Give a Gift to Your Future Self

In the Prepandemic era, the weeks following the holidays were once the time to buy for yourself the gifts you didn’t get. These were usually material things that we wanted at the time. 

I’d like you to think about one special person very close to you that you may have forgotten during the holidays: your future self.

We all tend to make decisions each day from the perspective of our present desires and short term goals. Too often we neglect our future selves.

We also don’t realize how different our lives and values will be in the future. If you’re a grown up, you know you are not the same person you were 15 years ago. How have your relationships, goals and sense of self changed over the years?

At the same time, we underestimate our capacity to change in the future. 

Daniel Gilbert, a Harvard psychologist, calls this “The End of History” illusion. He says, “Human beings are works in progress that mistakenly think they are finished.”

People with a fixed mindset, as defined by Stanford psychologist, Carol Dweck, are defined by who they are at the present moment. They are “trapped in the tyranny of now” and this influences the stories they tell themselves and how they deal with negative events and failure. 

With a fixed mindset, when we fail in any of life’s challenges, such as passing a test, getting a promotion or learning a new skill, we attribute failure to personal qualities that we assume will never change. We might label ourselves as dumb, not good at math or just not good enough. It can make us give up.

The opposite is the growth mindset with which we see ourselves as always in a state of growing, learning and becoming. With this perspective, we learn and grow from setbacks. 

If you want to be happier today and in the future, look at yourself and others with this growth mindset. In spite of the pandemic, the bad behaviour of some and the terrible events in the news, we can hope and work today for a better future. Our society will continue to grow and evolve, and we collectively have the ability to create that better future.

Lets begin today, with own our future selves. In what ways do you steal from your future self for expedience or gratification today? Making bad food or substance choices? Sitting alone in front of the TV or computer instead of calling up a good friend or going for a walk?

On the other hand, in what ways do you invest in your future self with positive, life-affirming and prosocial actions? 

Think about the kind of person you would like to be a year or five years from now: healthier and happier with more satisfying relationships. 

How will you invest your time, attention and energy today to be that person? In his book, Atomic Habits, James Clear says that every action today is a vote for the person you want to become. 

I’ll be giving a free online talk on The Keys to Positive Change at 7 pm on Tuesday, January 19^th, 2021. As part of the Burnaby Division of Family Practice’s Empowering Patients public health education program, I’ll share practical tips for improving your wellbeing and making positive changes that last. These are the secrets that my patients and I have successfully used to transform new habits into healthy routines that stick. 

For more information, please check https://divisionsbc.ca/burnaby/for-patients/empowering-patients  over the next few weeks or email Leona Cullen at lcullen@divisionsbc.ca

The Keys to Positive Change: Transforming Our Bad Habits Into Healthy Ones

I’m giving a free online presentation on The Keys to Positive Change: Transforming Our Bad Habits Into Healthy Ones.Please share this with anyone who may benefit. 

7 pm Tuesday, January 19th, 2021

Zoomregistration:

https://zoom.us/webinar/register/WN_U8NO1FA3TOSWJPVuTncQaw

A New Resolve for Pandemic Resolutions

If you like I made New Year’s Resolutions for 2020, you had the best excuse for not keeping them up beyond March.

The pandemic – and the never-ending upheavals to even our healthiest routines – sabotaged most of our plans, rearranged our goals and robbed us of many of the joys of daily life.

At this time, in any other year, I would sit down with my wife and children to review the old calendar. I would invariably be surprised with what has happened in the span of just one year. The media recapitulates the big world events with retrospective spins, but what matters most to you and me are our personal experiences.

This year was totally different.

We missed out on celebrating birthdays, anniversaries and other events that would normally bring us together; time spent with family and friends; plays and musicals seen with my wife – all cancelled indefinitely due to the necessary restrictions of the pandemic.

Before moving on to a New Year, we would ask, “What are we most grateful for?”

In contrast to the disruptions to our lives, the terrible impact on the physical, emotional and social wellbeing of so many of us, and the lives lost during this world-wide health crisis, there were redeeming actions taken by many for which I am grateful.

