561.368.0191|Richard A. Levine, MD FACP Board Certified Internal Medicine

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Doctors Notes: Fall 2021 – Riding the Rapids

May this note find you safe and well.

As we usher forth the Holiday Season and New Year, I remind myself that the times we find ourselves in, has no Owner’s Manual. Instead, it is being written on a day by day basis.

That being said we must be cognizant of our ongoing health and wellbeing. The prevention and early detection of illness may seem inconsequential in our busy lives but is actually the cornerstone of a life well lived. During these trying times we must remain free of contractible disease while at the same time showing  diligence for our routine health maintenance.

Here are some Current Issues that are good to keep in mind;

  • Continue to Stay Safe. If you are, and have been, well please continue to do the things you do as you are. Do not deviate from tried and true practices. Be proud of yourself, as slow and steady wins this game. Masks – Distance – Hygiene have not gone out of style.
  • I recommend vaccinations. COVID 19 booster vaccinations are currently being used for older adults with chronic illnesses and for individuals with major immune conditions such as those undergoing cancer therapy, transplant patients, those on high dose corticosteroid therapy and those with no spleen to name some groups.
  • Your immune response to the COVID 19 vaccinations can be assessed by a simple office lab draw. If you are unaware and interested in your status you may set up an appointment.
  • Flu vaccination for the 2021-22 Flu season has begun.  Please call the office and make an appointment for yours.

REMEMBER to keep at least 2-3 weeks between getting any COVID 19 booster and your yearly flu shot. That rule also […]

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Doctors Notes: Spring 2021 – Vaccination Updates

Much progress is being made in the control of the novel corona virus pandemic affecting everyone.

Getting vaccinated and maintaining your general health are at the forefront. Here is the latest:

THE OFFICE

The office is open and seeing a finite number of patients daily. The doctors and staff have all been vaccinated. We still however are continuing all the safe practices geared to keep us all well. This includes single patient screened entrance; temperature checks; hands free Purell and direct guidance to the exam room for nursing duties such as vital signs and lab draws. The nurses, doctors and staff wear masks while in the office and the office is kept clean regularly.

We are in the process of notifying patients who have not been seen recently. If you have not been in recently, call the office and set up a visit to maintain your health. All patients will continue to undergo COVID exposure screening prior to the visit and masks are required for safety.

My practice is accepting new patients. A HIPAA qualified telehealth program is used for a Meet & Greet, after which a telehealth visit is scheduled to obtain a comprehensive history in a setting without masks and in an unhurried fashion. The relationship begins at the actual face to face visit in the office where needed lab studies and EKGs can be done and the physical exam is performed. In this fashion the patient is seamlessly integrated into expert medical care, while maintain continuing safety.

VACCINATIONS

Today, March 3, 2021, access to COVID vaccinations here in Florida has been extended to include:

“…persons under the age of 65 years of age deemed extremely vulnerable to COVID 19 by a physician…and may be vaccinated […]

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Doctors Notes: January 2021 – Vaccination Locations

In hopes of assisting folks to coordinate where they “might” get a corona vaccination as of today, this is the latest information update.

For the latest info available on where one might possibly get vaccinated:

https://my.clevelandclinic.org/landing/covid-19-vaccine/florida

For the process in Palm Beach and Broward:

http://palmbeach.floridahealth.gov/about-us/important-notices.html

www.browardcovidvaccines.com

Broward County will begin giving COVID-19 vaccines to people 65 and older, and those interested can begin scheduling an appointment.

“We are excited about the opportunity to begin vaccinating our senior population, who are disproportionately affected by COVID-19, as we continue to work every day to protect our community during this pandemic,” said Dr. Paula Thaqi, director of the Florida Department of Health in Broward County.

The free vaccines will be available starting Sunday at drive-thru sites. Appointments are required and can be made online at browardcovidvaccine.com.

Anyone who gets the first dose of the Pfizer-BioNTech vaccine at one of these sites must also get their second dose 21 days later in Broward County.

Vaccines will be available by appointment only at:

  • Tradewinds Park, 3600 W Sample Rd., Coconut Creek. Hours: Sunday-Thursday (Closed Friday, Saturday): 8 a.m. to 4 p.m.
  • Vista View Park, 4001 SW 142nd Ave., Davie. Hours: Sunday-Thursday (Closed Friday, Saturday): 8 a.m. to 4 p.m.
  • Markham Park, 16001 W State Road 84, Sunrise. Hours: Sunday-Thursday: 8 a.m. to 4 p.m.

Broward Health also began distributing COVID-19 vaccines to people 65 and older Wednesday and is no longer accepting appointments. The hospital said it has more than 5,000 appointments scheduled through February.

The Florida Department of Health in Broward County said additional vaccination sites are expected to open and is encouraging everyone to continue checking browardcovidvaccine.com for appointment slots and locations.

