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Everything posted by Bajareque

  1. Sr. Guerra did not answer my call. The van we have booked is quite large and can easily hold four people plus all their luggage. The service is a trusted driver who we have known and used for many years. With four people the cost would be $125 per person, which we consider reasonable.
  2. We've booked a van and driver to take us to Panama City on the night of June 2 in order to get us there in time for our morning flight on June 3. This avoids having to stay overnight in Panama City where the available hotels are few and far between. The cost of the van is $500 and it can take another 1 or 2 passengers. If anyone is interested in sharing the ride please let me know.
  3. We need to get to PTY on June 2. Is anyone arranging rides or want to share a ride?
  4. Alfa Clinic in downtown Boquete now has the immunological COVID-19 tests available. The immunological tests are different from the acute tests done by MINSA. MINSA's PCR tests detect viral RNA in a nasal or throat swab. They tell you whether the virus is present at the moment the swab is taken. They turn negative when the virus is gone. The immunological tests measure antibodies to the virus. They don't turn positive until your body mounts an immune reaction to the virus. Sometimes it takes up to three weeks after symptoms start before the body makes enough antibodies to be accurately detected. So this is not a test to see if you HAVE the virus; it is a test to see if you HAD the virus. We have had only 17 known cases of COVID-19 in Boquete. That includes only cases that were symptomatic, suspect, and tested by MINSA. We have no idea how many asymptomatic or minimally symptomatic cases there were. So if you think that maybe that rash, mild cough, feeling blah, fatigue, etc. that you had last month was really a mild case of COVID-19 then this is one way to find out. Why would you want to know? 1) If the test is negative then you know you still have to take precautions if you're concerned about contracting COVID-19. 2) If it's positive then you know that a) you're not infectious, since you've already recovered from it, and b) you're not vulnerable since you have acquired immunity; so you can dispense with social distancing, masks, gloves, etc. since you can't give it to anybody and they can't give it to you. EXCEPT for the possible case where you touch something that has the virus on it and someone who is vulnerable touches you, e.g. shakes your hand, in which case you might be the intermediate vector. But of course if vulnerable people maintain precautions then this is not a problem. The first generation of immunological tests were unreliable and had many false negatives. The current generation is about 99% accurate. These particular tests offered by the Alfa Clinic have been vetted by the Gorgas Institute in Panama City, so I think we can be reasonably sure that they are accurate. If you are interested in the test it costs $45 and Alfa Clinic says: We are making a list of people who are interested in taking the test. If you are interested please send us the following information: Full name, age, identification number (E-cedula or passport), telephone, mail and place of residence. For further information contact WhatsApp 6949-5998 or send us a email to boquetemedical@gmail.com
  5. Bud, Browse to the MINSA map. Zoom in to the red dot for Alto Boquete. Click on the dot. A popup window will appear with the case count for Alto Boquete. As OrangeHoof says this was 4 yesterday. Now it's 14.
  6. From Consumerlab.com, a highly reputable subscription website with objective analysis of consumer health products, mostly supplements: Heating kills coronavirus Heat is very effective at sanitizing and disinfecting objects from coronavirus. In fact, the SARS-CoV-2 virus that causes COVID-19 may be even more sensitive to heat than the earlier SARS-CoV virus. Experiments done in China in 2002 with SARS-CoV in culture medium (Duan, Biomed Env Sci 2003) showed that it became undetectable after 30 minutes when heated to a temperature of 167°F, but recent tests with SARS-CoV-2 in Hong Kong showed that it became undetectable after just five minutes at only 158°F (70°C). The time required to kill SARS-CoV-2 increased as the temperature was reduced, such that the time by which it was undetectable increased to 30 minutes at 132°F (56°C), two days at 98.6°F (37°C), and two weeks at 71.6°F (22°C). At 39°F (4°C) the virus remained detectable at two weeks when the experiment ended (Chin, Lancet 2020). Coronavirus lasts longer on certain surfaces, particularly surgical masks! The Hong Kong researchers noted above also placed a small amount of the SARS-CoV-2 on a variety of surfaces at room temperature (at 65% relative humidity) to see how long the virus would last before becoming undetectable. On tissue and regular paper it became undetectable within just 3 hours. On cloth and on paper money, it lasted 2 days. Surprisingly and disturbingly, it lasted longest on the outer layer of a surgical mask: Virus was detectable on the mask at day 7 (although at only 0.1% of its original level), which was also how long it lasted on plastic and stainless steel.
