Preventative Care: Advice from an E.R. Physician

From the Midstory studio, our team chats with ER physician and a practitioner of integrative medicine, Dr. Jen Pfleghaar about the situation in the hospital and ER. integrative medicine and staying healthy during this pandemic.

Browse by topic or read the transcript of our interview below.

Topics covered:
[1:11] The pandemic’s impacts in the hospital and ER
[3:19] Personal protective equipment during COVID-19 pandemic
[5:50] Protocol for taking care of COVID-19 patients and medical staff
[8:05] Medical staff response to the virus, telemedicine and mental health during the pandemic
[10:04] Social media as a tool to inform about COVID-19 and integrative medicine.
[11:58] Comorbidity factors and vulnerable populations
[15:25] Healthy lifestyle choices to boost immune system function
[17:51] The normal day routine working in the medical frontlines 
[22:34] Living well and showing care to others during this time of pandemic

Jen Pfleghaar: I think that wearing a mask is almost an act of love for those who can’t or for those who are immunocompromised. When I am not working in the ER and I’m out where I’m going to be in close proximity or I’m going to talk, I wear a N95 because I do not want any of my particles getting to them. But, just if you can and you’re able to wear masks, it’s not about, we’re not getting into politics here, we’re literally showing an act of love. And people get very heated about this and it’s not a big deal. We don’t know enough about this virus, but we do know that it’s weird because you’re healthy for so long and you’re asymptomatic that your viral loads are high. 

Ruth Chang: Thank you for joining me for today’s episode of the Midpoint. I have the pleasure to speak with Dr. Jennifer Pfleghaar, who works as an ER doctor and also runs her own integrative medicine practice. She is here to share what she sees from diverse sides of human health, from the emergency cases in the ER to the importance of [the] immune system and daily nutrition. Hi, Dr. Pfleghaar, thank you for joining me for this episode of the Midpoint. 

JP: Hi! Thanks for having me, I’m really excited. 

RC: Awesome, we’re glad to have you. So, we know that you’re a very busy person. You are an ER doctor and you also run an integrative medicine practice on the side. It’s really interesting to see that combination in terms of the crisis these days. I’m really interested to know, what is happening in terms of the ER and in the hospital? What has the situation in the hospital over the last couple of weeks been like? 

JP: Well, it’s definitely been a roller coaster. Toledo in general has not been a hot spot like New York, let’s say. So you hear the frontlines there because we all talk, colleagues try to help each other, especially in the ER, we always do that. You’re hearing from the frontlines in New York City and first we heard from Seattle, long time, you know like how to treat these patients, what to do. This is something that we’ve never seen from a respiratory standpoint before. It just doesn’t behave like usual viruses, so it’s been kind of interesting. We kind of all ramped up, everyone was studying the papers, making sure we were prepared to treat our patients the best, and then we just waited. And while we were waiting, the ERs were actually not busy. It was like the calm before the storm. A lot of my friends and colleagues have experienced this, and I think it’s been hard on physicians and providers because the volume has gone down a lot. Actually, you know shifts have been cut back in the areas that aren’t a hot spot. So, it’s been very interesting. We’re all prepared for a surge, but if it comes … But, at the same time this is awesome because it means we were all mitigating so well to flatten the curve. I don’t see it as a negative, I see it as a positive. But, it’s been kind of weird. We’re slowly starting to pick up again in the ER, but for the last couple of months it’s been odd because sometimes you’d be sitting there like, it’s so quiet here. 

RC: So there has been some preparation behind the scene? I think in terms of Ohio especially, we’ve kind of acted before some of the other states have in terms of mandating staying at home. In particular with the hospital, we’ve seen some in other cities, like lack in PPE, protective gear, for our front-line workers, and so was that something that you guys had to kind of go through processes and obtaining that gear? 

