2021’s Top 5 Tips to Reduce Health Insurance Fees like Copays, Coinsurances, Deductibles

How to reduce or eliminate health insurance fees copays, coinsurances, and deductibles in 2021?

By Natan Schleider, M.D. Written February 27th, 2021 4 minute read

This is a sample claim I received from my insurance company saying I owed 70 dollars. The insurance company is wrong.
A REAL CLAIM FROM EMPIRE BLUE CROSS BLUE SHIELD I RECEIVED.. SEE WHERE It SAYS YOUR RESPONSIBILITY IS 70 DOLLARS. THAT IS WRONG! I AM ENROLLED IN A COPAY ASSISTANCE PROGRAM. I OWE ZERO DOLLARS!

The above insurance paperwork is what patients may get in the mail. It looks like a bill and patients freak out.

Health insurance is complicated. How many patients can define a copay, know what coinsurance is, know what a deductible is? In my experience not many.

As a patient, the doctor’s office either accepts my insurance or or does not.

Well it is not that simple. For example, many patients have plans called PPO insurance plans that allow them to see doctors ‘Out of Network’ meaning that doctor does not have a contract with their insurance company. These plans, which tend to be more expensive and better plans, allow patients to see a larger number of doctors.

2021’s TOP FIVE TIPS TO REDUCE OR NOT PAY COPAYS, COINSURANCES, OR DEDUCTIBLES:

  1. ASK ABOUT FINANCIAL HARDSHIP PROGRAMS: Copays are an amount of money you must pay every time you consult the doctor or go to the hospital or have lab tests done or have imaging done like x rays. Many nonprofit companies exist that help patients pay their copays like Copay Relief or Patient Advocate Foundation. Your doctor’s office can help you apply for these financial hardship programs OR you can go online and do that yourself.
  2. UNDERSTAND WHAT COINSURANCE IS. Coinsurance is a relatively new way for health insurance companies to reduce their expenses by making the patient pay usually 10% of the overall medical bill. Since this can get expensive, find out if your doctor’s office offers a Financial Hardship Program if you cannot afford your coinsurance OR find an insurance plan that does not have coinsurance.
  3. UNDERSTAND WHAT A DEDUCTIBLE IS. A deductible is an amount of money the patient pays BEFORE their insurance company will pay anything toward the patient’s care. Seek a low deductible insurance program and realize that if your deductible is very low, say 100 dollars, your 1st doctor visit may eliminate the deductible.
  4. BE HONEST AND TELL YOUR DOCTOR YOU DO NOT UNDERSTAND OR CANNOT AFFORD THESE ADDITIONAL FEES. You may find doctors offices understand that these are difficult financial times and lots of us are out of work. If you cannot pay today, maybe you can in a few months when you have a job.
  5. FIND COUPONS FOR YOUR PRESCRIPTION MEDICINES TO ELIMINATE PRESCRIPTION COPAYS AND SHOP AROUND AT DIFFERENT PHARMACIES. I love to use www.goodrx.com since this give me a list of what my medicines cost at different pharmacies and gives me coupons to reduce costs. You would be surprised at how much pharmacies may be overcharging, shop around.

BOTTOM LINE: JUST BECAUSE YOU GET A DOCUMENT IN THE MAIL FROM YOUR INSURANCE COMPANY THAT SUGGESTS YOU OWE THE DOCTOR’S OFFICE MONEY, DON’T FREAK OUT. CALL THE DOCTOR’S OFFICE AND SPEAK TO THE BILLING DEPARTMENT. INSURANCE COMPANIES ARE WRONG ALL THE TIME.

For more information on understanding how to save money on insurance and medicines visit www.doctorinthefamily.nyc which is the new office / telemedicine division of DOCTOR IN THE FAMILY.

2021’s Best ADHD Medication Treatment for NYC Patients

by Natan Schleider, M.D. January 30th 2021 3 MINUTE READ

As the COVID19 pandemic worsens mental health, my NYC patients with Attention Deficit Hyperactivity Disorder (ADHD or ADD) are anxious, less focused, and need close follow-up.

