#322 Justin is Recovering from Coronavirus
COVID-19 with Type 1 Diabetes
Coronavirus disease (COVID-19): Juicebox Podcast conversation with Justin Wilhite. Justin had Covid-19, has Type 1 Diabetes and he's on the show to share his experiences.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
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#321 Ask Scott and Jenny: Chapter Twelve
Answers to Your Diabetes Questions…
Ask Scott and Jenny, Answers to Your Diabetes Questions
How long can you safely turn off basal?
Let’s talk about ‘extreme’ management tactics and controversial lower A1c results.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello, everyone. Welcome to Episode 321 of the Juicebox Podcast. Today's show is an ask Scott and Jenny. And in just a moment, I'm going to tell you what the topics are and who the sponsors are. But first, I'd like to spend a brief second, discussing how I'm programming the show with consideration to the Coronavirus and what's going on in the world. So my family and I'm sure many of you have been held up in your homes. My family's been here at home for almost a month now. And in that time, I've been paying attention to the Coronavirus maybe more acutely than some parts of the country because I live in the New York Philadelphia metropolitan area. And it struck here pretty quickly. Now, some of you may live in places where it might not reach anywhere near that it has in New York. And I hope that for all of you. And some of you may just be a little behind where New York is right now. One way or the other. I felt like it was important for people to understand what Corona or COVID-19 is. So you know, back in mid March I had Adam Edelman Come on. He's a doctor we discussed Coronavirus, kind of in a broad way. Jenny Smith and I talked about Corona The following episode. So these are episodes 314 315 There were a couple other episodes came up. And before I knew it, Sarah who's listening to the show, reached out and said she's a nurse in New York City. And she's got Corona very mild case of Corona, she came on and told us about what a mild case of Corona was like. Adam came back on Dr. Needleman came back on again, just recently did a little bit of an update. And in that time, I was able to interview a gentleman named Justin, who's become kind of famous online for being one of the first people to put a picture of themselves up with a mask on saying that they had Coronavirus and asking everyone to be careful and, and follow the rules. Because it was serious. Justin happens to have type one diabetes, so I couldn't pass him up. Even though I thought I don't want too much Corona stuff on the podcast. Now Justin had a more significant more severe case of Corona, and I interviewed him just the other day, his episodes going to be out after this one. So what I'm gonna do this week is put an extra episode out, I'm gonna try to strike a balance, I don't want people who aren't interested or maybe are having anxiety around Corona to feel like they're not getting content. And for those of you who are interested, I don't want to stop providing the content. Now I can see the downloads and the corona episodes are very popular. And so I'm going to kind of override my inner voice that's telling me too much Corona. And I'm just going to try to continue to provide good solid information that's not click Beatty, and not meant to make you upset, you know, so that you'll come back and get more, which I think is what a lot of media does just want to offer you good information. You can do with it what you want. But there'll be three episodes this week, so that everybody gets what they're looking for. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the tubeless insulin pump that my daughter has been wearing now for a very long time. Now, since she let's think, already got an insulin pump around the time she was four and she's gone. And she's 15. She's going to be 16 this summer. That seems like 12 or 13 years, it's hard to know because my math skills are limited. Anyway, Arden has been working on the pod every day for that time. She's also been wearing a Dexcom CGM. Currently Arden wears the Dexcom G six continuous glucose monitor. And we absolutely love it, you can tell that if you listen to the podcast, that's sort of a no brainer, I don't really need to tell you her meter the Contour Next One blood glucose meter super small, super convenient, lovely and accurate, like they talk about and of course you know near and dear to my heart touched by type one. And I asked you to check them out at touched by type one.org. There are links in the show notes of your podcast player to all of the sponsors. Or you can type their links in yourself. My omnipod.com forward slash juicebox dexcom.com forward slash juicebox. Contour next one.com And of course, touched by type one.org. Let's play the music and then talk about some stuff with Jennifer Smith.
In today's Ask Scott and Jenny, we answer 123 questions. Wait. Yeah, three questions couple more bigger. I asked me a question. We chat a little bit about the Zoom meetups I've been doing on Thursdays come on out and check them if you want. There's one In the Facebook page, this Thursday is going to be at 7pm. Eastern time, I guess I should tell you that Thursday's date will be April 9 2020. In this episode, Jenny and I are going to answer a question about shutting off Basal, and how long you can do it safely. I'm going to tell a quick story about meeting some fans in public. I Muse a little bit with Jenny about the social meetups and whether or not they're valuable ways to help people make improvements. And I'll talk a little bit about that at the end of the podcast as well. And then we talked about extreme management. I put extreme in quotes here. Because is being healthy extreme. And why do people think of it that way? Sometimes. I'm going to want you to remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to please Always consult a physician before making any changes to your health care plan are becoming bold with insulin. Helen says, I hear Scott say he turns Basal off. If Arden is running low, we started to do this for my daughter, Ella. And it works amazingly well. However, we only dare do it for about 30 minutes. We were told ketones develop quickly if she doesn't have background insulin. How long is safe to do? I have my answer. Let me go first this time. Let's see how wrong I might be sure. Well, you're not wrong. Yeah, I could be wrong, you hold tight.
Jennifer Smith, CDE 6:32
Hold tight,
Scott Benner 6:33
I'll wait. Here's my thought. If your background insulin, if your Basal insulin is dragging you that low, then taking it away for a little while. It's not really gone, because you probably have too much to begin with. Now, if you take it away for a long while, and create an absolute black hole where no background insulin exists, then I think DK can come on very quickly, depending on a lot of other physiological implications. How was that?
Jennifer Smith, CDE 7:07
I was actually pretty, pretty good. Not bad. Not bad. Not bad at all.
Scott Benner 7:11
I gotta get you know how some people are like online ministers. I just need one like company to start online CDE. And I think I could get one wouldn't be like real, like, you know that while you're being married by a minister of the like, bah, bah, bah, live charge that got something by filling out a form online. It's not really a minister but it's legal. It's legal. I think if somebody would start that around diabetes, I'd be okay. Go ahead.
Jennifer Smith, CDE 7:38
Yeah, no, but you're I think that's a really good like baseline, and even a little bit more. It's a little more in depth than baseline even because you did go into the fact that if you're on Basal alone, there's little, literally nothing else left such as like an overnight, you go into bed, your last meal in Bolus was around six o'clock, it's three o'clock in the morning. And you can see that, like you said, before Arden's friend, she had a bad pump, or a bad pod site, or whatever it was, and she was middle of the night, you could see blood sugar was rising. There was no other reason for it to be rising. None at all. It was a bad site. So that kind of a deficit of insulin was likely started a couple of hours prior to the rise starting Yeah, right. Because anytime you're at a deficit of Basal, you can shut a Basal off right now, you still have circulating Basal insulin going for at least another hour, perhaps hour to two hours, right. So you're really not at that complete, utter zero level of Basal yet. So a 30 minute shut off, is really it's nothing, it's, I'm glad it's helping for the reason that you're using it for, but that 30 minutes is really like a drop in the bucket of nothing, as far as impact for causing decay a right. And the other, you know, piece that kind of goes into that as well. In this scenario. For example, let's say this low is happening during the daytime, and you shut the Basal off for just 30 minutes. And it helps for whatever reason that 30 minutes is really stabilizing things, evening things out into the next hour or two. So you don't stay low or go lower. Great. But you also have to look back and say if this was during the day, the low was probably as long as you've got Basal figured out. It was probably not from Basal. It was probably from insulin on board from a Bolus that drove things too low. Yeah, with whatever other variables in the mix that caused it to happen, right. So just that 30 minute deficit again, of only Basal it's not deleting any insulin on board from a Bolus that might still be in the picture. So again, the risk of decay a while it is higher on a pump than it is with multiple daily injections. Because once you take your injection of Basal it's there, you know it's there, you're never at a base at a deficit of it. With a pump though, you do have to be careful. And our baseline is when it usually comes in and discussions in summer when kids are going to the beach and using their pool a lot or you know, whatever it might be, they disconnect from a lot of pumps that are tubed. We usually say do not disconnect for more than a two hour time period, come back check blood sugar, take a Bolus of at least 50% of the missed Basal amount in that disconnected time period so that you don't have problems with a deficit leading to potential decay in the next several hours. So So yeah, so there's my long explanation.
Scott Benner 10:45
Oh, that's a great explanation. And and it brings up you know, what it reminded me of, you reminded me of how proud I am of the podcast, and how we can have long conversations about stuff like this, because 15 years ago, in the diabetes space, this was the message, you're more likely to go into decay with a pump. Because what if something happens and you stopped getting your insulin, and then that became the rule pumps are dangerous. And then people thought that for years, until people got other people bought pumps, and wore them and proved everybody hey, look, I'm still alive. I have a pump. So saying something, and it's not a wasn't a, an incorrect statement, right? You could be sleeping and Rick, rip out your site. And now you're not getting insulin. And that is a
Jennifer Smith, CDE 11:29
danger that could chew the to but you don't know it. I wish I could name this
Scott Benner 11:33
episode, the cat that chewed the tube, but no one would listen to it. But but but the point is, is that we used to say these very basic things, because that's what communication allowed. And then people were allowed in their minds to take the scariest part of that and run wild with it in their own imagination. Yeah, so I like that we can talk more about this. I like that. Helen can now think if I give a Bolus at noon, and I need to make it more aggressive upfront because of the nature of the food, but I know that at three o'clock, my kid's going to get low. I can still make that Bolus at noon. Turn Basal off at two o'clock, create a deficit of Basal at three when the Bolus from noon peaks and balance those things out. That is so cool that we can talk about that like that.
Jennifer Smith, CDE 12:24
That's great. Yeah. So I appreciate your tools, more tools for the toolbox.
Scott Benner 12:27
It's just more stuff to understand. I saw Jeremy in the Facebook group. He's being helpful and making fun of me at the same time, which I appreciate. Oh, because when people sometimes people are like, I don't know, like, how am I supposed to get to this place where a lot of you are what Scott's talking about? And my answer always is, you got to listen to the podcast. Like just listen through it because these things will build it's not it's not a checklist of five things you just do. And it all of a sudden works. There's you know, variability and, and nuance and everything. And Jeremy's like Scott's gonna say to listen to the podcast and, and he's like, but try this year. And he's both right in making fun of me. And he's right about what he said, too. Because this is not a quick fix. And it's not information that your brain just learns. Hearing it one time, you know. And
Jennifer Smith, CDE 13:23
when you since we've got some time now
Scott Benner 13:27
turn it up here.
Jennifer Smith, CDE 13:29
On those headphones, go for a walk with your dog, push your stroller, listen to it while your kids are running around in the backyard and whatnot. Actually, somebody yesterday that I talked to she and their family, they had come down to Atlanta for the JDRF conference to hear you, which was great. But all the way there and all the way back. They actually listened to the podcast to the podcast, because they had like I think she told me it was like an eight hour drive there an eight hour drive home. So they drove there and back listening to the pod.
