Pandemic Practice Update

The experience of practicing medicine during a global pandemic has challenged us all.  Most practices, including my own, have adopted telemedicine as a patient care option.

I've found that many patients prefer to come in to see me in person.  As a result we've taken precautions:

• Acrylic shields are located at the check-in desk and the desk inside the office
• Patients are being brought straight back to exam rooms, as opposed to spending time in the waiting room
• Exam rooms are cleaned before and after each patient

With COVID cases rising again, please do not neglect your health!  This week we are offering all follow-up patients the opportunity to be seen either in person or via telemedicine.This will be the case for the indefinite future.

If you have an appointment and you prefer to be seen by telemedicine, please let us know.

Feeding my Little One

With all the stress in the world, I felt like putting out a lighter post -- feeding a baby.

I've been asked often about whether or not my ten month-old daughter will follow a vegan diet.  At some point that will be her own decision.  For now, though, she eats what I eat, which is plant-based.

If there were any concern that a vegetarian diet is not appropriate for a baby, the Academy of Nutirition and Dietetics has a position paper that clearly states that plant-based diets are "appropriate for all stages of the life cycle, including... infancy"

I will admit, though, in order to make sure that she does not have allergies to dairy or egg, she has had a taste of dairy yogurt and egg, without any reaction.

There is always a protein and a food rich in iron at each meal.  We also eat in the spirit of baby-led weaning, which basically means I put food on her tray and she eats with her hands.  Spoons tend to be thrown on the floor, but she also seems happier using her hands.

This was a recent lunch:  The top glass contianer is hers, the bottom bowl mine.

The bowl is my salad for lunch.  The glass container is just about the same, but with smaller sized pieces.  There are shaved carrots and cucumbers, Japanese sweet potatoes, avocado, tomato, and cut-up tofu.  

Often meals are messy.  Here, she has guacamole and black beans.  

Here's a breakfast: Cheerios and mango.  Often breakfast is whole wheat bread with nut butter, cashew yogurt with fruit, banana (not too much because it's very constipating), or a smoothie with fruits and veggies (which she is a rare occasion when I will give her a spoon)..

Tofu, broccoli, and orange peppers:

So far, things are going well.  Ava definitely has her favorite foods -- guacamole, tofu, tempha (from Dave's Korean), sweet potatoes, and applesauce.  But she's prety easy at meal time, she'll eat just about anything I give her. And, she's getting enough iron, based on her hemoglobin measurement at her last check-up.

Telemedicine

With the COVID-19 pandemic, medicine has changed dramatically.  Now that going out of the home and mingling with others carries risk, gatherings that were once in person have now shifted to video conferencing.  And that goes for physician visits as well.

Telemedicine, conducting a visit with a patient from a computer or smartphone screen, was one of those concepts that I always appreciated, but never embraced, due to logistics and difficulty in getting paid.  It has now become a necessitiy, and fortunately insurers are reimbursing more generously for telemedicine than ever before (though likely not quite to the same level as an in person visit, but that will be seen).

Telemedicine isn't that hard, see?

I am using a website called Doxy.me for telemedicine appointments.  It's very straightforward.  You log in to the web site from your browser on a smartphone or computer with web cam.  No need to download anything.  Details are here.

If that seems too daunting, then FaceTime is also an option.  While it is not HIPAA-compliant, exceptions have been made during the pandemic to permit doctor-patient communication via other platforms such as FaceTime, Skype, and Facebook Messenger.

One silver lining of the pandemic and telemedicine is that insurers in many cases will pay for a telemedicine visit with a physician in another state.  So, if you wanted to get a consultation from a plant-based cardiologist in California, and you live far away, here's your chance.

As an absolute last resort, a phone visit is an option.  I don't like these because I think that a face-to-face conversation is a better way to practice medicine.

Adventures in Telemedicine
While I miss seeing my patients in person, telemedicine brings me into my patients' homes.  I've met family members and pets.  I even met a dog who sings "Happy Birthday".

I am a stickler for knowing exactly what medications my patients are taking -- on a telemedicine visit from home, my medical assistant can ask them to gather up their pill bottles, while often when I see a patient in the office they've forgotten their list or assume that I know what they're taking.

Another advantage of telemedicine is that I am often working from home.  This gives me the opportunity to spend more time with my daughter -- the nanny is taking care of her while I'm working, but I get to eat lunch with her and play with her when I have a break.

