Wait – What Test Did I Just Get? COVID-19 Testing 101

Recently I’ve had a handful of patients tell me they got same-day rapid COVID-19 tested at a nearby business and were very excited to report that they were “COVID negative.” I was immediately skeptical because the availability of true COVID-19 rapid tests in my area is slim, and usually reserved for the ER and hospital admission process. Here’s the gist of our exchange:

  • Me: Wow – you really got same day COVID tested? Where?
  • Patient: Well, yeah I think, I mean the sign says COVID TESTS in huge letters
  • Me (increasingly skeptical): Do you happen to remember what the doctor or nurse called the test?
  • Patient: There was no doctor or nurse, I just paid $50 cash and got my test results on a piece of paper and left.
  • Me (passed skeptical 5 min ago): Was the test up your nose or from your blood?
  • Patient: It was just a little finger-stick I did myself.

This patient and others were all under the impression that they were getting tested for active COVID-19. In short, what happened with this patient is that they actually got the COVID-19 Antibody test – NOT tested for active COVID-19.  This is a very important distinction.

So what’s the difference? Let’s break it down.

  • COVID-19 Serologic Antibody Test
  • Purpose: to detect antibodies to COVID-19 and identify past infection with COVID-19. Antibody tests should not be used to diagnose someone with acute (current, active) infection.
  • Method: blood test
  • Benefit: may be able to donate blood for convalescent plasma; identify past infection
  • Time to Result: depends on your area and testing center
  • Important Caveat: at this time, we DO NOT have evidence to suggest having COVID-19 antibodies means someone has “immunity.” This is currently being researched by people a lot smarter than me.
  • Tip: If you’re interested in antibody testing, ask your primary doctor for a recommendation on where to get tested. Not all places offer the same quality of antibody test.
  • COVID-19 Viral Test
  • Purpose: testing for acute (current, active) infection
  • Method: Nasal swab (up your nose), Nasopharyngeal swab (most common right now. It’s up your nose…higher), Oral swab
  • Benefit: identifying active COVID-19 infection
  • Time to Result: depends on your area and testing center
  • Important Caveat: we have seen cases where patients continue to test positive even weeks after their symptoms have improved. I always recommend talking to your primary doctor about your specific situation.

With both tests there can be false positives and false negatives. It’s important to talk about your results with the ordering physician or your primary care doctor so they can put your results into context for you.

I really hope this helps some of you with the testing process, and leaves readers with a better understanding of the nuances between the different tests. The healthcare system in general can be really difficult to navigate, and when you throw in a global pandemic – OOF, it just gets more complicated! Unfortunately, there are companies and businesses out there that will try to exploit and manipulate the situation for profit.

As always, please remember that medicine is always in flux and this information may change down the line. As we learn more about this virus and continue to develop innovative methods for testing and treatment, things will change – and that’s a good thing!

How have your COVID-19 testing experiences been so far? Let me know in the comments below!

Heading to College? Make & Take a DIY Med Kit.

I’ve been there. Flashback: It’s 8 PM during my freshman year of college and I just hobbled back from the library with monstrous bloody blisters from new sandals. The bookstore is closed. It’s already dark. And I’m hoping my roommate is home so I can convince her to walk with me (buddy system!) to the gas station to get some band-aids and Neosporin.  My roommate is not back yet, but fortunately I remember that my mom is The Absolute Best and packed me a first aid kit that she put together herself. I’m not going to lie and say I didn’t protest and roll my eyes when she packed it, but I kid you not – the entire floor of my dorm probably used that med kit at some point.

Did you know that roughly 1 in 4 college students will get influenza each year? Other infectious diseases like mononucleosis (“kissing disease”), strep throat/tonsillitis, norovirus (stomach bug that causes vomiting and diarrhea), and common colds are especially prominent on college campuses due to close quarter living.* Other issues of concern on college campuses include STIs, mood/sleep disturbance, injuries, and bacterial meningitis. Not all colleges are a short walk away from a CVS or a Rite Aid, and oftentimes campus stores or health centers have limited hours and options, so having supplies on hand is key.

* Obviously COVID-19 is the big elephant in the room. I’ll be posting a separate article dedicated to my thoughts on “college + covid” soon.

Over the years, I’ve made different variations of that med kit my mom put together ages ago. Now, after working in university clinics as a family medicine physician, I’ve put my own spin on it. See below for my recommendations!

