Updated Recommendations and Battling the Blues

Update: It was brought to our attention by our Jewish friends that our original message did not include Passover. Regretable, not intentional, our deepest apologies. And Chag Pesach Sameach!

As we see the data shifting, we are updating our recommendations for our patients:

1. Wear a cloth covering like a bandana over your nose and mouth and wear glasses when you are going places where you cannot maintain a 10-15 foot distance from others like the grocery store. Do NOT use medical masks

2. Choose a person in your family or friend circle to “buddy” with. That person should be someone you check on by phone, facetime or skype regularly to help them not feel so isolated.

3. Get a three month supply of medications that you take regularly

4. Get a three month supply of supplements that you take regularly

5. Our patients, who are ambulatory MUST walk 40-50 minutes daily outdoors. If you are on well travelled paths, wear a cloth covering over your face.

6. Wash your hands frequently.

7. Do not touch your face

8. Avoid congregating at all, especially in public venues that have seating, like the lobby of your apartment building.

9. Our lung patients (COPD and Cancer), MUST make a 15 minute appointment with us to get a preventive protocol in place right away.

10. Avoid people who are sick. If you have a family member who is coughing or ill, you must isolate them in their own room, preferably with their own bathroom. Text Dr. Roy at 248 260 8866 with the words: 911: Name: symptoms and we will issue you CDC guidelines modified to your situation.

Finding the joy during the quarantine has been challenging. Here’s where it is for me: it has been a beautiful thing to telemed and see patients in their homes. I have had the opportunity to talk to an artist in her studio, to see rare pieces of china passed down from grandmothers, to see babies I have never met, and photographs of ancestors. It has been an honor.

What I have noticed is we are all anxious and vulnerable, our marriages are strained, our kids are stir crazy, home schooling doesn’t work for many of us, and many of us are “over” the “trauma/drama” of the news. People are starting to experience anxiety and depression in ways we haven’t seen before and it’s all of us.

The common driver seems to be grief and all of its stages: denial, anger, bargaining, depression, and acceptance as people struggle with adapting to social distancing. We have lost a lot that we take for granted: our jobs, our routines, our favorite swim class, our yoga studios, our body work
people, our social connections.

Some resist the precautions, frustrated that spring has rolled around without the usual burst of socializing and activity. And with Spring comes birthdays, graduations, Palm Sunday, Easter, Ramadan, Passover….we are lost without the joy of gatherings, hugs, handshakes, and eating together. For
some of us it’s been weeks since we experienced a friendly touch.

For those of us with elderly relatives or far away loved ones, the challenge is more patent. I myself worry about my father in Florida. I cannot fly to see him without putting him and my patients at risk. I have made the difficult choice of watching him from a far, knowing that if he has another fall, a stroke, another event, he may not get swift care. He struggles with excruciating pain for which he was in physical therapy and water aerobics. My chest hurts as I think of how vulnerable he is to this crisis. And as a health care worker, not on the front line, but working nonetheless, Dr. March and I are devastated by unnecessary losses as our patients cannot receive the care we once took for granted.

And for many of us, isolation brings to the surface other triggers. I know many of you would give your kids away if you could now, and in fact, many of my colleagues have had to send their kids to live with relatives while they manage the very ill. My husband and I have not seen our nine year old son in 6 weeks as we both have risk of exposure and two of our son’s family members are front line health care.

For me, not having children has never felt like more of a failure than it does now, and where my relationships with my sisters or cousins may have already been weak, I feel a peculiar loss as I realize how petty our grievances may have been.

First off, stay the course. Many of you have heard that if the government instituted a mandatory nationwide complete shut down of everything including grocery stores and kept us in a stay at home order with enforcement for THREE weeks only, we would halt the virus in its tracks. Know that avoiding others is doing your part. And when you give up and give in, you give the virus ground to keep us out of work and out of touch.

Secondly, while we are in the midst of this viral pandemic, we have a massive mental health pandemic brewing in the shadows, and none of us are immune to it at this point. I talk to all of my patients about the fact that we are waiving co pays for April and May of 2020 and you have insurance coverage for mental health. This is a boon at a time where we have little resources.