So many individuals and organizations, recognizing those who have been most impacted by the pandemic and the necessary public health restrictions, worked individually and collectively to reduce those burdens.

If you have reached out to a neighbour, an elderly family member or families struggling with social isolation and the financial burden of the pandemic, I thank you.

With few exceptions, we have seen a wellspring of kindness to lift one another up. We have worked as individuals and as a community to protect and support the most vulnerable.

I appreciate the wonderful, kind actions of others; my gracious patients who continue to entrust me with their care, adapting to the new ways of connecting; my colleagues who support me in our shared calling; the many good people I have worked with to improve the health of our community; my friends, and my family.

As individuals and as a community, we have to recognize what we have endured and survived. Now more than ever, I reflect on these questions. How have we been helped? How have we helped others? What have we learned? How have we grown? The answers are measures of a year and of our lives.

In spite of the shifting sands of this past year, we have learned much. The general public now knows more than they ever did about infectious diseases, the novel coronavirus, physical distancing, the value of wearing masks and hand hygiene.

Most of us learned to use Zoom and other online video platforms for the first time.

We’ve also discovered the impact of acting collectively for the wellbeing of all.

And more than ever, we recognize what really is important in our lives. Of course, we miss vacations, parties, dinners, hanging out with friends, and going to school or work the old fashion ways.

More profoundly, we missed our physical and social connections with one another. This really is what life is all about.

Entering each New Year, we reflect on what we will do differently. Within the guidelines of public health, what activities should we do more of? What should we reduce? What should we cut out all together? What can we create?

We know we cannot predict what 2021 will bring us. We have to accept those things beyond control, but given our strengthened recognition of what we value most, where will we devote our time, energy and attention?

What positive actions can we each take to regain a sense of wellbeing and connection to the people in our lives? What can we do together? What can we do for others?

The pandemic has reminded us that life, relationships and each moment are precious.

This year, I’ll be continuing my work with the Burnaby Division of Family Practice in our free public health lectures (now being presented virtually during the pandemic).

I’ll be giving a free online talk on The Keys to Positive Change at 7 pm on Tuesday, January 19^th, 2021. As part of the Burnaby Division of Family Practice’s Empowering Patients public health education program, I’ll share practical tips for improving your wellbeing and making positive changes that last. These are the secrets that my patients and I have successfully used to transform new habits into healthy routines that stick. 

For more information, please check this website over the next few weeks or https://divisionsbc.ca/burnaby/for-patients/empowering-patients  or email Leona Cullen at lcullen@divisionsbc.ca (Please be patient while the Division works on providing the link to my online talk. I’ll update this site as soon as it becomes available).

Davidicus Wong is a family physician and his Healthwise columns appear regularly in this paper. For more on achieving your positive potential in health, see his website at www.davidicuswong.wordpress.com.

Emotional Wellness

This is the Key Points handout from my Empowering Patients presentation on December 10th, 2020.

What is Emotional Wellness? 

A deep sense of meaning and purpose, an abiding sense of peace, the ability to manage the stress and transitions of life, awareness of your thoughts and feelings and the ability to manage them.

Why emotional health matters

1. Emotions influence our behaviour, our relationships and our thinking.
2. Anxiety holds us back from doing what we need to do, from moving forward, from reaching out, and from giving our best to the world.
3. Depression is a major cause of disability and absenteeism from work or school.

Anxiety Disorders

When your anxiety has a significant impact on your function at work, school or home or in your social life.

1. Generalized Anxiety: excessive worry about many things
2. Panic Disorder: recurrent panic attacks (symptoms may include chest pain, a racing heart, sweats, shortness of breath and dizziness)
3. Obsessive Compulsive Disorder: repetitive intrusive thoughts or recurrent compulsions to perform an act (e.g. checking, handwashing, rituals)
4. Social Anxiety: excessive anxiety in specific social situations e.g. large groups, interviews, shopping
5. Phobias: extreme specific fears e.g. spiders, heights, flying

Mood Disorders

The Symptoms of Depression: fatigue, change in sleep, change in appetite, impaired concentration, forgetfulness, thoughts of death or suicide, self-blame and guilt, feeling sad, hopelessness, lack of enjoyment or pleasure, loss of motivation.

