Checking Up On Health: May 3, 2021

Medical Monday: A weekly post of healthcare- and technology-related policy news, views and commentaries.

Stop me if you’ve heard this one before:

A man goes to the doctor and says, “Doctor, wherever I touch, it hurts.”
The doctor asks, “What do you mean?”
The man says, “When I touch my shoulder, it really hurts. If I touch my knee – OUCH! When I touch my forehead, it really, really hurts.”
The doctor says, “I know what’s wrong with you. You’ve broken your finger!”

I share that to share this:

Vitiligo is a chronic, progressive condition in which the skin’s pigment-making cells (melanocytes) are lost or destroyed, causing white patches on the skin that spread and join together. This can happen at any age and nobody knows why. It’s believed to be an auto-immune condition – that is, a malfunction of the immune system in which the body attacks its healthy cells. It spreads in some people and goes dormant in others. There’s no known cure, although there are numerous treatments that might slow vitiligo. And some treatments can be worse than the disease, which is painless but can be psychologically debilitating. One treatment, for example, is abrading (scraping off) skin and grafting healthy cells.

Globally, about 1% of the population has vitiligo. I am one of them, and it spread on my hands and arms over the past two decades to the extent that curious people have asked whether I burned my arms in a fire. A dermatologist prescribed an intriguing medication –  one that permanently removes the pigment from the rest of the skin and evens the tone. In other word, it’s no cure but it improves the aesthetics.  It’s called Benoquin, or monobenzone. Applied in ointment form twice a day, this potent medication apparently takes one to four months to depigment the area where it’s applied.

I’m about a month into applying the ointment on my hands and arms. There’s not that much literature on side-effects. So when I noticed this week that my eyes were puffy and cheeks swollen in the morning, I immediately started fretting. Is the monobenzone giving me liver and kidney problems? Do I need to stop the treatment before it kills me? Is this one of those cases where “The operation was a success but the patient died”?

It appears the monobenzone was indeed the cause. But it wasn’t the medication so much as how I sleep:  After processing the problem, it occurred to me that I sleep on my back and have the habit of throwing my arm over my face and eyes. The swelling was a cumulative reaction to the medication transferring from my arm onto my eyelids,  something the prescription pamphlet specifically warns against.

So I didn’t need a doctor visit. I resolved to protect my face by wearing an eye mask at night. The swelling has disappeared, although the joshing about the mask hasn’t!

Reading another blog post about vitiligo also helped me understand why I may have reacted so strongly to the second dose of the Moderna COVID-19 vaccine, which took me about two weeks to recover from

But in any way you look at it, it doesn’t mean that your immune system is weak because you have vitiligo. It actually means that it’s a little too strong, so you are most likely NOT more susceptible to coronavirus or any other virus. Some of my patients report that they get fewer infections than their friends and family, and this may reflect the fact that the immune system is a little overactive.

The moral of the story: Try the process of elimination; it’s not always a complicated diagnosis.

Free again! Free again! Effective Saturday May 1, Georgia Gov. Brian Kemp’s latest executive order has restored the state to about as normal as things can be under the continuing COVID-19 pandemic.

Yes, the pandemic isn’t over. In fact, the governor renewed the public health state of emergency through the end of May in his executive order on April 30. Georgia is likely to face more cases, more deaths, and more Covid strains, or variants, as they’re called. And for so many Americans who have waited to be told what to do for the past year-plus, this new order of things may be quite unnerving. Here’s an idea: If you were satisfied under the previous protocols, as you were.

But … if you’re waiting for a return to your pre-pandemic routine, the new guidance includes these steps:

  • Social distancing and sanitation mandates are now simply “strongly encouraged” measures.
  • Bar and restaurants need no longer require workers to wear masks, and their table distances can return to pre-pandemic spacing.
  • All specific requirements end for gyms and fitness centers, movie theaters, body art studios, estheticians, hair stylist, and massage therapists, and restrictions on conventions are reduced.
  • Live performance venues will also now be held only to the requirements of organizations in general, regardless of seating capacity.
  • Graduation ceremonies need only follow the guidelines for other organizations, while professional, collegiate and high school sports organizations will still operate under the constraints issued by their leagues, conferences or associations.

At the federal level, however, the Transportation Security Administration has extended the federal face mask mandate that was set to expire May 11. Travelers must mask up at airports, aboard commercial flights and on other public transportation across the country through the summer through September 13.

Stress, anxiety and depression have all taken hold in the pandemic. In homes, healthcare, businesses and relationships, Americans are struggling to cope. Health professionals, too. A nurse interviewed in an article for Becker’s Hospital Review explained why she left the profession in the midst of the pandemic:

 My mental health suffered more than I had ever experienced. Since leaving ICU bedside nursing, I’ve dealt with anxiety and PTSD –  something I didn’t even realize nurses could suffer from as a result of working conditions. Mental health in healthcare workers is not talked about enough. There’s a stigma around it. And, in a hospital setting, those struggling with their mental health may feel inadequate or even be told they are inadequate by others.

Vaccine anxiety: Dozens of recipients of the single-dose Johnson & Johnson COVID-19 vaccine experienced adverse physical reactions because of anxiety and not the vaccine itself, according to the Centers for Disease Control and Prevention. The agency investigated clusters of anxiety-related events, with a total 64 incidents out of 8,624 doses administered, reported to the CDC by five mass vaccination sites across five different states.

Quote of Note

“One thing is clear: Months into the nation’s vaccination drive, the CDC has a limited view of how much vaccine is going to waste, where it’s wasted and who is wasting it, potentially complicating efforts to direct doses to where they are needed most. Public health experts say having a good handle on waste is crucial for detecting problems that could derail progress and risk lives.” – Kaiser Health News

Compiled by Benita Dodd, vice president of the Georgia Public Policy Foundation.

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