
 

My staff, about half of which are younger, are also really struggling. This is just such an uncertain time and many of us have adjusted, but we are heading into a fall/winter where these adjustments might not work. 
 

Otis the cat is doing really well! There for awhile, he was being kind of an a*#hole to our mini dachshund, like attacking her from under the ouch when she walked by, but they are sorting things out. My wife just said today, “He’s like 75% lover and 25% a*#hole now.” 😀

13 hours ago, mrflynn03 said:

My wife would love to foster cats but she would want to keep them all.

December 2018, a few days before Christmas I heard a cat meowing.  Found it cold and wet under my car in the driveway.  So we took it in and took care of it the best we could.  Spent $$$  but it died from MODS in June 2019. It sucked. 

Here are the newbies we have 

 

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Man, I love a tortie cat. We had one named Toffee for many years and she was such a good cat. We had to say goodby to her after 16 year and it was really tough. I thought I would be cool when it ha-pended, but I cried in the vet office. 

8 hours ago, Billingsley99 said:

I was just about to check on you to see if all was ok

Ha, sorry! I was just telling @IUFLA in a PM that my old 2013 MacBook died and I hate visiting message boards on my phone. Everything is good here, thank you for asking. I need to catch up on HSN!

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21 minutes ago, tdhoosier said:

This fake graph was posted months ago. Somebody cleaned it up a little to make it look like a 12 year old didn't create the graphic, but still fake. Nowhere is this data posted in the link supplied or on the CDC website. 

Where did you get this? 

Hmmm. Saw that while scrolling through some news this morning. Couldn't find it again after a quick look. I saw the link below to the NYT. Didn't bother checking further as it seemed credible. Seems @mrflynn03 fell into the same trap. I wonder what the actual data is?

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54 minutes ago, Reacher said:

Hmmm. Saw that while scrolling through some news this morning. Couldn't find it again after a quick look. I saw the link below to the NYT. Didn't bother checking further as it seemed credible. Seems @mrflynn03 fell into the same trap. I wonder what the actual data is?

There's this article from June, but I'm sure data has changed. It actually shows there has been an increase in deaths outside of COVID. As we've spoke about numerous times in the past, COVID doesn't account for all the excessive deaths (above normal this year); per this article it's only 68%. And I'm sure it has changed since then, just don't have time to go find it. 

53 minutes ago, TheWatShot said:

There have been doctored graphs/photoshopped images circulating social media sites for months. It's hard to know what's real anymore. 

It's extremely frustrating. A wonder why nobody can get onto the same page. It's hard. All that I can do is black ball any news source, internet group, etc.  that manufactures or shares blatantly false information and doctors graphs....and hope others do the same. This is not a situation where information is shared out of context; it's flat out lying. Why trust these outlets again? As far as I'm concerned, true colors have already been shown. Their goal is not informing; it's creating chaos and confusion....it's wanting to BE right, not GET IT right. 

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35 minutes ago, Billingsley99 said:

Ayden and my wife both getting tested now. I think its sinus infection for both but to go back to work and school they have to be tested. 

Prayers and good thoughts for both of them...and you...

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1 hour ago, Billingsley99 said:

Ayden and my wife both getting tested now. I think its sinus infection for both but to go back to work and school they have to be tested. 

I pray everything is well for both of them.

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I complained the other day about one of the shows we watch coming back and having covid storylines.  

Well first one was tonight. First 10 minutes were almost unwatchable.  Totally ditched the whole premise of the show. It has got better but they wont leave it alone. 

Saturday was really good for me mentally.  Cool fall weather, and an epic IU football game. From 330 until bedtime life was normal, actually better than normal thanks to our team. 

Just a bit aggravated right now. People need a break, an escape from the real world sometimes.  

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Worthwhile read-

Covid-19: A Swedish care home doctor’s perspective

This is a guest post written by a colleague who works as a care home doctor in a small Swedish town. In other words, he is responsible for the wellbeing of frail elderly people living in care homes. He has treated a lot of patients with covid-19. Since the situation may be different in some other countries, I think it is useful to know before reading the article that in Sweden, people stay in their own homes until they are very close to the end of their lives, and only really get moved to care homes when there is less than a year of expected life left.