JP: Yes. So, every hospital system has a different way of handling it. I’ve been really impressed where I work, we’ve always had PPE and I’ve always felt safe. But, we are more stringent about it, so we have like a little bag that we put our PPE in and use it for a couple shifts, especially the N95s. You’re not going to toss those. It’s crazy, where before if you had a patient that you were worried about tuberculosis, let’s say where you would need an N95, you would wear it in there, you’d just discard it. You wouldn’t even think about it. But now, we’re sanitizing masks and really saving it. The other thing, I don’t know if people know the N95 mask, you can actually fail a fit test. At my facility where I work, we wear, you get fit tested for that N95 mask. What that means is if there’s an air leak around it, then you have to wear the big PAPR (powered air-purifying respirator), the big hood. I failed my fit test for a regular N95, so if I’m going to do a high risk procedure, like an intubation, I put on my PAPRs. And that’s what that’s called, the PAPRs, with the big hood you’ll see. That’s for people who fail. There’s also like what painters wear, the actual gas mask. 

RC: With the valves?

JP: With the valves. I have that. I bring that with me to my ER shift because ER doctors, we have this mentality—we’re kind of like always prepared for everything because you never know what’s going to come in. So I bring that kind of an emergency kit with me to every ER shift just in case all the PAPRs were being used or something so we would all be protected. The other thing I bring from home, which is a good hack, is a poncho, a clear poncho. And when you’re intubating someone, you put that over them so it protects everyone in the room and I did use that once and it works really well. So I think I’m just so proud of the medical community. You know, nurses, physicians, respiratory therapists, everyone’s been so creative and amazing with all of this. 

RC: Yeah. So has there been, so you’ve had experience then with some people coming in with respiratory symptoms. What does the protocol say, someone comes in with a symptom? They’re coughing or sneezing, maybe it’s getting worse and not getting better. What is the protocol right now in the hospitals for that? 

JP: The thing about protocol throughout this whole covid-19 is that they can change every hour, every day. They’re always changing for the better. Where I work right now, we have a hot zone, which a possible covid complaint goes to. And then we have a separate area for say a kid falls and gets cut. So it’s just very impressive how we are working through everything. If someone does have complaints that we think they might be COVID-positive, we all gown up. We don our N95’s with our equipment. Everyone, also, if you’re considering COVID-19 as a diagnosis, there is a sheet and you write your name on it. Everyone in and out of the room, so it was an actual positive test, everyone would be notified. So it’s really about serving the patients and protecting our staff and the healthcare worker. I mean I’m very impressed with how Toledo, in general, is handling it. 

RC: I think that a lot of people still require more information about what the front-line workers are facing and how it’s not just about us as an individual but actually our part is really important in protecting others around us, right? 

JP: And the big thing is like I said it’s changing all the time, how many tests we have available and who we can test? So someone comes in, but their vital signs look good and they’re looking good. But they have this cough and they might be positive. We might not be able to test them. We might just say, “Right now, you’re safe to go home, but come back if anything changes.” So, I know that can be frustrating and I know we’re trying to get more tests, things are changing, so I think patients through all of this because it’s such a weird time is the best way to describe it. 

RC: Yeah, and there’s been a lot of in the news, talks about mutations and new symptoms showing up. So in some ways, you guys really have to be on the prepared end and kind of facing all of the emergency potentials, right? In some ways that’s the kind of spontaneous part of the job that is so difficult to prepare for. 

JP: Right, it’s a lot to keep up on. Especially, when all this was new, I mean I would spend hours at night just reading over all of the cases, all of the new journals. Just to make sure I knew what I was talking about and it was evidence-based, especially, not only all of my friends asked me questions, family. And I want to be prepared. I also went to some urgent care telemedicine when I wasn’t working in the ER and I would get… that was really hard to see because these people are at home and they are scared to go anywhere. And I had to send some of them to the ER because I’m like I’m worried about your breathing and that was the hardest thing for me, talking about it to you, is that what we don’t realize is people are really suffering at home because they’re scared to get help because they’re scared of getting the virus. So that was emotionally kind of hard for me to see. And the anxiety and depression going on. I spoke with a girl and she lived in an apartment by herself. And she was struggling with anxiety and depression, and it broke my heart because she lived alone in a city. I think that this is so complex. It’s not just physical, the mental implications of all of this I think it’s honestly being overlooked a little bit. I think we need to focus on mental health moving forward because of everything, our economy and the fear with all of this. 

