COVID 19 Concerns

We can all agree that we are among challenging times in this new world of social distancing, empty shelves, our school aged children at home, and dry but very clean hands…  Even though it seems like as a community we are trying to get away from each other, we are truly in this together and we will get through this with compassion for one another.

The purpose of my email is to give assurance that my office and the providers whom I share the common office space with are taking measures to protect us all against COVID 19.  

These measures include:

• Encouraging patients to stay home when sick.
• Encourage personal protective measures such as hand-washing and use of hand sanitizers
• Clean and disinfect frequently touched surfaces between patients.
• Ensure hand hygiene supplies are readily available in the office and building.
• Avoid public places as much as possible: offices, restaurants, stores etc…

Although I have limited my hours and I am seeing significantly less patients at this time, my plan is to provide care during the COVID 19 concerns.  It is important that we all ready our bodies to fight off any and all sicknesses that may come our way and I want to help you work through any discomforts and be as healthy and fit as possible.  If you are in need of care but have strong concerns about being in an enclosed building, reach out to me and we can have a visit in my backyard in Louisville on a warm sunny day.  

Some Immune System Boosting tips:

• Eat a diet high in fruits and vegetables. Take in lots of Vitamin C & D to fortify your diet with these powerful antioxidants.
• Call or connect with friends and loved ones. Sharing precious thoughts, compassion and time with those close to you can build up valuable immune system building hormones.
• Exercise regularly 
  • Improves cardiovascular and cardiometabolic capacity.  The COVID 19 causes shortness of breath. This shortness of breath is more life threatening when cardiovascular and cardio-metabolic capacity is lower.
  • Exercise can flush bacteria / toxins out of lungs and airways, lowering your chances of catching the flu, cold or other illnesses.
  • The rise in temperature during and post exercise may prevent bacteria and infection from growing …like how a fever helps kill-off the viruses and bacteria’s.
  • Decrease stress hormones.  Lower stress hormones protect against illness.
• Maintain a healthy weight and body composition
  • A healthy weight improves relative cardiovascular capacity.  
  • Healthy body composition allows healthy nutrition to be more effective.
  • An ideal body composition range will lower your visceral fat (fat around organs in the vascular system) which improves cardiovascular health.
• Drink alcohol only in moderation.
  • Alcohol disrupts the gut barrier allowing bacteria to pass into the blood.
  • Excessive drinking reduces the number and function of three important immune system supporting cells:  Macrophages, C and T cells.
• Get adequate sleep.
  • Sleep supports proteins like cytokines that help detect and fight viruses.
  • Sleep also supports T-cells; important disease fighters.

If you fall in this list below I urge you to stay home and reschedule to a later date:

• Are age >/= 65
• Lives in residential facility or group setting (e.g. e.g dorms, fraternities, sororities, shelters, jail, prison, skilled nursing facilities, adult family homes)
• Heme malignancy or Solid malignancy on chemotherapy
• Solid organ transplant
• Advanced HIV (CD4 count < 200) or AIDS
• Immune deficiencies or condition requiring treatment with immunosuppressive agents (common examples here):
• Prednisone >0.5mg/kg or equivalent (≥ 40mg prednisone or equivalent in patients 70 kg and above)
• Thymoglobulin in last 6 months
• Alemtuzumab in last year
• Rituximab in last 6 months
• TNF-α inhibitor in last 3 months (e.g. infliximab, etanercept, golimumab, adalimumab, certolizumab)
• Calcineurin inhibitors (tacrolimus and cyclosporine – excludes topical/ophthalmic administration routes)
• mTOR-inhibitors (everolimus, sirolimus – excludes topical routes)
• Mycophenolate, azathioprine, cyclophosphamide in the last 1 month
• Belatacept in past 2 months
• Eculizumab in last 6 months
• Have chronic underlying health conditions, e.g.: ESRD, CHF, Chronic lung disease (e.g. pulmonary hypertension; on supplemental oxygen), uncontrolled diabetes (Hgb A1c > 9)
• Pregnancy
• Clinical situations and needs of the patient should be considered in determining the best approach to individual patients.