Tuesday, July 14, 2020

Is Telemedicine Here to Stay?

I recently submitted an article to MIT's department of athletics in response to their request regarding alum's involvement in COVID-19. Life has been busy and with so many things going on in the news... it has been hard to find time to process, think, and blog. Honestly, by the end of the day, my brain just wants to vegetate. Well, here is what I sent them... I feel it summarizes life since March...

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Dr Ellen H Kim ’97 was a four year starter on MIT’s field hockey team during which they won their first ever New England Women’s Eight Conference Championship in 1994. She also made All-Conference team and the National Academic Squad her senior year and graduated with a degree in biology and a minor in music. She went on to receive her M.D. from Drexel University College of Medicine and then completed her residency in family medicine at the University of Pennsylvania, where she served as chief resident. Dr. Kim currently works in private practice at Wrightstown Family Medicine in Newtown, PA and is mom to four kids ages 6,9,10, and 12.



These last few months have been challenging, simultaneously transitioning a busy outpatient practice to essentially all telemedicine while managing four kids ages 6,8,10, and 12. Supervising their “distance learning” was a bit painful. Fortunately, my seventh grader was fairly independent, but the younger ones were easily distracted and needed more direction. The concern was not so much the volume or difficulty of the schoolwork, but so many hours in front of a screen affected their emotional lability and grumpiness. Keeping track of the different zoom calls was a whole other undertaking. My husband, Dr. Joseph Kim, MIT Class ’98, runs his own consulting and CME company, also had to work from home. Imagine the craziness of all six of us accessing our respective laptops and computers to participate in numerous zoom meetings throughout the day!

Our dining room turned into a temporary classroom for my kindergartner, third-grader, and fourth grader.

  

My seventh grader distance learning from her room.               

My fourth grader submitting homework online

My medical practice cares for a wide range of patients from newborns to great grandparents. We wanted to stay available and offer medical care and treatment to those who need it. However, it was necessary to protect the more vulnerable and not contribute to the spread of COVID-19 that was sweeping through our region. Many who live in our county either commute to New York City for work or have grown children who left the city to quarantine with their parents. There were also folks who returned from travel overseas or returned home from college, which all played a part in our rising infection rate.

Our office hosted a Friendsgiving luncheon for some of our patients in Nov.

At the end of March, the sudden surge of positive COVID-19 cases in our area resulted in schools emergently shutting down. We faced a similar urgency in our practice to separate the exposed with those not infected. During those early days, I recall the frustration of trying to help direct care when there were no concrete guidelines. Disappointed at the lack of testing availability, we felt somewhat helpless but pushed on to formulate treatment plans. We endeavored to help our patients and steer the course of their illness to recovery. Our goal was to ward off the need for emergency room visits which may ultimately result in hospitalization and even ICU admissions.

In order to prevent the healthy and especially the more vulnerable patients from contracting COVID-19, and to not be the vector of transmission ourselves, we converted our practice to mostly telehealth services online. Fortunately, we were able to do this without needing to ever close our doors. Of course, there were some bumps as we switched to conducting interviews virtually rather than face to face. The adjustment was both on our end as well as our patients’ end and it certainly took some getting used to.

At the end of the day, telemedicine provided us the ability to offer care to those needing routine maintenance for their medications and address new issues not related to the coronavirus, while also delivering care to those exposed and fighting COVID-19. It has been busy but rewarding to be able to meet needs. To avert hospital overload and to prevent medical staff burn out, it was crucial for us to help curve ER visits by treating sick patients from home. Telemedicine gave us the means to do so but we also had a physician available for in-office urgent cases that are not sickness related.

Information for COVID-19 constantly changes and recommendations still get revised as research and new data pours in. As primary care, our job is to filter out what is relevant and apply it to the care of our patients. This global pandemic is not yet over and although we are now seeing more patients face to face for in-office visits, telemedicine is still available. It is essential to have for those who may be more high risk, and convenient for those who do not need to come in person or those who have a hard time getting transportation. Some form of telemedicine will likely be here to stay even as the pandemic resolves. Given the way things look, that resolution may still take some time.


My little hockey player giving a virtual presentation about the sport to her class
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Thursday, May 7, 2020

Teacher Appreciation Week



When first we heard
No more school...
We shouted and danced
And thought it'd be cool!

But soon we discovered
This is no fun
No place to go...
Where can we run?

We miss our friends
We miss our classroom
It is not the same
Meeting up on zoom

But learn we must!
On our chrome books all day...
Oh, come on... really?
Is there no other way?

Thank you, teachers!
Thank goodness for you!
If you weren't there
What would we do?