Scott Benner 14:02
That's really nice. I thought was really cool on my way to Atlanta. I was I had to park my car to an airport, and I got a little shuttle bus to get to the airport. And there was this woman and her like 17 year old ish son sitting next to me, and we start driving out of the lot. And she just stands up and like goes way, way, way, way way. And like everybody's like, Oh, you know, what's this? She was I still have my key. So she was valet parking. So her car still running somewhere. But she left with her key, right? So she the driver stops, she runs out takes the key to the valet. And I turn to the boy and I say is that your mom? And he goes yeah, I said, my wife and I embarrassed our kids all the time. And he looks at me really strange, to the point where I thought Ooh, did I just offend this kid? Right and I felt bad. So I kind of withdrew back into myself and stopped talking to him. She gets back on the bus and begins to very kindly apologize to everybody on the bus. Oh, I hope I'm not making you late. Meanwhile, it was 30 seconds. You know, she just I hope I'm not making you late, Bob, I'm sorry, but and I looked up at her and I said, I just did something really stupid with my key two weeks ago. If you sit down, I'll tell you about it. It'll make you feel much better about this. She looks at me and goes, Are you Scott from the Juicebox Podcast? And I went, what? Because you know, we're on a bus at an airport with only eight other people. And I said, I am. And she goes, Oh, I saw you speak at this thing. And we listened to the show. And just as that happens, the kids CGM beeps, and I turned to him and I go, Oh, hey, and he looks at me. And he goes, I thought your voice sounded familiar, but I couldn't place it. My mom and I listened to the show together. And I was like, just think he wasn't mad at me. He was like, oh, man, why is this guy's voice seem familiar to me, you know, and it was just absolutely crazy. And then days later in Atlanta, I literally walked into them in a hotel lobby. I was like, they're there again. Funny, it was very, very strange. But, but nice. It was it was lovely, actually. So it might be different. You're being kind, but I appreciate that those it was very strange. It happened two weeks after I was recognized in an airport in Dallas. And that threw me for a loop. That was a woman approached me. He told me about Yeah, you're just sitting. Like, I was getting ready to get on a plane trying to decide when I was going to change my shirt, my sneakers, you know, like, and a person I have music on. And this lovely woman comes up to me, she kind of puts her hand out. And you know, you're just like, what's about to happen? You don't I mean? So I'm like, Hi, how are you? And she goes, good. I'm like, Can I help you? And she goes, Sure. Are you Scott? And I'm like, Uh huh.
Jennifer Smith, CDE 16:56
And who are you?
Scott Benner 16:57
And I was like, Were you just at my talk? And she goes, No, I'm in town. My daughter's running a marathon. And we're here to support her. And I was just like, wait, what? Like you weren't just at the thing I spoke at? And she's like, No, she says, My husband and I were sitting over there. 10 minutes looking at pictures of you online trying to decide that he's finally I think that's him. Go say hello. That kind of stuff. I gotta be honest with you. From diabetes podcast, I never thought and now it sticks in my head when I'm in public now. Now I'm like, Hmm, is there?
Jennifer Smith, CDE 17:27
Anybody knows what I look like?
Scott Benner 17:31
You just got to keep a lower profile. Because Because now I find myself thinking like, do I have to be nicer in public? Not that I'm not but like, am I gonna be judged by? Like, is there gonna be a story online one day, we're like, I saw this guy from this podcast, and he was being so he was being rude to a lady, you know, which I'm not. But now I'm worried about it. Right. So silly. Absolutely. So So I said, Jenny, let me ask you a question. I haven't asked Jenny question. I have. I'm doing that thing tomorrow on tomorrow, the first, you know, kind of group meet up for people. And I was thinking during this Coronavirus thing of starting like some sort of a challenge to lower your a one, see your deviation, your variability, like all that stuff, like we're all just sort of sitting around. Like, I wonder if we shouldn't, like try to help people like, right, like, I'm wondering if when everybody comes on this, this zoom later, if I'm not just gonna go through one by one and be like, Alright, everybody hold up your 24 hour graphs. Let's look at your Basal insulin. And then, and then talk about getting Basal adjusted for people, and then maybe see if we can't get back together once a week and see what we could do about like, I do a cool thing to do I do it with single, like people by themselves. Like, I think I could do it with a group.
Jennifer Smith, CDE 18:52
I not do it together and teach a big group. Right? Yeah,
Scott Benner 18:55
that might be fun. I think that would work.
Jennifer Smith, CDE 18:59
I do. And I think from the standpoint of looking, you know, I, in terms of looking at data, when you look at so much data, as I do, every day, lots and lots of data, lots of people's different kinds of data, you actually start to notice more things, right. And from a teaching tool, sometimes when it's only your own data that you're looking at, you can kind of get lost in it. Right, right. But when you bring together a big group, kind of like, like a kids for diabetes camp, or kids with diabetes kind of camp, you know, they they do a lot of things that are interactive like that, and they bring the information together and that sort of camaraderie. in a setting like this, yeah. where everybody's showing a graph. Somebody might be like, Hey, that looks like this is happening, right? Or, Hey, that looks like this is happening. And not only is it like a learning experience, you're also helping other people. You don't necessarily know.
Scott Benner 20:01
I just, I see it in the private Facebook group. So if you go on Facebook and search juicebox discussion group, I think that's what it's called. I named it, I should probably know what it's called. But it's a private group where people talk, and there's times people put graphs up. And I'll like jump in to say what I want to say, and somebody will have settled already, like, oh, great, you know, and I'll like, like, somebody comment and put a finger under it, like pointing to it. Like, this is what I would have said, Yeah. And then there are other times where somebody makes an explanation. I think that's better than what I was gonna say. And, you know, terrific. So I'm thinking like, maybe we can do it. Like, again, a mass like, you can get 100 people together and bring everyone's blood sugar down, Louis, Zoom call. I'm like, I'm like people. Yeah, I think I can. It's so and then like, yeah, I hope so. I really hope it works out. So I'm gonna even have
Jennifer Smith, CDE 20:51
like, focuses, like you said, kind of like Basal or like, even like a challenge of, okay, your challenge today is to go home and just Pre-Bolus for all of your meals. Right? And let's look at what that did from today. Compared to tomorrow. What did that do?
Scott Benner 21:06
That's what I was thinking. Alright, I like that you are doing. Jenny makes me feel better about myself. Sometimes. Like you said, one, though. Seriously, you said one time, I forget how you put it. But you said something about, like, you could do this for a living. I know you don't have the credentials, but you could. And that made me feel really nice. I just I never told you that. So thank you. Okay, let's see. How are we an hour and a half today?
Jennifer Smith, CDE 21:38
I set up for about an hour, hour and 15 hours.
Scott Benner 21:41
Okay, so let's do we'll do one more. Um, ah, Kelsey, I'd be curious to hear Jenny's thoughts from a clinical perspective on the post from earlier regarding extreme she without in quotes, management tactics versus being bold. And what her take is on lower a one sees and the pushback in the medical and sometimes social community based on available studies showing no benefit. Also thoughts on lag time of published studies and the advances made in the last decade? Have we talked about this? I brought this up in passing with you once. I just mentioned it as an article. I don't know if you've seen it or not. Right. But so I guess what Kelsey wants to know if I'm, by the way, that's a very well written question, Kelsey. It is no, so many smart people are listening to this podcast.
Jennifer Smith, CDE 22:34
They're all smart. Everybody's smart in different ways.
Scott Benner 22:36
Yeah, no kidding. But I'm saying this is a really well written question. Usually people's writing doesn't read. Well, Kelsey can write is what I'm saying. So, but but to boil down what she's asking. I think what she's saying is that there's a way that you know, the medical community generally talks about this, right? Like, oh, a seven a one C is fine. And then you see somebody say, Well, you know, me or somebody else. My kids got a five five and I just handle that by stopping spikes you know, making sure her blood sugar's Well, I don't think anything I'm saying is crazy, right? Like it's and, but to the, the masses, it seems like over management to them, because they've been given such a baseline of like, just do this, and whatever happens is fine, and go live your life. Right? So is her question really? Well, her, you know, let's ask answer a question first, like, what's your take on doing what you want, you do what I do with art, and with a lot of people listening to this do and what happens when those poor people then go into their doctor's office and then get sometimes really chastised for it? Like, like, I know, that's a hard thing to wrap your head around you and I talk about this privately, sometimes, but a lot of people that listen to this podcast, their next leap to make is to then talk their doctor out of being upset about it. Correct?
Jennifer Smith, CDE 24:03
Correct. And he we even get, sometimes not often, but again, a lot of the people that end up coming to us to work with us is because with all the information that is out there now and is so available online, we can not only see what other people are doing, but we're also reading such as she refers to, you know, these studies about lower isn't necessarily proving to be better in the long run, etc, etc, whatnot. But people want to do better, and they want to do better from the standpoint of understanding and I know that we addressed this somewhat in another podcast, there was a brief talk about this because I had referenced the fact that a one C for the population of people without diabetes is under 5.7%. Yeah, Why are we not aiming for that in a safe in in safety, right? With safe constraints? I'm not saying run at a blood sugar of 55. So you can get an A one C of 4.7. By no means, however, why are we not aiming for the goals that people without diabetes already have? Because their body does it for them? Right. And I bring it in to and I think I commented before as well about like pregnancy targets. If pregnancy targets are what, what we're aiming for, which is the normal blood sugar that the population of people without diabetes already has naturally, if we're aiming for that in pregnancy, why should somebody go back to aiming for higher or loosening that up? Once they're not pregnant anymore, but the baby's healthy? I guess I can, like, you know, lighten up on everything,
Scott Benner 25:57
go back to racing to my death,
Jennifer Smith, CDE 26:00
aiming for a target, you know, under 250. Target under 140. I, I don't I mean, from my personal and my clinical perspective, I don't know why that is the recommendation other than as we've also sort of alluded to, or really commented about previously, a safety factor from the conventional system of management that we have kind of that we've had to use, because that's all there is. There is a safety component that I think many, many, many practitioners, they, they don't see the every day. And so when they see data that's showing them and they're only looking at an AE one C, somebody comes in with an A one C that's 5.7. They're thinking, Well, gosh, this person's got to have a whole bunch of lows, or there are this a one C would not be 5.7. But if they looked at the actual data, and now that a good portion of people are using CGM, we should be looking at that to go along with the actual glucose management indicator, or the a one C or the average glucose, because if they're achieving an A one c that is phenomenal, 5.56, you know, 5.1, whatever it is, and their time in range is phenomenal. And their percent low is not more I mean, we as a practice, aim for less than 5% low. So if they're achieving that, why are you? Why are you upset that they're managing something? So well, a lot of preventing problems, a lot
Scott Benner 27:43
of people that reach out to me with a story indicate that the doctors even presented with the data, it doesn't stop them from being upset. They're so pre programmed to believe if you've got a great day one, see you did it wrong. And that no one can get that. And
Jennifer Smith, CDE 28:01
I'll tell you that I've had I had one really, really, really phenomenal Endo. In, I've had a couple of really good ones. But one really phenomenal one. When I lived in DC, he was fantastic. He he could side by side power with me on the level of information that I needed to talk at. And he was like, he was like a go for it. You know, it's here, let's attack this, I see this could be a problem area, he was happy when my a one C was like 5.4%. He's like, That's phenomenal. And your lows are not in the picture causing this. I mean, he could really talk on that level. And he was comfortable about that. Because I was also and I think maybe this is also a piece too. If you have the ability to talk back to your doctor about what you're doing to get there and to manage that. I mean, if you go in being like, I don't know why I'm here, I don't know how I achieve this, or whatever they're gonna be like, well, that's this isn't this isn't safe, I don't see data that's proving that this is safe. You don't really know what you're doing, obviously, but from the standpoint of many of the listeners, and many of the people that I work with. I don't love the data that I read the report that you mentioned the research report. I don't don't love that it's kind of telling people that they should aim higher when we know and diagnose pre diabetes and diabetes at certain emergency levels. If you're pre diabetic above this level, if you're diabetic at this level, why? Why is that then healthy for somebody to maintain once they do have diabetes?