RC: Right and in some ways you’ve turned pretty quickly to telemedicine and using information technology, using the internet to get some connection out there. And as you said, it’s not just physical, it’s as much emotional and a sense of support from a greater community. So you’ve been able to do that. Could you maybe talk a little bit about what you were able to do from your end besides your important job as an ER doctor? 

JP: Yeah, so my passion. I love ER, but I am so passionate about integrative medicine, so it’s an alternative medicine, evidence-based, more preventative. So I’ve been really turning to social media to help people, making informative videos on COVID-19, what’s going on, what are some different things you can do at home because I like to think of it as we’re kind of preparing for battle against this virus. So you want your best self, your best body to be ready to fight for it because honestly, I think we’re all going to be exposed to this eventually. And like you said and mentioned it that it does mutate. It’s similar to the flu that it’s a virus that mutates. It’s going to be different. It’s going to change; it already has mutated. So we’re going to see this; it’s not just going to disappear one day. So I think preparing what the focus should be on is knowing what you can do preventively to keep your body healthy. What are the right supplements? Let’s talk about that. It’s been a real big passion of mine to create social media, to create posts, to give out information because I don’t think everyone just wants to hear the negative news. I think the positive like what I can do proactively. I think that is reassuring, also. 

RC: Are there specific factors and conditions that make some people more vulnerable and some comorbidity factors that you’re seeing? 

JP: By far, hypertension and diabetes are the top two that we are really seeing when they look at morbidity and mortality for this. And then honestly, just today, a study came out from China and the correlation with obesity is huge. And the chart, the pie chart, your risk of adverse effect and outcomes was like this [draws an increasing slope in the air] with your BMI, your body mass index. What comes with obesity? Insulin-resistance, diabetes, blood pressure, so it makes sense to me. So when I study like that I’m like, “Okay. Come on, you guys. Let’s cook at home, let’s not get fast food. Let’s get healthy as a nation and our death toll is going up and up, but our weight as a country has been going up and up. And that goes with chemicals in our food and pesticides and toxins and instant gratification with food. And everything’s fast and you know, I do an 80/20 rule. We cook at home 80% of the time. We still have treats. You’re not depriving yourself, but for risk factors: obesity, diabetes, hypertension. And these are all chronic diseases and diseases of inflammation, so diseases that you just don’t get overnight. Some people are more genetically susceptible, but these are things that you can pay attention to to help yourself. And you know that’s the really sad thing is so many people that come into the emergency room they’re on diabetes medications, they’re on high blood pressure [medication]. I mean it’s rare to see someone just on an aspirin a day. I mean usually they’re the healthy ninety-year-old grandmother that just had chest pain and lives by herself. But the more medication, the more risk you’re going to be at for even just the regular flu, but you know SARS-[CoV]-]2 or COVID-19 is really hitting hard. Now, there are some cases of young people getting this being on a ventilator with no risk of having prolonged hospital stays, but I don’t want people to be scared by this and until we look at each one of those cases, who knows if they had an inflammatory process going on in their body? Who knows if their gut health was good or if they were taking over the counter Pepcid everyday for acid reflux. So when people are “healthy” or [have] “no comorbidities” I question that because we’re just not living optimally in the country. When it comes to it, when I do an integrative medicine intake, someone you know, they say I’m healthy, but we discover lots of underlying issues. If we live in fear about this, then that’s going to cause stress and inflammation and hurt your immune system. That’s not helpful either. I like to present facts, but not fear because that’s going to do more harm.

RC: You’re having both sides, both on the emergent medicine end and the long-term; what you can do to bolster your body and what you should do to live a truly healthy lifestyle. Those two actually come together. I think that’s something that I’m hearing from you is that there isn’t random. Actually, there are some things that you can do right now. I wonder if you, like what you advise? The patient’s that you’re seeing, besides just medicine, but there are some things that we do that do have a consequence in terms of our vulnerability to the virus.

JP: Other than the risk factors, drinking alcohol decreases your immune function.

RC: I feel like a lot of people are doing that right now to get over the depression. 

