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All posts by Alexandra Ames

Minor Surgery Available at Ames Medical Services

 

Did you know that we do minor surgery?  

 

If you have a lump or bump that you want removed, we can do a minor procedure under local anaesthetic, right here in our new treatment room. 

 

We also remove ingrown toenailsabscesses and do cyst and comedone extractions too! 

 

Have a pesky wart or verruca or skin tag that won’t go? We can freeze it off with Liquid Nitrogen, in a procedure called Cryosurgery that involves no cutting! If you are interested, you can watch a video of it being done by Dr Ames here:  https://www.youtube.com/watch?v=VOKdjNiKOy8

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When is a Duck not a Duck? The Pitfalls of COVID-19 Testing

So, you had a cough and cold and you were worried about COVID….but you went and got a rapid test and its negative so all is good right? Wrong! 

No test is perfect and this is to help you understand some pitfalls of Covid testing.  

Let’s start with the rapid “blood” test. This is looking for antibodies to the virus, and not directly for the virus itself.  

When we get the virus for the first time, it may take a while for our immune system to mount a response and produce antibodies.  

If the test is done too soon, for example before symptoms start, or even in the first 2 weeks after getting it when you may even have symptoms, it may read negative when you are in facet positive, a so called “False negative”! Then you might be falsely reassured and unwittingly go round infecting others.  

 

So, an antibody test MAY be useful after your symptoms have passed, and if you never managed to get the proper “throat swab” PCR test and you are wondering if in fact it was COVID you had! 

 

What if you wait, do the antibody test more than two weeks after your symptoms started and you have antibodies Does that mean you are now “immune” to COVID? 

 

Er, we are still not so sure. It seems that antibody levels wane after 3 months or so, so we are not sure how long that immunity may last…. this is also complicated by the fact that there are different strains of COVID and it may be that the virus mutates very so often, just like the Flu, so your immunity may be short lived! 

 

On top of this, some people can fight of the virus with a different part of the immune system that doesn’t use antibodies. So you might actually have fought off the virus successfullyand may even have immunity that we can’t measure on the test, but then have no antibodies.  

 

Confusing right?  

 

What about the “swab” or fancy RT-PCR  test? 

 

The swab tests for actual virus particles in the nose/throat.  It is not 100% either!  No test is I am afraid.  The swab is most accurate if done days 3-5 of symptoms.  If done in asymptomatic people right after exposure, it may be too early to get a positive result. Similarly, if taken very late in the illness like day 10, the chance of picking up the virus starts to fall.  

 

It is very specific and moderately sensitive. So, what does that mean? Well, it means that if you get a positive result it is likely to be a true positive, but a negative result is less reliable. So, we tend to believe the positive results, but if a person has a negative test, that doesn’t automatically mean they are truly negative and that they don’t have COVID 19 and are not infectious. 

 

That’s why in very suspicious cases you will see us asking for 2 negative tests. ..That’s because if it looks like a duck, and quacks like a duck and flies like a duck it is probably a duck…especially if it comes from an area where there is known to be a flock of ducks living. (Like say, you shot it in the middle of a swamp) So, if someone plucks a feather from that duck and analyses it and tells you it is not a duck then would you believe them?   

 

Similarly, if a person has been exposed to someone with COVID 19, and they then develop the classic fever cough, anosmia etc, OR we know that we are in the middle of a Pandemic or local spike and someone gets a cough and cold, we have a high suspicion of COVID and just one negative test is not going to reassure us.  

 

To complicate things, we will shortly be going into the “Flu Season” and it’s hard to tell the difference clinically between the Influenza virus and COVID 19! But that’s for a whole other discussion.  

 

In short, please don’t just take yourself off for a test without consulting a health professional who is up to date with testing and timing and symptoms. The test may not mean what you think it does, and you may even need a completely different test! 

 

 

 

 

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Recovering from Covid-19 at home?

Covid Positive at Home?

What should be in your Covid 19 “Recover at Home” Kit?

 

So you’ve tested positive and been medically assessed, and since you have no underlying conditions, and are not short of breath, you are allowed to recover in the comfort of your own home….

