March 2020

CHAPALA MED’S March Health Newsletter 
March 2020 Health Newsletter
Greetings to our patients and readers of Chapala Med’s Health Newsletter. I do realize that this is the first newsletter I have been able to publish this year. I have been very humbled and pleased by many of my patients and those on my reading list that have contacted me with anticipation of reading the updates on health related issues here in the Lake Chapala area as well as in Guadalajara. 
Of course the main health concern locally and globally is concerning the COVID-19 (Coronavirus) pandemic.  People are asking so many questions regarding what they see on television, read on the internet and hear from their friends. I have refrained from publishing any information until I got it from reliable sources and have had some experiences treating patients who were suspicious of having contracted COVID-19. That way I can speak from my professional experiences.
I hope to answer the most common questions regarding the pandemic as I share my experience and with the resources that I share with you this month.

The second most asked question is regarding the opening of the new hospital now that all the major construction has been finished. It expectations for the hospital are high and the community seems to be very excited to have the RMC as another option for hospitalization.  I was told today that the end of May is the expected date but with the pandemic and other unforeseeable events that may occur, I would estimate that July be the most likely month for the hospital to be open and fully functional.

I would also like to state for the record that CHAPALA MED will not only remain open as a PRIMARY CARE practice but by the year’s end will have 2  more offices in Guadalajara. Our first expansion will be at the hospital PUERTA DE HIERRO SUR on south Lopez Mateos by the end of next month.  Dr. Hernandez will remain in charge and also remain the main primary care provider and will continue to oversee and coordinate the care at CHAPALA MED. 
In closing I’d like to remind our readers of our (Chapala Med & Ribera Medical Center’s) MISSION STATEMENT so that you are all aware of what we are striving to accomplish everyday and hold us to this mission.
Santiago R. Hernandez M.D. 
Experience with suspicious COVID-19 Case 
Week of March 8, 2020 
Coronavirus Scare at
Patient presented to my office accompanied by the patient’s spouse. They had just returned from the U.S. and a cruise trip. The cruise trip had ended about one week prior to their return back to Chapala.  The spouse of the patient had presented with flu-like symptoms but did not appear ill anymore. The patient who had a history of a chronic respiratory disease did present with a fever, dry intermitent cough and progressive difficulty breathing.  The three most worrisome symptoms with a history of recent travel aboard a cruise ship.
Upon examination, the patient did appear ill, difficulty breathing, moderate fever and her oxygen saturation was low to the point that she would require supplemental oxygenation and be treated in a hospital setting, to manage her as I have had various times in the past with patients with similar history and presentation.
Earlier that morning CHAPALA MED equipped an exam room to isolate patients with respiratory infection symptoms in order to protect our staff as well as our other patients.

After examining the patient, I called ahead to a private hospital that I believe had the appropriate resources to manage her care. It just so happened that the hospital director, medical director, state epidemiologist and state health authorities had a meeting with them that very morning and gave them indications as what to do in the event a patient were to present to their hospital that was suspicious for COVID-19 infection.

I was advised to send the patient with a referral letter to INDRE at Hospital General de Zoquipan in Zapopan where they would be able to test the patient for COVID-19.  There are only 2 public labs for testing in Guadalajara – Laboratorio Estatal de Salud Pública y en el Centro de Investigación Biomédica de Occidente (CIBO) del Instituto Mexicano del Seguro Social (IMSS). The only other PRIVATE lab that is certified to do this testing is UPC (Unidad de Patologia Clinica) on Ave. Mexico 2341 and the cost is approx. $5000 pesos. I have heard that one doctor here has testing done locally but I would be weary of such local testing. 

The Medical Director of both the hospitals (private and public) as well as UDPC director confirmed the following  the rules for getting tested for COVID-19.
1. The patient must be accompanied by a “healthy” friend or family member who speaks spanish. Both are to wearing face masks.
2. While the suspected patient is examined and swabbed in an adequately isolated area, the family member must be able to give a complete medical history in Spanish.
3. Results will take between 24-48 hours to be reported.
4. Meanwhile the patient has to be isolated or under quarantine while treated.  The patient was kept at the INDRE at Hospital de Zoquipan for approx. 2 hours before being released back under my care.
5. The private hospital that met the criteria required by the local health authorities was Hospital Puerta de Hierro in Zapopan.  She placed in a room where she was isolated and had separate air ventilation
6. One of the pulmonologists on my team assisted me in treating the case.
All the appropriate blood, microbiological and imaging testing was done.
And yes, as is the case with most COVID-19 cases, monitors and respiratory support was needed.
All the healthcare staff took all the appropriate conditions to protect themselves and the other patients. I was very impressed.
7. It turns out the patient had a moderate-severe exacerbation of her chronic respiratory infection most likely due to a viral infection but not the COVID-19.
8. Once the authorities at the INDRE reported her case as negative or no longer suspicious, the patient was treated in the regular ward and was released a total of 4 days after she was initially admitted.
I am very happy to report that the patient is now doing well and I hope she follows my recommendations to self-isolate herself due to her elevated risk factors for contracting this dreaded virus.
As you can see the symptoms vary widely but the most significant are the FEVER, COUGH and SHORTNESS OF BREATH/DIFFICULTY BREATHING.
What should you do as of TODAY to protect yourself from COVID-19 ?
There is so much information especially on the web, some of it is conflicting but in my opinion the following informational video can clear up many concerns you may have.
How many active cases are there locally or nationally ?
I hesitate to answer this question because of the daily and exponential changes in the cases that are yet undetected and will soon be diagnosed. The following are reliable websites that the local health authorities recommend you check.
Are the medications Hydroxycloroquine or Remdesivir able to cure COVID-19?

What I have read in reputable medical journals and heard from interviews from world renowned physicians and scientists, the results look very promising but as many of you may know, pharmacies here in Mexico have a hard time keeping many medications in stock. I suspect that by the time you read this, there will be a scarcity of these medications in Guadalajara and in the Chapala Lakeside.

And as always, I advise against self-medicating.

What are Dr. Santiago Hernandez’s recommendations during the following (2-3)weeks ?

The EXPAT population of the Chapala Lakeside is a HIGH risk population due to their age group, their travel habits, the proximity to an international airport and the high degree of socialization that normally goes on in Chapala, Ajijic and the surrounding areas.  These are my recommendations

1. Avoid traveling to Guadalajara (malls, movie theaters, crowded big box stores)
2. Avoid gatherings of 5 people or more
3. Self-isolate if you have diabetes, high blood pressure, COPD, EMPHYSEMA or a weakened immune system 
4. Wear face masks if you need to out to a store or a very important errand. USE LOTS OF HAND SANITIZER
5. Stay at least 6 feet away from people
6. Do not shake hands or hug until further notice 
8. If you believe you have a respiratory infection call our office phone numbers ahead of your visit  or 
9. Do not go to GYMS, PARTIES, BARS or Restaurants.  Most bars and restaurants should be closed by government decree by now anyway. 
10.  WASH your hands OFTEN !!!!
11. If you BELIEVE YOU HAVE been infected with COVD-19 call 333.823.3220  or our office and we can help guide you. 
RMC HOSPITAL – Opening July 2020
The Healthcare providers & Staff at Chapala Med pledge
“We pledge to preserve our humility, integrity, and all the values which brought us to the practice of medicine. We will engage in ho
nest self-reflection, striving for excellence but acknowledging our limitations, and caring for ourselves as we care for others. We will seek to heal the whole person, rather than merely treat disease, committing to a partnership with our patients that empowers them and demonstrates empathy and respect. We will cure sometimes, treat often, and comfort always” 
Chapala Med |  | (331)950-9414
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