Posts Tagged ‘ covidblogorangecounty ’

Latest Covid Treatment FAQ's Orange County

By editor
January 5, 2022

ANNOUNCEMENT from CMO-


A woman calls a law firm,
"This is Schwartz, Schwartz, and Schwartz. How may I help you?"
"I would like to talk with Mr. Schwartz."
"Oh sorry; he is in court all day."

"OK, in that case let me speak to Mr. Schwartz."
"Apologies. He is on vacation."

"Then let me speak to Mr. Schwartz." "Speaking!"

(With thanks to Henny Youngman.)

As this story illustrates, there are times you really don't want to answer a question. But eventually, you have no other choice.

You have a sore throat. Cough. Maybe a fever. You test positive for Covid. You contact us and ask, "What can you give to treat it?"

A very legitimate question. But not so fun to answer.

Because it is frequently followed by a request for Hydroxychloroquine. Or Ivermectin. Or a Vitamin combination.
Lately, CoQ10 is a popular request.

You may be tempted to mimic the formula unsuccessfully used by
quarterback Aaron Rodgers. He declined to disclose his secret formula, but did state in an interview prior to his positive PCR he was taking a cocktail of Hydroxychloroquine, Ivermectin, CoQ10, zinc, Vitamin C, and D.

NONE of these treatments have been shown through ANY valid study to prevent or treat Covid. Hence Rodger’s recent Covid infection.

So what DOES prevent Covid?
Only one thing...a vaccine. And unlike vaccines we are used to, it has a relatively high failure rate. Their main advantage is they DO prevent severe cases, hospitalizations, and my personal favorite thing, to prevent-death.

And what DOES treat Covid? Well, none of those modalities mentioned above. Going into our third year of dealing with this virus, five therapies appear to have passed the tests of efficacy (working) and safety.

  • 4 of the 5 have FDA authorization, either emergency or standard approval.
  • 2 of the 5 are indicated only in hospitalized patients with severe cases.
  • 1 of the 5 is not currently available, at least in Orange County.
  • 1 of the 5 is very difficult to access, at least in Orange County.
  • 0 of the 5 "cure" Covid; they all reduce symptoms, and risk of death.

Here they are:

1. Remdesivir and 2. Baricitinib.
They are only given in the hospital. They are very effective in reducing days in the hospital, days on high flow oxygen, chance of needing intubation, and of course risk of death. So, unless you are tucked into your hospital bed, 2 of the 5 are off the list.

3.  Paxlovid and Molnupiravir, oral outpatient anti-viral agents just approved by the FDA. So why not prescribe these to our patients calling?

  • They are NOT to be used for prevention.
  • They must be used within five days of symptoms starting, which is a very narrow window to get a positive test, which is also required.
  • They are ONLY indicated in cases with a high likelihood of progressing to severe disease, hospitalization or death. Which limits to whom they can be prescribed.
  • But the biggest issue--it simply isn't available. We have called dozens of local pharmacies - nada. Some expect to not have it in common use until spring.

4.  Which leads us to the only other FDA approved (emergency use) treatment- Monoclonal Antibodies (MAB).

So far, they appear to be game changers. Safe, few side effects, and a very high success rate.

In fact, almost every case we have followed up on were improving. We do not specifically check for Omicron, but the MAB’s appear to be working in current strains we are seeing in Orange County.

And they are free, thanks to our federal government cutting a deal with Regeneron labs to supply the country with them. (A reasonable administration fee is allowed to be charged.)

Monoclonal antibodies are laboratory-produced molecules that act as substitute antibodies that can restore, enhance, or mimic the immune system's attack on viruses--in this case Covid.

A fair analogy is vaccines have the SWAT team waiting for the Covid perpetrators and neutralize them on entering the nose--I mean house. With MAB’s the SWAT team rushes the house once the perps have already entered. Either way, antibodies are doing the work.

PDQ Urgent Care, in partnership with Infusion IV Hydration & Injection Therapy, in conjunction with Caduceus- has been approved to administer MAB’s and has given approximately 50 doses in the last few weeks. However, allocations are sparse, and we run out quickly. We never know if more allocations are coming, since it is in short supply nationwide.

Recently it was reported the entire Houston area would run out of MAB’s and unsure if they can get a new allocations soon. With no other proven therapies, demand is far ahead of supply.

(Conspiracy theorists: I have been unable to verify the head of Houston MAB distributions is a Dodger fan.)

