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Dream Vibrant Health, Asia (2026)

28/12/2021

MY VERY COVID CHRISTMAS

Guess who had a COVID Christmas?

Yep, those two in the pic.

Everyone got PCR’s 48h before travel and all were negative, so we felt good about taking the plunge to see family. N95’s and rapid tests in hand.

The day after we arrive to our destination, we read an email from my daughters school that there had been several COVID cases in her grade and everyone should test. So the following morning we all test, and… she was positive. That evening she developed a fever. Overall, her course was mIld, three days of low fever (thanks vaccine).

So, we isolated her and limited any activities with family, only outside and with our N95 on, as we monitor ourselves, continued to test and continue to isolate our girl.

Two days later I start to feel an itchy throat and figured I was doomed. Antigen test negative, but I continued to isolate. The following morning I repeat the test and positive 😞

That evening, I get high fevers, headache and overall feel like 💩, luckily I had my three vaccines, so I recovered quickly, 24h later no fever and 48h later no headache and I’m feeling well enough to take a walk outside.

Luckily, hubs remains negative to this day!

So now the CDC says that after 5 days of isolation, if you are asymptomatic you can rejoin society, no test needed

Swipe left to see my day 1 and day 5 (today) antigen test results. Now, you tell me, is 5 days enough without testing? Who wants to come hang out with me today 😁?

19/12/2021

HOLIDAY PANDEMIC TRAVEL

In the middle of an Omicron surge in NYC, I am at the airport ready to fly internationally.

To see family that we haven’t seen in 3 years. We thought hard about postponing when we saw cases surge, but who is to say that things will be better a few months from now?

So, N95 in tow and an obscene number of rapid tests in our suitcase, here we go.

If you are in the same boat, play it as safe as possible because at this point, it’s all about risk mitigation (and you may still get sick):

1) Get vaccinated if not already vaccinated

2) If you are vaccinated, get boosted - immunity against Omicron improves significantly with a third shot

3) Test often and liberally - we tested before travel, we are taking several kits to self test during our trip (specifically before and after family gatherings) and plan to test on our return

4) Do the basics - outside as much as possible, wear a mask and distance when not possible and even if outside, avoid crowded spaces (the Bad Bunny concert in PR is an excellent example of how an overcrowded outside concert can become a super spreading event).

5) Enjoy the time you do have with family, because otherwise, why bother risk taking?

Anybody else holiday traveling?

25/11/2021

THANKFUL

Amidst a tough year (or two!), I woke up this morning feeling so thankful to be able to spend time with family again, get away from work and the city for a few days and feel like there is still some semblance of normalcy.

As always, shout out to for lives saved and allowing us to get back together.

Wishing everyone who celebrates a wonderful and healthy thanksgiving!

18/09/2021

What is long COVID?

Also known as long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID

➡️ It consists of a wide range of new, returning, or ongoing health problems people can experience 4 or more weeks after first being infected with the virus

➡️ It can occur even is those who did not have any symptoms with initial infection

➡️ Symptoms are super varied, but include:

Difficulty breathing, tiredness or fatigue, post-exertional malaise (feeling ill after activity), brain fog, chest or stomach pain, headache, heart palpitations, joints or muscle pain, pins-and-needles feeling, stomach problems, sleep problems, lightheadedness, rashes and mood changes.

📕What the research tells us:

➡️ COVID Symptom Study group showed that 1 in 20 people are likely to suffer from COVID-19 symptoms lasting more than 8 weeks

➡️ older people are much more likely to get long COVID than younger people

➡️ women appear to be slightly more likely to suffer from long COVID than men

➡️ people with asthma were more likely to develop long COVID

➡️the more symptoms a person had in the first week, the more likely they were to go on to develop long COVID

What else?

💉 Roughly half of people with long Covid reported an improvement in their symptoms after being jabbed - possibly by resetting their immune response or helping the body attack any remaining fragments of the virus, say experts.

Can I get long covid if I’m vaccinated and get COVID?

💉 Yes, BUT a recent study of breakthrough cases were associated with a 49 percent lower risk of symptoms lasting 4 weeks or more after infection.

So, still, get your 💉, best chance to avoid Long Covid.

Source: Lancet ID sept. 1 and COVID symptom study group

11/09/2021

The pandemic impact on women

We talk about the impact of this pandemic on life, health, medical systems, economy, but I want to highlight the impact it has on women, particularly working women, because it has been enormous and we don’t talk about it enough.