Supplies:

  1. Band-aids: various sizes, various purposes.
  2. Vaseline: great for chapped lips, cracked or dry skin, broken cuticles and more.
  3. Neosporin or other topical antibiotic: can be applied to minor cuts and lesions after washing well with soap and water.
  4. Hydrogen peroxide or rubbing alcohol: can be used to sterilize thermometer, retainers, toothbrushes, earrings, etc. For minor cuts I recommend washing gently with soap and water rather than using hydrogen peroxide or rubbing alcohol.
  5. Ace bandage: for all those unplanned injuries. Can be used to wrap a knee/shoulder/ankle, as a temporary sling, to hold ice packs in place, and also can be washed and re-used.
  6. Athletic tape + pre-wrap:  and for more unplanned injuries. Do not try to re-use.
  7. Instant ice pack: squeeze to activate and apply to area in question. Great for sprains, bruises, headaches, and more.
  8. Thermometer: fever or no fever? Crucial information for when you’re not feeling well.  
  9. Tweezers: splinters, etc.
  10. Cortisone cream: sold over-the-counter as a 1% cream and can be used to help stop itching associated with bug bites, eczema, and other rashes.
  11. Condoms: parents, this may feel awkward to put in your college student’s med kit, but remember that 30 seconds of feeling awkward is better than a lifetime of them dealing with herpes.
  12. Heating pads: It’s always nice to have some of the stick-on heating pads on hand for menstrual cramps, muscle aches, tension headaches, and more.
  13. Travel tissue pack: just for backup
  14. Extra masks: because we’re in the middle of a global pandemic
  15. Hand sanitizer: see above. Also, dorms are kind of gross.

Medications:

  1. Ibuprofen: pain relief, anti-pyretic (helps with fever), and anti-inflammatory.
  2. Acetaminophen: pain relief and anti-pyretic.
  3. Benadryl: itching related to rashes, bug bites, allergies / allergic reactions.
  4. Melatonin: can be used to help with sleep (see article on natural ways to improve sleep here)
  5. Multi-vitamin: because sometimes free will + college cafeteria = pizza every day.
  6. Cough syrup/tablets like Mucinex DM (generic is fine!): there are tons of different brand and generic versions out there. Typically, the ingredients I look for are dextromethorphan (cough suppressant) and guaifenesin (an expectorant that helps loosen mucous congestion).
  7. Cough drops: menthol & honey seem to work the best because they actually provide some soothing relief, as opposed to just being sugar drops.
  8. Tea bags (ginger, chamomile): soothing for sore throats, nausea, poor sleep, and more.
  9. Ginger chews: can help with nausea.
  10. Honey sticks/individual honey packets: helpful for coughs and sore throat. Some studies have shown that honey is just as effective as over-the-counter cough medications in reducing nighttime coughing. I know we are talking college kids now, but just a reminder to never give honey to children under the age of one.
  11. Icy Hot or other menthol muscle rub: some contain topical aspirin as well, so just pay attention to the ingredients.
  12. Loperamide: when you don’t have time for diarrhea.
  13. Pepcid/ tums: over-the-counter medication for acid reflux and heartburn
  14. Pedialyte powder: can be mixed with water to create the correct balance of electrolytes to help with dehydration.

This med kit does not include any prescription medications, which should be discussed individually with your physician ahead of time. Having a plan about how to get prescription refills is important! I also recommend keeping the following info with the med kit:  

Health Info:

  • List of university health center phone #, nearby hospital/urgent care, crisis hotline #
  • Insurance card
  • Brief health info:
    • Immunization record
    • Listed RX meds + any medical conditions
    • Allergies
    • Primary care doctor name/address/phone
    • Emergency contact info

The Bottom Line: Not all colleges are a short walk away from a CVS or a Rite Aid, and oftentimes campus stores or health centers have limited hours and options, so having supplies on hand is key. Take a med kit.

This med kit can also be used for a car first aid kit, travel first aid kit, and more. Are there any go-to items you keep in your med kit? Comment below!

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COVID-19: The Good, The Bad, and The Ugly

A Personal Perspective

Sonya Narla, DO

The good: A patient dropping off an extra container of Lysol wipes because they wanted to make sure we had enough. Surprise pizza delivery from an elderly patient after a particularly rough week. Working with a great team of colleagues that are like-minded, intelligent, and compassionate. The strong spirits of healthcare workers who are so creative at meeting patient needs despite pandemic restrictions. Birthday parades. Technology that allows us to function in ways we could not 40 years ago. Solidarity. The existence of an expert like Dr. Anthony Fauci, whose contribution to medicine over the years is immeasurable. Dogs because, well, duh. The phone calls that end with “please be safe; we need you.”