  7. re Masks If you want to use masks it's not a problem to get them. We ordered a pack of N99 masks from China through Ailibaba.com and received them in ten days. China has ramped up production of masks and is exporting them by the millions.
  8. Chris had ribs yesterday at Bid Daddy's. Mmmmmmm, good!
  9. It would be great if somebody would keep the list updated so we know which restaurants are really open for delivery or takeout.
  10. More on masks: Can Masks Capture Coronavirus Particles? How Long Do Pollution Masks Last? | New Data Is Washing Masks Effective After Virus Exposure?
  11. Masks can be disinfected and reused Stanford has just put out a study examining the effectiveness of different kinds of masks and the ability to reuse masks after disinfection. Bottom lines: 1. N95 surgical masks are the best, but masks made from vacuum cleaner bags run a close second. Cotton masks are in the middle of the pack at about 70-75% effectiveness. 2. N95 masks made from Meltblown fiber filtration media are 97% effective and lose only 1-2% effectiveness if steamed in hot water vapor for ten minutes. Coronavirus is heat sensitive. 3. Static-charged cotton masks are about 78% effective and lose virtually none of their effectiveness if steamed in hot water vapor for ten minutes. 4. Alcohol or chlorine-based disinfection of these masks results in marked loss of efficiency.
  12. Microsoft and the CDC have teamed up to create a chatbot for evaluating people with possible COVID-19 symptoms. It's called the coronavirus self checker. You can access it from this web page.
  13. The province of British Columbia has published an online COVID-19 Symptom Self-Assessment Tool. It follows pretty much the same guidelines as used here in Panama. If you develop symptoms you might want to take this quiz before calling your doctor. -- Ted Harrison, MD
  14. Translation of Abstract from MINSA's COVID-19 Action Plan VIII. HOME CARE (HOUSEHOLDS, HOSTELS AND OTHER COMMUNITY SETTINGS). A. General Taking as reference the WHO interim guidance outlined in the document: "Home care for patients allegedly infected with the new coronavirus who have mild symptoms and contact management", published on January 20, 2020, we designed the guidelines to be followed by the rapid response team (ERR) at home, shelters and other community settings and promptly clinicians caring for patients with respiratory infection infected with COVID-19. It is important that the physician who is going to determine the patient's home isolation fully applies the definition of a mild case, as described below: Patients with acute respiratory disease evaluated in the outpatient clinic of health institutions or at home who do not require hospitalization (that is, patients who are medically stable on medical examination and can receive care at home) or, patients who are given discharge after a hospitalization with a confirmed diagnosis of COVID-19. If the patient meets the definition of a mild case and does not suffer from comorbidities that may increase the risk of complications, they can be attended at home, in a shelter or in other community settings, as appropriate, for observation over a period of 14 days, during which MINSA will make recommendations related to the subject for the patient, their family and caregivers. (SEE ANNEX 2) The same principle of home care can also be applied to post-discharge patients so that they can complete their recovery period at home up to 14 days. The decision must be made based on careful clinical judgment and based on the evaluation of the safety of the patient's family and home environment. B. Guidelines to follow: * Home isolation should be carried out with strict monitoring of the patient, so that the transmissibility between the patient and his contacts is limited, remembering that for COVID-19 the transmissibility is from 2 to 5 * The safety of the patient's home and family environment must be evaluated, so that it does not constitute a limitation to avoid the spread of the virus and for the care and recovery of the patient. * Patients who have mild symptoms and do not suffer from underlying chronic diseases (heart disease, lung disease, kidney failure or disorders associated with immunosuppression), which increase the risk of complications, may be cared for at home. The doctor must decide according to careful clinical criteria. * Ensure that the patient and the people with whom they live have clear and precise information on personal and collective hygiene and basic infection prevention and control measures, and that there is the capacity at home to execute