What are the new telehealth rules?

This week, the Administration broadened telehealth coverage and eased HIPAA regulations for the duration of the COVID-19 pandemic.

What changed with the new telehealth rules?

-Sanctions and penalties were waived under the Health Insurance Portability and Accountability Act (HIPAA), which restricts where and how a patient’s health information can be shared.  The result:  Doctors and nurse practitioners can now use smartphones to communicate with their patients, which was not the case before.

-All 62 million Medicare patients can now receive telehealth services.  Telehealth can be provided in nursing homes, hospital outpatient departments, and the patient’s own home.

-The Office of Civil Rights has stated it will not impose penalties under HIPAA rules if health care providers are providing care in good faith.  Providers must use reasonable safeguards to protect patient information.

-Doctors and nurse practitioners can use Facetime or private chat apps, but cannot use public facing webcams (such as Facebook, TikTok, etc).

These steps will be important so that patients who need routine medical care  or have questions on their medical or behavioral health management do not have to venture outside of their home.

How can you access telehealth?  If you need to see a health care provider, call your doctor’s office to set up an appointment.  You can also call your insurance company to find out the coverage you have for telehealth and what services are available to you.


Young man using smart phone

Coronavirus: Do masks do any good?

The CDC (Centers for Disease Control and Prevention) is currently not recommending that people wear face masks to protect themselves from COVID-19.  The CDC recommends face masks if an individual has SYMPTOMS of COVID-19, to prevent the spread to others.

Part of the reason for the CDC’s recommendation is that there is concern of a shortage of face masks for health care professionals who care caring for COVID-19 patients.  In many countries, face masks are being purchased on-line and hoarded, resulting in shortages.  Face masks are also selling for exorbitant prices due to demand.  There is a special type of mask called N95 respirators, used by healthcare workers, and there is a particular concern that these will run out.

However, we do know that COVID-19 is spread by respiratory droplet.  So if someone sneezes or coughs, and a droplet lands in your mouth or nose, then you can catch the virus.  The virus can also be transmitted if you touch a surface with a respiratory droplet on it, then touch your nose or face.

Current recommendations at this time are frequent hand-washing, and not touching your face or nose.  While there are no high-quality studies at this time for COVID-19 and face mask use, at this time there is not an official recommendation to wear a mask if you do not have symptoms.


I’ve been exposed to Coronavirus, now what?

Coronavirus, or COVID-19, is a respiratory virus that causes fever, cough, and shortness of breath.  Most people will have a mild disease but some cases may become severe.

You would generally need to be in close contact with a sick person to become infected.  “Close contact” includes:  Living in the same house as a person sick with COVID-19, caring for a sick person with COVID-19, being within 6 feet of a sick person with COVID-19 for about 10 minutes, or being in direct contact with a sick person with COVID-19 (being coughed on, kissed, sharing utensils, etc”.  If you have NOT had these exposures you would be considered “low risk”.

If you are “low risk”, you can continue to go to work and school, but should monitor your health for 14 days and stay away from others if you become sick.

If you HAVE had close contact as defined above, you should monitor your health for 14 days after the last day you were in close contact with a sick person with COVID-19.  You should not go to work or school, and should avoid public places for 14 days.

If you get sick with fever, cough or shortness of breath, you should stay at home and away from other people.  If you have risk factors such as over 60-years-of age, are pregnant, or have other medical conditions, call and tell your doctor’s office.

If you do not have high risk conditions, but want medical advice, you can call your healthcare provider and discuss your symptoms and exposure, especially if you have a high fever, feel short of breath, or can’t eat or drink.

Tomorrow:  Do masks do any good?

Home quarantine:


What are the symptoms of coronavirus?

Coronavirus (COVID-19) symptoms can range from mild to severe.  The symptoms may appear from 2-14 days after exposure, and include:



-Shortness of breath

COVID-19 is spread from person to person, through respiratory droplet when a patient coughs or sneezes.  These droplets can land in the mouths or noses of people who are nearby or be inhaled into the lungs.   It may be possible to catch the virus by touching a surface that an infected patient has touched, and then touching the mouth or nose.

The elderly and those with chronic medical conditions such as underlying heart or lung problems are at higher risk.

Current CDC recommendations include hand washing, avoiding sick contacts, and cleaning surfaces with regular household detergent and water.  If hand soap is not available use a hand sanitizer with at least 60% alcohol content.

Tomorrow:  What to do if you have been exposed to the coronavirus.


Is daylight savings time bad for your health?

Can daylight savings time make you sick?
A study found a higher rate of workplace accidents on the Monday and Tuesday following daylight savings time.  The study found that the average worker got 40 minutes less sleep, and had a 5.7% increase risk of workplace injuries.
The time change has also been found to be associated with a higher rate of motor vehicle accidents, likely due to fatigue.  One study found a 17% increased risk of traffic fatality deaths on the Monday following daylight savings time!
Another study found that the rate of heart attacks increases by 10% on the Monday and Tuesday after daylight savings time.
The rate of patients having a stroke was 8% higher in the two days after daylight savings time, additional investigation found.   Prior studies have shown that stroke rates are higher if the circadian rhythm is disrupted and with sleep fragmentation, so the reseachers believe that the increased stroke risk is due to the change of sleep cycle.
daylight savings time

How much does a meth habit cost per year?

