Dr. Dan’s Notes

The type of jokes that the CDC wants us to tell nowadays are "inside" jokes. I would tell a toilet paper joke but I don’t want to be a potty mouth.

A pandemic is one thing but this one is different. This virus is new to humans and has not been transmitted to humans by bats or birds or pigs or any of the other usual animals that share their viruses with us. It has been transmitted from a rare armadillo type creature that is a delicacy in China.

This being the case, our bodies have not a clue as to how to prepare to fight this thing off and have to learn on the fly. This is no problem for most of us because God made our immune system very effective. It becomes a problem when the body is trying to fight off other conditions at the same time and while the immune system is sick on top of all that as well. An example is a person with emphysema, COPD, will not be able to cope as well and may need hospital care. This virus is, as we have found out, is more easy to catch so more people get infected at once. and the sickest people catch it the fastest. We are staying ahead of the curve here in Texas due to all of us following our local rules. "Flattening the Curve" just means keeping the virus from spreading too fast for us to keep up. Thank you all for your efforts to keep us all safe.

This week the CDC started recommending everyone wear masks. This is new and is due to a study where very small droplets tend to stay in the air for a longer time. Please remember that air comes in around the mask more than it goes through it so this is not perfect. The 6 foot social distancing is still about the best precaution along with the 20 seconds of hand washing often and hand sanitizer. Having a cross ventilation like a window open on either side of a room for a time once per hour is also recommended. These droplets are very light and get blown out in 5 minutes in most cases with this cross ventilation. Again, thank you all for helping us keep this under control.

Of course we at the office are encouraging people to do telemedicine. We are here to help you. I know it sounds complicated but if you have an iPhone, it is just a push of a button to switch to FaceTime, and if you have another type of smart phone or a computer and internet, it is a simple downloaded program like Skype or whatsapp. My staff are experts! The HIPPA restrictions on these modes of communication for telemedicine have been temporarily lifted and our staff is happy to hel p you make it work.

For those visits that need to be hands on, like shots or acupuncture, we have a system where there is only one pt in the waiting room at a time and we call you from your car We have plenty of cleaning supplies and are disinfecting after each visit. Please do not be alarmed when you see us in masks, it is just us following the guidelines because we care about you.

If you are sick, please let us know so we can keep the curve low. All of us working together will get us through this. If you are injured, rest assured we are taking all precautions to protect you and your families. Most people recover very well from the virus. The statistics still support this. Places that have the population more spread out have lower instances of the virus and we are spread out out here.

Concentrated population areas like New York have many more problems but we need to be social conscious early so problems don’t come up in the first place.

April 2020 – German Corona

As confirmed cases of the coronavirus in Germany soared past 10,000 last week, hundreds of Berliners crowded Volkspark am Friedrichshain to play soccer and basketball, and to let their kids loose on the park’s many jungle gyms.

The conditions seemed ideal for the spread of a virus that has killed thousands. Indeed, as of , Germany had the fifth-highest number of cases.

Yet Germany’s fatality rate so far — just 0.5% — is the world’s lowest, by a long shot.

"I believe that we are just testing much more than in other countries, and we are detecting our outbreak early," said Christian Drosten, director of the institute of virology at Berlin’s Charité hospital.

As Europe has become the epicenter of the global coronavirus pandemic, Italy’s fatality rate hovers around 10%. France’s is around 5%. Yet Germany’s fatality rate from COVID-19 has remained remarkably low since cases started showing up there more than a month ago. As of , there were 175 deaths and 34,055 cases.

Drosten, whose team of researchers developed the first COVID-19 test used in the public domain, said Germany’s low fatality rate is because of his country’s ability to test early and often. He estimates Germany has been testing around 120,000 people a week for COVID-19 during the monthlong period from late February to now, when it’s reached epidemic proportions in the country, the most extensive testing regimen in the world.

And that means Germany is more likely to have a lower number of undetected cases than other countries where testing is less prevalent, which raises the question: Why is Germany testing so much?

The Coronavirus Crisis
"We have a culture here in Germany that is actually not supporting a centralized diagnostic system," said Drosten, "so Germany does not have a public health laboratory that would restrict other labs from doing the tests. So we had an open market from the beginning."

In other words, Germany’s equivalent to the U.S. Centers for Disease Control and Prevention — the Robert Koch Institute — makes recommendations but does not call the shots on testing for the entire country. Germany’s 16 federal states make their own decisions on coronavirus testing because each of them is responsible for their own health care systems.

