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How to prepare for your Telemedicine appointment

Dear Valued Patients,

It looks like telemedicine appointments are here to stay, at least for the immediate future. We appreciate your willingness to participate in this joint venture to protect your health as well as our staff’s while staying current with your health care. Telemedicine works with internet-connected smart phones, tablets and computers. Here are some guidelines to make the process more streamlined, efficient and less stressful. 

Prior to your appointment:

  • Our staff will be contacting you via phone or patient portal to update your insurance information, demographics, get your consent*, and give log-on instructions.
  • Please make sure you have internet access – either wi-fi** or data plan with your internet provider. 
  • Please enable camera and microphone on your device.
  • Please update your browsers.
  • Acceptable browsers are: Google Chrome, Mozilla Firefox, or Safari 11+
  • Make sure your device is charged.
  • Ethernet linkage enhances the quality of the call.

At the time of your appointment:

  • If you are able, please have the following information ready:
    temperature 
    blood pressure 
    heart rate
    weight
    height (if you are a new patient)
  • Have your medications/supplements (or a medication list) available.
  • Have a pen and writing pad to take notes.
  • We will send you a link via text or email, or you can connect via the following link: Dr. Nguyen Telemedicine Link

*ALAMO WELLNESS ALLIANCE TELEMEDICINE CONSENT FORM.  This form is also available for review in your patient portal under “My Health” > “Medical Forms” > “AWA Telemed Consent Form”. Please let our staff know verbally that you have read and consented. You have to do this only once.

**Free wi-fi is available at public libraries, San Antonio Park and Recreation locations and Starbucks. Please park close to the building/park for a good signal and practice social distancing.

 

San Antonio Metro Health COVID-19 FREE Testing, Updated May 20, 2020

To find out if you qualify for testing, please use this online self-screening tool:  COVID-19 Screening Tool

To register for a test after taking the screening, call (210) 233-5970 or use the link COVID-19 testing request 

New locations for free mobile and walk-up COVID-19 testing: Mobile and Walk-up Testing Sites

The San Antonio Metropolitan Health District has opened a COVID-19 hotline for residents to ask questions about the virus. The hotline is available in English and Spanish. Residents can call 210.207.5779.

Hours of operation are Monday – Friday 8:00 a.m. – 4:00 p.m. and Saturday & Sunday 8:00 a.m. – 12:00 p.m.

Email questions or requests for presentations to COVID-19@sanantonio.gov

CLINIC SCHEDULE AND PROCEDURAL CHANGES – Posted April 30, 2020

DEAR VALUED PATIENTS:

BECAUSE WE ARE TRYING TO LIMIT PATIENT AND STAFF EXPOSURE TO COVID-19, WE ARE NOTIFYING YOU OF THE FOLLOWING OFFICE VISIT SCHEDULE REVISION: IF YOU HAVE AN UPCOMING PHYSICAL EXAM APPOINTMENT BETWEEN MAY 4 AND MAY 31, WE WILL BE REACHING OUT TO RESCHEDULE FOR JUNE 1 OR LATER (THIS MAY CHANGE ACCORDING TO CDC RECOMMENDATIONS). STAY AT HOME ORDER HAS BEEN EXTENDED TO 11:59 P.M. ON JUNE 4,

WE WILL BE SCHEDULING BOTH TELEMEDICINE AND IN-PERSON APPOINTMENTS FOR URGENT AND FOLLOW-UP VISITS STARTING MAY 4

WE ASK THAT YOU WEAR A FACE-COVER OR MASK FOR IN-PERSON APPOINTMENTS. YOUR TEMPERATURE, SYMPTOM AND COVID-19 EXPOSURE HISTORY WILL BE COLLECTED PRIOR TO CLINIC ENTRY.

FOR TELEMEDICINE APPOINTMENTS, YOU WILL RECEIVE INSTRUCTIONS IN PREPARATION FOR YOUR VISIT AS WELL AS A LINK FOR ACCESS. INSTRUCTIONS CAN ALSO BE FOUND HERE: How to Prepare for your Telemedicine Appointment

CHECK-INS WILL NOW BE DONE REMOTELY VIA A LINK SENT TO YOUR CELL PHONE PRIOR TO YOUR APPOINTMENT. PLEASE UPLOAD YOUR INSURANCE CARD, ANSWER POSED QUESTIONS AND SIGN ALL DOCUMENTS PRIOR TO YOUR APPOINTMENT. THIS IS TO HELP MINIMIZE PHYSICAL INTERACTION WITH FRONT-OFFICE STAFF AND TO PROTECT YOU. THE LINK IS HIPAA COMPLIANT AND ENCRYPTED.