As 2021 begins, many ‘new’ ADHD medicines have been advertised. Understanding which ADHD medication is best for my NYC patient involves understanding some chemistry. Know that pharmaceutical companies give the same medicine different names. So new medicines for ADHD: Adhansia XR, Aptensio XR, Concerta, Concerta XR-ODT, Daytrana, Metadate CD, Metadate ER,, Methylin, Methylin ER, Quillichew ER, Quillichew XR, and Ritalin ARE ALL MADE OF METHYLPHENIDATE.

So my first point: there are ONLY FIVE STIMULANT MEDICINES which form the roughly 25 different ADHD stimulant medicines available.

  1. Methylphenidate–First made in 1944, this is one of the most common ADHD stimulant medicines. The brand name known best is Ritalin but as stated above, twelve different medicines exist whose active ingredient in methylphenidate. I often use methylphenidate as a starting medicine for a new ADHD patient given it has an 80 year safety profile showing no evidence of permanent damage to the brain. [Source from Wikipedia]
  2. Amphetamine–Discovered in 1887, this is the oldest ADHD medicine. Amphetamine is actually a nonspecific term chemically and medically speaking, in my opinion. That’s because amphetamine exists as two different mirror image molecules (called enantiomers): dextroamphetamine (on the right) and levoamphetamine (on the left). In 2021, when a pharmacy uses the term amphetamine on their medicine bottle, they really mean levoamphetamine. Adderall is a combination of 25% dextroamphetamine–a stronger stimulant–and 75% levoamphetamine, a longer acting stimulant WITH MORE RISK OF ADVERSE EFFECTS ON HEART AND BLOOD VESSELS. Amphetamine prescribed alone in actually levoamphetamine. Evekeo are brand names of amphetamine (or I should really say levoamphetamine but that is not what it says on the bottle).
  3. Dextroamphetamine–As described above, this was discovered in 1887 and is a short acting stronger stimulant than its mirror image sister, amphetamine WITH LOWER CHANCE OF ADVERSE EFFECTS ON HEART AND BLOOD VESSELS. Dexedrine, ProCentra, and Zenzedi are brand name medicines for dextroamphetamine, approved for ADHD treatment.
  4. Dexmethylphendiate–Approved in the USA since 2001 for medical treatment of ADHD, this is a sister to methylphenidate commonly called Focalin or Focalin XR in NYC.
  5. Methaphetamine–Discovered in 1893 (also as two enantiomers), it is approved for treatment of ADHD under brand name Desoxyn.
  6. Lisdexamphetamine–Approved in the USA since 2007 for treatment of ADHD, this more specific molecular form of amphetamine, known as Vyvanse in NYC, has fewer side effects than most other stimulants but is inly currently available as a long acting capsule (although the books say a tablet exists, I have never seen it).

Apparently organic chemistry was not a complete waste of time when I was a pre-medical student. Understanding these six different medicines used for treatment of ADHD– sisters or first cousins so closely related most are mirror images of each other–helps me greatly choose which medicine may be the right fit for my patients.

Some NYC ADHD patient will swear by one medication. Reddit comments may tell horror stories about the same medicine.

The fact of the matter is, each of my NYC patient will metabolize an ADHD medicine differently. Do I always find the perfect medicine at my first treatment attempt with a new ADHD patient in NYC? No. But fortunately, the ADHD stimulant medicines will only last a few hours (unless they are bundled into an extended release form). Worst case scenario if a patient suffers a side effect from an ADHD stimulant medicine, I tell them to call me and not to take it again. It will be out of their system within a few hours and there are plenty of others to try.

Thanks for reading and click here for more information about ADHD treatment.

3 STEPS IN MANAGING ADULT ADHD/ADD, ANXIETY, & ADVERSE EFFECTS OF ADDERALL IN NYC

BY NATAN SCHLEIDER, M.D. / WRITTEN JANUARY 10TH, 2021 / 6 MINUTE READ

Attention Deficit Disorder (ADD) / Attention Deficit Hyperactivity Disorder (ADHD) impairs job or academic performance causing anxiety in NYC patients. Anxiety, depression, and other mood disorders negatively effect concentration and focus painting an ADD like picture. Stimulants (IE Adderall or Ritalin used to treat ADHD) can make New York patients jittery, hyperactive, and anxious

I cannot focus. Laundry and cleaning my toilet are welcome distractions. My mind races and stomach churns nightly despite TUMS, lucky to get a few hours sleep. Do you think I should try Adderall, it helped in college? A friend gave me something to relax and it helped but left me groggy, can’t remember the name.’ –TYPICAL CHIEF COMPLAINT OF MY NEW NYC PATIENTS IN 2021.

