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Kurt H. Leggard

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The Lesson of Thalidomide for Covid19, Look Before You Leap – My youngest daughter will say in the most excruciating terms that I am old, especially when I am trying to make a point based on some ancient piece of information that I remember to support an argument I am trying to win. She calls me ‘Lesson Plan Dad.’ It’s not a term of endearment. I usually go off and shake my head because she will sometimes ignore me or dismiss me from existence. But a funny thing happened as she was going out recently, she whispered to me before I had a chance to ‘advise her’  about following Covid19 precautions, “don’t worry Dad, I remember everything you said I had to do to remain safe. I hear your voice all the time.” This pleased me to no end because, 20 years after the death of my own Mother, I still hear her ‘voice’ warning me and giving me good advice. I’m sure some of you have that same experience.

The proverb, ‘Look before you leap’ has been a form of advice that has been given for centuries. This proverb was first noted in a 1380 manuscript and then captured in a collection of English proverbs by John Heywood in 1546; describes unintended actions and reactions that can lead to untoward results. The first use of this term in America is associated with a failure in diplomacy in the late 1600’s that occurred in New England during the time of the colonists and a war that caused significant damage of property and loss of life for both the Native Americans and many colonists who had previously coexisted uneasily (King Philip’s War). As defined, both sides in this tragic circumstance did not take-into-account all the consequences of their actions and could not avert the turmoil which befell them all.

In 1957 West Germany, a medication that was hailed a wonder drug and was marketed as a treatment for, nervousness, anxiety and morning sickness and distributed over the counter (OTC), turned into a nightmare for the German people. Many side effects of this medication included horrendous birth defects in the guise of malformation of the limbs, still born babies, tumor development and many other conditions. This medication was named Thalidomide. This drug was prevented from being introduced to the American market by a pharmacist, Frances Kelsey at the Food and Drug Administration (FDA), because of her concerns for the safety of our population. Because of the horrific birth defects noted in the so called ‘Thalidomide Babies,’ greater constraints and regulatory oversight of medications before their use in the public space has become one of the hallmarks of our American medical and pharmaceutical model. Appropriate oversight by the FDA has saved lives. We are looking before we leap!

During these dangerous times, in the Age of Covid19, our well-founded fear and concern for the lives lost and the lives at risk could have the effect of eroding the lessons of the past when it comes to the manufacture and distribution of a vaccine before the necessary due diligence has been implemented. I understand this rush for a cure, but I am reminded and informed about the possible consequences of not performing the work needed to safeguard ourselves from a malady of our own making. There is a reason why there isn’t a Corona vaccine in the world’s arsenal, its hard to create. Mutagenesis (DNA mutations that are engineered secondary to induction by an external factor) and Carcinogenesis (the result of agents capable of developing malignant tumors by inducing cellular changes) are the untoward effects that can result from the introduction of an external, uncontrolled factor into the population. I am not a fear monger, nor am I a scientist, microbiologist or anything remotely approaching an expert in the field on immunology or virology. I am a nurse by profession with a healthy appreciation for the rule of unintended consequences.

Let’s do this by the book! I am informed by the ethical boundaries of not experimenting on animals and conducting animal studies but in this most hazardous of times, please employ ethicists to conclude if utilizing an animal for determining if generational impacts can be averted in the human hosts who will be the final recipients of any vaccine that is developed can be averted. I am not a ‘Night of the Living Un-Dead Roach Avengers’ kind of guy but take a look at our oceans and see the harm we have done by introducing plastics to that environment and see the fish that have plastics in their systems that we are eating now. You get my point. There are potential downstream repercussions to our actions that must be considered and explored. For our children’s sakes, let’s not muck this up any worse than it already is by allowing political expedience to be determinative for the science that is necessary to figure this out and arrive at the best course of action to take. 

Yes, this is Lesson Plan Dad saying, we better LOOK BEFORE WE LEAP!!!

Hamptons Mouthpiece: On The Other Side of Covid19

Can you see the future? It is daunting. I see a change in some privacy protections regarding Covid19 status. Pre or Post Covid19 infection certifications. A loss of some HIPAA protections in the guise of Public Health prerogatives. Let the lawsuits proceed! What will be the civil liberty concerns as this pandemic changes the social structures of our future. Before going into a restaurant will you have to show your Covid19 certification? When you enter a hospital or go to an Emergency Room, will your Covid19 status dictate which door you enter. As a Black man who understands the ramifications of bias, my experiences extend to the general public: will my Covid19 status determine my access to jobs, travel, opportunity. Will dating apps now reveal the Covid19 status of the prospective date?