 

Most of you will be just fine, with the usual Flu like symptoms. Some people, however may experience more serious complications.

 

So what should you be looking out for?

 

Apart from the usual cough, fever and body aches, which would normally respond to Fluids, rest and Paracetamol/Acetomenophen (Brand names Panadol, Tylenol), there are a few complications you need to be aware of, because if they develop, it may mean you need to be in hospital after all.

 

  1. Shortness of breath that is bad enough that is stops you from doing what you would normally do as part of your daily activities. Ok, you won’t be able to go for your normal 3 mile morning run, but you should not be so short of breath that you can’t climb your stairs or get yourself dressed…If this happens, please call me. if you have a pulse oximeter, (a little device you put on your finger) you can even measure your oxygen saturation levels. If the oxygen saturation drops below 96% on room air, that’s a sign that you need extra medical evaluation and possibly support with oxygen in a hospital. If you have COVID -19 and you need to rent one, we do have some available with a useful leaflet on his to use them. The shortness of breath tends to begin to get bad on day 5, but everyone is different.

 

  1. Chest Pain– This can happen because of inflammation of the heart and lungs. this inflammation is actually because of your immune response and it can cause a heart attack, or heart failure. If it is going to happen, it is likely to be around day 10, although remember this is not set in stone. If you are experiencing chest pain please call me or if severe call 811. It could also be because of a clot.

 

  1. Focal weakness: If you suddenly find your face is drooping on one side, or you have slurred speech or weakness of a limb it could be a sign of a stroke or another neurological complication and you need to seek urgent medical help.

 

  1. New onset of confusion: This can be a sign of many complications and warrants urgent assessment.

 

5.Strange rashes, conjunctivitis or diarrhea in children. The recent evidence shows that thankfully most children have mild disease and very few end up in hospital. Very very few have died and the ones that have, have had underlying conditions. However if your child has any of the above symptoms you need to contact your pediatrician. (But then you should be in close contact with them anyway!)

 

If anyone has an underlying condition like Diabetes, heart, lung or kidney disease or an autoimmune problem then please contact me for more specific advice!

 

So in short have to hand: 

 

  1. Paracetamol/Acetomenophen
  2. Fluids
  3. Salt water gargles
  4. Thermometer (I am always amazed at how few people have one of these)
  5. Possibly (on discussion with a doctor) a pulse oximeter.
  6. Emergency Contact numbers.

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Finally Some Good News: A COVID -19 Update TT

 

Good News! We can isolate at home if we have COVID -19! No need to go into hospital if we are well enough to stay home. 

I know this is a huge relief to all of you right? Everyone wants to be in their own bed if they are feeling under the weather!

So what do you do if you think you have COVID 19?

 

First of all don’t panic! The main symptoms are:

 

  • Fever more than 38

 

  • Dry cough

 

  • Runny nose

 

  • Sore throat

 

Sometimes:

 

  • Body aches

 

  • Diarrhea

 

Sneezing is not normally a major feature but can be present.

 

If you have any of these

 

1.Do not go out

 

2.Isolate yourself from your family and household (see our Instagram page for a leaflet on how to do this

 

3.Seek Medical advice via Telehealth, or a hotline rather than coming in, so you do not infected others. If you are extremely unwell with shortness of breath, for example, and you believe you need emergency help then proceed directly to your nearest public health facility. You can call me to find out where to go if you are unsure.

If I think you need testing I can either refer you privately for accredited PCR testing or send you to be tested via the Public health.

I can also arrange a sick note or quarantine note.

If you are well enough to stay home, you can stay home with Pandol, Fluids etc. People with underlying illnesses like Diabetes, Lung, Heart or Kidney disease should have individualized advice

You will need to stay at home from 14 days from the start of your symptoms.

4.Make a list of all those you have had CLOSE contact with. A CLOSE contact is defined as less than 6ft for 10 minutes or more. It is not someone you passed casually in the corridor at work.