The article was published a few days ago in Svenska Dagbladet, one of the big Swedish daily newspapers. It is fantastic, the best thing I’ve read recently, so I asked him if it would be ok for me to translate it to English and post it on this site, in order for it to reach an international audience. He graciously agreed. The article clearly shows the difference between how the general public, and in particular younger people, think about death, and how doctors think about death. Enjoy.

The media reporting about covid-19 exposes the veritable fear of death that exists in our country. It creates a narrative where health care was denied to everyone in care homes, which caused them to die. It is for example claimed that these deaths could have been avoided with oxygen and intravenous fluids.

The perspective of the doctors working in care homes has been left out of the debate, and it has become clear that we need to communicate our work, since there are big misunderstandings among the population. Let me therefore tell you:

After 36 years working in internal medicine in a big hospital clinic, I now since four years back work as a home care doctor, with responsibility for, among other things, four care homes in a small municipality. Up to now, 36 of the patients in my care have been infected with covid.

I had met with all of them earlier, together with their relatives, as part of our annual care planning, where one of the main things we do is to plan what to do in the case of a decline in their health. This avoids meaningless and, for the patient, often tortuous ambulance trips in to hospital. It also avoids unnecessary investigations and treatments that don’t prolong life, but rather contribute to a drawn out and often painful process of dying.

Occasionally, covid-19 infected patients were sent in by me to the hospital, for different reasons. But most commonly a decision had been made, beforehand, that if an infection had been diagnosed with a pulmonary focus, with resulting low oxygen levels and malaise, we wouldn’t send old and frail patients to the hospital. Instead we would focus on giving good symptom reducing treatment in the care home. We wouldn’t give oxygen, which for dying patients shows little benefit compared with morphine and anxiety reducing medications.

I knew the patients well and am convinced that for many of the ones that died, death felt like a relief. Several had already during our care planning meetings told me that they longed for death, even though they showed no sign of underlying depression. Thus, it was not because of orders from above, or a lack of beds in the hospital, that the patients stayed in the care home. They stayed because it was decided, in consultation with the patients and their relatives, that staying was in their best interests.

The benefit of oxygen therapy is perhaps the most important misunderstanding. It is only in a situation where the patient has decreasing oxygen levels in the blood while still being relatively unaffected in terms of symptoms that oxygen therapy theoretically (there are no studies that prove it) possibly can be of benefit even in frail elderly patients, which is why individuals with this particular constellation should be sent to the hospital for oxygen therapy.

Among those whose general condition declines in parallel with their decreasing oxygen levels, oxygen therapy (and ventilator treatment) provide no benefit, something which was experienced in Italy and Spain early during the pandemic, when even frail elderly patients were put on ventilators. Virtually all of them died, after one to three weeks of ventilator treatment, in induced comas, with tubes in their throats, often without any relatives present, in an ICU – a foreign environment with unknown staff. In the care home they would instead have died after one to three days, in their own residence, surrounded by relatives and staff they know well.

Another misunderstanding becomes clear from the many stories in the media of patients who were first denied health care, only to later on be provided it after relatives demanded it, and then to have survived “because of” oxygen therapy. The experience of myself and my colleagues is that when a frail older person gets a covid-19 infection that goes in to their lungs and causes systemic symptoms, then oxygen therapy and ventilator treatment don’t affect the disease course (and there is no scientific evidence to support that they do).

That it is hard to determine the benefit of different treatment options can be illustrated by one of my patients: an almost 100 year old individual, who developed a mild cold and had an inital oxygen saturation of 98% , which is normal. The covid-19 test was positive. After a few days, the patient also developed a cough and shortness of breath, and the oxygen saturation dropped to 81%, which is seriously low. Since the patient had systemic symptoms, a decision was made not to send her to the hospital, in accordance with the reasoning provided above.

The patient improved spontaneously and was declared healthy a few days later. If the patient had been sent in to the hospital and received oxygen therapy, the newspapers and TV would have reported about yet another successful case of a patient who was saved by oxygen therapy (which the care home had “refused” to provide).

What about the fear of death? Both the media and the general public (and sometimes colleagues) seem to think of death as the health care system’s worst enemy, which always needs to be fought in all situations. Sometimes when a patient during a care planning session tells med that she longs for death, the children interrupt and say “don’t talk like that, mum!”

