COVID-19 Vaccine FACT CHECK

As a healthcare provider I am very fortunate to have already received the COVID-19 vaccine. My decision to vaccinate was make carefully after reading extensively about the vaccine’s development and preliminary published data. I’ve received many questions about the vaccine in the office and in my inbox. I hope the information below is a helpful summary.

What is an mRNA Vaccine?

From the CDC: mRNA vaccines are a new type of vaccine to protect against infectious diseases. Instead of injecting a weakened or inactivated germ into the body, the mRNA vaccine teaches our cells how to make a protein that triggers an immune response. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies.

The COVID-19 mRNA vaccines give instructions for our cells to make a piece of what is called the “spike protein.” The spike protein is found on the surface of the virus that causes COVID-19.

The COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions (mRNA) are inside the immune cells, the cells use them to make the protein piece. After the protein piece is made, the cell breaks down the instructions and gets rid of them.

Next, the cell displays the protein piece on its surface. Our immune systems recognize that the protein doesn’t belong there and begin building an immune response and making antibodies, like what happens in natural infection against COVID-19.

At the end of the process, our bodies have learned how to protect against future infection. The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain this protection without ever having to risk the serious consequences of getting sick with COVID-19.

Facts about COVID-19 mRNA Vaccines

mRNA vaccines do not use the live virus that causes COVID-19. They cannot give someone COVID-19.

mRNA vaccines do not affect or interact with our DNA in any way. The mRNA never enters the nucleus of the cell, which is where our DNA (genetic material) is kept. The cell breaks down and gets rid of the mRNA soon after it is finished using the instructions.

COVID-19 mRNA Vaccines Will Be Rigorously Evaluated for Safety

mRNA vaccines have been held to the same rigorous safety and effectiveness standards as all other types of vaccines in the United States. The only COVID-19 vaccines the Food and Drug Administration (FDA) will make available for use in the United States (by approval or emergency use authorization) are those that meet these standards.

The emergency use authorization (EUA) for COVID-19 vaccines expedites access of the vaccine to the public, but the FDA still requires safety and efficacy data in line with what is needed for eventual approval. The bar for vaccine EUAs is higher than the one set for COVID-19 treatments.

mRNA Vaccines Are New, But Not Unknown

Researchers have been studying and working with mRNA vaccines for decades. Interest has grown in these vaccines because they can be developed in a laboratory using readily available materials. This means the process can be standardized and scaled up, making vaccine development faster than traditional methods of making vaccines.

mRNA vaccines have been studied before for influenza, Zika, rabies, and cytomegalovirus (CMV). As soon as the necessary information about the virus that causes COVID-19 was available, scientists began designing the mRNA instructions for cells to build the unique spike protein into an mRNA vaccine.

Vaccine Efficacy

Early data suggest the Pfizer-BioNTech or Moderna vaccine has roughly 95% efficacy against COVID-19 after 2 doses of the same product separated by 21 or 28 days. Pfizer-BioNTech data over about 2 months showed 162 symptomatic, confirmed COVID-19 cases in the placebo group versus 8 in the vaccinated group. More than 43,000 people age 16 and up participated in the trial. After broader use nationally, we will learn more about real-world effectiveness including how long immunity lasts.

Vaccine Side Effects

Common reactions to the vaccine include injection site pain and flu-like symptoms (fatigue, aches, etc.) Symptoms were seen more frequently after the second dose. They should go away in a couple days and can be signs the immune system is working.

A small number of people have experienced significant allergic reactions with the COVID-19 vaccines. So far, according to reports, about 11 severe allergic reactions — representing about one in 190,000 doses administered — have been noted.

It is important to keep side effects from the vaccine in perspective. In Indiana, the I.U.P.U.I. Fairbanks School of Public Health calculates that for people 60 years and older who were not living in jails or nursing homes, Covid-19 killed about one in 58 of those infected. For people between the ages of 40 and 59, it was about one in 833, and for people younger than 40 it was about one in 10,000. For those who were not white, the fatality rate was more than three times that for whites.

Is the vaccine safe for people with autoimmune disease?

The vaccine was authorized to prevent COVID-19 in people age 16 and older. People with autoimmune conditions or who are immunocompromised are not excluded from getting the vaccine, but they are part of certain groups that require extra consideration.

Talk to your healthcare provider about all of your medical conditions, including if you:

• have any allergies

• have a fever

• have a bleeding disorder or are on a blood thinner

• are immunocompromised or are on a medicine that affects your immune system

• are pregnant or plan to become pregnant

• are breastfeeding

• have received another COVID-19 vaccine

If you are immunocompromised or have an autoimmune disease, you and your doctor can decide together whether getting the vaccine now is right for you.