DROP-INS ARE NOT ENCOURAGED AT THIS TIME AS OUR ENTRANCE WILL ONLY ADMIT SCHEDULED APPOINTMENTS.

LAB DRAWS WILL STILL GO OUT TO OUR PARTNER LABS (LABCORP, CPL, AND QUEST). PLEASE NOTIFY US BY CALLING OUR OFFICE OR MESSAGE THROUGH THE PATIENT PORTAL WHEN YOU ARE READY FOR LAB DRAW, AND WE WILL MAKE SURE THE ORDER GOES TO THE CORRECT LAB. PLEASE CHECK THE FOLLOWING WEBSITES FOR HOURS AND LOCATIONS:

Labcorp

Clinical Pathology Labs (CPL)

Quest Diagnostics

WE WILL CONTINUE TO POST UPDATES ACCORDING TO CDC GUIDELINES AND LOCAL GOVERNMENT MANDATES. 

Discontinuation of Isolation for Persons with COVID -19 Not in Healthcare Settings, Recommendations from CDC

Guidelines to discontinue isolation after being diagnosed with COVID-19 either clinically (by symptoms only) or by RNA nasopharyngeal testing (with and without symptoms) for patients who are not healthcare providers:

For Symptomatic Persons with COVID-19 Under Isolation:

1). Symptom-based strategy

May discontinue isolation under the following conditions:

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • At least 10 days have passed since symptoms first appeared.

2). Test-based strategy (if available)

May discontinue isolation under the following conditions:

  • Resolution of fever without the use of fever-reducing medications and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens). 

For Asymptomatic Persons Who have Tested Positive and are Under Isolation:

1). Time-based strategy*

May discontinue isolation under the following conditions:

  • At least 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test.
  • If they develop symptoms, then the symptom-based or test-based strategy should be used.

2). Test-based strategy*

May discontinue isolation under the following conditions:

  • Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens)*.

*Note, because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness, and it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test. There have been reports of prolonged detection of RNA without direct correlation to viral culture.

For the full CDC recommendation: Discontinuation of Isolation for Persons with COVID -19 Not in Healthcare Settings, Recommendations from CDC

If Someone in Your Home Has COVID-19: How to Keep Others Safe – article from WebMD

From WebMD*

“Since we know that the virus is transmitted through droplets when someone coughs or sneezes and contact with contaminated surfaces, there are steps we can take to stay safe. Here are some things to consider when creating an “isolation zone” in your home:

  • Designate a separate room where you can close the door, if possible. If that’s not an option, find a space where there is at least 6 feet between the sick person and other people.
  • Those who are not sick should use a different bathroom from those who are, if available. If a separate bathroom is not available, the sick person should clean the bathroom after each use. Others in the home should try to let the bathroom “air out” for at least 30 minutes before using it again. And make sure that everyone in the home – regardless of which bathroom they’re using – closes the toilet lid when flushing and runs the exhaust fan to limit viral particles in stool from hanging out in the air.
  • Try to make sure that any shared spaces in the home have good air flow, with an air conditioner or an open window. Air filters and air purifiers can also be helpful in these situations — look for air filters that are designated MERV 13 or higher. Humidifying the air can also be helpful, because viruses live longer at lower humidity. Setting the humidity to between 40-60% is ideal.
  • If possible, the sick family member should wear a face mask when they are around other people (a basic surgical mask is what’s recommended) . Caretakers can use one too when within 6 feet of a sick person. If a face mask is not available, limit time in close contact to less than 15 minutes and disinfect all surfaces that the sick person has come in contact with. If not having a face mask makes you feel anxious, you can make a DIY face mask at home, though be aware that we still don’t know how much protection a DIY mask truly offers. If you do make one, make sure it fits snugly around your mouth and nose. The University of Cambridge did some studies looking at the protection you may get from different materials: from vacuum cleaner bags to cotton t-shirts.
  • Avoid sharing household items like dishes, cups, utensils, towels, bedding, or other items.
  • Don’t allow the sick family member to interact with or care for any pets in the home.
  • Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, stool, or body fluids on them.
  • Wash laundry thoroughly. If you can, wear disposable gloves while handling soiled items and keep soiled items away from your body. Remember to clean your hands immediately after removing your gloves.
  • Place all used disposable gloves, face masks, and other contaminated items in a bag before disposing of them with other household waste.

Make sure to monitor your loved one’s symptoms and call the healthcare team immediately if their symptoms worsen.”

