Of Snakes and Mistakes

I was recently summoned because there was a snake in a public area and there was concern that it may be a copperhead and I am known to have an interest in snakes. By the time I got there, a man was in the process of decapitating a harmless milk snake while invoking the need to protect people walking by.

This made me frustrated because the snake could have easily been removed alive and taken to a nearby field or patch of woods.

The following day, in the midst of my still smoldering righteous indignation, I remembered an incident from maybe 10 or 12 years ago. We had moved into the mountains where we see snakes fairly often, including copperheads and rattlesnakes. One day, one of our kids reported seeing some baby snakes and, sure enough, there were multiple little snakes poking their heads out of a large crack in the blocks surrounding a planting bed right next to the house.

Baby snakes often look different than their adult counterparts and I did not know what kind of snakes they were and was concerned because they were right beside the house. I was worried that they may be baby rattlesnakes. So I killed the ones I could get to and tried to flush the others out with a water hose. Only later did I realize that they were baby rat snakes, totally harmless and maybe even helpful in keeping the poisonous snakes away.

Now I know what baby rat snakes look like and would never kill them. If that happened today, I would take some pictures and leave them be. But the younger, less-experienced version of me didn’t know what I know now.

At that time, I was basically the same as the guy killing the milk snake a few days ago. Perhaps we are most frustrated by the actions of others that reflect poorly on our past selves? As humans, we often react violently to things we fear because we do not understand. Fear and ignorance are a dangerous combination.

The antidote is to seek to learn more about the things we do not understand. After I had killed the baby snakes, I posted some pictures to ask others what kind they were and quickly got responses from a couple of people who knew. I confirmed this by checking in my field guides as well. In retrospect, it would have been good to do this before killing them.

How much of what we do to “protect” ourselves and others are simply illogical actions borne out of fear and ignorance? And what are the ramifications of those actions?

Running, fishing, and the benefit of the doubt

Sunday afternoon felt like mid-July so I was trying not to move too much, sitting quietly and reading. Then a nice thunderstorm came through and cooled things down and I decided to go for a run. When I was younger, I enjoyed running on trails in the mountains but that is a lot harder than it used to be so I headed down to my usual spot to run along the river where it is flat.

Several weeks ago while I was running there, I came across a fisherman wading in the river close to the near bank. He was trying to use his phone to take a photo of a fish he had in his net which is no easy feat while also trying to hold onto a fishing rod and not drop anything in the river. I immediately understood his situation. I am still pained that I do not have photographic evidence of my two best freshwater catches ever – a big brown trout from this same river a few years ago and a monster smallmouth that I caught last summer on the James. So I scurried down to the bank and offered to take a photo of him with the fish. After a couple of nice, quick pictures of a happy fisherman with a beautiful rainbow trout, he gently slipped the fish back in the water and it swam away quickly to continue enjoying the cool water and perhaps make another fisherman’s day.

It was just as it should be. A man communing with and respecting nature and leaving it intact for another day.

On my run on Sunday, I spotted four people on the far bank of the river. They had a large red cooler which meant they were either fishing with live bait and/or planning to keep what they caught, both of which are forbidden on that stretch of the river. I could not see them very well without my glasses but I was immediately annoyed.

But as I continued my run, I thought of other possible scenarios. Maybe they needed the food so that’s why they were going to keep some fish. Or maybe they didn’t know it was a special regulation area. Or maybe they weren’t even planning to keep any fish. Maybe they had some sandwiches and drinks in the cooler. And then I wondered if they knew part of the reason for not keeping and eating fish from the river was that it is contaminated with mercury. Maybe I should warn them instead of being angry at them.

I also have enough generational memory to understand why it seems silly to catch something and then just let it go instead of eating it, even if it is a turtle that was caught accidentally (but that is a whole other story). Catch and release fishing is something that people who have plenty of food do and not something that would make any sense to much of the world’s population. For that matter, going for a run on a Sunday evening to get some exercise also wouldn’t make sense to a lot of folks.

So I try to give people the benefit of the doubt and not immediately jump to ascribing malevolent intent to their actions. Maybe that makes me a sucker sometimes. But I would rather be a sucker than to accuse someone unfairly.

Thoughts on Ivermectin, masks, etc.

