By Natan Schleider, M.D.  Written 12/31/2021   3 Minute Read

DISCLAIMER: WRITTEN BELOW IS BASED ON CDC AND NIH GUIDELINES AS OF 12/31/2021. OBVIOUSLY THESE GUIDLINES CAN CHANGE AT ANY TIME.

One of many COVID-19 home test kits none of which are super accurate as of 12.31.2021

‘Hi Dr. Schleider, I just tested positive for COVID19, now what should I do?’

Here are my suggestions for what to do when you call asking: I just tested positive for COVID19 [in 2022] now what should I do?’

You should be prepared to answer my questions so I can give you advice!

Dr. Schleider: What kind of test did you have, a rapid test (essentially the same as a home test) or a PCR test (which is the one sent to the lab)? I ask because the rapid / home tests are likely to test positive if you have asymptomatic COVID19 ONLY 35% of the time. If you have COVID19 symptoms you are likely to test positive 64.2% of the time. THIS MEANS THERE IS A FALSE POSITIVE RATE OF 35.8% ON HOME OR RAPID TESTS. However, there true negative rate is 92% which is reassuring. [SOURCE: Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites — Pima County, Arizona, November 3–17, 2020 | MMWR (cdc.gov)]

Patient: I had a home test and it tested positive for COVID19, you still haven’t told me what I should do?

Dr. Schleider: If you want to be certain that your home or rapid test is indeed accurate, go get a PCR test.

Patient: Will do but what should I do or take in the meantime?

Dr. Schleider: My personal advice and what I advise my own family is to treat any symptoms aggressively. For example, if you have a runny nose with post nasal drip that is a breeding ground for not only COVID19 but other nasty infections like flus or bacteria that cause bronchitis or pneumonia. Get yourself the following: Zyrtec-D, a decongestant like Sudafed, Flonase, and a nasal rinse and decongestant which are available over the counter. USE ALL OF THEM ROUND THE CLOCK UNTIL FOR AT LEAST 1-2 WEEKS (I WILL COACH YOU THROUGH THIS OR ASK YOUR PHARMACIST FOR DOSING).

Patient: Is there anything else I can do, for example, I am developing a bad cough, maybe another bug has moved in?

Dr. Schleider: Great point. Having an antibacterial antibiotic on hand and an antifly antibiotic on hand can’t hurt.

AND MY BIGGEST CURRENT PIECE OF ADVICE IS TO START A CORTICOSTEROID LIKE A MEDROL DOSE PACK IF YOU ARE HOME, TESTED POSITIVE FOR COVID19, WANT TO KNOW WHAT TO DO AND SYMPTOMS ARE WORSENING.

THE NATIONAL INSTITUTE OF HEALTH (NIH) SAYS DOES NOT RECOMMEND STARTING A CORTICOSTEROID (IE DEXAMETHASONE OR PREDNISONE) FOR HOSPITALIZED PATIENTs NOT REQUIRING OXYGEN CITING NOT ENOUGH DATA.

HOWEVER, IF A HOSPITALIZED PATIENT DOES REQUIRE OXYGEN THE NIH SAYS THEY SHOULD GET A CORTICOSTEROID.

WHY WAIT UNTIL THE PATIENT IS TURNING BLUE AND NEEDS OXYGEN? START A CORTICOSTERIOD AND SEE HOW THE PATIENT DOES. WORST CASE IT DOES NOT HELP SYMPTOMS AND YOU END UP GOING TO THE HOSPITAL. BEST CASE HOSPITALIZATION IS AVOIDED AND YOUR LIFE MAY HAVE BEEN SAVED.

5 Steps to finding the Best Psychiatrists in NYC for Bipolar Disorder

By Natan Schleider M.D.  June 20th 2021  3 Minute read

 

Vintage Image of Bipolar or Psychiatric Patient reading 'I Used to be normal but it drove me mad'

How should a NYC patient find the best psychiatrists in NYC for bipolar disorder?

Here are 5 steps my NYC bipolar patients have used:

1. Schedule appointment with several psychiatrists. The ‘best’ psychiatrist for one NYC bipolar may differ from another NYC bipolar patient.

2. Figure out what ‘BEST psychiatrists’ means to the NYC bipolar patient. Some patients feel the best psychiatrists are the most accessible. On the other hand, the best NYC psychiatrists may be one who accepts their insurance. Or, the best psychiatrists may be: the smartest; the Chairman of a Hospital Department of Psychiatry; the friendliest and most personable or flat out cool.