JP: I know. That is what hurts so bad as a physician because people are self-medicating. I hear the statistic alcohol sales have gone up 110% and it breaks my heart. I’ll have like one drink a week, maybe, or glass of wine or something, but even while I’m drinking I’m like, “Oh, my immune function’s going down.” But sugar decreases your immune system for a couple hours after intake. So for me, I’m kind of odd, but when I go into an ER shift, I usually work night shift, but I do my vitamin C, my zinc, my quercetin. I do my whole botanical regimen and then I fast while I’m at work. I don’t need any sugar, I just drink clean filtered water. You’ve got to be smart and you can seek out this information. This is why I try to teach people on social media, because I want that information to be out there for free and for them to be healthy. But yeah, things like alcohol and sugar, if you get sick or if you’re feeling sick, or you’re going into a high-risk situation like an ER shift or a gathering once stuff starts lifting up, just be smart. Just say I’m going to boost my immune system, just going to drink water. Just make smart choices. Those are some things, keeping that immune system strong, preparing it for battle. Kind of like when someone prepares for a 5K or marathon. You’re training. You’re not just going to go out there and run it. You’ll fail.

RC: We didn’t get to talk about this earlier, but I was just wondering, maybe you can run through like your day-to-day? What do you do to get prepared when you have to go to work at the hospital?

JP: When I’m getting ready to go in, I kind of have a weird routine. We all go to work in our scrubs, everyone’s kind of doing this, we talked about it as an ER group. And then we change before we come home. I have a bunch of garbage bags. I look like I’m carrying a grocery bag and I have my pumping because I’m breastfeeding. I have my pumping supply in there with the bag and then I have my little emergency kit in case there’s an intubation with my mask, with the poncho. I have this biocidin throat spray that if we intubate someone I spray my throat and then I offer it to the nurses just in case we get some viral load, it would kill it. It’s made from botanicals. Then I have an extra pair of glasses in there. So I have all that in my bag and then if it’s a day shift I’m going to pack food in a separate bag, and then I have a big thing of filtered water to really stay hydrated. What we all usually do is we’re wearing masks the whole time, but then you can just take it off, chug your water, and then you put it back on.Then after the shift, I’m going to change out of my scrubs at the hospital, put on other clothes and then go home. Outside of my house I take off my shoes and I leave them outside. Then I go straight to the laundry and I take off all my work clothes. I always have a separate laundry basket for my work clothes anyway because there’s MRSA, it’s gross. So, I put them in the hamper and then I go to my shower and I wash my whole body and I wash my hair, and then I go to bed if it’s a night shift and I nurse the baby. I wash my hair unless I have a cap on. Sometimes I’ll wear one of those surgical caps, and then I won’t have to wash my hair. A lot of those people are working full-time, because right now I’m just part-time in the ER, the women have been…their hair is a mess because they’re washing it so much. That’s another thing you don’t see. And then if you’re wearing the mask for 12 hours straight and you don’t get a break to take it off, you’re getting the welts there. There’s a lot of things that are just different. In addition, I really make sure I’m taking vitamin C right before going in. I also take quercetin, which is a Botanical, it helps zinc get into the cells to fight viruses, the biflavonoids I take. I’m usually really on key with my supplements, but I take a little bit extra zinc and vitamin C for me before going into work. And then you come home and make sure you get sleep. You make sure you try not to be stressed at work, because that’s bad for your immune system. 

It’s been a little humbling the whole experience, because you go into work and patients are like, thank you for your service, or thanks for what you’re doing. I’ve done this as long as I can remember in the ER. I’ve always wanted to serve and help people and help patients. I personally think it’s hard for me to take that in sometimes. I’m the person … I always if I have a patient that has a Vietnam hat on or something, I always say thank you for your service and we talk about the war a little bit. It’s a little hard for me sometimes to be called a frontline hero, honestly, because when I took my oath to be a doctor, I mean that was when I just gave my life to the profession. I think it’s great that nurses are getting more recognition, and physicians, but this is what we love. As a physician, I took an oath. There’s not many professions that do that. I am very grateful that I can serve in general during this. I wouldn’t change it for anything. 