We are all sick of dealing with Covid and wish there was some kind of easy, fool-proof way to prevent or treat it. Unfortunately, as with most things in life, Covid does not work that way. Early on in the pandemic, hydroxychloroquine gained traction in some quarters as the answer and was ultimately shown to not be beneficial for Covid (and possibly made things worse). The new silver bullet being promoted by some which I have been asked about is Ivermectin.

Ivermectin is a drug I learned about in medical school but I do not have much experience with it because the human diseases it is typically used to treat are not common in the Shenandoah Valley. Ivermectin initially gained attention for Covid because it was shown to kill coronaviruses when used in high concentrations in a lab setting. Unfortunately, that does not necessarily mean it will work in a human being.

There are several studies which have been used to promote the use of Ivermectin for Covid which showed results that seem too good to be true. There are a lot of red flags with these studies which have been noted by epidemiologists who have reviewed them. One study included patients who died before the study even started, listed a hospital as part of the study as a participating institution even though the hospital denies any involvement, and listed an author who states he was never allowed to review the data. Other population studies do not account for the effects of concomitant policy changes such as lockdowns and one study appears to have sections directly cut and pasted from an earlier document.

It would be great if Ivermectin was effective. Imagine if it was really 100% effective as one study claimed. I could prescribe it for everyone and make it home in time for dinner with my wife. Unfortunately, the preponderance of the evidence for Ivermectin use in Covid is underwhelming (https://www.covid19treatmentguidelines.nih.gov/tables/table-2c/).

There are some things that we know help lessen the spread and effect of Covid. Masks have been shown to slow the spread of Covid. Vaccinations have been shown to significantly decrease one’s chance of catching Covid and to greatly decrease one’s chance of having a severe case of Covid. Being vaccinated also appears to decrease the amount and duration of viral shedding after a Covid infection, thus decreasing the chance of spreading it to someone else.

One of the most disheartening things for me about Covid is how much of the public discourse is about laws, mandates, court decisions, rights, and yelling at school board meetings. Wouldn’t it be nice if it was more about how we can voluntarily protect ourselves and those around us? Wouldn’t it be nice if there was more “What can I do to help?” and less “You can’t make me!”?

As of yesterday, our community hospital has 53 people hospitalized with Covid and has once again stopped doing elective surgeries. Several urgent cares have closed to reroute staff to where they are needed to help care for Covid patients. Recently, our days in the office are dominated by seeing patients with Covid, possible Covid, or exposure to Covid.

So please just wear a mask when you are indoors with folks outside your family and get vaccinated if you have not already. Ivermectin is not a panacea and we are unlikely to find anything else that is. The best way to get closer to our pre-Covid normal as soon as possible is for all of us to consistently do the things which we know work.

 

Warm weather and poison ivy

As the weather warms and people are spending more time outside, I have started seeing some children with poison ivy or poison oak.

It is important to note that even before the plants have leaves, contact with them can still result in a very unpleasant reaction. In fact, these photos are of a case of poison ivy contracted during the winter while cutting up some downed trees. Because there were no leaves, it was not clear until it was too late that there was poison ivy all around. Be especially wary of fuzzy vines on tree trunks.

The rash is a reaction to the oil from the plants. There can be secondary transmission from clothing or pets which have the oil on them. But once the oil is washed away, the rash itself is not contagious. If you know you have been exposed, washing as soon as possible with soap and water and washing your clothes immediately can help prevent any reaction. 

The rash is very itchy and can turn into weepy blisters as well. Treatment includes topical anti-itch creams, compresses and baths, oral antihistamines such as Benadryl, Zyrtec, or Claritin, and in severe cases a course of oral steroids.

So get outside and enjoy nature. Just be careful what you are touching.

I don't like masks

I don’t like wearing a mask.

It makes my face hot and gets snagged on my whiskers. It tickles my nose. My glasses get fogged up when I wear them. I can’t see the facial expressions of others who are wearing masks. I really enjoyed my surgery rotation in medical school except for having to wear a mask for hours at a time in the operating room.

But here’s the thing – it is one of the few effective measures we currently have to help keep from spreading a potentially deadly virus to each other. Masks aren’t perfect, but the mounting evidence shows that they decrease the spread of SARS-CoV-2.

We have all been wearing masks all day in our office for months now. I wear one whenever I am indoors in a public building, except occasionally when I am in a room by myself. I don’t wear it when I am outside unless I am in a crowd of some sort or visiting outside with particularly high risk people. So if I am working outside, or running or hiking or fishing, I don’t have one on but I stay away from other people.

