Personal Physicians
David Katzman, MD & Jennifer DeLaney, MD Internal Medicine Specialists
Office Precautions and CDC Guidelines
Given the recent surge in cases, the County Health Department announced that masks will again be mandated indoors in public places. We are aware there has been some controversy surrounding this mandate. We advise, however, that you follow the County's recommendation whether you are vaccinated or not. Breakthrough cases have occurred in those vaccinated and have led to a small number of hospitalizations and deaths. Therefore it's best to exercise precaution to help decrease the spread of COVID-19 in our community.
The CDC also emphasized yesterday that those fully vaccinated who are in areas of high transmission, like St. Louis County, wear masks in public indoor settings. The CDC added that this is strongly recommended for those immunocompromised, at high risk, or living with someone immunocompromised or at high risk whether in an area of high transmission or not.
Our office has continued to follow CDC's guidance to require masks in healthcare settings. If you are coming to the office, please wear a mask while inside the building. We are happy to provide you with one if you forget.
In addition, if you are experiencing respiratory or COVID-like symptoms, please inform us before coming into the office. While we are here to care for you, we want to make sure to decrease exposure to other patients. As extra precaution, we will schedule anyone with these symptoms as a drive-up appointment. 
While case numbers are high, we also request that family members and caregivers remain home or outside to decrease the number of people in the office. Those patients who require assistance during their appointments will be able to have a family member or caregiver remain in the office with them. Thank you again for your patience with this process!
COVID-19 Update
Jennifer DeLaney, MD
If you have not been fully vaccinated, now is the time to get your shots. COVID-19 infections in St Louis are up 10-fold, and local hospitalizations have increased to rates not seen since the winter surge. St. Louis ranks in the top 5 in the country for the rate of new infections. The delta variant of the virus is much more contagious than the other variants that have been in the region previously. It's being reported that 99% of people dying from COVID in the US are not vaccinated, and 95% of people hospitalized for COVID in St. Louis are not vaccinated. Please call our office if you need help scheduling an appointment for the vaccine.
Meanwhile, boosters are being studied, but do not appear necessary at this time for people with a normal immune system. The CDC is considering boosters for immune-compromised individuals and those over 65 given higher rates of breakthrough infections in those groups. We will keep you updated on this.
Testing for Fully Vaccinated
The CDC also updated its guidelines for fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID-19. They are now recommending to be tested 3-5 days after exposure regardless of symptoms and to wear a mask in public indoor settings for 14 days or until receiving a negative test result. If a positive test result is received, you will need to quarantine for 10 days. Please call us immediately if you receive a positive test result so we can discuss treatment options. 
New Drug for Alzheimers Not Worth the Cost
David Katzman, MD
The devastation brought on by a diagnosis of Alzheimer’s disease is compounded by the fact that we have no reliably effective treatment. The few approved drugs do very little to improve or slow down memory loss. The advertisements we all see for products to help memory are unproven and costly and can be considered the modern day “snake oil.”
It was in this setting that the FDA recently approved Adulhelm, a $56,000 per year infusion for Alzheimer’s disease. This medication targets the formation of the amyloid plaque in the brain that appears to correlate with Alzheimer’s.

This approval was granted in spite of the FDA advisory committee's recommendation against approval due to two clinical trials showing no benefit, and 6% of participants developed side effects such as brain bleeding or swelling significant enough to drop out of the trials. A later analysis done by the drug maker suggested a very small slowing of cognitive decline, though this was not seen in the other trial.

This nonsensical approval led several members of the advisory committee to resign, the FDA to limit the indication to only early-onset disease, and to an investigation by the FDA about inappropriate communications between the drug maker and the FDA.
Cleveland Clinic and Mount Sinai and likely others have decided not to administer the drug given its lack of benefit, side effects and cost.

In spite of the lack of treatments for Alzheimer’s, we do not recommend this medication at this time given the risk and benefit profile. While we agree it is frustrating to witness the decline inevitably brought by this terrible disease, we are hopeful that other medications in the pipeline will soon be available. Until that time, careful use of currently available medications, exercise, social engagement, and “brain exercising” activities remain our best options.
Overdue for a Dental Cleaning?
Many people fell behind on cleanings and dental care during the pandemic. Did you know that keeping your teeth healthy can improve your general health? Both gingivitis and periodontal disease are associated with heart disease. So if you're overdue for a cleaning, give your dentist a call. Flossing daily, brushing your teeth after meals and seeing the dentist regularly can make a big difference. 
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11709 Old Ballas Rd. Suite 101, St. Louis, MO 63141

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