Scott Benner 29:58
I think to that anecdotal evidence is more valuable in a time where we can all talk like this. Because, you know, calcium makes the point. You know, when was the study even done? You know, and just because data collaborate, right didn't look right, that study could be years old, just to get it out the way that's, that's and I'm not saying that the scientific community shouldn't do their studies the way they do. But the problem is you do a study with, you know, the proficiency of starting a fire with matches. And five years later, when you put your your data out, there's a flame thrower Now, that doesn't match up anymore. You know, you mean, I've got a flame thrower. I'm not using matches. Your dad is 100%, right about the thing that you thought I started thinking about four years ago, except we are in a different world now. So you're using CGM, and pumps, and you know, algorithms and everything else. And they're giving you you know, they're giving you advice from five years ago? Correct? I think too, it's important to remember. Not everybody's a bad student. Sometimes there's bad teachers. And so if you're failing, with bad information, are you failing? Or are they failing you? Right. And so if you start with a person who Jenny mentions having a great endo in Washington, right, so she met a person through happenstance, who really wanted to be a hands on endocrinologist, and sunk in and found out things and learn things, and was good at sharing them with other people. For every person like that, there's going to be a handful of people who, you know, we're coming out of high school and going, what should I do for a living, I'm good at math and science, I'd like to have some money, I'll be a doctor, my doctor goes on vacation twice a year, this is perfect. You don't just like there are some people who really want to teach children. And there are some people who just want to have off in the summer, they both end up being teachers. You don't I mean, and so not everybody's the great doctor from Washington. So if I'm just giving you look, I read the articles, this is what it says to tell people with type one diabetes. So this is what I say to them. And if they're failing, that's their fault, because I gave them the directions. You didn't tell them how to use the directions you didn't you left out all these other things. And so again, I used to talk about this a lot more in the podcast years ago, you have to just believe in yourself a little bit and what you're seeing, you know what I mean? Like you can't keep having outcomes that you know, are bad. And then turning back to the guy in the white coat. And he says, No, you're doing great. And then you swallow on that big fat pill and just going okay, I guess it's alright, the guy said, It's okay.
Jennifer Smith, CDE 32:37
And I think sometimes it's also hard. I mean, I've heard from many people, not many, but some people who've actually said, Well, if I, you know, if I choose, I choose to work with you or your practice, my endo doesn't want to see me anymore. Or if I do all of these things, and make my own adjustments, I get hand slapped every time and that doesn't change. Well, you know, in our healthcare system here in the United States. Thankfully, many of us with our providers, we've got the ability to change providers, we can look at our network, we can see who else could I go to, with social, you know, connections and whatnot. Now we can even ask, Hey, in your community, who has a really good Endo, who's a really good pediatric Endo, who do you love? What do you love about them? I mean, we can like network that way and actually make some different connections. I mean, I got an email from a woman in Canada, actually, probably at least a month ago, who she was asking how they could work with us, because she said, our endo makes all the pump adjustments. We literally get hand slapped. When we come to the office, if we made any adjustments. She's like, I even like, I save the adjustments My My doctor gave, I go home, and I make my own adjustments. And we go back to the office, I make them to back to what the doctor recommended. She's like, I know, he's also not really looking at the data, because otherwise the doctor would see that clearly. We weren't running on the profile that they told me to run on. I made my own adjustments or no, but they're also being told that a glucose value, you know, that's in United States milligrams per deciliter term was like a blood sugar of 105. They were being told overnight, was too low, to run their child at overnight. And so from that standpoint, you have to say, you do you have to say enough is enough, but I can't work with this practitioner. They're not willing to expand and allow me to manage something that's 24/7. It's not every three months of management that I come in, and I get your feedback. I look at this every single day. Every hour of the day. There is no shut off.
Scott Benner 34:55
Yeah. And at some point, you just have to The, you just have to say I can't change this person's mind. And the reasons why are unimportant. Like what it be, maybe the doctor doesn't understand, maybe the doctor is lazy, maybe, maybe, maybe, maybe who cares why it's happening to you just, you know, you have to remove yourself from a bad situation. And it's tough because some people will say, Look, I don't live near that many doctors, I need these prescriptions. And, listen, I don't know what to say about that. If you've got to suffer a fool to get your prescriptions, then you're gonna have to find a way around it. But stop trying to stop trying to make it. What do I want to say here? I have my example popped into my head, but it's too personal to share, because it's not about me. Not everybody does the right thing. And a lot of people want people to do the right thing. You can't make the fight, teaching someone else what's right, sometimes you just have to get through it on your own. And so if you've got some chucklehead, but they've got a prescription pad, then you've got to put yourself in that mindset, I'm going to go play a part for 15 minutes, and then I'm going to get out of here, and I'm not going to worry that he's wrong. I'm not going to worry, I'm just going to do what I need to do for myself. And I'm sorry, if you find yourself in that situation, but if you do still got to protect yourself. Yeah.
Jennifer Smith, CDE 36:16
And I think from the standpoint of even, you know, her question going further into like the research part of it, I think, if this is the kind of information that doctors are looking at and saying, Well, gosh, you know, running with an A one C of 5.5, doesn't seem to be any better than running with an A one C of 7.2. So why why would my patient want to get down here? I'm going to just tell them that that seven 7.2 is just as good? Well, again, we don't know necessarily where and when was the data collected? From what kind of information? What was the lifestyle of these people, etc, etc. I mean, we do know that glucose values that are well controlled, decrease, and for the most part, do limit potential complications down the road. We know that right? Now, is that to say, you're never going to get a complication, even if you did this sweet management your entire life. No, of course not. Now, sometimes things they they happen, right? We don't know necessarily everything because we we don't know 100% of how the body functions, right?
Scott Benner 37:24
We don't, don't you find that most questions around management are probably at the very core of their question. Hey, Scott, Hey, Jenny, how do I stop from anything bad ever happened to me or my kid because I have diabetes. And it's such a sad thing. But you have to, you just have to say to yourself, I can, this is my situation. And I'm going to do the best I can with it. And put myself in the best position to hopefully thrive for as long as possible. And that's sort of it you know, the rest is sort of out of your hands. Right. But the part you can control. That's the part you should focus on, I think. All right, Jenny, I'm gonna let you go live your life. Okay. This was excellent. You do? Yeah. Thank you. Oh, I'm gonna record again in 45 minutes with somebody.
Jennifer Smith, CDE 38:09
Oh, good. That's fun. Yeah,
Scott Benner 38:10
I'm doing today. Jenny Smith works for Integrated diabetes calm. She's also lived with type one diabetes for over 30 years. Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. She's also pretty damn lovely. Check her out at Integrated diabetes that com if you'd like to hire her to help you with your type one, diabetes management. I have more to say you want to chill out for a minute. Okay. So we did a meet up? Two weeks ago, there's been two already. There'll be a third one this week. As I told you on April knife that I say the knife. Yes, April knife. It's a Thursday going to be 7pm Eastern time, not the point. Point is did the first 175 People rolled in very cool. And I thought people would just hold up their graphs or ask their questions and we'd roll through their answers and their answers may help may help other people and other people may have helped for them. And it did mostly go like that. But there was something that happened. I didn't expect. And I don't know why I didn't expect it. Because now in hindsight, of course, it seems obvious. But some people were very quiet. And they were not wanting to hold up their graphs. As a matter of fact, the amount of notes that I got out that I got afterwards. That said I was embarrassed or ashamed or nervous or a lot of different words to describe how people felt to talk during the thing but could you help me now? That piece makes me feel like that what you heard me say to Jenny about like we should all just come together and do a challenge. Like it would be, you know, I maybe that doesn't make that reasonable. Perhaps most people aren't interested in sharing that much. And I get that. So in the second meetup, I just realized, let's make it informative. Some people will speak up, some people will be willing to share their data, and some will learn from watching. So while I like the idea of a challenge, I don't think it's reasonable. But what I found afterwards was that getting together is hugely beneficial for everyone there, no matter how they choose to participate. So I hope you come out. Like I said, there'll be links in the Facebook page for bold with insulin. I'll try to put something up on Instagram to remind you there, but here's a reminder right here. I think it holds 100 people. So it's kind of first come. The two we've done so far have been in the afternoon. So I'm going to shift it to the early evening to help accommodate other people. So 7pm April 9, it's on Zoom. Anybody can come and hang out. Just look for companionship, meet new people. There's a chat people can go off and chat on their own. Listen to the conversation. It's just a nice way to distract yourself during this time of crisis. Today's Juicebox Podcast was sponsored by Omni pod makers of the tubeless insulin pump that my daughter has been using for most of her life. You can get an absolutely free, no obligation demo of the Omni pod sent to your home by going to my Omni pod.com forward slash juice box and filling out a little bit of information. You can learn about the Dexcom G six continuous glucose monitor@dexcom.com forward slash juice box and to see if you're eligible for a free Contour Next One blood glucose meter go to contour next one.com Learn more about touched by type one at touched by type one.org 10 second dance party
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About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
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#320 Dr. Naddelman returns to discuss Coronavirus
Coronavirus COVID-19 discussion for 4-02-2020
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Adam Naddelman, MD 0:08
Hello, everyone, welcome to Episode 320 of the Juicebox Podcast a few weeks ago on episode 314 right about that 314 Dr. Adam Naddelmann came on to talk about the state of the Coronavirus. Well, Adam is back. And it may only be a few weeks later, but the world feels five years different. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise to always consult a physician before making any changes to your healthcare plan. The beginning of this episode is about how things are changing. But a large majority of it is really just two friends talking about how this whole situation is making them feel.
I want to thank touched by type one, and the Contour Next One blood glucose meter for sponsoring this episode of the Juicebox Podcast. Go to Contour Next one.com. And at the top, you'll see a button that says get a free Contour Next One meter, click on that you'll find out if you're eligible.
So I went out to get groceries just now a couple hours ago. And I'm you know, I've got gloves on. I've got the schmutz in my pocket. You know, like I took I didn't have any to cover my face was always like a side took like one of those like scarves that go around your neck and just kind of pull up. So now I look like I'm gonna rob the place. It's funny how now no one cares about that. By the way, there are going to be amazing armed robberies, once people figure that out. And right. And so I'm in there, you know, the stuff that goes on my hands, I kind of clean the card off, I do what I can do. But by the time I get done, it's like a workout. because everything's just different all of a sudden, like nobody gets near each other. So there's waiting and you feel really rushed to hurry while you're taking the food. The you know, I had to do a checkout on a full cart of groceries like by hand because the the ones that had cashiers were taking for ever. And I got done and I walked outside, I was like, I don't want to eat this badly.
Like, I get it, like hooked up to something where I can just get my nutrition, what I've ever done a once a week, why would 100% take that, but what
I was seeing was what was really super kind of interesting, is let me submit the slide off a little bit is that, um, what I noticed is that all the little things that are built into our life for convenience, they're gone. At least Yeah, right. And yeah, they, and then suddenly, you're left with the actual like, process of going grocery shopping. I couldn't enjoy the music. I had my ears. You know, you couldn't you couldn't see. You know, you couldn't see a guy rolling his eyes and his wife and like give him that knowing look like yeah, I'm married to like, you know, like all that was gone. And if if you had a mask on, or you're covering your mouth in any way, and someone wasn't they looked at you with two looks. It was either Oh my god, that guy sick? Or, oh God, should I have a mask on to? And so everyone's in that, like they're doing that calculus while they're walking around constantly. And it's just I don't know, I was like, this sucks. This can't stay like this forever. Because, you know, all the reasons I like, you know, being alive are kind of stripped down to this. I feel like an old man was like, this is the way the world should be.
No, I know. So
you and I recorded a couple of weeks ago now. Is that about right? timewise.
I actually loved it was March 16. Oh, that was two weeks. Little more than two weeks, but feels like three months. But yeah, about two weeks ago. Have you been out of your
house? Are you going to work? How do you handle work?
Unknown Speaker 3:57
Yeah. Now, I'm still going to work where you are limiting, incredibly who's allowed to come into the office that we're seeing well visits, we actually have a screener at the door that's stopping people making sure that no one sick, no one's had a contact with a known positive case. Or traveled now and travel is not really an issue anymore. because no one's been anywhere now for the last month but and then if the answer to any of those questions is yes, then they don't come in. Right. If it's no then they come in. Now that's only for the people that actually even get an appointment. We're not letting anybody walk into the office at all. So you can't just like strolling because you want to, you know, begin an appointment. And we're primarily doing just well visits and the kind of sick visits that are not like infectious illnesses. So, you know, the kid who falls off his bed and sprains his ankle, that that kid can come to our office. But other than that we're really not bringing the sick kids in at all. We're doing all telehealth for the
Adam Naddelman, MD 4:57
our most practices, doing this
Yes, or even more stringent than that,
okay? Like some people are being like, Hey, you twisted your ankle. Go online.