If Someone in Your Home Has COVID-19: How to Keep Others Safe

What to do if you test positive for COVID-19 – from Healthgrades

“Take immediate action to prevent further spread of COVID-19.

Have you received notification that you tested positive for the virus that causes COVID-19? There is no reason to panic. Most individuals who are not at increased risk for severe COVID-19 illness typically experience a flu-like episode and fully recover.

If you test positive for COVID-19, you should:

  • Isolate yourself at home and do not leave the house unless you have been instructed to visit a health care facility.
  • Wear a disposable face mask OR cloth face cover to protect others from contaminated respiratory droplets that enter the air when you cough or sneeze.
  • Stay in a separate room with a separate bathroom, if possible.
  • Maintain at least 6 feet distance from others.
  • Keep all ‘high-touch’ surfaces clean. This includes doorknobs, tabletops, telephones, and even your computer and keyboard.
  • Limit contact with housemates, especially those who are at increased risk of severe COVID-19 illness (elderly or immunocompromised individuals and those with respiratory problems).
  • Among the most effective practices that limit the spread of COVID-19 is practicing good ‘respiratory etiquette’ and hand hygiene:
  1. Avoid touching your eyes and mouth.
  2. Dispose of tissues after coughing or sneezing.
  3. Wash your hands regularly and thoroughly with warm, soapy water for 20 seconds. Use alcohol-based hand sanitizer in a pinch, if soap and water are not available.

If you are older than 65 and/or you are immunocompromised or have an underlying chronic health condition, you have a higher risk of developing more severe COVID-19 illness. Follow the same practices as everyone else, closely monitor your symptoms, and seek medical care if your symptoms worsen.

Notify close contacts.
As a courtesy and as an important step in controlling the pandemic, try to notify the people with whom you have been in contact over the past 7 to 10 days.

Contact your healthcare provider if symptoms worsen.
The same type of home care you would use for cold or flu symptoms also works for most patients infected by SARS-CoV-2. [For pain relief and fever reduction with coronavirus, there are some reports to avoid ibuprofen (Advil, Motrin) and use acetaminophen (Tylenol) instead, but there is no scientific evidence to support the claim.]

But, severe COVID-19 illness extends beyond cough, fever and congestion. Immediately notify your healthcare provider for any of the following symptoms:

  • Chest pain
  • Chest tightness
  • Difficulty breathing (having a hard time “catching” your breath)
  • Altered mental status
  • Bluish lips/skin (cyanosis)

Keep track of your symptoms and the calendar.
Start a journal to record your temperature readings. Measure your temperature more frequently if fever occurs. Note the dates when symptoms emerge, their severity, and their resolution. This is powerful information to share with your healthcare team as they track your progress or in case complications ensue. You can expect to remain in isolation until any fever has resolved for three days with steady improvement in your other symptoms.

Give yourself the time and space to completely recover, which takes a few days to a week in most cases of COVID-19. Reach out to friends and family and other support groups.”

From Healthgrades: What to do if you test positive for COVID-19, Healthgrades

PLEASE QUARANTINE YOURSELF FOR 14 DAYS FROM START OF SYMPTOMS TO FULLY RECOVER. YOU SHOULD NOT GO OUT IN PUBLIC UNLESS YOU HAVE BEEN WITHOUT A FEVER WHILE OFF FEVER-REDUCING MEDICINES FOR AT LEAST 3 DAYS.

For those interested in donating convalescent plasmaHow to Donate Convalescent Plasma

Steamed Vegetables with Rice

Ingredients

  • 1-2 Fresh beets peeled, halved and sliced
  • 1-2 Handful of fresh okra (washed)
  • 1-2 Tablespoon kimchi or sauerkraut (homemade preferable)
  • Juice of 1/2 lemon
  • Liquid amino to taste (optional if NOT on a low sodium diet)
  • Tabasco or any chili seasoning
  • 1 Teaspoon olive or coconut oil or softened goat’s milk butter
  • 1 Cup (per serving) cooked jasmine or basmati rice or quinoa (if on low carb diet)

Putting it together:

Place sliced beets and okra into a steamer (with about 1/2 inch of water on bottom of pan) and cover.  Steam on medium-low heat for about 15-20 minutes or until beets are tender.  Place cooked rice or quinoa into a medium-sized bowl and drizzle olive or coconut oil or place the butter on the rice.  Season with liquid amino (optional) and toss lightly to mix.  Place slices of beet and okra on top of the rice and squeeze some lemon juice onto the veggies.  Garnish with Tabasco/chili seasoning and kimchi or sauerkraut.  Refrigerate leftover veggies in air-tight containers for re-steaming later.

