Tag Archives: Dr. Evan Malone

SARS-CoV-2 Recovery and Athletes

SARS-CoV-2  Infection recovery for AthletesArticle by:
DR. EVAN MALONE
NON-LAWYER
BOARD-CERTIFIED INTERNAL MEDICINE PHYSICIAN

It is not difficult to speak with someone and not have them share their first-hand experience with SARS-CoV-2 infection.  If anything, someone close to them has been infected and impacted by the infection.

Rebound and Recovery From Acute Infection

What is not as readily discussed is the rebound and recovery from an acute infection.  Acute infection being distinct from a positive test in that there is a period of defining symptoms:  fever, myalgia, dyspnea, cough, lethargy, etc.

Just as the spectrum of symptoms is broad – ranging from nuisance, innocent symptoms (loss of smell, mild headache) to the more extreme hypoxia warranting hospitalization – the same is true for the duration of the symptomatic period across various individuals – some limited to less than two days, others spanning many weeks.

Can I Go Back To Working Out/Exercising?

Applying this nebulous symptom severity index and symptom duration timeframe to acute infection in an otherwise active, fitness-minded, perhaps obsessed age-group athlete and leaves one wondering “can I get back to working out?”  For the first many months of the global pandemic, this perhaps may have been taken as a bit of a selfish query – the desire to return to exercise when raised in the context of the gravity of the illness for many (death, hospitalization, loss of livelihood).

Along the way, in 2020 we collectively learned about the virus and its impact on the population and the human body.  Research into the mechanisms of infection, transmission, prevention, treatment, recovery, and short- and long-term impact – a different study or dataset or conclusion was being published nearly every hour of every day.

In the late summer of 2020, some guidance began to take shape for the exercise-minded individual recovering from acute infection.  Domestically, much of this was driven by research focusing on collegiate-level athletes, to understand when and in what manner it was safe for these young athletes to return to their respective sports.

Joe’s COVID Journey, Recovery, and Return to Exercise.

In Joe’s situation his symptom onset was around September 5, 2020 (Labor Day weekend), his positive PCR sample would result on September 7, 2020.  During the next many days his prime goal apart from strict isolation protocol was managing his symptoms and monitoring any systemic manifestations (shortness of breath, chest pain, confusion).  As that initial string of days wound by, interrupted by Hurricane Sally (landfall September 15-16, 2020, he would be confronted with fatigue and the sensation of breathlessness which was temporized and stabilized with supplemental oxygen use and a combination of systemic (oral) and inhaled steroid agents.  At this point, he understood that this was likely impacting his cardiopulmonary system beyond the simple nuisance symptoms which are mostly contained to the upper respiratory tract (nasal and sinus congestion).  This added another layer to what would end up being an additional step to take prior to returning to physical exertion (exercise) which is part of his daily routine as a multi-sport athlete.  This was somewhat uncharted territory for both Joe as well as the medical community as a whole – studies were being conducted to best understand the next step or steps to take.

Studies On The Heart and COVID-19 Infection

One of the first such studies was published on September 11, 2020, in JAMA Cardiology (Rajpal S, Tong MS, Borchers J, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. 2021;6(1):116–118. doi:10.1001/jamacardio.2020.4916) detailing cardiac evaluation including studies such as the electrocardiogram (EKG), echocardiogram (ultrasound of the heart), and cardiac MRI.  The test modality of choice is to be dictated by the severity of the symptoms and the findings along each step of the algorithm.  This would provide some guidance as to which athletes were at higher risk for myocarditis, cardiomyopathy, malignant dysrhythmia, or even sudden cardiac death and then to help apply some guidelines on activity limitations moving forward.

Lingering Effect of COVID-19 Infection

So, using that as a launching pad for the discussion with his physician, Joe and his medical provider team decided it was best to proceed with cardiac screening – EKG (electrocardiogram – electrical tracing of the heartbeat and myocardial contraction) and echocardiogram (ultrasound of the heart).  These studies would occur in late September, roughly 4 weeks after his initial symptom onset.  The tests were not fully “normal” as the echocardiogram (ultrasound image of the heart) revealed some enlargement of the right side of the heart – a potential sign that there was some increased stress or workload on the right side of the heart attempting to pump blood to the lungs for oxygenation (and carbon dioxide removal).  This prompted Joe and his medical provider to lean on some of these recent studies and pursue the cardiac MRI study to best visualize and understand if there was any myocardial involvement (i.e. myocarditis) otherwise known as inflammation of the muscle tissue which makes up the heart.  Inflamed muscles are something Joe is keenly aware of with his exercise routine, but an inflamed cardiac muscle is not on the same level as inflamed skeletal muscles weary from a long workout or race.