I know this seems absurd on the face of it but you would be surprised what fear will do to a society (see the Red Scare period of our country’s history). If and when a vaccine is developed, will the anti-vaccine crowd be denied access to public schools upon refusing to use it. Will you be able to refuse the vaccine based on religious grounds? There are public health laws that allow the incarceration of individuals that pose a threat to the general public, will this happen here if an individual is presenting symptoms but refuses to self-isolate? Get used to proximity tracking of your travel in cities based on your Covid19 status. Our days of innocence are over. We will not be able to look down on the political decisions of the leadership of China in their authoritarian way of governance to control their populace. Can that happen here?  And be cautious America,  be on guard for the hardline, authoritarian political leaders who will want to control many aspects of your life based on your Covid19 status. Any excuse for power-grabbing is fair game in the post Covid-19 age. 

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Will Covid19ism become the new racism? Or will all this fade as we get accustomed to this new reality. Our norms will change, are changing already.

Handshakes are a thing of the past, doorknobs will disappear (who wants to touch those anymore?).  We will wash our hands more as a result which is a good thing and anyone entering our homes will be expected to wash their hands immediately (I suspect there will be a decrease in seasonal Influenza). We have to be alert to the possible erosions to our privacy and freedoms.  I am all for testing , but please maintain my privacy. I know that a balance will have to be found  to protect my individual privacy and the protection of the public and my neighbors.  I just want to give you some food for thought.

We continue to pray for your safe travels!

We can do this !!!

Together

A Town of Bandits: Tombstone never looked like this. Wyatt Earp would have gone crazy. The line in front of King Kullen in Bridgehampton, NY and countless other supermarkets in the country are full of people wearing masks, bandanas of every color and stripe, waiting on line (6 feet apart) to swipe that Lysol spray. They are on line (6 feet apart) to get that last roll of toilet tissue in aisle 9, on the left behind the Bounty. “I refuse to use the Bounty to wipe my As…….. Too rough on the butt, but plenty absorbent!” 

The Bandits are on the loose! From Montauk to Flatbush, from Sag Harbor to Bed-Stuy, the Bandits are everywhere. Who would have thought? You can’t tell the good guys from the bad. “Oh look at that bad desperado over there in the shadows, leaning over to the side, with that slow purposeful walk; slight glint in their eye. They are heading right toward me. I’m getting scared now. Of course they have a mask on, hiding their face. What am I to do? Nowhere to run or hide. Here they come, reaching in their pocket, taking out a…. set of glasses…. oh she’s smiling….it’s Grandma. Damn I feel foolish now. I guess I’ll just have to trust my neighbors more”.  There are some bad people in the world but overwhelmingly good people are around us. Just look at the heroes in every Hospital, Nursing Home and providing Home Care services. The GOOD GUYS are fighting the good fight and will win this war!

Photo credit: Hamptons Mouthpiece

We are all Bandits now. No time to look at each other with jaundice eye. Our plight is the same. Social distancing in an age of disease with imposing names, SARS,  Corona Virus, Covid-19 or as it is known in the inner city….”The ‘Rona.” We are ALL IN THIS TOGETHER! We are all Bandits now, faced with the same circumstance, forcing us apart but bringing us together like never before. 

I was taken aback the other day when I was getting ready to order door front service from a local store in Southampton in an effort to support a local business. I witnessed multiple people going into the store, opening the closed door with their bare hands; no gloves on, no masks on (hey businesses, leave your doors open when possible to prevent the spread of virus on door handles). I left the store not ordering anything knowing that it was a risk. EVERYONE has to take this seriously, accept their responsibility for each other’s health; this is about life and death.

Photo credit: Cindy Warne (made by Cindy Warne)

To all my fellow Bandits, please continue to wear your masks, wear your gloves, wash your hands, wash your hands, wash your hands! Let’s #flattenthecurve. Practice social distancing, keep in touch with the elderly shut-ins, call a friend, ZOOM videoconference with the proper safety and privacy features enabled to stay connected. 

We continue to pray for your safe travels!

WE CAN DO THIS!!!

TOGETHER

Wash your hands, wash your hands, wash your hands!!! DO NOT place your hands to your mouth, nose, eyes and in your ear. These are all PORTALS OF ENTRY for the Covid-19 virus to gain entry to your body and cause infection. Any discussion about the danger of the Covid-19 virus must be first started by indicating that the best way to help arrest the spread of this pathogen is to insist that you wash your hands, use a lot of friction, wash up to your wrists, remove all your jewelry, wash your hands for no less than 20 seconds, force your fingertips into the palm of your hand to clean under your fingernails, use friction when washing between your fingers and then repeat this ritual multiple times a day. Do not get bored practicing this exercise in survival. It is important to note that the use of an alcohol based hand sanitizer is no substitute for hand washing; it is only a stopgap measure when you don’t have the ability to wash your hands thoroughly. Insist that visitors to your home or business first wash their hands when they enter your home. It’s OK to ask. You are not being rude, quite the contrary. You are showing the utmost respect as a host showing your concern for you company’s or customer’s wellbeing. 

