My previous post was about five true things that I have learned over the years about yoga. They were hard won epiphanies, you’ll have to trust me on that.
I have been reading a book by a fitness expert named Tom Venuto. Imagine my surprise to find this passage:
However, everyone can improve their fitness and physique above and beyond where it is today. Your goal should be to achieve your personal best while avoiding comparisons to others who have different genetics than you
Imagine my surprise to see what amounts to two of the true things I know about yoga, back to back, applied to general fitness! Could all of them apply to general fitness? Let’s see….
You can be more fit that you are today? Yes!
The fitness activity you dislike most is probably the one you need to work on the most right now? Seems very likely!
Admire but don’t compare yourselves to others? Absolutely!
Fitness as a practice rather than a performance? For those of us who are not professional athletes, unquestionably.
You have an intention when you do a fitness activity whether you call it that or not? I am willing to believe it. Maybe that’s why people who approach their workout with the attitude of “let’s get this over with” don’t get the same results as people who approach it as “I am doing this activity to meet that goal.”
I do not know if there are more truths out there for me to learn. Nor do I know if these five truths have application in the greater world. But I hope you can accept these truths as things you can learn from.
Over the years that I’ve been practicing yoga, I have had the honor of learning five true things. The first three were slow to come, and the last two were learned in the last year.
You can learn to do any pose better than you can right now. Always. Even something as simple as Tadasana.
The pose you hate most is probably the pose you need most right now. This does not apply if the pose puts any strain whatsoever on the neck or actively causes pain, of course,
It’s okay to admire and find beauty in someone else’s practice, but it’s never okay to compare yourself to them. They have their own practice, their own strengths and weaknesses, which are different from yours.
It’s a practice, not a performance. You are — or should be — doing this for you and not for anybody else.
Everyone sets an intention — what they want out of that day’s practice — whether they are aware of it or state it as an intention, or not! Sure you can say “I just want to stretch today.” Guess what? That’s an intention! “I’m not interested in any woo, I’m just here for the physical benefits.” Also an intention!
Someday maybe I will learn more true things. But for this moment, it is enough.
The funny thing is that I very recently learned something about these truths. I will share that in my next post.
It looks like the Liberty actually won game three of the finals, so the Aces will have to win one more to bring home a second WNBA Championship. As much as Vegas loves our Golden Knights, we also love our Aces!
Recently, a website I used to respect posted an item on a problem with a relatively new fungal pathogen called Candida auris and how it poses a problem for Las Vegas in particular. I would like to talk about this issue in a balanced and truthful way.
Some Resources by Actual Professionals: I actively encourage you to see what the CDC, the WHO, the NIH, medical journal JAMA, my professional organization APIC, healthline, okay fine Wikipedia, and the State of Nevada have to say. The public might have a right to be skeptical about what the CDC has to say, which is why I want to provide multiple sources (that all say mostly the same things).
And Now Some Sensationalist News Items: It gets pretty crazy. Of course some sources are better than others, but sensationalist news gets attention.
An important thing to remember: I’m going to stop for just a moment to explain a technical detail. You probably know what an infection is: it’s when a germ is making you sick. But most people don’t know what colonization means: that’s when a germ is there but it’s just hanging out and not making anybody sick. There is of course the risk it could cause an infection, but it isn’t right now. Most of the C.auris cases you’re hearing about are colonization, not infection.
But what would the symptoms of infection be if it’s not colonization? Depends where the germs are. If it’s in the urinary tract, UTI symptoms. If it’s in a wound, symptoms of an infected wound. You get the picture. An infection in the blood is particularly bad regardless of what organism is involved since the bloodstream is effectively a superhighway around the body.
Oh, and one more thing: I am always careful to specify Candida auris or C.auris to distinguish it from it’s itchy but mostly harmless cousin, Candida albicans — which causes thrush and what most people would call a “yeast infection.” There are other Candida species that are rare and not a huge public health threat.
Why it seems like Nevada and Vegas have so much of this stuff: Maybe you’ve heard the saying “you can’t find a fever if you don’t take a temperature”? Well the idea that you don’t find things you aren’t looking for cuts both ways. Most places aren’t looking for it — it’s a special test that in most places has to be sent away to a lab with special equipment (and by the way not all FedEx offices will accept biological specimens for shipment). Your local Quest or LabCorp might come back with “yeast” and nothing more. Last year, the State of Nevada insisted on testing all residents in Long Term Care, Long Term Acute Care, Skilled Nursing Facilities, and on patients in many other hospitals. They tested; they found more of it than most people expected. Why Vegas in particular? Because roughly 80% of the state population lives in Clark County.