 

What to do if you have been exposed to someone with known or suspected COVID 19:  Remember exposure is defined as less than 6ft for 10 minutes or more, as above…

 

  1. Don’t panic
  2. Stay home and quarantine for 14 days unless you are told otherwise by a qualified doctor. Monitor for any of the above symptoms. Seek medical advice if they develop.
  3. Seek medical advice as to whether you need to be tested.

 

Any questions or suggestions for further leaflets let me know!

 

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Top Tips For Your Medical Video Consultation

Book Telehealth session in Trinidad

 

Top Tips for a Successful Telehealth Consultation:

1. Be on time..to maximize the most of your appointment

2. You must have a device with internet connection, a mike and camera.

3. Have a Private space – remember this is a medical consultation. You want it to be confidential. Ideally lock the door and turn off phone ringers to minimize interruptions

4. Consider letting family/work colleagues know that you are in a virtual appointment to avoid interruptions. If you are in an open plan office consider going to your car.

5. Have your photographic ID ready so that we can identify you.

6. If you have insurance please have your Insurance Card ready if applicable.

7. Have a list of questions you want to ask and important points you wish to make

8. Have your medications or at list a list with dosages to hand

9. Have any relevant Test results to hand

10. Think about your clothing: If the lesion you wish to discuss is on your leg, consider wearing shorts…if on the arm, wear a tank top etc.

11. If you have any medical equipment like a Blood pressure machine, thermometer, blood glucose testing kit have these to hand as they can provide the doctor with additional information.

Advancement in technology has made Telehealth and medical video consultation a reality. Learn more about what is Telehealth and its benefits . Telehealth and Telemedicine services are  especially useful for patients who are housebound or are unable to show up at the doctor’s clinic due to time constraints. Follow the tips above in your next virtual medical appointment to make the most of your time.

Book Your Telehealth Session With Ames Medical

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What is Telehealth/Telemedicine?

Telehealth and video consultation doctor in Trinidad and Tobago

 

What is Telehealth?

It a way for doctors and patients to have a consultation and exchange information and advice when they are not in the same place. This can be over telephone, video, email and whats app, using a telephone, smart phone, tablet, laptop or computer.

Is it Secure?

lt is vital that confidentiality is maintained, so here at Ames Medical we use something called a HIPPA compliant system. This is not Whats app/Facetime . It is a medical grade system that is very secure. We never record you.

Isn’t this very New?

Ames Medical was as far as we know, the first video consultation service in T and T and we therefore have 3 years of experience delivering this service. We always knew that it was going to be a big part of the future, so we invested in a fantastic platform, not weeks ago or months ago, but YEARS ago.

Now, during the pandemic, many of you are also just beginning to see the usefulness of Telehealth. – No waiting rooms exposing you to other patient’s illnesses, for example.

But we think, and always did think, that Telehealth has a role to play in the future too.

What Conditions Can you deal with on Medical Video Consultation

Telehealth will never completely replace a doctor’s visit but it is a useful option for minor ailments, like red eye, UTI, sore throat, medication and results etc. Clink here for a useful video on other things it can be used for :

Conditions appropriate for Telehealth and Telemedicine – by Dr. Alexandra Ames

It is also very convenient – less time in traffic and away from work. No need to leave your comfy PJs and bed if you are feeling under the weather and don’t want to come out.

What Can you really Examine on Video?

There is a saying at Medical School: “The history (or the patient’s story) is 80% of the diagnosis.” The Examination is to confirm what we think..  So much more can be examined on video these days….human ingenuity is an amazing thing. We can barely keep up with all the technology coming out. Just look at the wearable devices you have in your own home that can provide information! Your FIT Bit, Your Blood Pressure machines, your Blood Glucose machines, Apart from that, Video gives us an awful lot of information we can’t see on the telephone. Like, how you are breathing, if you look jaundiced or anaemic; we can see rashes. The camera is so good that we can have a really good look at the back of the throat. Plus, our medical video consultations have always been backed up by the fact that if we both underestimated the situation wrong and during the video call we think we really need to see you face to face to be safe, we will convert your appointment to an in-house one at no extra cost.

How Can I get a Prescription?

