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.

How can I protect myself from the coronavirus COVID-19? 4 Coronavirus Prevention and Treatment Tips:

By Natan Schleider, M.D. February 26th 2020 2 MINUTE READ

Does this image scare you? It should if the common cold scares you. This is the coronavirus, one of the most common causes of the common cold.

4 Coronavirus COVID-19 Prevention and Treatment Tips:

  1. Keep following the Center of Disease Control recommendations daily. To date they continue to emphasize the USA is low risk. And for good reason: the coronavirus is far less deadly than the influenza virus and many other viruses that cause cold or flu-like symptoms. WANT SOME PERSPECTIVE: ‘So far, 16,000 people have died and 280,000 people have been hospitalized during the 2019-2020 flu season, according to preliminary estimates from the CDC released several days ago.’ If we use (sloppy, not quite technically accurate math) we see the death rate from influenza in the USA is about 5.7%. COVID-19 mortality rates are approximately half that in mainland China (probably lower if we include people that had no symptoms but were in fact infected)
  2. Read my blog: The 7 Effective Treatments for the Common Cold: https://www.doctorinthefamily.com/blog/the-7-effective-treatments-for-common-cold-symptoms-in-adults/ Here is a cheat sheet for those too lazy to click and sorry, chicken soup and Vitamin C are NOT on the list: Acetaminophen (aka Tylenol); Combination anthistamine plus decongestant (IE Zyrtec-D); Intransal ipratropium bromide (aka Atrovent) – particularly helpful for reducing the lingering cough after the infection which can last weeks; Intranasal oxymetazotine aka Afrin – not to exceed 10 days; Lactobacillus casei 22 grams per day in dairy products for 3 months; NSAIDs – ie Advil or Alleve; Zinc acetate or zinc gluconate – 80 to 92 mg per day within 3 days of symptom onset and continue until symptoms resolve
  3. Get an N95 Respirator Mask — not the flimsy masks we see surgeons wearing will not prevent airborne disease transmission very wello.
  4. Make sure you have the flu vaccine and get yourself some Tamiflu aka oseltamavir (and some antibacterial antibiotics) as the coronavirus may weaken your immune system allowing harmful viruses and bacteria to grow.

Thanks for reading

3 Reasons Why The Most Common Cause of the Common Cold – Coronavirus – Is Making So Much News?

Written by Natan Schleider, M.D. on January 29th, 2020

Disposable Paper Advertisement for Treating Common Cold
Vinatage Disposable Paper Advertisement circa 1950s

A common virus called the coronavirus (yes, like the beer) is making news. This virus is the most common cause of the common cold (along with rhinovirus and parainfluenza virus). This virus has NEVER killed remotely as many people as influenza virus or opiods or car crashes.

According to The New York Times ‘ 132 people had died from the virus’ to date.

For reference about 1,000 (that is one thousand) people died yesterday in the United States of America from atherosclerotic disease (artery clogging) like coronary artery disease. And 1000 people the day before…a total of ‘360,000 people will die from [atherosclerosis] each year’ according to WebMD.

So 5 Reasons Why The Common Cold causing Coronavirus is Making News:

  1. This new coronavirus may be as lethal as the Corona SARS virus which killed a total of 774 people in 29 countries according to the World Health Organization. in 2003-2004. More people died yesterday from heart attacks in the USA alone.
  2. This new coronavirus may be worse that the MERS Coronavirus which has killed a total of 858 people since 2012 in 27 countries. More people died yesterday from heart attacks in the USA alone.
  3. Anything new is fundamentally scary to humans which gets the media excited.

I am following the Center of Disease Control website actively and see no evidence that coronavirus poses a threat even close to influenza but I am no virologist, just a regular fully licensed board certified medical doctor / general practitioner.

5 Reasons to Consider the Human Papilloma Virus (HPV) Vaccine in 2020: Prevention of Warts and Cervical Cancer in Adults.

By Natan Schleider, M.D. Written January 14th, 2020 3 MINUTE READ

Vintage Medicine Container for Treatment of Warts. Circa Early 1900s.

Basic Facts About Human Papilloma Virus (HPV) and Disease in the USA as of 2020:

Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the United States infecting 1 in 4 Americans (79 million of the infected based on USA population of 330 million in 2020). This virus likes grows in skin cells where sexual contact has occurred and condoms do not prevent it. While causing a bunch of different cancers like Cervical Cancer, Anal Cancer, and Mouth (Oropharyngeal), it far more commonly causes little painless fleshy bumps called warts.

While ‘painless’ in that warts do not hurt physically, the look at you (former) new partner’s face running out the door after seeing your wart hurts. Getting the wart removed by the doctor also hurts and they can be stubborn and grow back.