When Drosten’s university medical center developed what became the test recommended by the World Health Organization, they rolled these tests out to their colleagues throughout Germany in January.

"And they of course rolled this out to labs they know in the periphery and to hospital labs in the area where they are situated," Drosten said. "This created a situation where, let’s say, by the beginning or middle of February, testing was already in place, broadly."

Drosten said that has meant quicker, earlier and more widespread testing for COVID-19 in Germany than in other countries.

Lothar Wieler, head of the Robert Koch Institute, Germany’s federal agency responsible for disease control and prevention, said at a news conference Last week that Germany’s testing infrastructure means authorities have a more accurate read of confirmed cases of the virus.

"We don’t know exactly how many unknown cases there are, but we estimate that this unknown number is not very high," Wieler said. "The reason is simple. We issued recommendations in mid-January about who should be tested and who shouldn’t be tested."

But some Berlin residents aren’t as confident as Wieler. Nizana Nizzi Brautmann said she was worried when a teacher at her son’s school tested positive for COVID-19 and a day later she and her son woke up with fevers and persistent coughing. She said she couldn’t get through to Berlin’s coronavirus hotline, which was continuously busy.

She finally got through to the city’s emergency medical service number, "and I told her I think we need to be checked because we have some symptoms," Brautmann recalled. "The lady was just saying, ‘We make no tests here. I can’t help you. I would advise you to stay home and drink tea.’ "

When she finally was able to speak to a doctor on the phone, the doctor told her to wait in line outside a local hospital to get tested, but she didn’t have a mask for her or her son, and she didn’t want to infect others in line, so she stayed home. She and her son are now in good health, but she said the episode left her wondering how prepared German society is for this pandemic.

Drosten said such experiences are probably an exception, not the rule.

"I know the diagnostics community in Germany a bit," Drosten said. "My feeling is that actually the supply of tests is still good. And of course, our epidemic is now also very much up-ramping and we will lose track here, too."

Drosten said the growing number of cases in Germany will soon exceed testing capacities. But for the time being, he thinks the country has had a robust response to the coronavirus pandemic. He’s most worried about countries in Africa that aren’t well set up for this — countries that, once the crisis comes to them, will find it more difficult to flatten the curve.

NPR Berlin bureau producer Esme Nicholson contributed to this story.

October 2019 – Acupuncture

Did you know that the Chinese culture is 3000yrs old, but the Hebrew culture is 5000yrs old? That means that for 2000yrs the Jews had no place to go to eat Chinese food on Christmas!

Acupuncture does not have to include being stuck with needles. I know it sounds strange so I will say it again. You do not need to be stuck with needles to get an effective acupuncture treatment. Acupuncture can seem very mysterious if you haven’t been exposed to it much. Most of the acupuncture, in the United States, is of the type called TCM which stands for Traditional Chinese Medicine. This type uses needles and herbs. This type of acupuncture is about 60 years old and is based on the much older 5 element type of acupuncture. Mao Tse Tung, the Chairman of Communist China, had forbade acupuncture at one time due to China being a Communist country and he thought acupuncture was too spiritual and not conforming to communist doctrine. Nixon and Kissinger went to China about that time for the first time any US officials had been admitted to China. hence the saying, "Only Nixon can go to China". While they were there, they expressed an interest in seeing acupuncture. TCM was created when the herbalists made a more clinical and less spiritual version of acupuncture that Mao could live with. You see, at that time, acupuncture was only practised on poor people and country people. If you had more money, you would see the herbalist and he would give you a prescription much like western medicine. Acupuncture was done by the poor, barefoot country doctors. Like me . but I wear shoes.

There are very many types of acupuncture. I am trained in more than 20 types and patients coming in for treatments often get 5 different types of acupuncture at a single visit. Many times patients do not even get stuck with needles as I said earlier.

The reason for using the needles is to change the electrical balance, the charge and the capacitance of the acupuncture points and the meridians. The goal of all medical treatment is to help patients become functional and comfortable. This means to have everything work and have nothing hurt. Acupuncture does this by manipulating the bioelectricity in the body that the Chinese call Chi (pronounced chee) and the Japanese call Qi (pronounced key). I guess you could say that Qi is the key to acupuncture. The symbol for Chi in both Chinese and Japanese is the symbol for steam over the symbol for rice. This signifies that it is the energy you get from food. We call that bioelectricity in the west.