them. * Provide constant support, information, training, and monitoring to ensure that the patient and caregivers have the necessary skills to use personal protective equipment (EPP) to prevent contagion to contacts at home, shelter or other community setting. * Establish a continuous communication channel through a home visit, carrying out diagnostic tests when necessary and following up by telephone until the patient fully recovers * Maintain epidemiological surveillance in the patient's environment, in order to detect symptoms among their contacts. C. Patient education Family and caregivers The patient and people living in the same home must be educated about the infectious agent and its mode of transmission and the best way to care for the infected patient. It is recommended to be very didactic in the instruction of the use of masks, gloves and respiratory hygiene and hand washing measures. The written recommendations will be delivered after explaining to them in detail about respiratory hygiene, followed by hand hygiene, among other things. Once the instruction is finished, make sure that it has been understood. You can ask questions or request that they demonstrate the use of PPE. The address and telephone contact details of the patients and family members must be recorded and the patient’s care will be explained and monitored by the health personnel in order to ensure the care of their health and their family at home. D. Patient follow-up In order to maintain an open communication channel for the entire duration of the care of the patient with respiratory symptoms, a suspected case or a confirmed case at home, a CALL CENTER 169 has been set up, centralized in the Ministry of Health, whose purpose is: - Respond to user calls by providing clear, accurate information on personal hygiene, basic infection prevention and control measures. Respond when questions or concerns arise. - Link with those responsible in each province and / or health region of the rapid response teams who will be in charge of activating the teams for home care and constant monitoring so that both patients and caregivers have the knowledge and the skills necessary to use PPE and to prevent contagion from contacts at home. Annex 1. DEFINITION OF COVID-19 CASE The detection of COVID-19 case will be made according to the following definitions: Suspect 1. Acute respiratory illness (fever and at least one sign / symptom of respiratory illness (e.g. cough, shortness of breath) in a person who, within 14 days prior to the onset of symptoms, was exposed in any of the following ways: i. Visited or worked in a country with community or sustained1 transmission of the virus ii. Close physical contact2 with a confirmed case of COVID-19; 2. Person with fever of 38 ° C or more and cough that requires hospitalization (Severe acute respiratory infection), without another etiology that fully explains the clinical condition and that presents with any of the following conditions: i. Travel history or a person who stayed in a country with community or sustained1 transmission of the virus; in the 14 days prior to the onset of symptoms. ii. If the symptomatology occurs in health personnel who have worked in an environment where acute respiratory infections are treated, regardless of the place of residence or travel history. iii. The person develops an unusual or unexpected clinical condition, especially sudden deterioration despite appropriate treatment, regardless of place of residence or travel history, even if another etiology has been identified that fully explains the clinical presentation. 1 Countries with community or sustained Transmission: China, South Korea, Italy, Japan and Iran as of March 3, 2020. 2 “Close or close contact” is defined as: - Exposure associated with: medical care, including direct care for patients with COVID- 19; working with health personnel infected with the SARS-CoV-2 virus; visiting patients or staying in the same close environment with a confirmed patient with COVID-19. - Work in close proximity or sharing the same work or school area with a COVID-19 confirmed patient - Travel together with a confirmed COVID-19 patient on any means of transportation. - Live at the same address as a confirmed patient with COVID-19. The epidemiological link may have occurred within a period of 14 days prior to the onset of symptoms or after the onset of illness in the case under consideration. Confirmed All patients who meet the definition of a suspected case and present positive laboratory results for SARS-CoV-2, endorsed by the National Reference Laboratory for