The average methamphetamine user uses 1 -2 grams of meth per day at $100 per gram.

Therefore the average user spends $36,500 –  $73,000 per year on their habit

Other costs include:

  • $687M – Workplace productivity loss
  • $545M – Drug treatment
  • $351M – Additional health care costs among meth users

13 million people in the United States use meth.  The death rate is difficult to calculate as most users die of various complications such as cardiac infections or strokes, but is now estimated to be over 5000 deaths per year.



How much does a heroin habit cost per year?

The street cost of heroin is between $10 and $25 per dose.  Street heroin is often “cut” with other substances such as flour, talcum powder or chalk so the cost can vary depending on purity.

The average addict uses heroin between 4-6 times a day.

Therefore, the average heroin user spends:

$150 a day

$4500 a month

$54,000 a year

on their heroin habit.

Approximately 13,000 people died from heroin last year, or 35 deaths per day in the United States.


Can you make the diagnosis?

Frank is at a cocktail party, and is enjoying a martini and the hors d’oeuvres.  As he is talking with clients, he begins to notice a swelling feeling of his lips, and then of his tongue.

He tries to continue with the conversation, but starts feeling like the room is very hot, and also his skin starts feeling itchy.  He decides to go to the restroom.  Once there, he sees in the mirror that his upper lip looks swollen.  He lifts his shirt, and sees a rash:


What does Frank have?

  1.  An allergic reaction
  2.  The measles
  3.  A reaction to alcohol
  4.  A heat rash



If you guessed 1.  An allergic reaction, you are correct!

Frank is likely having a reaction to something in the hors d’oeuvres.  More than 3 million people have an allergic reaction per year. Symptoms can include itchy, raised red welts called “hives” on the skin’s surface, lip or tongue swelling, and shortness of breath.  The most common food allergy is from seafood.

Treatment for an allergic reaction includes medications such as anti-histamines (Benadryl) and steroids.  In some cases breathing treatments such as albuterol and epinephrine may be necessary.  If a patient is having lip or tongue swelling, or any difficulty breathing, they must be seen in the Emergency Department.  Severe allergic reactions can progress to a condition called “anaphylaxis” which can be fatal.


The measles rash would typically start with gradual onset of cold-like symptoms, cough, and watery eyes.  It is more common in un-immunized children.  Some people do react to alcohol, but that would be rare especially if they have had alcohol before and have never had a problem.  A heat rash more often affects infants though it can affect adults.  Heat rash causes red bumps on the skin and can occur during hot, humid weather.

Is drinking cocoa good for you?

We all love drinking a warm cup of cocoa, but is it good for you?


Cocoa contains chemicals called polyphenols, which are antioxidants also found in fruits and vegetables.  Polyphenols improve blood flow, lower blood pressure, and improve blood cholesterol and glucose levels.


Cocoa is abundant in flavanols, which are also antioxidants and  have an anti-inflammatory effect on our cells.


A recent study by the American Heart Association in patients with peripheral arterial disease found that patients who drank cocoa daily had improved blood flow to their legs with improved muscle function.  The patients who drank cocoa were able to walk further in a 6-minute walking test compared to patients who did not drink cocoa.


Cocoa also increases blood flow to the brain, improving brain function and reducing risk of neurodegenerative disease.


Another study found that patients who drank cocoa regularly had a small but significant reduction in their blood pressure.


Cocoa also reduces “bad” LDL cholesterol.  Cocoa consumption is linked to lower risk of heart disease, stroke, and death.



Can you make the diagnosis?

Nancy is working at her computer when she begins to notice it is hard to use her left hand.   Thinking it was because she was resting her elbow on the desk for too long, she tries to change the position, and continues working.

Her coworker approaches and asks Nancy a question.  When Nancy answers, her coworker notices that Nancy’s speech is slurred, and one side of her face appears to be drooping.

What is Nancy’s diagnosis?

  1.  Meningitis
  2.  Carpal tunnel syndrome
  3.  Migraine
  4.  Stroke



If you guessed 4.  Stroke, you are correct.

A stroke, or Cerebrovascular Accident (CVA), is caused when the circulation to a part of the brain is decreased.  Strokes can cause symptoms such as weakness, slurred speech, facial droop, and difficulty walking.

A stroke is a true emergency and Nancy’s coworker should call 911.  A pneumonic to remember about the warning signs of stroke is FAST (facial droop, arm weakness, speech difficulty, time to call 911).

Risk factors for stroke include high blood pressure, irregular heart rate such as atrial fibrillation, tobacco smoking, high cholesterol, and diabetes.

Treatment can include very strong blood thinners such as tPA (tissue plasminogen activator) but the patient must present within 3 hours of onset of their symptoms to receive these medications.

Meningitis can cause fever and confusion, but would not typically cause weakness worse on one side than the other.  Carpal tunnel syndrome causes pain and tingling in the hand.  The pain is often worse at night.  Carpal tunnel would not be expected to cause speech changes or facial droop.  A migraine can cause neurologic symptoms but is usually associated with a severe headache and vomiting.

Left facial droop:


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