In a press release, the American College of Allergy, Asthma, and Immunology said the “Pfizer-BioNTech COVID-19 vaccine is not a live vaccine and it can be administered to immunocompromised patients. Physicians and other providers should inform such immunocompromised patients of the possibility of a diminished immune response to the vaccine. We do not know at this time if people with a weakened immune system will respond to the vaccine and be protected from COVID-19.”

The Basics are still important

It’s important for everyone to continue using all the tools available to help stop this pandemic as we learn more about how COVID-19 vaccines work in real-world conditions. Cover your mouth and nose with a mask when around others, stay at least 6 feet away from others, avoid crowds, and wash your hands often… even after vaccination.

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 Reference:

1. Understanding mRNA COVID-19 Vaccines, Centers for Disease Control and Prevention, Accessed 12/30/2020.

2. Pharmacist Letter Therapeutic Research, Share Answers About mRNA COVID-19 Vaccines. Posted 12/21/2020. Accessed 12/30/20.

3. Centers for Disease Control Recommendations for underlying conditions. Accessed 12/30/2020.

4. American College of Allergy, Asthma, and Immunology Releases Guidance on Risk of Allergic Reactions to the Pfizer-BioNTech COVID-19 Vaccine Posted 12/14/2020. Accessed 12/30/2020.

5. 8 Things to Know about the U.S. COVID-19 Vaccination Program Centers for Disease Control and Prevention. Accessed 12/30/2020.

6. Carroll, Aaron. (2020). ‘The Risks of the Covid Vaccine in Context.’ The New York Times. Dec. 30, 2020.

How to manage skin irritation from masks and hand washing

Winter weather is often associated with dry, chapped skin. The increased frequency of hand washing and use of personal protective equipment (PPE) during this pandemic adds additional challenges to our skin’s health this time of year. Consider some of these strategies to sooth and protect your skin:

General prevention strategies to minimize skin irritation

• Keep skin clean and well hydrated. (The Environmental Working Group has a wonderful app that can be used to find safe and green products.)

• Keep showers or baths short, limiting to about five to ten minutes, using warm NOT hot water, and using mild soaps.

• Avoid coming into direct contact with chemicals that are used for surface disinfection. For example, wear gloves when using disinfecting surface wipes or cleaning solutions.

• Wear gloves when coming into contact with water for purposes other than to wash your hands (e.g., washing dishes, washing a child’s hair, using cleaning products) to help keep the skin barrier intact. Consider wearing a cotton liner under your gloves to prevent irritation from sweat if you are wearing gloves for long periods of time.

• Use fragrance- and dye-free soaps, sanitizers, moisturizers, and laundry detergents. These are less likely to cause skin reactions. Avoid “unscented” products. These may use additives to mask smells that can cause irritation.

• When possible, give skin a break from contact with water or PPE. For example, try to take a break from a mask for about 15 minutes every two hours, if safe and practical to do so.

• Consider using a humidifier inside your home to increase moisture in the air.

• If possible, avoid using PPE containing common culprits for skin irritation/reactions (e.g., latex or formaldehyde).

Know when to wash verses sanitize your hands

Frequent hand washing/sanitizing and long-term glove use can lead to a skin moisture imbalance.

• Use alcohol-based hand sanitizer unless hands are visibly dirty. Hand sanitizer is less irritating than soap. Soap strips away natural oils. Alcohol-based hand sanitizers may sting, but are usually less likely to be associated with dermatitis than washing with soap and water.

• Pat hands dry or allow hands to air dry instead of rubbing to avoid further irritation. Use warm water instead of hot. Frequent use of hot water can lead to excessively dry skin.

• Avoid using hand sanitizer and soap one right after the other. Consecutive use increases skin damage.

Use moisturizer to help prevent or treat dry skin

• Apply moisturizer liberally, regularly, and whenever skin feels dry. Lean towards creams and/or ointments over lotions. Lotions are less moisturizing.

• After washing with soap and water, apply moisturizer while skin is still damp.

• After sanitizer use, allow areas to completely dry before applying moisturizer, to avoid trapping the alcohol in the skin.

• If moisturizers seem to increase irritation, look for ingredients associated with contact dermatitis (e.g., lanolin, fragrances, essential oils, propylene glycol, etc.).

• Applying moisturizer twice in a row may provide additional benefit. Just wait 30 seconds or a minute between applications to allow time for initial absorption.

• Apply moisturizer at least 30 minutes before putting PPE on to be sure it is fully absorbed and areas are dry.

• Avoid using petrolatum-based moisturizers if using N95 masks, as this can interfere with mask integrity.

• For severe hand dryness or to give hand skin a hydration boost, apply petrolatum and then put on gloves or socks. Consider doing this just before going to sleep.

• Though data is not strong, rubbing olive or coconut oil on dry skin may help moisturize skin, especially the hands. Be sure to stop using these products if acne or irritation occurs.

Ways to prevent irritation from wearing face protection

• Ensure PPE fits properly and avoid over-tightening masks, goggles, etc.

• Make sure skin and PPE are clean and dry before putting on PPE.