Unknown Speaker 5:09
Google spray
Adam Naddelman, MD 5:09
now they're like, yeah, they're like, all right, either like, you know, try to create a mask out of three socks or, I mean, not a mask. I'm so used to saying that create a, you know, ankle brace and a three sock. Yeah. Or go to the ER, no, we're still seeing kids that are that we think are relatively low risk. If someone shows up and they're not sure about anything, we just put a mask on them right away. And the doctors are all wearing masks and goggles and gloves. Now for every single patient, including balls.
I'm looking at this, there's a couple of sites that are tracking things. Now. I've been using this one and Cove to 19 dot live. And it's got total confirmed worldwide cases at over a million.
Unknown Speaker 5:53
Yeah, the one I like the best is the john Haas is the one from Johns Hopkins. Okay. You've seen that one. But that's the that's their that actually the very first one. I was looking at that before there even any cases in the US. That one is amazing. But yeah, there are over 1,000,001. That's just confirmed cases. Obviously,
Adam Naddelman, MD 6:11
I switched to this one thing, I switched to this one, their numbers incredibly consistent with what I just saw, and the other one. And it's funny too, like, obviously, if you take away personal freedom, like China, I mean, they're probably not reporting all their deaths. Right. But it's an incredibly low number.
Unknown Speaker 6:31
While they, there, the measures that they took were much more draconian than anything we could ever do here. Yeah, they were dragging people South Korea to I mean, South Korea was more just extremely aggressive testing. And then quarantining people who were positive quickly. So they had the ability to test a crazy number of people and get the results back fast. Right? So anyone with any symptom gets tested, they're positive, they're immediately quarantined. Unfortunately, because the testing here lagged, for so long, there's so many people walking around that, had it in the last month don't even know it right? Or have it right now, and can't get that
Adam Naddelman, MD 7:09
because of that this is going to go on much longer than we were hoping it is, isn't it? Like this isn't just a month away from being over?
Unknown Speaker 7:21
Well, I think it's gonna depend on how you define over. You know, I think that's a big part of it. I mean, I, but yeah, I don't think this virus is going away so quickly, unless there's some dramatic breakthrough with treatment or with a vaccine, but even a vaccine would take probably six months to 18 months to actually get to Market. But yeah, there's no reason to expect it's going to go away, it's just a matter of trying to spread out the cases to give the hospitals a chance to handle the volume. And right now they're getting close to not being able to handle it in some places.
Adam Naddelman, MD 7:51
And so what we're seeing right now is just sort of like the, it's, it's the all at once, feeling like it's happening to so many people, you know, within a three or four week period, and that's why the numbers keep kind of like growing as exponentially as they are, but you're gonna still hear like six months from now, you're gonna hear somebody got this and ended up in the hospital on event, like, it's not gonna, it's not gonna lessen or change. The frequency is what is what will change like, you don't I mean, like, yeah,
Unknown Speaker 8:21
yeah, it's hard to know. I mean, like, it depends on how many people are actually positive right now that we don't know about. There's some people estimating it could be five to 10 times as high as what's being reported in the US, especially in areas where there's a lot of cases like in New York, okay. So think about it this way, right? Like, if that number was really, you know, like, I don't know what the exact number is, for the US now, it's got to be a couple hundred thousand, at least, you know, several hundred thousand because it's a million worldwide. But let's just say it's 10 times higher than that. There will be a point where there's some protection within communities, because so many people have had it, that a new case coming into the community can wreak havoc the way it is now, because it's similar to like if, you know, chickenpox shows up in your child's school, and 99% of the kids there has either had it or been vaccinated, it can't do any damage. Right, right. So there will be a point where you have enough kids protected from an illness, where if it comes into the school, it's not going to be able to do the same amount of damage now. So that, that leads to the argument that some people are trying to make that well, why bother with all the social isolation, just get everybody sick right now, and then we'll be done with it. The whole reason you can't do that is because the hospitals could not handle it. And you'd have a ton of people dying for no reason, right? They couldn't get the care they need.
Adam Naddelman, MD 9:39
It would also overwhelm, you know, we think of overwhelming health care workers as their time and effort, but you could also get them sick. And oh, yeah, we'll and you could lose a number of them too. And, you know,
Unknown Speaker 9:53
yeah, there's been over 100 in the US that have died, supposedly, that that was. Yeah, that's the way to tally that up. But I saw but now there's no question about it. You overwhelm the whole system. It's not just the ventilators in the ICU, it's the how many masks you have on the gown. Do you have on the gods? do you have? Do you have the right equipment to test people? Right? If you if you take, you know, 5 million people and get them sick all at once, there's no way any health care system could handle that. Yeah,
Adam Naddelman, MD 10:19
we're you're basically, I mean, I don't know, we're draining a pool with a small hose so that our yard doesn't flood, you know, you could just knock the side down, let all the water out. But that would ruin the lawn. And so you're just gonna let it out a little bit at a time so we can manage what's happening. And so this is all
Unknown Speaker 10:35
well, and the other big thing. The other big thing about that is the slower that initial, or the lower that initial peak is, and the more the wider it is, the more time it takes, the more opportunity you give all of these drug trials that are going on the vaccine trials, the you know, you give it all a chance to start to, you know, for the science to catch up with what's going on and with the hope that at some point, you can really flatten it by treating it in a way that actually decreases the amount of serious illness. Right. And
Adam Naddelman, MD 11:05
and you're starting to hear stuff like I don't have you heard like, some people are trying z packs and having success.
Unknown Speaker 11:11
Yeah, it's the data is not there, unfortunately. So that's the whole plaque whittle is the name of the medication, which is also called hydroxychloroquine. It's a it's a medication that's used for certain autoimmune conditions, like lupus, for example. Very good for lupus. So one of the early studies, there was a study done in China and one in Italy, where they took Black Widow and they added the thermax to it. And they were different doses and the data was mediocre. It wasn't great, but they thought maybe there was a chance. So they've rolled that out and a lot of the sicker patients in the hospital. But unfortunately, the the data that's coming back is not super promising. But people started hoarding platinum. all over the country. Of course, right away. It might work. There was one guy that ate his fish food or fish cleaner or something because it was made with hydroxychloroquine and the same chemical. Yeah. And he died. Unfortunately, he died his wife in the ICU, but so No, there's not a lot of data yet to support that. That's gonna be the thing that's gonna make this all change.
Adam Naddelman, MD 12:09
Yeah, it's I think it's what, you know, we've all grown up with the movies like you just think like there's gonna be a guy late at night in a dark room and he's gonna you know what it is chewy sweet tarts, kills the Coronavirus. I can't believe it took us you know, and then it all goes away. And that's just I don't see that happening. I'm assuming, you know, I heard some, you know, the one of the doctors that's featured in that pandemic Netflix series. He's company came out yesterday, and they feel like they're on to something for inoculation. But at the same time, he said, you know, bright lights, maybe nine months, if we're right to get it like all together. That's the other thing is it's the
Unknown Speaker 12:53
first human vaccine trial started in Seattle a couple of weeks ago. But that stage, the stage that they're at in terms of the testing of safety. So it's sort of like, let's make sure that doesn't cause any harm first, right? Like, once they finish that step, then it sorry, let's see what kind of effect it might have. But that's they said they're 12 to 18 months minimum, and they don't even know if it's effective yet,
Adam Naddelman, MD 13:14
right? It's just, you know, I have, obviously you do too, but I have that background from watching my wife, I know how long it takes from, hey, we think this is gonna work to it works. Here it is in a box
Unknown Speaker 13:27
name. You know, I mean, the only difference now I think is for probably the first time ever, you have all of these different labs in different universities in different companies that are all working towards the two goals, right, they're working towards finding an effective treatment, and they're working towards trying to find a vaccine. So some are doing vaccines, some are doing treatment, some of the bigger companies are trying to do both. And the interesting thing is for the first time, they're actually sharing a lot of their inflammation. Yeah, so like when someone thinks, Oh, this might be you know, a step in the right direction, they are publicizing that together, and they're working together. So I don't know that you've ever had a situation where essentially, the entire world is trying to figure this out all at the same time. So that has to make you a little bit optimistic, it shouldn't be that difficult to figure out a treatment and to figure out one that can be ramped up quickly, but their energy being attacked by a lot of different angles, and just what they're trying now first is the kind of possibilities that already exists. That's where that whole black window thing came from. Because there was some thought that it has some anti anti viral activity when you do test them, like has to stop. So they said, Yeah, you know, there's a chance my work, sometimes it works for the flow, let's try it and they just started giving it to people with the hope that it would work. Same thing goes with
Unknown Speaker 14:41
dinner Mac, you know, that's another medication that has some amount of antiviral activity, not enough to recommend it for cold. But they figured, hey, let's just try it. Right now. I think that is one reason to be optimistic. You've never had the whole world working together. That's because all the people who could benefit financially from making a drug like this weren't all at the same time. thinking, Oh, I could get this.
Unknown Speaker 15:02
That'll that'll straighten your right up.
Unknown Speaker 15:05
Yeah. That will that will change your thought process. Yeah, you know what, let's just
Adam Naddelman, MD 15:09
whoever gets the money's good. I just want the pill, or whatever it ends up being well, good, you know, a mother necessity and all that, you know?
Unknown Speaker 15:17
Yeah, let them be I will say I mean, unfortunately, there's just not that much right now that looks super promising. So you have to really try to get it away from the most vulnerable people. And that's when the distancing comes in?
Adam Naddelman, MD 15:31
Well, it's interesting, because, you know, there's a difference between what's really, I mean, like, always, there's a difference between what's happening, and what people want to be happening or what they share, you know, when they're talking online to each other. You'll hear some people say, like, we should, we should talk about how many people have recovered. That's positive news. And I think that's true. I think we should, I also don't think that doesn't make sexy television. So you don't hear about it as much. And it is a shame. I mean, when you look at the real numbers, as I'm, you know, I moved over to the site you're talking about, we have United States total recovered over 800 total deaths, 5600, but total confirmed 236,000. So, you know, that's, that's still it's a it's a reason to be encouraged. And it's also a reason, you know, if you're part of the 5600, it's a reason to think this is the worst thing that's ever happened. And I think both are valuable points of view, do you?
Unknown Speaker 16:25
Yeah, no, I agree. I mean, I think the two things that we really need are the ability to do a blood test to prove that you've had it. Right, that would be pretty cool. Which you can do that for things like the measles or moto or other viruses, right? They're called titers, where you do bloodwork and approve that you have antibodies to that specific virus. Okay. Supposedly, that's not that far away. That would be super helpful, because then you could say, yeah, you know, back in January when I was sick and not feeling great, I wonder if I had it? Well, turns out, you did. Yeah. So that all of a sudden changes a lot of things. Because it looks like from all the data that is out there so far, you it doesn't seem like you're going to get it again. So imagine, like if you could prove to healthcare workers, Look, you've had this, you can go take care of these patients, and you don't have to be afraid that you're going to get it again. Right. So that's one thing. The other thing is, like I said, all those people walking around thinking they might have had it, you can prove that they did. So if you can do that, and if you at the same time can actually rapidly test people to show symptoms, you could start to envision a world where you could let people get back to their life, right? Because you could say, at the very first night of symptoms, you must get tested. And if you do that, and you are then quarantined for two weeks, you're gonna ideally protect the people that could really get sick and are vulnerable. You could also do a test to prove all the people that have already had it. So they could say, look, I have my, here's my test. I already had it, I'm good. And you can continue to really protect the most vulnerable people. Yeah, you can. We don't have any we have none of those mistakes yet,
Adam Naddelman, MD 17:52
you will also be able to say, hey, you don't have it. This is your seasonal allergies. Go ahead and keep moving. You know, right. Yeah. So the tests, I keep hearing. I mean, listen, it's politics. Right. So I understand, like, we've got this many tests out here. But I was like, yeah, that seems like 25 million too few. Isn't that a lot? You know, like?
