The downside of Zooming

Like most everyone else, I’ve participated in a few Zoom meetings, mostly with college alumni—just 20 or so of us. We took turns talking. When it was my turn, I had the sense that people were bored. The feedback (such as it was) from their expressions wasn’t encouraging. I sort of rushed through my statements. Later, I learned that the onlookers weren’t bored. It turns out that Zoom meetings make many people feel anxious and disconnected.

Because of the way video images are digitally created, they introduce all kinds of artifacts, such as blocking, freezing, blurring, jerkiness, and out-of-sync audio. While some of these disruptions might be below our conscious awareness, they confound our perception and scramble subtle social cues. Our brains strain to make sense of the disorder, which makes us feel vaguely disturbed. This is because we’re exquisitely sensitive to one another’s facial expressions, which are an intricate array of minute muscle contractions, especially around the eyes and mouth. Even though such expressions may be subconsciously perceived, they’re essential to our understanding of one another. But on pixelated video, those subtle twitches all but disappear. Or they’re frozen, smoothed over, or delayed to preserve bandwidth.

 Not only does Zoom mess with our perception, it also messes up our ability to mirror—our unconscious imitation of another person’s nonverbal signals. When the mirror neurons in our brains are activated, we have a greater connection and understanding of another person. To recognize emotion, we have to actually embody it, which makes mirroring essential to empathy and connection.

Video chats have also been shown to inhibit trust because we can’t look one another in the eye. Depending on the situation, viewers might perceive another person as uninterested (as in my situation), or shifty, haughty, servile or guilty. (Criminal justice activists have questioned the fairness of remote depositions, hearings, and trials.)

I don’t think I’d like a steady diet of Zoom meetings, but I did enjoy seeing my fellow 83-year-olds.

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The new normal temperature

In early April, during the lockdown period, my husband and I both had occasion to have our temperatures taken—he, for a dental procedure, and me for a wee Mohs surgery to remove a basal cell cancer from my upper lip. Our temperatures were both 97-point-something. Apparently, that’s the new normal. (I assume you recall that normal used to be 98.6.)

The 98.6 number dates to 1851 when a German physician began taking millions of temperatures from 25,000 patients in Leipzig. That standard has persisted, even though numerous more recent studies have put the average closer to 97.88 or lower.

Most scientists agree that the reason for this change is an improvement in living standards since 1851. That is, because of improved sanitation and medical care, we’re not all running around with chronic diseases such as tuberculosis, syphilis, and periodontitis—conditions that would cause our immune systems to be constantly fighting infections and thus raise our temperatures.

Body temperature varies both among people and within people. Older people tend to be cooler than younger people, and women tend to be slightly warmer than men. Temperature also fluctuates with the sleep-wake cycle (I often wake up around 2:00 in the morning feeling too hot).

Because of this coronavirus business, people are having temperatures checked more often. Supposedly, you should check yours from time to time—noting the points at which it rises and falls—so you know what’s normal for you. I’m not going to do it myself. Seems like too much trouble, especially with our old-fashioned glass thermometer.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Taking components of drugs instead of their combined form to save money

I read in the New England Journal of Medicine about an uninsured woman with very high blood pressure who came into an emergency room to get a prescription refill for her blood pressure medication (Hyzaar DS). This drug is a combination of two drugs. A month’s supply costs $90—or $1,080 a year out of pocket. Rather than refilling her prescription for Hyzaar, the doctor gave her prescriptions for its ingredients, bringing her monthly cost down to $6.

Taking the drugs separately is just as effective as taking the combined medication. Supposedly doctors prescribe combined drugs (usually two or three different ingredients) to make it easier on patients. They can take one pill instead of multiples.  Here are some examples of savings you get from switching from combination drugs to taking the components separately:

• Caduet, a combination blood pressure and cholesterol pill, costs $686. Taking their components as separate generic medications costs about $182.
• Duexis is a combination of ibuprofen and famotidine (an antacid and antihistamine) used for treating rheumatoid arthritis and osteoarthritis and to decrease the risk of developing upper gastrointestinal ulcers. As a combined drug, the cost is $977, but the generic components are $30.
• Lotrel, a blood pressure medication, costs $415 as a combination drug but $75 for the components.
• Actoplus Met, a type 2 diabetes drug, costs $288 as a combination drug, but $11 if taken as its two components.

