Tips for Prevention, Sleep & Anxiety during COVID19​

To Our Dear Spring Center patients:

So much as happened in the past week during this pandemic. Cases in the United States have surpassed the rest of the world. New York and New Orleans have been hit terrifically hard. It is expected that all major cities will follow similar trajectories. Our heart and prayers go out to all the healthcare workers, first responders, affected families and all those working tirelessly to combat this virus and keep our country functioning. And we fervently hope that you are all safe-at-home and practicing social distance in person and finding ways to stay healthy in mind, body and spirit.

As you know, we have transitioned to full time telemedicine with Dr McCann “seeing” patients Monday through Thursdays and Deanne Newton, our PA-C “seeing” patients at least for the next few Saturdays. We are using a wonderful platform called Doxy.me which is simple to use and kind of fun! I really enjoy seeing everyone’s smiling faces, so please do utilize this platform for your appointments, if at all possible.

In addition to “seeing” patients, I continue to read and watch videos to stay on top of this ever-changing situation. This weekend, I lectured for and participated in a virtual conference called the Forum for Integrative Medicine, founded by Susan McCamish from Beyond Balance which specializes in herbal therapeutics for Lyme disease. It is a fabulous collection of practitioners who care for chronically ill patients and it provides a wealth of information on a variety of topics. There were also lectures on COVID19. I intend to share some of the information for you here.

As of now, testing is extremely limited to patients who have a fever >100.4 degrees and who have severe respiratory compromise. (plus age >65, Diabetes, Chronic Lung disease, immunocompromise such as Combined Variable immunodeficiency, Immunosuppression due to organ transplant or active cancer or chronic medical conditions.) If you develop symptoms consistent with COVID19, please call the office. If possible, we will attempt to order a test, if warranted. If a test is not indicated, the staff will schedule you a telemedicine appointment with Dr Kelly to discuss individualized treatment options for you.

Additionally, there are some newer symptoms of COVI19 to be aware of:

  • Some people develop loss of smell and taste and some have more gastrointestinal symptoms.
  • These may also precede the fever and respiratory symptoms, so if you develop ANY symptoms please isolate yourself from other family members and contact the office.
    949.574.5800 ext 2 for scheduling
    Hours open for calls:
    Monday – Thursday 10am – 3pm
    Fridays 10am – 2pm

We also now have a BLOG on our website where you can reference these emails along with other info. Please feel free to share with your friends, family & colleagues as they may find it useful in these times.


If you or other loved ones have underlying conditions, you may want to invest in a pulse oximeter.


This enables you to monitor oxygenation. Lack of oxygen or hypoxia may not be accompanied with symptoms of shortness of breath. Please start checking your temperatures and oxygenation regularly!

It is still thought that most people will have a mild-moderate course of illness and be able to quarantine at home and recover without issues. Some of my

colleagues on the front lines have shared what they have witnessed to be a common clinical course of this infection. The author of this is unknown, though he or she is an ER doctor in Louisiana.

ER MD shares: 2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, muscle aches, back pain) nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell and taste, loss of appetite, and fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia due to direct lung damage.

Day 10– Cytokine storm leading to acute respiratory distress syndrome (ARDS) and multiorgan failure. This happens very quickly in a matter of hours.

  • 81% mild symptoms
  • 14% severe symptoms requiring hospitalization
  • 5% critical

He/She continues: “Patient presentation is varied. Patients are coming in hypoxic (Not enough oxygen – as low as even 75%) without Shortness of breath. I have seen Covid patients present with Cognitive changes (encephalopathy), or renal failure from dehydration. He has even seen asymptomatic patients have it when x-rays are done for other reasons, like a dislocated shoulder x-ray!

China reported 15% cardiac involvement. I have seen Covid 19 patients present with inflammation in heart (myocarditis), inflammation in the sac surrounding the heart (pericarditis), new onset congestive heart failure (CHF) and new onset atrial fibrillation.

If patients have a bilateral pneumonia, low WBC, low lymphocyte count, elevated CRP and elevated ferritin- they have covid-19 and do not need a nasal swab to tell you that.”

This person describes a terrifying picture that I hope none of you will experience.


Questions from our community about what Preventative Measures you can take:



Preventive Measures
Some reports that the virus can live on metal and plastic surfaces for 72 hours although researchers found viable SARS-CoV2 on cruise ships up to 17 days later. It was also reported that the virus lives on cardboard boxes for up to 24 hours and that it can linger in the air aerosolized for 3 hours if someone coughs, sneezes into the air, which is very concerning. However, after deeper exploration, this piece of research used a machine which projected the viral particle into the air in an way NOT consistent with a human cough.
So, how do we protect ourselves?
1.  Should people who are healthy wear masks (N95, etc) and/or gloves out in public when they go grocery shopping, etc? 
Good question. I would recommend wearing gloves at a minimum and be sure to wipe down with disinfectant any items purchased to reduce risk of contamination. We have no idea if the virus lives on things like fresh vegetables and fruit, so be prudent and cautious.
As for wearing a mask, if you are lucky enough to have masks, perhaps it is worth doing while in a confined place, like a grocery store. Up until now, this has not been the recommendation. I watched a video of an infectious disease doctor in Korea who stated that one of the reasons Korea is handling this crisis so well is because all the citizens are wearing masks. Now I double checked the WHO page and they too don’t recommend wearing masks unless sick. He
explained about the size of the droplets expelled from someone who coughs which are large and therefore heavy and tend to fall to the ground. Smaller particles could become aerosolized and these are the ones that are concerning. He described a situation in a church (a small confined area) where people are singing and how that is a risky situation for spread without masks.
Given what we know, my suggestions would be if you go into a store now, and you have a mask. Please wear it, plus gloves.
However, if you are outside, on a street, trail or in a park, I don’t think you need to wear a mask. Any droplets from infected people will fall to the ground and are unlikely to cause infection in someone walking by minutes or hours later.
2.  Do you need to decontaminate yourselves after a trip to the grocery store (strip off cloths and shower) when you return home?
At this point, that may be excessive, but for peace of mind, it can’t hurt. For all heath-care workers with known sick contacts, the answer is Yes, of course.
3.   Should spouses consider not kissing, family members who are sheltering-in-place not hug, if they are uncertain about their infective status?
I think the answer depends on the level of concern for developing complications from the virus. For those who have numerous medical conditions and immunocompromise or who have underlying inflammatory conditions, you may want to reduce bodily contact. That being said, I think that this quarantine is difficult enough. As long as there are no symptoms and limited exposures, I think the comfort and stress reduction of physical contact with our loved ones is more important for everyone’s health. I don’t think sleeping head to feet with one’s partner will be adequate “safety precautions.” If people are that concerned, or if anyone shows symptoms, sleeping in separate rooms, using separate bathrooms if able, is warranted.