Bipolar Disorder: episodes of depression and mania/hypomania (heightened mood and energy, overconfidence, decreased need for sleep, impaired judgment, decreased need for sleep, delusions of grandeur)

Psychotic Symptoms

 impaired reality testing, delusions (fixed false beliefs), hallucinations (seeing or hearing things that are not real), disorganized behaviour e.g. schizophrenia

KEY EMOTIONAL HEALTH SKILLS

1. A Meditative Practice

to calm your mind, centre your thoughts and reflect.

Recommended Reading on Mindfulness: Joseph Goldstein, Thich Nhat-Hahn, Jon Kabat-Zinn, Jack Kornfield. 

Podcasts/Websites: JackKornfield.com, TaraBrach.com

2. Cognitive Therapy

• Reflect on the thoughts that trigger your emotions. Is there another way to look at the situation? 
• Question the underlying beliefs behind unhealthy thinking.
•  Identify your cognitive distortions: 

Emotional Reasoning: Inappropriately reasoning from how you feel e.g. “I feel something bad will happen; therefore, it will.”

Fortune Telling: Assuming that you really know how things will turn out e.g. “I’ll always feel this way.”

Mind-Reading: Believing you really know what another person is thinking e.g. ”I know why my friend didn’t call me back.” “I know they think I’m a loser.”

Overgeneralizing: Making broad assumptions based on the facts on hand e.g “No one cares about me.” “All men/women are the same.”

Polarizing: All or nothing, black or white, good or bad thinking e.g. “She used to be an angel; now she’s evil.” “Either you’re with me or against me.”

Shoulding: Inappropriate judgment e.g. “Everyone should always treat me nicely!” “I have to be perfect.”

Personalizing: Taking things too personally e.g. “He did that just to hurt me.”

Catastrophizing: Believing the worse things will happen e.g. “I’m going to fail and I’ll never be a success.” “This is the end of the world.”

Recommended Reading: Mind Over Mood by Padesky and Greenberger; Authentic Happiness by Martin Seligman.

3. Visualizing Your Goals

• Turn your problems into goals. 
• Instead of replaying the past or ruminating on the negative, think about what you want. 
• When you are most relaxed, visualize yourself having achieved your goal. 
• How do you feel? What do you see? What do you hear? Make it real!

4. MANAGING STRESS

Burnout: when the demands of work or life exceed our ability to manage them.

Seizing the Locus of Control

• Identify your sources of stress.
• Are you reacting in proportion to the stress?
• Recognize what you can change or control.
• Accept what you cannot change; assume responsibility for what you can.
• Recognize your choices.

The 80/20 Rule: 20% of our reaction to a situation is related to the facts; 80% arises from what we bring from our past and how we conceptualize the present.

The Daily Management of Stress

Be a good parent to yourself:

1. Go out and play. Have an exercise routine.
2. Don’t skip meals. Schedule regular healthy meals.
3. Go to bed. Get enough sleep and take regular breaks.
4. Go to the doctor. See your own family doctor appropriately.

Express your emotions with those close to you with a group of confidantes. Form or join a support group.

Live in accord with your values.

Attend to Your Relationships

1. Foster emotional intimacy. Agree on a habit of checking in with one another each day. How are you feeling? How was your day?
2. Show your affection. Express your positive feelings. Remember the 5 languages of love and the human brain’s Negativity Bias: You need to see and say 5 positives for every negative.
3. Schedule regular dates, family time and time with good friends. Commit your time to who matters most. Don’t wait ‘til there’s time; make time!
4. Communicate in a healthy way. Take a breath and let anger cool before you react. Acknowledge the other’s feelings and point of view. Express how you feel without blame.

Right Speech: Is it true? Is it helpful? Is it kind?

Where to Find Help

Canadian Mental Health Association 

cmha.bc.ca

Courses, resources, cognitive therapy and support.

Burnaby Mental Health 

fraserhealth.ca (604) 453-1900

Assessment, treatment, counselling and crisis intervention.

Cameray Child & Family Services

203 – 5623 Imperial Street, Burnaby (604) 436-9449 cameray.ca

Counselling for children and families.

