Originally published in Hideaway Lake News on July 2 , 2021

After a rather wet and cool spring, we’re now in the midst of our hot Texas summer. Let’s make sure we stay cool and safe.

A veteran golfer came up to me this week and said “Doc, you need to tell people to use umbrellas on the green!”. We ended up talking about how most golfers have minimal sun protection on the green as they stand for several minutes waiting for everyone to get their turn. They do have shade in their carts while riding around, and some wear caps. Hopefully all are wearing sunscreen. But the sunscreen is probably all wiped off after the very first hole due to all the sweating and wiping within the first few minutes! I’ve rarely seen anyone reapply sunscreen on the course. Some say they don’t wear sunscreen because it stings their eyes as the sweat pours in. So the best thing to do is to wear a very wide brimmed hat that protects not only your face but your chest and neck. You might also consider carrying a light umbrella for when you’re standing in the wide open green.

And don’t forget to take a water bottle and fill it at each watering station. It’s very easy to get dehydrated between stations on the golf course, especially if you’re older and taking certain medications. It’s not enough to just get a few sips in a conical paper cup every few holes! Don’t wait until you get thirsty to drink water, just keep drinking the entire time you’re out in the sun. Being out on the lake in the summer heat can also take its toll. Frequently reapply sunscreen and don’t skimp on drinking water just because you’re surrounded by all that water on the lake!

Try to avoid the peak afternoon sun if possible because heat exhaustion can quickly turn into a heat stroke if you’re not careful.

Most of us are aware of sun burns and heat rashes and how to take care of them. But many may not be aware of the warning symptoms of heat cramps, heat exhaustion and heat stroke. If you develop muscle cramps while playing golf in the hot sun, you may be getting heat cramps. Stop playing immediately and get to a cool place where you can get hydrated. You’re at especially high risk if you’re on medications that cause low sodium such as for high blood pressure or heart problems, or if you sweat profusely. Talk to your doctor about safely using a sports drink for electrolytes, in addition to water if you get heat cramps.

Clammy skin, lightheadedness, headache, nausea and fast heart rate are all symptoms of heat exhaustion. Call for help immediately if you have any of these symptoms. Loosen your clothes, get to a cool place, drink lots of water and get prompt medical help if you are vomiting, not improving or symptoms last more than an hour.

If your skin feels hot and DRY, your body temperature is over 103 F or you get confused, call 911. You might be having a heat stroke and need immediate medical attention.

Enjoy the lovely summer in Hideaway’s pools, lakes and golf courses. Just take a few simple steps to stay hydrated and protected from the sun. Happy summer to us all!

Originally published in Hideaway Lake News on May 29, 2021

The CDC issuing new mask guidelines has sent some people into a frenzy of fear and panic and has made others throw up their hands and say it’s about time. It does not matter which group you belong to, the reality is that this change is based on excellent data that have been collected ever since we started mass vaccinations.

Real world data have shown that the vaccines are working very well in preventing transmission, severe disease and death. Although it is possible that you may get infected with COVID-19 even after complete vaccination, the chances are extremely small, and even then, the chances that you will end up severely sick on a ventilator or die from it are miniscule. We take risks everyday when we drive, eat, pop a pill or go for a hike. Life is never zero risk. We each make an informed decision, consciously or subconsciously, everytime we engage in an activity of living, about how much risk we are willing to tolerate. This includes getting vaccines and wearing masks.

If you are the person who threw up their hands and yelled “finally”, then please don’t be judgmental of those who still walk around with a mask regardless of vaccination status. Each of us has a different level of risk tolerance and we should allow people to do what they feel is best for their own health. On the other hand, if you are not yet psychologically ready to take off that mask despite being fully vaccinated, then there is no harm in continuing to wear one. Just don’t panic when you see someone else not wearing a mask. The biggest fear now is that the person not wearing a mask could be lying and is brazenly going about without a mask when they have not been vaccinated. Remember the science, the risk of that guy infecting you and causing you severe disease is extremely small. We also have good data that the vaccines are very effective against severe disease from all the variants too!

In recent times, just before the mask update, the CDC also upgraded airborne to the number one mode of transmission instead of droplet transmission which was considered the main mode up until now. Cloth masks mainly provide droplet protection and not airborne protection. This means that avoiding large crowds in indoor areas with poor ventilation becomes even more critical if you are unvaccinated.