Thank you for your time
Your devotion and care
Our appreciation and love
We want to share

We are lucky to have you
What more can we say?
Stay safe and healthy!
See you soon, we pray




Thursday, April 9, 2020

Staying Home During the Covid-19 Pandemic

Anytime you turn on the television or internet these days, I'm sure you are getting plenty if not too much information about Covid-19. Boy have things escalated and changed since my last post written in the beginning of March! Instead of re-hashing what's already out there, I figured I'd focus this post on our "new normal" and some of the blessings in disguise...

Some snapshots of our lives so far...
sibling chess matches
lots and lots of puzzles...
haircut in the garage
tae kwon do zoom class
Sunday church service
This week is Spring Break so I had a chance to step away from work and just be with my family. Since we cannot travel this break as we usually do... decided to be creative and just "pretend" we are on vacation anyway! 

Kids are sleeping outside in a tent as I type...
Personally, taking a break from going anywhere and having all outside activities cancelled has been a nice change of pace for me. Here is a list of some things I'm thankful for...
  • being able to wake up at around 8a (or later...) every morning because no need to get my middle schooler to school... before had to wake before 7a and not being a morning person... it was super painful
  • in fact, no morning "rush" at all... before had to get the 4 kids out of the door during the weekday... was always the most stressful 90 minutes of the entire day!
  • actually having time to go for a walk or run in the neighborhood... before I was either at work or in a car driving someone to sports or music lessons or something... by the time i got home and got the kids to bed I was exhausted...
  • actually having time to cook meals and having fun doing it... before I relied on my mom and my au pair to prep most of the meals because I was either at work or in a car driving someone to sports or music lessons or something...
  • even having time to bake and make desserts... yum!  ... and fun! ...before I was too tired from the day to want to do any of this even if I did have the time...
  • eating meals together... like all three meals... every single day... hm... now that I think about it, not sure this one counts as a blessing... lol. There are moments I suppose where good memories will be made along with the crazy.  Like today for instance, at dinner time we were all singing at the top of our lungs... different songs from different musicals... was a blast!
  • watching movies... lots of them... I'm a movie person because I like escaping into a different reality. What better way to not think about the negative news all day long then to disappear into another world. So we make popcorn, snuggle up with blankets on our beanbags in the basement and watch movies together. We kind of started this tradition last summer when we went through all the Harry Potter movies.  Now we have also finished all the Avenger movies in order, went through some DC Comics, even showed my kids the original Superman with Christopher Reeves, then on to the Dark Knight Trilogy... Ip Man 1 2 and 3 (looking forward to Ip Man 4!) ...and now going through X-Men series...
  • having "daddy" home... before he would travel at least two or three times a month so having him home everyday is a plus...
All in all... I'm grateful for the slower pace of life. I feel more rested. What's more, it's amazing how much gas I'm saving. Usually, I have to fill my tank about twice a week but now I think I've gone almost 4 weeks without the fuel gauge indicator moving much at all.

Next week, I'll be back to work. Right now, that means Telemedicine. We cannot risk spreading the virus to the vulnerable who can get very sick and end up hospitalized, intubated, etc. So the "stay at home" advice is truly to combat an invisible enemy... to protect those in our community most susceptible to falling severely ill... to prevent overwhelming the hospitals and medical staff in our communities. It may sound redundant and over stated... but truly... please stay home!