AnxietyBC 

anxietybc.com

Education, cognitive therapy courses.

BounceBackbc.ca a free online skill-building program for adults and youth over 15 years of age

Mood Disorders Association of BC

mdabc.net

Support groups, cognitive therapy and wellness programs.

SAFER  (604) 675-3985

Education, support and counselling for those who have suicidal thoughts, have attempted suicide. 

Support for family members.

Burnabycoronavirus.com for COVID information, social supports and Doc Talks

The Four Foundations of Self-Care

• What you eat (what you put into your body). 

• What you do (physical activity and rest). 

• How you feel (emotional wellbeing). 

• How you connect (healthy relationships).

Please share this information with your family, friends and anyone else who may find it helpful.

Together we’ll create a healthier community and a healthier future.

An Introduction to Mindfulness

by Davidicus Wong, M.D.

This is a handout I share with my patients to introduce them to the practice of mindfulness and principles of cognitive behavioural therapy. I consider these to be two fundamental emotional wellness skills that every adult and child should learn.

Like any other skills we wish to master, practice – particularly daily practice – is essential. Through the power of the human brain’s capacity for neuroplasticity (to change itself), we learn new skills – including new ways of thinking and feeling – through repeated practice. In the words of the pioneering Canadian neuropsychologist, Donald Hebb, “Neurons that fire together wire together.”

MINDFULNESS MEDITATION helps us to centre our minds, increase our awareness and calm the nervous system that modulates how we experience pain and other sensations. The practice of mindfulness teaches us a less reactive approach to the rest of our lives. We become open to accept and experience every aspect of our lives, our selves and our sensations, without clinging, aversion or judgment.

We begin meditation by spending 15 or 20 minutes each day just sitting in a quiet place in a comfortable position. We turn our attention to the natural flow and sensations of the breath without trying to control it in any way. This becomes a safe and calming anchor that we can return to at any time.

We can then turn our attention to sounds as they arise in our immediate environment, just attending to the arising and disappearance of different sounds as they come and go from our awareness. We don’t have to label or identify each sound. We simply remain aware of them as they arise.

We can centre our awareness on different physical sensations in the body, perhaps the pressure at points of contact, warmth, coolness, vibrations, pulsations, tingling and even pain. We can move awareness to different areas of the body, and if a sensation such as pain in one part of the body is difficult to manage, we can shift our attention elsewhere, to the part of the body that is most comfortable or back to the anchor of the breath.

With practice, we are able to maintain awareness and attention to every sensation without reacting to it, without aversion, clinging, judgment or identification. With time, we recognize that everything within our awareness is ever changing; nothing is constant – no sensation (not even pain), no mood, no emotion and no thought.

We are able to attend to each thought as it arises without getting carried away in a train of thoughts or a story in the remembered past or imagined future. We can note thoughts as they arise, without judgment or identification and let them go. We can do the same with the transient feelings and emotions that arise without getting caught up and carried away with them. We experience moods, feelings and emotions but we are not our moods, feelings or emotions. We can see them as transient, temporary conditions like a mist, a fog or a shower. They pass through us or we pass through them.

We can be mindful when walking, attending to the sensations of each step, the sounds and pressures on the feet and the movement of the legs. This becomes a mindful anchor from which what we hear, see, feel and think arises in our open and accepting awareness. 

Mindfulness can be practiced while eating, attending to the taste and texture of each bite of food; swimming, attending to the sensations of buoyancy, flowing water on the surface of the skin and rich sounds of moving water and air; and even driving. Mindfulness only begins with meditation. When you apply the healthy attitudes of non-reactive acceptance, gratitude and compassion to everything in your life throughout each day, you will discover a deeper level of peace, happiness and meaning. 

Mindfulness when diligently practiced can bring serenity to your mind and body throughout each day – an open, accepting and nonreactive approach to your life. It can foster in you greater compassion for others and yourself.

COGNITIVE BEHAVIOURAL THERAPY trains us to uncover our underlying beliefs and assumptions, choose our conscious thoughts, reframe our situation and shape our emotions. We can discover that we can improve our moods, thoughts and function in life through healthy self-care – eating regular healthy meals, ensuring adequate rest, daily appropriate physical activity and spending quality time with supportive friends and those loved ones who naturally lift our spirits. Mindfulness meditation can help us identify unskillful thoughts (those that increase suffering) and help us choose skillful ones.