As the cardiac MRI was being coordinated, the instructions were simple:  “take it easy and don’t get the heart rate up.”  Translated, this meant no exercise.  The potential risk being cardiac arrhythmia or heart failure if the already-angry myocardial tissue was additionally stressed.

Fortunately for Joe, the cardiac MRI would reveal normal myocardial tissue and the right side of the heart appeared normal as well.  The suggestion of the abnormal right-sided chambers on the echocardiogram was not present (or had resolved with additional time for recovery) on the MRI study.

Joe was now free to get back into his daily exercise routine – only limitation being “do what you can, take it easy getting back into it, and listen to your body.”

WATCH JOE VIDEO ABOUT HIS COVID JOURNEY HERE >

WATCH VIDEO ABOUT DR. EVAN MALONE’S DELTA VARIANT EXPERIENCE >

Fast forward many months later, and very similar guidance has emerged for application to the recreational athlete desiring to return to exercise.  The algorithm is meant to accompany the examination by and assessment of a qualified medical professional.

Key Points on Returning To Play.

For any age-group athlete looking to get back to fitness, exercise, physical exertion the first step following the acute infection (i.e. isolation period) should be an evaluation by your primary care provider.  A “return to play” or “return to physical exertion” discussion should be had.  For some it may be as simple as routine, annual bloodwork, or non-invasive testing.  For others it may include a larger, more-involved battery of tests.

 

 

 

 

Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. ZARZAUR LAW’S AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If you’ve been the victim of an accident, it’s important that you don’t make any rash decisions. Put yourself in the best possible position to receive the justice you deserve. It is also important to consult with a Board Certified Trial lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe, or by requesting a free case review through our website.

What Zarzaur Law, PA is Doing to Keep All Employees Safe While Returning to Work.

As Zarzaur Law, PA prepares to gradually bring staff back into the office, it is very important to protect everyone and safety is priority one!

Here is what the firm is doing to keep everyone safe during this transition time from teleworking to re-entering the office full time.

ZARZAUR LAW, P.A. + COVID-19

Before Reporting To Building:
Stay home if you are sick (fever, myalgia, cough, shortness of breath), except to get medical care.

Notify management if you become acutely ill (above) or have a sick close contact (co-habitants, significant other).

Commuting To Building:
Do not park in close proximity to others, park in open area while maintaining a safe walk to building entrance.

Do not touch handrails, elevator buttons, parking meters, door handles (besides office building).

Entry to building at Romana Street entrance (upstairs) – OR – Palafox Street entrance (downstairs).

Upon Entering Building (Before Doing Anything Else):
Wash your hands with soap and warm water, at least 20 seconds.
(Use hand sanitizer with at least 60% alcohol if soap and warm water not available – 30 seconds).

Exterior of all personal items brought into office must be disinfected with antiseptic wipe – coffee cup, water bottle, mobile phone, handbag, purse, wallet.

Wash hands again after disinfecting personal items.

Check temperature (see below).

Body Temperature Checks:
Three times daily: upon entering building at start of shift, mid-shift check (lunch break (full day staff), mid-morning or mid-afternoon (half-day staff), end of shift check upon leaving building. Wash hands (or use hand sanitizer) prior to handling thermometer.

Wipe handle and buttons of thermometer with alcohol swab after use of thermometer.

Document each temperature reading with a Slack message to Joe – temperature with date/time

Wash hands (or use hand sanitizer) after using thermometer.

Movement Within Office:
Maintain six foot separation from others in the office, including hallway and stairwell traffic.

One person at a time in common spaces – hallway, kitchen/coffee, copier/fax/scanner, water cooler, stairwell.

Only use your assigned workspace.

No use of conference rooms without permission.

Diligence on need to leave building at any time besides end of shift.

*** Three times daily = start of shift, mid-shift, end of shift.

Hygiene:
Cough and sneeze – cover mouth with tissue, immediately dispose of tissue.