Even if you have never spoken to a mental health therapist before NOW is the time. And it is NO COST to you. We have two excellent resources:

Michael Morris
o Masters level, in practice for over 45 years, has an existential approach that looks at “reframing your experience”

Jessica Blodgett
o Masters level, acute listener, very focused on gentle guidance to journey through your inner life.

Both are specialists in crisis, anxiety and depression.

Email us at dr.roy@aimnatural.com TODAY and we will set you up for a casual chat to check in and see if you feel comfortable talking further. If you don’t like either Jessica or Michael, we will find you someone you do.

Call at (248) 798-2942 for an appointment.

And try this meditation on gratitude in the mornings:
https://www.youtube.com/watch?v=KSM6hVkYhIs

We are all grieving, and it’s okay to not be okay. Now is the time to support each other, let each other cry, and lean on each other emotionally. Through our collective acceptance of our need to seek help, we will emerge as more grateful, grounded, and whole.

Drs. Roy and March, Jessica and Michael

Supplement Orders Update

Dear Patients:

I am and continue to be concerned by the trend to buy up as many of everything as people can as it impacts our patient population. Many doctors and clinics have been purchasing supplements and partially capitalizing on this panic. 

There is NO cure for ANY virus, your immune system will do its job and take care of it. Supplements can support your immune system but they will NOT prevent the spread of the virus as we think now that it may survive on surfaces for perhaps days. The result is that the major distributors of therapeutic pharmaceutical supplements are not able to keep up with the demand. 

Supplements aren’t like bleach, they cannot always be manufactured, and sometimes they are harvested or grown. 

There will be delays in receiving supplements necessary to your care.

Our biggest concern is our patients who are not able to get treatment, in chemoradiation and or in their first 2 years of survivorship.

Our response has been to take a loan against our staff salary budget and buy 20-30 bottles of available stock so that we have some sort of safety net for you and also don’t deplete the stock available to other cancer practices. 

They should be here by Saturday, March 21st. 

We will have in the office:

• Melatonin 20 mg

• Reishi 

• Vital 10 probiotics

• Glutamine

• Magnesium Glycinate

• Ginger Root

• Ashwaganda

• Vitamin D

• B12

We will make that stock available to all our patients but we are prioritizing cancer patients.

You can and should still order through bewellwithaim.com 

You may find though, that you place an order and are told the item you needed was out of stock. 

In that case, you will be told if we have it in the office or if we can replace it with an alternative. 

If we have it, you will need to show up during office hours and pick up what you need, as we cannot ship to you unless you are out of state. We are continuing to follow precautions and our office is a safe place for you to stop by.

If we do not have it, you and I will wait until it becomes available again.

It would behoove our patients who are IN treatment to try to get and store 3 months supply of supplements now in case there is a permanent shortage.

I am so sorry that we didn’t predict this and buy in bulk earlier, it wasn’t part of our business model and it is absolutely something I should have anticipated. I truly expected restraint from my colleagues. 

For those of you who do not have cancer, and are not in treatment, or are outside of your 2-year survivorship window, still place your orders on bewellwithaim.com but please be patient with us as we prioritize needs.

As usual, do not purchase supplements over the counter without running it by us. It may be safe or it may indeed make things worse.

Thank you. 

Be well,

Drs. Roy and March

(248)798-2942
dr.roy@aimnatural.com

Covid-19 Update

Dear Friends,

Please do not be alarmed by the news. Nothing new has been discovered about viruses in general. They are just trying to really nail down three things:

1. How is it most effectively transferred from person to person?

2. How can we quickly create infrastructure to manage higher traffic of people at health care centers who show up with cold or flu symptoms?

3. How can we have effectively tell which people who show up with symptoms have this virus versus another?

What is a virus?

Viruses are not living creatures. They are a plasma capsule carrying a fragment of genetic material. They cannot survive for a long time on their own. Without a host, they dry up and die.

Think of them as a partial blueprint for how to make themselves suspended in clear jelly.

If a person touches a surface where that virus (tiny fragment of DNA suspended in a jelly) is sitting, and then touches their nose, eyes, ears or mouth, they can deliver that little fragment to their nasal passages and lungs.

That little fragment enters one of your cells and tacks its blueprint onto yours.

