So, what do you think about COVID, Doc?

I'm writing this post as a response to a question I am now getting multiple times a day working in a clinic in Pantego. With this pandemic currently underway, the media bringing fear and panic into the lives of many individuals, I thought I would do my best to stick to the facts.

What is COVID-19?
Coronavirus disease 2019 (COVID-19), is a respiratory virus that can spread from person to person. Since it is a virus, this means that antibiotics do not kill it, and that we mostly need to manage the symptoms. COVID-19 was a novel virus that came from Wuhan, China.

How does COVID-19 spread?
We believe that COVID-19 originally mutated from an animal source, and now has been spreading from person to person. The virus can spread within people that are in close proximity (6 feet or less), through respiratory droplets when a person coughs or sneezes. It is also possible that the virus can stay dormant on surfaces where a person touches, and then an individual touches that surface, an touches their face, they can potentially get the virus.

How many cases are there in the world of COVID-19?
Uptodate counts of where COVID-19 is.

What does it mean to be in a pandemic?
According to the World Health Organization, a pandemic is declared when a new disease for which people do not have immunity spreads around the world beyond expectations.

What does it mean to be in a state of emergency?
This means that local officials are working together to contain and diminish the amount of possible cases. This means that various events that would have large groups of people coming together are currently postponed until further notice.

What symptoms should I be watching out for?
Patients with COVID-19 have had mild to severe respiratory symptoms, along with

• fever
• cough
• shortness of breath

In severe cases, this can lead to pneumonia in both lungs, multi-organ failure, and death.

How can I help prevent the spread of COVID-19?

• Avoid close contact with those who are sick.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Wash your hands with soap and water for at least 20 seconds. If you cannot wash your hands, use alcohol based sanitizer that contains at least 60% alcohol.
• Stay home if you are sick.
• Cover your cough or sneeze with a tissue, then put the tissue in trash.
• Clean and disinfect frequently touched objects and surfaces.

What steps are in place to prevent the spread of COVID-19 at Transcend Medical Group?

• We now have the testing capability for COVID-19 at the Randol Mill location.
• If a patient comes in for testing for strep, respiratory panel, or flu, we are now keeping them in their exam room until the test is completed.
• We are sanitizing surfaces more frequently.
• We are encouraging our employees to wash their hands frequently.
• For the COVID-19 testing, we have one employee testing patients, and that employee is wearing protective equipment.
• We are currently partnering with UT Southwest to monitor the current outbreak of COVID-19.
• Dr. Harbison will be employing fist bumps with patients, since that decreases the spread of germs by 90%, and she will continue to frequently sanitize her hands and wear gloves, when appropriate.

What should I do if I, or someone I know, is concerned they may have it?
They should go to their closest medical facility that has testing available for COVID-19. You may call your local ER ahead of time to ensure the testing is ready. Or, you can go to our main campus on Randol Mill and Davis.

What online resources are available for individuals?
Please see this link to be connected with the World Health Organization's page with factoids about COVID-19.

I hope that this post alleviates some fears. If you, or others, have any questions about COVID-19, please do not hesitate to ask a doctor you trust.

Weight Loss

Some folks may or may not remember that I have been working on my own weight loss for awhile. I have been attempting to eat more healthy food, like munching on peanut butter and carrots, while still having ice cream occasionally. I have also gotten back into running, and have been successfully running for a few months. I have noticed a slight decrease in my weight, by about 10lbs, which is very encouraging. Some people are unable to do even that, and may need medication to help. That's where it helps to have a doctor on your side.

One of the cheapest forms of weight loss medication that does work is called Orlistat, also known as Alli. You can even buy it over the counter. How this one works is that it does not allow your body to digest fat, and instead of digesting it, your body completely excretes it with your feces. This causes fatty bowel movements, and occasionally patients have issues with being able to control their bowel movements, meaning that they may soil themselves. Hence, it's affordable quality. I don't tend to recommend this to patients unless they are okay with that possible side effect and they have a bathroom nearby.

