Posts Tagged ‘ orangecountycovid ’

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 

 

 

 

 

 


Testing Testing 1-2-3

By editor
July 16, 2020

COVID 19...Testing…Testing...Testing… 1-2-3    
 
For my fellow baseball fans, this is a good time to recall the beloved Yogi Berra who told a post-game interviewer after a bad loss...
 
"We made too many wrong mistakes."
 
That sums up my viewpoint on our response to the Covid pandemic, both nationally and here in California. I have been purposely apolitical during the crises, and deflected blame, preferring to look ahead, not behind. Yet it is clear Yogi is right---both political parties have made too many wrong mistakes. 

If our elected leaders had pushed for universal testing early on (as we have advocated) many of the lockdowns and closures could have been avoided. 

We have been dealing with the nightmare that is Covid for four months, although it feels like four years. And in those four short months, we are learning so much every day.  When I look back and see what little we understood last St. Patrick’s Day, and then look at our current state-of-the-art, what we have mastered bears sharing here.
 
What I read on social media and here on mainstream media is so misleading, it’s actually frightening.

  • The swabs are part of a conspiracy to pay the hospitals more and are being falsified.
  • The antibody tests are inaccurate and IgG does not give you immunity.
  • Someone sent a swab dipped in a cup of coffee and it came out positive.
  • Only get tested if you are deathly ill.
  • Get tested daily to be safe. 
  • Someone's uncle can arrange for a swab to come back in two hours for $1500 cash.

Schiznick. All of it. 
Let’s deal with the bare facts.
 
If you follow Caduceus and PDQ you know our mantra... TEST.TEST.TEST.
and our slogan…

KNOW IF YOU’RE CONTAGIOUS
KNOW IF YOUR IMMUNE
 
CONTAGIOUS?  DO I HAVE COVID?
To find out if you are contagious or infected, you need a test for the virus. The gold standard is the PCR Swab.Things are changing there. At first, it was a long skinny wire that doubled as a brain biopsy. In the last six weeks, the labs are giving us a shorter swab, with equal accuracy. It is NOT just a Q-tip, its fibers pick up more mucosa and the virus is now known to reside primarily in the lower part of the nostrils. 
 
The problem is time. A finite number of testing machines are in play.  With the recent huge demand, swabs must wait their turn. So a 3-5 day wait has morphed into a 7- 10 day wait for results. For some people, that simply is too long.
 
Enter the newer "quickie" tests. Some are self-serve. Some use oral swabbing. Some do not need a doctor’s order. Many urgent cares offer them, as do the drive-up centers sponsored by local governments and large companies like CVS. And the results can be same day or one day. One catch----way too many (IMO) false negatives. Up to 20 % in some trials. These tests may be acceptable if the airline or your job just wants a negative test, and you feel great. But if you want to KNOW you REALLY are negative, I advise against the quickie tests. 
 
The companies that sell the quickie tests even warn you to repeat all negative quickie swabs with the PCR--which will take 7-10 days. So the only people who really benefit from the quickie tests are those that feel great but the airline, Hawaii, or job wants a test that was done in the last three days.  If you hear about a new test that is very accurate and results take less than a day, avoid it. That test does not yet exist.

IMMUNE? 

To find out if you are immune, you need the antibody test. For both IgM and IgG. 

IgM=you've had it. 

IgG=you’re immune.

IgM comes first, about 4-12 weeks after you are infected. It does NOT confer immunity.

IgG DOES confer immunity, but takes months to turn positive. We do not know how long the IgG stays on to protect you.  Maybe three months. Maybe three years. IgG from SARS 1 (in 2002) only hung around 4-6 months. The hope is your IgG will protect you until early 2021 when a vaccine is available.
 
So why do people on social and mainstream media keep insisting they are not accurate? If you are one of them and read this, PLEASE send me your source. If they aren't accurate I need to know NOW!!  Because all respected data says IgG confers Covid immunity.