Public Health at the Gorgas Institute for Health Studies and the Department of Virology. Discarded A case that does not show evidence of the presence of SARS-CoV-2 by laboratory techniques endorsed by the reference laboratory will be considered a discarded case. Imported An imported case will be considered as any confirmed case that after the epidemiological investigation shows that the infection according to the risk of exposure was acquired outside of Panama. Annex 2. HOME CARE STRATEGY FOR PATIENTS INFECTED BY COVID-19 WHO HAVE MILD SYMPTOMS The WHO recommends the following actions for home care: PRIOR TO SENDING A PATIENT TO THE HOME, YOU MUST VERIFY IF YOU CAN GUARANTEE THE FOLLOWING: The patient 1. You should limit your movement and minimize your access to shared spaces (e.g. kitchen, bathroom). 2. To contain the patient's respiratory secretions, you must use a surgical mask, which must be worn at all times if it is well tolerated. For those who do not tolerate the mask, you must strictly comply with respiratory hygiene and cough etiquette (if you have sneezes or coughs, cover your nose and mouth with your forearm or a disposable handkerchief, discard the handkerchief immediately and do hand hygiene) The room 1. If there is no room to separate the patient during his isolation, the other people who share the home with him must maintain a distance of more than one meter from the patient (for example, sleeping in separate beds). 2. The toilet must be well ventilated (for example, leaving windows open). 3. Do not allow visits. The caregiver 1. Must be a person in good health who does not have diseases such as hypertension, diabetes, asthma or lung problems, low defenses. Caregiver skills 1. To enter the patient's room, the caregiver must wear a tight-fitting surgical mask to the face. 2. When less than a meter away, directly caring for the patient, the caregiver should wear a surgical mask, gloves, and a gown or apron when sensing that any splashing may occur. Perform hand hygiene before and after the use of personal protective equipment. 3. The mask should not be touched or manipulated while wearing it, if it gets wet or stained with secretions, it should be changed immediately by disposing of it in the garbage container. You should wash your hands well and dry them. 4. You should carry out hand hygiene with soap and water or alcohol gel, frequently, mainly after any contact with the patient or his immediate environment, as well as before and after preparing food, before eating, after using the bathroom and whenever there is dirt on the hands. 5. To dry your hands, use a paper towel, if not, you can use a cloth towel exclusively for that purpose. You must change it when it is wet. 6. If the hands are not very dirty you can use alcohol-based gel alcohol 7. To clean and handle surfaces, clothing or sheets stained with body fluids, you must. avoid contact especially with oral and respiratory secretions and with the patient's faeces, for this you must wear disposable gloves, surgical mask and plastic apron, apply hand hygiene before and after removing gloves. Skills for people who live at home 1. All people living at home should follow respiratory hygiene or cough etiquette at all times, especially those who are ill, when coughing or sneezing. Do it with the angle of the arm or with a disposable handkerchief; throw it in the trash and perform hand hygiene immediately. 2. People with respiratory symptoms should use a disposable mask to contain secretions. 3. Avoid contact of healthy people with contaminated objects of the patient (do not share toothbrushes, cigarettes, plates, cutlery, drinks, towels, sheets, among other things.) Utensils such as plates and cutlery must be washed with water and detergent properly after each use, and set aside for control. Cleaning and disinfection measures at home. 1. All the waste generated in the patient's room (gloves, masks, handkerchiefs, among others) should be placed in a container with a bag inside the room, and later disposed of with the rest of the household waste. 2. Avoid direct contact with the patient's body fluids, especially oral and respiratory secretions, and feces. 3. Apply hand hygiene before and after removing gloves. 4. Gloves, scarves, masks and all waste generated by the patient or patient care must be placed in a disposable bag located inside the garbage can. 5. Dishes and silverware should be washed with soap and water or detergent after each use, or with a preparation of 5.25% sodium hypochlorite. To prepare this solution, add 100 cc of 5.25% sodium hypochlorite and 900 cc of water to a one liter container. 6. Wash clothes, sheets, towels, etc. sick people with ordinary soap and water, or machine at 60 ° -90 ° C with ordinary detergent, and allow them to dry well