Unknown Speaker 18:13
I mean, the reality is, we are living in New Jersey, which is the second hardest hit state right now after New York. And if you think you have it is very hard to get a test unless you are really sick. And I have friends who work in the emergency rooms of children's hospitals up and down the East Coast. And they they say, I can't test you unless you're like about to get admitted to the hospital. Yeah, you know, so yes, there are pop up sites. Every once in a while you hear Oh, there's a site by the Quaker bridge mall is a site by, you know, whatever. But the problem is that they run out of tests as quickly. And so it's, you know, there's not, you cannot get tested right now, easily. Unless you are about to go into the hospital. I have a friend who was tested
Adam Naddelman, MD 18:57
in Ohio. And she said, first of all, not pleasant having the swab putting her nose. She had a bloody nose when it was over. And then she got a call that said that the lab spilled her sample and she had to come back again.
Unknown Speaker 19:10
Yeah, so the people don't realize the test is the one that did that is used most frequently is a nasal pharyngeal swab. So that's exactly what it sounds like, in your, in your nose and into the back of your throat. So it's not just like, you know, touch the inside of your nostril. It's, let's see if I can touch your tonsils through your nose. Which is what it is
Adam Naddelman, MD 19:30
on. Anybody was gonna ever speak to you. Yeah.
Unknown Speaker 19:34
Right. So it is not pleasant. But that's the kind of sample you have to get. The potential for bloody noses is the potential they lose it. You know, I've heard multiple stories about people getting tested, and they never even get the result because it gets lost. Right?
Adam Naddelman, MD 19:47
Yeah, I mean, it's not what it should be. Yeah, it's crazy right now. They are working on tests like fast tests that seemed like why they're coming around.
Unknown Speaker 19:57
I mean, we get stuff you know, I get emails from companies that claiming that they're going to have it soon. But it's not anywhere near like, Hey, I can drive by get my nose swabs and find out 10 minutes later that I'm positive or negative, like, I don't think that's anywhere close, when you guess what they did everywhere else in the world,
Adam Naddelman, MD 20:14
when you get contacted like that, because you're the either president of your practice, is that a salesperson trying to get the head of the line? Like, is that a little bit of sound shift going on? Sometimes?
Unknown Speaker 20:23
It depends. Yeah, I mean, a lot of times, it's what it's like blast, you know, that are going out to anyone who's in their system. Sometimes it's the sales thing. Sometimes it's, you know, usually the sales things come more from like the rats that we deal with, and they go right to our lab. But, you know, we would know if, like, if there was an ability to get people tested rapidly. That would be that would be the biggest story on the news. Yeah, it just doesn't exist right now. Right?
Adam Naddelman, MD 20:49
Yeah. No, I know. It's, I, I always think when people are, they'll say like, Is there a cure for type one diabetes? I'd say, you know, you don't have to track it every day. If it happens. You'll find it right.
Unknown Speaker 21:00
Yeah. Yeah. Yeah. It's not like, Oh, my God, you found it on Facebook. Yeah, that did around. I can't believe you found it before you went. I
Adam Naddelman, MD 21:06
can't believe I live six years longer with this than I had to because I just didn't write it cured it. Yeah. You'll hear later. Yeah, it's hard not to be anxious, though. I mean, are you how are you doing with me? You're going out there you're going to work is? Is your wife leaving the house?
Unknown Speaker 21:21
Very, very, very infrequently. Yeah. Like, go to like the supermarket, buy 10 things and get out of there as fast as you can, like, that sort of thing. But like even at work, I mean, I am spending most of the day with the door closed in my office doing telehealth. Seeing a handful of well, patients.
Unknown Speaker 21:43
Nothing like what we would be typically doing right.
Adam Naddelman, MD 21:46
Do you miss it? Like the contact with people?
Unknown Speaker 21:50
Yeah, it's a it's very strange. I mean, I think for all of us, it's really strange, especially like, doing what I do where you spend all day long, talking to people face to face, right. So it's just weird when that I mean, now at least with telehealth, you can see some people. But it's, it's just bizarre, like, I think, the mental health aspect of this, not just for, you know, healthcare workers, but anyone who's in any kind of a position where you work with people face to face. Yeah, it's just weird to turn all of that off. We were meant to be social people. And it's just, it's bizarre.
Adam Naddelman, MD 22:22
I agree. I also think that if you exploded out into the future, you know, like, you hear people say, nobody's gonna have to go to work anymore. And I think well, then what are all those buildings for? What are we going to do with them? And, you know, what are the vines gonna grow over top of them? We're all just gonna live in our domiciles. From now on, what about people who don't like I'm at a house, they have a room where I make a podcast, some people live in a room this size, you know, so those people, you can't expect a human being to stay in a in a New York City apartment, every day all day long, forever and ever. Like, that's
Unknown Speaker 22:54
not Oh, yeah, I mean, I think clearly, like when this is over, however it ends, we're going to go back to work, and they're going to, you know, they're going to return to some semblance of normalcy. But I do think that it is made blatantly obvious, a bunch of things like a bunch of travel that people do for work is a total waste of time, you can accomplish it now on a computer. There are a lot of people that have been trying to get jobs where they can work from home, either because they're, you know, physically disabled, or they have some kind of condition where they can't get into an office. And they've been denied those opportunities. And clearly, they could do it from home. Right? So I think there's, it's gonna change a lot. But you're right. I mean, people are still gonna have to go like people, especially that are in service industries. How are you supposed to work in a restaurant or hotel from your house or a toast to cut hair? Or, you know, clean teeth, or see patients or whatever it is? You can't do that from your house? Yeah, 100% of the time now. And
Adam Naddelman, MD 23:50
I mean, there's some things like, don't get me wrong, I guess I want to go to a baseball game I've ever wanted to go to a baseball game so badly in my life as I have in the last three weeks. But they're, they're not going to just like sports aren't just going to become a thing that happens in front of an empty building. You know, they're talking about it now. But it's not going to give her the NBA talk about like, maybe we'll go to Las Vegas and just hold a tournament. My son's like, you mean, like an AAU tournament, like, you just all show up at the same place? I'm playing I'm like, I think that's what they're talking about, you know?
Unknown Speaker 24:21
And he's like, I mean, I think if anything, like you know, accelerate some of this eSports stuff that he put talking about, that you can play from your, you know, your from your couch. But no, I mean, look, I think at some point, you know, at some point, you're going to have a return to society, that's going to look a little different. But some of these things are going to either either they're going to come back or they're going to go away altogether, right.
Adam Naddelman, MD 24:43
You're gonna find out what you don't care about all the sudden.
Unknown Speaker 24:46
Yeah, yeah. Right.
Adam Naddelman, MD 24:48
I think I was. I saw somebody recently that I know. And their very first statement to me was, hey, are the divorce rates going up? And I said, Is this a personal commentary on how it's going
Unknown Speaker 25:02
I saw I saw something funny online, they just said in nine months, we're either going to have a lot of babies, or a lot of justifiable homicide, because parents are going to kill their children and they kill each other, like, people are just going bananas. I mean, there's only I don't care how big your house is. There's always so much room when you have like, you know, to get away large children. Yeah, like at some point, you need to get out, get away from each other.
Adam Naddelman, MD 25:25
And people are just getting, like I said this this morning, I said to everybody, listen, the weekends almost here, we have to find something mindless to just do. You know, like, that isn't just passing time, like we have to get together. And I don't care what it is. And I don't know how to figure that out. We're not leaving. I mean, maybe it'll be nice enough, we can go outside a little bit on our property. But we can't just keep doing this over and over and over and over again.
Unknown Speaker 25:49
I've been saying the same. It's funny that you say that, because I had been saying the exact same thing. Have you ever felt like time moves more slowly than it's moving these last three weeks? I mean, like you and I said, wasn't even three weeks ago, right? It feels like it's been six months. I mean, the days the hours, crawl by the days go so well. You know, you're stressed and anxious. And then the evening comes and you're like, Alright, well, now I guess, like we watch a different TV. And then what are you supposed to be doing differently? Yeah, in the on the evening, or, you know, on the weekend, we'll know the unbelievable
Adam Naddelman, MD 26:21
zero lie. I took the dogs out yesterday morning after I fed them. My neighbor's taking the recycling down to the street. And I said to her, why are you doing that? And she goes, I don't know what's out at other people's houses. And it's like, Oh, all right. So sometimes there's a mass hysteria that happens around recycling. And if you've ever seen this, someone gets the day wrong, puts the recycling out and everyone on the streets like oh, my God, it must be the recycling. Dan, I didn't know. So I just don't like Yeah. All right. So I took my recycling down. I come back in the house, I text my neighbor on the other side, I go, why did I just take my recycling down? And he goes, it's recycling day. And I said, It's Friday. And he goes, dude, it's Wednesday. And I went, oh, sorry to bother you. I was not kidding. I wasn't. I don't usually misunderstand what day it is. Friday to Wednesday, I had no context for what day it was. It just didn't matter anymore.
Unknown Speaker 27:15
But yeah, I mean, I think it's
Unknown Speaker 27:18
right. And I think people, you know, there's a certain rhythm to our lives that we've all gotten so used to where you, for most people, your work your five days, and then you have your two days off. I mean, a lot of us work weekends and evenings and things like that. But that's the general pattern of our society. And I just, I don't know how long we can go without any real distinction between what day it is some sort of schedule so many people. Yeah,
Adam Naddelman, MD 27:40
yeah. No, I had the strangest feeling. Like I said, leave in the grocery store today. Like I I'm not listen, I'm not depressed. I'm like, I haven't been overwhelmed by three weeks in my house. But I was like, what's the point of all this? If I can't talk to people? And like, what am I doing? I'm just staying inside, you'll have to go run and get a piece of chicken again, like, I can't be everything, you know,
Unknown Speaker 28:01
now I know. I know. I mean, like, I'm, I am relatively hopeful that we are going to start to see the case number and the real and the hospitalizations and all that start to kind of peak, and then start to, you know, head downward. And, and it's going to be a big sort of sigh of relief. Once you start seeing that. I mean, if you look at like what's going on in California, like, it's very interesting, when you compare California to New York, New York is very densely populated. Obviously, you have New York City, which is the most densely populated city in the country. And so they really had no way out of this, like they were going to get hit no matter what California enacted really tough measures pretty early on. And if you look, there's some evidence that it may actually be working like the cases, you know, these people that are getting sick or quarantined off and are not getting other people sick. Right. So that's how it's really starting to come down. And if you can get it down enough, then you can really start to think about what what's it going to be like when you know, the number of new cases per day is like, not, you know, a couple thousand Yeah,
Adam Naddelman, MD 29:04
that's it. That's no better, you know, proven then when you look at New Jersey, how the deaths in New Jersey are clustered in just towns. You know, they mean, like, it's, you know, like, Oh, do you live in Mars? 40 people died here. like, Wow, really? You know, like, that's, that's super interesting. And
Unknown Speaker 29:23
yeah, I think that just because they probably if you can go through Mars and test every person, you'd find that like, you know, 4000 people have it in Maurice for probably 10,000 people have it. And if you look further,
Unknown Speaker 29:37
further away, you get less of it.
Adam Naddelman, MD 29:38
You'll also find I bet the people in like New Jersey, obviously like we're basically a bedroom community for New York in North Jersey, right, like everybody leaves New York and goes to New Jersey and goes home. And, and so New York, New Jersey for the you know, my just won't be the same thing for for this situation, honestly, because the people so freely go back and forth. worth
Unknown Speaker 30:01
while you can do that, because the further north you get more and more if you're in Bergen County right now you might as well be in Manhattan. Yeah, pretty much the same thing right
Adam Naddelman, MD 30:09
now. I'm interested to see what happens to places like California that button it up quickly. I'm also a, you know, I was wondering what you thought about. You see the cruise ship that nobody will let port anywhere?
Unknown Speaker 30:22
Yeah. So Florida, apparently is going to take them now.
Adam Naddelman, MD 30:26
Last night, they were saying they were just going to take the Floridians off of it. Have you heard more since then?