HOW TO KNOW IF YOU OR YOUR PARTNER HAVE HPV:

HPV infection may not be obvious to the naked eye (nor obvious to the infected patient which is why doctor do PAP smears and HPV DNA tests during women’s health exams) sitting dormant for months to years until causing a wart or cancer, it is difficult to know whether your partner carries HPV. By the way, there is no test to confirm skin infection of HPV in men, at least nothing done routinely. We do not swab or scrape a man’s genital region to look for HPV infection, If anyone reading this wants to know why, contact me.

While the HPV vaccine better known as Gardasil has been recommended since 2006 for ages 11-26, now all men and women should consider it so….

Five Reason to Consider the HPV Gardasil Vaccine If You Have Never Been Vaccinated:

  1. You are sexually active and your partner is infected with HPV.
  2. You want to reduce your risk of getting HPV infection and are open to vaccination
  3. While considered about the risks of safety of any vaccine, 8-10 years of data not only in adults (more in children) show no evidence of any long term disease or risks of the vaccine.
  4. You do not like cancer.
  5. You have not figured out a clever, cool way to ask prospective or current sexual partners about HPV infection–if there is one?

Given this new information, I will be contacting my doctor for the Gardasil vaccine and will keep you posted. Thanks for reading.

Citation

Oshman LD, Davis AM. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). JAMA. Published online January 13, 2020. doi:10.1001/jama.2019.18411

Screening Options for Colon Cancer

THE BEST COLON CANCER SCREENING TEST IS THE ONE THAT GETS DONE!

By Natan Schleider, M.D.

July 9th, 2019

Source: American Family Physician Vol. 100 No,1 July 1st, 2019 p.10-11

As I approach 50 years old, I am thinking about which colon cancer screening test is right for me.

I will likely go with the gold standard, screening colonoscopy. If you don’t know what this is, the patient is put to sleep under mild anesthesia which is quite safe and a fiberoptic tube is placed up the anus all the way through the large intestine to look for colon cancers or precancers which appear as polyps. Pros of screening colonoscopy: you need it only every 10 years (5 if you are high risk or more often if you have colon cancer or have been treated for colon cancer); the procedure only takes about 20 minutes and you are home same day. Cons or the biggest complaint I hear is being up all night with diarrhea as patients are given a strong laxative to flush out their colon (aka large intestine) which allows the doctors to see the lining of the intestine without stool being stuck to the walls.

Screening colonoscopy is my choice because while there are many of good noninvasive tests which I will review below, if they are negative, reassuring; but if positive, you will need a colonoscopy anyway to confirm whether it is a true or false positive.

Other screening tests for colon cancer:

  1. Stool testing for blood also called Fecal Immunotherapy Testing (catches about 58% to 72 % of colon cancers). This is a cheap easy option an with a 97 percent specificity (meaning if the test is negative, you probably do not have colon cancer) this is a nice easy choice.
  2. mSEPT9 Blood Test (Epipro Colon) detects 73 percent of colon cancers with a specificity of 82 percent. This may be a nice option if you are not inclined to sending your poop to a lab, understandable.
  3. Cologuard is a stool DNA test where you ship your poop to a lab where the examine it for colon cancer risk. This can be done every 3 years and I like this alternative option.
  4. Computed tomography colonography means no invasive testing but you will still need to have your intestines cleaned meaning you’re up all night with diarrhea but at least this is not invasive.
  5. Flexible sigmoidoscopy is like a mini colonoscopy which while still approved, is hardly done anymore as it only looks at the first part of the colon potentially missing cancers in the middle or distal colon.

If you opt against colonoscopy, you can do some or all of the noninvasive tests. Any testing is better than no testing and unlike most cancers in the 21st Century, colon cancer is one we can catch and treat early. Go get tested!

Thanks for reading!

Natan Schleider, M.D.

Lofexidine (Lucemyra) for Treatment of Some Opiod Withdrawal Symptoms

By Natan Schleider, M.D.

Source: American Family Physician V.99 No.6 March 15th, 2019

While I am pleased that a new medicine recently FDA approved for mitigating some symptoms of opiod withdrawal (IE sweating, increased heart rate, some of the physical symptoms of anxiety) I am cautiously optimistic at best that this medicine will see much

The pros of lofexidine:

  1. Most importantly it demonstrates that someone / the pharmaceutical industry realizes a need for more medicines to address the current opiod epidemic. This is extremely important given the few resources available for treating opiod dependence so kudos to all who did the work to get this medicine approved seriously.
  2. See point 1

The cons of lofexidine:

  1. It costs about $1,776 dollars for a seven day supply whereas there is an older virtually identical medicine (also commonly used to mitigate withdrawal symptoms) clonidine which costs nine dollars for a 30 day supply.
  2. Dosing is 4 times a day (presuming a patient in acute withdrawal isn’t vomiting everything they try to swallow which is often the case).

