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So I’ve finally had my first dose of the Astra Zeneca COVID 19 Vaccine

So as a healthcare worker I finally got my first dose of the Astra Zeneca vaccine on Saturday! I feel like I have won the lottery, and I was so happy to have seen many of you there also…

So how did I feel after?

Well, truth be told on Sunday I had a mild fever and a few aches and pains, but honestly, I think that’s a small price to pay for being able to protect myself and my patients…..and by contributing to herd immunity I am helping to protect the wider population, aka our parents and grandparents. Speaking of parents, as over 60s, mine also got theirs and felt fine!

According to GAVI, the vaccine alliance, there have been about 190 million Astra Zeneca vaccines administered worldwide so far.

I know that there has been a lot of worry about blood clots with this vaccine, but let me put this into perspective for you:

Just being pregnant increases the risk of a clot 4-5 times above the non pregnant state. A woman on the combined oral pill has on average about three times the risk of a clot as a woman not on the pill (but note that this is less than the risk of a clot while pregnant). The risk of getting a clot with the vaccine is far, far lower than either the background risk from being pregnant or the risk from being on the pill. 

So would you not have had your children because of the risk of a clot? …because this risk is lower than that. And I know many of you take the pill, or have taken the pill, and this risk is lower than that too!

The WHO has issued an interim advisory that a causal relationship, while plausible, has not been confirmed.

Now, this isn’t to say that you must not be on the lookout for warning signs of a clot, or that you should not take individual advice if you have had a clot in the past, or are known to have a genetic condition which increases, your chance of clotting…of course you must check with your doctor in these cases!

However the vast majority are far more at risk of death or serious disease from getting COVID 19 itself, than from the small risk of this vaccine.

My advice: if you are eligible, call your local health center and get your shot!

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How to be a Sleeping Beauty

Sleep your way to weight loss, a more youthful appearance, lower blood pressure, better blood sugars, a happier mood and better memory!

Ronald Regan and Margaret Thatcher both boasted that they needed less than 4 hours sleep per night….but they both got Dementia.

Less than 6 hours good quality sleep per night is can lead to weight gain, high blood pressure, Diabetes and Dementia as well as Depression and Anxiety.  Most adults’ perfect sleep time is between 7-8 hours per night.

Far from being passive, sleep is an active process where your brain is busy eliminating toxins, repairing DNA, and backing up memories and new information you have learnt, into permanent files! If you take alcohol or sleeping tablets then your poor brain is trying to complete these tasks while drunk or sedated, so they can’t happen as well.

If you think you snore a lot or may be very sleepy during the day, then take this test to see if you may have sleep apnoea:  Epworth Sleepiness Scale (britishsnoring.co.uk)

If positive, we can help you schedule a simple at home Night Owl Test. This is a little device you wear on your finger, while you sleep.

For more general, practical help with Insomnia, take a look at these videos on our You Tube channel:

(83) Struggling to Sleep During the Lockdown? Here’s how to restore your Sleep Cycle. – YouTube

(83) Struggling to Sleep Part 2: How to Fall Asleep – YouTube

(83) Part 3: How to stay asleep : What to do if you wake up. – YouTube

(83) Medical Conditions That may wake you up at night – YouTube

 

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January is Cervical Health Awareness Month!

Cervical Cancer is one of the commonest and yet the most preventable cancers in Women worldwide.

We are so lucky to have a good screening test to help us detect precancerous changes in the cervix. – The “Pap” test introduced in the 1940s has reduced the incidence and mortality of cervical cancer by 77% in the USA.  In the UK The incidence has fallen by 44% and death rates by 70% since introducing screening for cancer of the cervix.

Rates of precancerous lesions in younger women have dropped even further since the introduction of the Human Papilloma Virus (HPV) vaccine.

Cervical Cancer, believe it or not, is catching! 99% of cervical cancer is caused by the high risk strains of the Human Papilloma Virus, most  commonly types 16 and 18 which are preventable. HPV is spread by sexual intercourse.

For this reason, Many countries including the USA, UK and Australia have national vaccination programs to vaccinate teenagers before they are likely to become sexually active. The aim of this is to prevent Cancers – of the cervix, penis, throat and anus!

Have you thought about discussing HPV vaccination with your adolescent? Cancer prevention could be the greatest gift you give to them.

Have you set a good example by to your daughters by having your smear test?

The Smear test is recommended for all women ages 26-64 and is done in office.

To celebrate Cervical Health Awareness Month book your smear test or consultation about the HPV vaccine on 221-3983 or by booking online at www.amesmedicalservices.com

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Long Covid

Long COVID

 

What is it?

 

Much like Chick V, the virus which causes COVID 19, SARS -CoV-2- can leave longer lasting symptoms in about 10% of people. We say these “post acute” Covid symptoms are symptoms going on longer than three weeks after the start of symptoms. The symptoms can last for months, up to 12 weeks. (Then known as “Chronic Covid” ) People suffering with Long Covid are not necessarily still infectious.

 

Common symptoms include Fatigue, breathlessness, cough, low grade fever, muscle pain and headaches as well as depression. These can come and go.