To answer the many questions about receiving MAB, let’s skip the questions and go straight to the answers:

  • To receive the MAB’s, you need to be referred by a PDQ provider. This is done via a video visit. Easiest way to do this is via the PDQ app, or live chat on the website at pdqurgentcareandmore.com. If they are closed, I suggest a Mouse Call, also available on the app or website.
  • You also agree to a follow-up video visit a few days after the MAB infusion.
  • (Advice- download the PDQ app. You can do all your Covid stuff anywhere your phone is via live chat. PDQ is then literally in your pocket.)
  • You will need to be positive by either a PCR or Antigen test and present the test at the time of the infusion.
  • You will need to be mildly to moderately ill, with a high likelihood that you may progress to a hospitalization. If you already have a severe case, you should go to the ER for possible admission to receive Options 1 and 2 above.
  • If you have Covid but are relatively healthy and improving, you should not receive MAB’s.
  • With supplies so limited, we are giving priority to our own loyal patients. It is not required to be a preexisting PDQ or Caduceus patient, however.
  • Your costs for MAB’s are modest. The two video visits are billed to your insurance. If you do not have insurance, they are under $50. The infusion fee is paid at the time of administration and is NOT billed to insurance. It is currently around $200-300.

What if you qualify for MAB’s but cannot find it? Or you are sick, but do not meet the criteria for MAB’s? We have looked and found one other therapy to replace MAB’s if needed.

Enter Option 5- Fluvoxamine aka Luvox. This is actually a type of psychiatric medication, meant for OCD in the category of drugs known as "SSRI’s.”

Luvox acts by increasing levels of the brain chemical serotonin. In addition, the drug has other biological properties that could quell inflammation triggered by COVID-19.

Why is this different than the other off label drugs touted by social media?

Well, this one has actual peer reviewed studies to support it. Yes studies--as in multiple ones. Its main claim to Covid fame is it prevents the cytokine storm responsible for the severe double pneumonias, ARDS, ventilators, and even the “long hauler” symptoms. 
And the studies are not in obscure journals. It was given passing marks from both
JAMA and The Lancet.

It is not FDA approved, and at least one local pharmacy told us they will not fill prescriptions for it until it is. But it has been taken by millions of patients over the last 30 years with a good safety profile.

Since it is an off-label use, many physicians will be resistant to use it, given the drama of Plaquenil in 2020. But our Covid team will consider it if all other options hit a dead-end.

Again, you will need a positive Covid test, and a video visit. It is NOT for prevention, and only for higher risk patients.

That's about it.

Five treatments with decent supporting data. But to review, only MAB’s are a realistic treatment to prevent hospitalizations and death.

Of course, having the antibodies ALREADY lying in wait for the dreaded spike protein is much preferred--and that means taking the vaccine, AND a booster OR check your antibody counts every 4-6 weeks as we have been advising. (Ok, nagging.)

In summary:

  1. There is no treatment shown to prevent Covid
  2. There are only five treatments showing respected data on treating Covid successfully.
  3. Only one is a current viable option for outpatients- Monoclonal Antibodies. And they work.
  4. Get vaccinated and boosted, or at least check a total antibody count regularly as your best bet to stay out of the hospital -or worse.
  5. PDQ, in partnership with Infusion IV Hydration & Injection Therapy and Caduceus, is an approved site for MAB’s. Allocations are sparse and there is no guarantee they will continue.

Just ask Houston.

We began with Henny, let’s end with Henny.

A man goes to his doctor and says "Doctor, I have Covid and I'm afraid I am going to die!"
The doctor says, "Nonsense! You'll live to be 80!"
"But I AM 80!" says the man.
"See? What did I tell you!!!!" 

Sincerely,

Gregg DeNicola MD Chief Medical Officer
Caduceus Medical Group

Antibody Quantitative Testing- Orange County CMO Covid Blog

By editor
November 19, 2021


In a world that keeps on pushin' me around  
I'll stand my ground 
And I won't back down. 
 
Tom Petty 
 
Let’s present the actual real-life case of a Caduceus married couple I will call Donald and Daisy.  (It’s real except their names of course.) 
They are both in their 60’s. 
Both were vaccinated in Feb/March (the brand isn't important). Being fully vaccinated, they assumed they were safe to travel to the Caribbean in late September. 
They needed to show proof of vaccination, which of course they had. 
 
They were gone two weeks, returning early October.  
On their second day at home they both began coughing. Coming to our Caduceus drive through curbside testing, they both tested positive for Covid in Mid-October. Daisy was moderately sick for two weeks.  Donald developed Covid pneumonia and was hospitalized and is still on home oxygen.  But both survived, thank God. 
 
Daisy's antibody level on diagnosis? 269. 
And Donald's?  27. 
 
What happened? Easy. The antibodies produced by the vaccine faded. Went away. Disappeared.   
In Donald's case, it was as if he wasn't vaccinated at all.  
 
Donald had "Mouse Called " Caduceus in mid-September asking if it was ok to travel. We advised to have an antibody count. They declined due to a busy schedule. Had they checked the levels BEFORE the trip they could have had boosters or perhaps postponed the trip. 
 