If you’re taking combination drugs, check out the ingredients! I’m sure you could handle taking an extra pill if it’s saving you, say, $600 a month!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Going crazy—or not

I recently read about a woman with anxiety, depression, and panic disorder who says she’s been doing pretty well since the virus lockdown started. “To some degree I feel like I’m conditioned for this, based on things I’ve experienced in the past,” she says. Although many people have found themselves struggling to cope, and many—if not most—people with depression and anxiety have seen their symptoms worsen, some people with those conditions have felt their symptoms alleviate.

One person whose symptoms have alleviated reports, “…when I wake up, I don’t feel as sluggish as I normally do. I find it easier to get out of bed. The intrusive thoughts that normally buzz around my brain like flies on a feeding frenzy have disappeared. …My mood has stabilized after years of oscillating between paralyzing anxiety and debilitating, at times suicidal, depression. Despite everything, I realize, I am OK. More OK than I have been in years.”

Psychologists and psychiatrists offer possible reasons that a person with a history of depression and anxiety might find some relief at a time like this. One possibility is that a big part of anxiety is the worry about something bad that will inevitably happen. Now that the terrible thing has happened, he or she is not in the anticipating state.

Another possibility is that those with depression and anxiety might normally separate themselves from their immediate situations—a mental process called dissociation—by distracting themselves by, for example, endlessly scrolling through Instagram. Disassociating isn’t generally such a great thing because you miss a lot in your life. Right now, however, if you’re great at dissociating, you’ve got a way to deal with scary feelings.

Finally, it may be that people with depression and anxiety are now seeing that everyone else is having a taste of what the sufferers’ inner world has been like. It can be kind of validating to see others actively struggling with loneliness and isolation. What’s more, seeing your inner state mirrored by the outside world helps to shut down self-critical thought patterns.

I guess this comes under the "thank goodness for small favors" category.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Maybe a pulse oximeter is right for you

I got the following information from a NY Times op-ed piece written by a physician who has been practicing emergency medicine for 30 years and who teaches airway procedure courses worldwide.

While working at Bellevue recently, he found that almost all the ER patients had Covid pneumonia—even those who had no respiratory complaints. Many patients reported no sensation of breathing problems even though their chest X-rays showed pneumonia and their oxygen was below normal. It turns out that Covid pneumonia initially appears to cause a form of “silent hypoxia.” (Hypoxia is a deficiency in the amount of oxygen reaching tissues.) The coronavirus attacks lung cells that make surfactant, a substance that helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. (Detergent is a surfactant. As my high school chemistry teacher told us, it makes water wetter by breaking surface tension.)

Even though their oxygen levels have fallen, patients don’t feel short of breath. That’s because they compensate for the low oxygen in their blood by breathing faster and deeper, but without realizing they’re doing it (the “silent’ in silent hypoxia). Their lungs are not yet stiff or heavy with fluid and they can expel carbon dioxide. Without ta buildup of carbon dioxide, patients don’t feel short of breath. Normal oxygen saturation at sea level is 94 to 100 percent; that of Covid patients seen by the writer were an alarming 50 percent. By the time they have noticeable trouble breathing and dangerously low oxygen levels, many require a ventilator.

 The writer believes a pulse oximeter could provide an early warning of silent hypoxia. Pulse oximeter are those devices you see on patients’ fingers. You can buy them at the pharmacy or elsewhere for around $30.00. But don’t go off half-cocked with this. The devices are not 100 percent accurate; you might misinterpret the readout; some people might have unrecognized chronic lung problems, and so forth. But if you’re feeling ill and wonder if you might have the virus, it might be worth checking into.

Note that Trump did not suggest this. Not by the time of this writing, anyway. If nothing else, you can use the device to play doctor.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.