Update Notice: January 12, 2022
Update for My Patients about Omicron, the most recent variant of Covid-19
Many of my patients even those who are vaccinated and boosted have come down with Omicron although at present only one is gravely ill.
Nevertheless, my patients who take medications that compromise the immune system are much more likely not only to get Omicron but also to get seriously ill. My advice to you is to wear a good quality mask i.e. not a cloth mask, whenever you are indoors with people of unknown vaccination status such as the grocery store or pharmacy. I suggest not eating indoors at a restaurant. I suggest traveling only if it is necessary such as to see a terminally ill relative and if traveling on a plane to wear a KN95 or N95 mask.
If you have not gotten your booster yet, if you are taking a medication that compromises your immune system you do not need to wait six months in between the second vaccine and the booster. The booster has been shown to reduce the chance of getting Omicron and if affected by Omicron for it to be less severe. Also if you take a medication that compromises your immune system, you need to get a third shot which is a full dose rather than a booster as the Moderna booster is only half-strength.
If despite all of these precautions, you do get covid-19, please stop your immunosuppressive medications for two weeks from the onset of your symptoms as these medications can prolong the illness and cause it to be more severe. These medications include Enbrel, Humira, Cimzia, Simponi, Remicade, Kevzara, Orencia, Benlysta, Rituxan, Xeljanz, Rinvoq, Olumiant, Taltz, Tremfya, Cosentyx, Saphnelo, Arava (leflunomide), methotrexate, CellCept (mycophenalate), Imuran (azathioprine) and cyclosporin.
If you are taking hydroxychloroquine, sulfasalazine, Dapsone or self-injections of Actemra you can safely continue these medications as the Actemra is being used to treat covid in hospitalized patients. If you have had covid in the past, you can still get Omicron. I have many patients who have had covid at least twice.
Finally, if you are not vaccinated, please get vaccinated as soon as possible as even though they do not prevent you from getting covid, they almost always prevent hospitalization and death. If you have questions as to how long to hold your medications before getting the vaccine and/or booster please see another notification on this website. If you get Omicron and do not feel seriously ill please quarantine for at least 5 days, take Tylenol and make certain that you drink at least 6 eight ounce glasses of water daily. If you become very ill for example very short of breath or if you have a pulse oximeter and the reading is below 90 consistently please go to the ER.
If you are not seriously ill, please do not go to the ER as there is nothing that they can do as they do not have the infusion of monoclonal antibodies that is effective against Omicron and cannot prescribe the Pfizer or Merck pill that is an anti-viral against Omicron.
If you do become ill and are on an immunosuppressive medication and feel that your condition is worsening, please reach out to my office, as I have been able to find the monoclonal antibody therapy for a few patients and can find out where and how to obtain the anti-viral tablets. As always, if you have questions please do not hesitate to contact the office.
Due to the recent surge in Omicron, I might not be able to get back to you for 24 hours but I am doing my best to return patients’ calls as soon as possible. Please stay safe and don’t underestimate Omicron.
Thank you, Dr. Robin Dore
Update Notice: August 13, 2021
On August 12, 2021- The FDA amended the emergency use authorization for the Pfizer and Moderna Covid-19 vaccines to allow for an additional dose for certain people with compromised immune systems. This group includes: “specifically, solid organ transplant recipients, OR THOSE WHO ARE DIAGNOSED WITH CONDITIONS THAT ARE CONSIDERED TO HAVE AN EQUIVALENT LEVEL OF IMMUNOCOMPROMISE”.
The latter, pertains to MY Patients on immunosuppressant medications such as all IV and self-injectable medications also including the list below:
• Enbrel, Humira, Remicade, Cimzia, Simponi, Orencia, Actemra, Kevzara, Rituxan, Tremfya, Taltz, Cosentyx, Kineret, Benlysta, Ilaris
• Prednisone 10mg per day or higher
But Does Not Include: Plaquenil, Otezla, Dapsone or Sulfasalazine.
The CDC’s Advisory Committee on Immunization Practices is scheduled to meet on August 13, 2021, to discuss booster doses. If you are taking one of the above medications, I recommend that you contact your pharmacy to schedule a third dose of the vaccine that you previously received.