  15. COVID-19 Testing In Chiriqui province testing for coronavirus is available at MINSA. In Boquete at the Polyclinic they have two test kits available, although those can be replenished from David if needed. Only specimens are collected here. The actual testing is done at the Gorgas Institute in Panama City, although other hospitals (e.g. Obaldia) will have the capability soon. The doctors in Boquete have been given the following protocol to observe in regards to testing: 1. If you think that you have symptoms of COVID-19 (COVID-19 is the disease caused by coronavirus) you should call your doctor if you have a private doctor. DO NOT GO to the doctor’s office or clinic. If you do not have a private doctor then the MINSA clinic (next to Romero’s) has established a special entrance for people who think they might have COVID-19. 2. The doctor will ask several screening questions to determine whether your symptoms are suspicious. 3. If they deem you suspicious they will make arrangements to see you at either your home, their office, or some other place where they can examine you. They will examine you and take your vital signs (respiratory rate, temperature, blood pressure, pulse). 4. They will call the epidemiologist at MINSA in David and make a disposition. A. If and only if you meet requirements for testing and do not require hospitalization then MINSA will arrange for you to be tested. Probably they will send someone to your home to collect a swab for testing and you will be placed under self-isolation until the results are known. A physician will be assigned to follow up regularly with you. B. If you don’t meet requirements for testing then you will be placed under quarantine and assigned a physician for regular follow up. C. If you are ill enough to require hospitalization MINSA will arrange transportation to the Regional Hospital in David. Regional Hospital has only ten ICU beds - i.e. beds with ventilators for those who come down with the most severe form of the disease. If you have medical insurance that covers air ambulance evacuation to the USA, Canada, or elsewhere you might want to familiarize yourself with the details now. 5. If your test comes back negative then you can end self-isolation. 6. If your test comes back positive then you will need to remain in self-isolation for probably 14 days, or until you are cleared by MINSA or your doctor. 7. MINSA has established a hotline number for the public in order to answer questions and give out information. Just dial 169. We don’t know if there are English-speakers available at that number. Ted Harrison, MD Digna Diaz, MD For those who desire further detail we attach 1) MINSA's action plan for the country (in Spanish. About 40 pages), and 2) our English translation of some salient pages from that document. plan_de_accion_ante_un_brote_o_epidemia_del_covin-19_en_el_territorio_nacional.pdf COVID PLAN abstract.pdf
  16. Medical Laser Treatments Dra. Diaz and Dr. Harrison offer medical laser treatments for the following conditions: Toe fungus Psoriasis Rosacea Age/Sun spots Spider veins Warts Scars & striae For further information please email info@bajareque.com, or to book an appointment please call Dra. Diaz at 6615-6740 or the Alfa Clinic at 720-2434.
  17. Facial rejuvenation, hair removal, vein ablation, rosacea reduction, ... Drs. Harrison and Diaz are back with the Aerolase medical laser. Just in time for Christmas and New Years we're offering a holiday special- a 15% discount on NeoSkin, our all-in-one facial/neck rejuvenation treatment that takes care of fine wrinkles, blemishes, redness, spider veins, rough skin, unwanted facial hair and age spots all at the same time. Usually we offer a 5% discount for booking a package of three treatments. But for this limited time we're going to knock an additional 10% off the price of these 3-treatment packages. Reserve your treatments (or get NeoSkin as a gift for your significant other) before 28 December to take advantage of this special offer. The treatments need to be done at one-month intervals, so get your appointment soon so that you can get all three treatments done before the medical laser goes back to the USA in April. For details on Aerolase laser treatments please visit the Aerolase website at aerolase.com/treatment-list/ For questions please contact us at info@bajareque.com, or to make an appointment please call Dra. Diaz at 6615-6740.