Every time you make things you need for your own cells and you print out copies of your blueprint, you also print out copies of the virus’s blueprint. 
The thing to remember here is that this is ALWAYS happening, every day that you live on this earth.

We live in a world that is crowded with critters not visible to the naked eye. There are more bacteria, viruses, fungi, parasites in your own body than your own cells—some are critical to your survival.

How do we survive in this invisible microbiome? We have a really sophisticated and well developed immune system that is designed to notice critters of every kind and to knock them out.

If you are immunocompromised, this means that your immune system is not at its best, but it does NOT mean you will get the virus and get sick.

It means compared to someone who is not immunocompromised, if both of you run your hand on a doorknob and pick your noses, you are more likely to have cold symptoms.

If you do get “sick”, that does not mean you will get very sick. Even if you are immunocompromised, it's still true that over 80 percent of people do not get very sick and instead just have mild respiratory symptoms that resemble a cold.

Also, typically, even if you are weaker, your immune system will take care of it, it just takes longer. Antibiotics won’t help and can make things worse. 

Immuno supportive supplements can help but nothing can replace sleep, lots of green leafy veg and bright colored fruits, meditation, yoga, prayer...and a little bit of cardiovascular exercise to strengthen your immune system.

Here’s what we do know about this strain:

ϖ The only difference between this virus and its cousins is it can last longer on surfaces. So if someone coughs, sneezes etc, on a table, that little jelly thing can live there for maybe even one day.

ϖ There is still NO change from what I’ve told you before about transmission. You CANNOT get a virus by living in the world.

ϖ There are only two ways to get a virus:

1. To be coughed or sneezed on by someone who is less than 6 feet from you so that respiratory droplets land directly in your nose, eyes, mouth.

   OR

2. To touch a surface that has been coughed or sneezed on and then touch your face.

An example would be if the person who has a virus coughs in their hand and touches a door knob and you touch the same doorknob let’s say 20 min later and then touch your face. 

But just because you are exposed, (see above) does not mean you will get sick.

General precautions for generally healthy people:

♣Do NOT touch your face

♣Wash your hands in case you forget and do touch your face

♣Wipe down high touch surfaces with a bleach containing solution

♣Do not let your kids or elderly family members hang out in crowds where people are coughing

♣Teach your family to cough into their armpit

Precautions for our Vulnerable Patients:

If you are worried or unsure if you are vulnerable, I expect you to schedule a 15 min phone conversation with me or Dr. March at (248) 798-2942 or mailto:dr.roy@aimnatural.com to learn if you are at risk or need to take specific precautions. 

Please know, if you haven’t gotten bloodwork done in three months, we will need to draw blood before we speak to you. If you have blood work, I still may do a repeat CBC.

At AIM we are defining our vulnerable patients as:

ϖOver 75

ϖAnyone with COPD (asthma, chronic bronchitis or emphysema)

ϖAnyone getting chemotherapy, radiation or targeted therapy (not hormonal therapy)

ϖAnyone who had surgery (not reconstruction) within the last three weeks.

ϖAnyone currently fighting leukemia, lymphoma

ϖAnyone with an absolute lymphocyte count under 1.0

ϖAnyone with a total WBC count of under 2.5

If you are in this group, I’d like you to limit unnecessary interactions and stay home for the next 3 weeks, like a self quarantine. 

If you are in this group, I’m advising a travel restriction for 6 weeks unless it’s absolutely essential. 

15 min phone conversations are an opportunity for you to ask specific questions about your situation and also to MODIFY the self-quarantine. 

You are each unique individuals in unique situations, the quarantine can be modified for your circumstances; however, please do not modify without speaking with one of us. 

The Office Environment:

You do NOT need to come in if you are opposed to doing so, but for those of you that fall under “General Precautions,” it is safe to do so. 

If you are scheduled with us, barring medical emergency, you do need to keep your appointment.

We have to ask for your patience. As we move many patients onto tele conference, there may be delays in when we get to you. Similar to longer than usual wait times in the waiting room, we will still expect that even if we are running late to get to you, you will be available to talk. 