My NYC medical practice comprised 50% primary care and 50% mental health care until early 2020. Now 80 to 90% of my practice is based on keeping the mind healthy. This the key to ensuring a healthy body and spirit.

ADHD / ADD OR anxiety OR adverse effects of medicines (ie Adderall or Xanax)? That is the questions.

Three Step Approach to Making a Diagnosis of ADHD/ADD OR Anxiety OR Adverse effect of Medicine used in my NYC Practice.

  1. The treatment of choice is a stimulant (whereas child ADHD has more therapeutic options). While caffeine may help keep you awake it is NOT helpful for treating ADHD. Stimulants kick in right away and last a few short hours. Suspect a diagnosis of ADHD or anxiety (they can have both of course). Try a few short acting Adderall or Ritalin tablets. Call the patient after they try the stimulant. If they have ADHD works gets done. Anxiety dissipates. The patient is happy. When stimulant medication does NOT help ADHD symptoms, it is out of the patients system in 2-4 hours. I tell them not to take it again.
  2. Now that ADHD has been excluded, my working diagnosis is an Anxiety Disorder. These are more complicated to treat. Many medicines are FDA approved for treatment of anxiety. Finding the right medicine may take weeks. Trial a short acting anti-anxiety medicine. Alleviating anxiety confirms the Anxiety Disorder caused ADHD symptoms.
  3. Stimulants like Adderall or Ritalin or Vyvanse may be feel speedy. ‘I think the ADHD medicine is helping me. But my hands tremor, it takes hours to fall asleep, and I chew my nails or tug my hair. Should I stop taking the medication?’ All ADHD medicines including non-stimulants buproprion (Wellbutin) and atomoxetine (Strattera) can exacerbate anxiety; Just because the first and second and third ADHD medicine’s adverse effects were not tolerable does not mean give up. Sometimes it is a matter of trial and error. Just as some of us New Yorkers swear by Pepsi and others Coca Cola, same with prescription medicines.

The 21st century buzzes: smart phones vibrate and chime as text messages and over zealous employers contact us at all hour. Working 9 to 5 in NYC is a distant memory. Commuting and using phones attached to a wire attached to a wall…so last decade! Media blasts ‘crisis,’ and ‘new viral strain’ ad nauseum. No wonder adults who may have displayed no ADHD in childhood now display Adult ADHD symptoms. Check emails, return texts, discard snail mail, and try assimilating piles of digital data all before the opening and closing of the New York Stock Exchange–good luck!

Makes sense that even the most punctilios New Yorkers worry.

Thanks for reading and please visit www.doctorinthefamily.com/blog for more articles like this one for help finding the right doctor to treat you ADHD,.

5 Secret Tips to finding a Good Psychiatrist in NYC in 2021

By Natan Schleider, M.D. Written January 24th, 2020

Doctors without gloves studying gross anatomy.tients until the 19th Century
The Anatomy Lesson of Dr. Nicolaes Tulp,by  Rembrandt van Rijn
( 1632) Mauritshuis, The Hague

How to find a good psychiatrist in NYC has been an issue for years. Most do not accept insurance. Many doctors and psychiatrists are working remotely during the COVID19 pandemic. For those patient who prefer office visits here are 5 tips that you have found a good NYC psychiatrist or doctor:

  1. Clean lab, good doctor. Dirty lab coat,, sloppy medical care.
  2. Hand writing easy to read, good doctor. ‘Chicken scratch’, bad doctor.
  3. Doctor office with old magazines in waiting area, bad doctor. Magazines current, good doctor.
  4. Bathrooms are dirty, dated, disheveled, so is the doctor. Bathrooms clean, contemporary, neat, good doctor.
  5. Doctor greets you personally at the door upon arrival and runs on time, good doctor. You sit in naked (in a paper gown) in freezing tiny exam room and see nurses, ancillary staff, and ultimately the doctor more that 30 minutes late for less than 5 minutes, bad doctor.