The vaccines have been a scientific miracle. They have exceeded all my expectations. I have to be honest, I was very sceptical when people were talking about a vaccine in 2021. I am thrilled to have been proven wrong. We now have vaccines whose safety and efficacy have been firmly established after 274 million doses over almost 6 months. If any problems show up later, we know they are going to be extremely rare. Again, nothing is risk free.

So I for one am very pleased to see the CDC adjust guidelines based on data. That is what following the science means. Let us not panic about what the other guy is not doing to protect us, instead let’s focus on what each of us can do to protect ourselves. Let’s get vaccinated!

Best of health to us all and here’s to a cautious crawl towards normal.

Originally published in Hideaway Lake New on May 1, 2021

The pandemic has led to an average weight gain of 29 pounds in the past year, with some people gaining more than 50 pounds during that time. There is no quick and easy way to lose the weight that took months to put on. We have to go back to tried and true methods that are slow, steady, healthy and guaranteed to work. Each one of us has to find the plan that works with our bodies, our lifestyle and our likes and dislikes. However, having said that, we can all use the following guiding principle to help us get started and adapt it to our individual needs. The mantra always is eat more whole foods, more plant based and not too much.

The Harvard Healthy Eating Plate is a guide that I have used both with myself and with my patients over the years. It is a system that allows for balanced eating regardless of the type of diet you follow. If followed exactly as shown, it is closest to a Mediterranean diet which has been clinically proven to reduce cardiovascular risk. If you substitute the whole grains with veggies and healthy fats, it will accommodate low carb diets. If you choose only plant based proteins, then it will accommodate vegetarian and vegan diets. But ultimately, it allows you to get a healthy meal regardless of the type of diet you choose.

Notice that the vegetable portion is much larger than fruits. If you are following a very low carb diet, you can completely substitute non-starch vegetables for the fruits as well. Starchy vegetables like potatoes are considered a grain equivalent and should not be counted as veggies on the plate. Berries are low in sugar and a good option for fruits. Try to get at least one plant based protein such as lentils, beans and chickpeas for your healthy protein portion for the day. Drink plenty of water and avoid drinking your calories in the form of juices and soft drinks. Make sure that every plate in front of you has healthy proteins and lots of non starch vegetables.

The above method avoids counting calories, fat grams and carbs and gives you a nice visual guide to what should be on your plate. Take a minute to analyze your plate at your next meal and make some changes to get the right proportion of your nutrients. For more information on this method of eating, go to https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/.

Wishing you all the best for healthy and tasty eating!

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Hideaway COVID-19 Vaccine Database

Hello Hideaway residents! 

The City of Hideaway has set up a voluntary database of  residents who have been vaccinated  in our community. The list will not be shared with anyone for any reason, it is simply to get an idea of vaccination rates. This will also enable us to estimate in the future how close we are to getting to herd immunity.

Please go to the link below if you have been fully vaccinated and would like to be included in the vaccine database. Again, this is completely voluntary and confidential.

Thank you for your help in safely getting us all back to normal!

Vaccine Database

As of April 20, 630 or about 20% of people in Hideaway reported being fully vaccinated. Of these, 55% were women, 45% were men and 96% were over the age of 60. 

Originally published in Hideaway Lake New on April 2, 2021

As more and more high risk people get vaccinated and COVID-19 deaths decrease across the country, we realize that the virus is not the only thing killing people out there. In our urgency to fight this new disease, we have forgotten the old ones that continue to threaten us just as much.

We heard about the “quarantine 15”  like the “freshman 15”, as people started gaining weight when they sheltered at home during lockdowns. However, after one year of drastically changed lives, it is no longer just a matter of the “quarantine 15”. A new survey of over 3000 people reported an average gain of 29 pounds during the one year since the pandemic started. 10% of people reported a gain of more than 50 pounds!

We know that even a 5-10% increase in weight above normal puts us at increased risk for diseases such as diabetes, high blood pressure and heart disease. So the large weight gains seen here are very disturbing as they could bring on a host of other chronic diseases that people will have to battle all their lives. Such rapid gains in weight often point to a combination of psychological and physical stressors, which is exactly what all of us have faced during the pandemic. Some more than others.

