Dr. David Singer(Board Certified in Internal Medicine)

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February 24, 2021

COVID-19 Update


I wanted to take this opportunity to bring you up to date on the most recent developments regarding the COVID-19 pandemic particularly in regard to the vaccines which thankfully are now available.

As most of you may be aware, there are two vaccines currently available in the United States; one from Moderna and the other one from Pfizer. Many of you have had questions regarding several different aspects of the vaccines and vaccination process.

I would like to try to provide some information regarding these issues. First of all, let me say that these vaccines are known as Messenger RNA (MRNA) vaccines and this means that they do not contain any live virus!

There should be no concern whatsoever about the vaccine being able to “give you COVID.” This is not possible.

The vaccine works by making the immune system of the recipient respond as if they were exposed to the virus thus producing antibodies of various types which have been shown in multiple studies to reduce the risk of serious illness if one does contract COVID.

The side effects from vaccination so far have been quite limited from no reaction at all to some soreness in the arm at the site of injection to one or two days of flu-like symptoms which are usually gone by the 3rd day. Most people who receive these vaccines will not experience any significant side effects and only approximately 15% of people will experience the flu-like syndrome described above.

Many patients have asked me,
“Well, which vaccine is better?”
“Which one should I get?”
Fortunately, it really doesn’t matter. Both of these vaccines are equally efficacious in providing protection from serious COVID-19 illness.

Moreover, it is more than likely that none of us will have a choice since there is still a serious shortage of available vaccine at the current time – although this situation will hopefully improve soon. The drug companies and the government are working hard to ramp up the supply and, hopefully, within the next few months the vaccine will be much more readily available to all of those who wish to receive it.

I am sure that many of you have been aware via news reports that the virus has been able to mutate or change its structure thus accounting for what are known as “new variants.” There is some concern that perhaps the vaccines are not as effective against the new variants. However, early studies seem to indicate that although this may be the case, they still are effective and will provide good protection.

In addition to the two current vaccines, Johnson & Johnson has announced a third vaccine which is currently undergoing approval by the FDA. The J & J vaccine requires only one injection compared to two doses required by the Moderna and Pfizer vaccines.

This J & J vaccine also has the advantage of being more easily stored and it is possible that this vaccine may be available in doctors’ offices for administration, although this is not certain at this time.

Most likely these vaccines will be distributed via pharmacies and at inoculation centers (super centers) and I would certainly urge you to get a vaccine as soon as it is available to you.

However, there are some exceptions from the CDC as to who should NOT receive vaccinations at this time. For example, if an individual has a history of severe anaphylactic-type reaction to bee stings or other allergens, it is not recommended for those individuals to receive the vaccine at this time.

Also, pregnant women need to discuss the advisability of receiving the vaccine with their physicians.

In summary, I believe we have entered a phase in our battle against COVID-19 which is going to prove to be effective in finally turning the tide and allowing us to get back to a more “normal” way of life. In the meantime, however, even after you have been vaccinated , you need to continue following the CDC guidelines of social distancing, frequent hand-washing and most important of all, WEAR YOUR MASK!

Finally, I do believe, that things will get better and hopefully we will finally gain a good degree of control over this pandemic.

Stay healthy, stay safe and please, keep following all the necessary precautions.

Dr. Singer

July 20, 2020

Hello again!

As time goes on, I wanted to give an update on some of the peripheral issues regarding the ongoing COVID-19 virus. As you are probably aware, this contagion continues throughout the United States (and the world) with varying degrees of success in terms of control.

Unfortunately, we here in the United States, and particularly in California, have continued to see surges in both the number of positive tests, as well the number of hospitalizations. Although, in some cases, some areas of the United States have been able to control, and even lower, their case rates so far. In the not too distant future that should surely reduce the severity of this pandemic.

We are still hopeful that there will be both therapeutic treatments that will be available to either modify symptoms of the disease, or prevent or reduce, the likelihood of contracting the disease at the onset. And also, of course, we are all awaiting and hoping that a vaccine or vaccines will become available.

In the meantime, however, it should be pointed out that medical problems such as high blood pressure, diabetes, heart disease, arthritis, etc., all continue to require evaluation and treatment but are currently being neglected for a variety of reasons.

