Me and a medical student at 2019 Burning Man sewing up a finger laceration. Skills, but no degree yet.
What to do with exquisite medical knowledge but without a medical degree yet? Due to the pandemic, medical student’s schooling has been turned on its ear. It is all hands-on-deck with patient care and medical students rotations have been curtailed, furloughed, stopped.
Here’s an article from our Dean Schwenk MD highlighting the medical students and physician assistant students efforts to help wherever needed. I am proud of the University of Nevada Reno School of Medicine and its ingenuity at this time of need.
I know we are hyperfocused on our current pandemia and rightfully so. I recently came across an article discussing the effectiveness of the influenza vaccine for this past season.
According to a Feb. 21 CDC Morbidity and Mortality Weekly Report, the current influenza vaccine has been 45% effective overall against 2019-2020 seasonal influenza A and B viruses.
Specifically, the flu vaccine has been 50% effective against influenza B and 37% effective against influenza A
This year’s vaccine substantially protected children and adolescents ages 6 months to 17 years, with 55% vaccine effectiveness seen in this population.
How to leave coronavirus behind when you come home
This is a spot-on article from a family medicine journal. I’m adopting ALL the tips in the hope that my husband and three kids don’t get the virus from me.
A selfie in the hospital parking lot. Ready for action!
Providing patient care during the COVID-19 pandemic means you and your family are at risk for exposure. The ideas below, compiled in consultation with family physicians from across the country and incorporating Centers for Disease Control and Prevention (CDC) guidance, describe how to limit the risk to your family as you return home at the end of your workday.
Monitor your health
Check your temperature twice a day. Watch for respiratory symptoms. Contact your local or state health department if symptoms develop.
Prepare for work
Consider wearing scrubs every day. Always have a clean set ready.
If you wear a white coat, wash it every day. I’m not wearing mine as I’d rather be able to wash my arms.
If you typically wear jewelry, a tie, a watch, or other nonessential accessories, leave them at home. This is first time in my 25 years of marriage that I haven’t worn my ring. It feels odd, but also makes me feel alerted to the viral danger. I asked my husband (who is also a physician) to not wear his either.
If you have medium or long hair, wear it pulled back. I am wearing it back, with a Wonder Woman scrub hat that a local sewer made for me and my inpatient physician team.
If you wear contacts, consider wearing glasses to decrease the need to touch your face and for the glasses to offer a physical barrier to the virus. I am opting for no makeup and glasses. This is not a beauty contest!
Prepare clean clothes and shoes to change into after work. Take them with you if you can change at work. I have opted to wear long johns and a tank top under my scrubs. I take off my scrubs at my car ( I have gotten some strange looks from passers-by)and put them in a washable bag. Then purell my hands and arms before getting in my car.
Remove nonessential items in your car, and stock the car with disinfecting wipes to make it easy to wipe down key surfaces after traveling home.
If taking mass transit, have hand sanitizer available and use it after touching any surfaces.
If you have extra disposable gloves, take them with you in case you need to touch potentially contaminated surfaces as you travel to work( like gas pumps). Be sure to carefully remove and dispose of them.
Before leaving work
If possible, shower and change into clean clothes and shoes before heading home.
Put dirty clothes and shoes into a bag for soiled clothing. Consider using a cloth bag you can wash along with your dirty clothes each day.
Wash your hands or use hand sanitizer after removing work clothes and before touching clean clothes.
When you arrive home
If you were unable to change clothes before leaving work, change in an isolated location (e.g., garage, mudroom, laundry room).
Do not wear shoes from work into your home. Clean them, top and bottom, with disinfecting wipes.
Wash clothes worn at work using your usual laundry detergent.
Wash or safely discard dirty clothes bag.
Wash hands after handling dirty clothes and shoes.
Shower before interacting with your family.
You may choose to isolate, if possible, from your family to limit their potential for exposure:
Identify a room and bathroom to be used exclusively by you. Have another family member leave needed food and items for you outside your isolation area so that you don’t have to move throughout your home to meet your needs. Consider using disposable plates, cups, and utensils.
If you are unable to use separate spaces from your family, attempt to maintain six feet from others in your home, and be sure to sleep alone.
Disinfect your home regularly
Clean and disinfect frequently touched surfaces in your home daily. This includes tables, doorknobs, light switches, countertops, handles, desks, toilets, faucets, sinks, and electronics.
Burning Man 2019 at dawn. Photo credit: Leslie Greenberg
Do you want to boost your immune system? I was recently asked “What was I doing to boost my immune system?” This got me thinking about what do we know about this… Here is my research.
The strength of our immune system is largely determined by modifiable factors. This means that you have the ability to change these factors. Lifestyle factors like stress, sleep, diet and exercise (as well as the germs we have been exposed to during our lifetime) all play a role in the strength of our immune response.
There is no magic pill or supplement or food that will irrefutably bolster your immune system and protect you from the new coronavirus. But you can take care of yourself to give your immune system the best chance to fight against a respiratory illness.
Lower your stress. Worrying will not help anything. Consider yoga or meditation. There are many free apps to help get you started: Inscape. Calm. Headspace. Consider talking to a therapist or a trusted friend to help release stress and feel more at peace.
Improve your sleep habits. Those who sleep less than 6 hours per night are 4 times more likely to catch a cold compared to those who sleep more than 6 hours per night. A sleep-deprived immune system doesn’t work as well as a well-rested one. Even if you are isolating at home or your work schedule has changed due to the pandemic, stick to a regular bedtime and wake schedule. Avoid tv or screens at bedtime. Don’t eat before bed as this can increase your symptoms of heartburn. Don’t exercise immediately before bed as most people find this activating and difficult to induce sleep.