Normal practices are going to vanish for a while. DON’T shake hands when greeting someone. Respectfully decline and instead touch elbows or nod your head. These are challenging times and we must collectively meet the challenge of this danger among us. This is not the time to panic. It is never a time to panic. It is a time for effective, collective action. Take the time to show your kids how to wash their hands and make it a ritual. Kids respond to rituals and they like to follow the leader. Make it a game of who can wash their hands more. Tell them to keep count on the amounts of times they have washed their hands during the day and see who can ‘win’ the count. Let your young kids see you rush to the bathroom to be ‘first’ to wash your hands when you get home from school pick-up, a visit to Grandma and Pop-Pop (please wash your hands when entering any elder’s home. This virus is disproportionately impacting the elderly, especially with those who have underlying chronic diseases such as diabetes or hypertension). Your kids will run to beat you every day. Start this at the earliest time that your youngster can understand the need to wash their hands (3 years old).

When putting gas in your car, wear a glove. Wear a glove when placing your credit card in the slot, there are germs there. Wear a glove when handling the spigot putting gas in your car. Carefully take off the glove when entering the car without touching anything then before you touch your steering wheel, sanitize your hand. Yeah, I know…that’s a lot of steps, but once you get used to it, this becomes second nature. Just remember that viruses can live on surfaces for a long time and the amount of time this virus can exist on a surface is undetermined. Remember, THINGS HAVE CHANGED!!! 

Businesses on Main Street, restaurants, grocery stores should make their bathrooms available for hand washing and stock the bathroom with soap and paper towels. Write this expense into your budgets and manage the bathrooms well. Businesses should schedule times during the day that they will clean the doorknobs leading to their store. Door knobs and handles harbor a vast among of germs and keeping this clean will go a long way to protecting your customers and staff. A simple solution of 1 part bleach to 10 parts water will suffice. Wash your hands after cleaning these surfaces.

If you have counters in your business, similarly clean these surfaces on a routine schedule. No less than once every ½ hour if it is a busy day. If, available provide a ‘Purell/ hand sanitizer station at the store entrance. You can gently ask customers to use the sanitizer upon entering your shop. If every store does this, it will become customary and not seen as an imposition. Normal Operating Procedure. We can do this.

Now for the virus. High fever, Shortness of Breath (SOB), difficulty breathing, coughing and cold symptoms, feeling like crap are hallmarks of this disease. See you doctor. If you cough or sneeze, please do so in the crook of your elbow or in a tissue that should be disposed of in the trash. Wash or sanitize your hands. Covid-19 is called a droplet infection and is carried primarily by germs in the droplets you sneeze or cough out. If you are symptomatic, it does not mean definitively that you have the infection but out of caution you could wear a surgical mask. For the uninitiated, regular surgical masks will NOT protect you FROM the illness but should be used by those who are symptomatic to reduce the amount of infection spread. Over -The Counter (OTC) N-95 designated masks will provide some protection against infection but these are not ‘Fit-Tested’ which means these masks are not specifically molded to your face so there still remains some risk for illness while wearing these OTC N-95 designated masks. Save your money! Self quarantine/isolation is not always practical but may be necessary in your own home to prevent the spread of this illness before seeing a doctor.

This is a PANDEMIC. Pandemics unfortunately have histories of coming in waves. During the Spanish Flu of 1917-1918, there was a first wave of illness, then it subsided, making everyone think that things were improving, but the virus mutated and came back more dangerous and deadly on the second wave. We must be cautious and vigilant. Be consistent in your approach to addressing this disease. Good consistent hand washing will go a long way to keeping you and your family and community healthy. This is by no means a complete list of things to do to protect you and your family and community but it will give you a start on how to think about this illness and our response to it.

Stay safe!!!

For more information and updates click on the following links:

World Health Organization https://www.who.int

Centers for Disease Control and Prevention Coronavirus Disease 2019 (COVID-19)

Ask Kurt, Home Care 101: How to cope with Sundowning

Ask Kurt: Is a new column by Professional Homecare expert Kurt Leggard, a registered Nurse Chief Clinical Officer -Director of Patient Services for a Licensed Home Care Services Agency in NYS. Each week Kurt will be answering your questions regarding Home Care.

