Dr. Caren and Dr. Urman's Heart Health e-Newsletter

The latest from Drs Urman and Caren regarding the coronavirus pandemic as well as staying heart healthy

This complimentary monthly educational service is for our patients and their families but please forward it to anyone who might find it of interest. It usually is sent out the first Friday of each month but since March, in order to keep our patients educated with the latest updated information on the COVID-19 pandemic, we have had additional special editions as well. Click here to enter our website and learn more about our practice. We encourage you to contact us if you have any questions or wish to make an appointment. 

Dear patients and friends,

We sincerely hope you and your families remain safe and healthy during this continued challenging and unprecedented time. On behalf of everyone at COR Medical Group, please know that our thoughts are with you and your loved ones, and with all who have been affected by the coronavirus (COVID-19) pandemic, whether due to the condition itself, whether due to the emotional or psychological toll, or whether due to financial strain.

As health care providers, there is nothing more important to us than the well-being of our patients. This situation is totally unprecedented and so very challenging for all of us. Yet it is an opportunity for us to connect (perhaps only virtually) to each other more than ever before.  Let us remain prudent and rise to the occasion to help each other out to get through all of this together.  And get through it, we will.

Prior COVID-19 Heart Health e-Newsletters

March 22, 2020

March 29, 2020

April 6, 2020

April 12, 2020

The latest frequently asked questions (FAQ’s).

[Author’s note: This e-newsletter was written on Thursday, April 30, 2020. The subject matter is rapidly changing, and the recommendations below may be out of date within a short period of time. Find the latest general recommendations from the LA County Dept of Public Health and the Centers for Disease Control by clicking on the links.]. In addition, this link is quite thorough and complete in giving you the latest statistics not only for LA county but also how we compare to the rest of the country: https://corona-virus.la/data 

 Is your office still open?

 Yes, we remain open to meet the needs of our patients. While for the past 6 weeks, we were seeing only urgent appointments in the office that could not be handled by other means, we are slowly expanding in-office appointments whether for seeing one of our doctors or for having testing that should not wait.  This is in line with the guidance from the California Department of Public Health as of April 27, 2020 regarding resuming the state's deferred and preventive health care. All in-office appointments will be screened to make sure that an in-office appointment is preferable and more appropriate rather than a telemedicine appointment.

If you come in to our office, we are doing our best to have as few patients in the office at once to allow for appropriate spacing between everyone. Please make sure to wear a mask and all of our staff will be wearing masks. You will have to have your temperature taken as all of our staff will have had done on their arrival to the office. While we have always maintained a very clean and spotless environment, our staff is well versed in making sure all exam areas are extensively disinfected and cleaned after a prior patient has left.  We are taking precautions to keep all patients safe when they come into our office.

We are handling everything else by phone or virtual / telemedicine (more below). We are here for you. However, we have limited staff to help reduce the risk of exposure for you, our staff and the community at large.  Some of our staff have been set up to provide service from home as they are able to do.

 Are you performing cardiac testing?

While purely elective testing had been put on hold for the safety of everyone, as you might imagine, when it comes to cardiovascular care, today's preventive or elective test might become more urgent if delayed for too long (click here to read about the pandemic delaying routine medical care). Thus, we are assessing each patient's situation on a case by case basis to determine if it is important to proceed with testing (whether cardiac testing or lab work) sooner rather than later. Please call our office to discuss if you have any questions or concerns.

 Should I cancel my upcoming appointment?

No. You should call us and will will help determine if you should be seen in person in the office or change it to a virtual visit or telemedicine visit, if at all possible. We are encouraging our patients to stay safe at home and take advantage of technology to continue their medical care. While in individual cases, our physicians may feel that some patients might be better served in person here in the office, for the foreseeable future the majority of visits can and will be done virtually until the coronavirus pandemic is clearly under adequate control.  This is for your safety as well as ours (and the whole community’s).

How can I arrange a virtual visit?