Reference: PPE-Related Skin Irritation: Prevention and Treatment

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How about a “Quarantini?”

Daily life in the times of COVID-19 requires extra attention to our coping skills. Unwinding with a glass of wine or a "quarantini" has become a new norm for many people. 

I recently came across two news reports that put in perspective the significance of this new coping habit. One article detailed the increased sales and consumption of alcohol this spring during the COVID-19 lockdown, while the other discussed the upcoming revised (and lowered) guidelines for safe alcohol consumption. Just as Americans are drinking more, research suggests we should be drinking less.

How much is too much?

For many years, the US Dietary guidelines implied there was evidence that moderate drinking could lower the risk of heart disease and reduce mortality. With that in mind, the US Dietary Guidelines 2015-2020 states that if alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men. High risk drinking is the consumption of 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more drinks on any day or 15 or more drinks per week for men. With these guidelines, a daily “quarantini” may be classified as high-risk drinking. 

Presently, a committee of scientists updating the latest edition of the Dietary Guidelines for Americans is changing the current stance on alcohol. After careful evaluation of the research, they report that studies showing alcohol can protect health are deeply flawed, and that any potential cardiovascular benefits would be outweighed by the fact that alcohol is a leading preventable cause of cancer. The committee plans to recommend that men and women who drink limit themselves to a single serving of wine, beer or liquor per day. They do not recommend drinking for health and suggest drinking less is generally better.

What are the risks of drinking?

While our nerves may be soothed in the short term, regular alcohol consumption may be counterproductive to our overall health and wellbeing. Many people are aware that excessive drinking can increase the risk for liver disease and obesity, but may not realize that even moderate alcohol consumption (one drink a day) can increase the risk of breast cancer, depression and a wide range of cardiovascular problems, including high blood pressure. Alcohol compromises our sleep quality which can translate into irritability, brain fog and a weakened immune systems. The more you drink, the higher your risk.

Finding alternatives to the “quarintini”

An occasional alcoholic beverage can be part of a healthy lifestyle, but now is a good time to evaluate your current drinking pattern. When do you typically drink and how often? Do you drink to unwind? Could you go a month without a drink? These questions may give insight into your relationship with alcohol. 

If you find you are reaching for alcohol to help you unwinding in the evening, consider some of these alcohol-free strategies for coping with pandemic stress. 

• Practice regular self-care. Staying physically active, getting plenty of sleep and eating healthy foods are three of the most important tactics to prioritize.

• Find a mindfulness practice you enjoy and will complete. Yoga, meditation and deep breathing techniques are well documented to help ease stress. Headspace and Calm are great apps for guided meditation. “Tapping” or emotional freedom technique is a form of phycological acupressure that can also give dramatic results. Check out “The Tapping Solution” app to get started. 

• Replace alcohol with alternative beverages you enjoy. Plenty of filtered water during the day is helpful, but consider mocktails, kombucha or green juices. I’ve been enjoying this refreshing fennel scrub lately.

• Replete your nutrients. If you are drinking regularly you may have a micronutrient deficiency.  Regular alcohol consumption can trigger low levels of magnesium, zinc , and glutathione. Correcting these deficiencies, especially in the case of magnesium, may support your mood and promote relaxation. I recommend talking with a health care provider to customize a supplement plan to meet your needs.  

If you find yourself drinking excessively on a regular basis, seek professional help in person or via phone or video chat. The Substance Abuse and Mental Health Services Administration's Disaster Distress Helpline is available at 800-985-5990. For those in recovery, Alcoholics Anonymous provides a listing of online meetings at aa-intergroup.org.

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Vitamin D for COVID-19 Prevention and Treatment

I am so grateful for the many publications discussing preventions and treatments of COVID-19. Last week a randomized controlled trial looking at vitamin D treatment in COVID-19 was published in The Journal of Steroid Biochemistry and Molecular Biology.

The results are exciting. In summary:

• A group of researchers in Spain randomized a small group of COVID-19 pneumonia patients to receive high dose vitamin D as part of their otherwise standardized treatment. 

• Of the 50 patients that received the vitamin, only 1 patient (2%) was admitted to the ICU. There were no COVID deaths in this group. 

• Of the 26 patients who did not receive vitamin D as part of their treatment, 13 patients (50%) were admitted to the ICU. There were 2 deaths in this control group. 

The researchers found that the difference in ICU admission rate (but not death rate) was highly significant between the treatment groups. This is just one small study that needs to be replicated, but the findings may change how we treat and prevent COVID illness. 

Vitamin D for virus prevention

The study released last week looked specifically at Vitamin D as a treatment for COVID-19 pneumonia, however vitamin D has been researched since the early 1930’s as a potential way to prevent viral illnesses. Meta-analysis of vitamin D studies shows a modest protective effects of vitamin D against acute respiratory infections. Vitamin D helps regulates the body’s early response to a virus and subsequent inflammatory phases as the viral illness evolves. 