Need to be seen by your cardiologist, and don't want to leave your home?  Call my office at 818-938-9505 and we'll get you in for a telemedicine visit!

COVID 19 -- Unique Challenges

None of us has ever encountered anything like what we are experiencing.  This is just the beginning, and there will be more who are vulnerable and will get ill.

As a cardiologist, I'm worried, and I'm fearful for my own health, and the health of my family.  I'm being as careful as I can -- mask when near patients in the hospital, change clothes and shoes before coming home, no jewelry, washing and sanitizing my hands even more than I already do.

As a business owner, I've had to contemplate how to change my practice model.  In many ways, I wish I was still an employee -- I would not have to worry so much about finances in that I would have a salary, and wouldn't have to concern myself with the logistics of setting up telemedicine, or finding the correct codes to use to bill for that service.

I think telemedicine is key right now.  I can't in good conscience ask the majority of my patients, most of who have multiple medical issues, to come to my office.  I've been doing phone calls with patients who are due for follow up, and next week I'll be ready to do telemedicine, where I can see and hear my patients.

I thought initially that it would just be follow-up patients, and I would push the new patients to when the pandemic is over.  Unfortunately, I don't think that's any time soon, so I will make do with telemedicine to provide the best service that I can in these times.

If you have an upcoming appointment, or you wish to schedule an appointment, call my office.  My staff will be able to help you.

Coronavirus Update from the Office

To my patients:

The office is open.  We are here to help you.

If you are feeling unwell, or otherwise do not wish to come in, please call and reschedule, 818-938-9505

If you are a current patient, we can do a telephone check-up or portal email exchange in lieu of an in-person appointment.  Call us for details, 818-938-9505.

Please know that we are taking extra precautions to clean and sanitize all surfaces in the office.

Be well,
-Dr. S.

Time and Exercise (and a baby)

I've always challenged my patients who tell me they don't have time to exercise.  After all, there's always time somewhere.  Carve out your lunch hour.  Wake up early.  Stop at the gym on the way home from work.

Having my daughter Ava, which is rewarding and fun beyond what I could even express, has definitely challenged my own ability to get to the gym.

Ava, tummy time champion

Many years ago, workouts would happen in the evenings.  Then, once in my interventional cardiology fellowship, I realized that the days could go very long, and that if I wanted to know that I'd get in that workout, it had to happen early in the morning, before work.  And, that's a habit I continued for more than another decade -- I'd run, spin, bike, swim, go to Barry's, or whatever workout for the day, in the morning.  While there was an occasional evening workout (well, more frequent than "occasional" when I was in triathlon training), morning was the time I knew was mine.

Now with a baby, who is nearly six months old, it's harder to work out.  I remember coming home after my four week check-up with my OB, once "cleared" to exercise.  I asked Ray to watch Ava while I went to boot camp from 7-8 pm.  That didn't work out so well as I came home to a crying baby who wanted to breastfeed.

The first few months were tough, because even though I physically could work out, Ava needed to nurse.  I would need a block of time when she wasn't nursing, I wasn't working, and time was left to shower.  As a result, not much exercising happened until about three months post partum.

I'm still challenged to find time, even as she approaches six months of age.  In the mornings, I am waking up with Ava and feeding her.  Sometimes I can get in a morning workout, but only if I know I have a later start to my work day.  And in the evening, I am watching Ava until my partner gets home and often that's close to 7 pm.

I've gone to some creative lengths to exercise lately.  One evening, I set Ava in her music bouncer (see below) and went through a ten minute workout on an app on my phone.  I did squats, pushups, and other exercises while Ava entertained herself in the bouncer and squealing at our dogs (she's fascinated with dogs, but that's a story for another time).

Musical bouncer, with a view of the dogs

 On a busy Saturday morning, I walked with Ava, in her stroller, to the market, loaded the stroller up with heavy groceries, and rather than walking home, I power walked with the weighted down stroller, up and down the hills in my neighborhood for the next forty-five minutes, while Ava napped.

I have a membership at LA Fitness now, which includes child care.  About three weeks ago, I dropped Ava off at the gym child care.  About 40 minutes into working out, I was paged overhead to my crying daughter who was not enjoying her time with strangers.

So, I would definitely have to say, I have a new appreciation for finding time to exercise.  I'm still trying to figure it out.