Since we know that it is possible to have the novel coronavirus and not know it, wearing a mask not only protects me but those around me. In fact, the evidence suggests it protects others even more than it protects me. The person I walk by in the grocery store could have a medical problem that I can’t know about by just looking at them. Wearing a mask is an act of compassion. It is a tangible way to love your neighbor as yourself.

For 99% of us, wearing a mask is a minor inconvenience. If masks work, I can potentially help save lives by wearing one. An itchy nose seems like a small price to pay. If it turns out we were wrong and masks didn’t really help, is it really so bad to have inconvenienced myself a little bit in an effort to protect my fellow human beings?

Running Red Lights

There is a Subway just up the main road from our office and one day last summer I went there to get a sandwich for lunch. There is a traffic light almost immediately after turning left out of the Subway parking lot to head back towards the office. Sometimes I am a bit absent-minded and thinking about other things and I was most of the way through a red light when I realized what I was doing. Since the intersection was empty I proceeded on through instead of stopping in the middle of it.


Almost immediately I saw blue lights flashing behind me. My first thought was “Well that was really dumb of me. I hope I can just pay a fine and not have to go to court.” I pulled over and the officer came up. I handed him my license and told him I needed to find the registration.


As I rummaged around in the glove box, he asked me why I ran a red light. I told him I didn’t know, that I had just screwed up. He asked where I was going, what my job was, etc. After I found my registration, he looked at it and my license for a while. He handed them back to me and told me to be more careful. And that was it.


I had clearly violated the law and was expecting a ticket and a fine. And there was nothing.


This morning I read a story from an African-American professor who had not done anything wrong but was still detained because he “matched the description.” He spoke of his fear and how the incident left him rattled afterwards. His experience and mine bore little resemblance to each other. I was actually guilty and he wasn’t. But I was never frightened.


I know some police officers and I think the ones I know are good people. And I think I am a basically decent human being as well. But years ago I read some data about the differences in medical treatment of white children and African-American children with respect to pain control, etc. It was jarring and I began to examine myself. And one day in the office, I realized I had a white patient and a black patient with pretty much the same issue, and I had provided a more aggressive evaluation for the white child. I could rationalize why I did that. But there isn’t a good reason.


I hope that doesn’t make me a bad person. Both of the children were fine and the white child got more evaluation than was needed. But I think it does show that I am (was?) a biased person. Both mothers were worried about their children and I did more to allay the fears of one than the other. And only by knowing and admitting that about myself can I do anything to correct it.

Is this Covid Information Reliable?

It seems like every day there is a new video from a doctor claiming some special insight into Covid-19. I have a few thoughts about how to approach these.


I think it is important to remember that being a doctor can mean a lot of different things. If you have a sick three year old, I am your man. That is why I am here. That is what I do. But you should worry if you are sixty years old and possibly having a heart attack and I show up to take care of you. That is not what I am trained to do. I could maybe muddle my way through and help some, but you would have a much better chance with an ER doctor or cardiologist caring for you. For information on Covid-19, I want to hear from virologists, epidemiologists, and the ER physicians, intensivists, and hospitalists caring for patients with the disease.


It is also important to remember that even doctors in the same field can have varying levels of expertise. This can vary based on intrinsic abilities, where someone went to school, where they did their residency (or if they even completed one), whether they are board certified, how much experience they have, if they did fellowship training after residency, etc.


Some mechanics are better at fixing engines than others. There are some basketball players who are more likely to make a clutch shot on the last possession in the championship game. Some carpenters build a more solid house than others. Some people make tastier, more nutritious food than others. No matter what field you are in, I am sure there are people who you recognize as being more competent and trustworthy than others. In the same way, some doctors are better positioned to speak about Covid-19 than others. Being a doctor does not magically imbue one with wisdom on all things medical.


Medical progress is plodding. It is based on rigorous evaluation of data and attention to detail. I am not aware of any significant medical insights to ever first be released via You Tube or Facebook. They are much more likely to be on page 38 of The New England Journal of Medicine. Some of the videos I have seen in the past few weeks have some basic errors that are easy for other doctors to spot. So just be cautious about jumping on bandwagons, unless you are fine with me treating your heart attack.