We can email prescriptions, sick notes and helpful leaflets and advice.

How do I Pay?

You can pay online via Paypal, Wipay or by direct transfer to Ames Medical Services account. The best bit? Your Insurance company may even cover it! – Many like Sagicor Health are now seeing the benefit of Video consultations to their clients…so ask them.

Wars like this one have always bred culture change, and we think this is one of them. Don’t be afraid of it, we can still bring you down to be seen in office if we need to….and look out for the next blog Tips for a Successful Telehealth Consultation.

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How to Save Money on Medical Costs

We are all Hurting right now.

But Health is Wealth so we need to be able to prioritize the important things. Here are some tips for how to save money on medical bills and medication:

 

 

  1. Switch to generic. Not all generics are created equal, but there are some really good ones out there Like the APO and Sandoz brand. You can literally save hundreds of dollars on an antibiotic prescription by switching. Also brand names like Panadol and Tylenol are just bog standard Paracetamol AKA Acetaminophen:  You can save 50% or more by not buying brand names. Ask your doctor or pharmacist if switching to generic is an option for you. Important note: certain medications classes DO need to be always the same brand – like for example anti- epileptics . Once you have found a brand (either generic or branded) then stick to it.

 

 

2.Can you switch to a CDAP version of your drug? The chronic disease assistance program is for ALL nationals. Ask your doctor if this is an option for you….and they are free! Aspirin, Metformin, just to name a few

 

 

3.Consider going direct to the supplier like Smith Robertson or Oscar Francois to save money. You will need an order from your doctor so talk to her.

 

 

4. Consider buying scored tablets and cutting them in half. If you are on a drug like Euthyrox for example, this comes in a variety of doses. If you are on 50mcg, it may be cheaper to buy 100mcg tablets cut along the scored line….YOU CANNOT do this with all drugs but if they are scored you probably can. Long release tablets are not suitable for this because they have a coating which controls how quickly the drug is released. But it’s worth asking your doctor or pharmacist if this is an option for your drugs. Don’t take the decision on your own as you need to make sure this is safe for your medication.

 

 

5. Attend your regular medication reviews: This may seem like an upfront cost, but it can save you hundreds in the long run as you can take the opportunity to talk to your doctor about the possibility of switching to cheaper generics. You can also look at combination tablets, For example, Galvus Met is a combination of Galvus and Metformin and is cheaper in combination than when bought separately. If you are on three or more Blood pressure tablets also review with your doctor to see if a combination tablet might be cheaper, and lets face it, easier to remember to take. Also, if you find that the drugs are not working for you as expected, then it’s better to know and do something about it sooner rather than end up with an expensive emergency hospital bill if you become ill.

 

6. Consider a dose box or medication reminder app and take medications as prescribed. There is no point forgetting to take medicines you have paid for as not taking your medications regularly can cause you to become ill and again, end up with a trip to the ER or a Hospital admission.

 

7.Go for your chronic disease appointments regularly – asthma, diabetes etc, Uncontrolled illness may again land you with an even bigger ER or hospital bill than your GP appointment!

 

8. Prevention is Better than Cure: Check your Insurance policy to see if you have an annual medical benefit. Using this to have your health check will detect problems earlier and make them cheaper in the long run

 

9. You do NOT always need a pap smear or mammogram every year. If you are healthy with no previous abnormal smears it is fine to have pap smears every 3 years instead of annually. A mammogram is fine every 2 years unless your history or family history means you should have them more frequently. Talk to your doctor about this

 

10. Colonoscopies are the gold standard for detecting asymptomatic bowel cancer or polyps before they become malignant. Check your insurance policy to see if you have preventative coverage for this. If you don’t, and you don’t have the $4K it costs to have a screening colonoscopy, then talk to your doctor about having a special stool test called the FIT test instead. This detects microscopic blood int he stool that you and I cannot see with the naked eye.

 

 

11. Ask your insurance provider about switching to copay options. Lots of local insurers now offer these options. This means that if you may only have to pay a percentage of the cost of your doctor’s visit or medication bill up front, and they pay the rest direct to the provider….so you don’t have to pay the whole bill up front then wait for re-imbersment. This can be a life saver when cash flow is a problem.