We continue to advocate for regular antibody level testing. When we began offering this in early summer, it was purely data gathering. But now, after several thousand tests, we can tell you our findings, and make reasonable assumptions. 
 
A disclaimer--we will be simply giving you data from our own Caduceus patients. We will not draw scientific conclusions. We won't claim proof or speculate on data from other groups. 
 
For example, if I tell you the street corner by my house has intersecting traffic stopping when the signal light is red, every day I drive by it, I'm just giving you factual data. I am NOT concluding red lights prevent accidents. That's for the statisticians and scientists to do their thing.  
 
Yet, it IS a reasonable assumption. But it's not valid proof. All I can say with certainty is all traffic stops at the red light by my house.  
 
So, Mr. Petty I am taking your advice.  
 
I’ll stand my ground. 
 
At Caduceus we have been advocating to check antibody levels monthly, since that appears to be an accurate way of telling if you are protected. 
 
Antibodies work.  
 
No matter how you get them- vaccine or natural. Whether Moderna is better than J&J or a vaccine is better than natural isn't the point. It doesn't matter. What DOES matter is how high your antibody count is. At least that's a reasonable assumption based on our numbers. 
 
Over 400, good shape. 
Under 300, beware---mask, avoid large gatherings, and get vaccinated and/or get a booster. 
300-400 appears to be the dreaded gray zone. 
 
More data to chew on; if the antibody count is over 400, we have had ONE symptomatic  Covid infection. Mind you, some patients do not allow us to check their antibody level when they are first diagnosed, but that is what our data is telling us. 
 
What about an antibody level under 300? Dozens of new cases. In fact, ALL but one of our new Covid cases who had been vaccinated had levels under 300. 
 
Again, I caution that this is just Caduceus data. It has not been analyzed by a Chi square, confidence interval, or signed off by Dr. Fauci. 
 
And there IS good data from our medical researchers showing a definite link to high antibody levels and Covid protection.  
 
However, a recent JAMA article called antibody testing a "flawed science.”  They acknowledged high levels appeared to be protective, but the exact thresholds were still in question. We agree. That is why we give our data here, without making a conclusion. 
 
About six months ago I made a prediction- we will reach herd immunity by Halloween. I rarely make predictions, since I feel NO ONE can look into the future. Yet in this case I had a good feeling. 
 
Since both Caduceus and California are experiencing a surge in new cases, it’s easy to say---I was wrong. But was I?  
I'd say yes and no. 
 
Explanation- People think herd immunity is having Covid go away. 
Not at all. 
 
Herd immunity occurs when a significant portion of a population is immune to an infectious disease, thereby limiting disease spread. For those who are not immune, they are indirectly protected because the ongoing disease spread is small.  
With herd immunity, masks, social distancing and even showing proof of vaccines should all go back to normal- whatever that was. 
 
In California, our numbers tell us 2/3 of adults are vaccinated. And another 20% have had Covid but not yet vaccinated. That's 86% protected, and we are thus at herd immunity.  So I was right, and you can pay me your losing bets when next see me. 
 
But wait. Cases are RISING. Especially in states with the HIGHEST vaccination rate. Pretzel logic, right? (That's for you, Steely Dan fans.) 
 
To explain we need to get three things straight. 
 
1. Vaccines work (by producing antibodies.) 
At Caduceus, 60% of our recent new Covid cases were in vaccinated people. That's right. Over half. So, do vaccines work or not? 
 
Answer: Vaccines do not prevent Covid infections. Look at Donald and Daisy -they were two of many vaccine failures.  Neither does having previous Covid infections.  
 
ANTIBODIES work. 
 
Now in fairness, the vaccines do trigger the antibodies. And a Covid infection also triggers antibodies. So how does that explain the lack of herd immunity? 
 
Think of guns. To quote an old political argument...Guns don't kill people. Actually people don't kill people either.  
BULLETS kill people.  
Saying I am going to protect my house by buying a gun means nothing if you don't have bullets.  
To illustrate- Just ask Alec Baldwin. The gun didn't kill Halyna Hutchins. A bullet did. 
 
Now work with me on this analogy. What if bullets actually let’s say, melted after a while? Or turned into blanks? Some in three months, others in a year. You would not be able to defend yourself until you checked for this and then got MORE BULLETS!  Not more guns! 
 
So, in my weird analogy, the bullets are the ANTIBODIES. No bullets, no protection. Vaccine or not. Previous infection or not. 
 
2. The CDC says that those with natural antibodies are five times more likely to be hospitalized with a second Covid infection than those that are vaccinated. Yet at Caduceus, you want to guess how many new infections were in patients with natural antibodies over 400? 
 
One. 1. Uno. 
 
And that patient had no symptoms. She had a PCR in hopes of attending a friend’s wedding.  
 