Our tests come from labs in the USA. They are ready the same day. Almost no false positives and about 5% false negatives. Uses a finger stick.

We will soon announce we have obtained for our patients a newer more sensitive, moderate/high complexity, laboratory grade antibody test.  It is not necessarily more accurate, but does pick up the antibody earlier. 
 
We have had one patient IgG positive and then swabbed positive, but he had swabbed positive a month earlier. So far no one has been IgG positive and THEN contracted Covid. Not only in our practice, but in the literature. Again -if you read of anyone IgG positive later contracting Covid, please email me; that would be big news to the medical community. Good news...so far ALL of our Covid positive patients eventually turn antibody positive, confirming the accuracy.
 
Caduceus Medical Group/PDQ Urgent Care and More strives to be the best partner we can be to our loyal patients. We are honored to be helping blaze the trail in providing the newest and most accurate tests available. Soon, we will offer two types of antibody-(quickie/accurate and overnight/more accurate.) We are planning to offer two types of diagnostic swabs...both the PCR (very accurate, seven day turnaround) as well as a type of quickie (one day turnaround, less accurate).
 
As far as who needs what, and how often, here are the current Caduceus guidelines:
 

  • You have never had it, and no symptoms- do both swab and antibody.  We advise repeating monthly (no video visit required for repeat testing) if you are working, going out, or traveling.  It is less essential for regular testing if you are homebound. 
  • You recently swabbed positive for Covid---retest weekly until clear.  Then test monthly for antibody until IgG positive.
  • IgM positive, IgG negative...test monthly until IgG positive.
  • IgG positive…test every three months to ensure immunity. Stop when vaccine available. 

 
What about the posts stating "only test if you have symptoms?"  
 
Hooey. Poppycock. Horsefeathers.
 
Caduceus/PDQ does NOT require symptoms to be tested. We advocate EVERYONE should know if they are contagious and immune. By frequent testing, we will all know just that.
 
Why? 

How did China, Spain, New Zealand, Denmark finally reopen? Bingo! Universal testing. 

In some provinces of China, the government went door-to-door offering free tests. 

Denmark had a policy to test every willing citizen at no charge--and THEN offered them a digital "passport" to show they were free of the virus as of the date of their test. This was used to allow travel, certain jobs, and general reassurance of friends and family. 

And Spain? This is a quote from an article from Reuters on APRIL 6---at the peak of the high death rate:  "Spain is planning to widen coronavirus testing to include people without symptoms as a first step towards slowly easing a lockdown in the nation with the second highest death toll from the global pandemic." Guess what happened to the number of cases? Exactly!
 
Recently, with employers and traveling requiring swabs, we are finding up to 30% of our positive swabs show NO symptoms. So to require symptoms to be tested is missing a large reservoir of contagious people. It is a common-and deadly policy.
 
Our diligent staff work tirelessly to commit to our patients we will not run out of either swabs or antibody tests, and will test curbside daily as many people that can squeezed into one day. We do not require only Caduceus patients to be tested by us. We gladly swab all people, even from Kaiser, St. Jude, St. Joes, Memorial Care, and Hoag. 

How do we keep acquiring enough tests to have done this for four months now?

Sometimes it involves putting unmarked bills in a paper bag behind the palm tree in exchange for enough swabs...well ok, not exactly (but close to it). It shouldn't be that hard. Whatever the cost to produce adequate testing, it is less expensive than the devastation of closing down our economy.
 
Covid testing is definitely not a profit center. But -as Spike Lee would say—“it’s doing the right thing.”
 
Only by universal testing, and REPEAT testing, can we begin to tame this fast moving, lung eating, deadly virus. 
 
CONCLUSIONS 

  • If you know you are contagious, strictly quarantine yourself until you are documented not contagious.
  • If you are not immune, avoid close contacts, confined spaces, and crowds. (And wear masks, wash hands…the whole bit)
  • Staunchly consider putting yourself and your family (and workplace) on a monthly testing program until the numbers fall, or a vaccine is approved. Even….no wait...ESPECIALLY if you have no symptoms! 
  • When testing, avoid "quickie" tests and sacrifice speed for the best accuracy available.
  • If you have tested positive for Covid, or are IgM positive, antibody test monthly until your IgG becomes positive. It will.