Immediately wash hands and re-sanitize workspace and electronics.

All paper towels are single use and to be placed in provided receptacles immediately after use.

Workspace:
Surfaces disinfected three times daily. ***

Electronics:
Use only your assigned machine (computer) and office phone.

Sanitize machine (keyboard, mouse, mousepad) and phone (handpiece, earpiece, keypad) three times daily. ***

Personal Items:
Do not allow others to borrow or use pens, mobile phones, keys, coffee cups.

Make your own coffee.

Sanitizing The Office:
Handrails, coffee/water, copier/fax/scanner, sink handles/faucets, and door handles (inside and outside) must be sanitized three times daily ***
> management to decide on rotating assignment vs single owner of this task

Kitchen and coffee counter surfaces to be sanitized thee times daily ***

Conference room tables to be sanitized before and after every use – permission required for use.

Visitors:
Front door guests – utilize doorbell, reception wears mask/gloves when interacting, inform of closed office protocol.

All visitors, vendors, clients must be approved prior to permission into building.

Visitors must follow hand washing protocol upon entry to building.
Disinfect all surfaces and touch points when visitors exit building.

*** Three times daily = start of shift, mid-shift, end of shift.

The Zarzaur Law firm remains fully operational and the staff is working hard on client’s behalf (safely and remotely). Attorneys will still be seeing clients either safely in office or via video conferencing.

Joe Zarzaur, founder of Zarzaur Law, P.A., a Pensacola Personal Injury law firm, has created this blog in an effort to educate the many citizens and visitors of Pensacola, Florida about their legal rights. Joe Zarzaur knows the ins and outs of Florida law, and offers friendly-quality legal help whether you have experienced an auto accident/car wreck, have been a victim of medical malpractice or are in need of a personal injury lawyer. For more information, visit: https://www.zarzaurlaw.com

11 E Romana Street
Pensacola, FL 32502
Telephone: 850-444-9299
Email: info@zarzaurlaw.com

 

New Florida Law (HB21) Targets Opioid Addiction at the Root Level.

Opioid Epidemic—How Did We Get Here?
According to a report from the National Institute on Drug Abuse, in the early 1990s through 2012, opioids were commonly prescribed to relieve pain. But over time, abuse of the drugs grew.
Some facts on the opioid crisis:

ZL_blog_opioids_2

• Opioid addiction and overdose are the leading cause of accidental death in the U.S.

• In 2016, more than 40,000 Americans died from drug overdoses that involved an opioid.

• Between 21 percent and 29 percent of patients who are prescribed opioids for chronic pain misuse the drugs.

• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.

3.6 percent of kids aged 12 to 17 years old misuse opioids as well as 7.3 percent of those 18 to 25 years old.

• In Florida, opioid-related deaths increased 35 percent from 2015 to 2016, with opioids associated with 5,725 deaths in 2016.

As of July 1, 2018, most opioid prescriptions will have a 3-day limit.

What are Opioids and Why Are They Addictive?
Dr. Evan Malone, Board Certified in Internal Medicine and physician consultant for Zarzaur Law, P.A. provided insight on this important subject. Opioids are a class of drugs that include synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even when prescribed by a doctor—can lead to dependence, the National Institutes of Health (NIH) says. As the brain becomes used to the dosage, it requires more of the drug to provide pain relief and the feeling of well-being. This makes it easy to become addicted. In a report from the Center for Disease Control (CDC), prescription opioid addiction can serve as a gateway to use and misuse of illicit drugs (i.e. heroin, illicitly-manufactured Fentanyl) or controlled substances (i.e. Fentanyl, Dilaudid, Oxycodone).

As of July 1, 2018, This Law Now Implements the Following:

• Limits prescribing of Schedule II medications to a 3-day supply for management of acute pain

• Defines acute pain as – the normal, predicted, physiological, and time-limited response to adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute “illness”

• May not apply to management of chronic pain, terminal condition and palliative care (i.e. Hospice care)

• May not apply to qualified cases of severe trauma

• A 10-day supply of medications may be provided if the provider documents accordingly

• Requires providers to access the Prescription Drug Monitoring Program (PDMP) when prescribing controlled substances

• The PDMP is a state-wide database which details a patient’s history of controlled substance prescriptions

So, How Does This Impact Patients?