 

We are not entirely sure what causes the prolonged symptoms but it is likely to be multifactorial. Long lasting symptoms after an infection are not unique to COVID 19.. ,Many viruses can cause chronic fatigue, for example and many can cause a post infectious  Immune or inflammatory response which can affect many organs including the lungs, brain, muscles/joints or nerves. There is also likely to be  a Psychological component also.

 

What should you do if you have ongoing symptoms? 

 

See your doctor for an examination and if appropriate some baseline Investigations to rule out secondary causes for your symptoms/complications of COVID 19. For example your doctor may need to rule out: Anaemia, secondary pneumonia/chest infections requiring antibiotics.; inflammation of the heart or also even heart failure in severe cases. If you were hospitalized and are breathless they may also want to rule out a clot in the lung for example.

 

Once these have been excluded, rest, limitation of caffeine, monitoring of oxygen levels where appropriate, and possibly graded exercise therapy, and psychological support can help people feel better.

 

For fatigue, once your doctor has said it is ok, then 4-6 weeks of self paced light exercise such as walking can help.

 

When is it generally safe to return to exercise?

 

If you were reasonably active before COVID 19, then after mild illness – try one one week of stretching before attempting light cardiovascular exercise such as walking. Increase your rest periods if you get tired in between.

 

If anyone has been hospitalized, or required oxygen they should see their one doctor for an individualized assessment.

 

Patients who had heart  involvement need a cardiac assessment with Blood pressure, pulse, ECG pulse oximetry and review with doctor before resuming exercise.

 

If you are allowed to exercise, then usually light graded exercises, over 4-6 weeks helps people to recover from the fatigue, brain fog and depression that can follow COVID 19.

 

Psychological Support can help especially if you are suffering with depression, the death of a loved one or the loss of a job or income.

 

Peer-peer support groups have been known to be helpful. Perhaps consider starting one on Facebook?

 

Fever usually responds to paracetamol, although as I mentioned above see doctor to r/o secondary infection.

The good news is that if you are kind to yourself, and allow rest and positive thoughts, most people recover slowly with the above measures…hopefully by 12 weeks or so!

Here are some helpful links:

How to conserve your energy – RCOT

Long Covid Support Group | Facebook

 

 

 

 

 

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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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Morning Edition Fazir Mohammed Interviews Robert Trestrail of Sagicor Insurance And Dr. Ames On SAGICOR LIFE’s Telehealth Benefits in Trinidad and Tobago

Insurance giant Sagicor has announced that they will be accepting telehealth service related medical claims in Trinidad and Tobago. Online platforms have been helping medical services stay functional during the current situation with COVID19 pandemic, and has made the concept of telehealth and telemedicine more acceptable in Trinidad and Tobago.

Sagicor is piloting the service for three months and will introduce telehealth claim benefits for the 1st time to Sagicor clients. Sagicor aims to help their clients through the challenging scenario COVID19 has created. Mr. Robert Trestrail, the Executive Vice President and General Manager of Sagicor said, “The offering is really designed to help us build our experience and support our clients in these difficult times of COVID”.

Morning Edition Fazir Mohammed interviews Robert Trestrail of Sagicor Insurance

Mr. Trestrail was remotely joined by Dr. Alexandra Ames who shed some light on the effectiveness of Telehealth services and explained the process she follows to decide which illness can be treated via telehealth and which ones need patients to physically visit the doctor’s clinic. Dr. Ames said, “I think communication is extremely important and this(telehealth) is just another way of communicating. We are taught in medical school that 80% of diagnosis is the history”. “I believe in listening to my patient and part of being able to listen is being able to increase access and I think that’s what it does”. She added, “I back my video consultations up with the fact that if in the course of the consultation either the patient or I realize that this is much more complicated than we initially thought, and I actually have to physically lay hands on the patient, then I bring the patient down at no extra cost to do that.”

Morning Edition Fazir Mohammed Interviews Doctor Alexandra Ames on Telehealth Services Trinidad

In his interview with Morning Edition, Mr. Trestrail said, “from a Sagicor perspective, we had the issue of telemedicine, we’ve been reviewing for many years. It’s not a new factor in the field of medical service providers. It’s been something you’ve seen on the international market for many years. In fact, when Dr. (Alexandra) Ames speaks, she’s a great advocate for this (telemedicine) and really a pioneer in Trinidad, and she has been promoting this type of engagement for the past, I would say 2 or 3 years”. 

Watch the full interview here: Morning Edition’s Fazir Mohammed Interviews Robert Trestrail of Sagicor and Dr. Alexandra Ames of Ames Medical Services

To initiate the project, Sagico has provided Dr. Ames and ten other medical practitioners with an online form for the claim. Once the medical examination is completed the medical practitioner will fill in the form and share it with the patient. In the next step, the patient will print and sign the form and email it to Sagico along with the receipt. In case the patient does not have necessary technical support required to complete this step, Sagico will process the claim in good faith based on the form submitted by the medical practitioner.

Contact Ames Medical for Telehealth Services in Trinidad and Tobago

Source: Morning Edition

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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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