Respiratory syncytial virus (RSV) is a common respiratory virus that infects the nose, throat, lungs, and airway passages. RSV spreads via contact with respiratory droplets from an infected person or via touching surfaces contaminated with the virus and then touching your eyes, nose, or mouth.

RSV is the leading cause of lower respiratory tract infections in infants and young children.

However older adults can also contract RSV.

As per the CDC, RSV is responsible for estimated 60,000-120,000 hospitalizations and about 6,000-10,000 deaths in older adults in the United States.

Which adults are at highest risk for a severe RSV infection?

  • Older adults, especially over the age of 65
  • Adults with chronic heart or lung disease
  • Adults with weakened immune systems

Severe RSV Infection in Adults

Most adults who contract RSV infection develop mild cold-like symptoms such as runny nose, coughing, sneezing, fever. Healthy adults may have very mild symptoms but still can spread RSV to others. Some adults at high risk can progress to an RSV pneumonia.

Those infected with RSV are usually contagious for 3 to 8 days. People typically require 1 to 2 weeks to recover from RSV.

RSV can also lead to worsening of serious underlying lung (such as Asthma or COPD) and heart conditions ( such as Congestive heart failure).


  • Cover coughs and sneezes
  • Wash hands often with soap and water for at least 20 seconds
  • Avoid close contact with others who are sick
  • Avoid touching the face, particularly eyes, nose, and mouth
  • Clean frequently touched surfaces (such as doorknobs)
  • Consult a healthcare professional if you have cold-like symptoms that linger or worsen.


Sources: CDC, National Foundation for Infectious Diseases, Medscape


The flu season is coming and the best way to protect yourself against the flu is a yearly influenza vaccination.

Flu vaccination has many important benefits such as decreasing flu illnesses, less visits to the doctor, and most importantly it can decrease the severity of the symptoms as well as decrease of flu-related hospitalizations and deaths.

As per the Center for Disease Control (CDC), people 6 months and older should get an annual influenza vaccine with certain exceptions (please talk to your doctor!).

Influenza vaccination is especially important for people who are at a higher risk of serious complications from an influenza infection. As per the CDC, this includes…

  • Young children
  • Asthma
  • Neurologic and neurodevelopment conditions
  • Blood disorders (such as sickle cell disease)
  • Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
  • Endocrine disorders (such as diabetes mellitus)
  • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
  • Kidney diseases
  • Liver disorders
  • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
  • People who are obese with a body mass index [BMI] of 40 or higher
  • People younger than 19 years old on long-term aspirin- or salicylate-containing medications.
  • People with a weakened immune system due to disease (such as people with HIV or AIDS, or some cancers such as leukemia) or medications (such as those receiving chemotherapy or radiation treatment for cancer, or persons with chronic conditions requiring chronic corticosteroids or other drugs that suppress the immune system)
  • People with history of stroke
  • Pregnant people and people up to 2 weeks after the end of pregnancy
  • People who reside in nursing homes or other long-term care facilities
  • People from certain racial and ethnic minority groups are at increased risk for hospitalization with flu, including non-Hispanic Black persons, Hispanic or Latino persons, and American Indian or Alaska Native persons

Who should not get the flu vaccine?

People who SHOULD NOT get a flu shot include:

  • Children younger than 6 months of age.
  • People with severe, life-threatening allergies to any ingredient in a flu vaccine (other than egg proteins) should not get that vaccine. This might include gelatin, antibiotics, or other ingredients.
  • People who have had a severe allergic reaction to a dose of influenza vaccine should not get that flu vaccine again and might not be able to receive other influenza vaccines. If you have had a severe allergic reaction to an influenza vaccine in the past, it is important to talk with your health care provider to help determine whether vaccination is appropriate for you.

When is the best time to be vaccinated against flu?

For most people, September and October are generally good times to be vaccinated against flu. It takes about two weeks after vaccination to develop antibodies that protect against the flu.

Some individuals may benefit from two flu vaccines per season.

Different flu vaccines are approved for use in different age groups and patient populations. People should talk to their doctor before getting a flu shot, especially if:

  • you have an allergy to eggs or any of the ingredients in the vaccine. Talk to your doctor about your allergy.
  • If you ever had Guillain-Barré Syndrome (a severe paralyzing illness, also called GBS). Some people with a history of GBS should not get a flu vaccine. Talk to your doctor about your GBS history.
  • If you had a severe allergic reaction to a previous dose of any other flu vaccine, talk to your health care provider.
  • If you are not feeling well, talk to your doctor about your symptoms.


Please stay healthy during the upcoming flu season!

Dr. Drourr, Dr. Shtern and the staff of Concierge Medicine of Jupiter

It is normal to urinate about 6-8 times a day for a normal adult, assuming they consume at least about 2 liters of fluids per day.