What is an adequate level of vitamin D?

An ideal vitamin D level has not been formally established, but most laboratories report a range of 30-100 ng/mL as normal. New emerging research has associated low levels of vitamin D with a variety of illnesses including  Alzheimer’s disease, poor physical function, higher markers of inflammation and even schizophrenia. The studies cannot differentiate whether low vitamin D levels caused these disorders or the disorders themselves contribute to the low vitamin D levels, but these associations have renewed interest in identifying optimal levels of vitamin D. 

According to data collected between 2005-2006 by the National Health and Nutrition Examination Survey (NHANES), insufficient vitamin D levels were found in 41.6% of US individuals sampled. Obesity, race, education level and lack of dairy consumption were additional risk factors for low levels. African-American adults had vitamin D deficiency rates at 82.1% and Hispanic adults had a deficiency rate of 62.9%. There is a striking overlap between risk factors for severe COVID-19 and vitamin D deficiency. And indeed, in a new study published in JAMA also this week, vitamin D deficiency was a risk factor for COVID-19 infection.

Should you supplement with Vitamin D?

Given the high prevalence rate of vitamin D deficiency, I believe new and established research support judicious supplementation with vitamin D for most people. However, vitamin D is a fat soluble vitamin and can become toxic if overconsumed. Here is what to consider when starting vitamin D supplements:

1. Know your vitamin D level. NHANES data suggest that at least 40% of the US population is deficient. Knowing your current vitamin D level will help you identify your proper supplement dose. Dosing needs vary between individuals based on their current blood levels, body weight, health status, skin color and gut health/nutrient absorption. Since many of these factors are not easily known, most people can safely target a dose of 2000-4,000 IU daily. If your vitamin D levels are well below 30 ng/mL or you have other health conditions, then you may need high doses.

2. Consider a higher dose of vitamin D if you contract COVID-19. If you happen to contract COVID-19, you may consider taking a higher dose of vitamin D for a short period of time—especially if you don’t know what your D levels are, or if you know you’re deficient. Please consult Relish Health or your physician to determine what is appropriate for you. (In the study, the doses used during the first week of treatment were about 20,000 IU on day 1, then about 10,000 IU on days 3 and 7 and weekly thereafter until patients were discharged from the hospital.) 

3. Consider taking a multivitamin. Vitamin D requires adequate levels of cofactors like magnesium, vitamin C, calcium, and vitamin K2 for optimal absorption and function. Eating a diet rich in veggies, fruits and high quality proteins while minimizing sugar and processed foods can help minimize risk of additional nutritional deficiencies.

Need help assessing your vitamin D need?

Dr. Leazenby has created a hand-picked list of supplements to support immunity. Review or purchase the Relish Health approved supplements through Fullscripts. Discuss all supplements with your medical provider before starting.

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BOOST YOUR IMMUNITY WITH FUNCTIONAL MEDICINE

Is It Time for a Whole-Body Tune up?

Sugar, wine, comfort food, boredom snacking. Sound familiar? The coronavirus has many of us “coping” in ways that may not be ideal for our long-term health. Finding ways to break the cycle of food cravings and unhealthy habits may be as close as 5 days away. 

What is a Fasting Mimicking Diet (FMD)?

A fasting mimicking diet is a type of intermittent fasting. It was developed by Dr. Valter Longo, an Italian biologist, researcher and expert in the field of longevity. Science has demonstrated that water fasting (drinking only water for a prescribed amount of time) can enhance healthy aging. Unfortunately, many people find skipping meals too challenging for regular practice. Dr. Longo, with his team of scientists at the University of Southern California, developed a FMD protocol using specific amounts of plant-based proteins, carbohydrates and fats that allows the body to “mimic” the beneficial response of a 5-day water fast. These include:

• Improved blood sugar- When it comes to managing blood sugar, intermittent fasting takes center stage. It has been proven to lower insulin resistance and increase metabolism. 

• Weight loss- Weight-loss resistance can often be due to an underlying hormone imbalance. Leptin is a hormone produced in your fat cells. Leptin resistance occurs when your brain stops recognizing leptin's signals to use your body’s fat stores for energy. This causes your body to continually store fat instead of using it. Fasting has been shown to improve chronic inflammation that can dull the brain’s leptin receptor sites. FMD is clinically shown to help individuals with normal-BMI reading to lose an average of 5.7 lbs of fat and 1.2 inches off waist circumference, while overweight/obese lost >8lbs, mainly with visceral fat reduction while protecting lean body mass.

• Curbed cravings- Fasting decreases your hunger hormone ghrelin, which in turn can increase dopamine levels in the brain. Fasting can also help free people from emotional eating and kill cravings by transitioning your metabolism from unstable sugar-burning to steady fat-burning.

• Lower cancer risk- Multiple studies have shown a link between fasting and a reduced risk of breast cancer.