Many of us worked from home, often in front of computers for hours on end. When we finished work, we just moved in front of the television or got on our phones. These were the only options for entertainment as people were encouraged to stay home to reduce the spread of the virus. We stopped going to gyms, crowded walking trails and  playgrounds.  

Several of us turned to cooking and baking as we had more time on our hands that we would otherwise spend on commutes. And we couldn’t share these goodies with anybody else due to gathering restrictions, so we ate it all ourselves! We were scared, lonely, bored, and many of us were clinically depressed. So we turned to food and alcohol to comfort us, old frenemies that fill our needs when our real friends cannot. 

We wore pyjamas, leggings and t-shirts since we didn’t need to dress for work. The elastic and stretch in our comfort clothes didn’t alert us to our expanding waistlines. It’s not until now, when restrictions are easing and we’re trying to get back into work clothes, that we realize how none of those clothes fit us. Many of us missed our annual physical with our doctors, so we may not know if our blood pressure, cholesterol or sugar have increased along with our weight.

This is a wakeup call. Not to start obsessively weighing ourselves and counting every calorie and carb that goes into our mouths. But to get up off the couch, turn off the TV, clean out our pantry of all the junk food, and replenish our refrigerator with fresh fruits and vegetables. Find our walking shoes and get back into our daily exercise routine. Take the first steps to improving our mood, getting better sleep, eating more whole foods, being more physically active and reconnecting safely again with our loved ones. 

Wishing us all good health and happiness. Healthy ways to get back into shape coming soon

Originally published in Hideaway Lake New on March 4, 2021

Almost 50 million doses of the mRNA COVID-19 vaccine, either Pfizer or Moderna, have been administered at the time of writing this article. According to data, the risk of severe disease is reduced by 95% after you receive two doses of either vaccine.

You get maximum protection against the virus starting at about two weeks after the second dose of your mRNA vaccine. At this time we do not know how long the immunity from the vaccine will last, but we hope it will be for several months to a year. A recent study reported that people with natural COVID-19 infection could have immunity for 8 months or longer, so we expect something similar with the vaccines as well.

Although about 10% of the population has been vaccinated, and about 20% of the population has been estimated to have recovered from a natural infection, these numbers are not close to providing herd immunity. We will likely need at least 60% of people vaccinated or recovered to reach herd immunity, which is when things can start getting back to where they were before the pandemic. However, until that happens, there are some allowances that can be made for those who have been fully vaccinated, i.e. two weeks post second dose, and have no COVID-like symptoms.

Note that none of these activities described below are completely risk free since the vaccine does not provide 100% protection, but then there are very few things in life that are totally without risk. If all interacting parties are fully vaccinated, then the risk of severe disease is minimal.

The CDC has announced that if you are fully vaccinated, you don’t need to quarantine after exposure to someone with COVID-19, as long as you have no symptoms.

You could hug someone who has been fully vaccinated.

You could have a small group of fully vaccinated people socialize over a meal.

You could play a game of bridge with a small group of fully vaccinated people.

You could sit with your fully vaccinated buddy in a golf cart.

It will take several months for us to reach herd immunity, and while we get there, we would still need masking and social distancing in general public settings since there is no way to know who is and isn’t fully vaccinated. Unless you personally know that a person is vaccinated, assume that they are not.

For those of us who have not yet been vaccinated, we should take heart that vaccine production is steadily increasing and new vaccines are being submitted for approval, including some that will need only one shot. The future’s certainly looking brighter. Of course there are risks of new mutations that may not be susceptible to the current vaccines, but the sooner we reach herd immunity, the harder it will be for the virus to replicate and mutate.

Let us start taking cautious baby steps towards socializing among fully vaccinated people.

Hopefully these baby steps will soon get us back to normal. Be healthy and happy!

Originally published in Hideaway Lake News on Jan 29, 2021

Yes folks, they have arrived! I’m talking about the greatest celebrities in the world right now – the COVID-19 vaccines. They have been a miraculous achievement of modern science, technology, engineering, manufacturing, storage, transportation and distribution. So many people all over the world had to come together to make the unthinkable happen. When they started talking about a vaccine by the end of the year in 2020, I scoffed. History told me that the average vaccine takes 8-10 years to produce and the fastest vaccine to market prior to the pandemic took four years. There was no way any vaccine, let alone a safe and effective one, was going to be ready within months. Or so I thought. But I am thrilled to have been proven wrong! We now have not one, but three, and likely several more in the coming months. Not only have they been manufactured, they are being distributed and administered to healthcare workers and high risk general public despite the many challenges involved.