  18. In the last week or two I've made several ACH transfers from my Global Bank checking account to a checking account at another bank. Each time the bank has sent the money to a SAVINGS account rather than the recipient's checking account. Since the savings accounts don't really exist, the money disappears from my account, but never reaches the recipient's account. Despite these failed transfers Global Bank has not restored the money to my account. Their customer service so far does not have a clue as to what's going on. Is anybody else having this problem with ACH transfers from Global or is it just me?
  19. In 2007 (before we started using PRP in prolotherapy) Jane Brody wrote an article in the New York Times: http://bit.ly/prolorx
  20. At the risk of sounding like a conspiracy theorist I have to say that the article by Dr. Schmerling is typical of the kind of answer you would get from any mainstream medical doctor who is unfamiliar with the topic and hasn't bothered to educate himself. You know the saying about doctors and new ideas: "If they're not up on it then they're down on it." Dr. Schmerling says, "The theory is unproven" and, "I could find only a few articles in the medical literature that critically evaluate its effectiveness..." He didn't look very hard. Anyone can go to PubMed (the National Library of Medicine's database of the medical literature) and do a search on "prolotherapy" and get 200 article citations. And this is just the tip of the iceberg, because in most medical literature the term prolotherapy is not used. It's called "regenerative injections" or something similar. But that article was published three years ago. A lot of research has been done in the last three years. In fact, just one year a later an editorial in the prestigious medical journal Arthroscopy pronounced, "Platelet-rich plasma injections, in a systematic review and meta-analysis of 10 Level I randomized control trials, were found to provide more pain relief and better functional outcomes than hyaluronic acid in patients with knee osteoarthritis at 12 months after injection. The time has come for those of us who have not yet tried platelet-rich plasma injections in our patients with symptomatic knee osteoarthritis to do so." Platelet-rich plasma is, of course, what we use in prolotherapy these days.
  21. Medical laser treatments can make you look and feel better. Get rid of unsightly toenail fungus - Our new treatment is even more effective Remove dark skin spots and discoloration - usually takes only a treatment or two. Is your face red? - Rosacea and spider veins can be instantly treated. Hair in the wrong places? - unwanted upper lip and facial hair can be quickly eliminated. Facial rejuvenation - regenerate your facial skin; smooth fine wrinkles; improve skin tone and color. Warts, tattoos, melasma, psoriasis, acne and a host of other problems can also be treated. Dr. Harrison works with Dra. Digna Diaz here in Boquete. For details of our laser treatments please visit our US website: www.rejuvacare.org. For questions please email Dr. Harrison at questions@bajareque.com. For an appointment please call Dra. Diaz at 6615-6740.
  22. Could someone record this talk, please? I'm really interested, but I'm not in Panama at the moment.
  23. Or your hips, back, shoulder, . . . ! Many of you have asked about the availability of prolotherapy treatment for arthritis, especially of the knees and hips. This year we have obtained a centrifuge for the Alfa Clinic so that they can prepare PRP for prolotherapy treatments. This will cut the number of necessary treatments by half, so you’ll get better quicker. Last week we treated our first three patients here in Boquete with PRP prolotherapy, so our clinical system here is now tested and proven. Prolotherapy is the only known way to cure osteoarthritis. It’s also very good for chronic sprains and strains. It takes two treatments, on average, about a month apart and the success rate is greater than 80%. If you’re interested in getting into the details please visit our website pages for: Arthritis: http://rejuvacare.org/index.php?option=com_content&view=article&id=188&Itemid=469 Back pain: http://rejuvacare.org/index.php?option=com_content&view=article&id=187&Itemid=470 In Boquete we work with Dra. Diaz at the Alfa clinic on main street downtown. For an appointment in Boquete please call Dra. Diaz at 6615-6740. For questions about pricing or more detailed information about the treatments send your email to: questions @bajareque.com. Theodore Harrison, MD MBA FACEP ABAARM Rejuvacare PC
  24. My iMac trackpad has broken. Where is the closest spot to get a new one?
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