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 Volume 12, Issue 25  |  March 27, 2020


Important – possibly life-saving – topics

By Gregg DeNicola, MD 

Chief Medical Officer, Caduceus Medical Group

There is a new phrase I’ve noticed being used regularly.

It used to be that when discussing planning, we would mention a time frame. Want to plan a vacation? Maybe in the fall. Try the new sushi place? Let’s go next month. Go wine tasting? Next weekend!

Now the answer to all of those ideas is the same – “after all of this is over.” Six short words that express despair, hope, and concern all at the same time.

I want to discuss three important – and possibly life-saving topics. 

--A plea to not ignore your normal health care needs 

--Whether to advise the new therapies being touted 

--The need to test – real or overblown?

I noticed about 10 days ago a patient I am treating for an irregular heartbeat had canceled the appointment he has every six months to keep an eye on it. He has been stable for years. Concerned, I called him. He said – you guessed it – he wanted to hunker down, and he would reschedule “after all this is over.” I convinced him to convert the office visit to a video visit. He needed blood done, since he was also on thyroid meds, which could affect his heart rate, and his blood sugar was always in prediabetic range. We arranged a curbside blood draw a few days before the video visit. And sure enough, his thyroid level was too high, requiring a lowering of his thyroid meds. Unchecked, it easily could have led to a serious arrhythmia. His blood sugar was also higher than usual, which he admitted was due to increased snacking during his “hunkering.”

It is obvious that high cholesterols stay high during a pandemic. Fatty livers are still fatty and need their blood tests to check them – moles do not stop their progression to melanoma just because Mr. Newsom tells us to stay home. 

With video visits and curbside phlebotomy, all of these can be evaluated and watched over via telemedicine. We have been doing telemedicine at Caduceus for over six years with excellent results. Of course, there are situations where the patient must be seen in person. Since our lobbies and rooms have been infection free for a while, it is still safer to be seen by your doctor than letting your non-COVID health suffer.

The moral? 

Keep your appointments. Convert them to video. Have your blood drawn curbside. Not waiting until “all of this is over” is even more important than preventing the spread of the virus. And it is even more essential than a trip to Costco.

I have examined the evidence to use Hydroxychloroquine for COVID cases and it is promising. We have been using it at Caduceus to treat swab positive cases, but it is very hard to find. Some pharmacies are concerned they are depleting their supply which will lead to Lupus patients not being able to refill their prescriptions. Others say they don’t agree with the indication. Yet others simply deny having any. There is little question to me the risk/benefit curve points in favor of its liberal use in positive cases. If there are no symptoms (e.g. the patient was returning from Europe and tested positive but has no symptoms) it is not indicated. 

For any physicians reading this, the dose is 400 mg BID x 1 day, then 200 mg bid x 4 days. Warning: you will need to call around and be prepared to beg. 

Also, Proteus Inhibitors have shown activity against COVID. You may have heard of them as an HIV med, but current guidelines reserve their use for cases admitted to the hospital.

Both WHO and CDC are advising us against the use of Tamiflu for COVID, as well as NSAIDs like Ibuprofen. More importantly, they also advise against the use of steroids, such as Prednisone or a Medrol Dosepak. 

The moral?

Although there is no consensus from the specialists on this, as Chief Medical Officer (CMO), I advise the routine use of Hydroxychloroquine for all swab positive COVID cases with symptoms. It is not to be used preventively.

No other drug therapy is currently advised, unless admitted to the hospital.

I am sure most of you know Caduceus and PDQ Urgent Cares have been testing for over a week now. The first day we allowed in-office testing, but soon saw the need to test people in the comfort of their homes and cars. A video visit is required to receive the order from the provider, then the patients are directed to one of our three curbside locations in Orange County to be swabbed. Results currently take two to four days. This process is being replicated by other medical facilities within the county. But it is not enough.

I speak here as a private doctor with 40 years of experience, not as a spokesman for Caduceus. We need to test everyone with symptoms or at risk due to exposure. Caduceus has done over 350 swabs so far, but we could have done thousands if we had them.

I must respectfully disagree with Washington officials who say if you don’t have symptoms, you do not need to be tested. It is very easy to spread this virus

without symptoms. Not every COVID patient knows how they were exposed.

The problem with comparing this to the flu, or almost any other virus, is that it has such a long incubation period – for non-nerds that means you can spread it without knowing you have it. And its penetrance is very high – for non-nerds that means it is very easy to catch it, no matter how good your immunity. To our immune systems, this is a total stranger they have never seen before, which makes fighting it very difficult. 

These are the reasons we are seeing it spread like a wildfire, and why officials demand quarantining of everyone to control it.

Worse, it is not true that only the old and infirmed are at risk for dying. The last two deaths I am aware of were a 35-year-old and a 24-year-old. It appears COVID is a “lung eater.”

If it stops at a sore throat or a bronchitis, there is full recovery. But 10-20 percent of the time, it goes into a full pneumonia, causing a SARS picture. This is more common in vapers. It makes more and more mucus and fluids, which doctors cannot always keep up with. These victims literally drown while in ICU. 

Despite this plea for more tests, I want to caution against the new “at-home” test kits. User error is one issue, and the accuracy is suspect. There are already knock offs that are not FDA sanctioned. They may be perfected soon, but as of now, I’d avoid them.

Caduceus is working toward a point-of-care test – for non-nerds that means you get the results while you wait – we can do curbside. Until we can achieve this, we will continue to ask for swab test kits to test as many as possible.

The moral? 

Don’t count on your immunity to save you. Don’t use the new at-home tests quite yet. If you are sick or have been exposed, get tested. We will help. Only by testing as many people as possible can we get our lives back – after all of this is over. 

Caduceus Primary Care and Urgent Care is located at 333 Thalia St.

For more information on Caduceus Medical Group, go to www.caduceusmedicalgroup.com or call (949) 499-0577.

 

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