MORE RESOURCES (I’ve put my favourites in bold)

MINDFULNESS MEDITATION

The Miracle of Mindfulness: An Introduction to the Practice of Mindfulness (Thich Nhat Hanh)

Insight Meditation: The Practice of Freedom (Joseph Goldstein)

Mindfulness: A Practical Guide to Awakening (Joseph Goldstein)

Radical Acceptance (Tara Brach)

True Refuge: Finding Peace and Freedom in Your Own Awakened Heart (Tara Brach)

JackKornfield.com, TaraBrach.com Jack Kornfield and Tara Brach’s videos, guided meditations and lectures are available for free on these websites. By listening to these teachers, you will quickly see how the attitude of mindfulness can be applied to your everyday life.

Local mindfulness retreats: Westcoast Dharma Society http://www.westcoastdharma.org

MicrodosingMindfulness.com will show you how to fit in routine mindfulness breaks in just a few minutes a day

THE PRACTICAL SCIENCE OF NEUROPLASTICITY

Hardwiring Happiness (Rick Hanson)

Buddha’s Brain: The Practical Neuroscience of Happiness, Love and Wisdom (Rick Hanson)

COGNITIVE BEHAVIOURAL THERAPY

Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment(Martin E. P. Seligman)

Feeling Good: The New Mood Therapy (David D. Burns)

Mind Over Mood: Change How You Feel by Changing the Way You Think (Dennis Greenberger, Christine Padesky)

Anxietybc.ca has many useful resource including the Mindshift app for smart phones

Checkingin is a free mindfulness app for your smart phones

DIALECTICAL BEHAVIOURAL THERAPY (a synthesis of mindfulness and cognitive therapy)

            The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free From Worry, Panic, PTSD, & Other Anxiety Symptoms (Alexander L. Chapman)

For an effective technique for establishing healthy new habits, check out TINYHABITS.COM

Understanding and Embracing Emotional Health – Challenging Common Mental Health Myths

Understanding and Embracing Emotional Health – Challenging Common Mental Health Myths

Davidicus Wong, December 6^th, 2020

It’s been called the parallel pandemic. The social isolation, uncertainties and financial impact of COVID-19 has stressed us all, but those most vulnerable – including the elderly, the homeless and those struggling with addictions – have been hit hardest.  

Most people don’t realize that up to 30% of the daily work of a family physician involves emotional health – helping patients manage difficult emotions, relationship challenges, anxiety and stress. 

But I know that this is just the tip of the iceberg because many people are reluctant to bring up emotional issues and may never seek support. 

There remains a stigma attached to emotional or mental health challenges. In recent years, pubic health agencies have tried to remove the stigma by getting people to talk about it. 

But for many, just raising the awareness that you can and should talk about it to those who can help hasn’t erased the prejudice, embarrassment and myths associated with emotional health.

An unfortunate legacy of the 17^th century philosopher, Rene Descartes is mind-body dualism, the incorrect separation of mind and body as completely distinct and independent. 

The reality is that there is no such separation. The brain is obviously an inseparable part of the body. In fact, you can recognize many emotions by how you experience them physically. 

When we are anxious or stressed, we breathe more rapidly, our hearts beat faster, our muscles tense, our stomachs turn and we sweat. 

When angered, not only do our thoughts race, but so do our heart and breathing rates. We feel a surge of agitated energy throughout the body. 

When depressed, we slow down physically as well as mentally, sleep is disturbed, energy dips and we may gain or lose weight from changes in appetite.

Our thoughts and emotions affect other “non-mental” aspects of our health and can contribute to high blood pressure, insomnia, irritable bowel syndrome, an overactive bladder, stomach ulcers, heartburn, chronic pain and fatigue. 

Compounding the false belief of mind-body separation are myths about emotional health. Because some conditions require medication, some incorrectly conclude that emotional problems are strictly chemical (i.e. neurotransmitter) imbalances. Others incorrectly assume that all emotional health problems are genetic. 