What about "natural antibodies"? Our data show with a low viral load (mild case) natural antibodies last three-six months. But a high viral load (as in hospitalized and ICU patients)? OVER a year.  
 
Caduceus data would suggest you are much better off -i.e. have more antibodies- having been in the hospital in January than having the vaccine in January. 
So why is our experience so much different than the CDC’s? 
 
Well, many more people have had mild cases of Covid, i.e. low viral load. And this is word for word from the study: 
 
"The study only examined adults who had tested positive more than three months ago.” In other words, they stacked the deck against natural antibodies by picking patients whose antibody counts would be lower. No such restriction was placed on the vaccinated group, however. They also excluded the J&J vaccine! 
 
Could it be the CDC and others want to downplay the efficacy of natural antibodies so that more people will vaccinate?  (I am asking for a friend.)  
 
Now let’s address #3. 
 
"I have an immune system, thus do not need a vaccine," or in the case of Aaron Rodgers, "I bolstered my immune system using a technique championed by that famous immunologist Shailene Woodley.” 
 
The problem with that is that all your immune system does is produce antibodies AFTER the alarm goes off to your ADT alarm system.   
  
Once your body sends out the troops, Covid may have already made it into your lungs (speaking from personal experience). Having a "good “immune system doesn’t mean you have anti-Covid antibodies already in the house waiting to attack the Covid perpetrators as soon as they enter your nose.  
 
But wait----is there any way we CAN have the troops already there--waiting to neutralize (kill) the infamous spike protein without needing to first send an alert to your immune system? 
Yes!!! 
Can we Have antibodies ALREADY in our system -Designed to kill Covid right off! That'd be so cool if we can arrange that! 
But how? OMG, I know! Take a vaccine -it produces anti-Covid antibodies!   Or actually recover from Covid and let those antibodies you sent out hang around and protect you from a second Covid infection. 
 
This is immunology 101. Taught accurately in every high school, college, and medical school in the country for decades. But for some reason, between politics, and stupidity, antibodies are not recognized as what is needed for herd immunity. Or to get into a venue for that matter. 
 
In some diseases, antibodies (either vaccine or natural) last a long time...maybe even a lifetime such as Measles and Chicken Pox. 
In other cases, maybe five-ten years, such as Tetanus. And in other viruses only one year---like the annual flu vaccine we take.  
 
Here is what we have found at Caduceus.  
 
Vaccine antibodies last 3-10 months. 
Moderna- 6-10. 
Pfizer- 4-9. 
J&J- 3-6. 
Then they are gone. As in- you have NO antibodies once they disappear. 
 
This is how previously vaccinated people are getting Covid now. If they were vaccinated in early 2021, there is a good chance their antibody count is low or zero. 
Here's the irony. To get into a concert tonight at the Performing Arts Center, I must show my proof of vaccination. But if I was vaccinated in the spring, there is a good chance I'm NOT immune. Yet I am welcomed into the venue. 
But if I bring my trusty antibody count I do every month showing tons of good anti Covid antibodies (from BOTH my infection plus my vaccine), I would be banished to return home. Although I am VERY protected.  
 
For this I blame our leaders and giant organizations such as the CDC and WHO for not doing the simple research that will prove this.  
 
To summarize:  
1. Antibodies work. Whether from vaccines or natural immunity. 
 
2. Having no or low antibodies puts you at high risk of contracting Covid. No matter if you have been vaccinated or had a previous Covid infection. 
 
3. We advise all Caduceus patients to check their antibody counts every four-six weeks, regardless of vaccination status or past Covid infection, at least until we do reach herd immunity. 
 
I advise to not get hung up on whether you need a booster. Or if you had J&J in March. Or if you have natural immunity from your Covid infection in 2020. Or if it’s safe to travel if you’ve had the vaccine. 
 
Just check your antibodies.  
 
If your count is under 300, we advise full vaccination, including receiving boosters as needed. 
 
Caduceus can draw your antibody level anywhere they draw blood. Most insurance covers this; if not the cost is reasonable. No visit is needed if you are a registered Caduceus patient. To discuss the findings with a doctor, a video visit can be easily arranged from the comfort of your home or office. 
 
We won't back down. 


Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

Covid Blog- Herd Immunity Orange County

By editor
April 19, 2021

A farmhand was helping the farmer with his herd of cows. The farmer asks, "How many cows are in my herd?"

“49,” says the farmhand.
"Ok then; round them up!"
"Ok,fine! You have 50," says the farmhand.
 
Now that I have you trying to figure this out, I will do something totally out of character for me. 
 
I will make a prediction. About Covid. 
 
This is risky because all the predictions about Covid by experts, epidemiologists, the CDC, WHO, and even the Geico Lizard have proven wrong.
 