The efficacy has been very clear with the mRNA vaccines – 95% reduction in severe disease with two shots. These vaccines produce a robust immune response, which means they are also likely to produce the side effects associated with that response – sore arm, fevers, body aches, fatigues, chills and headaches. These have all proven to be temporary and resolve in a few days. No severe reactions were observed during the trials, but after the vaccine was administered to over 2 million people, a handful experienced life threatening anaphylactic shock, all of whom recovered fully with prompt medical care. Most of them had a history of anaphylaxis, so if you have a previous history of severe allergic reactions, talk to your doctor before you get the vaccine. 

Some people are concerned about the long term side effects such as autoimmune reactions. We probably won’t know until the vaccine has been out for a few months. Such events are most likely going to be very rare, just like the anaphylactic reactions. So if you are a person at high risk for severe disease from the virus, your likelihood of dying from the virus is much higher than of getting a long term side effect. On the other hand, if you are a person at very low risk of severe disease, such as a child or a young adult with no underlying medical conditions, then you may choose to wait until the higher risk people are vaccinated and we have more population data available. 

Our supply of the vaccines is limited right now, so please don’t find loopholes to get vaccinated if you are not at high risk for severe disease. If you are young and healthy with no medical conditions, then even if you are in a job at a high risk for exposure, you are not at a high risk for severe disease if you do get infected. Please allow our most vulnerable populations, the elderly and the sick, some of whom have been sheltering at home for months, to get their vaccines first. If you get infected without the vaccine, it will only cost you 10-14 days of mild cold-like symptoms, but for them the vaccine could be life saving.

Since we currently only know that the vaccines prevent severe disease and don’t know if they prevent transmission, we unfortunately still have to continue to take precautions like social distancing and masking even if we get vaccinated, until we have more data or we have achieved herd immunity through vaccination. It is going to take several months for the vaccine to get to everyone. Let’s be patient, cautious and hopeful for life to return to normal. We will be hugging our loved ones and gathering in large celebrations before too long.

Best of health and happiness to everyone in the new year!

Originally published in Hideaway Lake News on Dec 27, 2020

COVID-19 cases continue to rise in our community, as it has in the rest of the nation, with the holiday season and the colder weather. Although death rates from COVID have generally declined since the early days, the number of cases have risen so dramatically that  our hospitals are starting to fill up to capacity. What does this actually mean for you?  Clearly, if you get really sick with COVID, there may not be a bed available for you at the hospital. But if you get sick with something else like a heart attack or appendicitis, you may still not get adequate care because of shortage of beds and staff. So this affects all of us, not just those who get COVID. 

Our health care workers are exhausted, both physically and mentally. They have been on a long and difficult road for nine months and they have several darker months up ahead. Let us make every effort to not overwhelm our hospital staff by reducing viral  spread in the next critical months. We just need to hang in there with tighter controls for a little bit longer until the most vulnerable can be vaccinated. And that may start as soon as the end of the year! In the meantime here are some tips to keep yourself and your loved ones safe.

1. If you get tested for the virus because you have symptoms or you were told you were a close contact of someone who tested positive, then PLEASE stay home as soon as you get tested and while you are waiting for your results.
2. If you choose to dine with a small group of people (2-4) not in your household, do not sit at a cafe or restaurant table. It does not allow for 6 feet of social distancing as you eat, drink, laugh and make merry without masks for an hour or more. Instead, entertain at home, outdoors if the weather allows. If you have a large dining table that allows six feet of separation, then eat at the table. Otherwise take a plate and distance around the room with individual TV trays. Get take out from your local restaurants so you can support them while still staying safe.
3. Exercise outdoors if possible, put a treadmill or exercise bike indoors, or walk up and down the stairs. Avoid going to a gym, especially during the months of peak spread. Join a virtual gym class so you feel connected and motivated, while supporting your local gym instructors financially.
4. Avoid personal grooming services such as hair coloring, perming etc. that take more than a few minutes of up-close time with your service provider. Shampoo your hair at home and go for a quick cut or a trim. This way you can still support your stylist, while minimizing your exposure. Call ahead and make sure your salon is requiring its providers to wear masks, it protects not only you, but your stylist as well. Remember, they are getting up-close and personal! 
5. And lastly, please avoid all large family gatherings such as birthday parties and holiday parties. Just postpone them by a few months to when the numbers go down and our hospitals are not busting at the seams. These are the riskiest of events because they could turn into a superspreader event and very quickly overwhelm small local hospitals with limited resources. Have a virtual party, send online gifts, open them together. I know it’s not the same thing, but it’s a small price to pay.