Why test those facilities? Because people in the kind of places where they call them “residents” instead of “patients” have severe medical problems to begin with. They’re in and out of acute care hospitals. They have plenty of chronic conditions and often end up with complications. They’re at risk for opportunistic infections from lots of different organisms, including C.auris. Sure, they tested a few people who were just fine until the motor vehicle accident, but that was the exception.
Ok, so how do you test for it? Per the CDC “The nurse or doctor will wipe or rub a cotton swab on the skin near your armpits and the area where your leg joins your body (groin). The test is not painful. The swab will be sent to a lab, and in 1 to 2 weeks, the lab will tell your doctor the results.” Ok so remember that we are looking for it in armpits and crotches when it comes to colonization. That will come up again later.
A quick summary of the bad news: It’s hard to test for, it’s a lot more common than most people know (and not just in Las Vegas!), it’s resistant to many antifungals (it’s not a bacteria so it wouldn’t be susceptible to antibiotics), there’s no proven decolonization strategy, and yes an infection could potentially be deadly.
Is there any good news? Yes! First, it’s a big heavy germ that does not and cannot float in droplets or the air. A C.auris cell is 2.5-5 micrometers, twice the size of the typical bacterium and ten times the size of a tuberculosis germ. Someone with a C.auris infection or colonization does not require droplet or airborne precautions, just contact precautions (gloves and gown) while in the hospital. It is not, I repeat NOT, lurking in casino air ducts waiting to reach out and make you sick! More good news: bleach will kill it on surfaces. Note: do not clean granny’s groin and armpits with bleach.
What can I do to keep from getting it? Remember that we test for colonization in the groin and armpits? Keep adult activities clean and in clean places. Don’t go to the casino floor naked (they frown on that anyway). If you or a family member have chronic conditions, make cleanliness your habit. If you find yourself or a loved one in a hospital, be that person that reminds others to clean their hands. That includes visitors, doctors, and staff! If a staff member rolls her eyes, that’s exactly the person you needed to remind so don’t let her get to you. And a pet peeve, gloves are not a substitute for hand cleaning and must be changed between patients!
Yesterday, I received notification that COVID-19 data would be reported to the Department of Health and Human Services instead of the CDC. That change is effective today. This abrupt change was sent to me from the Association for Professionals in Infection Prevention, then confirmed about a half hour later by email from the CDC itself. As an Infection Preventionist, my duties include reporting regularly to the CDC’s National Healthcare Safety Network. Until today, this was the single largest and most accurate repository of infection information in the United States.
Some hours later, the various news services got wind of the change.
Sometimes professionals use words in very specific ways that aren’t obvious. Just the other day I realized that is what happened with those two words. My Facebook friends have seen me very carefully point out articles like these, which suggest than COVID-19 is airborne, rather than droplet. I did this carefully because before yesterday, the WHO and CDC staunchly denied any such thing and today the WHO merely confirms that there is “emerging evidence.” Today I want to explain why it’s different, and a really big deal, in fairly simple terms.
Standard precautions are what we do to protect everybody at all times. This includes keeping your hands clean, using disposable gloves, and changing those gloves between patients. Hand washing is still the most important thing you can do to keep from getting or transmitting any disease. It’s so important the CDC has an entire section on it.
When we know a person has certain infections that could spread, we use Contact precautions. This is for fairly heavy organisms that can survive for a while on surfaces, and that we can inadvertently transport to a new victim on our hands or clothing. One such organism you may have heard of is MRSA, Methicillin Resistant Staphlycoccus Aureus. We also use Contact for more mundane bugs like head lice. For Contact, we make sure to use gloves, treatment gowns to cover our clothing, and we are extra sure to wash our hands after taking our gear off.
Now for the meat of this discussion. Droplet precautions are for organisms that can move in droplets we create when we talk, cough, or sneeze. These droplets can go maybe 6 feet or so (that’s where the 6 feet apart for social distancing comes from) before they go SPLUT! onto a surface. Droplet precautions always includes Contact precautions. That surface can be somebody else’s face, which is why the protective gear for Droplet precautions includes a facemask and ideally eye protection, in addition to gloves and gown. The most common organism for which we use Droplet is the Flu. Remember, up until yesterday, the WHO insisted this was all we needed to protect ourselves from COVID-19. And as of this moment — subject to change without notice — the CDC still does.