Unknown Speaker 30:30
So this morning, I heard that the the governor of florida said we can hit that he had assurances from one or two healthcare systems in that area that they can handle the volume, the volume, I suspect that they tested the people on the ship. And they figured out who actually has it and they said, Oh, well, maybe that's not as bad as we thought. So they're going to grab, they're going to take off the people that are sick. Yeah.
Unknown Speaker 30:51
Yeah, I know.
Unknown Speaker 30:52
That was I you know what? I think honestly, it's like, if you're going on a cruise ship now. And that cruise gets stuck. I mean, I think there's a point of personal responsibility here. Like who in their right mind would get on a cruise ship right now? Yeah. with what's going on? What like when did that cruise leave? And where did it leave from? Right? That's what I don't get. Yeah, no one takes a three week cruise to Fort Lauderdale. Right? Right. So it had to have last in the last 10 to 14 days, like who in their right mind would get on a cruise ship right now I don't get it.
Adam Naddelman, MD 31:20
When we were a young family, we took a cruise. And Cole was in the pool. And then suddenly everyone was rushed out of the pool. But water was drained out of the pool, I noticed a little human poo in the middle of it that a guy went in, cleaned it out. And at that moment, I turned to Kelly and I was like, well, we're not doing this again. I've never been somewhere before where this happens. So let's not go to places for stuff like this
Unknown Speaker 31:46
happens. It's just I mean, I just think that industry is going to be in serious trouble. Like, I just can't imagine, once people can travel again, if you had a rank the types of trips you can take, I can't imagine people are going to say Sign me up for the next cruise. I mean, that's a statement against any particular cruise line or anything but just the idea of being on an enclosed, closed, basically a hotel at sea. With hundreds of people with potential for elements like this. It just doesn't seem rational. I keep waiting.
Adam Naddelman, MD 32:17
I wondering if, you know, one of the airlines is gonna not go out of business to like, at some point?
Unknown Speaker 32:22
They definitely Yeah, I think they definitely are unless they get they've managed to get the money from the government quickly,
Adam Naddelman, MD 32:28
in the past even fold it together at times in the past. Am I remembering that right?
Unknown Speaker 32:33
I think so. Like I mean, some of these airlines have been different things like remember Eastern Airlines. And like, you know, so who knows, I mean, so much of that industry is, I think is they operate on margins that aren't as big as you might think they are until you do something like this to them. And it's just devastating. Although I do find it interesting that when the oil spike happens a few years ago, you remember there was like they were they started charging people fuel tax, because gas prices were so high. I don't hear anything about them. Pulling the fuel taxes off. Now, gas costs $2 a gallon again.
Adam Naddelman, MD 33:05
You can't suddenly fly somewhere for $55. I mean, I listen in fairness, I you know, we were just slightly ahead of the this whole thing happening when I was getting back out of Florida when Cole was playing. And I flew home from Florida to Newark. Just me and nine other people on a jet. Yeah. I mean, there's no money being made there. You know?
Unknown Speaker 33:30
Yeah. They just say like somebody asked andrew cuomo about why they shut down the airports in New York. And he said, you know, it's first of all, it's a very difficult thing to do, because you need goods to come in and you need health care workers coming back and forth. But he this is what he said the other day. Apparently, the the number of passengers traveling in and out of the New York City airports in New York, JFK, LaGuardia down 95% Oh, yeah. Yeah. So like, whether they're open or not. Nobody's nobody's in the airport anyway. So what's different is probably the safest place.
Unknown Speaker 34:01
There's no crazy.
Adam Naddelman, MD 34:03
So what would you say if I told you that, um, last weekend, I got up in the morning and I was fixing something around the house. And I found myself missing a piece that I needed. And I thought like that, I thought, no one will be at like Lowe's. I'll go there. It'll be me and the guy working there. And when I got there, the parking lot was so full. I turned around and went home. Like, do you think do you think there's sort of like a, I'm starting to believe that there's like that we I think as humans we set like false timelines for things. Like you know, I'll understand this better in a month, a week a year, like we do that to ourselves for for no reason. I used to I talked about it on here all the time. When Arden was diagnosed, I thought, what a year and I'll understand it better. And then when I didn't understand it better in a year, I actually said to myself, but it probably takes two years. Like why doesn't it take 17 and a half months? You don't mean like so I wondered if it if people hadn't woken up on Sunday morning and been like it's been a couple of weeks. This is probably okay. Now, you know, like I was interesting, but I wouldn't. Yeah, it sounds like no.
Unknown Speaker 35:05
Yeah, you know, I don't know. I mean, I think a lot of people that do work outside, like, especially contractors that, you know, are mostly outdoors. Like, I'm sure you see this to driving around, but the landscape guys are all out and doing everything, right. So I think they maybe they have a little bit of a false sense of security, because they think I'm doing a project outdoors, I got to get my equipment for the day, you know, you hope that they're keeping apart from their coworkers, but certainly seems a lot different than people that are working in office buildings or, you know, getting furloughed by companies, because the companies are basically almost going out of business. Right? It does seem like that industry for whatever reason, maybe there's maybe these guys are outdoors a lot more. I don't know. Yeah,
Adam Naddelman, MD 35:44
no, I don't know. It's just, it threw me off. And then I actually, you know, I basically had a conversation with myself on the way home where, because the first thought in my head was, what are all these people do it here? And then I said, Oh, yeah, you're one of them. So at least caught myself in time and said, my cell phone. But you know, as I was being, you know, morally outraged about there, not being concerned. I was like, I just did the same thing. But maybe we all felt the same thing. Like how there won't be anybody there. This will be completely okay.
Unknown Speaker 36:14
But yeah, I've had a bunch of conversations with people asking like, Oh, you know, what do you think about doing this? What do you think about doing that? And I think the answer is just got to be the same. Are you going to be within, you know, six feet of a person for more than 10 minutes? Yeah, the answer to that is, definitely then don't do it. If you think Well, probably not, I'm not really sure, then you probably shouldn't do it.
Adam Naddelman, MD 36:35
You know, have you heard today, I went downstairs and Kelly told me, they're starting to talk about it maybe being more airborne than they thought.
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Unknown Speaker 38:39
So this has been going on since China was the first one really dealing with it. And you know, I heard some interesting stuff today that they really don't think it is airborne, okay, I think it's just really infectious. So you can get, I think you can get confused by that. Because, you know, airborne means, like, I live in a building and my ductwork connects to the apartment above me, I can get it from the person above me. That's really what airborne is. Okay, that's not, there's no evidence that this can do that. I think this is by droplet. So I sneeze and you walk into the path of my droplets, they land on your face, you can get it. If it's a particularly infectious agent, it's easy to transmit it that way. Sometimes it's harder, like this is a pretty hardy virus, you sneeze onto the surface, and it can live there for a while. It has to surface and you get it like we were talking about last time. But airborne really means like, I you know, I got it through my air conditioning then another person. Exactly like legionnaires Right.
Adam Naddelman, MD 39:42
Right. Yeah. So it's it's tough because it really is tough because I mean, look at you and I are talking about this. A lot of people listen to us talk about this. And we are you know, I'm me. I shouldn't be telling anybody anything. You're a doctor. But, you know, because of the internet. Everyone's got the ability and all that You have to do is misuse the wrong word. And then the person who understands the word correctly hears it and says, Oh, I heard it was airborne. And and that's it. It's, it's a little, it's a little dangerous. It's why I like, well, it's why I would like it if the information would come out, you know, in
Unknown Speaker 40:17
easily
Adam Naddelman, MD 40:19
understood segments on a Dale, it would be nice if somebody just came out and ran through it in a way everybody could understand instead of you having to pick through all this information and decide what's right.
Unknown Speaker 40:28
Well, and I think the Internet has made that obviously 1000 times worse, and social media on top of that, because you end up having to look at sites where the opinions of the people that you're looking at are match what you already believe. And sometimes those people may not be experts on what you're reading about. It's why the messaging that comes from the top has to be clear and concise and accurate and not speculation. Right? And there from from the beginning, from January, even going back to probably the end of December, you heard tons of speculation ads are going to be a big deal is gonna be like the flu. Why do we, you know, stuff that just wasn't based on in reality, instead of just saying we were not 100%? sure yet. This is what we're seeing this is what we think. But when you dismiss stuff. People like to hear that because they're like, well, that's that sounds great.
Adam Naddelman, MD 41:21
I can tell you as a person who communicates with people, I've done it in writing, and you think you make something 100% clear in writing, there's no way someone will misunderstand this, or take it wrong, and then they they do and then you'll look back to what you wrote and think No, this this is unmistakably clear. But it doesn't mean someone won't miss here. I thought when I moved to talking, that would completely go away. But it doesn't, you can't say, you know, we, you have to say he can't say we think this is going to be something that last 10 days, because what a person hears is this is only gonna last 10 days, they drop the I think, you know, the qualifier. It doesn't. I think people hear what they want to hear very often.
Unknown Speaker 42:05
Yeah, I think they bring their own beliefs into the conversation. And then those beliefs kind of shaped the words that they're bringing in. And there's also you know, it's very much in a person's best interest to believe what they would like to believe because it makes you feel better. Yeah. Right. So like, like, if I hear something on the news, and it sounds like oh, my God, they might actually have it back to you. I'm going to say, Alright, I have to be a little skeptical because these things take time. But Wow, that would be amazing. If they and then within five minutes, five people will text me Oh, my god, did you there was a vaccine? And the truth is, right, that's not exactly what they said. He just said, there's now a study about vaccines
Adam Naddelman, MD 42:41
ready to put this in context for people living with diabetes, every time you hear a mouse has been cured from type one diabetes. That really should make you think not, oh, wow, there's almost a cure for humans. But it should make you think as well, I should probably try to find a way to become a mouse. Because, you know, like, there's, there's so you don't realize sometimes like what I asked you about the sales earlier, because there's a thing I call cure season around type one, where researchers float their research, looking for more money to continue their research. And the way they get that money is by saying, oh, we're hot on the trail of a cure, you know, and, to your point, when you hear that you or your kid or somebody you love is living with it, you think, oh, gosh, and it does it lifts you up a little bit, you know, makes you feel like you're close to something, which I've always found to be unfair. I don't like it when people do that. And so, you know, when we hear this information, like, Oh, it's gonna go away or back when he said, there's only 15 cases there'll be none. Soon. I was like, that's not even how math works. Yeah. But for every person that heard that and thought, That's not right. There was an equal amount of people heard that and thought, Oh, great. This will be over a week.
Unknown Speaker 43:55
Yeah, it's really a kind of an interesting study and so many different things. But one of them is definitely this like mass kind of communication and messaging and just leadership, I think, and there's a real benefit to being optimistic and sort of aspirational. And trying to get people to understand that there is going to be another side of this, like, we're not going to be stuck in this forever. There is a way out of it. Just because we can't see that way, for sure yet doesn't mean that you know that there's not a way but it's, there's a fine line between optimism and that sort of can do spirit and like we all need to pull together. And just talking in a way that is purely what you hope might happen. And have you have no basis for making those statements other than this is just what you wish for. Right? And I think like, you know, if it's a fifth grader making comments like that you excuse it, because you're like, Oh, look, I understand you really want to go back to school and do with your friends. And it's good to say, Oh, no, we're you know, we're going to be back on May 1 and to believe that that's fine. But if you're like the superintendent, and that's how you're talking to your students, you probably aren't going to keep your job as superintendent much longer. Cuz you're just not being rational or truthful, right? And I think, you know, the best leadership skill is actually telling people the truth. They'll respect you more, if you just, you're honest with them than if you are just making stuff up because it makes everyone feel better.
