COVID and WELLNESS - Dr. Claudia Machado Cooke

November 3, 2020

Dear Ones,

I hope this email finds you each well, doing the most you can to keep yourselves calm and centered while informed and in touch.

It has been all of 4 months since I sent out the last newsletter – travails of transitioning to new EMR platform, the challenges of developing new strategies to continue the medical practice, various “paperwork”, keeping up with personal matters – mostly at a distance – and here we are at the top of November.

This newsletter is organized in 4 parts:

Updates on the office front.
Sundry COVID-related topics of interest, and answers to some of your questions.
Links and follow ups.
Closing personal remarks.

THE OFFICE:

We prevail! The office continues to function at 35 East 35^th St, Suite 206, although quite differently than in earlier years pre-pandemic. While an estimated 30% of my patients came from out of town over the past 22 years in practice, of the roughly 70% of you who were living in NYC in February 2020, approximately 75% of those continue to shelter out of town, mostly temporarily, some permanently for the foreseeable future. I have been happy to connect with many of you for remote appointments and will continue to be available for such indefinitely.

The appointment times available are as follows:

Tuesdays: morning, remote appointments; afternoon, in office.
Wednesdays: remote appointments only
Thursdays: IV appointments and in office procedures take precedence on these days; some in-office consultations possible.
Fridays: consultative hours available by remote appointment in the early part of the day.

Dr. Michael Hutchinson, my preferred general neurologist for referral over the past 6 years, is in consultation in the office on Mondays and Wednesdays, and by remote appointment on other days. He is an outstanding diagnostician, and has special expertise in multiple sclerosis, Parkinson’s disease, seizure disorder, and migraine. You can read more about him here: https://www.nyneuroscience.com/#meet or call to schedule at 212-889-2500. You can also email his office manager at Zaida@mhutchinsonmd.com

Montclair Physical Therapy and Todd Edelson continue their practice at 35 East 35^th Street, Suite 206, where Todd continues to do great work for a number of people. As I always say, he knows the musculoskeletal anatomy as well as anyone I have ever met which is the foundation of his great work. In recent months he helped one patient whom I referred with 15 years of head tremor which “resolved completely”, in her words, over the course of 4 remote sessions with Todd and focused neck exercises. He can be contacted at 212-684-9098.

Just over 6 weeks ago, Jomarly Bulado, RN, joined the team as a Healthcare Virtual Assistant (HVA) and remote scribe through HelloRache*. Sharon Fekete, my trusty practice management consultant, told me that two physicians known to her said that they wouldn’t be able to maintain their practices without their HVA. Jomarly’s assistance has proven to be invaluable to me and Carolina with respect to scribing and various administrative duties.

Carolina Tenecela who continues with the practice has done a great job and is training Jomarly with respect to handling prescriptions, calls, scheduling, and other administrative tasks. As Carolina prepares to begin graduate studies toward medical school in January, she will be reducing her hours later this month while Jomarly takes over many of the day to day administrative tasks.

IV therapy in the office continues on Thursdays in the able hands of Anzhela Pishchana, RN. However, due to the large number of you that have left town, and many in town who are sheltering, we have reduced the availability to 2 to 3 days per month at this time. If you have an interest in scheduling, please notify the office well in advance so we can accommodate you. Preliminary lab tests may be required if you haven’t been seen in a long time.

Rest assured that I and my office mates are doing the necessary to assure your safety when you come. Masks, appropriate distance keeping, standard precautions, and disinfection measures are in place, and an air purifier with HEPA filter and UV-C light is being run in the waiting area. If you have engaged in high risk travel or believe that you have had a COVID exposure, please let us know in advance so together we can review appropriate quarantine precautions.

COVID TOPICS OF INTEREST:

A number of you have asked if the office is offering nasopharyngeal (NP) PCR testing. If you do NOT have suggestive symptoms, the doctor can send a NP swab from the office. The turnaround time with Bioreference is currently 3 business days. Antibody testing is available by lab order at commercial draw stations. One patient who needed a 24 hour return on testing for her son prior to his SAT exam used the services of this at-home service: http://leaa.io/ Otherwise, most of the walk-in clinics are offering testing with reasonably rapid return on results.
Vitamin D: I have been following the reports on this since late March and its significance looms larger all the time. The portal of entry of COVID-19 is through the endothelial ACE2 receptors in the upper airways and lungs. The endothelium is the fine diaphanous membrane which lines all the blood vessels, lymphatic vessels and hollow organs. The ACE2 receptors are found in many cell types and organ systems, include the upper airways, lungs, heart, kidneys, and digestive tract, among others. One of the key nutrients which support endothelial integrity is vitamin D. Quite a number of observational studies have been published in the last few months looking at vitamin D levels and vulnerability to COVID and its complications. The cutoff between deficiency and sufficiency which most of the studies looked at was 31 ng/ml. However, I continue to be guided by the Australian surfer range, based on a study done years back on young Australian men in their prime, getting full sun exposure with no supplementations, aiming for vitamin D-25-OH in the range of 42-65 ng/ml. Dr. Fauci himself reported to the press that he takes daily vitamin D to lower susceptibility to infections generally, as well as up to 2 grams vitamin C daily for antioxidant benefit.
Ivermectin: What became of it? Discovered in 1975, introduced clinically in 1981 for treatment of parasitic diseases, a breakthrough in the treatment of river blindness (onchocerciasis) and filariasis, for which its developers received the 2015 Nobel Prize in Physiology and Medicine, there was some buzz out of the Eastern hemisphere earlier this year about its potential in the treatment of COVID. The rationale was sound theoretically but untested clinically. A study out of Bangladesh published in August of this year reported favorable results in 100 COVID patients exhibiting mild and moderate infection in response to combined single dose Ivermectin and 10 days Doxycycline with improvement in 72 hours without significant side effects. The NIH has not approved the drug for this indication at this time.
BCG: The Bacille Calmette Guerin was introduced in 1921 by the Pasteur Institute as an immunization against tuberculosis. It found its way into increasing use from the 1930s on and since that time was adopted variably by different countries. Some countries enforce it broadly, and others selectively, such as to indigenous populations or high risk groups. What is interesting is that some of the countries with the lowest reported COVID-19 death rates are those countries which enforce 98 to 99% coverage of the population, including, China, Japan and South Korea. What we also know by now is that Asian populations tend to be more compliant with mask wearing. BCG for immunization has been largely unavailable on the US market since 2012, and the preparation used for treatment of bladder cancer is also in scarce supply at present due to issues with foreign manufacturing standards and supply. Early in this pandemic, it was proposed that reinstating the BCG might provide enhanced immune protection against SARS-Cov-2, at a much better price point, and lower risk. There has been relatively little follow up on this in the literature.
Inhaled steroids? At the outset of the pandemic, it seemed that asthmatics would be at increased risk. As it turned out, asthmatics had a lower incidence of serious illness and complications from COVID. It has been suggested that inhaled steroids conferred a protective edge that turned the tables on those predictions. Inhaled steroids may be a strategic intervention early in the course of COVID infection, although not currently endorsed by the authorities.
The FEND: A novel saline inhalation device, aka Pulmatrix. Neti goes 21st Century. A friend and colleague just send me this information. “… if you take just two puffs with his device, you reduce your chance of exhaling COVID-19-filled droplets by 99% for six hours—which he validated over a series of studies with 92 people. In theory, it should make your own nose and throat more resistant to contracting COVID-19…”

LINKS AND FOLLOW UPS:

Many of you will remember that David de Silva’s Fame from London was about to debut on BroadwayHD. It is here and it is terrific and you can catch it “live” in London here: http://www.fatherfamefoundation.org/videos/famelive.html and here: https://www.broadwayhd.com/movies/AXEOPBJCXohZH4dIgHA4?display=portrait
Petra van Noort has created a beautiful offering in video and voice for centering and releasing: https://drive.google.com/file/d/1I86bihEAt2Fh0lNGXhGxGIzzVyAU9l0D/view You can read more about Petra’s work here: http://www.petranyc.com/
Steve Horney brings huge energy and enthusiasm to his practice of Functional Integrated Rehabilitation Exercise (FIRE). He is in the West Village and can also be booked for home visits in some cases. Check out his site: https://ihealthsciences.com/ And his webcasts: https://ihealthsciences.com/webcasts I enjoyed being his guest back on June 17.

CLOSING REMARKS:

Wherever you may be on your journey, my wish is that you are finding time in every day to enter into stillness, however you may find it. And that in every day you are moving the body, and allowing your body and spirit to be moved, by beauty, by love, by nature, by hope, by faith “in the substance of things hoped for.”

The pandemic has dealt a mighty blow to so much that we too often took for granted – our freedom of movement, our relative sense of safety in the society, our joy in gathering – for now, for now. It has challenged us to connect with each other in new ways and to preserve our humanity in so doing.

The published and scientific evidence for functional integrative medicine and mind-body approaches to health and wellness has increased exponentially in the last 20 years, but the time to broad assimilation from the laboratory to common practice lags approximately 17 years behind. Not so long ago, it was said that it took a generation and half, 30 years, to move a proven therapy from the lab to general acceptance.

Continue to do the noble work of making life-affirming, health promoting choices for yourself in the day to day of your life, in the food you eat, the life you live, the company you keep, the thoughts you think. It may be just around the corner that something unimaginably wonderful bursts upon you.

W Watch the world in wonder – beyond this crisis, sink in to the awesomeness of nature, and life, and love, and resilience.
E Enjoy the little things, the beauty that surrounds you.
L Love from your depths.
L Look deeply – within yourself and others.
N Never give up!
E Energize yourself – hydrate optimally, breathe from your diaphragm, move the body, create, choose well for your mind and your body.
S Sing and hum, even if it’s a sad song, vibrate your body and soul!
S Sink in to your Soul and draw from its depths.