COVID Transmissions for 2-23-2021
Practical advice day: pulse oximeters, cancer screenings and vaccines
Good morning and welcome to COVID Transmissions.
It has been 463 days since the first documented human case of COVID-19. 463 is an area code in US phone numbers covering Indianapolis.
A couple of very practical health updates today—on pulse oximeters and some advice for people getting the vaccines who also happen to have a mammogram coming up.
As usual, bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
FDA issues guidance on pulse oximeters & potential for misreading
The FDA issued new guidance today warning consumers that home pulse oximeters can be misled by things like nail polish, that can get in the way of their optical measurements. Annoyingly, these guidelines do not fully spell out what they mean by “skin pigmentation.” It means if you have dark skin—particularly if you are Black—you are at risk of getting misreadings on a pulse oximeter that can lead to missing a drop in oxygen saturation. This is something for readers of color to be aware of, and I think is an important message. I can’t (at least not on my own) correct the systemic bias that led to these devices not being calibrated properly for darker skin tones, but I can at least warn you about it.
That said, this FDA alert has some important things to be aware of if you’re using a pulse oximeter: https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication
Vaccination against COVID-19 and mammograms
I heard yesterday about some concerns regarding falsely-concerning mammogram signals following COVID-19 vaccination, and I want to walk everyone through this situation. This particular discussion most directly applies to people who have sufficient breast tissue to warrant their receiving regular mammogram screenings, but I want to point out that this is actually not such a gendered issue as you might think. Everyone is born with some breast tissue, regardless of the gender and sex determinations made at birth. Every human being has the potential to develop breast cancer, and so advice about mammograms applies to all of us. Yes, cisgender men can get breast cancer. Now, to the discussion:
First, let’s understand what’s happening. For your reference, in addition to training in virology, for several years I was a medical communications professional supporting the breast cancer treatment palbociclib (better known as IBRANCE), and am very familiar with the diagnosis and treatment of breast cancer.
One of the things that the care team is looking for in a mammogram is inflammation of the lymph nodes in the armpit on one side of the body. Under many circumstances this can be a sign of breast cancer, since it is a sign of localized inflammation in a region near the breast. Breast cancer with lymph node involvement is consider more advanced and higher-risk than breast cancer without lymph node involvement. The reason that lymph node swelling on one side is important to look for is that it is harder to confuse with something like getting over being sick, which might lead to lymph node swelling all over the body.
Coincidentally, vaccines can also cause lymph nodes in the armpit on one side of the body to become inflamed and swollen. This is a sign that the vaccine is eliciting an immune response, and generally a good thing!
Unfortunately, it can also complicate the results of a mammogram, particularly if the technologist performing the scan is not aware that the patient has recently received a vaccine that might cause lymph node inflammation. They might think there is lymph node involvement when there is none.
As a result, some national medical organizations have suggested that patients who are in the middle of a COVID-19 vaccine course should delay mammograms for some period of weeks after the administration of the full course. You can read the advice of the Society for Breast Imaging on this topic here (please note that they use gendered terms in their recommendations, but like we covered at the top of this piece, everyone is born with some breast tissue): https://www.curetoday.com/view/national-organization-recommends-women-delay-mammogram-screening-following-covid-19-vaccine
Take notice of the fact that the society only suggests that you may wish to delay screening mammograms—these are mammograms conducted as part of a well visit and intended to catch very early breast cancer before it becomes advanced and more serious. They still advise that mammograms conducted for any type of symptomatic disease—including finding a lump, or noticing pain and other unusual manifestations in the breast—should occur without delay. This is a very important point. They recommend, however, that practitioners should consider asking their patients if they have recently received the COVID-19 vaccine when such a mammogram is being administered, so that the scan can be better interpreted.
However, even the advice to delay screening mammograms is somewhat controversial. For example, this article ( https://newsnetwork.mayoclinic.org/discussion/screening-mammograms-and-covid-19-vaccine/ ) from the Mayo Clinic suggests instead that patients should not delay any mammogram for any reason, but should notify the provider, particularly the technologist, if they’ve been recently vaccinated, so that they can account for this in interpreting the results.
Now, look, I’m not an oncologist and I’m not even a physician. I know about breast cancer and I know about viruses, but I am not the right person to tell you what to do in this situation. That person is your healthcare provider, particularly the one who you see for a screening mammogram. Your best bet if you have a screening mammogram coming up within a 4-6 weeks after you receive either dose of a COVID-19 vaccine is to discuss it with that provider and see what they have to say about the scheduling of the screening mammogram.
If you have a mammogram scheduled for suspected breast cancer, you should also discuss your vaccination schedule with your provider. They will be able to guide you.
One thing I will say is this, though: I don’t think this is a reason to delay getting the vaccine. Have the conversation with your provider about how to approach the mammogram, but the reality is, COVID-19 is a leading cause of death for Americans right now, and if you have the opportunity to get the vaccine on the advice of your doctor, get it.
What am I doing to cope with the pandemic? This:
Cooking skills for stir frying
Something I like about my efforts to perfect the stir-fry is how complex this style of cooking is and how many skills it requires. Most European styles of cooking are relatively simple and you can generate something that tastes good even if you have inconsistent knife skills or suboptimal cooking times for seasonings and ingredients. It won’t be haute cuisine, but you’ll get a meal that you’ll like most of the time.
Stir-frying at high temperatures isn’t so forgiving, so it has forced me to try and revisit my skills with knives and my general plan of attack for cooking. I’ve become more of an adherent to the mise en place approach to cooking since I’ve been doing this, which really I should have been doing all along.
Mise en place— “everything in its place,” or perhaps “setting up,” or “getting your crap together,” is an approach to cooking where you set up everything you need for your dish right at the beginning before any cooking starts. Generally it is a multistep process, starting with developing a recipe plan (or reading a recipe), getting your equipment together and your workspace prepared, arranging containers for your ingredients, and preparing your ingredients for cooking (eg, knife cuts, measuring, etc).
The approach can use…a lot…of containers, but I think it’s worth it because you have a better output. The advantage is that you’ve set yourself up to succeed. It’s easy to underestimate how long it will take to prepare the next ingredient when you already have one cooking. By the time your garlic is minced, your onions may be burned. Down that path lies madness and loss unless you have made a recipe a million times and know how fast you can make everything.
The mise en place approach avoids that, which is why it’s the favored method of many chefs and is ever more popular for home cooks as well. It yields consistency because you can be paying attention to your ingredients the whole time they cook.
Another thing that yields consistency is improvement of knife skills, so that you cut everything the same size. The same size means each piece cooks in the same amount of time, which is really critical for a high-temperature stir fry. That’s something I learned in college from a cooking basics class that Caltech offered, but it’s something that the mise en place approach has helped me focus more on and continue to improve.
Both of these ideas, taken together, are what you see in the photo at the top of this section today. A neatly-prepared display of ingredients, cut to very similar sizes, and ready to go into a hot wok at just the right time for them to cook properly.
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Always,
JS