How do I manage anxiety, stress and sleep during this time?

Managing Stress, Anxiety and Sleep
During this unforeseen and challenging time, our minds are working overtime to try and process all that is occurring and our bodies are reacting from the hyper stimulation. Many of us may feel more tired than normal despite getting 8 hours of sleep. Many of us are having trouble quieting the mind and therefore unable to sleep. It is critical during this time, we give our bodies and minds the rest and recovery they need to continue with daily tasks, and sustain our immune system functioning efficiently.
In fact, research shows that sleep deprivation substantially reduces our immune systems. One study with the rhinovirus, which is the common cold, showed that people who averaged < 7 hours of sleep were 3 times more likely to develop the infection, compared to those who regularly got >8 hours of sleep. When we get adequate sleep, our immune cells, specifically our T cytotoxic cells are able to deal with the virus. “
So, it is clear we need to focus on getting adequate sleep and manage our stress in this challenging time.
One thing I think all people should start for sleep support and antioxidant support is melatonin. This supplement has been shown to reduce inflammation caused by SARS-COV. Dr Klinghardt, who is 70 years old is taking massive doses, but I would recommend that: Melatonin
  • Over 60 begin taking 3 mg and work their way up to 20mg at bedtime
  • Everyone else take between 3 mg or more, if they have medical conditions.
  • Children, teens and 20 year olds can probably get by with 1mg at bedtime.

 

TIPS for Optimal Sleep
Refrain from using Phone at night or in Bed:
Now that we are all connecting with the rest of the world via our computers and phones, we have to be aware of the blue light from the devices will suppress melatonin and disrupt our sleep. 
Please be sure to put your phone in night shift mode and use an app on the computer called F.lux to reduce the blue spectrum light. 
At least on the iPhone you will access the Night Shift is under Display and Brightness Settings. And if you google F.lux you will prompted to download this app and the night shift will happen automatically.

 


There are several supplements I myself, my staff and many patients use that they have found helpful.


For those of you familiar with Kavinace, I created 2 similar products
Sleep Support
Designed to resembleKavinace Ultra Pm, this contains melatonin 3mg, 5HTP 100mg and sleep-inducing herbs. The active ingredient is from Magnolia which hits the same GABA receptors as the phenybutyric acid that was the active ingredient in Kavinace. Start with 1 cap but you may need 2-3 to achieve the same effect.
60 capsules $62.50
Stress Relief
Designed to resemble regular Kavinace. It can be taken in the daytime for mild anxiety or at night to help with sleep. Most people will have to determine the ideal dose for them, so I would start with 1 cap and adjust as needed.
60 capsules $56.50
Designs for Health PharamGABA
A chewable tablet to support GABA, this is gentle and can be used fro mild anxiety or for sleep. I find it works great for helping me get back to sleep in the middle of the night on top of my other sleep support.
60 capsules $46.50
Neuroscience Calm CP
This product can be take in the daytime or at bedtime to help lower cortisol and calm an over stimulated nervous system. Can take 1-2 caps as needed.
60 capsules $59.85
ParaSYM Plus
This product is designed to help shift people from Sympathetic overdrive back into Parasympathetic, where they can relax and function better. If you are stressed out about your health, the state of the world and really struggling to calm yourself down, this is worth trying.  Start 1-2 caps in am.
60 capsules $58.95
Dr. Monacos’ CBD fomulas
 A colleague of mine designed these wonderful, clean CBD products. The 2 best for anxiety and sleep are the CBD Calm and CBD Women’s Formula. The primary difference is the herbs added to synergize the effects. Women can use Calm but I would recommend that Men avoid the women’s formula.
  • CBD Calm Tincture. Start low 5-10 drops for anxiety or sleep. Some people need a dropperful to see an effect.  500 mg $65.00
  • CBD Women’s Formula. Use similar doses as Calm. 500 mg $65.00
Travel sizes of these available for people to try. 166mg for $25
Metagenics Hemp Oil. This is a full spectrum hemp oil that also works well for sleep and anxiety. Start with ½ dropperful in the daytime or more at night if needed. 30ml, 1oz $ 52.45
Thank you for taking your time to read thru all of this information.
We will be sharing another update later this week.
Stay well, stay safer at home & we are here if you need us.
Fondly,
Kelly K McCann, MD & The Spring Center Staff