Another common misunderstanding among friends and family members of those suffering from severe clinical depression is that it is just the same as when we feel sad with a loss or other negative event. Depression can be so profound that it affects an individual’s outlook and ability to think clearly and solve problems. Those who have never experienced clinical depression may not understand why their loved one just can’t get over it or snap out of it. 

Your emotional wellbeing is an important aspect of your overall health. There is much we can do individually and collectively to support the wellbeing of everyone in our community. When your mood, stress or anxiety are affecting your function and enjoyment of life, don’t hesitate to seek help. 

Every community has organized supports for those struggling socially and emotionally. In Burnaby, we’re all working together through the Primary Care Network. Check the resources that are available at https://www.burnabycoronavirus.com/social-supports

On Thursday, December 10^th, I’ll be giving a free online talk on behalf of the Burnaby Division of Family Practice’s Empowering Patients program. The topic: Emotional Wellness. I’ll be sharing key emotional health skills that we all need to manage the effects of this pandemic and community resources for help. For more information: https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Maintaining Your Health During the Pandemic

In February, when celebrating her 100^th birthday with her family, my patient, Helen (not her real name) continued to thrive while managing her chronic health conditions. 

The pandemic changed all that.

She wasn’t infected with COVID-19. Her assisted living facility made every effort to protect its residents. However, this meant an end to all social activities . . . and visitors.

By June, I learned of Helen’s profound functional decline. She had lost weight, fell frequently and was no longer able to stand on her own. Her daughter, an experienced nurse recognized that she was in a potentially irreversible decline.

Once we were able to get approval for weekly visits from her daughter (in full PPE to protect Helen and others at the facility), Helen progressively regained her strength and quality of life.

The pandemic has affected every one of us, but in addition to those infected with COVID-19 and their families, those suffering from social isolation have been the most vulnerable.

We are at a crucial crossroads in this pandemic. With the daily rise in new infections, we each have to double down on our efforts to reduce the spread. We can’t wait for the majority of Canadians to be vaccinated. Many more will become sick and die in the coming months.

Continue to keep your distance, wear a mask when you can’t, keep your hands clean and ask yourself whenever you leave your home, if you really need to. Is it worth the risk to yourself and your family?

In the meantime, we must work together to maintain our physical, social and emotional wellbeing. We can’t do this alone. 

Your family physician’s clinic is still open – at least to calls. Don’t neglect chronic conditions and proactive healthcare. Labs and x-ray clinics are also still open. We’ve all made changes to provide the care you need while reducing your infection risks. 

If you haven’t had your flu shot yet and your local pharmacy or family practice clinic has run out, Burnaby residents can book an appointment with https://www.burnabyflu.com

Stay connected to your family and friends with frequent calls or video chats. Reach out to those who are living alone and ask what you could do to help. 

If you are feeling stressed, frustrated, anxious and even depressed, you are not alone. You are not alone in how you are feeling, and there is help in our community for you. 

Every community has organized supports for those struggling socially, emotionally and financially. In Burnaby, we’re all working together through the Primary Care Network. Check the resources that are available at https://www.burnabycoronavirus.com/social-supports

On Thursday, December 10^th, I’ll be giving a free online talk on behalf of the Burnaby Division of Family Practice’s Empowering Patients program. The topic: Emotional Wellness. I’ll be sharing key emotional health skills that we all need to manage the effects of this pandemic and community resources for help. For more information: https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Dr. Davidicus Wong is a family physician.

Four COVID Confusions

by Davidicus Wong, October 25^th, 2020

Our knowledge of COVID-19 and how it spreads continues to evolve. Now that we’ve entered our second wave, let’s clear up four endemic COVID confusions.

Bursting Bubble Confusion

Many of my patients, the general public and even some healthcare providers have been confused by the advice to keep our bubbles small. 

Does this mean it’s safe to interact as usual (without physical distancing or masks) with a small number of friends, relatives and colleagues?

Though knowing who you are seeing socially makes contact tracing easier AFTER one of you is diagnosed with COVID-19, you are still at risk for getting infected and passing it on if all of you are not maintaining careful hand hygiene, distancing and masking.