I don’t mean to ‘poo-poo’ this medicine and I will certainly prescribed it when indicated. I will be astonished if an insurance company covers it but at least there is one more weapon in the arsenal.

Thanks for reading.

Natan Schleider, M.D.

Aspirin: Good or Bad for Preventing Heart Attacks?

BY NATAN SCHLEIDER, M.D.

JUNE 24, 2019

Image result for vintage aspirin

As a physician in private practice for 15 years, the specialty I once viewed as rigorous in the scientific method and always backed by strong data in powerful studies has been disappointing me. When paying half a million dollars for medical school, the professors tend to omit the fact that 50 percent of what they are teaching as the latest important clinical findings will be completely wrong.

For example, in medical school I was taught that hormone replacement for women after menopause would reduce risk of heart attack and osteoporosis. Hormone replacement not only helped hot flashes but was good for you, right?

Wrong. In 2002 The Women’s Health Initiative (a large study dwarfing the studies that had provided the info I learned in medical school) found that hormone replacement significantly increased breast and uterine cancer risk. Suddenly, prescriptions for menopausal symptoms went the way of the dodo.

I was also taught that Oxycontin was not addictive, ha!

For years aspirin has been considered an excellent choice for reducing risk of heart attack, stroke, and even colon cancer. Suddenly this month’s editorial in American Family Physician says with need to ‘rethink’ aspirin’s role in primary prevention. Really! Aspirin is the oldest pain medicine around since the mid to late 1800s. And we still are unclear about it’s efficacy?

In medicine’s defense, new large studies are constantly done (as the cornerstone of science is ability to repeat results given the same questions and data but often the second study does not jive with the first. So medical students are left knowing less then when they started [but at least the tuition bills are consistently on the up and up].

Simply put, for patients with risk factors for artery clogging/heart attacks (but with little or no risk for aspirin inducted gastrointestinal bleeding) aspirin 81 mg daily is recommended, especially age 50 to 70.

I am 43, have high cholesterol (addressed with Lipitor) and high blood pressure (addressed with medicines). Rather than perfoming certain convoluted risk calculations to determine my need for aspirin, I just take it daily.

Do I won’t to over-medicate you dear reader? No. But you can take comfort in the fact that if the ‘experts’ praise the results of a study this year, 10 years from now they will likely praise a newer study which discredits the first one.

As objective as medicine presents itself, the good doctor knows the art and science of good medical practice.

A Succinct Review of the Top Medical Research Studies of 2018 for Family Physicians

By Natan Schleider, M.D.

May 19th 2019

SOURCE: AMERICAN FAMILY PHYSICIAN V.99 # 9 MAY 2019 P.565-573

Every year I try to some up the most important easy to understand studies for my patients, doing my best in eliminating fancy medical mumbo jumbo.

Here are the important points for 2018:

  1. Home blood pressures are more accurate than doctor’s office blood pressures. Sooo, if your blood pressure is high at the hospital or doctor’s office (which it should be unless you are super zen), check your blood pressure at home with any machine that measures above the elbow OR ask a friend who knows how to check blood pressure. If you find yourself surrounded by machines as in the above photo, you are doing something wrong…that photo is actually an old ECG machine.
  2. Lower blood pressures are almost always better EXCEPT in elderly patients 85 or older.
  3. Shorter courses of antibiotics are almost always as effective and have fewer side effects than longer courses. So, for example, if a Zpack usually helps your bronchitis or ear infection or sore throat, opt for the 3 day Zpack rather than the 5 day.
  4. For women who suffer from 3 or more UTIs annually, drinking an additional 1.5 liters of water daily reduces risk of future UTI by 50%.
  5. Several studies show that non-opiod pain medicines are as effective for relieving acute injury of arm or leg pain in the emergency room compared to opiods.
  6. Patients who exercise (at least 150 hours per week or more) have lower risk of depression.
  7. For patients being medically treated with anxiety who then stop their medicines, 1/3rd will have a relapse and require medication again. 1/6th of all patients with anxiety will have worsening anxiety despite treatment.
  8. Stool testing for colon cancer screening using DNA found in stool (called Fecal Immunochemical Tests or FIT) is better than standard stool testing for blood and an optional substitute for colon cancer screening other than colonoscopy.
  9. Type II diabetics should shoot for a HbA1c of 7-8 percent (and not lower as previously advised).
  10. If you are 60 or older, a blood pressure of 150/90 or lower is ok presuming you do not have other serious medical issues. Below 60 lower than 140/90 is ok.

Please contact me with any questions or comments.

Thx,

Natan Schleider, M.D.