At present, we do not have recommendations for those who received the J and J vaccine. There is not enough data to discuss the possibility of an extra dose of Johnson and Johnson ‘s one shot Covid-19 vaccine. The official guidance from the ACIP, is to get the same mRNA vaccine as the first two doses and not to receive it sooner than 4 weeks after the second dose of the vaccine. Also, just like you held certain medications before and after the first and second doses of the vaccine, please do this again before and after the booster shot.
Thank you for your review and consideration of the latest Update.
Dr. Robin Dore
As of 12/30/2020, Update on Covid-19 Vaccination:
As many patients have been calling with questions about the Covid-19 vaccination, Dr. Dore wants to clarify that status of the vaccine in Orange County. At present, after the distribution to the first group of people that included everyone in hospitals, nursing homes and assisted living, first responders, military and teachers grade K-12, the distribution can vary from county to county.
You should be able to find updates on your local county public health department website. In Orange County, based on your age group you should be getting a text, email or written letter when you are eligible to receive the vaccine. You will be given a website or phone number to call and schedule the vaccination; you should also be told where to go to get the vaccine. Currently, this group will probably start receiving the vaccine in March at the earliest as it will take this long to vaccinate all of the above groups. You will not have a choice as to which vaccination you receive.
Dr. Dore received hers at St. Joseph’s Hospital on December 29, 2020; she received the Moderna vaccine and has not had any problems other than a sore arm. Both the Pfizer and Moderna vaccinations are two doses either 3 weeks apart (Pfizer) or 4 weeks apart (Moderna). You cannot get the virus from the vaccine.
At present when you receive the vaccine is based solely on age; there is no way of differentiating those with chronic conditions from others. If this becomes available, Dr. Dore will notify you on the portal. Due to this, Dr. Dore is not able to move you to an earlier group to receive the vaccination.
Dr. Dore recommends that all of her patients receive the vaccine. Once you receive notification that you can schedule the vaccination, please contact Dr. Dore so that she can discuss with you whether you need to hold your medication before you receive the vaccine. If you take hydroxychloroquine, sulfasalazine, prednisone, Otezla or Dapsone you do not need to stop these medications. Depending on what other medications you are taking, the period of time needed to hold the medication varies with the medication that you take. If you continue one of these medications, it can lessen the efficacy of the vaccination. For example, if you continue methotrexate at the time of your vaccine, it could lessen the efficacy of the vaccine by 30%.
Dr. Dore realizes that if you must stop a medication in order to receive the vaccination, that you might have a flare up of your condition and have more pain. If this occurs, please contact her.
With regards to treatment, hydroxychloroquine and ivermectin are not recommended by either the CDC or the NIH as treatment of Covid-19. If a person is very ill with covid-19, but not sick enough to be admitted to the hospital, an infusion of a monoclonal antibody made by Eli Lilly can be given but practically this is difficult as most infusion centers don’t want active Covid-19 patients in their center. This treatment is not approved for mild or moderate cases of Covid-19. For hospitalized patients, the use of Olumiant (an RA medication) and Remdesivir (an IV anti-viral medication) has been shown to be effective in severely ill hospitalized patients.
Due to the delay in vaccination, we all must continue to wear face masks, practice social distancing and wash our hands immediately when we return home. Given the ease of transmission of the virus, there is no way “to be very safe”. You should not be entering anyone’s home or have anyone come into your home who is not in your immediate “bubble”. If you must visit someone in their home, you must wear a mask at all times. Eating or drinking in someone else’s home, is not recommended. These restrictions will ease with time, but currently we need to stay within our bubble.
Happy New Year. May 2021 provide some relief from our isolation and allow our children to return to school in person.