Adam Naddelman, MD 45:13
Yeah, I'm seeing that in a couple of places where places they just kept setting these arbitrary two week dates, like we'll see in two weeks. Finally, they're like, Listen, we'll let you know when it comes back. Okay, like, let's stop. Yeah, let's stop pretending it's gonna be two weeks from now. Yeah, I'm a, I'm a big fan of speaking to people like that. It's also important to remember that everybody doesn't feel or hear the way you do. Like, for me, if I told you how I thought about this, you'd laugh. It's ridiculous. It's either gonna be okay. Or it's not. That's literally how I think of this. It's either is or it isn't. If it is, yeah, right. If it's not, what am I gonna do about it? But I don't have anxiety. I don't live you know, I don't live with anxiety. I don't live with that kind of stuff. I have perspective. I tell people all the time, like you give your kid an incurable disease, it'll change your perspective on the world. You know, like, I can't sit around and worry about things. I don't have sway over, you know?
Unknown Speaker 46:08
Yeah, I think one of the challenges with this is that there's no, like, there's no escape from it. Like, if you turn the TV on, and you want to just watch the news about anything else you can't find, right? It's impossible. I was driving today. And I was flipping through the stations and I, I don't even know what channel it was. But they were clearly playing a segment that had been recorded, like four weeks ago, about some some guy's book that, you know, he wrote, and it was whatever it was. But I'm literally just thinking there is no chance they don't this, like last week, this has to be from a month ago. And the difference, just like they found it like oh, this is a great theoretical topic to be talking about what an interesting book, I'm thinking of myself, every person who's thought to this channel, just just turn it off. Because it seems like it's divorced from reality. Or reality. Now is this all the time, all you talk about with people that you like, even if you do a zoom, happy hour, and you're hanging out with your nine friends, it can be friends from college or friends from down the street? This is all you talking about? All the time, there's no escape.
Adam Naddelman, MD 47:06
Yeah, there's a real there's a line where you can feel it change. Like it just ended. I don't want to say it's never the same again, just that reality is, is is colored differently now. Because you have this new experience. Before today, what's happening has only been in most people's minds, the the plot of a movie, you know what I mean? And now it's, it's they they're seeing it happen. Now they recognize this tree and others researchers who were probably walking around going I've been I've been tried to say this too, and nobody's listening to me. But you know, I think it's good. You know, not everybody needs to walk around with that, that wait all the time. But I think forever moving forward, it'll, it'll color the way you feel until you generation out of it and get to that point where you know, you find people were like, don't remember 911. Because they Yeah, well, it happened or something like that.
Unknown Speaker 47:55
I think that's the closest parallel for us that we can think about is 911. But the difference or 911, like my feeling about, I was just talking about this with somebody else, like, on 911. I remember trying to get in touch with my wife, it was working in the city. And I remember like I was on my cell phone, and I was talking to one of my co workers. And I went outside onto my deck. And as I was standing on my deck, this is probably like, maybe 45 minutes after the second tower got hit right before the towers fell. But after the second one got hit, and I'm standing outside and I'm talking like what in the world is going on. And all of a sudden, I saw, like, three fighter jets fly overhead that were clearly coming from the south to go fly over New York. Right. And they were I've never seen anything move so fast in my life, right overhead. And I remember thinking to myself, This is insane. Like, are we literally the whole country under attack, and they were all the stories on other planes. And there's, you know, there's all that that sense of like, you don't know what's going to happen, right? This is that, but it's been going on for three weeks. Like, right, I mean, in all seriousness, like we are hearing every day about constantly. Yeah. And you're like, well, who's the next famous person you're gonna hear about that gets sick and who's like an older famous person who you're going to read about tomorrow? who passed away from complications from this? And oh, my god, did you hear so and so's brothers in the hospital with it? And so it's like, closing in, because there's so many more cases? Yeah, I think that is what's causing this incredible level of anxiety. But it's, it's like nothing, nothing our generation has ever seen. And, I mean, I guess this is what it must have felt like during the Second World War, except that went on for years. Right. And you had people that you cared about overseas fighting and you never heard from them. You didn't know what was going on.
Adam Naddelman, MD 49:35
And I don't know what you can do about it too. Like if you ever heard the the theory that Irish people are more susceptible to depression because of the potato famine. If you're looked at that, like that, I like that concept that they were so sad for so long that it got burned into their DNA. And I don't know if I believe that but I mean, in the short term, you know, this is this is your reality, all of a sudden, it's hard to think Something Oh,
Unknown Speaker 50:00
yeah, I mean, just there's so many things about the way we live as a people I think are gonna, they're just going to change unless there's a vaccine and a vaccine really soon or a treatment that's going to be shown to be that basically can just eradicate this, like the way that we did with smallpox you know, things like that, where there's where there's a vacuum that bad effective that you can say Coronavirus is gone. There's gonna be other pandemics. I mean, this is not gonna be the only time in our lives you have to deal with something like this, unfortunately, right?
Adam Naddelman, MD 50:29
I you know, it's funny, I think there's a real opportunity for like a worldwide celebration of something like that could happen, it could be a real unifying thing. I've also noticed my wife wanted to buy a used car. Like, right, she's been looking at these little weird cars that nobody has, they're not expensive, and she's like, this is what I want. That's all she could talk about. And this came up, I have not heard about that car one time. The other thing that I'm seeing happen, which is super interesting, is um, you know what virtue signaling is right? Like, you know, you say something on Facebook to prove to everybody you know, the right thing, you know, to me, like, there's that, that's all gone. Like, nobody's got any time for any first world nonsense. They're all just worried about this, like all this. I, I was saying to my son, you didn't realize how good your life was, and how much free time you had to fill with, like, other stuff because you weren't worried about anything. You know, like everything was just going the way you wanted it to?
Unknown Speaker 51:25
I mean, it does seem like there's still a small group of people that think they have all the answers with this. Yeah. Like I saw a comment on social media every day where someone was trying to argue that they don't have COVID they have Coronavirus, like what that person like that doesn't make any sense. The same thing. This Coronavirus It's called COVID-19 because it was from 2019. They first discovered it, it's the same exact thing, literally the same exact thing like how could you I saw like power and I didn't engage in it. I was just reading it but people going back and forth with this theory that just because you're ever Coronavirus interaction with this particular Coronavirus. It doesn't mean you have COVID. Like that is just completely not true. So there's still this weird like, No, I mean, some of the two is I guess, political, but it's stuff with like going after some of Trump's advisors that are trying to play it straight. And if you saw that stuff about Fauci, but apparently there's been people that are like after him and attacking him because he touched his forehead. During one of the press conferences, it looked like he was unhappy with something, someone else's thing. So they're attacking him, like with this fury that he needs, actually, he's actually now getting protection from the government. And if you saw that,
Adam Naddelman, MD 52:41
for trying to keep
Unknown Speaker 52:42
trying to help us all stay alive. There is an element of some of this stuff. But you're right. I mean, I think there's much less of this holier than thou sanctimonious nonsense that goes on online where you're like enough with you're showing us how smart you are about everything. There's less of that.
Adam Naddelman, MD 52:56
Yeah. And because, yeah, if you step back and watch one of those conversations, like you were talking about, you see, 10 1215 people come in, they're all saying something different. And then all of a sudden, like, oh, that person's right. And then you think that's how everybody feels about this. Like, maybe I'm, maybe I actually know that person's right. Or maybe I'm wrong. Maybe I just agree with them, like you were saying. So there's it, there's literally no benefit. It either serves to make you upset or serves to make you feel like hmm, I'm right about this. It's just, it's a very, but anyway, there's a lot less of it. I think people are focused now on, on core survival ideas. And it's different, you know, it's different now thinking about, do I want to risk getting sick? Do I need to do I need a chicken breast bad enough to risk getting sick? You know, maybe that'll help moving forward? I don't know. Maybe it won't. Maybe it'll be three weeks, there'll be a flag that goes up. This thing's all over and everybody will just go back to the way it was. I have no idea. Yeah,
Unknown Speaker 53:52
I mean, yeah, it is interesting, right? I mean, like, if, if all of a sudden tomorrow morning, we woke up and they said good news, it looks like this virus is weakening every time it jumps. And each virus can only infect X number of people. So it's gonna die out. Like that's what they that's what the studies show. And then, you know, and they said, and you know, all our models show that within two weeks, that's going to happen. I think two weeks later, you would have like, like Bourbon Street would be packed the beaches and follow the pack, people would be pouring beers on each other's heads. It would be like, the biggest celebration ever. And then 24 hours later, there's the argument online about nonsense and, you know, fighting over different things with the grocery store, and whatever. So it's hard to know. I mean, I hope I really hope it's a shortlist thing. I guess the impact it has on everyone and will be something we'll have to watch over time.
Adam Naddelman, MD 54:39
Well, what I've learned is, is that what you just said, where you were clearly saying, Let me make up a scenario and tell you how it would it may be and somebody just heard that and heard Oh, this is going to be over in two weeks because I because the disease indicated the same like power and it just dies out. It's you know,
Unknown Speaker 54:57
as I was saying it I thought I was thinking to myself, you should just edit That whole part out that someone's gonna hear just that piece and go, Oh my god, that doctor that was talking and said that it's not gonna be bad at all. That's not what I'm saying.
Adam Naddelman, MD 55:07
No, no. And I know but you could, you know, you listen away for a second you're listening while you're you're cleaning or something. I see it happen a lot. It's really, I'll get no, it's like you said this and I think to myself, No, I didn't. And then they're like, no right here, and I go look him he had a listen that again. That's not what I said. And then though Oh, yeah, I got it. Thanks.
Unknown Speaker 55:25
Well, and they saw the, you know, the really amazing thing about that is, so that's someone accidentally just not listening to the whole segment, right, you just pick up. But you can see how so easy to just take something that someone says out of context, and then use it for your own benefit. Yeah. Right. Like, you know, there's so many times where you hear a clip, a one sentence clip of something and you completely, like that clip I just said, If you would just pull that out and say, well, there's this guy saying there's going to be nothing like that can be manipulated so easily. It's ridiculous, right? Especially now with social media.
Adam Naddelman, MD 55:56
Yeah. Oh, no, please. There'll be a there'll be an animatronic you saying it, it's, somebody will look more real than you, your kids will look at and think that's definitely him. Right? So your children are pretty active people is this. My my son is he's getting to cage tiger. Like he's trying to like doll, his mind with video games. And he's keeping up with his college work. Which by the way, I explained to him how much the semester cost, and I didn't care what room he was in, I expected the same grades. Yeah, but he needs to get he needs to get warm. Like he just wants to go throw a ball or, you know, he's like, Can we just go to a field in the head or something like, I gotta get out of
Unknown Speaker 56:36
here? Yeah, I mean, my kids are the same way. My my older two are their high school age. So they're, they're actually decently busy with their work, like their school is doing a pretty good job with their online schooling, it's actually pretty, it's, it mirrors pretty well what they'd be doing in the classroom, because their classes are small. So they have like, real zoom lectures, and they have homework and assignments and assessments and stuff. My daughter's school is not quite as much just because she's only in seventh grade. So she gets done quickly. In terms of the physical piece of it, yeah, I've been trying to encourage them, like, get yourself outside as much as you can. My older one runs. So he's been still running, I think he still has a hope that the season is not completely lost, but nothing else is getting ready for college. But the other two are like, you know, they're used to going from a basketball practice to a baseball practice, or a softball practice or whatever. And they're like, not doing much. My daughter's softball program just started these virtual session, where they're doing like 45 minutes of conditioning to, you know, two or three times a week on zoom. And they're gonna do like virtual hitting sessions, where they're gonna, you know, yeah, try to do it. But it's not the same, right?
Adam Naddelman, MD 57:40
Yeah. You could learn to hit a baseball like that. I'd be standing usual. So
Unknown Speaker 57:44
it's hard to play softball by yourself, then maybe basketball. But so yeah, I mean, I think it's hard. It's a combination of their bodies aren't moving, and they're not engaging in the same way. I mean, could you imagine what this would be like? They 15 years ago with no zoom meetings and no FaceTime and no cell phones, like the way we have them now where you can, you know, see a picture of the person you're talking to imagine the isolation in that scenario, it'd be, it'd be unreal, like, if you had to turn on the nightly news, to find out what the weight is, is yet
Adam Naddelman, MD 58:14
to sit around 24 hours to get the new update, you know, Yeah, I was gonna try to find it. I heard last night that. In France, it was France, they were so worried about domestic violence, that they they basically put a safe word into play, and you could walk into any pharmacy and say that word and someone would collect you like to get you because you think about that if you're if you're a victim of domestic violence, this thing has now locked you in the room, you least want to be in in the entire world with no way to get out. I thought that's, that's pretty smart.