Usually, I will then ask the children, “why not?”. The patient feels that she has accomplished what she wanted to do, and is due to her illness bed bound, can’t any longer read or listen to music due to declining vision and hearing, suffers from chronic pain and loneliness. Is it so strange in that situation to long for death?

I don’t think so, and neither do many of the patients I meet on a daily basis in my work. These are the oldest and sickest patients, and that is why they live in care homes. Why so many younger people, not least journalists and newspaper columnists, don’t understand this, I have no good explanation for.

Personally, I am convinced that the best thing for many people at the end of life is not infrequently to let the disease take its natural course, and focus efforts on relieving symptoms. I have never met anything other than the greatest gratitude from patients and relatives when I have helped seriously sick and suffering patients, by removing anxiety, pain, and shortness of breath with the help of medications, so that they can pass on calmly.

With that said, we of course have to look at things that haven’t worked so well when it comes to elder care, in order to become better. For example, decisions about palliative care shouldn’t be taken without personal knowledge of and examination of the patient, and the decision should be made together with the patient and relatives.

Eric Bertholds
Home care physician in Tibro

Personally, I was moved by this article. I think it shows perfectly the huge disconnect in thinking that often exists between the medical profession and the general public, and that is why I thought it would be worth sharing.

In the Emergency Room, I often seen very old, very frail people, who have been sent in inappropriately from care homes. Instead of being in a familiar environment, surrounded by their own things and people they know, they lie in a crowded emergency room for several hours, on an uncomfortable hospital gurney, surrounded by unfamiliar people, while suffering painful needle jabs. Very rarely do they gain any benefit from the experience.

You might also be interested in reading about my experiences from working as an emergency physician during the covid pandemic, or be interested in reading my article about deprescribing, possibly the most important health intervention there is when it comes to the health of frail older people.

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As much of the country surges, Louisiana is not.  Interesting because they got hit hard in the initial April surge and were hit especially hard in the July/August surge. Yet, now, in the October surge, their number of cases and deaths is remaining steady. 

Now, does it mean anything?  Maybe, maybe not.  But worth keeping an eye on.

https://www.worldometers.info/coronavirus/usa/louisiana/

 

 

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4 minutes ago, 5fouls said:

As much of the country surges, Louisiana is not.  Interesting because they got hit hard in the initial April surge and were hit especially hard in the July/August surge. Yet, now, in the October surge, their number of cases and deaths is remaining steady. 

Now, does it mean anything?  Maybe, maybe not.  But worth keeping an eye on.

https://www.worldometers.info/coronavirus/usa/louisiana/

 

 

Well they are getting hit hard by hurricanes so maybe they are getting a break from the virus

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29 minutes ago, 5fouls said:

As much of the country surges, Louisiana is not.  Interesting because they got hit hard in the initial April surge and were hit especially hard in the July/August surge. Yet, now, in the October surge, their number of cases and deaths is remaining steady. 

Now, does it mean anything?  Maybe, maybe not.  But worth keeping an eye on.

https://www.worldometers.info/coronavirus/usa/louisiana/

 

 

I have no distinct evidence to support this, but my thinking is that there's only one way to mitigate spread until a vaccine comes along and that's human behavior. And nothing changes your behavior like a good scare. 

 

 

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Went into my Manhattan office today to do a few things and it was the first time I’ve been on the subway since March 13th. I waited until rush hour was over and headed out about 10am to the sub. Subways were pretty quiet and not too crowded. Pretty much everyone was wearing masks. At one point a couple wearing chinstraps got on and sat down right across from me. I got up and moved away from them and luckily the trains were quiet enough to get your own space. 

On the way home there was a big group of maskless people (chinstrappers) hanging out on the platform. You had to walk around them to get through. I would have mentioned it to the cops, but the group of chinstrappers were NYPD. They seem to get off on flouting the mask rules and I’ve seen people confront them, but it never really ends well. 

Overall, it wasn’t too bad and I enjoyed being in my office again. If the low rates hold here, I might start going in a day a week - still avoiding rush hours. 

One thing that struck me was the number of places near my office that were out of business. Places that relied on catering or morning/lunch rush were definitely hit the hardest. Many more For Lease signs in Manhattan than our neighborhood - it was shocking. All of those closures represent real people losing their jobs - the delivery people especially already had such hard jobs and now even those are gone. 2020 just blows. 

 

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