Finding a good psychiatrist in New York whether you prefer remote virtual consults or not:

  1. If you are unable to pay for psychiatry consults out of pocket, than obtain a health insurance plan with GOOD OUT OF NETWORK BENEFITS (PPO PLAN). Most New York psychiatrists do not accept insurance; however a good insurance plan may reimburse you for your consult
  2. Expand your search for a psychiatrist outside of NYC. Given the COVID19 pandemic a psychiatrist outside of New York City (but licensed in New York State) can manage your care.
  3. If you like to check reviews of the psychiatrist you are seeking, use a reputable website that has a lot of traffic and does not curate their reviews like Google or WebMD.
  4. Most good psychiatrists are booked when using online appointment websites like zocdoc BUT their office may have cancellations so call the office,
  5. Ensure the psychiatrist treats your medical condition and prescribes the medicines you need. For example, I do more medicine management than psychotherapy. Good NYC psychiatrists and good NYC patients do their homework BEFORE the visit.

Thanks for reading and please visit my other blog articles.

NYC Psychiatry & Primary Care is Certified in SPRAVATO (Esketamine) Treatment to New York City Patients with Depression

7 Tips for NYC Patients seeking SPRAVATO (Esketamine) Treatment for Depression

Image of Spravato, a medicine called esketamine administered intranasally

Ketamine, an anesthetic with anti-depressant properties, treats stubborn depression. Depressed patients treated with esketamine (Spravato) often note significant mood improvement for weeks to months on average.

As of late 2020/early 2021 Spravato is difficult to obtain. Pharmacies and doctors must become REMS certified to dispense and administer Spravato.

Seeking a NYC doctor or psychiatrist to prescribe Spravato–if so, this article is for you.

7 Tips for NYC Patients seeking SPRAVATO (Esketamine) Treatment for Depression

  1. Firstly, qualifying for Spravato treatment requires a diagnosis of intractable depression, in other words, having tried and failed at least two antidepressants.
  2. Spravato is available only at certified pharmacies and is closely monitored by the authorities like FDA and DEA.
  3. NYC Patients must go to their doctor’s office for Spravato treatment for depression where the patient’s pharmacy will have delivered their Spravato.
  4. NYC Psychiatrists and Primary Care Physicians administered Spravato. Monitoring for elevated blood pressure, sedation, and other side effects occurs 2 hours after treatment.
  5. Appointments are required during Spravato therapy twice weekly.
  6. Spravato treatment information for patient can be found on pages 2,3,14, & 15.
  7. Treatment for depression with ECT or medicines does NOT prevent you from trialing Spravato.

In conclusion, esketamine (Spravato) is an FDA approved medicine for chronic stubborn depression with promising results.

If you enjoyed reading please visit my my blog for additional articles.

THANKS FOR READING!

NATAN SCHLEIDER, MD

Ashwaganda, the Royal Herb of Ayervedic Medicine: An Herb with Anti-Anxiety Properties and Much More

Ashwagandha, the Royal Herb of Ayurvedic Medicine, Can Be Used in Treatment of Anxiety and Much Much More

Ashwaganda is a medicinal plant found in Asia and Africa. Many phytochemicals have been extracted from Ashwagandha.

The literal meaning of the word “Ashwagandha” is “smell of horse” for two reasons. One reason is that the fresh roots of the herb emit the smell of horse. The second reason a belief that a person consuming extracts of the ashwagandha herb may develop the strength and vitality similar to that of a horse 

Ashwagandha is the most commonly used and extensively studied adaptogen. Adaptogens are herbs that improve an individual’s ability to cope with stress.

Adaptogen herbs with ASHWAGANDA AT TOP LEFT.

Ashwagandha has a central and prominent place in Ayurvedic medicine (the traditional system of medicine in India). Ashwagandha is a “royal herb” because of its rejuvenative effects on the human body.

Ashwagandha is a multipurpose herb that acts on various systems of the human body: the nervous system, the immune system, the endocrinal system and the reproductive system.