Click here for more information.  However, feel free to call our office and as we have done more of these virtual visits, both our patients and doctors have found them to be quite helpful, reassuring and important in this challenging time.  Some patients wonder why some issues cannot be handled just by a phone call. However, a virtual visit, while not quite as ideal as an in-person visit, allows your doctor to "lay eyes on you" which can be worth a lot and, in our experience, allows for a better interpersonal connection. Also it allows a more complete review of your medical situation and assessment by the doctor. These visits are covered by Medicare and are increasingly covered by private insurance.

SARS-CoV-2 Antibody Testing

We are not yet testing for COVID-19 / SARS-CoV-2 antibodies in the office mainly because we have been unable to get tests that we have confidence in. Cedars-Sinai is making a great effort to validate COVID-19 antibody tests, which determine if someone has been exposed to the virus and has developed antibodies.  Please be aware that there are many non-FDA-approved tests that are publicly available right now, but may not be proven as accurate. We continue our research to find an available but validated antibody test as soon as possible. Our goal is to provide a valid, trusted test that is FDA-proven to be effective for our patients.

In addition, we still do not fully understand exactly what percentage of COVID-19 patients develop antibodies and how much cross-reactivity from other much less serious coronaviruses there might be (that is many, if not most of us likely have had "colds" from other coronaviruses in the past). While we assume there will be some degree of immunity, and thus protection, from COVID-19 if we have SARS-CoV-2 antibodies, we do not know for sure how strong that protection is or how long the immunity will last. Based on experience with other coronaviruses (including much more serious but rarer types such as SARS-1 or MERS), it likely will not be lifelong, it likely will be more than just a few months and perhaps it will last a few years but this is still uncertain. So arguably, antibody testing is more important now for us to continue to study and learn how most people react to the virus.

The Curve has flattened. Now What?

 Perhaps a time to re-calibrate based on more accurate data and balance benefits and risks so we can move forward as prudently as possible.

Did we “over”-react?  Given what we did and did not know two months ago, and knowing that inaction had the potential to lead to widespread and significant death and suffering, no, we do not think so.   For those who say, “see, it wasn’t all that bad,” we say that it definitely would have been a lot worse had we not acted.  For those who say, “there is no way we will have a vaccine or successful treatment anytime soon and most will eventually get COVID anyway, we are just delaying the inevitable,” we say that if the curve would not have been flattened, there would have been surges in many more places similar to New York and Northern Italy and New York would have been even worse (which is difficult to even imagine). If the curve would not have been flattened, the healthcare system no doubt would have been overwhelmed and the sight of people dying in the streets unable to get medical care would have been a significant psychological blow to society that would have hit our economy even worse with even longer lasting consequences in addition to the tragic effects on individuals and families.

However, we now have a bit more knowledge and facts, albeit still far from complete and with still plenty more to learn.  We have the experience of different countries and cities where the illness spread prior to here in the US to assess and help guide us going forward. We have had some time to digest the data and make more accurate predictions.

And clearly there are significant deleterious effects of the current extensive lockdown, whether due to effects on some people’s psychological or mental state, whether due to serious financial strains, or whether due to unintended effects on patients’ non-COVID health issues. Thus, it is important to find the right balance and figure out how we can move forward and slowly, cautiously and prudently try to gradually get back to some sense of normalcy.

No doubt, even under the best of circumstances, life for us will not be entirely back to normal anytime soon. Below in the 'In Focus' section are also some opinion pieces with fresh and balanced perspectives on how we should move forward to achieve reasonable control of the pandemic without causing worse problems.

No matter what, we are here for you.  Let us know if you have any questions or concerns and take advantage of technology to stay medically connected with us to keep you healthy.

 Share Your Experience

Please help get the word out about our doctors and our practice. It will only take a minute and we will be so grateful! Share your experience in our office by clicking on your cardiologist:

If you Yelp review your healthcare encounter with Dr. Urman by clicking here.

On Google, look Dr Caren or Dr Urman up in Google, on the right of the screen you will see a picture of the office, a map, hours and other reviews, if you look just above the review section toward the bottom and to the right you can click on the button ‘Write a review’

On Vitals, here is the link for Dr Caren: https://www.vitals.com/doctors/Dr_Jeffrey_Caren.html

On Vitals, here is the link for Dr. Urman: https://www.vitals.com/doctors/Dr_Mark_Urman.html

Following a Heart-Healthy Diet and Lifestyle