Coronavirus

Corona Virus Protocol

 

CDC has warned that more cases of Corona Virus will be reported in the community. At present there are no vaccines and there is no treatment.  We have to isolate patients of suspected Corona Virus quickly and this is our protocol.

 

Instruction for Staff

  1. All the patients on schedule, must be called ahead of the time and asked if they have
    1. Respiratory Symptoms, with cough and or shortness of breath ; If yes, we must ask if they have been to affected geographic areas or have had contact with someone who has been to affected geographic area -- in that event patient must be told to go to ER at medical center of aurora while wearing a mask and call medical center of aurora prior to going there to alert the response team to receive them
    2. If they have respiratory symptoms but have no epidemiological risk identified by CDPE, then they must be offered virtual visit from home.
  2. If someone still comes to the clinic with respiratory symptoms, please room them immediately to Exam room 5; Ask the patient to wear protective mask. Providers too must wear procedure mask; We have been requesting N95 respirators for more than a week but they are not available at Pandemic Supply Network. When they are available, employees will be given respirator masks. 
  3. Their history must be taken using the phone call to the patient. 
  4. If provider suspects COVID 19, then there is no lab test available at Labcorp. Instead call ambulance and let patient go to Medical Center of Aurora.
  5. After the patient has left, do not use the room for one whole day. The room must be disinfected before using the room again. 
  6. Keep the blinds to that exam room open all the times. Sunlight is disinfectant.
  7. Do not use exam room 5 for regular patient visits. Keep it ready for COVID emergency.
  8. Please refer to this page for updates and additions.

Instruction for Patients

  1. If you have respiratory symptoms such as cough, shortness of breath and have been to one of the areas where there is Corona Virus emergency in last 14 days, or
  2. If you have respiratory symptoms such as cough, shortness of breath and have been in contact with someone who has been to one of the areas where there is Corona Virus emergency in last 14 days, or
  3. If you have respiratory symptoms such as cough, shortness of breath and have other health complications such as COPD etc.

Please get yourself phone screened before booking appointment. 

You must call 720.400.8935 and speak to one member of our provider team and they will instruct you appropriate treatment.

 

  1. If you want to see a provider, for any other reason, check if you can do an eVisit instead. We are supporting eVisits from March 05th, 2020. 
  2. If you need physical exam, please finish all the paper work online and make your waiting room wait a very short one. 
  3. Wash hands at the end of office visit for at least twenty seconds, using the faucet and soap provided at the exam room.
  4. Do not touch your eyes, ears, nose, our mouth. Wear masks to prevent you from touching your nose and mouth by accident. 
  5. Do not shake hands with any team member of your provider team. A Namaste or a Hello is preferred. 

Instruction for General Public

 

Dr. James Robb, one of the first pathologist to work on Corona Virus in 1970's has shared this on email and you may have already seen this on your favorite social feed. If not, please read the content here. 

 

Date: February 26, 2020

Subject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic.

Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.

The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:

1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us! Jim
James Robb, MD FCAP

 

Cellulitis and Erysipelas

What is Cellulitis?

Cellulitis and erysipelas are infections of the skin.

Symptoms are redness, pain, swelling, chills, fever.

Erysipeles affects the superficial layer of the skin, cellulitis affects the deeper layers.

Normally our skin has germs superficially. Skin cuts or breaks allows the germs to enter under the skin and cause infections.

Other conditions also increase the chances of skin infections like chronic skin conditions (ex: eczema), overweight, certain medications. 

Common location of erysipelas and cellulitis are legs or arms. It can affects skin on the belly, the face, in the mouth, or around the anus.

 How is it diagnosed and treated?

You should see a health care provider immediately. Untreated skin infections can be dangerous, it can spread to the rest of the body causing complications.

Your health care provider will diagnose you and order tests if indicated.

Treatment is with oral antibiotic pills.

Please finish all the prescribed antibiotic pills even when you feel better with only a few pills. The bacteria does not die completely if you do not finish all the antibiotics prescribed to you.

 How to care for yourself?

You should do the following at home

Finish medications as prescribed. If any problems with medications, contact your health care provider immediately

Raise the arm or leg for 30 minutes 3-4 times per day to reduce swelling

Keep the infected area clean and dry

Wash your personal clothes with disinfectant detergent

Personal hygeine, wash hands frequently with soap and water.

See your health care provider immediately if you have, worsening redness, swelling, fever, pain or any worsening of health.

Your health care provider can determine if you need antibiotics changed or if you need to go to the hospital.

 Prevention

Avoid skin cuts, shower daily, maintain normal body weight, obtain instructions for skin care if you have chronic skin conditions like eczema, hand hygeine wash frequently with soap and water, shower after using public swimming pools, hot tubs.

 

Birth control

 What are the different forms of birth control?

There are various forms of birth control available in the United States.

Contraceptive methods based on effectiveness?

 More than 99% effective.

Implants like Nexplanon

IUD like Mirena, Copper devices.