Be aware of the massive demand for testing as cases surge. Expect a delay for a video visit, results of swabs, as well as phones and chat lines. We pledge to offer all of our patients daily video visits and curbside testing. No one will be turned away, which may intensify the delay. We thank you in advance for your understanding. 

KNOW IF YOU’RE CONTAGIOUS
KNOW IF YOU'RE IMMUNE


Let’s conclude with one more Yogi wisdom. One day at Shea stadium, streakers ran naked across the outfield. The reporters later asked Yogi (who was managing the Mets that day) if they were male or female streakers. With a puzzled look, Yogi answered....

 “I don’t know. They had bags over their heads.” 

Don't wear a bag over your head. 

Get tested.

Gregg Denicola MD
Chief Medical Officer 
Caduceus Medical Group

To make an appointment for a video visit from your phone for Covid-19 diagnostic swab and/or antibody or any other urgent or non-urgent medical needs including your annual physical, please email our appointments team at videovisits@caduceusmedicalgroup.com.
 
If you own a business and are interested in more information about our on-site corporate Covid-19 testing program for your employees, please email us at support@caduceusmedicalgroup.com.


MEET YOUR ORANGE COUNTY COVID TEAM

By editor
July 1, 2020

A Message from our CMO-

With movie theaters being closed, I’ve found- like many of you-the magic of Netflix. And since I do not have sports to follow, I gravitated towards sports movies. 

I found that no matter what era or sport, the main characters varied little. It appears that success of a team is predicated on a stereotyped group of defined roles.

It reminded me of the Caduceus Covid Team we assembled in mid-March to objectively diagnose and treat the wave of cases we were diagnosing.  The characters were eerily similar. There are many advantages to treating some conditions with a team approach, and a new serious one like Covid has been best fought with just such a team. 

Like an old sports movie, there is always a head coach who is tough but fair. In the older movies, he wore a fedora and chomped on an unlit cigar. His game plan appeared to yelling things like "GO GO GO" and "FIGHT FIGHT FIGHT!!”
“Yours truly” is the Covid Team’s "head coach.” I actually do have a fedora, and when gatherings were allowable, was known to enjoy a cigar at a summer BBQ. And with the volume our team has with Covid cases, the strategy of yelling GO! and FIGHT! has been effective.

Then there is the quarterback- good looking, popular, and pulls off the winning score by overruling the head coach and calling some creative off the wall plays.
Our quarterback Is Dr. Mary DeNicola (Doctor of Nursing Practice).  I hope to avoid political backlash by divulging Mary is my wife of 44 years, as I say she is good looking and popular. And she has consistently pulled off one win after another, fighting off this unpredictable and deadly bug. We form the game- I mean treatment -plan together, but she is on the iPad over 12 hours a day making creative and life-saving decisions on our Covid patients. I know with her “play calling” our patients are in excellent hands.

Of course, every winning team has excellent Special Teams. 

Our OBGYN Covid consultant is Dr. Nathaniel DeNicola, Senior Fellow on Health Economics and Chair of the ACOG Department of Telehealth. Yes, you do see a trend--to be a member of the team it does help to be named DeNicola--and in Nathaniel’s case, my first born son. As a board certified OBGYN, we refer him cases involving GYN issues and all Covid patients that are pregnant.  Yes, they have special needs that require a specialist with Covid knowledge and experience.

Our pediatric Covid consultant is Dr. Cyndy Krepps-Hoffer (another Dr. of Nursing Practice) with the most beautiful South Carolinian accent on Earth.  And astonishingly, she is NOT a DeNicola! She is an excellent clinician with extraordinary diagnostic skills, which is so important with pediatric Covid cases. All Covid related kids issues are referred to Cyndy, under the auspices of the team. Recently, Cyndy diagnosed a MultiSystem Inflammatory Syndrome in a child that previous doctors had missed. This condition hits kids with Covid exposure, yet they do not test positive. A few days in the ICU and -thanks to Cyndy--a life saved.