Ashwagandha has also been studied as antioxidant, anticancer, anxiolytic (anti-anxiety), antidepressant, cardioprotective, thyroid modulating, immunomodulating, antibacterial, antifungal, anti-inflammatory, neuroprotective, cognitive enhancing, hematopoietic agent, anti-hyperglycemic, neuropharmacological, immunomodulatory, cardioprotective, musculotropic, hepatoprotective, radiosensitizing, chemoprotective, anti-aging, macrophage-activating, diuretic, cholesterol reducing, aphrodisiac and rejuvenating agent.

Ashwaganda plant native to India has data that it reduces stress and anxiety
Ashwagandha plant for anxiety treatment

Ashwagandha dosage

Ashwagandha root powder is used at dosages of 300 mg to 2 grams, Capsule and tea formulations doses are 1 to 6 grams daily. Tincture dose is 2-4 mL by mouth three times daily.

Ashwagandha side effects

Nasal congestion (rhinitis), constipation, cough and cold, drowsiness and decreased appetite were seen in people who take 300 mg Ashwagandha root extract 116). An analysis of the adverse events recorded in this study 117) indicates that high-concentration full-spectrum Ashwagandha root extract is safe and well tolerated as there were no serious adverse events. The side effects that were observed were mostly mild in nature and no known causal mechanisms relate them to the study drug. Insignificant changes in laboratory values were observed in both the groups. The results on safety in this study are consistent with previous studies on Ashwagandha, where generally there were no adverse events leading to drop outs or withdrawal symptoms 118). Long-term administration of the roots of Ashwagandha was found to be safe also in animal studies 119). A word of caution, however, those allergic to herbs belonging to the Solanaceae family are contraindicated for treatment with Ashwagandha.

FOR ANY PATIENT RELUCTANT TO TAKE PHARMACEUTICAL MEDICINES TESTED AND APPROVED BY THE FDA THIS MAY BE A REASONABLE ALTERNATIVE.

Thanks for reading and please visit my blog for more articles and contact me if you found any typos or are looking for different medical subjects.

2 COVID19 Lessons From 1927 That Apply TODAY August 14th, 2020–Time to Turn off your handheld device and open a book.

By Natan Schleider M.D. August 14th, 2020

Having consumed my fair share of data in the last 6 months about COVID19, I turned off my news feed and all my screens and checked my ‘antique’ medical literature only to learn 2 COVID19 Lessons From 1927 That Apply TODAY August 14th, 2020.

  1. WHATEVER WE KNEW IN 1927 IS BEING REVIEWED TODAY ONLY TO CONFIRM THAT THEY WERE RIGHT ABOUT ALMOST ALL TACTICS WE ARE USING TO COMBAT THE COVID19 EPIDEMIC.
  2. THE CHANCES OF A VACCINE BEING SUCCESSFUL THIS YEAR 2020 ARE MEDIOCRE AT BEST IN MY OPINION. WE LEARN THAT EXPERTS IN 1927 WERE SO SURE THEY KNEW THE GERM THEY WERE FIGHTING THEY HAD A VACCINE AGAINST THE BACTERIA THAT CAUSED INFLUENZA ADMINISTERED TO THOUSANDS OF AMERICANS BY 1919.

Interestingly, if you read the page on Influenza above, you will learn that ‘It has been authoritatively stated’ that Influenza is caused by a ‘bacillus [a bar-shaped bacteria]. In fact, at least several hundred thousand Americans were vaccinated against this bacteria which we now call Haemopholis influenza.

The above 1927 article does a great job at succinctly teaching 2 lessons about COVID19 that apply today covering the importance of: face masks, appropriate ventilation, social distancing, asymptomatic carriers, hand-washing, and keep up your general health.

The only suggestion from 1927 NOT in news and medical coverage from 2020 is “Buck up. Be cheerful. We’ll get over the grippe trouble just as we will over every other obstacle.’

About 5 years later, medicine learned that influenza is caused by a virus BUT the vaccine against the bacteria MAY have been helpful and is in our current pediatric vaccine schedule.

FOR UPTODATE INFORMATION ON covid19 PLEASE VISIT WWW.CDC.GOV.

Thanks for reading.

NATAN SCHLEIDER M.D.

7 Vital Medical Items You Need BEFORE a Pandemic to Prevent Hospitalization for COVID-19

Louis Pasteur (1822-1895), French Microbiologist, Chemist, Pioneer of ‘Germ Theory,’ Inventor of Pasteurization. Quote attributed to Louis Pasteur In the fields of observation chance favors only the prepared mind.’