🚺 Women—especially women of color—are more likely to have been laid off or furloughed during the pandemic, stalling their careers and jeopardizing their financial security

🚺 Decades of research shows that women do significantly more housework and childcare than men—so much so that women who are employed full-time are often said to be working a “double shift.”

🚺 Single mothers are much more likely than other parents to do all the housework and childcare in their household, and they are also more likely to say that financial insecurity is one of their top concerns during the pandemic

🚺 Another study by Drexel University found women going through stress associated with work challenges, social situations and life circumstances are at significantly higher risk for developing coronary heart disease, compared with men.

🚺 The U.S. Bureau of Labor Statistics reported women’s unemployment has increased by 2.9% more than men’s.

🚺 Another study reports more women than men reported exhaustion, burnout and pressure to work more.

🚺 What about women in medicine? According to a JAMA Network Open research letter, physician work hours and income decreased with the percentage of full-time physicians dropping from 84% to 80%. At the same time, among physicians with preschool aged children, the percentage of full-time female physicians decreased from 18% to 14% while full-time male physicians did not change.

We need to take action to support working women and ensure diversity and gender parity in the work force.

How are you managing work during this pandemic?

Source: McKinsey.com and other sources mentioned in bullet points

28/08/2021

As requested, here is a review of vasoactives agents and inotropes we often use in pediatrics. Don’t forget to swipe next on the image to review your receptors! I will start with the 4 I use most.

❤️ Epinephrine — Has potent beta-1 adrenergic receptor activity and moderate beta-2 and alpha-1 adrenergic receptor effects. It has a dose dependent effect (lower more inotropic and higher more vasoconstriction). Agent of choice for cold septic shock (IMHO, not a fan of dopamine). Also, often used for the treatment of anaphylaxis. Use caution in patients with dysrhythmias (due to beta-1 adrenergic receptor stimulation).

❤️ Norepinephrine — Acts on both alpha-1 and beta-1 adrenergic receptors, thus producing potent vasoconstriction as well as a modest increase in cardiac output. Excellent choice in the treatment of warm shock and spinal shock.

❤️ Dopamine — Has a variety of effects depending upon the dose range administered. Also dose dependent effect. At doses of 1 to 2 mcg/kg per minute, dopamine acts predominantly on dopamine-1 receptors in the renal, mesenteric, cerebral, and coronary beds, resulting in selective vasodilation. At 5 to 10 mcg/kg per minute, dopamine also stimulates beta-1 adrenergic receptors and increases cardiac output, predominantly by increasing stroke volume with variable effects on heart rate. At doses >10 mcg/kg per minute, the predominant effect of dopamine is to stimulate alpha-adrenergic receptors and produce vasoconstriction.

❤️ Milrinone — Intravenous [IV] milrinone, a phosphodiesterase III inhibitor, increases contractility and reduces afterload without a significant increase in myocardial oxygen consumption. If blood pressure allows, it is a great adjunct in cold shock and when EF is affected.

Source: utdol.com

14/08/2021

On breakthrough infections

I know this is worrying so many of us (me too!), so here is what we know so far:

🦠Breakthrough COVID-19 cases, hospitalizations and deaths are extremely rare among those who are fully vaccinated with the rate of infection well below 1% in all reporting states (not all states report this data)

🦠 In May, a CDC report found that there were around 10,000 patients with breakthrough COVID-19 infections out of the over 100 million people who got vaccinated - that means .01%

🦠 People who are vaccinated have had some immunity, some antibodies - many will be asymptomatic - it seems like around 25% to 30% of the patients who have had breakthrough infections are completely asymptomatic

🦠 About 50% to 60% of the patients who would have some symptoms have mild and unlikely to need hospitalization

🦠10% of the patients require hospitalizations

🦠How many will die out of those? 1% to 2% of those hospitalized from breakthrough infections may still die unfortunately. That is 1-2% from the .01% that got infected.

🦠So out of 10,000 vaccinated, that would mean about 1 could die. What about without the vaccine? In the US we currently have a case fatality rate of 1.5% for patients with COVID. That means that from 10,000 infected people, 150 patient would die.

🦠 So, which would you rather be?

Source: AMA

10/08/2021

How lucky are we!

I used to think a lot about this when I spent a volunteer month in Tanzania’s second largest hospital during my fellowship.

Every morning, during morning report, I heard the pediatric deaths from the previous 24 hours. The first morning I was there, I was shaken.

Eight pediatric deaths were reported. Eight children in under 24 hours.

Surely this must be a fluke, I thought. There is no way so many children are dying!

Here in the US, during a particularly bad MONTH, I may have seen 3-4 patients die in the ICU. But this was in ONE day. What?