3. Ask your family doctor or psychologist or talk therapist for a referral to the best psychiatrist in NYC for bipolar.

4. Know your budget. The BEST psychiatrists in NYC often do not accept health insurance. If the best psychiatrists accept your insurance, realize you may be seeing them weekly or monthly. Copays and coinsurance fees may add up if using insurance.

5. Realize the BEST psychiatrist in NYC for bipolar disorder MAY NOT NEED TO BE A PSYCHIATRIST! For example, a NYC bipolar patient stable on their medicines can have them prescribed by their NYC Primary Care doctor. In addition, psychiatrists do not always do medical work ups to search for organic symptoms of bipolar disorder. In other words, a thorough physical exam and thorough lab testing should be done BEFORE  bipolar diagnosis is made.

For more articles on mental health in NYC visit our blog: doctorinthefamily.nyc/blog

To return to the home page click here.

THANKS FOR READING!

Dr. Natan Schleider M.D.

 

By Natan Schleider MD May 25th 2021 3 minute read

Physician Supervised NYC Home (or Work)  Drug Testing or Work in 2021.

Home Urine Drug testing is available without prescription.

I find patients and the courts / legal system treat them like pregnancy tests. For example, you’re positive or negative and there is no room or understanding for anything in between.

During a recent court case, an attorney  states: ‘This addict has too much marijuana in their urine.’

A standard urine drug screen may be information, but does NOT speak to the quantity of drug a patient is testing.

NYC Home Urine drug testing is an essential component of monitoring patients who are receiving controlled medicines–medicines monitored by the DEA.

Why is HOME testing so important? Because it allows the physician to have the patient perform a RANDOM drug test in the comfort of their home in minutes.

How does it work? Patients are mailed urine drug test containers. At a random time, the physician will contact them and ask them to produce a urine sample within 5 minutes on camera live. This virtually eliminates the chance for a patient to mess with the urine sample.

Both doctors and patients should be familiar with the characteristics and capabilities of screening and confirmatory drug tests.

Immunoassays are used for initial screening. In other words, hhey can give false-positive and false-negative results.
Therefore, all results are considered presumptive until confirmatory testing is performed.
False-positive results have significant implications for a patient’s pain treatment plan, and false-negative results can be a missed opportunity to detect misuse.
Urine drug testing is an essential component of monitoring of patients: who are receiving long-term opioid therapy, receiving long-term benzodiazepine, or stimulant therapy. This is especially true if the NYC doctor suspects misuse of medicine.
Standard urine drug screens (aka immunoassays) for opioids may not detect commonly prescribed semisynthetic and synthetic opioids. For example, methadone, fentanyl, and buprenorphine aka Suboxone mustbe tested for separately.
Similarly, home drug testing for benzodiazepines may not detect alprazolam (aka Xanax) or clonazepam (aka Klonopin)..
Basic urine drug tests can cross-react with other medications. This gives false-positive result.  important implications for a patient’s pain treatment plan would result. False-negative results can cause missed opportunities to detect misuse.
Urine samples can be adulterated (diluted or tampered).  Adding substances to mask positive results on urine drug testing is an example.
A toxicologist, a medical review officer (MRO), or lab pathologist are experts I turn to to help with home urine drug  testing.
I provide my patients free urine drug test containers via mail (or in office).  This way, I can practice medicine remotely  and ensure compliance.
FOR MORE INFORMATION OF NYC HOME URINE DRUG TESTING PLEASE CALL 646-957-5444 OR SCHEDULE AN APPOINTMENT WITH ME VIA ZOCDOC.
Be sure to visit out home page or blog page for more medical information.
SOURCE: AMERICAN FAMILY PHYSICIAN

Teladoc Psychiatry vs NYC Psychiatry and Primary Care Doctors  3 minute read

By Natan Schleider MD April 13th 2021

At $49 dollars for a teladoc psychiatry NYC consult, sounds like a bargain, and if its too good to be true,,,,

In my experience you get what you pay for: see How Much Does Teladoc Cost? | HowMuchIsIt.org

So should you call a real doc aka NYC Psychiatry and Primary Care Doctors or a teladoc psychiatrist in NYC?

TAKE THE FOLLOWING TEST FOR AN ANSWER:

  1. Are you looking for a teladoc psychiatrist because they are listed on the New York Stock Exchange?
  2. Are you looking for cheap medical care?
  3. Do you want a teladoc psychiatrist in NYC who NEVER prescribes controlled medicines (IE clonazepam for anxiety)?
  4. Do you like the idea of consulting a different teladoc psychiatrist every NYC consult?

