August 14th

8/14
Warm Summer Greetings!

I have a treat in store for you today!

AN IMPORTANT MESSAGE ABOUT MASKS

I have a few things to tell you about masks. They are an important tool, but if used without discrimination one can experience harm!  This is a fact that is under-represented out there but is my main message for today.

Read on and I will tell you FIVE essential facts about masks that will make you more in the know that anyone confined to what the Mainstream Media seems to be able to convey. It’s crucial to get it right because the MASK MANDATE is definitely here.

Eat your Porridge

Today we are seeking something we could call the “just right.”
Goldilocks was one of our first teachers of this. No extremes for that little girl:

  • not too hot, not too cold-
  • not too hard, not too soft,
  • not too big, not too small- – but just right.

Whatchu looking at, Bear?

The Middle Path

Harmony and health are born out of the middle. It is more difficult to avoid living with an extreme position or a reactionary one, but there is a richness when one learns to move about freely in the middle zone.

The two extremes create a vacuum between them where something entirely new can come in to being. This is a noble task for each of us- to occupy this middle place.  There is a whole schooling in Mindfulness which points in this direction. Attention and precision certainly are key.

The clinician knows about the middle path. Medication dosages need to be just enough to be effective but not too high as to have untoward effects. The dosing has to be right on the point. Someone else’s way is not necessarily yours. Yesterday’s answer is not necessarily today’s.

In diagnostics, the same principle holds true. There are errors at either extreme. There is the error of inaction on one side and of over-instrumentation, needless intervention on the other side. A path in the middle which is neither too conservative nor too aggressive comes into view and invites the patient and clinician to explore it. Trust between a doctor and patient is indispensable for proper navigation. Trust comes from relationship!
Icarus

My favorite Greek myth is the tale of how Daedalus and his son Icarus set out to escape from the labyrinth that Daedalus had been forced to build and that then became his prison.

The maze was alive and would shift, so there was no simple formula to escape.  The walls were high and Daedalus knew his only chance for freedom was to go over them. He built wings which were held together with wax. His famous instructions to his son were to seek safe passage through the middle zone.

If they flew too high the sun would melt the wax in the wings and the wings would fail. Flying too low and too close to the water the wings could get wet and heavy and their weight would carry them into the ocean. The tragedy of Icarus was not being able to hold the middle. We all have Daedalus’ wings. We all access freedom and our highest goals through finding the delicate balance of the middle.

When errors happen, learn to examine them thoroughly and kindly. They are our greatest teachers.

 

 

Bringing it home

With the PANDEMIC we have a rock and a hard place. It’s easy to have the middle squeezed out!

  • Horrible outcome from isolation and shutdown on one side.
  • Terrible losses from massive amounts of illness on the other.

The middle is there. You can see it, right?
Persevering and going forward with the right amount of sensible planning and preparation and just enough caution.

I’m writing to tell you that masks need a middle ground as well.

New Englanders generally don’t underuse masks. We seem to know that indoors and in crowds where physical distancing isn’t possible that masks make sense. We have more of a tendency to make the mistake of not recognizing the risks of masks.
What I am saying is there are two tiers to protective interventions. The first tier of interventions to greatly limit the risks of contact with others is:

  • physical distancing
  • inhabiting well ventilated spaces or staying outdoors
  • hand-washing with soap and water

These are low risk. Ok, zero risk. Use these indiscriminantly, early and often.

Masks provide additional protection when these first tier aren’t possible. They are an important part of our COVID response but because of their risks I put them in a second tier category (along with alcohol based hand sanitizers, as discussed in a previous bulletin).

When distance can be maintained outdoors please consider breathing freely. It’s important.

Masks are PPE which DO interfere with normal air exchange. They traditionally required training to understand proper use, risks and limitations. Why? Because they can cause illness in the workplace when used! Not in everyone, but in some for sure. This is getting no air time in our national discussion.

Here are my 5 points to consider:

First, realize the correct time for a mask is when you are in a poorly ventilated area, where physical distance cannot be maintained. If possible don’t spend a lot of time in these types of settings, no matter who you are.

Second, realize that when in well-ventilated areas and not around other people you shouldn’t wear a mask. Don’t exercise with a mask on. I’ve heard that occupational safety and health consultants limit mask use to 5 hours in a day and take extra precautions when the temperature is hot. Implement these ideas.

Third, certain medical conditions would raise a flag in the workplace and require extra fit testing to determine safe and healthy mask usage (anxiety disorders, pregnancy, PTSD, cardiopulmonary disorders, kidney disorders, cancer history, stroke history). If you are one of these people, limit your time in settings where you will need a mask. Don’t wear them in settings where you don’t need them. Mask exemption requests will make sense in some scenarios. Rely on your top tier interventions!

Fourth, know the symptoms that an come from mask use, the possible side effects. Headaches, lightheadedness, nausea and fatigue are possibly from wearing your masks and should be watched for with vigilance. Take mask breaks by going to sparsely populated, well ventilated areas and removing your mask!

Fifth, surgical masks optimally shouldn’t be used over and over. They filter the particles in the environment and hold on to them. Cloth masks should be boiled in hot water to clean them.  Avoid the perfumes in fabric softeners, for example.  It’s not good to breath that in.


 

Parting thought

If you see someone in an aisle not wearing a mask, maybe they have a medical indication to not wear one. Stay cool. No judgment. Give them some distance. All will be ok.

And if you’re outside and it’s not crowded and people are around without masks: join them. They are seeking the middle, like we all should!

Be safe, Be judicious, Keep striving!

Dr Cooney and staff