View the full presentation of the top 5 things pain patients need to know during the coronavirus pandemic
Hi everybody. This is our second webinar. My name is Dr Corey Hunter. I’m the executive director of the Ainsworth Institute of Pain Management and I’m an assistant clinical professor of physical medicine rehabilitation at Mount Sinai Hospital and I’m going to do another webinar. There are still some questions I think that people had that I didn’t address, so I wanted to do a second one to kind of really cover, a few more things that people wanted to flush out, some things that people know and really just in addition to covering what’s relevant to my specialty with pain management. I really realized how much disinformation there is out there on COVID-19. So as a doctor, I want to try to put some more information out there, some correct information, and I guess kind of combat some of the disinformation that’s there.
So, a little bit about me. I’ve been board certified in pain management for about 10 years now. I did my training at NYU and Cornell and about in 2011 I founded the Ainsworth Institute of Pain Management. The predominant part of my life I’ve spent doing research, bench research, clinical trials, a lot of research on STEM cells and more recently been doing some, the bulk of my work has been on medical devices for pain. I can tell you I’ve never really seen anything like this. Anything that we’re going through now. I’ve never seen anything like this when I was in medical school. I remember a lot of the doctors that were training us were always talking about that though, one day that there’s going to be an epidemic, but I think what people were talking about was bacteria.
This being a virus, I don’t think it was anything that anybody had ever contemplated. There’s nothing anybody’s ever seen or really predicted was going to happen, I guess to this level. I’m going to hopefully try to cover as much as I can at the end. I’ll leave it open for questions. If anybody has any questions or things that they feel like weren’t addressed during this. This is the world that we’re in. As of today. We’re looking at cluster maps. The words ‘flat flatten the curve’ and ‘social distancing’ have really become as common place as the Kardashians. We’re really becoming, I guess, comfortable for better or worse, with what’s going on. Unfortunately, people are still kind of resisting the concept of social distancing. Being a doctor in New York city, one of the densest cities in the United States, and unfortunately the absolute epicenter of the outbreak in the United States and we don’t have more cases in the world. People are still going outside, and people are still traveling in groups. Just going off that – a little while ago, the sun finally came out for the first time in a couple of days and people were back outside as if the virus cares what the weather’s like. People will need to get used to this. I think the longer that we resist it, the longer that this is going to last.
Really briefly, I don’t know how much people know about the virus. A lot of the news outlets I think seem to be more interested in pushing their political platform than really keeping people informed. I think news sometimes cares more about ratings then they do about keeping people calm. This is just a little bit about it – very brief and very cursory. People want to know why we can’t just use antibiotics on it or people were confused, because some of the stuff that’s going around with it is that they’re my son and I’m going to go into that. Why can’t we just use antibiotics? Viruses don’t work with antibiotics. Bacteria do viruses. Your body has to run its course, or you have to have the vaccine, which is something that’s still is months away.
Coronavirus itself isn’t new. This has been around. If you pick up a bottle of, like Lysol or Clorox wipes and you look on it, you’re actually going to see coronavirus on there. That’s not because, they quickly got that printed on the labels in the last like month or two. Coronavirus has been around for a long time. This is a new strain, which is why you hear people calling it a novel strain. This is brand new and mutated somehow. We don’t know yet. It attacks the upper respiratory system predominantly, and then it leads to pneumonia or shortness of breath. What pneumonia is, is basically a consolidation in the lungs where the lungs will fill up with fluid. The lungs are supposed to be all air, so the less room there is for air, the less oxygen you can exchange and then people would come short of breath. It’s extremely contagious. This is something that’s elegant how contagious it is. People can carry it for two weeks and not even know it. People can have the virus completely and not even know. We’re finding out now that people are having it, it’s going completely undetected and they’re transmitting it to people thinking, well I feel fine. I don’t have a fever. I don’t even have a sore throat or a cough, so I must be fine. People are going out there and infecting other people. Whether people want to believe it or not, this is more dangerous than the flu. There are some people that are, conspiracy theorists, that are talking about how this is no more dangerous than that, or they’re bringing up statistics from H1N1. This is killing people very quickly. The elderly, people who are immunocompromised, people that have even the slightest flaw in their genetics. This virus is taking full advantage of them.
This is something that I came across, someone actually gave to me. We found out now that there’s actually eight different strains of this. The SARS-CoV-2, which is the virus of the COVID-19, they found out that this is not eight different strains. And it seems to be these strains that are more or less isolated to the different continents or the different geographical areas that they’re at. This is giving people, the scientists that are studying it, a little bit more information about it and it’s going to get them closer to a vaccine, understanding how this thing mutates and how it tracks. This is actually something very interesting that I came across. If you Google that term right there, I took it directly from the article, you can read more in depth about it. It is mutating, but the scientists actually think this is a good sign.