There is certainly a light at the end of the tunnel with three very effective vaccines already available. Some countries have started vaccination programs, ours could start within a matter of weeks. We just need to work hard together for a little bit longer so we can all make it through safely during these very difficult times.

Here’s to a less eventful, healthier and happier 2021!

Originally published in Hideaway Lake News Dec 1, 2020

We have all been bombarded by depressing and scary news about the virus for months. But amidst all this, we forget to stop for a minute to think about the amazing and unprecedented things that have been happening in the wonderful world of science and medicine. Today, I am unapologetically going to focus on just good news.

The Pfizer/BioNTech and Moderna mRNA COVID-19 vaccines are being reported as 90% and 95% effective respectively at preventing COVID-19. There are still many questions left to be answered, but even getting to this stage is still an astounding achievement. Historically, new vaccines have taken 10-12 years to develop and now we have multiple viable vaccine candidates, some on novel platforms, within just a few months! The rapid development of promising vaccines is a testament to the advancement in science and technology, rapid access to information, and collaboration among scientists across the globe. 

The next big news is the sharp drop in death rates due to COVID-19. One study in New York showed that mortality in hospitalized patients dropped from 25.6% at the start of the pandemic to 7.6% by August, that is a 70% drop in mortality! Doctors have learned how to treat hospitalized patients better. Even though there is no specific cure for the virus yet, they have discovered the use of dexamethasone, Remdesevir and monoclonal antibodies to treat the sickest of patients. They now know how much oxygen to give them and when to put them on ventilators. Research also showed the need for blood thinners in certain hospitalized patients. These are all things the medical community did not know at the beginning of the pandemic. All of these treatments greatly improve our chances of survival if we become hospitalized with COVID-19 now.

Even though the number of cases is surging across the country, the number of hospitalizations is still lower than what was seen in the spring. During the peak in April, there were 900 hospitalized patients on ventilators in the New York public hospital system. In October, when the number of cases was very similar, there were only nine. There are several theories for why the percentage of positive people in the hospital is fewer now. One possibility is that higher risk people have become better at protecting themselves, so it is the younger and lower risk people who are now getting sick with milder disease. Another possibility is that widespread masking in crowded areas may have reduced the amount of virus particles that a person is exposed to, thus resulting in less severe disease. Regardless, it is clear that whatever we are doing now is helping reduce the severity of the disease. So let’s continue to social distance, wear masks and avoid larger gatherings. Let’s continue to stay home as much as possible if we are at high risk.

I see the light at the end of the tunnel and fervently hope that things will be far better this time next year. If we continue to take precautions during the holidays, keep our hospital systems from getting overwhelmed, and get a safe and effective vaccine, we may be back to normal sooner than we think. 

Here’s to a happy and healthy Christmas with your loved ones!

Originally published in Hideaway Lake News Nov 1, 2020

After a rough year, many of us may not feel the spirit of the holiday season. The traditional Thanksgiving meal may not happen for some of us and for others it may look very different from the usual. Regardless of how the celebration actually looks, we can, however, always find things to be thankful for. If nothing else, we can find joy in and be grateful for the simple pleasures of daily living. There is no reason we should restrict expressing our thankfulness to Thanksgiving Day. We can do it every day by keeping a gratitude journal or sharing things we’re thankful for at the dinner table each night. Research tells us that just the act of being thankful, when done regularly, has several health benefits, including improved mood, better sleep, lower blood pressure and greater overall well-being.