For example: 
-It wasn't like the flu. 
-It didn't end in warm weather. 
-It didn't burn itself out after a year. 
-It didn't only kill frail seniors and diabetics.
-And the vaccine was not at all a piece of cake.

 
So here is the senior cynical doctor’s prophecy:

We will reach herd immunity this year. In 2021.
 
As a matter of fact, I see it by Halloween. Maybe even Labor Day.
 
When I say herd immunity, I mean enough people will become immune to Covid, rendering its spread unlikely. As a result, the entire community will be protected, even those who are not themselves immune.
 
A disclaimer, I am not the only forecaster to make this projection. But I do firmly believe it.
 
In January, as I was couch bound recovering from Covid, I spent time with my iPad aimlessly surfing. I started doing the math, and as the data is now more solid, the facts speak for themselves.
 
It seems the government experts are trying hard to downplay this scenario. It makes sense-they don't want us complacent. Ripping our masks off. Filling up restaurants. Just in case we NEVER reach herd immunity. 
 
Remember, these are the same people that said antibodies will not protect us.
And no test of cure is needed.
And only get tested if you have symptoms.
And that we need to close our schools,,.no I mean open the schools,,.no close...no....you get the idea. 
 
Now I have an alternate theory. 
First, I would like to pay homage to Monty Python and the genius of John Cleese. If you haven't seen it, please You Tube the “Pythons Ann Elk” skit on the theory on Brontosauruses.
 
Here is my theory  
AHEMMMM!
 
My theory--which belongs to me--is as follows...
 
This is how it goes--
 
The next thing I will type is my theory...
 
Ready???
 
My Theory by Dr Gregg DeNicola will begin now...
AHEMMMM!
 
We will reach herd immunity via natural antibodies against Covid, with additional antibody protection from vaccine programs.
 
That is my theory, which is mine, and belongs to me, and I own it. 
 
For any viral disease, immunity is afforded by antibodies. 
There are only two ways to get these gems in your system. You can make your own, however that would require you to actually contract Covid.
 
The antibodies are also obtained via a vaccine. 
Which are better? I refer you to hours of research on the WWW where you will find no clear answer. 
 
"Natural" antibodies appear to keep you Covid free 99% of the time you have them. 
Vaccine antibodies also appear to be working at a 99% clip. 
 
So, as your bartender says---"Pick your poison."
 
Although if you have had Covid, odds are you are protected- we just do not know how long the protection lasts. We've seen it last a month. We have seen it last 11 months. 

With the vaccine the CDC is hoping for a year efficacy but we don't have the data to support that. A yearly booster is likely.
 
So let’s do some math to validate my theory.
 
To achieve Covid herd immunity as defined earlier, the numbers vary from 50-80% by epidemiologists. Because of potency, penetrance, geographic spread, and different strains, each virus has a different percent.
 
Measles needs 90% herd immunity. Polio only 80%. 
 
Remember herd immunity does not eradicate the virus from the face of the earth. That has only happened once in history. The wonderful Dr. Edward Jenner and his Smallpox vaccine destroyed the Smallpox virus, with the last known case reported in 1977.
 
Since we do not know the exact percentage for Covid yet, let’s pick a reasonable 75%. 
 
In 2020 the US population was 331 million. Let’s say the 2021 US population will be 333 million.
 
That includes infants and children, who notoriously do not have antibodies, so this will require a higher number of adults to have antibodies.
 
333 million Americans, times 75%, means we need 250 million of us with antibodies at one time to achieve the Holy Grail of herd immunity.   
 
On April 1, we had 56 million Americans vaccinated.  
 
The CDC reports in the US, we average 3.1 million new vaccines a day (not the second shot). So by May 1, we should be at 150 million Americans vaccinated. 
 
Now let’s say for various reasons, we do not hit 150 million until July 4th. We also have to count the number of post-Covid patients with antibodies.
 
Sloan Kettering did a study on "seroprevalence" to estimate that in March we had up to 120 million Americans immune due to post-Covid antibodies. 
 
December 2020 had over 20 million documented Covid cases in the US. We are averaging 70,000 new cases a day currently. That means between April 1 and May 1 alone we will have around an additional two million Americans antibody protected. (Yes, nearly all Covid cases make antibodies.)
 
The wild card here is that these numbers are only for swab POSITIVE cases. Experts estimate that there are at least three additional cases never tested or reported for every swab positive patient.
 
You get it. The Mrs. has symptoms, gets PCR tested positive. The Mr. also has symptoms and says “no need for testing, I know I have it. I’ll just hunker down until I feel better.” Then their 2 kids with fevers refuse that "brain biopsy" swab. Four cases but only one positive swab.
 
The "untested" immune help offset the fact that of the 150 million vaccinated Americans we will get to by the summer will include a fair number of people who ALREADY have antibodies from a prior Covid infection.
 