One roll in all sports movies is the “play by play’ guy. He keeps the audience up to date on the goings-on, and despite trying to be objective always roots for the home team. When they win the big game, he beats up the announcer on his left with a rolled up program, who coincidentally always was for the other team. Our play by play person is Talia Wright. Whew! Another non-DeNicola. Actually Talia's maiden name IS DeNicola, and yes -full disclosure--is my sister. 
Acting as a concierge, she keeps all the patients and providers informed, of appointments and results, late into the night if necessary.  I do not believe she has ever beaten anyone with a program, she can get quite irate when labs delay test results.

Another essential character is the water boy (water person in 21st century jargon). He offers comic relief, always smiling and joking around. He has the uniforms clean, Gatorade handy, helmets painted, and talks the star player into playing in the Big Game despite his girlfriend dumping him.
Our water person is Pam Dukes. Pam is not related by blood, however has been in the DeNicola family almost 50 years and has a permanent smile painted on her face. She keeps the team in good spirits and does whatever it takes to oversee 200 patients with Covid and related conditions. Phone calls, getting the video visits working, tracking down labs, and even making daily runs to TruBru coffee house next door to keep everyone awake. Without Pam, there is no team.

I understand  nepotism invites criticism . But I counter with an iron clad argument--using pizza of course (the Covid Team’s theme). You have all had Pizza Hut--and it is a competent pizza. They are a big pizza system, and have many resources available to them. 

Now compare with the pizza at Tony’s Little Italy in Placentia. Tony’s is family owned and run by Tony Manzella since 1978, with his wife and son (also named Tony).  They aren't part of a big company. Yet you taste the care and passion the Manzella family brings to their pizza--the best I have ever tasted. And I admit to tasting a LOT of pizzas!
I pray our Covid team matches Tony’s results with Covid instead of Pizza.

The team enrolls patients from positive swabs or antibody tests, and referral from friends and other doctors. All visits are conducted by telemedicine, varying from daily to weekly appointments. Treatment protocols are followed and change frequently, depending on what we see working and not working.

We prescribe total isolation while infected. 

And total bedrest. 

We trace close contacts--which we define as being within five feet for at least 15 minutes the 15 days prior to symptoms or a positive test. Yes, we know the two week incubation period and six feet rule. But 5-15-15 is easier to remember. 

Depending on details of the case, we prescribe the "Double Z's" and the Covid Cocktail. (Further described in a previous blog).

Our #1 goal is to have Covid patients die far in the future of something OTHER than Covid. #2 goal is to keep them off of a ventilator. So far, we are batting a thousand on both goals. 

ADVICE?
1.  If you test positive, self-isolate. Do not leave your room. Get under the care of a doctor or team. It doesn't need to be ours. But do NOT attempt to ride it out our on your own. That could be a fatal mistake.

2. If you test antibody positive, prepare to repeat it every few months to ensure the immunity is working.

3. If you have Covid, call all your contacts you were within 5 feet of for over 15 minutes within the past 15 days. Get them tested.

4. If you have Covid and are pregnant or are post-operative from a gynecological surgery, you need a specialist.  If you are positive and are under 18, you need a pediatric specialist.   It does not have to be our special teams but you do need special treatment.

5. Know if you're contagious. Know if you’re immune. Test.Test.Test

This is our Covid Team. We will expand it as the virus grows. We treat aggressively, and change protocols frequently. And we work very hard- no hunkering down for the TEAM.

To end with a word from the coach to the team (with apologies to Herb Brooks)-- Covid Team, great moments are born from great opportunity. You were meant to be here. This is your time. Now go out there and BEAT COVID!!!

Gregg Denicola MD
Chief Medical Officer 
Caduceus Medical Group