The local hospitals, I believe, are gearing up for the public, but they are not being […]

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Doctors Notes: Winter 2020-21 – COVID 19 Vaccine is Becoming Available

Two vaccines have been given Emergency Use Authorization by the FDA recently. There is enough data on their use to show they each have 95% efficacy in preventing symptomatic illness from the novel virus SARS-CoV-2, known commonly as COVID 19.

They are the Pfizer vaccine and the Moderna vaccine. Each have a similar mechanism in stimulating immunity. The protein on the surface of the COVID virus capsule is what interacts with our cells to allow entry of the virus into our cells and thus cause illness. A copy of that protein is what makes the vaccine work. It “teaches” our immune system to recognize the virus and builds up our immunity against it.

The Florida Department of Health in Palm Beach County has contacted outpatient doctor’s offices and is in the process of enrollment to obtain vaccine for the public. The Moderna vaccine is easier to store as it does not require super cooling and thereby improves its’ use in, and for, the general public. There are other types of vaccines being developed at this time but they have not yet completed their study trials. The current available vaccines have shown that the benefit of taking them greatly exceeds what risk is involved, thus protecting us from this vigorous virus.

The State of Florida and the Governor  are in charge of distributing the vaccines, and should be doing so as per the Center for Disease Control and Prevention CDC and the Advisory Committee on Immunization Practices ACIP guidelines. They are stratified to first go out to healthcare personnel, first responders, residents of skilled nursing facilities and their staffs.

This Press Release from the Morbidity & Mortality Weekly Report of December 20, 2020 reviews the framework for distribution

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Doctor’s Notes: A Happy Healthy Holiday Season 2020 – 2021 to You All

As the year comes to an end and is filled with the joy we have for loved ones, this year requires attention to detail. I would like to thank you all for being diligent and compliant in your efforts to stay well. Anything we forego in the short term will bring success in the long term. It has been said “If you got your health, you got just about everything”.

That being said I would like to share some tips for enjoying the holidays. These are basic public health practices espoused by every doctor, nurse and medical organization in the entire world. The following was taken from an article by the American Medical Association Senior News Writer Ms. Sara Berg and Megan Srinivas MD Infectious Disease Specialist at the University of North Carolina at Chapel Hill:

“7 things Doctors and Nurses wish patients knew about holiday gatherings this year”

This is not the normal holiday season. As much as we miss our loved ones, staying safe and reducing risk, are the smartest things we can ever do, particularly this year. This could mean not being able to attend the typical in person holiday gatherings. This may assure that the same loved ones are around for the following holidays to come.  

  • Transmission Risk is High – disease rates are increasing as we head for the winter in the northern hemisphere, typically the worst period for upper respiratory illnesses. COVID 19 is a respiratory virus. The difference between it and a cold, strep throat or the flu is, there is no completely effective therapy or vaccine. They are being worked on daily. There are medical protocols but each patient is different. Vaccine production for the average individual […]
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Doctor’s Notes: Fall 2020 – Vaccinations 2020/2021 and Other Topics

This year it is especially important to consider vaccinations.

The most important ones available being influenza and pneumonia. As we continue to follow personal public health advice it behooves us to consider the basics.

The seasonal influenza vaccine is a mix of the most prevalent strains followed over the year that present the greatest risk of getting the flu. The reason we get vaccinated is to reduce our risk of, and prevent the, severe outcomes of the infection that can lead to hospitalization and or death.

This season the vaccine is a formulation of the prevalent known subtypes each Influenza A and Influenza B. It is a Quadrivalent Vaccine (two types of Influenza A and two of Influenza B, ie four types). The majority of the vaccines given are inactivated viral particles. They stimulate our immune system to develop antibodies so that we are better equipped to fight off the flu. Timing of the vaccine is important as we want our immune system to have the maximal response at the time of maximal flu prevalence in the community. This is usually from the late fall into winter.

Schedule your appointment now for the flu vaccination, in the safety of our office, as supplies are limited.

The pneumonia vaccine PneumoVac is a onetime vaccine given at 65 years of age to the general population. It protects us from community acquired pneumonia caused by Streptococcus pneumoniae. It does not assure one will not get pneumonia, but in the case one does, it is usually much easier to treat and usually does not require hospitalization. Individuals with chronic medical problems such as diabetes, heart or kidney disease are well advised to get one prior to 65 years of age.

Vaccination for corona virus […]

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Doctor’s Notes: Summer 2020 – The Visit

I hope this note finds you all safe and well.

As the country continues through Phase One reopening, the virus is completing its’ own Phase One and entering into its’ own Phase Two here in the northern hemisphere. March 15th through June 15th this year was the first local 90 day period of our encounter with this brand new virus. The next 90 day period is summer in the northern hemisphere, a time for relaxation. The fall into winter period is typically flu season and we must remain vigilant that although we may be getting a bit of a break, we must remain aware of our health and safety until this pandemic goes from historic to history book.

The office will be opening on a safe basis starting this coming week of June 15th. All safeguards, in conjunction with CDC recommendations, have and will continued to be in place, and utilized for our mutual safety.