Meeting up with a few friends in a restaurant or social event may seem safe but if you are not appropriately distanced (2 meters apart), you will have exponentially expanded your exposure risk. In effect, you are merging all the social bubbles of each person in the group. 

It’s analogous with sexual intercourse and the risk of sexually transmitted diseases and pregnancy. An orgy is a higher risk event than connecting with one person at a time, but if you are not using adequate protection and sticking with one trusted partner, you are effectively sharing your infectious risks with each contact – and everyone with whom each has slept, eaten and talked.

COVID Testing Fallacy

We’ve seen the folly of the White House’s approach to infection control. Trump and his staff continued to interact without masks or distancing and relied on frequent testing.

A positive test again is great for retrospective contact tracing but the horse has left the barn. It is insufficient to prevent the spread . . . and the serious impact of this potentially deadly infection.

This again is analogous to unsafe sex. 

You shouldn’t rely on repeated pregnancy and COVID tests. They may only tell you that you’re not in trouble yet. And like a pregnancy test done too early, you may get a false negative . . . a false sense of security when in fact you are in trouble. 

When you do a COVID-19 test, you will be told that there is an approximately 30% chance that the test comes out negative even if you do have an infection. 

You would be told to continue to self-isolate until your symptoms resolve and to contact a healthcare provider if those symptoms continue or worsen. 

Frequently, those ultimately diagnosed with COVID-19 have had negative tests earlier in their infections.

The Myths of Masks

Masks have been proven to reduce the spread of COVID-19. 

A well-fit mask covering both your mouth and nose does protect you to some extent. But don’t allow it to give you a false sense of security. You should still maintain a safe distance from others and clean your hands carefully.

Your mask is better at protecting you from passing infected respiratory droplets to others than from protecting you from others. If others are also wearing masks, your personal risk is significantly reduced. If you maintain a safe distance, your risk is even lower.

That’s why wearing a mask sends a message to others.

Knowing that any of us can have no symptoms early in the course of an infection, wearing a mask says to others, “I’m protecting you.”

Beware of the masks with valves. These were originally designed to protect industrial workers from inhaling small toxic airborne particles. Masks with valves are not used in the medical setting because the valves are one way. You can still exhale your infectious respiratory droplets through that valve.

When I see someone with a valved mask, they are sending me much different message, “I’m just protecting myself but not others; you should keep a safe distance away.”

A Little Claustrophobia is a Good Thing

Though respiratory droplets are the main way that COVID-19 is spread, there have been cases of airborne transmission: smaller particles can stay in the air for longer periods of time.

That’s why we should avoid interacting with others (outside of our small bubbles) in small, enclosed areas for extended periods of time, such as in a car or small room. 

That’s why your doctor is doing mainly video and telephone consultations with you and why in person clinic visits are limited to shorter periods of time and only when absolutely necessary.

Please share the evolving facts about COVID-19 with your family and friends, we all need to keep each other safe – especially the more vulnerable in our community. 

Our Smoky Air: Another Reason to Stay Indoors and Wear a Mask?

by Davidicus Wong, M.D. September 14th, 2020

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The mountains along the horizon begin to fade on Saturday as wildfire smoke from the western states moves north into Whistler (photos by Davidicus Wong)

Most people don’t realize that Smokey the Bear’s real name was Smokey Bear, and that he was an orphaned bear cub rescued by firefighters in New Mexico 70 years ago. He has remained a symbol for forest fire prevention and wildlife preservation.

Today, smoky air – from wild fires in California, Oregon and Washington – have given all of us in BC another reason to stay indoors or wear a mask. 

Wildfire smoke poses a health risk to everyone including those of us who are otherwise healthy. It can cause irritation of the throat, nose and eyes; coughing, and shortness of breath. 

Those at highest risk are babies, young children, older adults, and those with chronic conditions such as respiratory or heart disease. For example, individuals with asthma, chronic bronchitis or emphysema will notice increased shortness of breath and wheezing.