We have implemented protective measures for you and our staff. These include:

1. Daily meetings with oncology at three large hospital complexes in the region to make sure that our safety protocols are consistent with theirs.

2. Daily internal meetings with our clinical staff to discuss emerging data.

3. Our offices are cleaned with hospital grade cleaning products, especially our “high-touch” surfaces, multiple times a day.

4. We are running filters that do clean the air of airborne particulate, including viruses and will filter every square inch of our two clinical spaces while you are in office to prevent any airborne transmission (which at this time, is not necessary).

5. We have a new “no touch” policy to avoid skin-to-skin contact where we will not shake hands, fist bump, or do physical exams that involve skin-to-skin contact.

6. We will contact you before your appointment to move you to phone or Zoom instead of having you come into the office to avoid you coming in unnecessarily.

7. The admin and front desk, who really carry the brunt of all of the grind associated with these changes are critical personnel for us. We cannot serve you if Kyle, Emily, Sydney and Diana are not well. For that reason, all front desk persons will be wearing a mask and/or gloves while in office to protect them from multiple patient contacts.

8. We clean the offices at night and the morning before clinic DAILY with hospital grade antimicrobial products.

9. All of our clinical equipment is sterilized after each patient use.

10. ALL clinicians wash their hands before and after each patient contact, including mental health.

11. We have fliers posted on the building and on our door advising patients on what to do if they have a cough or cold symptoms.

What do you need to do to protect us so we can continue to serve you?

Please only bring a family member with you into the clinic if they are necessary for you to walk, hear or process information. Otherwise, to keep traffic low flow, only patients who are well enough to be in office and need to be seen in office will be in the clinic for the next three weeks.

Please do NOT come to the office if you have been in contact with someone who has cold or flu symptoms, has tested positive for, or is suspected to have, TB, Hepatitis, (Herpes Zoster) Shingles, Chicken Pox; or if you yourself have cold symptoms or a dry cough.

Please call us from your car and we will escort you from the parking lot, and will help you get to the office safely.

Do show up for your appointments, even if they are on the phone or zoom and be seated and at home. We will not talk to patients if they are in a public place or in transit and you will be charged for the time.

I want to close by saying the following: First, we will continue to keep you posted. I realize that you may be afraid. Don’t be. We are committed to keeping you safe, and we really will be okay, as a community and as a society.

Second, you really only have one gold star weapon against a virus: Don’t touch your face. 

Third, as people are unable to gather in large groups at community centers, churches, support centers, addiction groups, concerts, and so on, people will start to feel isolated. Please use this as an opportunity to demonstrate that love is greater than fear. 

Fourth, this can be an opportunity to allow our character to shine. 

Do not forget your neighbors, reach out to the elderly people in your building. Continue with support groups over the phone. Small groups meeting at homes are safe. Model for your homebound children civic action. Public schools were providing meals for kids from poorer families, reach out to those who may need a hand. Just don’t shake hands!  

Do not buy every roll of toilet paper on the shelves, leave a roll for someone else. Frankly toilet paper has no real purpose in this crisis. Do NOT buy surgical masks or medical supplies. That action is one of the reasons why we are ending up with this quarantine, it puts medical staff at risk as there aren’t supplies left. Because our doctors and support staff have high volume exposure to sick people, they can be unable to work or worse, become a vector to spread disease. 

Try to reinvest in ways of communing with each other and your kids that we have gotten away from. Don’t go to play centers, malls and movie theaters with them, read, write, paint, play outside. Recognize that as caregivers of grade school kids have to make adjustments, people are trying to communicate remotely, and our healthcare workers are slammed and under resourced, we all need to be a little more patient and forgiving of each other. 

Accept that there is some financial loss associated with these changes and that will change, treat it as a time to slow down, recognize the long game and take good care of yourself. 

The government’s reaction to this crisis has nothing to do with any one of us getting a respiratory infection. It has to do with the lack of supplies and infrastructure necessary to manage high traffic flus and pneumonias. The quarantine is to lower the burden on the system as much as it is to protect you. So don’t worry, you still have a life to live. Email us at mailto:dr.roy@aimnatural.com or call (248) 798-2942 to modify precautions. 

This will pass. 

Be well and with love,

Drs. Roy and March