‘Hi doctor, I was exposed to Coronavirus 19 and now feel fever, chills, cough, and/or difficulty breathing. Do I have COVID-19 & when should I go to the hospital?’

Written by Natan Schleider, M.D. March 25th, 2020 10 PM 3 MINUTE READ

NOTE TO ALL MY PATIENTS: INFORMATION PROVIDED BELOW IS BASED ON CURRENT CDC GUIDELINES LAST REVIEWED MARCH 25TH, 2020 AND THEREFORE LIKELY TO CHANGE GIVEN THE DYNAMIC NATURE OF A PANDEMIC; HOWEVER, SINCE STARTING MEDICAL PRACTICE IN NEW YORK CITY IN 2005, MY GOAL REMAINS KEEPING YOU OUT OF THE HOSPITAL AND LOWERING YOUR RISK OF HOSPITAL-ACQUIRED INFECTION.

TO KEEP YOU SAFE AND THINKING RATIONALLY, REDUCE YOUR RISK OF STRESS, ANXIETY, WORSENING MOOD DISORDER, AND/OR MOOD INSTABILITY, STAY IN CONTACT WITH ME AND MY OFFICE. DO NOT WAIT UNTIL YOUR MEDICINE BOTTLE IS EMPTY BEFORE SCHEDULING A CONSULT. THERE IS NO SHORTAGE OF PRESCRIPTION MEDICINES (ALTHOUGH SOMEMEDICINES NOT NORMALLY MASS PRODUCED LIKE CHLOROQUINE ARE BACK-ORDERED). IT IS NORMAL TO GET ANXIOUS WHEN RUNNING LOW ON MEDICINE SO PREVENT THAT ANXIETY BY SCHEDULING DOCTOR CONSULTS WELL IN ADVANCE.

PLEASE OWN A PULSE OXIMETER AND KNOW HOW TO USE IT. THEY COST AROUND 50 DOLLARS, CAN BE BOUGHT ONLINE, & MAY SAVE YOU A TRIP TO THE EMERGENCY ROOM. IF YOU KNOW HOW TO USE A LARGE PAPER CLIP AND HOW TO INSTALL BATTERIES INTO THE BACK OF A REMOTE CONTROL, YOU KNOW HOW TO USE A PULSE OXIMETER (A MEDICAL DEVICE ABOUT 2 INCHES LONG AND 1 INCH HIGH THAT RUNS ON 2 AAA BATTERIES THAT GIVES AN INSTANT DIGITAL DISPLAY OF YOUR PULSE / HEART RATE AND YOUR BLOOD’S OXYGEN SATURATION)

PLEASE HAVE AN ADVANCED DIRECTIVE OR LIVING WILL PREPARED. THIS IS SOMETHING EVERY RESPONSIBLE GROWN UP ADULT SHOULD HAVE LIKE HEALTH INSURANCE OR CAR INSURANCE. PLUS IT IS FREE. SHOULD YOU VISIT AN EMERGENCY ROOM THE DOCTORS AND NURSES WILL WANT TO KNOW WHO YOUR HEALTH PROXY IS (A HEALTH PROXY IS A PERSON TO CONTACT IF YOU GET SICK NEED, SO SICK OR CONFUSED THAT YOU CANNOT ACCURATELY ANSWER QUESTIONS). YOU DO NOT NEED AN ATTORNEY TO COMPLETE AN ADVANCED DIRECTIVE / LIVING WILL. IN NEW YORK STATE AND THEY CAN BE FOUND FOR FREE ONLINE AND ALL YOU WILL NEED ARE 2 COMPETENT ADULTS WHO ARE NOT YOUR DOCTOR NOR WORK IN THE HEALTHCARE FACILITY YOU MAY OCCUPY: https://ag.ny.gov/sites/default/files/advancedirectives.pdf OR https://livingwillforms.org/wp-content/uploads/new-york-living-will-form.pdf

PLEASE HAVE AT LEAST 3 PAPER COPIES OF THE MEDICINES YOU TAKE AND ONE COPY ON YOUR SMART PHONE. HELPFUL HINT: LINE UP ALL YOUR MEDICINE BOTTLES INCLUDING OVER THE COUNTER MEDICINES AND TAKE A GOOD CRISP PICTURE OF THEM WITH ALL PARTS OF LABELS READABLE.