So the math says of the 150 million people that will soon be vaccinated, perhaps only 66% had no antibodies. 
 
That makes 100 million protected from getting the vaccine.
 
NOW add the 120 million people the experts say are protected from natural antibodies post-Covid 
 
Add 30 million people who are protected but don't know it because they haven't (or won’t) be tested.
 
VOILA! 250 million protected Americans, the number for herd immunity. 
 
This doesn't even count continuing at three million vaccines a day, and the 70,000 new cases that are still occurring across the country getting natural antibodies.  I postulate herd immunity by Halloween is not only possible, but probable.
 
An example is the DeNicola Thanksgiving dinner in 2020. There were nine at the table. All tested PCR and antibody negative days before.  All nine were negative.
 
Today, just four months later, six of the nine have had Covid and have antibodies. Six of the nine also have had the vaccine. All nine are currently protected, either by natural or vaccine antibodies. This is happening all over the country.
 
The more people that contract Covid, the more protection we achieve.
The more people that get the vaccine, the more protection we achieve. 
 
Want to hear a joke about immunity?
Never mind, you've already “herd it.”
 
What herd immunity should mean is no more masks. Eating at a restaurant that has tables three feet apart. Salad bars back. Stadiums and concert halls full again.
 
We will know there is herd immunity when the 14 day rolling average of new cases and deaths take a sharp drop to below what a typical flu season has.
 
Yet, I suspect public health experts will still want masks and distancing practiced long after herd immunity has kicked in. Immunity is invisible, and our paranoia over any possible Covid spread will make returning to normalcy difficult. 
 
Yet my math says that we are far closer to herd immunity than the public health officials want to acknowledge. 
 
Yes, new mutations and strains may not respect the vaccines or antibodies.
Yes, some vaccines may wear off in three months without our knowledge.
Yes, natural antibodies may disappear in two months, leaving the post-Covid patient unprotected.
 
Yet despite those concerns, there will still be a steady flow of both natural antibodies and vaccines offsetting them. 
 
And we will reach herd immunity by Halloween.
 
That is my theory. Which is mine and belongs to me.
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

Covid Blog 2021 Physicals Orange County

By editor
March 16, 2021

With apologies to Gilbert and Sullivan, this is for all you Pirates of Penzance fans who have had to deal with the pandemic over the last year.
 
Pirates of Pandemic Patter
(to be sung at a rapid tempo)
 
After all the quarantine it’s time to move around, even dance
Ask Gilbert and Sullivan; sing along to Pirates of Penzance
 
You are the very model of a novel coronavirus
You ruin health, economy, and holidays are quite the fuss
 
Sneaky how you incubate, 2 weeks ‘til you rear your ugly head
Some folks don’t even know they’re sick while others can’t get out of bed
 
You mimic every symptom out there, what a tangled web you weave
So many “experts,” self-appointed, hard to know whom to believe
 
CDC just cracks us up, thinks it knows exactly when you’ll leave
You come and go without reservation, offering no reprieve
 
 
Time to take a break from the patter
Let’s talk important next steps that really do matter.
 
Whether you’ve had COVID or not, you’ll need a checkup in 2021.
 
It will be different than any physical you’ve ever had before.
 
In fact, at Caduceus there are three categories of checkups for 2021. As we introduce HUEY, DEWEY and LOUIE, see to which one you relate.  Call us quacks if you like, however Caduceus may be the only medical group with COVID specific checkups for 2021!!!
 
 
HUEY-
 
HUEY has not had COVID.  He mostly stayed home, wasn’t able to exercise, packed on the COVID 19 pounds, may have consumed more than his usual amount of cheeseburgers and does recall daily happy hour.  Diabetes runs in his family however he’s sure he’s fine.  HUEY schedules his annual checkup which includes:

  • Lab work to check on diabetes, high cholesterol, fatty liver and more
  • If female, mammogram and Pap, depending on date of last test
  • COVID antibody testing.  Huey may have been an asymptomatic case and already have protection.  Or Huey many have gotten the vaccine(s) and have antibodies

If over 50, HUEY meets criteria for:

  • Colon cancer screening
  • PSA if male
  • Bone density testing
  • Shingles vaccine

If over 65, HUEY meets criteria for pneumonia vaccine.
 
HUEY is still nervous to go out in public, so the good news is HUEY DOESN’T HAVE TO COME INTO THE OFFICE.  We can start the 2021 checkup from the comfort of your home or office.
 

  • Curbside lab draws
  • Video Visits to review the tests
  • We’ll go from there – some things will require an office visit as we haven’t figured out how to biopsy a mole, pierce an ear, or do a Pap remotely.

