Blog

We recently marked the one year anniversary since Hurricane Ian came to Central Florida and wreaked havoc on our homes and businesses. So many of you have described how your homes and were terribly damaged and many of you are still waiting to be made whole. Weirdly, much of our county was under flood watch now, with and our garage filled with several inches of water, initiating a needed purge to the curb. Reflecting on the last 12 months, we have seen much personal, local, state, national and global upheaval—testing the resilience of us all.  Our practice at Twin Lakes, saw the exodus of three partners and the doubling of our call and overhead for the remaining partners. We feared that we could not maintain care for group’s patients and anticipated divesting of a number of insurance plans. One year later, we have grown by five new providers—twophysicians, one midwife, one physician assistant and one nurse practitioner. All five of these women come to us with energy, experience and passion for women’s health. We have been able to accommodate our existing patients and new patients and are excited to be thriving. It was necessary to end our relationship with Humana and we encourage our Human Gold to change to another Medicare Advantage Plan with the coming open enrollment. Pregnant moms who are using Medicaid Insurance should proactively choose United Health Care, as the only private Medicaid that we can participate with. As the elder physician, I can look at how these providers who,along with the young Drs. Tyser and Esquivel, represent a younger, highly trained and savvy side of health care. I know they will do amazing things when I do decide to be a full-time grandmother. Another grandbaby is on the way (this time in Minneapolis) and we are thrilled. Reducing my hours is an inevitable necessity in my sixties, as I move a little more slowly, need to sleep a little more and look to complete a few more passion projects before retirement in about five years. And as I see fewer patients in the office, I depend more upon my amazing physician assistant Ashley Clark. Some of you who have been with us thirty or more years have been surprised to see a physician extender/midlevel (neither term does them justice) when I or Dr. Tyser are in the hospital or otherwise out of the office. Both Dr. Tyser and I have providers at our side, trained to have our mindset, who are experts in care and compassion, and often your choice at the next annual. They enable you to have a considerably shorter wait time, and should any issues of concern be identified, they will get you in to see Dr. Tyser or me quickly. Sometimes we are behind, and you can choose to see Brittany or Ashley, or you can wait until we catch up. Other times, we are out of the office for deliveries or delays in hospital care and you would need to reschedule in order to have the physician. We hope that you see this as a win-win for both you as patients and for us as providers. We are very proud of our mid level peers and welcome any thoughts you may have. We are a large practice and we receive hundreds of calls daily. Please give us 72 hours to fill prescription requests! Also, calling multiple times in the same day, when your provider may not get to your message before the end of the day will actually delay our response, as charts must move back and forth from our phone room to our physicians’ desks with each call. We will do our best to address these non-emergent calls within 24 hours. For those issues of urgency, know that the clerical staff brings them to the providers’ attention in real time. There is a new class of medication now available for unacceptable hot flushes and night sweats. Neurokinin Receptor Antagonists are non-hormonal alternatives that work immediately and can be game changing for those who cannot take estrogens or find that estrogens do not relieve their symptoms. Like so many new medications designed for women, there is a disconnect between what is available and what insurance carriers will cover. Medications for menopause and incontinence are too often considered “life style” choices and categorically denied. While newer does not necessarily mean better, the newer medications for hot flushes and overactive bladder are novel, have great safety profiles and in a less misogynistic world would be affordable for all women needing them. Until that happens, be patient with us while we fight the battle of prior authorizations and non-formulary exceptions. Our legislators averted a government shutdown in the last hours of September—avoiding a terrible consequence for our most vulnerable moms and babies who depend on WIC for formula. Even so, the need outpaces the capacity of the WIC program to enroll moms right away. We have too many moms in our community who are diluting formula, unable to get a specialized formula, or using cows milk. We strongly encourage breast feeding, but for some moms, it is not possible. Consider small directed donations (gift cards work great) to our health department or Healthy Start—or to a mom you know, to help babies receive the correct nutrition without delay. Let this holiday season be one where your awareness of the challenges faced by so many does not overwhelm or paralyze you, but encourages you to feel gratitude for the people and places you have. They are precious and impermanent and need your attention.