  • Call the office if you desire an appointment. In office visits are being scheduled with social distancing in mind. If a Telehealth visit is preferred they remain available.
  • You will be asked to be seen on a one to one basis with the doctor, unless direct assistance is a pure necessity.
  • Upon arrival to the building, you will be asked to call the office first, and then come up. You will be met at the front door by the courteous staff. The door will be locked, as Walk Ins will not be allowed. It is preferable you travel as lightly as possible and leave large items safely stored elsewhere.
  • MASKS will be MANDATORY. We all will be masked, as it is the easiest way to assure your safety.
  • Our masked staff will accompany you directly to […]
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Doctor’s Notes: Testing – The Path Forward – SAFELY

WHERE WE ARE…WHERE WE ARE GOING

Unless you are 100 years old, we have never experienced an event as we find ourselves in now.

It is not a conventional war, it is a biological event. Good times or bad, biological events rule the day.

 

TESTING is available.

PCR testing for the presence of the virus: Early on in our current dilemma we became able to use PCR testing by nasal swab. The PCR test checks to see IF a patient HAS the ACTIVE Corona Virus. Questions are asked regarding fever, cough, shortness of breath and very importantly, contacts and travel history as well as gastrointestinal symptoms such as nausea, vomiting or diarrhea. This helps define if the patient HAS this HIGHLY TRANSMISSIBLE, POTENTIALLY LETHAL virus. 

It is a diagnostic test to ascertain the patient has the virus and requires care. Simultaneously it also gives the Nurses, Doctors and Ancillary Care team the information they need to protect themselves while helping the patient. It is the drive through test done by fully protected people, being done as we speak.  

Antibody Testing: This blood test checks to see if the patient has been exposed to the virus, whether they are aware of any exposure or not. It tests for Immunoglobulin G, the antibody that tells us you have developed a response to that exposure. The degree of long term protection, ie immunity, is currently being studied as our knowledge of this disease progresses. These tests have been released by the FDA by Emergency Order. MOST IMPORTANTLY, it seeks to ascertain who has been EXPOSED and SURVIVED and WHO IS STILL AT RISK for this highly transmissible and potentially lethal disease.  

Routine Lab […]

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Doctor’s Notes: Staying Well – A Path Forward

“When the goin’ gets tough, the tough get goin”

                                                                                     Mr. Harris, high school football coach 1968

Hello, and I hope this Doctor’s Note finds You & Your Loved Ones Safe & Well. I want to bring you an update based on where we’ve been and where we are going.

I want to keep you informed as to how I, as your Doctor, can keep you as well as we can. This experience is a new one for everyone on the planet. It is a first for known mankind. That being said, open mindedness, resourcefulness and creativity should rule the day.

The Institute for Health Metrics and Evaluation website https://covid19.healthdata.org/united-states-of-america/florida is a daily update of the evolution of our efforts regarding the spread of COVID 19. It changes daily, based on the success of our response to this dilemma. As of today, here in Florida we are beginning our ascent to the current peak on Wednesday May 6, 2020. Two weeks later on May 20, 2020 is the time period currently stated to allow for some phasing in of services. This timeline has been changing as new data arises and is improved by our compliance with Public Health advice. As the old adage goes “when you have your health, you have just about everything”.

That being said, here is how my office can assist you in that endeavor.

THE OFFICE: The office has been closed to public entrance since March 14, however the Doctor and full […]

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Doctor’s Note: We Can Do This

Primum non nocerum…First, Do No Harm
                                 Hippocrates

A young Resident in Medicine confronted with an emergent clinical problem learns, the first day, to think intelligently, act quickly and … First… do no harm….Then, do something helpful.

When the young Physicians arrive at an emergency they learn to “first, take our own pulse”. It is an exercise in maintaining your own calm in a difficult situation.

The Red Cross always starts out the First Aid Courses with reminding us that when arriving at a scene in need, we must first caution to assure we do not become another, in need of assistance, but remain as one of those helping remedy the situation. Good advice.

Try to not to panic in these times. Communication is King, and Queen.

Our Office is functional. We have adjusted our practices following guidelines that offer guidance to the patients, the staff and the Doctors. Some of the new approaches to maintaining our collective ongoing good health, include:

PLEASE NOTE:  Needs must FIRST be communicated with by PHONE.  NO WALK INs PLEASE. It puts you and us at risk.

Keeping our distance through “Social Distancing” (see my Doctor’s Note from 3/16/20) is the first and most important line of defense(along with stringent hand washing) for this new communicable virus that transmits by the respiratory route.

CALL FIRST. Also, if calling 911 or going to the ER with any COVID 19 condition PLEASE let 911 and the ER personnel know you are coming prior to just presenting ourselves.  It protects the care givers that will help you. As Jerry Maguire so aptly stated…”Help Me…Help You!”.

OFFICE VISITS: Phone visits associated with visual assistance […]

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