According to Dr. Malone, the end-point of preventing dependence upon opioid agents will hopefully be realized over time. This could directly benefit patients, their family members, friend, co-workers, etc.

The offset will require patients to be diligent in their follow-up and management of acute pain whether it be following an accident, following a planned procedure, or the like.

Besides the aforementioned appropriate use of controlled substances, should a patient’s health care provider deem appropriate for the condition, below are some helpful points to remember:

– If patients continue to have pain beyond the expected “acute” timeframe (a few days in most instances), make sure the pain is not a harbinger of an undiagnosed cause of pain or worsening of the initial condition by following up with their provider (which may include a visit to the ER depending upon the condition or circumstances)

-Once more concerning conditions have been ruled out and after consulting with their provider, consider alternatives to opioids for management of acute pain:

– Over-the-counter agents (Ibuprofen, Tylenol, Aspirin)
– Systemic or local corticosteroid
– Physical therapy
– Massage therapy
– Chiropractic care

The 3-day supply of medications is not limited to a one-time instance – appropriate follow-up with a provider may result in an assessment (following interview, examination, and medication review) which indicates the need for a renewal of the 3-day medication supply should it be appropriate for your condition

What are the Alternate Chronic Pain Management Options?

Pain is a subjective problem, and different people experience pain differently. An injury one person might shrug off is an excruciating experience for another.

The definition of chronic pain is a pain condition that lasts for more than six months. Less than six months, it’s considered subacute pain. It’s something of an arbitrary cutoff, but it’s a standard definition.

The effectiveness of alternative treatments for chronic pain has been known for a long time. There were a large number of multi-disciplinary pain clinics opened on a somewhat experimental basis back in the early 2000s, where patients would come in and see a physician, a physical therapist, a psychologist, a massage therapist, an acupuncturist, etc., all under one roof. These practices were very successful in alleviating pain in chronic pain patients, as the CDC later confirmed, but the idea wasn’t widely adopted because the approaches were expensive and some insurance companies didn’t want to pay. Opioids were cheaper. Unfortunately, opioids don’t work.

If you have a chronic pain condition and the current regimen of treatment is with opioid medications, you have more effective and more long term options without as many side effects. It will require an investment of time and effort, but, in the long run, you will be happy that you made the change. If you have a chronic pain condition, and you’re not satisfied with how things are going, challenge your doctors to see if there is a better approach.

If you or a loved one have been involved in an accident and suffer from chronic pain caused by negligence of another, it is important to consult with a Board Certified Trial Lawyer who has the knowledge and experience to help you.

Pensacola Personal Injury Attorney, Joe Zarzaur works in all areas of personal injury including motor vehicle accidents, truck accidents, pedestrian accidents, motorcycle and boating accidents, medical malpractice, slip and fall and wrongful death. Call Zarzaur Law, P.A. today at (855) Hire-Joe for a free legal consultation or visit www.zarzaurlaw.com. Offices in Pensacola and Destin, Florida.

Resources:
Florida Law Chapter 2018-13 (Controlled Substances)
http://laws.flrules.org/files/Ch_2018_013.pdf

Florida’s Controlled Substance Prescribing Law Patient FAQ
http://www.flhealthsource.gov/FloridaTakeControl/patients

CDC Opioid Overdose
https://www.cdc.gov/drugoverdose/epidemic/index.html

DEA Drug Schedules
https://www.dea.gov/druginfo/ds.shtml
https://www.deadiversion.usdoj.gov/schedules/orangebook/orangebook.pdf

http://www.theledger.com/news/20180702/how-floridas-new-opioid-prescription-law-affects-you

https://www.orlandohealth.com/blog/what-to-know-about-floridas-new-opioid-prescription-law-effective-july-1-2018

https://www.orlandoweekly.com/Blogs/archives/2018/03/02/florida-house-approves-bill-that-would-limit-opioid-prescriptions-to-three-day-supplies

https://www.caron.org/blog/2018/03/chronic-pain-management-alternatives-to-opioids

https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview

https://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html

https://www.usnews.com/news/best-states/florida/articles/2018-03-19/scott-to-sign-opioids-legislation-on-monday

https://www.drugabuse.gov/drugs-abuse/opioids#summary-of-the-issue