Home care, is supportive care provided in the home. Teamed with physical alterations to the home such as having mobility wet rooms fitted, it’s a great way to allow your dependent relatives to stay in the comfort of their own home while still getting the help they need. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living(ADL’s) are met. Also, very similar to RIGHT ACCORD HOME HEALTH CARE, In-home medical care is often and more accurately referred to as “home health care” or formal care. If you’re looking for an elderly care facility, The Hermitage of Northern Virginia has very nice assisted living facilities in Alexandria VA.

This weeks question is from Stephanie in Sag Harbor, NY

Question: My question is this: What do you recommend to cope with “sundowning” , a condition of extreme irritability of older people between 5pm and 7pm…hard time for caregivers to handle.

ASK KURT:

Kurt: Thank you for the question Stephanie. As defined, ‘Sundowning’ is characterized as a spectrum of behaviors of individuals with a diagnosis of Instant Coupons! Alzheimer’s Disease or other dementias with the individual presenting as agitated, extremely confused and sometimes combative beginning toward the end of the afternoon to early evening sometimes extending through the entire night. Basically, when the sun goes down.

I tend to begin any recommendations with addressing ‘Sundowning’ as a condition that is very stressful for the caregiver as well as a potential safety risk for the sufferer. It is imperative that the caregiver takes care of their own health care and emotional needs and gets appropriate rest and respite to handle the rigors of caring for the individual suffering with ‘Sundowning.’ Please get support if you can. Companies can Immanuel can provide lakeside assisted living to help reduce the physical and emotional load.

The immediate things you can do for the sufferer is to ensure that a recent medical examination has been conducted to determine if there are any medical conditions that may be the underlying cause for the ‘Sundowning.’ If an individual is in pain, this may cause ‘Sundowning’ to start or become more pronounced as will severe constipation, Urinary Track Infections, poor nutrition, dehydration and many other conditions.

If the sufferer tends to wander (a possible secondary affect), it is very important to conduct a complete environmental review of the client’s home. Remove safety hazards (loose carpets or rugs, telephone or lamp wires, use night lights, etc) to prevent falls. If the client is at risk for wandering out of the home, safety door locks should be installed out of the reach of the client but easily accessible to the caregiver. Visible signs inside and outside of the door to identify where the lock is located can be helpful if there is a need for an emergency evacuation, as in the case of fire.

There is nothing more frightening than a love-one wandering outside and lost. Safety locks can prevent this. Do not lock a sufferer indoors without appropriate supervision. If a lock is needed, then there is a great chance that ongoing supervision is indicated (consider the many Homecare options available but be cautious to consider caregiver compatibility and costs).

The following are my recommended interventions: Maintain a routine for the sufferer. Stress will exacerbate ‘Sundowning’ and routines reduce stress. Maintain or increase the activity status of the sufferer during the day and avoid naps if possible. Naps can tend to disrupt the clients nighttime sleeping pattern. As the sun light in the sufferer’s home decreases through the afternoon to the evening, increase the amount of lighting used in the home. The use of lights will reduce one of the triggers of ‘Sundowning.’ Reduce foods that have caffeine and sugar during dinner and snacks. Keep snacks light prior to going to sleep. Ensure that the sufferer has had adequate hydration during the day (the elderly are prone toward dehydration) but reduce fluids at night to minimize nighttime urination (nocturia). Minimize disturbances during the night This seems pretty reasonable but is sometimes difficult to manage, depending on outside traffic, neighbors, etc.

I read in Healthline.com (http://www.healthline.com/ ) that each sufferer has triggers that lead to ‘Sundowning’ and they recommend keeping a journal, recording all triggers to be avoided. Great recommendation!

A final or perhaps initial intervention may be to medicate the sufferer based upon their symptoms and behaviors. Interestingly, some medications may themselves be the cause (trigger) for what appears to be ‘Sundowning’ but may actually be causing medically induced insomnia and confusion. Review all medications the sufferer is taking with their physician or nurse practitioner to determine if medication may be the cause of the problem.

Ultimately, this is a very difficult and challenging circumstance for caregivers to handle. It can be very exhausting and frustrating for everyone involved. A combination of the recommendations offered will hopefully provide some answers and work for you. Get plenty of rest and support if possible. (please review Web MD (http://www.webmd.com) and the Alzheimer’s Association ( http://www.alz.org/nyc/ ) for excellent information.

Each week I will be answering your Home Care Questions: Email your questions to HamptonsMouthpiece@gmail.com