From the Office of Robin Ellen Leder, MD:
Once again, as things evolve rapidly on all fronts, I wanted to keep you updated on several things:
I understand that some patients are concerned about going to a laboratory to have blood testing done. For that reason, if you need to have any blood drawn, I can do it myself. The office setting has very few people in it at any given time. Basically a good part of the time only myself and Karen are in the office (as some visits are currently done by telephone, and both of us are rarely exposed to anyone else, even in out off-work hours.) So, if you are able to come in, I am ready, willing, and able to do most blood drawing for you to keep your testing of various levels current.
Tests that are not done on blood (i.e.,stool, urine, and saliva) can be drop-shipped to your home directly by labs, which makes those things simple to accomplish.
Some folks have requested plaquenil (hydroxychoroquine) as a “back-up" for acute illness, and I do appreciate that thought. I alluded to this in my first email about a week ago. I am able to order it for you, but I cannot in any way guarantee that at this point you will find it available in a pharmacy. If you want to try, let me know and I will forward my sign-off consent form to you, as this drug, though it may be helpful in an acute situation, has a number of contraindications and side effects that can be very unpleasant. You will need to carefully read the consent form, sign it truthfully, and return it to me before I can write you such a prescription.
Azithromycin has been discussed as a companion drug to plaquenil, again without firm evidence that it would be effective. This is the same drug used in the Z-pack. Again, it is now barely available, but if you want it, you will need to locate it at a pharmacy before I attempt to call it in for you, as with plaquenil. Many pharmacies are very short, or are totally out of, both this drug and plaquenil..
It now appears that a small percentage (approximately 5%) of coronavirus cases begin with GI problems (i.e., diarrhea) without upper respiratory tract manifestations. Those folks usually do not get much sicker beyond the diarrhea, though they would test positive (if tested at all). However, if the GI positive patients do go on to have respiratory symptoms, they are apparently in a fairly high-risk category for more aggressive disease. Now, not all diarrhea represents coronavirus by a long shot, of course. But, if you do develop diarrhea, and this is not a normal state for you, please treat it as at least a warning sign, and I recommend that you stay at home meticulously until it passes. And do drink plenty of water and or electrolytes to replenish. And if respiratory symptoms of cough, headache and fever develop to a concerning level, contact me or an emergency care facility. This is especially important if you are over 60 or have any sort of immuno-compromising or respiratory conditions.
That’s about it for now. I am anxious to hear how you are doing at this time.
As has been reiterated time and again in the past few weeks (but I already understood as you must all have), pandemics are not simply medical disasters. They have profound financial consequences, of course, but then, related to those issues, there can be serious emotional fallout, as well as critical spiritual issues (lack of hope, loss of faith).
Whatever your concerns may be as we move forward over time, and this will take time, they are not foolish, I am sure they are quite real. Remember that we can discuss anything that is troubling you, at any of these levels. They are all very much a part of your health in the broadest, and yes, holistic sense. And after all, isn't that what you and I are all about?
As I am writing to you and about you, you must know that I am going through very much the same things; I think we can all empathize with our fellow citizens, probably more deeply than at any time I can remember in my lifetime.
I think that the more we distance ourselves physically, the closer we will all become spiritually as a nation - at least that is my hope. G-d bless you all and please stay in touch!
Best regards,
Dr. Robin Ellen Leder