 

12. Are you taking your asthma inhalers correctly? – spacer devices mean more of the drug gets into your lungs rather than hitting the back of the throat. This means less wastage, better control and studies have shown that spacer devices can be as good as nebulisers!

 

13. Are you storing your medications correctly? – For example,Insulin needs to be stored in the fridge. If not it may not work as well.

 

14. Get vaccinated! Again preventing hospital admission..

I hope you found this helpful. Call us for a virtual medication review if you don’t want to come in!

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Woodbrook

Port Of SpainPos

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Sleep in the time of COVID: Part 1: Struggling to Sleep

My Prescription for Sleep during the lockdown:

 

It can be tempting to relax our regular sleep routine while in lockdown…especially since we are not going to work, or working from home. .But this lack of, or change in routine can sometimes exacerbate insomnia. Many of us barely know what day it is far less the time! We need to try to maintain our normal sleep rhythms.

Many of us are also not able to exercise as we usually would, and our body is missing those endorphins. This coupled with increased anxiety over this crazy situation we are in, can really affect our sleep…and lets face it, when we can’t sleep…we feel even more anxious and crazy! Think about it: The Japanese used to use sleep deprivation as a form of torture!

 

 

As much as possible try to stick to a regular bed time, and still set an alarm for waking up, as well as one for going to sleep

 

Resist the temptation to nap during the day

Exercise in the morning at home and not after 5pm. Exercising too late in the day can make some people feel “reved up”

Watch out for “workout ” drinks and supplements. Many of them contain Caffeine or taurine or “Green tea extract” or “Coffee bean extract” These all are basically stimulants and can keep you up at night!

Avoid Cigarettes especially before bed.  Nicotine is a stimulant.

Try to limit yourself to caffeinated beverages in the morning only, and certainly not after 3pm.

Avoid an alcohol night cap if you are struggling to sleep…alcohol can interrupt our normal sleep patterns

Dinner time is important. Try to eat at least 2-3 hours before bedtime. Going to be too full can increase heartburn which can wake you up at night with pain or a cough. Remember: Breakfast like a King, Lunch like a Prince, and Dinner like a Pauper.

What you eat is also important. Foods high in Tryptophans like Turkey and chicken can help promote good sleep.

 

Practice good sleep hygiene: Ideally the bedroom should be for sleep and sex only….but if you are forced to stay there because you are in isolation then keep a window open, and leave the curtains open during the day to let natural light in.

 

If you are in isolation Try to have a desk and comfortable lounge chair in the bedroom so you resist the temptation to spend all day in bed. 

 

At night, limit noise and increase darkness by using black out curtains or an eye mask and ear plugs if you need to.

 

DO NOT look at any screens like TV, Computer,  phone or tablet an hour before bed. The bright light breaks down our natural melatonin.

 

Have a wind down ritual: A warm shower, doing a crossword or planning what you are going to do/wear  the next day can help your brain understand it’s time for bed.

 

Sometimes medical conditions like depression, anxiety, pain, hot flushes and night sweats and restless leg syndrome can interfere with our ability to fall asleep. If you think you may be experiencing any of these, talk to your Doctor. Further updates will give more information on medical conditions which can affect your sleep.

Certain medications like Steroids and Diuretics are best taken in the morning to avoid interfering with sleep. Another common problem is Migraine tablets or “Multi symptom day tablets” – These sometimes contain caffeine. If they do, try to use these only during the day or use some without caffeine if this affects you. The common decongestant “Phenylephedrine” can also make children and some adults feel “hyper”

 

 

If you are still struggling try two Camomile tea bags in hot water and allow to draw for six minutes. You can add honey to this if you are not Diabetic. Camomile actually works on the same receptors int he brain as sleeping tablets!

 

 

You can also try 5mg of Melatonin, available over the counter, an hour before bed. This has been shown to be even more effective if you are over the age of 55.

Look out for my next update which will be on how to deal with waking up at night.

Night Night and Sleep Tight!

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