 
 
Can’t resist the urge to rhyme
Let’s indulge the patter one more time
 
Virus analogy is a dragon, with a very long tail
Ignore bedrest and do too much, the symptoms come back without fail
 
Docs try and try, I don’t know why, as we all know there is no cure
Despite Hydroxychloroquine and Ivermectin, you endure
 
Z-Pak, zinc, lots of vitamins, then Decadron and Tylenol
Trying any and everything, like throwing pasta at the wall
 
Has convalescent plasma become the ultimate gift to give?
Will sharing antibodies be the thing that helps others to live?
 
Prone position, oxygen, Remdesivir flowing through the vein
As soon as something starts to work it transforms into a new strain
 
 
DEWEY-
 
DEWEY did have COVID last year, not a bad case.  DEWEY took a Z-Pak, some cough medicine, and had an inhaler, just in case.  He feels pretty lucky to have been out of commission only a short time.  He’s pretty sure he’s back to 100%.
 
In addition to EVERYTHING COVERED in HUEY’s physical, DEWEY’s checkup will include some additional post COVID labs.  Studies show that even people with asymptomatic or mild cases may have post-COVID Syndrome, affecting their organs.  Labs may include:
         

  • Tests double checking your heart, lung, kidney, and liver function
  • Additional labs looking for post-COVID inflammation
  • Antibody testing monthly

 
 
OK, it’s time
A little more rhyme…
 
IgM and IgG – antibodies are talk of the town
Everybody wants a bunch, to last and last and never go down
 
Pandemic rocked our world so hard and now the aftershocks we feel
Enter Moderna, Pfizer, J& J – is vaccine the real deal?
 
You are the very model of a novel coronavirus
You ruin health, economy, and holidays are quite the fuss
 
Learning more each day; using science and common sense best we can
Let’s hope virus this mutates out, and leaves as fast as it began!
 
 
LOUIE has survived the monster virus, had a severe case, may or may not have been to the hospital and may or may not be feeling back to 100%.  LOUIE may still be experiencing fatigue, occasionally still needs inhalers, sometimes can’t sleep, and his head feels a little foggy.  Oh, and LOUIE’s gut is still bothersome.  LOUIE is not alone.  We are shocked at the number of patients who still have lingering post Covid symptoms.  Post-Acute Sequelae of Sars-CoV-2 infection (PASC) is a thing.  Worldwide, reported incidence ranges from 10-30%.  LOUIE has won the war, however the battleground may have sustained some damage and needs time to repair.  LOUIE’s annual checkup will include everything that HUEY’s and DEWEY’s did, and can also start from the comfort of home or office. We may run a few additional tests or labs to specifically check on LOUIE’s heart, lungs, kidneys and brain depending on the severity of LOUIE’s post Covid symptoms.  Tests may include:
 

  • EKG
  • Echocardiogram
  • Pulmonary Function Studies
  • Pulmonary Rehab
  • Antibody testing monthly
     
    So, for 2021, are you HUEY, DEWEY or LOUIE?
     
    We recommend antibody testing regularly for everyone and will offer monthly antibody options for all categories.
     
    We’ve instructed staff not to giggle if they receive a call asking to schedule a HUEY/DEWEY/LOUIE physical!

    Gregg DeNicola MD CMO, Caduceus Medical Group, PDQ Urgent Care & More, & PDQ Telehealth
    Mary DeNicola DNP PDQ Operations Officer 

 

 

 

 

 

CMO Covid Orange County Blog- Shares his story

By editor
January 26, 2021

It was 3 PM on my second day in the hospital--Christmas Eve- and was due to have a half hour IV infusion of Remdesivir for my Covid pneumonia. 

I looked up at the IV bottle.

It was a dark glass container, looking identical to an upside down Kahlua bottle. More bothersome - there were three heads coming off the bottle, each looking like a Satanic face.

Scared, I assumed I was dreaming. But squeezing myself, I knew I was totally awake. I closed my eyes, and looked up again at the bottle being hung. Same vile image. I noted one of the faces looked identical to the character "Anonymous.”

As a physician I knew I was hallucinating.  I knew hypoxia or high flow oxygen, of which I was having both, can cause hallucinations.

Yet it was as surreal as it comes, physician or not.

I decided to not look up until the infusion was done, and not ask my nurse about the unorthodox IV she hung.

The next day on Christmas, at 3 PM it was time for my second dose. The nurse came in to hang the IV bag. It took all I could do to look up as she hung it. It was a small clear vinyl bag, used for all IV meds. I was relieved the devilish Kahlua bottle was nowhere in sight.

I summoned the courage to ask my nurse, “was yesterday’s dose put in a different bottle?” “No,” she said, “it was the exact same small clear IV bag.”

I asked her if I had been napping when she hung the first dose. “No,” she said, “you were wide awake; why?”

I decided if I ever wanted to get released, I’d best keep my hallucinations to myself. “Just wondering,” I answered.

This falls into the category of "you know you are sick when.”

