in this issue

 Conundrum: noun/ a confusing and difficult problem or question. Autonomy or Mr. Rogers "You've Got to Do It". 

A long 2 years ago,  few of us could have imagined what has transpired in 2020 and 2021.  First, a year, 2020, of being responsible "social distancing, masks, lockdowns, surface cleaning, hand washing, contact tracing". Followed by a year of hope/freedom/normalcy, 2021,  "vaccinations/booster for many, herd immunity? for some, my Faith/Luck/Trump will protect me for the rest" and it's somehow over.   Well, It's not.  We have a Conundrum.  Two camps, You need Vaccination/Boosters and Please Leave me Alone, AUTONOMY.   Autonomy, to remind you is at the core of all medical ethical decisions in the United States. "Autonomy" or "Self Determination"  means that patients have the right and ability to make their own decisions about the medical care and treatment they receive, as long as those decisions are within the boundary of the law. All health professionals respect this fundamental right each of us has.  For much of our recent history, we have evolved some medical treatment/prevention strategies for many devastating illnesses and most of the population has surrendered to certain restrictions/procedures/vaccinations to solve these scourges.  Witness: Polio and Smallpox are the good examples of how this Conundrum was resolved in favor of "You've Got to Do It" and these two diseases which killed and maimed millions are for the most part "history".   And most, not all, are comfortable with current requirements for Vaccination for Measles, Diphtheria, Pertusis, Tetanus, Hepatitis, Chickenpox, Human Papillomavirus (HPV), Meningitis, Shingles, Pneumococcal Pneumonia and Yearly Flu. As of 23 Dec only 61% of the USA Population has been fully vaccinated against the Covid. Note the Johns Hopkins COVID Tracking Database Comparison between last Christmas and now.  So here we are, still dealing with a virus that is doing its best to kill us and/or drive us broke or crazy and 39% of our population remains very vulnerable to catch and maybe die of this virus.  "Unfortunately", the current vaccination (Pfizer, Moderna, J&J, Astro Zenica) protocols have not created the long lasting immunity that we had hoped for and there have been some acute adverse reactions that continue to make headlines, so I understand the hesitancy.  But, overall, I think those that are vaccinated are better off for the protection that they have received.  There is no question that they are effective and reduce the severity of infection, hospitalizations and death. They are not totally effective in preventing Breakthrough cases and boosters are recommended for almost everyone 6 months after their initial vaccination.  Most of the increasing cases over the course of this year have been in unvaccinated people and easing of restrictions on travel, events and schools plus new more contagious variants Delta and Omicron have helped perpetuate this pandemic.  See CDC Data.  I do believe that vaccination is still the key to making this problem manageable and newer and probably more effective, safer vaccines may be approved in the next year. Our own experience at Inside Outside over the past 6 months is as follows: Botox & DXA 793 Unique visits, only 20% not vaccinated. This is about 20% better than national figures. THANKS!  We continue to see unvaccinated clients but do not do any open face procedures and wear N95 Masks and Face Shields when dealing with unvaccinated clients. As everyone is aware, there may be more restrictions on the unvaccinated, witness the Military and Federal Employee requirements for vaccination.  Venues in NYC are requiring vaccination and more restrictions

 (?travel) may be on the way. Our medical, social/mental welfare and educational resources are under tremendous stress. Today, the Drudge Headline is hinting at a "Soft Lockdown".  I'm siding with Mr. Rogers, "You've Got to Do It"!   Individually, each of us is a part of the solution to this conundrum, we must do our part and most of us have made many sacrifices to help, but some have not and that's NOT GOOD, and may eventually be against the law.  The crisis in 2020, as today, was shared eloquently by Dr. Craig Smith, Chief of Surgery at Columbia New York Presbyterian, one of the first "hospital hotspots" in the United States in March 2020.  He is one of the Pandemic Poets.  Please re-read his letter of 20 Mar 20 in which he describes the dire situation at his hospital. This was the 3rd week of the crisis in the USA in 2020.  By now, none of us should have a problem understanding what he is writing about.  And a everlasting lesson, we continue to learn "What Men Live By" over again and the Alberta Quadruplets showing us what to do when it is over and Mr. Rogers singing "You've Got to Do It", Nike "Just Do It" and Gary Gilmore's Final words "Let's Do It".  Yes, We Must Mush on....  

Mr. Rogers "You've Got to Do It!" 

Dr. Craig Smith, 20 Mar 20 "We Mush On"

Institute for Health Metrics COVID-19 Projections

Mr. Rogers, "How he would handle dealing with the Coronovirus Quarantine"  

2023 was a year Dr. Christan and the UTSA Interns focused on The "Air Quality Intex"!

Dr. Christian was asked by Dr. Susan Blackwood (long time friend and Inside Outside Client) and Founder of the Global Pain Association to present a Webinar for the Saturday Edition of GPALive on 5 Jun 21. It was a timely opportunity to inform those who suffer from Chronic Pain about the contribution that ongoing low grade Inflammation adds to their symptoms.  Global Pain Association is a Non-Profit dedicated to exploration of non opioid methods of pain control for those that suffer from Chronic Pain. The deleterious impact that Opioids have had on the management of Chronic Pain is well recognized and almost everyone knows someone personally someone who has died of an opioid overdose. Recently legal decisions have highlighted the responsibility that makers and distributors of opioids have had in propagating this serious public health problem. The presentation focused on the definition of chronic inflammation, how it contributes to chronic pain, how we can measure it and what measures we can take with diet, skin care and Omega-3 (See Dec 2020 Newsletter for More Details about Omega-3) to create less inflammation in our bodies. Unfortunately, one of the most important risk factors for the development of chronic pain are "Adverse Childhood Experiences" (ACE). See ACES Too High.

ACES are well defined and there are 3 categories. Abuse, Neglect and Household Dysfunction.  It is shocking to recognize that we now have 80% more people in refugee camps, war zones or in migration than 10 years ago.  Many of them are children, suffering ACES every day.  Our Surgeon General Dr. Vivek Murthy has issued an Advisory pointing out the Mental Health Crisis that will be a consequence of the COVID-19.  This Pandemic, added to the "routine" issues of war, famine and persecution do not bode well for the mental and physical health of a whole generation of our children. 

Read This, if nothing else! Great Article (Inflammation) Harvard Magazine "Raw & Red Hot"

Global Pain Association Website!

Dr. Christian, Webinar for Global Pain Association

Dr. Christian, PowerPoint Presentation "Inflammation and Chronic Pain"

Dr. Vivek Murthy, Surgeon General,  Advisory on Youth Mental Health Crisis

"ACES Too High" Website.