Unknown Speaker 58:48
One of my partners actually had to put a post up on Facebook about keeping your kids safe at home for the same reason. You know, these kids that are in kind of dangerous households, potentially abusive parents, whether it's emotional or physical. Yeah. And spouses too. I mean, this is a nightmare. Yeah, they can't go anywhere to escape any of it. It's a nightmare. I think, too, about the kids who said My brother is
Adam Naddelman, MD 59:13
my brother's in Wisconsin, and he, he was changing jobs. And he had a couple of weeks, you know, between jobs, and he thought, I'm gonna keep doing something. So he took this job delivering lunches for like a local school. And within two days of doing it, he goes, Scott, some of these kids take the lunch on Monday morning, the food I bring him on Monday morning, and they told me they haven't eaten since the thing I gave them on Friday. And he's like, and now they're all like, you know, so they kept doing it. They're still taking the meals to these places, and people are showing up like, Well, what about places that aren't or these kids just at home? Nobody's feeding them?
Unknown Speaker 59:45
That was one of the big reasons why New York didn't.
Unknown Speaker 59:49
Oh, really is because they were Yeah, they were I that's what I read that they were really concerned about the kids on the on the lunch program. Yeah. So they were bused. There were stories about bus drivers kind of drive their route with the kids. One drop them off. But as you can imagine that super inefficient
Adam Naddelman, MD 1:00:03
Yeah, yeah. a school bus to delivering lunches is a it's not gonna work. But yeah, there's just my point is that there's a lot that impacts people's lives that most of us wouldn't think about, you know? And yeah, you're right it is, you know, as all
Unknown Speaker 1:00:18
I mean, I've been saying it for a while, but like, one of the things I'm worried about is just what is going to happen to the economy, and not the economy in terms of like the numbers up, but just, you know, there's a certain dignity and getting up every day and going to work and like doing what you do getting paid for it, being able to support your family, having, you know, food for your kids to eat. Like, there's going to be times pretty soon when people are deciding, do I eat this? Or I give it to my kid, right? And I just don't know, how is this as a society, you can maintain this level of the closed off, Miss everything, before people are going to get desperate. You know, and I know that there's been three pieces of legislation now. And there's even rumblings about a fourth. But, you know, at some point, like, I'm nervous that people are going to really get desperate. And I don't know what that looks like, in certain parts of the country. Actually, every part of the country, you're not even confined to one area.
Adam Naddelman, MD 1:01:14
No, I know. I mean, you see, listen, obviously, people are thinking about it, you want to see a long line still look at a gun shop, like people are in lines to buy guns, there are people who you never would have thought of owning a gun in their lives who are out trying to find one, because they're extrapolating out three months and thinking, this is gonna get upside down, and I can't protect myself. Even when you said what you just said, I thought, Oh, you know, you were gonna see soup lines again. And I thought, Oh, no, no, we're not because we can't get in line next to each other. So that won't happen. You know?
Unknown Speaker 1:01:43
Well, right. I mean, like, I think the way one of the things I keep thinking about is you see all the craziness with the toilet paper and, you know, that's like the perfect like, panic buying moment, right? So some people got nervous that they're going to get stuck in the house. So they started buying a lot of toilet paper. So then other people saw those people buying toilet paper and said, Oh, no, they're gonna buy up all the toilet paper, I need to go buy a lot of toilet paper. And then by the time we got to like the third round of that there was no more toilet paper, right? That's fine right now, because you're buying toilet paper, and you can afford to buy it. But what happens when you can't afford to buy the toilet paper anymore? Then what?
Adam Naddelman, MD 1:02:20
Yeah, no, yeah. No, I mean, it's a it's a slippery slope. I like I've said before I, I those zombie TV shows they write themselves, it's not hard to sit into a room and extrapolate out what happens when people get desperate. And it's, you know, as I'm sitting here, I've never thought about this once. But I'm like federalize the grocery stores. Just make food free for a while. Everybody gets, you know, enough to get them by and it keeps you that that kind of hope. But like you said to like, you'll want to be able to pay for it yourself. And at some point, that'll become that'll feel desperate to you like, I don't want this to be I don't want to be handed this food every time. You just run into it. Yeah, you turn into a robot at some point. Like, I think that life is in the, you know, it's in the moments, right? It's not the things you do. It's the things you do in between those things. It's, you know,
Unknown Speaker 1:03:10
yeah, I mean, look, I mean, I think like, we're talking scenarios where this goes on and never stops for six months, or 12 months or 18 months. I don't think that's gonna happen. I mean, I think especially when you look at what's going on in China and parts of Italy, that got absolutely walloped with this. They're starting to come back. I mean, if you look at like Wu Han, now they are more worried about cases coming in from the outside, right, in cases from within Milan. Yeah. Even though like the social distancing stuff started way too late. The testing is not anywhere near where it should be. We don't have the ability to prove someone had it, at some point, you're going to get to into a situation where the number of new cases is significantly dropping, right. And as it dropped, the comfort level with people returning to normal is going to come back. It's just a question of, When is that going to happen? I
Adam Naddelman, MD 1:03:55
didn't mean to say I thought it was gonna happen. I meant to say that in nuff people's heads, they're thinking about it.
Unknown Speaker 1:04:02
Like they're there. They look, I just gave that ridiculous toilet paper story. Right. So I'm thinking about it too, right. I think the reality though, is, we're not gonna get to that point, right? Like, I just can't believe in the United States of America in 2020. We're gonna be at a point where we're like, you know, no one could afford a roll of toilet paper anymore. Like, that's, I just can't imagine that's gonna happen. I'm gonna be sharing a loaf of bread for three days.
Adam Naddelman, MD 1:04:26
Yeah, I don't think so. either. I just think that it's, um, I've talked to enough people who have anxiety issues now. And I know that something like this just, it just shoots them off like a rocket like they were doing like back when I was talking about everything just goes your way. They were struggling then.
Unknown Speaker 1:04:42
You know, oh, there's no doubt about it. I mean, think of it's the worst case scenario for people with anxiety. You know, even if you want to save one hour at a time, take it one day at a time, all that kind of stuff. That's fine, except that you don't even know what's gonna happen. So, you know, you can make yourself bananas and then if you try to take a week or two out. Are you trying to take all you know, my kids want to go back to college in the fall? Are they gonna be able to go or not? I'm hearing rumors like, you literally can make yourself insane. And there's no distraction. That's the problem.
Adam Naddelman, MD 1:05:10
Yeah, the only thing to distract you is more thoughts like this. Like, I actually thought I had the conscious thought this morning, that since my son has been three and a half years old, he's been playing baseball. And since he's been about nine, he's been telling me he's gonna play in college, and now he's there, and they canceled the college baseball season. Are they gonna cancel? The next one was my next thought. Did he do? Right, you know, like, yeah. What else have we all done for nothing?
Unknown Speaker 1:05:35
It's so true. Like, I mean, I think when they closed the schools for a couple weeks, everyone was saying, oh, they'll probably close until like Easter, and they'll or they'll close them through spring break, and then they'll get back after break. And, and then it was sort of like, well, it's only getting worse. So why in the world are they going to get back? So now everyone's like, well, I'm probably just gonna be close for the year. And I still hope maybe there's some outside chance they get back for a few weeks, but odds are they're going to be closed for the year. Right? Well, so then you say, Well, why would their camp be open over the summer, right? And why would their sleepaway camp is supposed to go to an August field? And why would we be able to take that family vacation we're supposed to take in the summer and and then you're like, Well, why would the school reopened? And you can make yourself absolutely bananas, like life is gonna end? That's probably not really what's gonna happen. You just have to wait and see them.
Adam Naddelman, MD 1:06:21
No, I agree. All right. Well, I feel better after talking to hopefully people. Yeah, but I seriously do I, you know, like you said, there's, there's, you get caught in a vacuum. And, you know, it's tough. Like Kelly's Kelly loves the news. And Kelly's like, if it rains, Kelly's watching the weather, she loves it. So even my son's, like, Mom, stop watching this. And she's like, I like knowing what's going on. She's not freaked out. But like, I walked through the room, sometimes they'll say, I don't want to hear about this right now. You know,
Unknown Speaker 1:06:49
I mean, it's so true. Like, I mean, you know, you and I have known each other a long time. And we've always been kind of, you know, into the politics of what's going on, and the process and all of that, like, we're kind of losing all that, like, you don't even get to be like a you know, political junkie anymore, because there's nothing, you can't even find coverage of the campaigns and all which I understand, right? But, and the sports is the same way. And there's so many things that people really enjoyed as part of their life. They faded into the background, but I'll tell you what, when they come back, they're going to come roaring back, right? I mean, could you imagine what baseball is going to be like that first weekend when they start playing again, or, or, you know, like, you know, first weekend of the NFL, or if they get to the NBA playoffs, or whatever it is going to be crazy. Oh,
Adam Naddelman, MD 1:07:33
I don't like I mean, I never again, I want I'll bring it back to diabetes for a second, I do anything for my daughter not to have diabetes. But there have been so many good things that have come from it, it's hard to believe that would not have happened if she didn't have it. I don't just mean like, I don't mean this podcast, I mean, just like, the way we think or see or things and there's gonna be a lot of good stuff that comes out of this. So you're right, like, you know, you turn on a baseball game as a baseball fan, and go, I cannot believe these guys are playing in front of 10,000 people, I wish there were more people there, people are going to be dying to get out. You know, and, and the ball teams are gonna have to make season tickets, pretty cheap, and you know, and it's gonna, everything's gonna feel exciting. Again, I think that we have so many options for how to spend our time that it kind of created like a paralysis. For some people, people are just like, why there's too many options. So I'm not doing anything. And now all of a sudden, people are gonna pick again, this is what I think's important. I'm gonna go, I'm gonna support it, I'm gonna do it. Yeah,
Unknown Speaker 1:08:29
I think, honestly, I think there's two things that are really gonna happen once we once you get back to normal one is people are gonna remember how nice it was to be with other people. And they're going to make more of a point to do that, like, it was very easy to just text or call or not actually see people face to face. I think that this is reminding people how you need that. And the other thing is this idea of like experiences versus things like, actually, you know, living through something right versus just owning something. I think that there is a trend towards that already. I think people are going to go way, way more towards that. Once this is all kind of moves back to normal.
Adam Naddelman, MD 1:09:07
Well, I'm glad we did this today. Because like I said, I was this afternoon, I was a little like, what's the point? And then I, you know, I needed to be reminded the point is in a month or so this is going to be over and then you know, that'll be the point. I really appreciate you doing this. Thank you so much.
Unknown Speaker 1:09:21
Now of course.
Adam Naddelman, MD 1:09:24
Thank you so much, Adam for coming on the show and sharing your feelings about the Coronavirus. And for talking it through with me I felt good about that. I really did like chatting with a friend and you know going over real things that are happening and getting to like sort of sort through how I felt about them. Huge thanks. Of course the Contour Next One blood glucose meter go to Contour Next one.com to see if you're eligible for an absolutely free meter. And to check out all the reasons why this blood glucose meter and in my opinion is the best one Arden has ever used. And don't forget touch By type one.org check out their programs, their awareness campaign, their dance program. Everything, just, you know, pick through their website. Have a great time. Next week on the show, we're going to be doing some stuff with Jenny. And I actually have another person with type one diabetes who has had the Coronavirus and is done with it now. I'll be interviewing them tomorrow. And if everything goes well, I should be bringing you that show. In the next few days. Everybody stay safe. Cover your coughs cover your face. Don't forget your hand sanitizer and we'll get through this
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