February- March 2020
At the onset of the pandemic, it was very challenging, with many unknowns. Fighting the unknown can be cruel. In our professional life, we weren’t strangers to masks and gloves and gowns, but we were strangers to the sudden and enormous demand for personal protective gear. We were very alien to the relentless continuous concern about an infection How is this virus really transmitted, who is vulnerable, can it be avoided or is it inevitable, is it on a surface, and for how long, did I clean my work area well, did I miss a spot?
In our personal lives, we struggled even more. Should we distance ourselves from loved ones, how far, can we walk outside, should we send our kids to school, can they see their friends, can they play sports?
In a spontaneous reflex we took harsh and sometimes extreme measures and all of us made sacrifices on the professional and personal side. We had one goal in mind to keep our patients and loved ones safe. Sense of self was on pause, definitely one silver lining.
So we closed our practices to flatten the curve, we wore our masks, we invented them when we didn’t have them, we spaced, we stopped friendly lunches, we remodeled our space, we changed our furniture, we installed negative ventilation, we put up plastic barriers, tested and tested. Our hand hygiene verged ridiculously, we stopped touching door nobs and went crazy with temperature taking. We even questioned thermometers and cross-checked them against each other. We created extra washrooms for staff and patients. We learned to meet with patients across new platforms. Zoom I had never heard of it. FaceTime with a patient? I would have never imagined. It wasn’t terrible after all, another silver lining.
Hair tied back, glasses, blue disposable gown, scrubs … for the longest time we forgot what normal attire looks like.
The personal side was harsh. The continuous fear of being the vector of transmission of the virus to a loved one is a huge burden. Our children’s routine was broken, their world turned upside down. My daughter's few words summarize the tragedy. “Everything was going for me before COVID and now everything is not, will life ever go back to normal ?”. School remote, playdates canceled, sports canceled, more and more solitude.
But we adapted and we became more confident and here we are.
April- December 2020
What a journey, this virus has not left anyone untouched. For those of you who have lost a loved one we are deeply sorry and we are still reeling with you from the shock. For those of you who have fought the battle, we heard you. My oldest patient who conquered this infection is 90, he just celebrated his Bday.
We have learned a lot about the diagnosis and management, of this disease, thank you to all the first responders and the entire medical team.
Fast Forward December 2020
On the topic of Covid Vaccine, I Chose to take the vaccine. I can’t describe the elation and gratitude when I received the first dose. Finally, there is hope!
I made that choice and so did the colleagues in our practice. We have fought a whole year to avoid any transmission and this seemed a very natural and easy step.
At the first dose, I developed arm soreness, but felt well otherwise, after the second dose and precisely 12 hours later I developed symptoms of a viral infection. Typical headache, myalgia, and mild fever and sweats. The Next day I felt remarkably well. The symptoms don’t necessarily mean that I would develop stronger immunity, but it was an attestation to the design of the vaccine. Before the vaccine, my body had no memory of this virus, but after the first dose, my body was instructed to start recognizing this microbe as a threat.
Me and Dr. Zack performed a mini-study where we measured our immunoglobulins before the vaccine and they were negative. IgM antibodies developed after the first dose. This is the first antibody to be born after exposure, it's a transient antibody. 2 weeks after the second dose we developed the IgG antibodies which are the long-term antibodies. This is by no means a true measure of the immunity, there are other components of our immune system called the T cell system and the cytokine system. We don’t have measures for these. This part of the immune system is invaluable.
Our goals are unchanged our precautions are steadfast. There are risks in every decision we make, we just have to weigh the risks against the benefits. I understand these decisions can be very personal to the reader. Always consult with your provider as your medical conditions are unique.
COVID and Medical Dermatology
Skin continues to be a mirror and a reflection of our internal body, we have reviewed the possible skin findings in the last blog. We will continue to learn and collect more data as we go by.
COVID and Cosmetic Dermatology
As your body learns to build a specific immune reaction and is becomes responsible to fight off future Covid exposures, It may direct some of its energy towards the dermal fillers. A topic that is much discussed these days. As such I have noted a few cases, where patients observed localized reactions in areas of previous fillers. Most of the reactions have been mild and involve some form of swelling, itching, or tenderness. This can be very alarming. But with prior awareness and simple strategies like compressors and antihistamines, most of these reactions resolve very quickly. To date I have not observed any negative impact on the filler itself or the patient afterward. It has been hard pinpointing which fillers are the most reactive because some patients have more than one type of filler over time.
This phenomenon is not new and has been noted with the flu vaccine as well.
On a different note, there is data suggesting that lymph nodes may react after the vaccine too which causes alarm on mammograms and breast cancer screenings.
On my end, I disclose this information to my patients and we make a decision together. For those of you that continue to have concerns, I recommend 2 weeks between the vaccine and the filler injection. And maybe it's a great time to have a great discussion about alternatives to dermal fillers including PRP. A natural approach to cosmetics.
I definitely would not recommend postponing a vaccine, if that is available to you and you have made the decision to receive it.
JANUARY 2021
The immune system is a wonder, it's intertwined with every cell in your body and has an impact on every skin condition. Hyperactivity or under activity can cause complications. Imbalance of the immune system from one profile to another can exacerbate skin conditions as well. The concept of this vaccine is not new. I hope that there will be other applications for messenger RNA and other viruses as transporters. In an ideal world, we may have a vaccine against every cancer.
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