Tubal ligation which is permanent.

Vasectomy which is permanent.

Contraceptives that are more than 99% effective if always used correctly, but generally less than 95% effective with typical use:

Birth control injections like Depo shot

Birth control pills [combination of estrogen and Progesterone]

Progesterone only pills.

Birth control patches.

Vaginal rings.

Contraceptives that are 98% effective if used correctly:

Male condoms

Contraceptives that are 95% effective if used correctly:

Female condoms

Contraceptives that are 92 to 96% effective if used correctly

Diaphragm or with spermicide gel

 

Contraceptive methods depending on duration 

Intrauterine device [IUD]- 5-10 years.

Birth control implant-3 years.

Birth control injection-Every 8-12 weeks.

Vaginal ring: worn vaginally 3 out of 4 weeks

Birth control patch: 3 weeks on, 1 week off

Oral birth control pills: to be taken daily.

Male or female condoms: to be used consistently during every act of sex.

 

Please talk to your healthcare provider which method of contraception is appropriate and safe for you.

Your healthcare provider will determine the appropriate birth control after taking your medical history, performing a physical exam and your preferred method.

 

HPV Positive

Our methods are effective in preventing health complications. 

We do Pap Smear and HPV test during our well women exam.

Pap Smear is used to determine malignancy. HPV is used to determine the presence of HPV virus that is linked to future incidence of cervical cancer that can lead to malignancy.  This post is for explaining HPV test.

The human papilloma virus (HPV) test detects the presence of the human papillomavirus, a virus that can lead to the development of genital warts, abnormal cervical cells or cervical cancer. 

The HPV test is a screening test for cervical cancer, but the test doesn't tell you whether you have cancer. Instead, the test detects the presence of HPV, the virus that causes cervical cancer, in your system. Certain types of HPV — including types 16 and 18 — increase your cervical cancer risk. Knowing whether you have a type of HPV that puts you at high risk of cervical cancer means that you and your doctor can better decide on the next steps in your health care. Those steps might include follow-up monitoring, further testing, or treatment of abnormal or precancerous cells.

 

Results

Results from your HPV test will come back as either positive or negative.

  • Positive HPV test. A positive test result means that you have a type of high-risk HPV that's linked to cervical cancer. It doesn't mean that you have cervical cancer now, but it's a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in a year to see if the infection has cleared or to check for signs of cervical cancer.
  • Negative HPV test. A negative test result means that you don't have any of the types of HPV that cause cervical cancer.

Depending on your test results, your doctor may recommend one of the following as a next step:

  • Normal monitoring. If you're over age 30, your HPV test is negative and your Pap test is normal, you'll follow the generally recommended schedule for repeating both tests in five years.
  • Colposcopy. In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.
  • Biopsy. In this procedure, sometimes done in conjunction with colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.
  • Removal of abnormal cervical cells. To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.
  • Seeing a specialist. If your Pap test or HPV test results are abnormal, your health care provider will probably refer you to a gynecologist for a colposcopic exam. If test results show that you might have cancer, you may be referred to a doctor who specializes in treating cancers of the female genital tract (gynecologic oncologist) for treatment.

If pap or HPV test is positive, we typically have patient come back to office and choose appropriate care plan. 

Bacterial vaginosis, BV

 What is Bacterial vaginosis?

It is a change in the balance of bacteria in your vagina.

What are the symptoms of Bacterial vaginosis?

Unusual vaginal discharge with strong fishy smell, particularly after sex.

Change in the color, consistency of the vaginal discharge

How is Bacterial vaginosis diagnosed and treated?

Consult your healthcare provider.

Your healthcare provider will talk to you about your symptoms, and perform a vaginal exam.

Your healthcare provider will order a urine test or a vaginal swab. 

Bacterial vaginosis is treated with oral antibiotics or vaginal gel.

If your symptoms persist, please contact healthcare provider.

How can I decrease the risk of Bacterial vaginosis?

Do's:

Use water and plain soap to wash your genital area.

Take a shower instead of bath

Use condoms during all acts of sex

Use sanitary pads instead of tampons

Daily consumption of probiotic products.

Don'ts:

Do not use perfumes, soaps, bubblebath, shampoo, shower gel in the bath.

Do not use vaginal deodorants, washes or douches.

Do not put disinfectant liquids in the bath

Do not use strong detergents to wash your underwear

Do not smoke.

 

 

 

Information

At the time of office visit, please present your insurance card.  We bill your visit to the insurance card you present. 

In the event of an error in your insurance, please let our front office staff know.

We are in network with most insurances. However individual plans may vary and not known till a claim is adjudicated.

We are a smoke free facility.

We need every patient to finish all the forms online and check in online if possible. 

Most visits start on time, so please plan to be at the office, fifteen minutes before your appointment.

Habitual no show patients are terminated from the patient panel.

We charge a no show fee.

If you are not able make the commute, or take time off for commute , explore tele medicine available now.