So what to do during this time?  Many creative ideas out there on the internet on how to not be bored... but keep in mind these main things to stay healthy:
  • Eat well - with all the extra time and easy access to the kitchen, may be challenging to avoid binge eating, snacking, grazing... may be tempted to fill up on sugars, chips, carbs... so don't forget your fruit and vegetables
  • Exercise - try to get outside for fresh air and exercise daily... make it part of your routine
  • Relax- important to find your own space and have some "alone" time... if necessary may need to do this outdoors but it is important to have a moment in your day to evoke the relaxation response
  • Sleep - perhaps this is the most important of them all... but get your sleep! sleep will boost your immune system, improve your mood and energy, sharpen your mind and focus... cannot emphasize enough the importance of sleep... below are some tips I posted a while back on some tips to improve sleep:
  • routine routine routine... 
    • develop a bedtime routine about 1 hour before bedtime to wind down
  • induce physical relaxation
    • take a hot shower or soak in a warm bath to relax the muscles
    • give yourself a body rub with a moisturizer that has a pleasing but not super strong scent
    • can try lavendar scented candle, room spray or essential oil
  • avoid increasing stress right before bed
    • avoid the news right before bed
    • avoid hard conversations
    • write down your worries and put it in a box if need be to address in the morning
    • shut down all electronics at least 30min but the longer the better before bedtime
  • minimize sound
    • use white noise if needed
    • try ear plugs
    • go to bed and fall asleep before the person snores next to you
  • exposure to light
    • flood yourself with natural sunlight during the day
    • avoid blue light at night (computers, cell phones, ipads etc)
    • if need to use night light, use red light
  • exercise
    • don't do it too close to bedtime
    • but regular exercise during the day helps
  • watch what you eat
    • certain foods actually may help (like cherries, milk, bananas, turkey, and even not too sugary carbs)
    • avoid foods that cause heartburn (like burgers and tomato based foods or spicy foods)
    • avoid foods that are high in sugar
    • watch what you drink
    • avoid caffeine of any type past 4pm
    • avoid alcohol too close to bedtime (less than 2-3 hrs prior) as this may initiate sleep but disrupts the maintenance of sleep
    • avoid too many drinks of any type past dinner as this may cause the need to go to the bathroom during the night
    • in small quantities certain herbal teas may help
  • minimize disruptions
    • avoid sleeping with a pet
    • sleeping with small children can also be disruptive
    • so what to do if you just can't get the worries out of your head? 
      • try thinking of a story or play a movie in your head that would not evoke a strong emotional response, that way while you are thinking of that, other thoughts have a harder time creeping in and it is much easier to fall asleep when imagining things that have no emotional tug than dwelling on worries, things that happened during the day, or things that you plan to do in the future... 
    • what NOT to do if you wake up in the middle of the night...
      • look at the clock (cause then you're doing math and that wakes up a part of the brain that otherwise would not be activated at this time...)
      • get up and go to the bathroom (I know this one can be hard and may not be possible for everyone, but truly if you get up you are now using muscles and again that wakes up another part of the brain that normally is not active at this time
Well, stay healthy and well, everyone. If you start to feel sick, develop a fever and cough, or just need to get checked, do reach out to your physician. Despite everything, lots of encouraging stories out there as well. We can get through this!
...rejoicing in hope, persevering in tribulation, devoted to prayer - Romans 12:12 (NASB)

Tuesday, March 3, 2020

Corona Virus Update

So here is my update to my previous post about the new corona virus that started in China...

Credit: NIAID-RML

What is COVID-19?
That is the new name given to the new strain of corona virus that was first discovered in Wuhan, China.

What are the symptoms of COVID-19?
  • most common symptoms
    • fever
    • fatigue
    • dry cough
  • other symptoms
    • aches and pains
    • nasal congestion
    • runny nose
    • sore throat
    • diarrhea
Is it serious?
  • usually starts with mild symptoms and 80% of folks who are infected will recover like getting the flu or bad cold
  • 1 out of 6 folks may get very sick and develop difficulty breathing (usually folks who already have chronic conditions and weakened immune systems)
  • 2% of those infected have died so far
How widespread is it?  click here for latest map and update from NY Times
  • at least 71 countries are affected so far
  • 116 cases in the US with 9 deaths so far
How do I catch it?
  • from droplets of someone who is infected expelled on cough or exhale
    • if you touch a surface that has the droplets on it
    • if you breathe in the droplets after someone coughs or exhales
  • no studies yet suggest that you can catch it just from the air
  • very low risk of catching it from someone who is not sick
    • however symptoms are mild in the beginning and person may not know they are infected until their symptoms are more severe
  • symptoms may not show up until up to 14 days after exposure
How can I prevent getting it?
  • regularly and thoroughly wash your hands with soap and water
  • maintain at least 3 feet distance between yourself and anyone who is coughing or sneezing
  • avoid touching your eyes, nose, mouth
  • make sure you and the people around you follow good respiratory hygiene
    • cover your cough/sneeze with bent elbow
    • throw away used tissues immediately
  • stay home if you feel unwell
  • call your doctor if you have fever, cough, difficulty breathing
  • follow instructions from local health authority
** these are great guidelines everyday anyway and should be practiced ALL the time to prevent the common cold, flu, pneumonia, sinusitis, and GI bugs, etc!

Who benefits from wearing a face mask?
  • those who have symptoms have COVID-19
  • those caring for folks who have symptoms of COVID-19
  • health care workers caring for individuals with fever and cough
**if you do not have symptoms or caring for anyone with symptoms, it is not recommended to wear a mask

For more detailed explanations and Q&A's on this topic you can read it here on the WHO website.

So what is the bottom line?
  • do not panic
  • stay up to date on the latest recommendations from reputable sources
  • use common sense
  • there is a growing list of countries that have travel restrictions... but stay up to date and consider whether non-essential travel is worth the risk, click here to check the cdc website for travel advice for your destination (remember - this may change in a day)
  • if you get sick and are not sure what to do, call your doctor