This is something that I came across in Timeout New York yesterday. It was unnerving. I live in the bottom part of Manhattan there, in the 308, 309, and 310 general region and you can see there is not a single neighborhood that’s not affected. That white area in the bottom right of Queens, that’s JFK. Then the top part up there next to 402, that’s LaGuardia. It’s not that it’s not infected, but you can see these areas in the bottom right is the legend. Every single part of New York city is affected. Unfortunately, Queens and Brooklyn seem to be the most infected. Elmhurst Hospital, which is in Queens is pretty much the epicenter of the country right now where they’re experiencing double digit deaths a day. They’re experiencing at least 20 deaths a day now. My heart goes out to the health practitioners that are there. God bless you. You guys are real superheroes for what you’re doing. Every doctor is at every hospital right now, but you can see if you’re in one of those areas right now, you should be staying inside. This hasn’t spared any part of New York city.
One thing that people were asking, pretty much almost every patient I see during telemedicine, they’re asking should I just pick up and leave? And the answer is no. I’m originally from Florida. I was born and raised in Miami. Well, growing up in Miami we know it is where snowbirds come. So, it’s where people from New York come to retire. Everybody from New York seems to have a home there or have family there. The vast majority of people from New York, with this going on, they seem to feel safer just picking up and leaving. The problem is that now you’re taking the virus with you and some of these people don’t think that they have it and it’s making it harder for epidemiologist attract this. And now Florida, which has the largest concentration of elderly in the country, which is where people go to retire. This thing is going to run through there like a wolf in a hen house because now people are bringing, taking it from New York and they’re taking it with themselves down there. The best advice I can tell you is to do what we’re doing. Stick it out in New York. If you’re from New York and you’re here, stick it out here. If you want to, if you have family out in the suburbs, that’s fine, but I can tell you, being here in New York, the supermarkets are basically empty. They’re fully stocked with food and the city is empty. If you’re still here and you haven’t left yet, don’t leave. Just stick it out here and don’t take the virus with you. If you do go, don’t take for granted that you don’t have the symptoms with you. Wherever it is that you go, quarantine yourself. If you’re leaving New York, quarantine yourself for 14 days. This was recommended by the federal government. So again, the answer to that is no stay put in, stay inside.
I’ve gotten this message from a bunch of people from the last webinar that we did last week. Asking, I think I have COVID-19, what do I do if I think I had the symptoms? So, this is just kind of quick steps to take. The first thing everybody wants to ask is like, I think I have it, where can I go to get tested? The testing is painful. The testing is, if you look it up, it’s about a six-inch Q-tip swab that they shove through your nose all the way to the very back of your throat. It just doesn’t go slightly up your nose. It goes to the back of your nose and it will induce a gag reflex. So, unless you really think you need to get tested, don’t. The testing takes five days. Abbott just approved or just got testing approved by the FDA that takes about five minutes, but it’s not readily available yet. So, the one that’s owned is still there is the one that’s a little bit invasive and you must stick a swab to the back of your throat, and it takes five days. What you’re going to do in those five days is you’re going to stay inside and avoid contact with others. You could do that anyway. If you think you have it, stay inside, just assume you have it until proven otherwise. If your symptoms get worse, than yes at that point you should probably get tested and then you can get treatment.
Avoid emergency rooms. This one, people are surprised to hear. A reason being is if you don’t have it, you’re virtually guaranteed that you will get it. Emergency rooms are packed with people that do have it. If you’re going there, if you don’t have it, you’re going to get it. If you’re short of breath. If you have family members that are short of breath, you can’t call an ambulance on their behalf. They must call 911 themselves and have someone come and get them. If you really are convinced you have it, you’re short of breath and you really can’t breathe and you’re having trouble taking a breath. Don’t take a cab, don’t take an Uber, just call 911 to have them come pick you up, take your temperature.
If you have a fever and you’re short of breath, chances are you probably do have it. Some people are saying I have a sore throat, I have a cough, but they have no fever. The hallmark sign of this is a fever. If you have a sustained fever for a couple of days, chances are you have it. And again, most importantly, please just wash your hands.
One of the things that’s out there is people are going on the internet and they’re hearing there’s a treatment for it. And the one that’s making the rounds of the Hydroxycholoroquine, Azithromycin and Zinc. So, is it real or is it a hoax? We don’t know yet. We, as I would say, every doctor is hopeful that it will work. Hydroxychloroquine is an old drug. We use it for Malaria and for whatever reason, people that are using it seem to think that it hones in on the virus and it’s somehow protect cells. The way Malaria works is it’s like a microscopic parasite and it gets inside cells. The Plaquénil seems to do something to protect the cells from the virus is what people think it does. Azithromycin is an antibiotic, so it doesn’t work on viruses, but what we think it somehow protects the lungs from getting ill, from developing a pneumonia along with it. We don’t know. There is a lot of evidence to show it works. There was a clinical trial that just came out. Well not really a clinical trial, but a study where a doctor showed that it didn’t work, it was no better than placebo. But I think what some people believe is, is for it to work, it has to be given very early on and before the person becomes fully symptomatic, where you believe that the person has it, you give it to them early on. Once it’s like full-fledged and the person is intubated, that’s, I think past the point where it’s not going to work. We’re not advising people should take it preemptively or prophylactically yet. But the study is still going and we’re all very hopeful for it.
This is really important – as far as like the scams and the hoaxes, uh, you know, just when I think people can’t stoop any lower in medicine and not take advantage of people, I’m surprised because people find a way to do it. When I originally made this slide last week, there was one company that was out there that I was very surprised at cause it’s a very legitimate company and they were touting Exosomes as a potential cure for a COVID-19. Now, that’s not true. Exosomes haven’t even been proven for the things that it was used for before COVID-19, it didn’t even have proof before COVID-19 existed. It’s predominantly something that’s used in regenerative medicine for people. If you’ve heard of PRP or Platelet Rich Plasma or Stem Cell Therapy for chronic pain – Exosomes was like the brand-new thing. It is still in studies for that. It’s a cash procedure, but one of the companies that has Exosomes was putting out there, and there was finer print than like a Carly’s commercial, but they’re putting it out there. I reported them and it got taken down. One of my best friends out in California, he does a lot of regenerative medicine and Stem Cell Therapy like me. He forwarded me another email about something very similar for Stem Cell Therapy and they wanted to set up a call with him, for the doctor that’s using Stem cells. So, he has a treatment protocol for COVID-19. Now we know better, but there are some doctors out there that aren’t as up on the literature and they might believe it. There are patients out there that don’t know the difference and if they come across these things, they believe it. So, I’m telling you now so you can hear it. These things don’t exist. Exosomes do not work to treat COVID-19. Stem Cell Therapy does not work to treat COVID-19. Immune system boosters, these are controversial as is, has not been proven to treat COVID-19. Holistic treatments – there is not a holistic treatment on the planet right now that has been proven with any level one evidence to treat COVID-19. There is no cure and there is no vaccine. When people are talking about, with conspiracy theories, that the government had a vaccine for the coronavirus back in 2019 when they’re holding off on it. That’s not true. This was something that a couple of companies were researching for the original coronavirus. Now, this was, again, this is a novel strand mutated, so it will not work on that. But they were working on vaccines for it, but the money dried up, so they abandoned it. Before any company even goes forward with the research, they always file for a patent because they want to have a patent before it comes out. They don’t want someone else to compete with them and take their idea. There’s always a patent out there for drugs that don’t exist. So, if you see that circling and making its way on social media, it’s not true. There is no vaccine yet. If you think you have it, don’t search for a cure on the internet. Don’t fall victim to people that are preying on you. Call your primary care doctor and follow the evidence.
What now? My patients, one of the things they’ve been kind of saying in all their emails to me, which is what prompted me to do this webinar to begin with is the world is on pause, but my pain is still going. What am I supposed to do now? That’s what kind of prompted this. This is where I’m going to spend the rest of my time on is going over the people that are in pain, what they should do and how they’re supposed to get through this. Because pain doesn’t wait, and pain doesn’t take a day off. That’s why I kept my practice open, so I can be there for my patients. My patients’ pain is not going to take a pause, this virus is out there, and it told people that they have to stay at home.
The impact on medicine, as you can imagine, that there is going to be a very palpable impact on it. But, it’s not what you think. One of the first things I think that all pain patients encountered was the word elective medicine. The reason why people are talking about that is every hospital since the 1950s, during the nuclear standoff between the Soviet Union, the United States feared a nuclear Holocaust. And if that happened, all hospitals were basically given an emergency protocol. On a week’s notice you can take any operating room and you can convert the pressure from an operating room and convert each operating room into an ICU bed. The reason that works is an operating room works on negative pressure, so it sucks everything out and it keeps the room sterile. An ICU bed works on positive pressure. That room is used to keep everything in. In every ICU bed or ICU room, you’ll have a ventilator to keep the person breathing – if they suddenly fall short of breath and they can’t breathe on their own. Every operating room has an anesthesia machine, which is meant to work as a temporary ventilator, to help the person breathe during surgery. All elective medicine – anything that is not considered emergent was moved out of a hospital to basically make room for only emergency medicine, to keep those rooms as operating rooms. Then, the rest of the rooms that would be used for elective medicine are now being converted into ICU beds. That finished happening about a week or two ago. Across the entire United States, there’s less than about 90,000 ICU beds, including every hospital in the country. Well, there’s probably close to 6 or 700,000 operating rooms. I wouldn’t say that many, probably more like 300,000 is a more accurate number. Instantly the United States probably tripled its ICU capacity. Now, make no mistake, that’s still not enough. It’s still not enough to make room if the United States doesn’t flatten the curve and if it doesn’t slow this down. Those beds won’t mean nearly enough, but it’s going to help. That’s where the word elective medicine came from, because they’re trying to figure out which ones they should move forward with and which ones not to. Unfortunately, pain by a lot of people has been deemed quote unquote elective. Now again, it’s also to conserve supplies. It is to free up doctors so they can use people in hospitals. I’ve been called in. It’s a reduced hospital volume to keep the healthy people away from the COVID-19 infected people. It’s also to keep doctors away from people that may potentially be sick. So you don’t want to, even if you’re not in the emergency room, if you have someone with COVID-19 or thinks that they have it but they don’t know that they have it yet, walking through the lobby of the hospital. Think of all the people that are there that may be getting chemotherapy or they’re about to deliver, or a baby that was just born two days ago, there going to be walking within a foot of them. You want to try to keep people away from that. And most importantly, you want to keep the sick from infecting healthcare professionals because you know, right now we’ve got a job to do.
People want to know; well what difference am I? I’m in agony doctor. How can you tell me that my medicine or my condition is elective? I don’t think pain for the most part is elective. I think that patients that are in pain, I think that it needs to be dealt with, but that doesn’t go across the board. There are people that are certainly elective. This is kind of a quick, dirty breakdown of the difference between elective and emergent. Elective is something like a cosmetic procedure – that’s something that can certainly wait. A person isn’t going to die if they don’t get a nose job or a tummy tuck, LASIK eye surgery (you can continue wearing glasses), varicose vein treatments. Again, it’s not going to kill you if you don’t get it. A knee replacement. My brother had a knee replacement. He put it off for years before he got it done. You could. These are things you can put off. Emergency surgery – heart surgery for like a bypass. If you’re having a heart attack, that can’t wait. A kidney transplant, childbirth, chemotherapy – those are things that can’t wait. So, where does pain fall in that? If a person is getting basic steroid shots in their joint for arthritis, I’m pretty sure that most of the people out there, if they got a bum knee, they probably think to themselves, yeah, you know it stinks having it, but I could probably put it off for a couple of weeks. I think the rule of thumb is if you can think to yourself, I could live with this for another couple of weeks, that’s probably elective. If you’re managing with over the counter medications, again, let’s wait this out. Let’s revisit this in about a month when things have died down. Emergency is someone who is in a pain crisis. Someone who is actively thinking to themselves, if I must deal with this, even for another hour, I’m going to go through, I’m going to go to an emergency room. That’s what we call pain crisis – uncontrolled pain that would otherwise, someone’s saying to themselves, I can’t make it through the next day unless you give me like Oxycodone. That’s emergent. Someone who has an intrathecal pump. I have several of them in my practice. I couldn’t even imagine shutting down my practice, because what would these patients do? This needs to be filled and managed in-person. These people need more medication, they need less medication to refill it. That is an in-person visit. I can’t close down. Someone who has a spinal cord stimulator, some kind of surgery, and the device isn’t working properly or there’s an infection, that is emergent. These are things where patients need to come in. They need to see me, and I need to make myself available for them. This is a quote from one of my patients, but I think that this would probably apply to anybody. “What am I supposed to do? I just can’t wait in pain for the next two months.” And you’re right. That’s what this is here for – to go through some options that we have for you.
This was pretty much the first slide that I came up with and I think this is something that people still don’t know the difference about. About a month ago, some of the doctors in France had believed that Ibuprofen was making the bug worse. Anti-inflammatories create an enzyme and they believed that the COVID-19 virus was feeding off that and it was making it worse. Then, there’ll be a show about a week later. That’s the World Health Organization (WHO). They piggybacked on that and they said, you know what we agree with these doctors in France that were saying that people should not take Ibuprofen if they think they have COVID-19, or they should just avoid it all together. Right now, the reason why it’s relevant is because it’s an antipyretic, which means it’s a fever reducer. As I was mentioning, one of the first things that COVID-19 gives people is a sustained a fever for several days, and your first instinct is to take Tylenol or Ibuprofen. Some people prefer Ibuprofen because they think it’s stronger. Patients in pain, this is one of the go-to drugs – Advil, Ibuprofen. What do I do? The WHO retracted it. It’s fine. It’s safe. The United States, the FDA backtracked on it. It said there wasn’t enough evidence to support that. So, for anybody who is in pain, Ibuprofen is safe to take.
Opioids. Anybody who knows me, my practice, knows that I’m particularly passionate about opioids, about people not taking opioids. My mother was a prescription drug addict in the 80s. She suffered from chronic migraine headaches. Back then, people really didn’t know the dangers of medications, of addictive medications. So, the drug of choice back then in the 80s was fearing all in fear set with coding. I remember her going through like a hundred pills in a day. I’m very outspoken against people taking opioids. I’m proudly year after year on the bottom 3% of prescribers nationally and I like to keep it that way. I don’t want you to think that I’m just coming out this topic biased. There is evidence to support my decision on this. People have asked and countless patients have asked me on emails – look Doc I can’t come in. Can you just prescribe me some Percocet to get me through this and I’ll be fine? The answer’s no. The reason being is not just forget everything I said about opioids being addictive or everything that happens with it. Not at all. It only takes three days for a person to develop an addiction to an opioid. This has nothing to do with addiction. Opioids, and this has been shown for over 20 years’ worth of evidence. There was a direct negative correlation between your immune system and the number of opioids you’re on. So that means the more opioids you take, the less your immune system works. Now, right now, a lot of people have been getting the virus and they’re fighting it and they’re surviving it. That’s because their immune systems are doing their job. A lot of people are getting the virus and they’re fighting it off completely. They’re not showing any symptoms at all. That’s because their immune system is fighting it off. You need to give yourself and your immune system the best chance you can to fight this evil virus, and the way that happens is to stay off opioids. We’re all agreeing amongst the doctors, that we’re not starting anybody on any new opioid prescriptions and anybody who’s on them, we’re not increasing them. If you’re at a point where you feel like you cannot get through your pain, unless we start a prescription for you, I need to see you and we need to do something in person. If your pain is so bad that you’re like, Doc, you must increase my opioids. You’ve got to come in, because there’s something we got to do. We must do anything possible to avoid you taking opioids.
Supplements, any remedies or anything out there that can help my chances with this. For those that are out there, they’re the holistic doctors or the ones that are the anti-vaxxers who give us all the joke ammunition in the world about essential oils and things like that. There really isn’t anything that I would recommend except for Zinc. Zinc has been shown to really boost the immune system. My best friend growing up in Miami, he swore by Zinc, stress tabs and Vitamin C and it’s funny some 30 years later, after that being his home remedy, that I’m putting this here in a webinar. Zinc has been shown to be effective against the COVID-19 virus and its part of the cocktail with Plaquénil, a Z Pack and Zinc. Taken together, they’re supposed to be effective, but by no means if you take this as a substitute for social distancing or conventional medical care. You still need to abide by everything that people are doing. I think that the information you can glean from this as it would help your chances of fighting it off and it may help your chances of maybe not getting it potentially, some people are saying. I don’t know if that’s valid, but there’s no harm in taking it within the recommended daily allowances. But again, just follow the guidance of your healthcare professionals and stay inside.
So, the most important one of all is the one that I’ve heard countless times from new patients – my doctor closed up, what do I do now? Your doctor’s closing for a good reason because he or she is doing what he’s supposed to do. If they have a practice where they don’t have to stay open, they’re supposed to close. I can’t close because I have patients that are depending on me. It’s not that your doctor can’t depend on you, but I have patients that have medical devices and I have patients with pumps, so I must stay open. The ones that don’t have some of those obligations, they’re allowed to close and they’re doing the right thing. If your doctor works at a medical center, an academic center, they were forced to close because the administration told them that pain is considered to be a non-essential specialty and they want that doctor to be freed up because they’re probably an anesthesiologist and they need to be on standby to intubate patients if they fall short of breath and they need to go on a ventilator. They’re doing the right thing. But for me, we’re staying open. Again, if possible, if you’re not in a pain crisis, if your pain is something that you think you can get through with over-the-counter medication, stay home if possible. But if you can’t, we’re here. There’s several of my colleagues around the country, probably one or two in each major city, we’re staying open. Here at the Ainsworth Pain Institute, we are available for select patients. If you’re seeing this and you’re not one of our patients, we are open. We can help you in the interim, until your doctor reopens or if you’re a pain clinic at your university hospital reopens. I know I trained at Cornell and I know they closed very early on because they wanted to free up the supplies and free up the clinic and just make sure that the healthy patients weren’t being mixed with the sick. They will be reopening. Your doctor isn’t abandoning you. But in the meantime, if you need to see someone, we are here.
One of the things that we’re doing is we’re offering telemedicine. This was something that the government got right, quickly. Telemedicine was approved in general for about a year or two ago. But the problem was, it wasn’t reimbursed by any insurance company. This was considered like a concierge service. You had to pay for it. While it was an approved, valid way to conduct and perform an encounter with a patient, no one paid for it. So, this is why your doctor wasn’t doing it. Now, with what’s going on, these telemedicine platforms and telemedicine exists, so they’re offering it. And, rightfully so. Medicare, about three weeks ago, they immediately said, we’re covering it. And then, one after another, all the insurance companies ended up doing the right thing and they all covered it, to the point now where even workers’ comp in New York, and if you can believe that or not, is covering it and no-fault. Everyone is covering it, from Medicaid and Obamacare to a Cadillac PPO plan and Blue Cross and Blue Shield – everyone’s covering it. We’re using a pretty slick platform called Doxy, which we’re sending text messages to patients and they basically just click on the text and it takes them right to a platform that can do right from their phone or their computer. They sit in a virtual waiting room and we see them. We’re doing all of our follow-up visits for patients and now we’re even doing virtual consults for brand new patients. So, if you’re a patient, you’re watching this and you’re not a patient of ours and you think you would like our help, we can see you without you leaving your home. We can send a prescription for an anti-inflammatory or something that you may need, electronically. You can send it to a pharmacy that delivers. From beginning to end, you may not even have to leave your couch. Telemedicine is really kind of made it available or made it possible for us to treat our patients and get them through this and keep them safe.
For the patients that are emergent. For the patients that need an injection, they need a therapy. They need some kind of a treatment to get them through this because medication just isn’t enough, and they don’t want to start an opioid. We have our own private facility where we do our procedures. Even if the hospitals in the surgery centers were open, you wouldn’t want to go there because there are patients with COVID-19 that are probably walking right near you. The facilities are sterile, but in order to get to those facilities, you’re going to be walking past a lot of people with COVID-19. That’s why they’re closed. Even if they were open, you wouldn’t want to. We have a private facility. It’s sterile. As far as we know, we have not had a single patient test positive for COVID-19 and be within our office within two weeks. We’re a completely sterile facility. For the patients that do require on-site procedures, we are able to offer them safely and privately, so that the risk is as low as it could possibly get.
Ketamine infusion. This is something that we do for a lot of patients with pain. Intravenous Infusion Therapy – it’s been around for a while. We’re able to, I think we’re the only one, one of the only ones in the country, where we are able to get it covered by insurance. Ketamine is an old drug. It’s been around since the 1960s. It was a very popular drug during the Vietnam war that allowed field medics to do surgery right in the field of battle. Surgery conventionally must be done in a hospital for very specific reasons; the person needs to protect their airway. The beauty of Ketamine is that it can be performed right out in the field of battle because it doesn’t cause airway depression. The person’s airway stays completely intact and they can perform surgery right there without having to worry about the person stopping breathing. And then in 1980, some kids figured out that if you put it in a microwave and you snort it, you can take some glow sticks and go to a rave and have a good time. Then, doctors and hospitals basically got rid of Ketamine and they sent it to veterinary hospitals to use. It became known as a horse tranquilizer. It was always meant for humans. Then in the late 1990s, a doctor at my medical school at Hahnemann, by the name of Dr Schwartzman figured out that if you use it for pain at sub-anesthetic doses, it’s a very powerful medication and can help people with all sorts of chronic pain. So, for I’d say about the last 10 years since we’ve been open, we’ve been using it for a variety of types of pain very effectively. Facial pain, headaches, pelvic pain, fibromyalgia and CRPS. I think it’s an effective medication right now, because it’s not an opioid. It does act on the opioid receptors slightly, but unto itself, it’s not an opioid and it’s not a steroid. Now, steroids are a little bit controversial right now on pain management because we’re not quite sure if they are going to suppress the immune system and if it’s going to do anything to the white blood cells that would keep someone from being able to fight a COVID-19 infection; God forbid that they get it. Those of us that are using steroids are using much lower doses and less potent versions of it. But the advantage of Ketamine is it’s not a steroid. For patients that, want something as non-invasive as it gets, it’s basically an IV and we give them the medication. It’s very effective. We use this year-round, but it’s something that we especially are promoting for patients right now just given the advantages of it. We use it for depression. This is something that’s been around, I’d say for about four or five years. I know it’s something that people are dealing with. Even more so now with everything going on with COVID-19. Because, let’s face it, this is a really maddening experience. Ketamine for depression, however, is not covered by insurance. This is something that is a bit of a cash procedure, but it’s not terribly expensive. It’s about four visits. It’s something that we are offering for patients. So, if you’re watching this and it’s not so much pain, but you’re dealing with depression, anxiety from everything that’s going on, Ketamine is very effective for that as well.
What do I do next? If you have a fever or coughing, stay home, but we’ll do a telemedicine visit for you. 65 years of age or older – stay home. We’ll do a telemedicine visit for you. Recent traveling or contact with anybody that’s infected – I hope it goes without saying, stay home, not just for us, not just for a doctor’s visit or anything. Stay home, order your food from Whole Foods, Amazon Prime, watch Netflix, do whatever you got to do to get through this, but don’t go outside. If you need us, we can scale out, schedule a telemedicine visit for you. Just call us, we’ll deal with the insurance. And like I said, all insurance companies are covering telemedicine right now across the board. There is not an insurance company that’s denying it, so we can do your entire consult virtually. And for those of you that meet one of those criteria above (a fever or 65 years of age or older or someone that we wouldn’t want to come outside), we’ll do everything we can to offer you a therapy or treatment that wouldn’t require you to come in. If your condition can’t wait still, let’s do the initial consult over telemedicine. I don’t want anybody coming in that doesn’t have to. Short of a physical exam, is really the only thing that I can’t do with you, being over telemedicine. I can see your face, we can meet, I can really get a good idea of what’s going on. Review your medical history. I can probably come up with a pretty good plan for what to do. Then, if I do really feel that you need to come in; if I can’t narrow it down between two or three things, and really the only thing that I need to do is do a physical exam. At that point, we could get you to come in and we can plan for a procedure and then say, it’s going to be one of these three things based on your exam. When you come in, we’ll figure it out right then and there. But if it’s something that can’t wait that, we can do with a prescription. We’ll send an electronic prescription. You don’t have to come in and pick up a paper one. We can treat this, and you can stay home. But again, depending on the severity of it, if you’re really in pain, and you know, it’s on a case by case basis, based on severity and priority and most of all your safety. If it is something that we deemed to be safe, not just for you but for us, we’ll have you come in and we’ll schedule a treatment.
This is who we are. Ainsworth Institute of Pain Management. We’re located on 57th Avenue between park and Lex. Our phone number is (212) 203-2813. Our email is email@example.com. If you go to our website, www.ainsworthinstitute.com, there’ll be a little link there to chat with someone live. Our office hours are generally between 9 to 4: 30 or 5. So, if you click on that link during the day, you’ll get someone from my front desk, and they will see your question. You can just chat with us over the computer. If you chat after hours, it’ll give you a message that we’ll get back to you.
I’m going to open it up for questions. If anybody wants to send any questions through on the text and the right-hand side of your screen. I just want to leave everybody with one parting message – stay safe, stay healthy, and most of all stay home. Anybody have any questions? Feel free to write them in on the right-hand side in the comment section. If not, please feel free to send us any messages over email. Again, our email is firstname.lastname@example.org. You can send an email to me. It’s a cHunter@ainpain.com. If you’re seeing this after the fact, feel free to send me a message and I’m more than happy to reply. Some people send me questions just about, I think I have COVID. What do I do? Some people are asking, I’d like to be a patient. My doctor is going to be closed for the next couple of weeks until May and I can’t wait.
Ryan, you sent a question. Can ventilators really support two patients? I know the article you’re talking about. I saw that was two doctors at Columbia that worked on it. The chief medical officer over there basically commissioned the doctors, I think about two weeks ago, to figure it out. They can, that’s really an emergency protocol. The way a ventilator works is it has a splitter on it. I think that what they did was they figured out a way to split the settings on it, so it’s able to get sufficient amount of oxygen. But I think the one thing that they haven’t quite worked out is, if one person is infected and maybe the other one isn’t, are they going to be able to transfer the bugs between them. I think that part they’re still working out, but it will be able to, I think the settings they were able to split them off. Hopefully it won’t come to that. If anybody has kind of seen the Defense Production Act has been enacted. GE, GM, a lot of these companies have basically turned their production into creating ventilators. Medtronic and a few other companies that make them have really answered the call. General Electric out in, I think in Washington state where they’re making jet engines, all the employees basically, went on protests and said we need to be making ventilators. As of last week, they’re making them.
Another question, this one from Astrid. Is Tylenol safe to take? There’s been no issue with Tylenol. I think the one question that people had was about Ibuprofen. So far, they’re both safe to take. They work totally differently. What I usually recommend for patients is take Tylenol first. The maximum amount of Tylenol anybody can take within a 24-hour period is 4 grams. That goes down based on your age. Once you start to get upward in age about 65, I think it gets down to 3 grams. You can only take, I think, a gram within every six hours. If you take it and it’s not coming down, the next thing you would probably want to do is go to Ibuprofen. Tylenol is safe to take. If your fever doesn’t come down, the next step would be to take an Ibuprofen. If this still doesn’t come down, and you’re not ready for the next dose of either, cold bath. That’s like an emergency thing. I think pediatricians recommend that, a really cold bath with an ice pack. That’s what they would do for you in a hospital to.
Fiorinal. That was something that I was just mentioning. My mom took Fiorinal, which is a mixture of a couple of different medications. Fiorinal can be taken. It’s basically Acetaminophen, caffeine and a barbiturate. Caffeine is actually very good for headaches. The barbiturate is not necessarily good for it, but if it’s something I think we can definitely talk about it. One of the things that I prefer to do for headaches long-term is Ketamine. I’d mentioned that if you tuned in before, Ketamine is a really powerful medication for facial pain and is something that works better than having to take a Fiorinal every single day. For those of you out there that have chronic facial pain and migraines, Ketamine’s very effective and again, it’s covered by insurance. The only thing that person covers is the cost of the Ketamine, which is about $10, $15. That’s something I would probably tell you to lean on before I would start taking it all again.
Ben, thank you so much for the comment. It was really nice of you. I appreciate it. Hopefully, I was able to answer anybody’s questions that are out there and help people out. I’m going to sign off. If anybody has any other questions, feel free to email me. I’m going to put our office email here at the bottom that goes to our gentleman. Then if you need to send anything to me, this is mine – cHunter@ainpain.com.
Just get one of the questions here. Opioids, we don’t know exactly how they do it on, there’s a couple of different articles out there, but if you look up opioids and immune system, there’s a bunch of different articles, some as recent as 2018, some going back to 1998. We don’t know how it is that they decrease it. It basically makes you more nascent, more sedentary. But it does. For those of you that are already taking opioids, don’t take more. Okay. That’s basically where it is. Your body gets used to it over time. It’s kind of like the law of equilibrium. Your body comes back up. For those of you that are concerned about taking them that are like, oh my God, I’m on opioids, is it going to decrease my immune system? It is. If you’ve been on a steady dose for a while and you’re not increasing it, you should be fine. The moral of the story is really don’t take any more.
Then, the other question you had Ryan – so what if one patient’s lungs are stiff and the others with the oxygen be able to, if you’re talking about two patients, again, they’re able to split off the pressure. Will the additional oxygen create a problem with the overall pressure and damage along further? Not really. If a person’s lungs are stiffer, I’m not going to want to make myself look stupid here, but I haven’t done intensive care in 10 years. Ventilators when used in short periods of time, which is what people are using these for, it’s not going to cause lung damage. What it is trying to do is to try to get people to get through this. It’s trying to help them get through the period where they can take a normal breath again. The settings are there to just get them enough oxygen. When a person has pneumonia, they have water filling the lungs and they have what is called a consolidation. They don’t have as much surface area to exchange as much oxygen. All it’s doing is it’s making sure that the air, the breath that they take, that they get more oxygen per breath so that they can get enough oxygen and blood, so they don’t get brain damage.
One of my best friends in the world, Miguel, for Robaxin and for back pain. I’m not a big fan of muscle relaxers. I think in general they tend to cause more problems, than good. The only muscle relaxer I’ve ever prescribed, that I stand by is a Zanaflex or it’s also known as Tizanidine. It’s an alpha two add blocker, so it does work in the central nervous system. It’s an old medication that we used to use for children with cerebral palsy. If you take it at low doses, at like two milligrams, once a day, it helps people sleep. It can help back pain. It’s not addictive. People can take it for very long periods of time. I have a lot of patients that are taking it. They can tell you that it doesn’t work for everybody, but for the patients that have been taking it, they seem to work very well on it. If anybody is having spasms or if they want to try a muscle relaxer, I would tell your doctor to try Tizanidine, two milligrams once a day.
Everyone who tuned in, thank you so much! I really appreciate you guys coming on in. Anybody who is catching this after it’s over, feel free to send me an email. Anyone that emails, I put it up there and I’m happy to answer your questions. God bless you all. Stay safe and hope to see any of you in person down the road. Take care. Bye.