I can boil my experience into three unexpected memories. That bottle was obviously number one.

The second was my activities during my nine day stay. I had brought some books to read, planned on watching classic movies, brought a shaver and toothbrush, and some shampoo if I had a shower in my room.

Ok, I had never been hospitalized before. What did I know?

I spent eight days laying on my right side-flat, which produced the best oxygen readings.  Flat on my right side, 24/7.
 
Realize all of my adult life, I was a multi-tasker. Running a busy practice.... Running a business.... Working as a Medical Director.... Husband and raising three boys into men.... Cooking and wine tasting.... And recently I took up gardening and boating, weaving those into the hours I had in a week. The idea of lying down in my bed for even 30 minutes during the day would be my biggest nightmare.

Yet here I was, lying flat for 200 consecutive hours. This wasn't a bad dream;  it was torture.

There were a few exceptions. I could sit up to eat. But that dropped my oxygen so it had to be done quickly. One day physical therapy visited and stood me up. To achieve that, they had to crank my high flow oxygen even higher. I had one quick sponge bath. No shower, no shaving, no reading, no TV, and no visitors. My only view was of the nurse’s call button on the rail next to my face.

I knew that position was the only way my oxygen number would stay in the 90’s, allowing the nurses to try to wean the high flow oxygen from the 100% they started me on to the 30% goal-- when they could convert me from high flow to regular low flow.  They had mentioned if they couldn't wean me in two weeks, I may be transferred to a "higher level of care". I knew what that meant-- the ICU for possible intubation.

To keep from going crazy, I tried to think of as many bad doctor jokes as I could ...you know, like-

“I’m sorry,” said the doctor to his patient. “You have Covid.  We must quarantine you, and you’ll only be fed sliced cheese and bologna.”

“Will that cure me?” the patient asked.

“Well, no,” the doctor replied, “but it’s the only food that will fit under the door.”

OR

“Doctor, there’s a patient in room one who says he’s invisible.”

“Well, tell him I can’t see him right now.”

OR

How did the doctor cure the invisible man?

He took him to the ICU.

That took up about half hour before I realized I’d rather be hallucinating than thinking up bad jokes.

By day eight, they finally managed to wean me from high flow to low flow, but I was still confined to lying flat on the right side position. On day nine, they tried to sit me up. My numbers held in the 90’s. Not only could I read, eat, and watch TV from a sitting up position, but also they said they were sending me home. There were too many people in the ER as sick as I was the week earlier with no beds available. My Italian guilt took over as I realized I was glad there were enough sick people to force them to kick me out of my prison.
 
That leads to the third unexpected experience being home.

I imagined sitting on the couch watching Netflix, catching up on my medical reading, chatting on the phone with friends and family, and being back to normal in a week or so.

You can stop grinning now.

I was still on 24/7 oxygen, so my nurse/wife Mary was in charge of the slow steady wean. I am still on oxygen now, so I learned this will be a long-term project.

I was given exercises to help build up my strength. Problem is they drop my oxygen numbers plus they exhaust me. I need to use an incentive spirometer every 10-15 minutes to expand my lungs.

So I found recovering from Covid pneumonia is a lot of work. I should have believed my doctors who warned me to measure my recovery month to month, not week to week.

Yet as I recover, I find myself wanting to resume previous activities. When I was first came home, I told my staff I was retiring from blogging. Yet three weeks later, I know I want to go back to some sense of normalcy.

Believe me, writing this blog today is much more therapeutic for me than you.

One of our patients in Laguna Beach is the glass blower from the Sawdust Festival. 

He isn't going to believe the special commission I have for him this summer.

I just need to empty out a bottle of Kahlua.
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group, PDQ Urgent Care and More, PDQ Telehealth 
 
P.S.  It is an understatement to say I am overwhelmed by the hundreds of cards, emails, and calls from our amazing patients and skilled staff wishing me healing. I tried answering everyone personally, then realized it was an impossible goal.

Reading these well wishes was stronger healing than the Remdesivir. I am truly humbled. Reading them made me realize I have had a career blessed by the heavens and the very best patients in the universe. Believe me the love goes both ways.
 
Remember to get tested with ANY symptoms and stay home as much as possible. I have been asked where I contracted Covid and I am sure it was from some asymptomatic person I came in contact with at work. I was still seeing patients in the office four days a week and masks are only 80-95% effective. It was a matter of time that a Covid particle sneaked around the masks we were wearing.

In retrospect, I should have stayed home doing video visits only when the numbers exploded after Thanksgiving. Do not repeat my mistake.

Caduceus will not be receiving the vaccine soon, so make best efforts to get vaccinated where you can. If you have had Covid, we advise a monthly antibody test through 2021.

We are now researching what a 2021 check up should entail and will be publishing that in a future blog.

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