As my time there continued, I came to realize this was the norm. Not because of lack of physician expertise, because the doctors I met were truly excellent.

The problem was lack of resources – there was a nursing shortage, there were 2 vents for all the hospital, the power failed frequently, there was no pharmacy mixing drips for ICU patients, not enough monitors, not enough beds. Just not enough of anything.

And I was sad, but grateful. So grateful that I lived in the place where we had all the resources, all the technology.

However, during this pandemic I have realized how this privilege has made us lose touch.

We are so used to having our kids saved that we have grown entitled, the expectation being that all children will be saved. But if hospital resources are taxed, nobody can be saved.

Also, if you don’t wear masks and vaccinate eligible children and adults, not only adults die, but so do children.

Do children with SARS-COV-2 infection die less frequently than adults? Sure. However, 416 children under 18 years have died from COVID and this doesn’t take into account all the comorbidities that may develop ( speaks about this eloquently!). These include post-acute COVID (about 10% of children), new neurologic deficits (5%) and let’s not forget MIS-C. There are also many other conditions that we are just learning about!

Bottom line? Don’t take your children’s health for granted! Protect them with the prevention strategies we have (AKA masks and distancing) and vaccinate them if eligible.

Thank you .79 for my beautiful science necklace.

01/08/2021

ꜱᴄɪᴇɴᴄᴇ ʜᴀꜱ ɴᴏᴛ ꜰᴀɪʟᴇᴅ ʏᴏᴜ ᴀɴᴅ ɪᴛ ᴅᴏᴇꜱ ɴᴏᴛ ʟɪᴇ

Science gives you facts and it’s a self-correcting process. It does not interpret, it just provides you information and as that information evolves, it updates the information and gives you new facts.

What we are seeing with this pandemic and changing of recommendations is based on what we learn from new data. It will continue to change and evolve, it is not a failure or lie, it is the scientific process.

Less than two centuries ago, science taught us simple rules of hygiene such as washing hands before going to the delivery room could significantly decrease maternal and infant mortality.

Sixty years ago, pneumothorax was used to treat pulmonary tuberculosis. As we learned more, we changed and now this type of therapy is considered obsolete and we effectively treat most instances with anti-microbials.

The average life expectancy a century ago was 45 to 55 years, and thanks to scientific discovery and evolution, we are now at almost 80 years for developed nations. Life expectancy has constantly increased by 2.5 years per decade from 1840 to 2002, thanks to scientific progress.

“The eternal evolution of medical science and medical technology, and their clinical applications, will result in continuous changes and metamorphosis of diseases of time present, as it was the case with diseases of time past”

Source: Hellenic Journal of Cardiology

26/07/2021

ᴅɪꜱɪɴꜰᴏʀᴍᴀᴛɪᴏɴ ᴅᴏᴢᴇɴ

If you follow the news or saw .nicolebaldwin interview on CNN, you may have heard about the disinformation dozen.

These are the people responsible for 65% of the misinformation spread on social media regarding the COVID vaccine.

The ones that said you will become infertile or transmit 5G 🤦🏻‍♀️

I am going to do a little whistle-blowing because if you follow any of these people as sources of COVID information, please don’t. There is 0 scientific merit to what they are saying and they are giving you erroneous information as we go into yet another surge. Sadly some of these are physicians.

Who are they?

1) Joseph Mercola, an osteopathic physician

2) Robert F. Kennedy, Jr., the son of Robert F. Kennedy and an environmental lawyer, known anti-vaxxer.

3) Sherri Tenpenny, an osteopathic physician who believes vaccines cause autism

4) Rizza Islam, an antisemitic and anti-LGBTQ social media influencer

5) Rashid Buttar, an osteopathic physician known for using chelation therapy for numerous conditions, including autism and cancer

6) Erin Elizabeth, runs an alternative health site called “Health Nut News”

7) Sayer Ji, the founder of GreenMedInfo

8) Kelly Brogan, an author of books on alternative medicine

9) Christiane Northrup, an obstetrics and gynecology physician and author

10) Ben Tapper, who works as a chiropractor

11) Kevin Jenkins, a social epidemiologist focused on inequities in healthcare

12) Ty and Charlene Bollinger, self-acclaimed filmmakers

As always, carefully vet everything you read and see and question anything that doesn’t seem to make sense.

Source: nautilus

Dream Vibrant Health

28/12/2021

19/12/2021

25/11/2021

18/09/2021

11/09/2021

28/08/2021

14/08/2021

10/08/2021

01/08/2021

26/07/2021

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