Update: Oct 26, 2020
As promised, an update about Covid-19 and the office. First, I hope that all of you are safe and well. Based on an article in the New England Journal of Medicine last week, it does not appear that hydroxychloroquine prevents a person from getting covid-19 and data published earlier demonstrated no benefit for hydroxychloroquine in preventing worsening of the disease or death. It appears that at present the only proven treatment for severe disease is a very potent steroid, dexamethasone. Although rendesevir was just approved for treating Covid-19, it does not appear to prevent death but it does appear to reduce the length of hospitalization with the virus which is a benefit to the patient and family and a cost savings to society. The monoclonal antibody treatment that the President received is still in the experimental phase of testing and the use of convalescent plasma is still being investigated as well but it did receive an emergency use authorization (EUA). Unfortunately, there is no preventive therapy; although many of the deaths that occurred were in patients with Vitamin D deficiency this is more likely due to the fact that people of color are dying at a higher rate and people of color are often Vitamin D deficient due to their skin pigmentation blocking the sun from converting inactive Vitamin D to active Vitamin D. There is no reason to take extra Vitamin D if your labs show that your Vitamin D3 level is between 30-60.
As emphasized in my prior note, the most effective way of preventing the virus from entering your life is to always wear a mask when you leave the house even if you are at work just as we do in the office. In a recent study, a double cloth mask was almost as protective as wearing one of the paper surgical masks. Of course, hand washing, and social distancing must be performed as well.
I am still in the office seeing new patients, patients who prefer to be seen in person or patients who need injections. For patients other than those just mentioned, please schedule your appointment as a Telehealth visit either video (preferred) or on the phone if you do not have access to a smart phone or a computer. Pilar and Alfonso can help you with scheduling a Telehealth visit. If you are seen for an in person visit, please call 714-264-4466 (not the usual office number) and let us know that you are in the parking lot and we will tell you when to come up for your appointment. Once at the front door with your mask on, please knock or ring the doorbell, be patient and someone will come out to ask you several Covid-19 questions and take your temperature. If you answer questions with a “yes” you will be asked to reschedule your appointment. Once your in-person appointment is completed, please go to the front desk in the lobby and make a follow up appointment with Pilar and then leave out the back door past the restroom so that we can maintain social distancing in the office. If you have a Telehealth appointment, please be patient as Dr. Dore may run late. We are trying to be as efficient as possible but sanitizing the rooms in between visits and changing protective clothing take extra time. We are doing our best to protect the patients, the staff and Dr. Dore.
Finally, all patients should get a flu vaccination unless they have an allergy to the flu shot; for those 65 years of age and older please get the dose for 65+. The flu shot is dead so even patients on biologic therapy and small molecules like Xeljanz, Olumiant and Rinvoq can get the vaccine. It is recommended to get it by the end of October.
And please VOTE!!!
Effective: 06/02/2020, New Telephone Office Hours:
- Monday-Friday 07:30AM-12:00 & 1:00-4:00PM (Phones on Voicemail 12:00PM-1:00PM Mon-Fri)
- During After Hours, Exchange Service is available for Urgent Matters. Emergency, call 911.
- Phone Messages Left after 4:00PM Mon-Fri, will be attempted to be returned by the Next business day.
May 19, 2020: Dr. Dore would like to thank all the patients who participated in the Virtual Arthritis Walk on Saturday May 16. Thank you to all our very generous patients especially in these very difficult times who again have helped Team Dore be the number one walk team in the nation. To share our joy, Dr. Dore would appreciate it if any of those who participated in the virtual walk and took photos would be able to forward them to (email@example.com) so that they can be posted on the portal and forwarded to the Arthritis Foundation so they can see how Team Dore was able to thrive even during these difficult times during which many patients have been furloughed, laid off, lost their insurance and visited with Dr. Dore through TeleHealth rather than in person.
For those of our patients who have lost their insurance, most of the pharmaceutical companies have programs that offer free medications to these patients. Please go to your medication website and click on the link such as Patient Assistance. If you need further help, please contact the office and we can provide further information.
As promised a few weeks ago, Dr. Dore stated that she would provide a further update on the information when available about the use of hydroxychloroquine in the treatment of Covid-19. It is very clear from evidence-based studies that hydroxychloroquine (plaquenil) does not prevent a patient from getting a Covid-19 infection. Nor does it prevent death in patients who have a severe manifestation of Covid-19 infection. Studies are still being performed to determine if hydroxychloroquine prevents a person who has a mild Covid-19 infection from developing moderate or severe disease. Once data is available from these studies, Dr. Dore will update the portal. Also, many of our patients have stopped taking hydroxychloroquine due to the fear of side effects primarily cardiac. The cardiac side effects that have been seen with hydroxycholoroquine when being used to treat Covid-19 have occurred when a dose of 800mg daily was used (the dose our patients take varies from 50-600mg), many of these patients also were treated with azithromycin, an antibiotic that by itself is known to cause abnormal cardiac rhythms, and most of the Covid-19 patients also have cardiac disease caused by the virus so what is reported in the news does not apply to the majority of our patients. Dr. Dore has prescribed hydroxychloroquine for over 33,000 patients and has had only 2 patients who developed severe cardiac toxicity so please before you stop your hydroxychloroquine or decrease the dose, please check with Dr. Dore.