There is a fear among many individuals that were they to seek medical attention that it may expose them to the virus and this has limited their follow-up and access to medical care. While there is always some risk, I would like to remind you that you should not neglect your ongoing health issues and care !

Also, it is important to let you know that our office is open and seeing patients, although we do require all patients wear masks when coming to the office, if anyone has had any contact with a known positive COVID-19 patient they need to let us know of that in advance of any office visit. So far, we have not had any active COVID-19 patients in our office.

Below I would like to add some reminders in regards to COVID-19. First of all, be aware that the overall incubation period is approximately 14 days, while the average time from initial infection until symptoms occur is usually four to five days (although symptoms can occur later, if at all).

As a reminder, the most common symptoms of COVID-19 are the following:

    1. Fever
    2. Chills
    3. Cough
    4. Shortness of breath or difficulty in breathing
    5. Fatigue
    6. Fever
    7. Muscle or body aches
    8. Headache
    9. New loss of taste or smell
    10. Sore throat
    11. Congestion or runny nose
    12. Nausea or vomiting
    13. Possible diarrhea

Also, just some reminders regarding the proper use of face coverings:
Face coverings should cover both nose and mouth to protect both you and those around you from the spread of infected droplets.

Remember! Both your nose and mouth need to be covered! So please, do not pull your covering below your nose. Avoid touching your eyes, nose and mouth as much as possible.

    1. Wash or sanitize your hands as often as possible and before putting your face covering on
    2. Try not to touch your face once you have put your mask on
    3. Try to change your face covering as often as possible but at least daily
    4. But if that is not possible, as often as you can but if it is a single use, you should discard it after wearing it

I will keep you posted as we deal with this ongoing illness and hopefully begin to see progress soon. Stay safe and stay healthy.

We have all heard it but I cannot stress it enough:

Help stop the coronavirus!

    1. MASK Wear a face covering n public
    2. HANDS Wash them often
    3. ELBOW Cough into it
    4. FACE Don’t touch it
    5. SPACE Keep six feet apart

May 1, 2020

Coronavirus Update

As the COVID-19 pandemic continues the daily statistics from the media regarding new cases, hospitalizations, and death rates is nonstop and makes us feel uneasy, anxious, and afraid. As I mentioned in previous columns part of the reason for this continuing distress is the longer this pandemic continues the more mixed messages we receive.

In today’s column I would like to discuss aspects of testing and its ramifications. Other than the fact that most agree that testing is important there is considerable confusion regarding testing procedures and the results of the tests themselves. Part of the problem arises from the fact that there are different manufactures of tests and that the tests measure different things and are also performed differently. Also in question are the varying times and availability for getting test results. For example, many tests are done in a drive thru “testing site” in which nasopharyngeal samples are obtained. Other tests are done with a simple collection of saliva from the oral cavity (thus requiring the nose to be penetrated). Also, reliability is an issue, since there have been reported cases of both false positive and false negative results. Following are some of the current difficulties in regards to testing;

    1. Was the test performed “too soon” to developed positive results?
    2. If an antibody test is positive does this mean the patient has immunity?
    3. Is there a level of antibodies that is needed to provide immunity?
    4. If a person has immunity how long does the immunity last?
    5. If a patient has immunity can the patient be re-infected?


Despite the continuing and somewhat conflicting data, I still remain fairly optimistic. I believe that ultimately the control of this pandemic will occur when we either have an effective therapeutic intervention, an effective vaccine or both. Also, I am fairly confident that these will be achieved sooner rather than later.

Finally- please keep your spirits up in this difficult time and keep in mind that we have the best scientists and researchers in the world working feverishly on treatments and vaccines for this pandemic.

I will continue to try to keep you updated as further new developments occur as they surely will.

March 24, 2020

Coronavirus Update

By now I am sure all of you are aware of the pandemic that is the coronavirus and how it has in so many ways impacted us, not just physically, but also economically and emotionally. Indeed, it is difficult, if not impossible, to keep up with the never ending stream of information (and unfortunately, sometimes misinformation) that we hear and see all around us from the media, friends and colleagues.

