March 2020 – Dr. Plastic Picker
 

Month: March 2020

One of many COVID-19 calculators out there.

March 31, 2020

by drplasticpicker

Dr. Plastic Picker knows a lot more about cortisol than the average outpatient pediatrician. I did two years of pediatric endocrine fellowship, and here is the blogpost that explains why I left in good standing https://drplasticpicker.com/covid-19-social-distancing-is-like-bedrest-dr-plastic-picker-understands-but-this-time-you-stay-home-and-i-get-to-do-something/. Cortisol is a stress hormone and is often referred to as almost how doctors in the 1700s would speak about “humours” that would float in the body. This is before we knew about germ theory. It’s somewhat accurate though, because we refer to cortisol in general but to actually get an accurate cortisol level is very difficult. It fluctuates through the day, and to really get an accurate level of one’s cortisol level one has to admit a patient short-term to do an ACTH stimulation test. The cortisol or “stress humors” are running rampant in your body right now if you are in healthcare. In the end of the day, Dr. Plastic Picker is still a middle manager and I’m hearing all about it. I’m calling in the Great Freak Out. Yes, you are all freaking out about COVID-19.

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This is a picture of Mylar baloons in the desert from one of our Dr. Plastic Picker friends. Does the heat aleve or exacerbate eczema? How should you bathe your atopic child when the weather changes?

March 29, 2020

by drplasticpicker

Today the politicians are again arguing about who is to blame for the skyrocketing COVID-19 cases. But in California, there is a glimmer of hope. We began mandatory quaratining relatively early, and in our community our local leaders have been working together across the aisle to help our homeless communities and provide rent relief to our population. Beaches are closed and our local friends the Police were driving calmly up and down the beach telling our relaxed San Diegans to disperse. I was born and raised in San Diego, and I have a great love for my homeworld (Star Trek reference). In this increasingly polarized world, there is still a sense of civic responsibility and engagement in my hometown. I am hoping this helps us #flattenthecurve. Looking at the prediction models, it looks like we will likely have enough ICU beds for our county. So I am still vigilant but hopeful. I wrote yestserday that the best way I can help, is by doing the job I am qualified to do – a general outpatient pediatrician who middle-manages a department and is responsible for a few actual outpatient clinics https://drplasticpicker.com/be-like-a-tree-during-the-covid-19-cytokine-storm/.

So in that vein, I will be an outpatient pediatrician and give general advice about eczema! This is such a common problem and I hope this gives you some relief since we are trying to keep these “minor” issues at home. But minor issues are important to deal with as well.

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A Torrey Pine. Beautiful ancient tree species. It has survived many storms.

March 28, 2020

by drplasticpicker

The COVID-19 pandemic has definitely proven how powerful Facebook physician groups are. There are three main COVID-19 MD-only Facebook groups, and the clinical discussions, mutual assistance and advice is phenomenal. These are doctors helping other doctors, because we are all trying to save our communities. I was Zoom chatting with engineers from Hewlett Packard yesterday, and they were asking for information on what designs and equipment the medical community needed. I honestly told them, everything is on these Facebook groups. CNN is at least 48 hours behind these groups.

But one of the primary COVID-19 MD Facebook groups has 21,000 members! It can be a whirlwind of journal articles, posts, tutorial videos on how to make PPE and comments. There are journalist on the fringes, friends or spouses of members, and suddenly a post will receive a few comments and is then featured on a major news outlet. This is usually with permission of the commenters of course. You can see the pandemic coming toward you, as MDs from the current hot spots give us a preview of what is to come. One post that has been shared and copied multiple times has mentioned that on “Day 10 of illness Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours,” wrote the internist.

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The only time Mr. Money Mustache accepted one of my comments. This was one of hundreds of comments. I had just had my blog accepted on KevinMD and COVID-19 and social distancing, and used some of the same phrasing. MMM blog is one of the more popular FIRE blogs and he has a devout following, which kind of scares me.

March 24, 2020

by drplasticpicker

One of the bright spots of becoming Dr. Plastic Picker is since I have my own blog and a catchy internet handle, I can comment on some personal finance blogs that I have been reading for over a decade. When I was a young resident taking NICU call, I would look around me and analyze people’s lives. I realized that these super smart physicians that were training me were not as versed in personal finance. Some of the smartest ones went over to the dark side and sold their souls to pharmaceutical companies. You see, I am the daughter of an accountant and successful small-business owner. I absorbed their wisdom regarding medicine, but disregarded much of what they said about finances or real estate. Except Dr. Young-Ho Yoon, who advised me to start my Roth IRA https://drplasticpicker.com/dr-young-ho-yoon-pediatrian-and-environmentalist-1/. That guy is smart with his money.