• Enhanced heart health- Intermittent fasting is thought to lower heart disease risk due to its ability to lower triglycerides and blood pressure and raise beneficial HDL cholesterol.

• Improved autoimmune conditions- A fasting-mimicking diet under 1,000 calories a day for three-day cycles has been shown to improve symptoms associated with autoimmune conditions like multiple sclerosis as well as lupus.

How does it work?

During the five days of restricted FMD calories, the body goes into repair and recycle mode. When caloric consumption is low, the body turns to internal sources of stored energy. Not only does the body burn stored fat, it begins breaking down and recycling internal cellular components or entire damaged cells that weren’t working optimally. This process is called autophagy. Toward days 4-5 of the FMD, the body increases stem cell activity triggering a regenerative process to occur. It’s “out with the old, in with the new” at the cellular level.  There are many studies ongoing right now looking at FMD in cancer, cognitive impairment, kidney disease, multiple sclerosis, cardiomyopathy, depression, diabetes, metabolic syndrome and obesity. 

How to complete a FMD?

While there may be multiple ways to complete an FMD on your own, Dr. Longo and his researchers have developed a specific, patented product called Prolon, which I believe achieves the best results. It includes a kit with 5 small boxes containing all the food and beverages you need to complete a 5 days FMD. The meals include a nut bar for breakfast, dried soups for lunch and dinner, various snacks, a special low-calorie drink, as well as herbal teas. After you finish the 5-day cycle, you return to your normal, healthy eating habits for the rest of the month. Each cycle is beneficial, but completing a FMD for 5 consecutive days per month for 3 months shows significant benefits for people with excess weight or metabolic concerns, but even those at their ideal weight will also see benefits. The daily calories are as follows:

• On day one, 1090 calories are provided (10% protein, 56% fat, and 34% carbohydrate)

• On days two through five, 725 calories are provided (9% protein, 44% fat, and 47% carbohydrate).

My experience with FMD:

As a foodie and nutritional expert I did try my hand at recreating the FMD myself. I copied the calories and macronutrients described in the studies and created my own snacks, soups and salads. After comparing my results with my experience using Prolon, I found I had more weight loss and better energy response using the pre-packaged Prolon kit. I have now completed five Prolon FMD cycles. Here is what else I have discovered:

• I loved having the boxes of Prolon food. One of the hardest parts of being on a diet is figuring out what to eat, so this made it simple.  I completed 3 cycles in 3 consecutive months and plan to continue doing 2-4 cycles per year.

• Day 1 is fairly easy, but days 2 (and sometimes 3) can bring fatigue. By days 4-5, my energy and focus skyrocket. I have found that each cycle becomes easier. 

• The food: As a trained chef and foodie I know that my food choices are particular. The nut bar, olives and kale crackers are delicious. The soups are tasty, but I admit that I add a few dried herbs like oregano or basil to liven them up. The choco-crisp bar is a welcome sweet treat. 

• At the end of the five days, my clothes fit better, cravings improve and my sleep is more restful and energizing. I will admit I have been tempted to continue the fast because I felt amazing!

• I lost weight with each cycle. There is a small (and expected) bounce back in weight after resuming regular eating habits. However, over time with multiple cycles under my belt, I have experienced sustained reduction in weight and waist circumference.

Who should try Prolon FMD?

Prolon is best for people who want to maintain healthy levels of:

• Fasting blood glucose

• Cholesterol

• Blood pressure

• C-reactive protein

• Triglycerides

• Reduce excess fat while maintaining body mass.

Prolon fasting mimicking diet is not for everyone. Side effects include weakness and lightheadedness. It is important to keep exercise minimal while completing the 5 day program. Prolon FMD is NOT appropriate for anyone with nut allergy, diabetes or significant blood sugar problems, low body weight, eating disorder, pregnant or nursing women, chronically weak/ill, or the elderly. I recommend working with a healthcare practitioner to decide if it is right for you, especially if you want to monitor your health status with blood pressure and lab work.

Learn more about the various types of fasting.

Schedule an appointment to learn more. 

Prolon kits are available in the office or can be ordered here. 

COVID-19 Policy for In-Office Care

As Indiana has experienced a decline of new cases in recent weeks, Relish Health has updated its policy to allow some appointments in the office by request. Relish Health is focused on your well-being inside and outside the office and wherever your travels take you. Virtual appointments will continue to be available and encouraged, especially for all follow-up appointments and for anyone at high risk of Covid-19 complications. However, if you request an in-person visit with Dr. Leazenby, please take note of the new policy below.

Relish Health Covid-19 policy for visits in the office:

• Screening – You will be screened upon arrival for COVID-19 symptoms and risk. This will include a questionnaire and temperature assessment. 

• Disinfecting – Dr. Leazenby is spacing appointments to allow for rigorous disinfecting of the office prior to each patient. It is extremely important you are punctual to your scheduled time and do not arrive early as there is no waiting room. 

