Dr. David Singer(Board Certified in Internal Medicine)

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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?

Clearly THERE IS STILL A LOT WE DON’T KNOW ABOUT THIS VIRUS!

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
      symptoms.
    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

Hello!

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.