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Useless shelf. They put it right up in front.

March 23, 2020

by drplasticpicker

The COVID-19 pandemic is still raging. The silver lining is Harvey Weinstein and Paul Rand have coronavirus. I don’t wish ill will on anyone, but I hope they have to wait in line at their local ED. I took a vacation day prior to knowing the pandemic was going to happen, as the kids originally had the day off school. The kids are home due to school closures, and I decided to just roll with life and keep my day off. I return to work tomorrow.

But rather than wasting energy and ranting at the poor decisions being made at various central government level or becoming unreasonably upset when I see former premed students on Facebook at weddings when they are doctors and supposed to model #socialdistancing and #flatteningthecurve, I will instead focus on things that are in my realm of control. I will today write about 5 things you should not waste money on.

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Two bunnies that are being sheltered. We shall do the same with ours.

March 22, 2020

by drplasticpicker

I binged 10 hours of Star Trek: Picard yesterday. I haven’t binge-watched any TV since being on bedrest over a decade ago https://drplasticpicker.com/covid-19-social-distancing-is-like-bedrest-kevinmd-version/. I was making myself sick from worry because I thought I may have COVID-19. I won’t go over the specific symptoms, but I talked to an adult phyisican I trust yesterday over phone, and I am less likely to have COVID-19 than anything. It was been a trying time for the country and for parents, and for me.

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Peach Tree with beautiful blossoms. Hopefully after COVID-19 there will be delicious fruits to enjoy.

March 18, 2020

by drplasticpicker

Wow. I just finally sat down at about 340pm and starting this Hopeful Wednesday post late. I usually have this series ready to go by Tuesday night but it has been busy, to say the least. I only worked this morning and saw mostly virtual patients (which means telephone appointments). Then I got home, ate lunch and took a nap. Mr. Plastic Picker is still toiling away at the hospital.

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March 17, 2020

by drplasticpicker

Snorlax and my mish-mosh plastic bag.

Did the picture above catch your attention? The large Pokemon bean bag belongs to my children. The other object is a plastic bag I made from plastic scraps. I know it’s weird, but I have embraced my off-kilter personality as Dr. Plastic Picker. Our children consume enormous amounts of clementines. Clementines come in orange plastic mesh bags.  I am now master of the glue-gun which is how I make trash art. With my glue-gun, I reuse bits of plastic.  I reuse the orange mesh bags as my base. I make pretty sturdy bathroom trash liners! Every time I finish one, I show it to my in-laws, children and sometimes husband.  They all exclaim at how marvelous my bags are.

I bring up making these trash liners because I understand everyone’s anxiety over the COVID-19 crisis. It’s easier to DO SOMETHING rather than to be asked to sit at home and social distance. I have been a student of medicine and human nature for 20 years. It is so hard to be asked to do nothing, even when that nothing can save lives.

We have two children. The two beings that eat all those clementines.  I was on bedrest for both pregnancies for 8 weeks apiece. I was placed on strict bedrest for cervical incompetence. Having your cervix called incompetent is hard even though it’s your cervix and not your brain. I did not feel pain.  Yet ultrasounds showed a shortened cervix. There was less than 0.5cm of cervix keeping these still not viable fetuses in. I think there are more treatment modalities than just asking a pregnant woman to lay flat, but 15-years-ago I did just that for 8 weeks and got up only to go to the bathroom and shower occassionally. But mostly I was flat on my back.

COVID-19 social distancing is like bedrest. You don’t see the danger when you look out the window. The weather looks fine and the sky is clear. There are not gasping senior citizens on the street. But health officials are telling you that the signs don’t look good.  Soon there could be catastrophic social change as the most vulnerable of us could die if we don’t #flattenthecurve. They are asking you to stay home. The high-risk Ob-Gyn doctors asked me many years ago did I want to terminate my 18-week-pregnancy or did I want to to save it? Was I ready to go on bedrest without any guarantee of how this baby would turn out?  I opted to try bedrest.  At that time my body felt fine.  I couldn’t actually see the danger but I trusted my Ob-Gyn doctors.

When I went on bedrest it was one of the hardest things I ever did. Everyone thinks bedrest is easy. It’s horrible.  This was pre-social media. I had to lay on my back and dwell on jumbled thoughts of the possibilities of how life may or may not end up. One painfully sees the world go about its rhythms while one just lays there. I did finish one scientific paper while on bedrest. But my other grand ideas about brushing up on foreign languages did not happen.