I think for most of us the biggest fear maker is the unknown. Sadly, with this disease there are still quite a few unknowns:

    1. How bad can it get?
    2. Can you get the disease more than once?
    3. After symptoms abate, will there be any lasting effects on our health?
    4. Will this disease go away or will it be with us forever?

Because these and so many other questions remain unanswered, it is natural to expect fear and stress levels to rise. Here are a few things you might consider doing to lower your stress levels:

    1. Clean out that closet you have been meaning to organize
    2. Send a card to a friend to let them know you are thinking of them
    3. Dust off that book (or Kindle) you have been meaning to read
    4. Transport yourself with far flung films such as Mamma Mia!, Planes, Trains and Automobiles, Sideways, Roman Holiday, The Grand Budapest Hotel
    5. “Face time” with your children/grandchildren/friends

Here are my thoughts:

My 40 plus years as a physician as well as my clinical experience with similar outbreaks, leads me to be hopeful. I do believe that in time medical science will find a way to tamp down, if not eliminate this scourge that is COVID-19. There is a high likelihood that a vaccine will be developed which will provide significant immunity for most individuals and that even sooner there will likely be medications to treat those who do become infected.

Despite the high level of anxiety, I would urge all of us to keep these things in mind and remember that we have come through similar epidemics in the past and I feel confident we will do so again in the future.

Please be well and know that I will stay in touch.

March 2020

Coronavirus aka COVID-19

What we know and what we don’t

Coronavirus is a member of the coronavirus family which consists of several related viruses which differ in their genetic and DNA
makeup. There are four human coronavirus that occur worldwide and account for 10-30% of upper respiratory infections in adults.
Previous global epidemics caused by coronavirus family include the SARS virus in the Middle East and MERS virus which emerged
from animal reservoirs to cause global epidemics with alarming morbidity and mortality. On December 31st, 2019 Chinese
authorities reported a cluster of pneumonia cases in Wuhan China, most of which included patients who reported exposure to a
large seafood market selling many species of large animals. This appears to be the origin of the coronavirus spread to humans.
The situation with coronavirus is evolving rapidly, and the case count currently is growing in to the thousands.

What do we know about the virus currently?

    1. We know that human to human transmission is occurring and occurs with relative ease.
    2. We know that the most common clinical symptoms appear to be similar to those of the flu with stuffy nose, cough, fever,
      and can proceed to acute respiratory distress (trouble breathing).
    3. So far it appears approximately 80% of individuals that contract the virus remain symptom free or develop only minor
    4. We know that the disease can cause fatalities and so far this appears to occur in higher risk individuals which include
      those with compromised immune systems, especially in the elderly.
    5. The current estimated mortality rate is approximately 3% but this may change as the number of cases increase with the

What can we do to reduce the risk of coronavirus?

    1. Frequent hand washing, avoid touching faces and avoid large gatherings in areas where coronavirus has been identified
      (the current recommendations of using the mask including the N95 mask is controversial in that some health authorities
      believe this would not significantly reduce the risk of transmission).
    2. If you become ill and not in any acute distress it is recommended by the CDC and health organizations that you stay at
      home if possible i.e., avoid work, school, etc.

What we don’t know.

    1. Will this virus repeat the pattern of previous flu type viruses, that is waxing and waning during the winter and
      summer months?
    2. How long will it take until we are able to provide a therapeutic treatment for the virus?
    3. How long will it take for researchers to produce effective vaccines for this illness?
    4. What will be the economic i.e., non medical consequences of a worldwide viral epidemic?

Final word: Whenever we are faced with a new medical illness that is wide spread and of uncertain consequence it is normal
to be concerned. Hopefully, if we all follow sensible infection precautions i.e., hand washing and avoiding areas with high rates
of infections, we can reduce our risk of illness. I believe with proper public health efforts and cooperation as well as with the
research that is being moved into high gear to combat this illness, it will be controlled like similar infections in the past.

July 2019


Thank you for visiting our website! I hope you’ll find it helpful and informative, but I want to add my own thoughts.