Before calling your physician worried with any coronavirus 19 COVID-19 questions, please be ready to answer your doctor’s questions and follow these instructions (because this is what I will ask you):

Doctor Question 1: ‘When did you last check Center of Disease Control (CDC) recommendations about coronavirus COVID-19 Website?’

Intelligent Prepared Patient Answer 1: ‘I visited the CDC website before calling you.’

Doctor Question 2: ‘Have you checked your vital signs including Temperature, Respiratory Rate, Pulse, and Oxygen Level?’

Intelligent Prepared Patient Answer 2: ‘Yes because I own a thermometer and pulse oximeter and know how to use them.’

Doctor Question 3: ‘What is your temperature over the last 12-24 hours and does it go down if you take a fever reducing medication like acetaminophen (Tylenol) or an NSAID like ibuprofen (Advil) or Naproxen (Alleve)?’

Intelligent Prepared Patient Answer 3: ‘My thermometer reads 100.4 degrees Farenheit [38 degrees Celcius] AFTER the maximum recommended dose of acetaminophen (or ibuprofen or naproxen).

Doctor Question 4: ‘What does your pulse oximeter read?’

Intelligent Prepared Patient Answer 4: ‘My pulse oximeter which I put on my fingertip is reading BELOW 95%-98% oxygen saturation. My pulse is reading on average ABOVE 100 beats per minute.’

Doctor Question 5: ‘What is your respiratory rate?’

Intelligent Prepared Patient Answer 5: ‘I counted the number of times I took a breath over 60 seconds at least twice before I called you and the rate was above 20 and yes, I used my inhaler and took an anti anxiety medicine you prescribed’

Doctor Question 6: ‘Do you have a bag packed for a log emergency room or hospital stay as advised?’

Intelligent Prepared Patient Answer 6: ‘Yes including my medicines and my phone charger.’

Doctor Final Question 7: ‘How are you getting to the hospital because all the vital signs you are giving me are approaching the red zone?’

Intelligent Prepared Patient Answer 7: ‘ I am on my way to the hospital already because I knew what you would ask and yes, I am wearing a facemask to protect others from getting infected.’

Coronavirus 19 STILL News March 2020 and 3 Ways to Combat Fear Generated by The Media

BY Natan Schleider, M.D. March 13th, 2020 THREE MINUTE READ

‘POLIO: POINTERS for 1951’ emphasizes washing hands; watching for signs and symptoms of fever; trouble breathing; flu-like symptoms; avoiding contact with the potentially ill

So what do you think of this coronavirus 19 thing? Because I’m scared…’

This is a common question I am getting regularly, especially from patients. Assaulted with news, updates, national guard movement, and political responses I have 3 suggestions:

  1. Educate yourself about Human Coronaviruses (there are a bunch of them) from a reputable source.
  2. Make emergency preparations within your budget and mindset and expect help from the government to come along the timeline and quality of Hurricane Katrina
  3. Study American History of viral epidemics and realize that when neither the ‘government’ nor ‘experts’ know that to advise, hand washing, isolation of the ill, and avoiding / cleaning of fomites ( objects or materials which are likely to carry infection, such as clothes, utensils, and furniture) will be advised.

Knowledge safeguards against fear so before you turn on the news or you smart phone latest feed, learn about the 7 strains of human coronaviruses currently known and ask yourself which of them CURRENTLY scare you?

Seven strains of human coronaviruses are known:

  1. Human coronavirus 229E (HCoV-229E)
  2. Human coronavirus OC43 (HCoV-OC43)
  3. Severe acute respiratory syndrome coronavirus (SARS-CoV)
  4. Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus)
  5. Human coronavirus HKU1
  6. Middle East respiratory syndrome-related coronavirus (MERS-CoV), previously known as novel coronavirus 2012 and HCoV-EMC
  7. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV or “novel coronavirus 2019”

You will learn that after rhinovirus (the most common cause of the cold), coronaviruses are the second most common cause of the common cold (at about 15%).