Aeromedical Acupuncture is the type of acupuncture I developed as a Flight Surgeon on active duty Air Force while I was working with NASA and with Combat Search and Rescue units. I needed a treatment that would work more quickly than Bioenergetics, the type of acupuncture most physicians are trained in now a days. Aeromedical Acupuncture works right away and it did not ground my pilots. My colleague in the Air Force, Dr. Richard Niemtzow, developed Battle Field Acupuncture shortly afterward and I use both these very different forms of acupuncture extensively. The 5 Element acupuncture is the 3000 year old stuff and I use that daily as well as the Auricular Medicine developed by Dr. Paul Nogier and Dr. Barr who were part of a European think tank about 60 years ago. They started their work on Auricular Medicine as a response to the great results patients were getting after being treated by a Gypsy that cauterized a point on their ear. A Texas Pain Management doctor at Southwestern Medical School, Dr. Bill Craig, developed PENS, Percutaneous Electrical Nerve Stimulation, and I use that for stubborn musculoskeletal problems. Dr. Richard Tan didn’t give his technique a fancy name. He called it System 1. That, actually, is one of the techniques patients seem to enjoy the most. There is Koryu, Osteopuncture, Inverse/Contrary, Ahshi, Scalp microsystem , nose microsystem, Tendinomuscular, and the list goes on. It is not limited to TCM.

The reason that I have studied so many types of acupuncture is because I am a nerd and I started studying acupuncture in 6th grade but also because when I graduated from medical school, I was one of the youngest in the acupuncture classes and all the old guys were telling me that their way was the best. I just went to all of their classes as well over the years. There really is more than one way to skin a cat. but who would want to skin a cat?

If you are interested in the particulars of the most common types of acupuncture I do regularly, there is a technical tab on this website you are welcome to peruse. it goes into great detail.

Still you don’t need needles, we have laser, magnets, piezoelectric stimulators, semipermanent studs, not to mention cupping and moxa. I still use needles sometimes but not if you ask me to not use the needles.

Bonus Joke:
The Dalia Lama was visiting New York and went up to a hot dog vender and said "Make me one with everything" The vendor chuckled a little and handed over the hot dog to the Dalia Lama who in turn handed the vender a $20 bill. The vender pocketed the money and went about his business. The Dalia Lama said "Hey! where’s my change?! the vender responded" You of all people should know that change comes from within."

September 2019 – Tendonopathy

A patient told me that she hurt her shoulder in two places. I told her not to go back to those places.

Tendonopathy is a common problem nowadays. We have many treatments for these pains. and some of them work.

Rotator Cuff problems in the shoulder are problems involving the four muscles of what we call the rotator cuff. I guess that is why we call these problems rotator cuff problems. The four muscles of the Rotator Cuff are the Supraspinatus, Teres Minor, Subscapularis, and Infraspinatus. Many times these problems do not require surgery and can heal completely. According to the experts in Bethesda that treat all our military personnel’s injuries and according to much if the literature on this topic in the medical journals, the main treatment for this problem for long term relief is the proper physical therapy. This physical therapy can be as simple as a single exercise I can show you in less than a minute. You do ten repetitions once or twice a day and it works well. You keep your elbows next to your body with your elbows bent at 90 degrees and rotate your upper arms out against resistance like from a stretchy band. If you need it I will show it to you.

Combining physical therapy with other modalities like NSAIDS ( non steroidal anti-inflammatory drugs like advil and motrin and aspirin), Iontophoresis, Phonophoresis, shoulder injection, tendon fenestration (poking holes in the tendon to cause small amounts of bleeding in order to let the healing components in the blood into the injured area), IMS (a special form of acupuncture developed by Dr. Chan Gunn, the former chief neurologist of the country of Canada), Tumeric, cryotherapy which is icing the area and of course Aeromedical Acupuncture which is my type of acupuncture that is a combination of over twenty different types of acupuncture that I have learned since I first started studying acupuncture in the 6th grade.

Other types of tendinopathy can occur in any part of the body where there is a tendon. X-rays can show calcification of tendons. sometimes called heel spurs or other types of spurs. These are most likely a side effect of what is causing the pain and not usually the cause of the pain itself. Often, the spurs can be reabsorbed by the body when the problem is resolved. Some of my patients have gotten better when the surgeon removed these spurs but it seems like just as many got worse or stayed the same. Everybody is different. What is important is functionality and comfort. If it works (functionality) and it does not hurt (comfort), what else can you ask for?

As always, I am at your service, so if you need me call me.

. Incidentally, it is Rotator Cuff not Rotary cuff. I guess Rotary Cuff could be a dirty sleeve obtained at a meeting of a social service organization meeting. We just have the Lyons Club here in Gorman no Rotary Clubs.