Now that you have found a cheap and easy way to boost your health, the next is to figure out how to safely celebrate all those wonderful things in your life this holiday season. If you are a person at very high risk of severe coronavirus disease, you may choose to forgo the entire extended family Thanksgiving dinner this year. If so, please make sure to find ways to still stay connected with your family. You could Zoom while eating so you feel like you’re part of the larger family, record your cooking and upload the videos to engage with family and friends or Facetime with your grandchildren while you bake pies. Use that wonderful technology to your advantage!

If you choose to have a gathering of family members from different households, here are some tips to help reduce the risk of a “super spreader” event. One way is to simply cut the number of people in half by having two groups meet at different venues instead of one. You can  mix the groups up so you can see some of the other family over Christmas. This will reduce your risk to half by only exposing you to half the number of people at a time. Additionally, each family can bring a cooked dish from home rather than many people cooking together in the host’s kitchen, as is often done during holiday meals. This prevents crowding, thereby cutting risk. Another place to avoid crowding is at the buffet table. Families from each household can get food as a group, rather than people from different households standing in line mixed in with each other. Also have one person serving food rather than everyone handling the serving utensils. Next, instead of everyone sitting around a table, have some of the high risk people sit farther apart with their own TV trays so they are not exposed while eating without masks.

Finally, when it’s time to watch TV, divide the group into halves or thirds, instead of everyone crowding together in the den. Maybe some can be in the den and others in the living room or one of the bedrooms. It may not be as much fun as everyone in the same room, but at least it’s better than you sitting at home watching TV by yourself with a frozen dinner on your lap. 

You can choose to focus on the negative and complain about how this is no way to celebrate the holidays, or you can focus on the positive and the things that you can still do, the family that you have, the good health that you enjoy and the lovely home that you live in and find innovative ways to still celebrate your life and the wonderful people in it.

Give extra thanks this holiday season for your health and happiness!  

Originally published in Hideaway Lake News on Oct 2, 2020

Don’t Be Trapped by the Treacherous Trio This Winter – Covid-19, Flu and Pneumonia

The entire world is focused on the coronavirus. We are waiting with bated breath for an effective vaccine as more than a 100 companies race to be the first. Let us however not be distracted from other killers such as the flu and pneumonia for which we already have vaccines. Last year only 45% of Americans got the flu shot. The pneumonia vaccine uptake among Americans 65 and older is somewhat better, at about 64%, but still nowhere near where it could be.

We know that people who get the flu are at a higher risk of getting bacterial pneumonia. It is not certain if such a risk is present with COVID-19, but it is certain that people who have co-infections with bacteria and COVID-19 are at a higher risk of death. Simultaneous infections with flu and COVID-19 are also likely to lead to more severe disease, especially in the elderly and other high risk populations. We will learn a lot more this winter, but until then, let’s protect ourselves from infections that we do know about and that we do have vaccines for.

If you are 65 years or older, make sure you talk to your doctor about vaccines for bacterial pneumonia. Some younger high risk patients such as those with chronic diseases or those who have a weakened immune system may also be eligible. So if you fall into one of those categories, check with your doctor too.  There are two types of pneumonia vaccines and your doctor will recommend one or both based on your age and medical history. These vaccines are highly effective in preventing severe invasive disease. Most adults over 65 will need just one dose of the pneumonia vaccine.

The flu vaccine of course needs to be taken yearly to accommodate new strains of the virus. Some years, the vaccine is a good match, but other years, it may not be so. Studies have shown that even in the years when the flu shot is not highly effective, it can protect you from severe disease and hospitalization. The CDC recommends the flu shot for everyone 6 months and older. Make sure and get your shot in October to be prepared for the peak season starting in December. It will be interesting to see how this flu season is changed by all of us social distancing, wearing masks when social distancing is not possible, washing hands and disinfecting surfaces. Such measures, while helping reduce the spread of coronavirus, should also help reduce the spread of flu and bacterial pneumonia. 

Currently there are 33 COVID-19 vaccines in human trials worldwide, with an additional 88 being tested in animals. For a vaccine to be considered effective, it needs to protect at least 50% of people, according to the FDA. In the most optimistic scenario, the vaccine will prevent infection in almost all and not just severe disease, thus preventing spread via asymptomatic people. Early data from Moderna’s Phase 3 vaccine trial have shown promising results in older individuals, which is very encouraging since they are at the highest risk of severe disease, complications and death from COVID-19. Here’s to continued good news in this area!

Best of health to us all!