The bad: Medical masks stolen from our waiting room. Trials and tribulations of telemedicine. Missing the face-to-face connection we value so much in primary care. Elective procedures placed on hold – necessarily, but also to the detriment of our patients. Limited fresh air due to 110+ degree temperatures. Burn out. Missing my people. Cancelled [insert important trip / reunion /season / milestone here]. No idea what to do about school.

The ugly: Reading and re-reading social media posts that spit in the face of medicine and healthcare professionals. Being told that you’re part of a conspiracy to control free people, when you’re just trying to keep people alive. Gaslighting. Watching people proudly declare they won’t wear a mask when healthcare workers are pulling shift after shift dealing with COVID-19. Watching medicine become politicized. Physicians fired for speaking out about lack of PPE in NYC.  Lies. Job loss & furlough. Seeing people take advice or get information from a random web source or Facebook post, as opposed to trusted healthcare professionals. The disproportionate rate of COVID-19 fatalities in Black and minority patient populations.  The sensation of watching things go awry from a bird’s eye view, while simultaneously being in the thick of it. Preventable illness. Preventable death.

What are your Good / Bad/ Uglies of the COVID-19 pandemic?

Trouble Sleeping? Try Sleep Hygiene Measures.

Sonya Narla, DO

We’ve all had those nights where we struggle to wind down in the evening – whether that means staring at your glaring phone screen until midnight, running through 15 different mental checklists, or tossing and turning through the night. Practicing good sleep hygiene on a regular basis can help promote more restful sleep, which leads to more energy throughout the day. So what is sleep hygiene? Sleep hygiene is simply a term used to describe a set of good sleep habits. These good sleep habits can help to train your body and brain for better sleep. 

  1. No screens at least an hour before bedtime. This means TVs, computers, phones, tablets, etc. Studies have shown that screen time within an hour of bedtime is associated with poorer sleep quality, later bedtimes, and less hours of restful sleep. It is possible that stimulation from bright screens disrupts the circadian rhythm (your internal clock) and causes increased alertness. If this seems impossible at first, start with 30 minutes before bed instead of a full hour.
  2. Increase physical activity during the day – but not too close to bedtime! Exercise during the day, afternoon, or early evening naturally makes for better sleep at night. Like screen time, exercise can be stimulating to the brain, so avoid exercising in the later evening hours.
  3. For adults, try to use the bedroom for sleep and sex only. No more working or watching movies in bed – doing these activities in the bedroom train your brain to think that the bedroom is a place to be alert, engaged, and well…awake. Instead, you want to train your brain that the bed is for sleep, winding down, and relaxing. 
  4. Have a bedtime routine. The idea here is again about “training your brain” to associate your bedtime routine with sleep. Over time, your body will recognize the bedtime routine as a signal to relax and wind down. Some ideas to incorporate into a nighttime routine include a shower, skincare, reading a chapter of a book in the living room, using calming scents like lavender, or enjoying chamomile or other decaffeinated tea. 
  5. If you can’t fall asleep after about 30 minutes in bed, leave the bedroom. Sit in another room while doing something relaxing, like reading a book or the newspaper (remember, no screens!), until you feel tired. Once you actually feel tired, return to bed. 
  6. Try to keep your bedtime and wake up time consistent throughout the week.
  7. Keep your bedroom cool. Did you know that the ideal room temperature for restful sleep is thought to be between 60-68 F for most adults?
  8. Avoid caffeine, nicotine, and sugary snacks late in the day. This one’s obvious, and easier said than done. 
  9. Alcohol is sneaky when it comes to sleep. While a glass of wine before bed may seem like it helps you fall asleep, it comes with a cost. Alcohol actually reduces the quality of sleep you get by decreasing REM sleep and interrupting your circadian rhythm (your “inner clock”), so that sleep is not as restorative. 
  10. Avoid having pets in the bed with you. I cringed as I wrote this one, because I’m guilty of this myself. But having pets in the bed causes significant sleep disruption, as our furry friends make noises and movement throughout the night that wake us up multiple times (for example, a certain dog I know is guilty of stealing the covers at 1 am, walking across my face or stepping directly on my stomach at 3am, then barking at pigeons at 5 am…)

The Bottom Line: the sooner you start good sleep hygiene habits, the closer you are to training your brain for restful sleep. 

Do any of you practice good “sleep hygiene?” Which ones do you find the hardest or most helpful? Let me know in the comments!

Anxiety in the Time of COVID-19

Sonya Narla, DO

What is anxiety?