RC: As it may be the last question for you, what advice would you give our viewers watching this, or even your viewers that you talk to on your platform? What is the advice that you would want them to know, and what would you like to maybe see and hear from the community?

JP: I really just want everyone to live a healthy life and feel good, that’s my passion. You need to start with a good base and that’s nutrition, and a lot of people struggle with this. There’s the internet now, where you can look up healthy ways to eat, different diets, whatever works for you, but eat your vegetables. Eating vegetables it’s shown to decrease mortality study after study,  time after time. Try to notice if you’re self-coping with sugar or alcohol, because those two do have a negative effect on your immune function. So, if you are in a place where you need help, go get it. There’s online therapists, we’re here in the ER, if any mental illness, there’s no reason why I should stay home. No one will, we [are] always in the ER, I open to everyone with open arms. People are like, I feel bad for coming, I’m like, no. You’re here because you need to be, and I’m here for you to talk to. I don’t want anyone to struggle in silence. So, going on with that, make sure you’re taking good supplements, whether you’re getting vitamin C in oranges or you’re taking a supplement, and zinc, quercetin,  probiotics, melatonin I mean has been shown to possibly help against SARS, so there’s a bunch of different things I go into detail more on my platform with that. And then, I know that people are kind of upset about the whole wearing a mask thing and I just wanted to touch base on that. I wear a mask; I actually wear an N95 if I’m really close to people because I could be an asymptomatic carrier because I’m healthy. And this could also affect me and I could be in the hospital. We just don’t know enough yet. But wearing a mask is almost like an act of love. I think that wearing a mask is almost an act of love for those who can’t or for those who are immunocompromised. So when I am not working in the ER and I’m out where I’m going to be in close proximity or I’m going to talk, I wear an N95 because I do not want any of my particles getting to them. Or if you’re just walking at the farmers market, just wear a cotton mask. Have your kids wear one; kids are coughing and sneezing and shooting those particles. So just tell them.There are people and I think the one group that we forget about are the people that get anxious when they wear a mask. It’s not dangerous to wear a mask. If you’re over the age of 2, you can pull it off. But some people, they get really anxious and I don’t think we should shame people that don’t wear masks. We don’t know, but just if you can and you’re able to wear masks, it’s not about … we’re not getting into the politics here. We’re literally showing an act of love. And people get very heated about this and it’s not a big deal. It’s just we don’t know enough about this virus, but we do know that it is weird because you’re healthy for so long and you’re asymptomatic, but your viral loads are high. So I guess that would also be a good thing. One other thing would be [to] get outside, walk, be in nature. So exercise, just walking around in nature, being in nature, putting your feet in the grass, grounding, and meditation; I mean that the one thing that I wish I could get everyone to do, okay? it’s really, especially, in these times right now of uncertainty so meditation. Something that you just try it out.

RC: Yeah, well thank you so much. I think those are really great tips. It’s even more important that you added the notes about the mask because that is a huge point of contention as we speak. And I think you’re right. I totally agree that it’s not about politics and it’s just something that as we’ve been talking about this entire episode, it’s our bodies. We’re all humans and we all have a biological immune system that needs to take care of and there are certain things that like wearing masks that [are] basically proven that it will reduce how much we can spread and how much the virus will be contagious in our own community. So I think you’re right it is in an act of love that we hope to be sharing with the community. And thank you so much for your time and again, I know you might not want to hear it, but thank you for your service as we really truly are beneficiaries in this community for not just the service and the skills, but also the information that we hope to be spreading. 

JP: Thank you so much for having me. It was so nice talking to you and I had a good time. 

RC: Thank you, doctor. Thank you for tuning in and I hope you got something new from today’s episode as we learned the toll of the pandemic is as much mental as it is physical. We also heard just how important it is to show an act of love toward fellow citizens through mask-wearing. This time may be difficult, but it can very well be an urgent call for us to get on a healthier and conscientious track for the future of our country. If you enjoyed this conversation, like, subscribe and share our content as always stay safe, stay healthy, which made me and eating more vegetables, and stay human 


Please enter your comment!
Please enter your name here