This is an excellent description of what is a cautionary tale. Please consider these bullet points: Ten percent of people infected with SARS CoV-2 may be responsible for 80% of infections. “Super spreaders” are profiled as young, social and often asymptomatic. SARS CoV-2 is believed to be infectious for 4-9 days, except when it isn’t: there is debate that asymptomatic spreaders may not mount as strong a response as those who develop symptoms to which their immune system then responds. Therefore they may not clear the virus from their bodies as quickly as those who fight the virus While most SARS CoV-2 infections are passed through contact with respiratory droplets (such spread is greatly reduced by the wearing of masks), some super spreaders may aerosolize the virus in large amounts, meaning it will spread through air-conditioning ventilation systems and at greater distances than 6 feet in contained spaces. The good news to take away from this long, but highly informative article is that “Super spreaders” are not common. They are likely infectious for a short period of time, but highly infectious during that time. Avoiding large indoor gatherings and the encounter with an unexpected “Super spreader” can impact the spread of this pandemic and it can save your life and the life of someone you love. Not addressed specifically in the article, is the point that respiratory droplets containing viral particles are greatly inhibited by the wearing of masks—any masks. The concern over build up of carbon dioxide behind our masks has not panned out to be an issue in operating rooms or cities across the world that have worn masks seasonally for decades. There is no ADA proclamation that wearing a mask infringes on the rights of any disabled person. That is not a thing. One of my dear patients of 30 years came in with her oxygen tank and her stylish, decorated mask. In our office, where we see up to 200 women daily, with many pregnant, elderly or others who are experiencing various high risk conditions, we must maintain an abundance of caution. A mask is required to enter our office. We ask you to keep it on, even when you are alone in an exam room. Please do not wear gloves. We are wiping down all surfaces between exams and using Lysol aerosol in each room, after each patient. We will be happy to fax your order slips directly to your lab or imaging center to avoid coming in. We will renew medications (whenever possible, if you choose to postpone your visit to our office. Please call us 72 hours in advance, if you know you do not intend to come in for your visit!!!!! We need that time slot for other patients! Please be patient with us, regarding ”call backs.” We are working with fewer staff, who are required to serve more patients than in the past. When you call repeatedly during a single day about a single concern, it interferes with our ability to address everyone’s concerns timely, accurately and kindly. Minors may be accompanied by a parent or guardian. To help clarify testing options 1) A “point of care” POC antibody test is the test commonly performed at testing sites and medical offices. It works much like a home pregnancy test and indicates the presence of antibodies to the virus by revealing a colored line on a test strip. This does not indicate the presence of active virus or infectivity! It indicates previous exposure and creation of immune antibodies. 2) A “point of care” POC antigen test looks for proteins made by the virus when it “hijacks” our cells to do so. These are nasal or oral swabs that can give a result in 15-30 minutes and are reasonably accurate. They are difficult to obtain because of very high demand. 3) A PCR test, obtained by submitting to an uncomfortable nasopharyngeal swab looks for viral RNA in the cells of the upper respiratory tract. While very accurate at detecting small amounts of viral coding material, the result depends on the collection of an adequate sample from the infected area. Because of demand, the “turnover time” (from collection to reporting result) can be 7-10 days or longer, as reagents, equipment and manpower are not keeping up with the numbers of samples in the system. Testing availability varies considerably among different locales and different times. Call ahead to see if and when appointments can be made. Because testing is not available to many needing confirmation that they are virus free before leaving quarantine, the CDC states that three days without a fever (on no anti fever medications) or waiting 10-14 days after initial symptoms should be adequate time to avoid being infectious. None of our current protocols, recommendations, predictions are carved in stone. Science, and especially the science and art of medicine are fluid. My father taught medical students for 50 years and repeated the well known meme “Fifty percent of medical knowledge that we teach you will change, and we do not know which 50% it is…” And so it goes with COVID-19. Dr. Pamela Carbiener Source: https://www.washingtonpost.com/health/2020/07/18/coronavirus-superspreading-events-drive-pandemic/