Finally, an update on the office opening. Dr. Dore’s physician (as you know she has lifelong asthma) has advised her that she can only see patients in the office if she uses a full-face shield and wears a protective gown when examining patients. These supplies should arrive by May 28. After that date, all of the staff will be wearing scrubs (including Dr. Dore) so that we can change clothes before returning to our homes at night, all staff with direct patient contact will be wearing eye protectors like a painter wears, a surgical mask and gloves. All surfaces will be sanitized in between patients. The California Medical Association has recommended that until there is an adequate treatment or a vaccine, that most of the patients still be seen by TeleHealth with in-office visits limited to patients who need joint injections, don’t have access to TeleHealth or have a strong need (desire) to see Dr. Dore. No more than 2 patients will be seen per hour and you will check in from your car by calling 714-264-4466 and Pilar will notify you when you can come into the office. Your temperature will be taken downstairs at a temperature station and you will bring a sheet up to the office with your temperature on it. The temperature will be taken with an infra-red thermometer so there is no contact. If you have a temperature over 100 degrees, you will not be allowed to come into the office. If you have symptoms of an infection, please cancel and reschedule your appointment or make a TeleHealth appointment instead. If you will not wear a mask, you also will not be able to enter the office; we have masks to offer you if you do not have one on. You may not be accompanied into the office unless you need the assistance of a caregiver and that person will need to have their temperature taken as well. The front door will be open, so you do not have to open it. Pilar’s workstation will be surrounded by Plexiglass and Lynette will take the rest of your vital signs, review your history and draw any necessary labs and then Dr. Dore will come into the exam room for the visit. Lynette will then go on to the next patient so that she will not be going back and forth between patients. After your visit with Dr. Dore, you will exit through the back door that will also be open. Pilar will call you the next day to schedule your follow-up appointment; we are aiming to have a “touch-free” office. If you have any questions about our office policies, please contact the office. Our goal is to have a safe environment for both patients and staff and to be able to continue to provide care for you whether it is in the office, on the phone, on the portal, on FaceTime or doxy.me. We are here for your rheumatology needs.
Stay well and healthy please. Dr. Dore
Effective 03/23/2020: Even though Dr. Dore is not physically in the office she and the staff are here to meet your needs. Currently, one of the staff will physically be in the office daily. If you need labs drawn or an anti-inflammatory injection, Lynette will be available from 12-4 PM Monday through Friday until further notice; please contact the office ahead of time to schedule an appointment with her. Pilar will be in the office physically from 7:30-11:30 to answer your calls, to help complete prior authorization forms and to give you samples if needed. If you come to the office, please knock on the door and someone will come to the door to take your temperature and to ask you questions before you can enter the office. This is to protect you, the staff and the office from infection. If you need to speak with Dr. Dore she is available on the portal, on the phone or via Telehealth visits 7 days per week. Please do not hesitate to reach out to the office if you have any needs or questions at this very stressful time. If our policy changes we will have regular updates on the portal. We are all looking forward to when life returns to normal but meanwhile, we are here for you. Dr Dore and staff.
*** Important Office Update, effective 3/20/2020 ***
Important Office Update, effective 03/20/2020. Dr. Dore has made the very difficult decision to close the office for in office patient visits for at least the next 3-4 weeks. She will still be available for Telehealth and phone visits if desired/needed. Pilar and Lynette will be in the office to help me take care of your needs during this period of time. We will answer your questions, refill your prescription, obtain prior authorizations for your medications if needed and provide advice as always but on the phone or on the portal rather than in person. I look forward to getting back to business as usual once it is safe for all of us. Please practice social isolation and proper hand washing techniques. As always, Dr. Dore is concerned about your health and safety.