Enjoy with a cup of naturally un-caffeinated mint or ginger tea.

~Bon Appetit~

Healthy steamed vegetables dish prepared by Dr. Huyen Nguyen

Steamed vegetables

Rating

Links for Good Eats Under “Patient Education”

Local Produce – lists resources for obtaining local and seasonal organic fruits/veggies.  Farmhouse Delivery requires membership, but will deliver weekly or bi-weekly (every other week) produce/groceries to your door.  GO TEXAN from the Texas Department of Agriculture Commissioner provides a list of local farmer’s markets and their hours.  River City Produce offers bi-weekly organic baskets, and weekly specials at wholesale prices.  Hours and weekly specials are posted on their Facebook page (search River City Produce Co., Inc.).

Nutrition Education – HEB offers individual nutritional counseling and group health classes for a fee.  Whole Foods Market‘s website assists with healthy meal planning even with dietary restrictions.

A Soda A Day

Ever wondered what the consequences are of drinking just one soda a day?  Click on the following link to find out.

How much weight does one gain with a soda a day?

Some suggested healthier alternatives:  

  • Plain carbonated water + fresh fruit juice in a 80:20 dilution (80% water, 20% juice)
  • Plain carbonated water + herbal tea (favorites are jasmine, mint, hibiscus, ginger, etc.) sweetened with a few drops of liquid Stevia (a natural sweetener)
  • Plain carbonated water + a squeeze of citrus (lemon, lime, orange, grapefruit, etc.)
  • Plain carbonated water + fresh fruit infusion (slices of orange, pineapple, kiwis, berries, cucumber, etc.)
  • Plain carbonated water + 1-2 drops of essential oil (lemon, orange, mint)
5 Stars

1 Review | Average Rating: 5

5 Stars

Very informative. The variety of alternate suggestions you give are a great idea and much more healthy! Hopefully more people will see this and start making changes.

Kale Greens Stir-Fry

Ingredients

  • 1/2 white onion, thinly sliced 
  • 2-3 peeled cloves garlic, minced
  • 1 inch ginger root, peeled and julienned
  • 1 large carrot, peeled and sliced
  • 1 large portabello mushroom, de-gilled, brushed and sliced
  • 2 links (1/2 package) Tofurkey meatless Kielbasa “sausage”, diced
  • 1 roma tomato, sliced
  • 6-8 cups kale greens (HEB sells this already washed and cut)
  • seasoning salt to taste
  • 2 Tbsp rice vinegar (or to taste)
  • 4 Tbsp water
  • 1 Tbsp coconut oil (can also use grapeseed oil)
  • freshly ground black pepper and/or Sriracha hot sauce to garnish

Putting it together

Preheat a large saute pan or wok on low heat while you gather and chop/slice ingredients.  Once you are ready to cook, turn heat up to medium.  Begin by drizzling oil into pan or wok.  Wait about 30 seconds until it heats up.  Then, drop in onions, ginger and garlic (in that order), stirring steadily until onions are semi-translucent.  Add carrot slices and continue to stir for about 3 minutes.  Add the diced Tofurkey and mix for another 3 minutes.  You may need to add a bit of water to the pan to make sure nothing is sticking.  Maintain cooking temperature by turning up heat slightly. Add the kale greens and stir.  Season with seasoning salt and rice vinegar (taste after adding).  Continue to mix as you saute, and the greens will go limp in about 2-3 minutes.  When the greens are limp, add the sliced portabello mushroom and incorporate into the mixture.  When the mushroom starts to sweat (in about 3 minutes), add the sliced roma tomato.  Cover the pan and turn off heat.  Let the stir-fry rest for about 5 minutes, then uncover and give a final mix.  

Stir-frying tip:  Using a pair of sturdy wooden chopsticks (no, not the ones you saved from your favorite Asian restaurant) or a flat wooden spoon or spatula to toss the veggies while saute-ing will prevent food from sticking to bottom of wok or pan and ensure even cooking.  Making sure the pan is hot enough (you can hear the slight sizzle and smell the fragrance) is also important to have tender, not limp veggies.  

Serve on a bed of cooked quinoa (shown here) with a side of steamed vegetable gyoza (from Trader Joe’s) and dipping sauce (made with rice vinegar, liquid amino, sesame oil, freshly ground black pepper, and a few drops of agave).  If you like your stir-fry spicy, sprinkle a bit of freshly ground black pepper or drizzle some Sriracha hot sauce onto the plate before serving.  Bon appetit!

Kale greens stir fry

Kale greens stir fry