But I made it through bedrest because I am an analytical person.  I wanted each of those babies however they came. I did what many of you are doing now holed up at home. I made schedules. I did ankle and arm exercises. I talked to my family. I read medical articles.  I was upset.  I had taken care of other people’s babies.  Why couldn’t I just have a little girl of my own?  What got me through the hardest times was my analytical brain. I had calculated out roughly that for every minute I stayed on bedrest, a certain number of alveoli (the end-unit of respiration where there is gas exchange at the capillary level in the lung) were opening in the fetal lung. Every day the baby stayed it had a better chance for the baby. It was due to lung maturity. When I wanted to give up, I would sing to myself “pop pop pop.”  I knew alveoli were opening up.

To all of you who are having a difficult time with social distancing, I realize that you want to do something. Just like my making the plastic bag with my glue-gun because I want to do something about the plastic pollution crisis. You want to do something, so you are hoarding toilet paper and reposting crazy conspiracy theories. You are reacting to this abstract existential threat. But my advice is to instead think of (1) every hour you stay in and every human contact you do not make by social distancing and think of (2) the breath of a grandmother or the tap of an elderly friend’s cane as they make their way down the nursing home hallway still alive. Think of that incremental life and human moment you are saving by doing nothing.

For me though, I have been on bedrest. My two children did not require prolonged intubation. Enough alveoli popped open. The world is in a similar situation. You have to social distance.  I feel your hardship. But now I am a doctor and my uterus is voluntarily closed for business.  I get to go to work and help save the world. I am lucky to be a bit player in this historic moment. But for you friends who are not in healthcare, who are brilliant attorneys, educators and engineers, I know you want to DO SOMETHING. But the best thing you can do is do nothing. Social distance and stay home. You will be saving lives by slowing the spread and #flattenthecurve. Think of the sound of your grandmother’s breath or the tap of an older friend’s cane. Tap tap tap. Whoosh whoosh whoosh.

*I am grateful that KevinMD accepted this blog post to be published among the academic COVID-19 articles. It was an interesting and useful exercise, as I had to edit the original blog which was almost 2500 to 1000. Mr. Plastic Picker helped quite a bit as he used to be the editor of magazines at the Pingry School and Harvard College back in the day.

Did this catch your attention?

March 15, 2020

by drplasticpicker

Did the picture above catch your attention? It’s a bit odd. The large stuffed animal/bean bag animal is some kind of anime/Pokemon formerly loved object my millenial brother dropped off at my house. His 2-bedroom-2-bath downtown condo was getting too filled, and he passed this on to us. It’s an interesting piece of human artifact. Honestly, I did it more to keep it out of the landfill. If you want it , it’s in excellent condition so just let me know and I’ll clean it up (it’s pretty clean) and send it over after the COVID-19 crisis if you have kids who will love it. The other object is a plastic bag I made from scraps of plastic I save. I know it’s weird, but I have embraced my off-kilter personality. The Plastic Picker children consume enormous amounts of clementines now known universally as cuties. They actually do have fiber. My daughter and son pointed out to me about 1.7 grams per clementine https://drplasticpicker.com/squeasy-gear-1-tackling-the-pediatric-fiber-deficit-with-real-fruit-and-not-plastic/. But those cuties come in this god-awful orange plastic mesh bags with an elongated plastic product label strip that is a third the size of a piece of paper. Every time we throw these away, I have this irrational sense of guilt. I think it’s having picked up now 178 bags of ocean bound plastic. I’m not sure how a peditarician who picks up trash and pays my taxes and has not ever had an extramarital affair and never fake-called in a sick-day feels guilt? Not sure what my parents did to me when I was young.

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March 13, 2020

by drplasticpicker

The rain came and it made me hopeful after an exhausting day yesterday.

I had purchased these rain barrels about 3 years ago. There was a major discount or rebate when I got them for almost 50% off. I forget the actual numbers. They are also made from 100% recycled plastic. They have served us well and with every downpour they catch gallons of rain that we later use to water the garden. Lettuce, tomatoes, lemons and many other organic delicious vegetables are the result. What I love about these rain barrels is that they were an investment that keeps on generating food and money savings. I just bought the rainbarrels, and my mother-in-law has taken them over and is so eager to use the water she catches as she says it’s better for her garden. I get to benefit from her garden’s bounty.

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