Vitamin D may help. May. Some studies have shown no immune benefit from vitamin D but a metanalysis of 11,000 patients showed some protection against respiratory infections. These benefits may take months to work, but if you would like to try. Start now. Vitamin D3 is available over the counter. 2000 IU a day is a routine dose. In the current times of the pandemic, I would NOT suggesting get a lab order to check your vitamin D level. You can find vitamin D in salmon (and other fatty fish), milk or vitamin-D fortified foods. Sun exposure can also increase our vitamin D in our bodies, but most of us are covered in clothing and do not get sufficient amount solely from the sun.
What else can you do to help booster your immune system? Avoid excessive alcohol consumption. Men drinking more than 14 drinks per week, or women more than 7 per week is considered excessive. This amount of alcohol may impair immune function, alter your gut microbiome, and damage the lungs. Also, avoid binge alcohol intake.
Eat a balanced diet, exercise and skip unproven supplements. I spoke with a patient recently who had started a handful of “immune booster” supplements and was suffering from gastrointestinal distress. I advised to stop the new supplements, which doubtful were going to help, and instead eat fruits, vegetables, and lean meats. Be healthful. It is unknown if garlic or elderberry or turmeric or oregano oil or ginger help significantly.
Should you take zinc? First ask yourself if you have a healthful diet and if so, you most likely get all the zinc needed from food. Zinc supplements and lozenges are popular. Zinc may reduce the duration of cold by about a day and, may reduce the number of upper respiratory infections in children. Nausea is a common side effect of taking zinc supplements.
Don’t smoke. Smoking never helps any part of the body and it certainly weakens the lungs ability to clear secretions and to exchange oxygen in the alveoli.
In summary, decrease your exposure to the coronavirus! This is the most important step. Stay home. Only leave to do truly necessary errands: seek medical care or buy groceries. Sleep 7 or more hours per night. Eat healthful foods. Stay calm. Wash your hands for 20 seconds frequently throughout the day. Don’t touch your face.
University of Nevada Reno School of Medicine Match Day 2019. An Alice in Wonderland themed Match celebration with each medical student opening their gold clock. Inside the clock was a note with their residency specialty and location.
What is “Match Day” for medical students? Match Day is a monumental milestone for all graduating fourth-year medical students. There are almost 12,000 residency and fellowship training programs in the US. There are 20,000 medical students graduating with MDs yearly. The match process matches the medical students with the specialties and destination of choice. First there is an application and interview season (October – January) and all training programs create a rank list. This lists the medical students from most desirable to least. AND, each medical student applicant makes creates a ranked list of their desired training programs.
How does the match happen? A computer (with a Nobel Prize winning algorithm) matches medical students and program interest. The algorithm favors the student’s choice. On Match Day, the results are known by all. Nearly 75% of students receive one of their first three choices.
What happens if a medical student wants to match with another medical student? This was the case with my now-husband and me 25 years ago. We “couples matched.” This adds an additional level of difficulty where an even more complicated algorithm balances the training objectives of the two students. The students each decide which medical specialty they want to train in and how far apart they are willing to live. This is all reflected in their joint match lists.
When is Match Day? Friday, March 20th. Every medical student in the country has their “reveal” time at the same time. Noon Eastern Standard Time and 9 am here in the West.
Medical school is actually the beginning of a physician’s education. Physicians train for an additional 3-10 years AFTER medical school, depending on their specialty.
Add this to one more medication that may cause birth defects… There is a study just released with over 100,000 patients which shows that when macrolides (antibiotiocs like erythromycin, azothromycin, and clarithromycin) are used in the first 13 weeks of a pregnancy, may increase birth defects.
Compound this with the thought that most women do not know they are pregnant until they miss 1-2 menstrual periods. So, I urge you to be aware of your menstrual calendar when your physician prescribes you antibiotics.
And, while you are thinking of it, take a prenatal vitamin daily. It’ll help the fetal spinal cord and may make you feel better.
Lower incidence of heart disease, type 2 diabetes.
Live longer. Consider that your time exercise may be paid back to you later in life in longevity.
Better circulation
Ward of depression
Makes you more creative, have more focus, and increase productivity
Helps you sleep better
Move your body!
25% of adults are sedentary. Lack of exercise is one of the top modifiable risks to decrease cardiovascular disease.
Exercise can be split up throughout the day. Aim for 20 minutes of moderate exercise every day. This can be a walk around the block… or walk from the far end of the parking lot.
How to build this into your day? Make a plan! Have gym shoes in your car ready to go. Like to listen to music or podcasts? Pair your exercise with something you enjoy and have your headphones ready. Bad weather coming? Have a backup plan (walk the mall or big box store). Need a partner? Make a standing date with a friend or get a dog! Make it convenient: get a treadmill desk or pace when talking on the phone. Do you want to monitor your progress? Get a tracker.
What kind of exercise is beneficial? 3 different kinds of exercise are beneficial: aerobic, resistance, and stretching.
Aerobic is raising your heart rate (swimming, walking, bicycling).
Resistance training is using weights or resistance bands.
Stretching is just that. Try yoga or pilates if you would like to take an organized group to learn how to stretch, or find stretching regimen on youtube!
Most benefit is from going from zero to SOME exercise. This will impact your overall health. Get a move on….
Dr. Leslie Greenberg's Blog 
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