Emergency preparation, especially in an urban environment, is extremely nuanced and from a medical perspective, is changing very quickly. If a patient with metastatic cancer on hospice is in a quarantine zone, will they be provided a large supply of opiod pain killers in the setting of an opiod epidemic AND viral pandemic?

For example, the following New York State Department of Health has new guidance which seems only applicable to Medicaid and remains active only until the ‘Declared Disaster Emergency in the State of New York COVID-19 has ended’ https://mcms.org/resources/Documents/Practice%20Manager%20Resources/Medicaid%20Pharmacy%20Guidance%20Disaster%20Emergency%20in%20the%20State%20of%20New%20York.pdf

This allows for early refills of controlled and non-controlled substances for Medicaid members due to quarantine or outbreak. Does this mean physicians can prescribe larger quantities of pain killers to the cancer patients on hospice in quarantine zones? I asked the New York DEA this past in January 16th, 2020 and they replied promptly and politely referring my to the state medical board. The New York State Bureau of Narcotic Enforcement has not yet replied to my questions.

A Review of American Response to Infectious Pandemics is quite interesting with hygiene and quarantine staple go to initiatives by the CDC or historic equivalents.

Soap advertisement for fighting Polio circa mid 1900s [with later data showing soad does NOT kill Polio virus, chlorine does]

As a result of Polio in the early to mid 1900s, soap sales went way up (like hand sanitizer is currently) despite later evidence showing that soap did not kill Polio virus, rather chlorine did.

Hope the above provided a bit of insight, knowledge and comfort.

sincerely,

Natan Schleider, M.D.

Coronavirus COVID 19 remains in the News causing ‘Turmoil’ and ‘Panic’ March 6th 2020: ‘When It Bleeds it Reads’

By Natan Schleider, M.D. March 6th, 2020 9:20 am

Information and news regarding coronavirus 19 changes as quickly as the name of the virus (1st called ‘2019 novel coronavirus’, then ‘2019 nCoV’ and now Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This leads to a misinformed public and more confusion AND MORE CLICKS AND USE OF MEDIA NEWS WHICH IS OBVIOUSLY A STRONG FINANCIAL MOTIVE.

Example: February 12th, 2020, Article by Healthcare Purchasing News Title reads WHO renames novel coronavirus Covid-19 BUT writes in very 1st paragraph The World Health Organization (WHO) head, Tedros Adhanom Ghebreyesus, said the group has come up with an official name, Covid-19, for the disease caused by the new coronavirus. If media editors and journalists cannot accurately report simple definitions like a name change, how can we trust ANY information they provide moving forward. These semantics are important. Maybe it is done on purpose (making it disinformation)

Information about SARS-CoV-2, again aka COVID19 aka coronavirus 19 causes changes, misinforms, and misleads. Moreover, by the time I finish typing half of what is written may be dated BUT media use of words crisis, turmoil, panic I can guarantee will remain in use for a long time as they have in the past.

Cultivating more anxiety creates more: readership, followers, and newspaper sales. ‘When it Bleeds It Reads’ remains tried and true.

Simply saying the truth about coronavirus 19 like We Don’t Know Much about What We Don’t Know probably would not sound good for the CDC, WHO, politicians MIGHT leave them more street credibility?

News information / updates from this morning rea something like: coronavirus 19 causes 3000 people dead worldwide and 87,000 infected.

Let me rephrase: a strain of coronavirus has caused no symptoms or cold symptoms in 96.6% of people tested with the remaining 3.3% (many with underlying serious health conditions) hospitalized or killed by either the coronavirus OR a bacterial pneumonia that easily set in when the patient’s immune system was weak.

I have to head to work so please contact me with any specific questions and I can tell you whatever crappy data and information is or is not available.

BY THE WAY, 7,000 AMERICANS DIED LAST WEEK FROM ATHEROSCLEROSIS, A DISEASE LARGELY PREVENTABLE AND HAVE BEEN DYING AT A RATE OF ABOUT 1000 DAILY IN THE USA FOR SOME TIME. THAT IS 4000 DEAD IN 1 WEEK IN 1 COUNTRY THAN CORONAVIRUS HAS KILLED WORLDWIDE. WHY IS THAT NOT NEWSWORTH?

Thanks for reading,

Natan Schleider, M.D.