• Hand Sanitizing – You will be asked to sanitize your hands upon arrival. 

• No Visitors – Patients will only be seen alone. Exceptions will only be made for minors, who may be accompanied by one adult. Adult patients may have their loved ones join their appointments though speaker phone, video conference, etc.

• Masking – Please wear a cloth face covering or standard medical ear-loop mask to your appointments. A facial covering is required for the entire duration of the visit.

A Playbook For Socializing During SARS-COV-2

Boost Your Immunity with Functional Medicine

A Playbook for Socializing During SARS-COV-2

The illustration highlights the importance of physical distancing in our day to day interaction with each other to "flatten the curve". We win by staying apart while remaining connected, not just as individuals but as a community. Image created by Sukriti Banthiya. Submitted for United Nations Global Call Out To Creatives - help stop the spread of COVID-19.

Many businesses are back open and life is starting to feel more “normal.” The new freedom to move about socially is refreshing. As we emerge from our lockdown it is tempting to assume the pandemic is over. However, the virus is still active and circulating. Unfortunately, there is no official playbook for how we manage the ongoing risk of this virus. See this story in the New York Times which includes excellent tips. Here is a summary below.

Tips for Socializing During a Pandemic:

1. Follow the health of your state and community. Be an informed citizen. Two important indicators of viral activity in your area include the percentage of tests that are positive and the overall trend of cases. For example, if in Indiana, check the Indiana State Department of Health Covid-19 Dashboard for the latest stats.

2. Limit your number of close contacts. Form a “COVID bubble” with a small number of family and friends. Inside this group communicate openly without judgement about what each person or family considers “reasonable precautions” and potential exposures. 

3. Manage your exposure budget. Each activity outside the house carries some risk and the risk is cumulative. The NYT article describes this exposure budget well. “You spend very few budget points for low-risk choices like a once-a-week grocery trip or exercising outdoors. You spend more budget points when you attend an indoor dinner party, get a haircut or go to the office. You blow your budget completely if you spend time in a crowd.”

4. Keep high risk activities short

   • Brief encounters (ie, passing someone on the sidewalk) are unlikely to make you sick.

   • Face-to-face contact with someone outside your “COVID bubble” should be kept short and with a mask. Ideally exposure should be less than 15 minutes to reduce the amount of potential viral exposure.

   • Indoor exposure is best kept to less than 1 hour. In an enclosed space you can still become infected from a person across the room if you share the same air for an extended period of time.

5. Keep taking precautions

• Keep a mask handy

• Practice social distancing — staying six feet apart — when you are with people who live outside your household or “bubble.” Keep social activities outdoors.

• Wash hands frequently and be mindful about touching public surfaces.

• Adopt stricter quarantine practices if you or someone in your circle is at higher risk.

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Who will you be after COVID-19?

The world looks very different today than it did two months ago.  It is safe to say that we will never return to many habits of the past. Our social interactions will be different for the foreseeable future. Our economy has changed, and for many of us, the work that we use to define ourselves looks very different in practice. 

The Name by Jason Dorsey

The silver lining in this economic and social disruption is that we have the time and opportunity to ask some very intimate and probing questions of ourselves. In all the upheaval, we can reinvent and redefine ourselves. In my practice of medicine, I have come to believe that our biography becomes our biology. Indeed, own stories and life experiences have such a profound impact on us that the science of our bodies are forever changed. The sum of our experiences, good and bad, our changing purpose and meaning in life, and the pursuits we follow can all influence our health as much as the medication we may take. When patients understand the effects of their life on their health, it is only then that lifestyle modifications can begin to assist in healing.

Several years ago, I had my own epiphany of self. I was unhealthy in body and spirit. I didn’t feel well and was burnt out in the traditional practice of medicine. I ultimately made radical decisions to change my lifestyle and transition my career to functional medicine. I left behind a secure practice in conventional medicine to attend culinary school, pursue training in functional medicine and start an independent medical practice that treats people holistically. This helped heal me physically and emotionally. Part of my evolution was to recognize the role and purpose that I have in this world. I have a unique and particular impact to my health, family, community, work and environment. You, too, have a unique and particular role to play in this world. Identifying my purpose was transformative in my health and my career and I know it can be transformative in others as well. 

Making this drastic change in life did not come easy. We humans are spiritual, philosophical and social beings. We are not meant to figure out life on our own nor to go it alone. It is helpful to have wise counsel to help us determine our path. I found wise counsel to determine my purpose by working with two amazing coaches. Jason Dorsey, a Presbyterian pastor, has written a book entitled “The Name” which leads individuals through a process of mapping their core identity and setting goals for each sphere of their life including personal, family, work, community and place. Marcia Newman is a gifted life coach that listens and is an excellent teacher and sounding board as one works out their purpose and goals in concrete details. They can help you too. 