Another medication is called Victoza/Saxenda. This is a diabetic medication, that is an analogue (man-made version) of the GLP-1 hormone. This hormone is the one that triggers your body to let you know that you are hungry, and to get more glucose into the body. By taking this class of medication, your appetite is decreased. It is an injection that has to have doses adjusted over time. It can work, as long as the patient is okay with doing injections, and okay with the possible side-effects of nausea and upset stomach. Also, since insurance companies are not the easiest things to work with, this can also be quite expensive. It is a good idea for patients that are either diabetic or prediabetic because it will lower your blood sugar readings as well.

If needles are not for you, another option is a medication called phentermine. This is a controlled medication, because of possible addictive qualities to it. Due to the controlled nature, patients have to come in monthly for medication refills. It does work as an appetite suppressant. However, this medication can only be used safely for 12 weeks at a time. "Phentermine is not approved for long-term use. Clinicians should carefully examine the potentially benefits against potential risks associated with use of medications in this class. Consult weight loss guidelines for current pharmacotherapy recommendations. Therapy should be used in conjunction with a comprehensive weight management program." It will work, but should only be used for a short term period.

Another option is a medication that called contrave. It is a combination of bupropion and naltrexone. Bupropion (wellbutrin) is an antidepressant, which also helps diminish appetite. It can help with mood, and with quitting smoking. This medication should not be used if the person has ever had any issues with seizures, because it lowers the seizure threshold (the likelihood of a seizure occurring). This medication also has to be titrated over time to help with weight loss. This medication tends to be well tolerated and can be used for longer periods of time. This is an expensive medication, but through the company's website, they do offer a deal of only paying $99/month.

The final medical option of a pill, and not surgery (which is a whole other discussion), is called qsymia. Qsymia is a combination of phentermine (at low dose) and topiramate (a medication commonly used for migraine prevention). The combination is good at decreasing appetite. This medication has to be titrated over time and is safe for longer periods of time. This is also expensive, but the company has a deal of paying $99/month if you use their portal.

Contraception

What you may not know about me, is that the uterus is my favorite organ.

I love all the things that the uterus can do. I love helping women get pregnant, taking care of babies, and helping women prevent pregnancies when they are not wanting to have a baby. Today, I would like to talk about the options for contraception.

First, a helpful chart:

This shows that family planning (going off of your cycle), and spermicide, are the least effective methods of birth control.

Next comes barrier methods, which still have a high fail rate.

After barrier methods, are the prescription medications, that a lot of women are interested in.

There are combined oral contraceptive pills, that still have a fail rate of 9%. This rate is so high because it is hard to take a pill every single day, and there are a fair amount of medications that do interact with oral pills.

Then there is the depo-provera shot. This is effective for 90 days at a time. It has with it an associated 2-4lb weight gain, and can cause some osteoporosis, which tends to be reversible after the medication is stopped. It has a fail rate of 6%.

Next come two rings. One is the NuvaRing, which is a vaginal ring that is placed inside the vagina for 3 weeks at a time, and is removed after 3 weeks to have a period. It has a fail rate of about 9%. Women need a new prescription after every month to get a new ring. Some women complain about the fit of the ring. Next, is a different ring called Annovera. With this ring, it is very similar to the NuvaRing, but does have some advantages. With one prescription, one ring, the woman can use it for 13 months. The ring goes inside for 3 weeks, and out for 1 week, like the NuvaRing, but then she washes it, and uses it again for the following month. With the Annovera, it tends to cause less weight gain because of the way the hormone is derived. It is also a lot cheaper because you are only needing to buy the prescription once. Also, it's fail rate is only 2%, a lot better than NuvaRing.

Annovera

Sterilization is the next most effective, with the vasectomy for guys and the tubal ligation for women.

Surprisingly, both the IUD and the implant are more effective than the surgeries, and they are also reversible.

For IUD, there is the Mirena. It goes inside of the uterus and thickens up the mucus keeping semen from going inside of the cervix. It can prevent pregnancies for 5 years. It has a fail rate of about 0.2-0.5%.

And lastly, the most effective method of birth control is the Nexplanon. It is a progesterone only small 4cm rod that goes right under the skin in your arm. It can help prevent pregnancies for 3 years, and has a fail rate of 0.28%.

Nexplanon

All of these forms of birth control can also be effective methods in helping control periods, making them less frequent, less painful. Feel free to contact us directly if you want to learn more.