By contrast, Airborne precautions are for organisms that can float in the air a long ways and a long time. Much farther than 6 feet. And to do this, they are very small and very lightweight. Examples include Measles, Tuberculosis, and Ebola. These bugs are small enough to get through and around normal surgical masks. These patients should be cared for in a special “negative pressure” hospital room — the HVAC system is designed to create lower air pressure than in surrounding areas while still having fresh air move in and out, so germs aren’t likely to go into the rest of the hospital. To care for these patients, you need special masks, such as N95 or a powered respirator, and they need to fit correctly to prevent germs getting around the edges. That’s over any above gloves, gown, shoe covers, hair covers, and eye/face protection.
As you can see, there’s actually a huge difference between droplet and airborne transmission. And although many experts have privately held that COVID-19 is airborne, its a huge step for the WHO to admit that. I hope the CDC joins them shortly.
Masks in public has become the new normal. So let’s talk about this for a few minutes.
Masks are a whole lot like condoms: they do work; they only work if you use them, and use them correctly; they don’t work with holes cut in them; and they are not foolproof — you and the people around you are safer if you’re all doing something to prevent the spread of disease.
Nor are masks a substitute for things like quarantining the sick, isolating those who are known to have unprotected exposure, washing your hands, or social distancing. Hand hygiene is still the number one thing you can do to keep from getting almost any disease — it will even stop you from accidentally making somebody else sick. That last point is really important, because people can spread COVID-19 two days before they feel sick, and worse yet they can spread it and never feel sick at all.
Again, just like condoms, masks are only one tool to prevent the spread of disease.
We haven’t got a cure or a vaccine for this thing yet. Prevention is literally all we’ve got to prevent more people from getting sick and possibly dying.
Now for those of you who like actual research results: here’s the Mayo Clinic; Journal of the American Medical Association (JAMA); some research from Hong Kong; and The Lancet. For those of you who are total data nerds, here’s some more fine studies.
Wear the damn mask, people. There’s nothing “unconstitutional” about it. Your “rights” end when you interfere with the rights of others, such as when your selfishness accidentally spreads disease.
Today I would like to make some comparisons between COVID-19 and Influenza. For simplicity, we will look at data from the Southern Nevada Health District, which serves Las Vegas and surrounding communities.
This page will give you SNHD’s flu reports. Flu season is generally considered to run from October to March or April here. Let’s call it 6 months. Please note that when they refer to the week number, they mean for the year. So the first week of January is week 1. It is true that we never know exactly how many cases of the flu there are (the CDC estimates tens of millions of cases and tens of thousands of deaths nationwide). That’s because a lot of people recover at home without tests or hospital visits. However, if you look at the latest report, you’ll see that 47 people died of the flu this flu season. This number is pretty close to accurate; someone is either dead or they are not.
The fact I want to point out is that as of April 29, Southern Nevada has had 202 deaths from COVID-19. In 6 weeks, 202 COVID-19 deaths, compared to 47 influenza deaths due to influenza in 6 months. Same population. Same location. Same risk factors. That’s four times as many deaths in about a quarter of the time.
In a nutshell, that is why we need to take this thing seriously.
I have become aware of voices on the Internet saying we shouldn’t waste time on a vaccine, but go for a cure. I would like to remind those folks that we never did get a cure for measles, polio, or rabies, just a vaccine. Even tuberculosis had a vaccine decades before we had a cure.
Stay safe out there. Wash your hands. Don’t stand too close to other people. Wear your mask in public. And remember that the economy is meaningless if you’re dead.
Spring rolls at Jasmine Rice, Henderson NV. Profoundly ok, but not worth driving out from the Strip (just go to Lotus of Siam or Weera Thai if you’re near the Strip and hankering for Thai food).
So, I’ve been trying to eat more mindfully lately. This means really stopping and enjoying food rather than gobbling it down like some kind of race. One side effect of this is that I end up being satisfied by my food faster, and eat less of it. I also don’t really put up with food that isn’t really tasty.
I also learned that it’s hard to chew soup.
Bonus picture of a bowl of chili I made a couple years back:
