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David Katzman, MD & Jennifer DeLaney, MD
Internal Medicine Specialists


Office News

Thank you for everyone's cooperation as our office eases in to reopening! Our building has asked all offices to limit patients waiting in common areas. When you arrive for your appointment, please call the office from your car. We will let you know when it's okay to come in for your appointment. This allows us to decrease your exposure to any other patients of ours or those of neighboring offices and helps lessen any potential wait time in the hallway for a temperature check. Also please do your best to arrive at your appointment time - not early or late - as this will help with the flow as well.
Metformin Recall

The FDA has alerted patients and health care professionals that some generic brands of the popular Diabetes medication, Extended-Release Metformin, contain NDMA, a potential carcinogen. You may recall the same chemical was found in certain blood pressure medications last year. The manufacturers who recalled the Metformin include Apotex (all lots), Amneal (all lots), Marksans (one lot: XP9004), Lupin (one lot: G901203), and Teva (14 lots). If you are taking Metformin ER by one of these manufacturers, please contact us and we will change you to a safer product.

Yes, You Should Still Wear a Mask
Jennifer DeLaney, MD

COVID-19 cases continue to climb in Missouri, with a statewide increase of 6.4% this week. The rate of cases is likely to increase further as restrictions on gatherings, like youth sports, day camps, and work and restaurant occupancy are rolled back. People are becoming less restrictive in their behaviors, putting themselves and others at risk. So, how do you keep safe as the lockdown is loosened?

  • Wear a mask whenever you are in close contact with people outside of immediate members of your household. This means at the grocery, hair salon, restaurants, coffee shop, work, etc.
  • Make sure that others you encounter are also wearing a mask. This may not be possible in public places, but is certainly possible when you visit the grandkids or have coffee with a friend.
  • Consider wearing a face shield if you are going to be close to someone outside your household for more than 10 minutes. These actually are more comfortable than wearing a mask for many people. In riskier situations, wearing both a mask and a face shield offers much higher levels of protection, shielding your eyes, nose and mouth from droplets. So, if you are going to the hospital or another high-risk location, this is your safest option.
  • You do not need to wear a mask or a face shield if you are outside and at a distance from others of more than 6-10 feet.
  • Wash your hands for 20 seconds or more with soap every time you use the restroom, every time you eat, and every time you touch surfaces in public places.

Here is the good news: The data is consistent that countries and states that made mask wearing mandatory showed marked reductions in their rate of infections. Austria made masks mandatory in early April. Within 2 weeks, new cases declined 90%. Rates of spread in Asia are significantly lower, in part because of mandatory mask wearing. Fifteen states and the District of Columbia made mask wearing mandatory, and the rate of new infections declined 2% within three weeks as opposed to adjacent states where the rates of new infections continued to climb. Another local example of the value of masks is that recently two hairstylists at Great Clips who were infected with COVID-19 cut the hair of 140 customers without infecting a single person because of the fact that they and their clients were required to wear masks.

A Potential Breakthrough in COVID-19 Treatment
David Katzman, MD

There has been a frantic search for reliable treatment for COVID-19. This newsletter has discussed Hydroxycholoroquine and Remdesivir, which have not been shown to improve survival for those with COVID-19.

We may have had a major breakthrough this week with the release of the RECOVERY trial, which looked at the effectiveness of a common and inexpensive steroid, Dexamethasone. Hospitalized patients with COVID-19 who were critically ill on a ventilator or needing high doses of oxygen therapy were either given Dexamethasone for 10 days or a placebo.

Those patients on ventilators who received Dexamethasone had their risk of dying reduced by 33%, while those needing oxygen saw their risk reduced by 20%. The steroid had no effect on people with mild cases of COVID-19 - those not receiving oxygen or ventilation.

This pattern of response supports our notion that a hyperactive immune response to infection contributes to the lung and other organ injury. Steroids blunt the immune response and accordingly leads to less organ toxicity. While this was a large and well-done study, it will be critically evaluated and likely repeated to confirm its findings.

Dexamethasone is widely available at the hospital, and there is no need to take it in milder illnesses that do not require hospitalizations.
Tdap vs Td Vaccine: What’s the Difference?
Jane Kozlowski, RN

Most of you are probably aware that you should receive a tetanus booster every 10 years. But does it matter what type of tetanus vaccine you get? For adults, the tetanus vaccine can come in two forms: Td and Tdap. Both the Td and the Tdap vaccines offer protection against tetanus and diphtheria. In addition, the Tdap offers the added protection against pertussis.

Most adults received a series of injections as children to help protect against pertussis. However, in 2005, after a resurgence in pertussis cases, the CDC recommended that adults aged 19-64 receive a Tdap booster vaccine; the CDC expanded this recommendation in 2012 to include adults 65 and older. Therefore, the Tdap vaccine has commonly filled the role of both a pertussis and tetanus booster over the last several years. By this point, most adults have received the recommended Tdap booster and can now transition back to the Td vaccine for their next tetanus booster. As mentioned, the CDC recommends receiving this booster every 10 years, unless required sooner, as in the case of wound management.

At your next complete physical, your doctor will review your immunization record as usual to determine if you are due for a Td vaccination. Our office will still continue to offer the Tdap to those individuals who haven’t yet received it or require it for other medically necessary reasons. These reasons include being a caregiver of an infant, expecting a grandbaby, or traveling to a country with a high pertussis rate. If you don’t fall into these groups, your doctor will now recommend the Td going forward.
Please visit our website if you have missed any past newsletters. The newsletter archives can be found by hovering your mouse over the "Medical Links" tab.

11709 Old Ballas Rd. Suite 101, St. Louis, MO 63141
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