While our air quality temporarily ranks among the worst in the world, we should all stay indoors as much as possible. Keep your windows closed, and if you are using an air conditioner, you should close the outside air intake and keep the filter clean to reduce bringing smoky air into your home. HEPA air purifiers can help remove small particles from the air but you are less likely to find them in our local stores. 

Although cloth and surgical masks provide some protection against COVID-19 and other respiratory infections and you should wear them when you are unable to maintain physical distancing (2 meters) from others, facemasks only protect against larger particles in the air and not the fine particles of wildfire smoke. 

N-95 facemasks do offer some protection as they filter smaller sized particles if fitted correctly. However, they are more expensive, hard to find and are really no substitute for staying indoors as much as possible. 

Prior to the wildfires, we were encouraging more outdoor exercise during the pandemic. While our air quality remains so poor, even the fit should avoid strenuous outdoor exercise such as running. 

The challenge of this unfortunate time of wildfires at the end of summer during a pandemic is to remain cool indoors but away from others. I anticipate the shopping malls may be more popular than our park trails over the next week. Remember to maintain your distance and hand hygiene. 

If you or anyone you know is suffering from shortness of breath, a possible infection or any other medical condition, remember that your healthcare providers, including your family doctor and our emergency departments remain open.

The majority of family physicians have remained available for their patients throughout the pandemic. We have reduced in person clinic visits to what is essential; however, we’ve been connecting through telehealth – phone or video if appropriate. 

Don’t hesitate to call your family doctor as you normally would for your usual medical concerns, including the management of chronic conditions such as high blood pressure and diabetes. If you have a chronic lung condition such as asthma, call the clinic if you are running low on your inhalers. 

Dr. Davidicus Wong is a family physician. His Healthwise Column appears regularly in the Burnaby Now, Royal City Record and Richmond News.

COVID-19: The New STI (Socially Transmitted Disease)

There is a growing and alarming complacency in communities across Canada including BC. 

Our self-congratulations and comparisons to the worst case scenarios unfolding in the US is like being a C+ student comparing himself to the kids who are failing. It’s not the time to stop studying, skip classes and start experimenting with drugs.

In recent weeks, we’re already seeing a potential second wave in the pandemic and it’s not just because we have opened more businesses and public facilities. Many individuals have forgotten about the effectiveness – and necessity – of social distancing and are just plain confused about “expanding your bubble.”

Birthday celebrations and other house parties, gathering in large crowded groups, playing contacts sports and meeting up with friends at restaurants and coffee shops without physical distancing or masks are contributing to the accelerated spread of COVID-19 infections in the community.

I have spoken to patients who are back to work and although the majority of workplaces are adhering to pandemic safety guidelines to protect the public as well as their employees, I’ve been alarmed with the lack of adequate physical distancing (or the alternative of face masks when this is not possible) behind the scenes in many stores, restaurants and even pharmacies and health care facilities. 

You shouldn’t be working face to face or side by side with coworkers without adequate barriers or face masks. You shouldn’t be taking breaks, chatting or eating with coworkers without physical distancing or wearing face masks.

It’s okay to go to a restaurant that has taken the appropriate measures to protect their patrons. 

But with whom should you be meeting?

Eating and talking less than two meters apart are high transmission activities where respiratory droplets may carry the virus. Don’t even think about sharing foods and drinks.

That’s why we should consider COVID-19 the new STI (socially transmitted infection). When you talk, hug and eat with one person – even a trusted friend who doesn’t feel sick – you’re talking, hugging and eating with everyone they have talked, hugged or eaten with in the past two weeks and whomever each of their social contacts have met up with.

You may think you know who is in your expanding bubble but you really don’t because your bubbles have merged with multiple other bubbles.

Ultimately, if you don’t keep track and consider the logarithmic expansion of your shared bubbles, it’s the opposite of a slow leak: a rapidly expanding bubble that when large enough and risky enough can explode like the Hindenburg.

Mind your bubble. Keep it safe and small. 

Don’t let it burst.

Dr. Davidicus Wong is a family physician. He was the founding chair and lead physician of the Burnaby Division of Family Practice and continues to serve on the board. His Healthwise Column appears regularly in this paper. For more on achieving your positive potential in life, read his blog at davidicuswong.wordpress.com.