There is no single correct answer to this question, and the reason is because anxiety can present differently person-to-person. Yes, anxiety can be different for different people. For some people, anxiety may present in purely physical symptoms. Maybe they experience nausea, stomach discomfort, palpitations (a sensation that your heart is beating very fast, or fluttering), dizziness, jitteriness, tingling or numbness body sensations. For some people, anxiety may present as excessive worrying thoughts or racing thoughts, a sense of dread, irritability, a constant sense of apprehension, changes in appetite or sleep patterns. For others, anxiety can be any mix of these symptoms.*

*It is important to talk with your doctor if you are experiencing these symptoms to rule out other possible diagnoses. 

Why do I feel this way now? 

This is a stressful time full of uncertainty, fear, frustration, and for many, a complete deviation from his/her/their normally structured life. We are in the middle of a global pandemic and have had to make many adjustments to our lives – cancelling vacations, postponing family get-togethers, facing new work environments or losing a job entirely, wearing masks to the grocery store, missing social interactions with friends, and worrying about loved ones to name a few. A lot of these adjustments are out of our control, and loss of control is an unsettling feeling in it of itself. You’re experiencing anxiety because these are anxiety-ridden times. It’s OK. 

What can I do about it?

Let’s talk about that. The bad news? There is no magic expecto patronum to ward off COVID-19 and change our current circumstances overnight (yet! And for all you muggles out there, that is a Harry Potter reference). The good news? There are things that we can do to try to address and minimize anxiety.

  • Get enough quality sleep. Easier said than done, right? See my other article on Sleep Hygiene for an in-depth look into natural ways to improve sleep. 
  • Limit anxiety boosting foods/drinks. A good place to start would be limiting foods with high sugar content and limiting alcohol, caffeine, and nicotine intake. Alcohol, caffeine, and nicotine may be comforting routines in the short term, but cause jitteriness and also actually interfere with getting true, restful sleep. High sugar content foods would be those with simple sugars, like soda drinks, candy, and desserts. Choose more complex carbohydrates when able – for example, whole grain bread instead of white bread, whole wheat or chickpea pasta instead of regular pasta, or whole grain cereal with nuts instead of a sugary frosted cereal. 
  • Set some attainable goals for the day. The trick here is NOT to make a never-ending to-do list – this can lead to increased pressure and stress. Try sticking with a handful of items that are realistic, attainable, and would give you a sense of relief to have completed. I recommend choosing at least one that would bring you some personal joy. That cookie recipe you’ve wanted to try for months? Home tie-dye project? Kickboxing workout video or walk around the block? The first chapter of a new book? A phone call to catch up with your best friend? Go for it!
  • Stay connected. Social distancing has become the phrase of the year, maybe the decade. At the very least, it’s a trending hashtag. But I kind of hate it. It implies that we need to throw socialization out the window, but so many of us rely on connection for a good quality of life. Get creative and use technology to your advantage. Try Facetime, Google Hangouts, Zoom, Webex etc to stay connected via video chats. Many platforms are user-friendly, even for the least tech-savvy person in your life. Try reading a book or watching a new TV show at the same time as a friend and discuss it along the way. Drive by a loved-ones house for some face-to-face time, abiding by CDC and/or state guidelines on staying at least 6 feet physically apart. #spatialdistancing anyone?
  • Mindfulness & Meditation: These practices can help you stay attuned to what is going on with your mind and body. Being mindful of how you are feeling (mindfulness based stress reduction) can help you intervene before anxiety takes control, and studies have shown that mindfulness helps to review generalized anxiety disorder and other anxiety conditions. Studies have also suggested that meditation practices help reduce cortisol levels, the “stress hormone” of the body. There are many guided mindfulness or meditation videos on YouTube, Headspace, and more. You can also try a guided recording by Dr. Ronald Siegel, who is an assistant clinical professor of psychology at Harvard Medical School- the recordings are free at www.mindfulness-solution.com.  
  • Exercise: Did you know that exercise has been shown to reduce anxiety and depression? Aim for 30 minutes of aerobic exercise. Your breathing/ HR goal should be the point where it is difficult (but not impossible) to have a conversation with someone while exercising. This is the difference between a leisurely stroll and an exercise walk. If you’re just starting out, even 10-15 minutes of exercise can help release feel-good endorphins in the brain. 

The Bottom Line: Anxiety can present in many different ways, anxiety is hard, and perhaps most importantly, anxiety does not discriminate. You can have a beautiful, instagram-perfect life and still experience anxiety, and it’s OK to need some help. Sometimes drastic situations like the COVID19 pandemic will worsen anxiety. You are not alone in this. 

*If you’ve tried a lot of these things without improvement, consider talking to a therapist or your primary care doctor for recommendations! http://psychologytoday.com can be a great resource for locating therapists in your area.

Hopefully you found this article helpful- be sure to leave any comments, questions, or personal experiences in the comment section.