Newsletter #65 minute read

Steven Kornweiss, MD covid-19, exercise, mental health, newsletter Leave a Comment

In this issue:

Read time: 6 Minutes




New Article: Stress Management: Strategies And Tactics


I wrote a new article about stress management which is now posted on my website.

In the article, I identify three specific levels of stress: acute stress/panic, anxiety, and disappointment. The article includes a discussion of the nature and source of each type of stress. It also contains examples, pertinent stories and excerpts from amazing books and podcasts, and specific stress management techniques.

The article is meant to address the sort of stress that can affect anyone, especially people who are highly motivated and productive. I’m sharing these ideas with you because they’ve been helpful to me and to the people I care for.

The article is a 15 minute read.

Click here to read it.



Here are a few excerpts from the article:

On acute stress / panic:

“Panic, or acute stress, is a cognitive and psychological state in which our entire mental content is occupied by an emotional response. It is a state in which no thinking can take place. Instead of clear, linear, rational thinking, our minds flash from one fragment of an idea to another. We can’t grab onto any one of these ideas because we are overwhelmed. This state of stress is so mentally disorienting, that it is common to have physical symptoms along with it: a feeling of being in a fog, heart palpitations, dizziness, or even nausea, shaking, and sweating. The essential emotion that underlies such an episode is fear. Our bodies respond physiologically to fear by increasing the tone of the sympathetic nervous system.”

On anxiety, confusion, mental-overload:

“When we have many goals, we end up with many ideas and tasks. Eventually, these tasks lead to a state of mental overload, and it becomes unclear what should be done next. We may try to do more than one thing at a time. When we try to think about and do many things at once, we end up feeling scattered and overloaded.

If this state of overload continues, eventually we will forget something important. This mistake reinforces our fear and causes a further feeling of anxiety.”

On disappointment:

“Even the calmest, most focused, people can still suffer from yet another more insidious type of stress: disappointment. Disappointment is the state or feeling of being depressed or discouraged by the failure of one’s hopes or expectations. Unfortunately, many people who appear remarkably successful fail to experience a feeling of success.”


Does any of this sound familiar? I share strategies and tactics that I’ve learned from really smart people to help combat these types of stress.

Click here to read the full article.




Covid-19 Update: Are new variants more deadly or vaccine resistant?



Several days ago, CNBC published an article with the title, “New Covid strains ‘may even escape the immune response,’ says Biden Covid advisor.”

Within the body of the article, CNBC gives a bit more context:

“They’re more virulent, can cause more death, and some of them may even escape the immune response, whether it’s natural or from the vaccine,” said Dr. Celine Gounder. “So it’s really important right now that we do everything possible to preserve the vaccines to make sure they keep working and that means preventing the spread of these new variants.”

I believe these comments are overstatements based on my review of publicly available evidence.


Here is a 6 Bullet summary of what’s known about these new variants:

  • There are three major variants of concern being tracked by the CDC
  • These three variants are: B.1.1.7, B.1.351, and P.1
  • All three have been reported within the United States
  • Of the many variants, these three are being tracked because of concern that they may be more transmissible, cause a higher rate of death in those infected, or both.
  • An in depth analysis conducted by Horby et al. concluded, “There is a realistic possibility that VOC B.1.1.7 is associated with an increased risk of death compared to non-VOC viruses.” Having read the entire report, I want to emphasize the clause “realistic possibility.” My read of these data is that they are speculative and suggestive at best. The CDC concluded, “this variant may be associated with an increased risk of death compared to other variant viruses, but more studies are needed to confirm this finding.”
  • An excellent article on the issue of potential vaccine resistant variants reported that patients vaccinated with two doses of the Pfizer-BioNTech vaccine were able to neutralize the B.1.1.7 variant.

My Conclusions:

  • My conviction of the safety and efficacy of the mRNA vaccines has increased, especially in light of emerging data about variants of SARS-CoV-2.
  • The current information about these variants is not conclusive that they’ll increase infection rates or mortality, especially in vaccine recipients.

For more in depth analysis and discussion of Covid variants, I suggest following Trevor Bedford on Twitter.

Bonus news: J&J filed with the FDA for an emergency use authorization for their vaccine, which is an adenovirus vector vaccine.




Update to My Exercise Routine



I’ve updated my exercise routine. I’m now doing these two things on a regular basis:

  • Protocoled aerobic training
  • Resistance training (weight lifting)

Up until several months ago, I was lifting weights and running regularly, but without any specific protocol or tracking, I couldn’t tell to what extent I was improving. Now, I’m training to improve my aerobic fitness by walking at a fixed pace on an inclined treadmill for 45–60 minutes 3–5 times per week. I wear a 20 lbs weight vest. At the end of the exercise, I measure my blood lactate level with this device. My goal is to hit roughly 2 mmol/L without going over. This measurement is a proxy for measuring the workload at which you begin to metabolize glucose via the anaerobic pathway. The more work you can do under this threshold, the greater your endurance, the more flexible your metabolism, and the higher your output at all levels.

The way to improve this ability is to train right up against the threshold. After 3 workouts, I was able to increase my speed from 3.2 mph to 3.4 mph and the incline from 10% to 11% while maintaining the same blood lactate level. Then, during week two, I was able to run an 11 minute mile pace for an hour with my lactate still below 2. I actually felt good. I know this is not a fast pace for a runner, but I am historically a very bad runner and would have been in distress at that pace in the past.

This way of training might sound boring, but it’s really exciting to be able to measure the progress so easily. If you’re sane, and therefore don’t have a lactate meter, you can approximate this type of training by maintaining a pace that is conversational, but just barely. You don’t need a weight vest, and you can adjust your speed and incline for your own needs. You should be slightly uncomfortable the whole time, but never so much that you need to stop early.

Another great thing about this kind of workout is that it doesn’t leave you sore, stiff, or exhausted. You can do it almost every day without extended periods of recovery, and you can hop off the treadmill or exercise bike at the end, and sit down to read, write, or talk on the phone without feeling completely exhausted.

I’m also lifting weights 3–5 times per week using the Wendler protocol for squat and deadlift, and I’m doing a lot of workouts designed by Jeff Cavalier. I love his Youtube channel.

Disclaimer
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