In this unique pandemic time, I invite you to ask the hard questions. What is your purpose? Why are you here? Do you want to continue life as it is? How can you transition to a different lifestyle or career to better embrace your purpose? 

Note that this is not a sponsored post, nor do I receive anything from this endorsement. There are many talented coaches that can speak into your biggest life decisions, and I suggest everyone explore a coach that works for them. However, I do recommend Jason Dorsey and/or Marcia Newman because they are talented, good and decent people that want you to live into your purpose to find joy, contentment and fulfillment. I, too, want this for my patients because it is good for your soul and ultimately, your health. 

Jason Dorsey’s Book “The Name”

Jason Dorsey’s Counseling Service

Marcia Newman and Associates Life Coaching Services

Curious how your biography is affecting your biology? Schedule an appointment with Relish Health to address your health.

Boost Your Immunity with Functional Medicine

5 things you should know about a face mask

5 things you should know about a face mask

On April 3, 2020 the Center for Disease Control (CDC) updated their guidance for the use of cloth facial masks by the general public as they continue to study the spread and effects of the novel coronavirus across the United States. Scientists now know from recent studies that a significant percentage of individuals with coronavirus lack symptoms or can transmit the virus to others before showing symptoms.  This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms.  In light of this new evidence, the CDC recommends wearing face-coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.

As we adopt these new recommendations to protect ourselves and our community there are several items to consider.

5 things you should know about a face mask:

1. Wearing a face mask is not a guarantee you will not contract COVID-19. Many face masks do not keep the virus from entering your mouth or nose . They also don’t cover the eyes and a bit of coughed saliva that sprays into the eye can cause an infection. Not all masks offer the same protection. However, a face mask may discourage you from touching your face with contaminated hands.

2. Masks can be effective at capturing many droplets, which is the main transmission route of the coronavirus. Face masks help prevent the infection of others by reducing the number of airborne respiratory droplets created by coughs and sneezes.

3. Medical grade masks are in limited supply. They should be reserved solely for health care professionals and family members caring for someone who is ill.

4. When using a mask be sure the mask covers your nose and mouth. Wash your hands before applying the mask and again after taking it off. If your mask is made of cloth, it should be washed with soap and water after each use. 

5. The information about the transmission of COVID-19 is evolving. The CDC may continue to issue new guidance. 

While helpful, wearing a mask may result in a false sense of security and minimize addressing more essential interventions to reduce risk of infection.

Remember to follow these best practices:

1. Keep your distance. It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus. Do not gather in groups and stay out of crowded places. 

2. Clean your hands often. Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. 

3. Avoid touching your eyes, nose, and mouth with unwashed hands.

4. Cover your cough. Coughing into a tissue then immediately throwing the tissue away and appropriately washing your hands reduces your risk of transmitting viral particles.

5. Stay home as much as possible.

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Keep Calm and Moving

There have been so many changes to the world in such a short amount of time. For most of us our weekly rhythms of work, family time, exercise and stress management have been disrupted.  Given current social distancing recommendations, daily exercise might look like streaming an online yoga flow from home, taking a jog outside while responsibly keeping your distance from others, or simply doing some squats between conference calls. Regardless, getting into a groove at home is important for our physical and mental health. Maintaining a regular exercise and mindfulness routine is helpful to relieve anxiety and help build physicial and mental resiliency. Aiming for a least twenty minutes a day is a good target.

Enjoy some of these helpful links to bring some calm and movement back into your routine.

Yoga

Yoga is an ancient meditative practice that has many well documented health benefits. It is easy to do at home and can help promote a sense of calm.

• Indianapolis based “The Yoga Studio” is offering free yoga classes and meditation sessions via Instagram stories (@indyyogastudio). Their schedule is posted here.

• Yoga with Adriene on Youtube is a free on-demand resource that is great whether you are new to yoga or have years of experience.

High-Intensity Interval Training (HIIT)

HIIT is a type of aerobic exercise that involves alternating periods of regular intensity with short bursts of high intensity activity for 30 to 60 seconds duration. HIIT training is very time efficient and offers a great workout in as little as seven minutes. Check out these links to get started:

• The New York Times' Scientific 7- minute workout

• The workout app "Workout for women" offers free 4-60 minute routines that can easily be mixed and matched for variety and targeted body work. There is something for everyone in this app.

Meditation 

The benefits of meditation are numerous and supported by science. Many people start meditating to manage stress, reduce anxiety, and to cultivate peace of mind. But, there are thousands of studies documenting other less-known mindfulness meditation benefits including improved mood, lower cortisol, greater happiness and decreased inflammation.

• Headspace is a subscription-based app. During this trying time, the company is offering free access to supportive guided meditations called Weathering the storm. If you are a healthcare provider or an educator, the company is also offering free access to meditations to target your needs as well. 

Staying home in this season is our way to care for each other. Hopefully these resources help you care for yourself and find small joys in the new routine.