IF YOU ANSWERED YES TO 3 OR MORE OF THE ABOVE, TELADOC MIGHT BE FORE YOU!

IF YOU ANSWERED NO MOST OF THE ABOVE, CALL A REAL DOC, NOT A TELADOC.

NYC Psychiatry and Primary Care Doctors:

  • participate OUT OF NETWORK with select PPO insurance plans
  • have no hidden or surprise fees
  • have a copay assistance program for patients struggling financially
  • are real New Yorkers who you can consult in our Manhattan office or virtually, as you like

Please contact us with questions.

Virtual Psychiatry in 2021 in NYC- What to expect from telepsychiatry — communicating with a psychiatrist when you are not lying on their couch.

Updated by Natan Schleider M.D. May 25th, 2021

 

‘Virtual psychiatry in 2021 in NYC is here to stay. The psychiatry office visit is as practical as a rotary telephone and will soon be as nostalgic as a telegraph.’ -Stated by Natan Schleider, M.D. at the onset of the COVID19 Pandemic 0f 2020.

Having practiced medicine on house calls, in hospitals, and in my office, it has become apparent that virtual psychiatry in 2021 and beyond in NYC is now the norm. Do I maintain an office in which to see patients when seeing the face to face is required–yes I do. Do most patient want to come to my office–no they don’t.

So what is virtual psychiatry? It has the same meaning as telepsychiatry which simply means, for me, communicating with a patient electronically or by audio and or video.

So is a text message saying:

PATIENT ‘Hi doc, my mood is down despite my Prozac 10 mg dose, do you think we can increase the dose?’

DOCTOR ‘Yes, you have been taking Prozac 10 mg which is a very low dose, let’s increase the dose and follow up in 1 week to see if your mood improves.’ I would argue this is a consult and there is no data I know of stating that patient care is improved when using a telemedicine platform, that is, something like Zoom with audio-visual communication.

Some patients prefer seeing their doctors in person. I am all for that–unless you have COVID19 without symptoms or vice versa. 

What about patients that need lab testing and or drug screening, how do you handle that? Good question, the answer is in part 2 of this blog.

Thanks for reading and to read similar article check this blog out: 7 Reason Why Virtual Psychiatry in New York City is here to stay

Natan Schleider MD

TO SCHEDULE AN APPOINTMENT WITH ME PLEASE CALL OR TEXT 646-957-5444 OR  VISIT ZOCDOC

Virtual psychiatry are two abstract words we literally cannot put a finger on. 

Virtual psychiatry generally means consulting via the internet live in real time with a mental health care medical doctor–a psychiatrist or physician who specializes in mental health–who is a human (not an AI robot) using any means of audio-visual communication like Skype or Zoom at an agreed upon time.

As a physician with six months experience with technical issues using computers to communicate: internet too slow, lost meeting ID code; empty ‘virtual waiting rooms’, no audio just visual or vice versa (resorting to hand signals or holding up a piece of paper that says ‘Turn on on your audio microphone’)—I prefer a device called a telephone or phone for short.

Virtual mental health care / virtual psychiatrists are used commonly, especially since the COVID19 pandemic began.

As I often like things explained to me like I’m a 6 year old, what exactly is virtual psychiatry? 

Practicing live mental health care using virtual psychiatry requires a psychiatrist and a patient, each with a good internet connection, a computer to access the internet, and a webcam. Notice I emphasize the word GOOD.

A bad internet connection on either computer results in all sorts of technical issues like video will not work and screens appear black; audio and talking will not work so you see the psychiatrist on your screen but do not hear them

A virtual psychiatry consult is scheduled in the same was you scheduled doctor’s appointments in the last 20 to 40 years (except no walk ins which my office does not accept, nor do you want since you don’t know if a coronavirus 19 positive patient or staff member is sitting there symptom free and contagious).

So yo

Let’s start with definitions

virtual [ˈvərCH(o͞o)əl]   ADJECTIVE

  1. almost or nearly as described, but not completely or according to strict definition. “the virtual absence of border controls” synonyms: effective · in effect · near · near enough · essential · practical · for all practical purposes · to all intents and purposes · in all but name · indirect · implied · implicit · unacknowledged · tacit
    • computing not physically existing as such but made by software to appear to do so.See also virtual reality. “a virtual computer”
    • carried out, accessed, or stored by means of a computer, especially over a network. “a virtual library” ·  [more]
    • optics relating to the points at which rays would meet if produced backward.
    • physics denoting particles or interactions with extremely short lifetimes and (owing to the uncertainty principle) indefinitely great energies, postulated as intermediates in some processes