Medicine today has become less and less personalized perhaps because of technology, computers, and the time-stressed pace of our lives. There is often little chance for person-to-person time.

In all my years of practice, I have tried to consistently fight this trend. The time I spend with patients in my office is one of the best parts of being a doctor – and so – over the years for myself and my staff, our patients have often become like family. And I like it that way!

As a result, I think you’ll find a very different patient experience and vibe when you visit us. My staff and I are looking forward to your visit.

Take good care!
Dr. Singer

PS: From time to time, I will be posting topics that I hope will be of interest.
Stay tuned!

September 2019

Shingles Q and A

What is Shingles?

Shingles is a viral illness caused by the Herpes Zoster virus which is the cause of chicken pox illness. Unfortunately, after the resolution of chicken pox, the Zoster virus “hibernates” within the nervous system of the body and at a later time it can reactivate and cause the clinical syndrome we know as Shingles.

Q: What causes the virus to reactivate?

ANS: There can be a combination of factors including stress, immunodeficiency, chronic illness, and advancing age. Because the immune system generally declines with advancing age (especially after 50), those advancing years put individuals at increased risk of developing Shingles.

Q: What are the signs and symptoms of Shingles?

ANS: Shingles generally presents as a painful blistering rash usually on only one side of the body that may involve the upper torso, the scalp, and even the eye on the affected side. Although it is possible for Shingles to occur on both sides of the body, this is rare. Shingles can be extremely painful and can be associated with fever and other symptoms such as fatigue and headache.

Q: Is there treatment for Shingles?

ANS: Yes. There are medications that can be quite helpful when treating Shingles, however in some cases although the signs of the rash may disappear, pain may persist for a long time following the resolution of the rash.

Q: Can I catch Shingles from someone else?

ANS: No! Shingles is a reactivation of Herpes Zoster Virus in the body, you do not “catch it” from someone else!

Q: Is there a way to prevent Shingles?

ANS: There currently is a vaccine available “Shingrix” and it is a series of two injections which can boost your immunity and decrease the risk of developing Shingles in the future.

Q: Will the vaccine cause Shingles?

ANS: No. The Shingles vaccine does not contain any live virus and cannot cause Shingles.

Q: Can I get Shingles again?

ANS: Yes. Possible but rare!

I hope this provides some additional information for you regarding Shingles and it’s complications and treatment.

If you have other questions please don’t hesitate to discuss them with me at your next visit.

December 2019

Holiday Stress – Manageable?

One of the things that most people can count on entering the holiday season in addition to the fun of meeting with family and friends, celebrations, special meals, etc. are generally higher than normal levels of stress. One of the things I have learned over my years of practice is that stress can cause just about anything! For example, the more research that is done on stress and how it affects the body and the mind, the more we learn about how significantly important a factor this can be. In the holiday spirit I made a list (not Santa’s List!!) of some of the things that stress can do:

    1. Increase blood pressure
    2. Increase heart attack risk
    3. Damage the immune system
    4. Cause multiple gastrointestinal illnesses (including ulcers)
    5. Insomnia
    6. Irregular heartbeats
    7. Depression
    8. Memory difficulties
    9. Generalized fatigue
    10. Just feeling “lousy”

These are just some of the things I have seen over the years, especially when holiday time comes around. So the question becomes, are there things we can do to moderate if not eliminate the stress of holiday times? And yes, there are things that we can do, although reducing all holiday stress is probably unrealistic. But here are some suggestions.

A significant part of holiday stress is related to feeling overwhelmed by “all the things we have to do” during the holidays. For example, shopping, planning get-togethers, sending out holiday cards, etc. It’s easy to get overwhelmed! Try to keep your holiday expectations somewhat tempered. This may allow you to avoid those out of control feelings, which are a significant factor in increasing our stress level. Also, try to stick to a routine. This can be difficult during the holidays, but continue to do some exercise and try to get your usual amount of sleep. Of course, there are also traditional things such as meditation, which may be helpful to some.

The bottom line is that stress is an inescapable accompaniment of the holiday season, but being aware of what stress can do and trying your best not to let it overwhelm you would be an excellent approach to get through the holiday season. I hope this helps – at least a bit.