(This post is not sponsored. Relish Health does not receive anything in return from any link included here.)

Is it COVID-19 or a Cold?

What is known about the novel coronavirus (COVID-19) is evolving daily. There are still many unknowns about the actual number infected and the best public health measures to slow population progression. A common concern for the public is the reported similarities of COVID-19 symptoms to a seasonal cold or influenza, other viruses that are still circulating in the community. Based on symptoms alone it can be difficult to differentiate what virus is causing a patient’s symptoms. Here’s how the illnesses differ and what to do if you have symptoms.

How symptoms of COVID-19 differ from the common cold or flu

Coronaviruses are not new. They are a group of RNA viruses that cause a variety of diseases in humans and other animals. Symptoms from different coronavirus strains vary. Some cause common cold symptoms while others can cause more serious respiratory infections like SARS. The specific coronavirus making headlines today is highly infectious and new (novel) to humans meaning we have much to learn about it’s potential effect on our global community.

Many viral infections have similar symptoms, ranging from fever, mucus production, body aches and cough to shortness of breath and fatigue.

Common cold

In most cases, a cold typically comes on gradually. Symptoms typically start with a sore throat and runny nose and may be followed by coughing and sneezing. Fevers are less common. Most people recover in about 7-10 days.

Seasonal flu

Symptoms of the flu differ from colds in that they often start abruptly. Influenza can include fever (over 100.5) or chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. Some people may also have vomiting or diarrhea, though this is more common in children. Influenza (flu) can cause mild to severe illness.

COVID-19

Data from a recent study of patients in China with confirmed COVID-19 showed that the most common symptoms of this illness are a fever and cough. Shortness of breath is also a hallmark symptom that may peak on days 8-9 . The same study found that a small percentage of patients also experienced nausea or vomiting and diarrhea. 

Immunocompromised individuals are more at risk for developing a more severe version of COVID-19. They may not be able to mount a strong enough initial immune response and are at risk of significant inflammation and tissue damage triggered by the virus.

What to do if you’re sick 

Most importantly, if you get sick with fever, cough, and congestion stay at home. It is wise to reach out to a trusted health care provider for advice on differentiating between the viruses above. If you have not had the flu shot, a doctor may prescribe an anti-viral medication if the flu is suspected. If after a few days your symptoms stabilize—meaning you continue to have cough, low-grade fever, and body aches but no noticeable shortness of breath, you should continue to stay home and rest.

Reports from hospitalized cases of COVID-19 indicate that the potential for clinical deterioration appears to peak in the second week of illness (usually after day 8-9). Patients may develop shortness of breath—a major indicator of respiratory compromise.

If your symptoms worsen, particularly if you experience shortness of breath, it is imperative that you proceed to the closest emergency room. For safety, it is important to take private transportation and call ahead to let the ER know of your condition. 

How to get tested for the coronavirus?

Currently, testing for COVID-19 is being performed at state public health laboratories and The Centers for Disease Control (CDC). The CDC has broadened their guidelines for coronavirus testing so that anyone can be tested for COVID-19 if they have symptoms and a doctor’s orders.

Testing is expected to continue to become more widely available. This, however, does not mean everyone with signs of a cold should be tested for coronavirus.

The CDC is currently recommending that the following patients be tested:

1. Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

2. Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

3. Any persons including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of their symptom onset.

What if you test positive for COVID-19?

If you are sick and have been diagnosed with COVID-19 or suspected to have COVID-19 because you have been exposed to someone with COVID-19, follow the steps below to help prevent the disease from spreading to people in your home and community. Since the Seattle area faced some of the earliest cases in the United States, the Washington State Department of Health has good recommendations on their website:

• Stay home except to get medical care. You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis.

• Separate yourself from other people in your home. As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.

• Call ahead before visiting your doctor. If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

• Wear a facemask. You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not be in the same room with you, or they should wear a facemask if they enter your room.

• Cover your coughs and sneezes. Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can; immediately wash your hands with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer that contains at least 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water is preferred if hands are visibly dirty.

• Avoid sharing personal household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.

• Clean your hands often. Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water is preferred if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

• Clean all “high-touch” surfaces every day. High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

• Monitor your symptoms. Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.

Discontinuing home isolation

From the Washington State Department of Health:

• If you have tested positive for COVID-19, you should remain under home isolation precautions for 7 days OR until 72 hours after fever is gone and symptoms get better, whichever is longer.

• If you have fever with cough or shortness of breath but have not been exposed to someone with COVID-19 and have not tested positive for COVID-19, you should stay home away from others until 72 hours after the fever is gone and symptoms get better.

Additional information for your household members, intimate partners, and caregivers is available here.

Dr. Leazenby has created a hand-picked list of supplements to support immunity. Review or purchase the Relish Health approved supplements through Fullscripts. Discuss all supplements with your medical provider before starting.

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