Urinating more?
Can be due to increased intake of water as the kidneys promptly respond to the stimulus!
However certain medical conditions can increase frequency of urination, such as a urinary tract infection, an overactive bladder, or due to certain medications a person is taking for treatment of blood pressure or their heart.
In men, enlarged prostate can cause increased urination even at night.

Urinating less? Are you drinking enough fluids? Are you dehydrated? Are the kidneys working? Some people with end stage kidney failure on dialysis have been known to completely stop producing urine and when they receive a kidney transplant, they start urinating again.
An enlarged prostate and other obstruction anywhere in the urinary tract (like a kidney stone) can block urine from coming out.
Having a very low blood pressure from serious blood-Bourne infections, heart failure, or liver failure can also cause low urine production.

If you are concerned about the frequency of your urination, you should speak to your doctor.

Low-dose computed tomography (also called a low-dose CT scan) is a screening test for lung cancer.


Who is eligible for screening? As per recommendations by the U.S. Preventive Services Task Force (USPSTF), a yearly lung cancer screening is recommended for people who

  • Have a 20 pack-year or more smoking history, and
  • Are current smokers or have quit smoking within the past 15 years, and
  • Are between 50 and 80 years old
  • Do not have any current symptoms of lung cancer

pack-year is smoking is a calculation of # of packs smoked per day multiplied by number of years. 

What are the benefits of screening?

  • Early Diagnosis of lung cancer

What are some of the risks of screening?

Due to certain risks associated with lung cancer screening with a low dose CT scan, the screening test is only recommended for people who are at high risk of developing lung cancer that is based on their age, smoking history, and normal anticipated life expectancy. 

  • A False-positive result: The test can say that a person has lung cancer when no cancer is actually present. This could lead to more follow-up tests, procedures, and surgeries that are not needed and these interventions may have more risks.
  • Overdiagnosis: A lung cancer screening test can find cases of cancer that may never have caused a problem for the patient. This can lead to treatments/therapies that are not necessary. 
  • Radiation exposure from repeated LDCT tests can cause cancer in otherwise healthy individuals.

When Should Screening for Lung Cancer Stop?

The USPSTF recommends stopping yearly screening for lung cancer when the person: 

  • Turns 81 years old, or
  • Has not smoked in 15 or more years, or
  • Develops a health problem that prevents treatment for lung cancer if it was discovered. 

Speak to your doctor if you are interested lung cancer screening. Remember, the best way to decrease your risk of lung cancer is to not smoke and to avoid secondhand smoke. Lung cancer screening is not a substitute for quitting smoking.

Who Should Be Screened for Lung Cancer? | CDC


Regular exercise and physical activity has numerous benefits. Everyone benefits from exercise.

–        Exercise can reduce the risk of cardiovascular disease (such as heart attack, stroke, peripheral vascular disease) by strengthening the heart, lowering cholesterol, improving circulation, and lowering blood pressure.

–        It can help control weight and prevent obesity

–        Exercise helps your body control insulin and blood glucose levels which can decrease the risk of diabetes Type 2 as well as obesity and metabolic syndrome

–        Exercise can improve mental health by releasing chemicals that can increase relaxation, help with anxiety, depression and improves cognitive function.

–        Exercise releases chemicals that improve the structure and function of the brain

–        Exercise strengthens bones and muscles which can slow the loss of bone density that occurs with aging, helping to prevent osteoporosis, and improve arthritis

–        Exercise can reduce the risk of some cancers especially ones associated with obesity such as colon cancer, breast cancer, and uterine cancer.

–        Exercise can improve your sleep by helping you sleep longer and increasing the duration of sleep

–        Exercise can improve sexual health in both men and women

–        Balance and muscle-strengthening activities as well as moderate-intensity aerobic activity can help reduce the risk of falls in the elderly

–        Evidence shows that physical activity can reduce your risk of dying early from the leading causes of death, like heart disease and some cancers.


Exercise has a lot of benefits however prior to initiating an exercise program, please consult with your doctor. This is especially important if you have not exercised in a long time, have chronic health conditions, or have any concerns about your health.


Constipation is a symptom rather than a disease, generally defined as when bowel movements occur less than or equal to three times a week and when the bowel movements are difficult to pass.

It is the one of the most common digestive complaints in the United States. Constipation is typically a chronic condition. New and rapid-onset constipation in older persons may suggest an obstruction in the gastrointestinal tract.

A person suffering with constipation may also experience abdominal pain, painful defecation, rectal bleeding, episodes of diarrhea, or lower back pain.

Some people may develop such severe constipation that they require medically manual removal of the stool from the lower gastrointestinal tract.

Patients who experience constipation and have abdominal pain, inability to pass gas, fever, vomiting, or bleeding from the rectum should seek immediate medical care.

Initial management of constipation involves dietary changes and exercise. Dietary changes include increasing intake of fiber and fluids while decreasing the use of constipating agents (eg, milk products, coffee, tea, and alcohol). Constipation should not be ignored and persons suffering from constipation should contact their medical provider.

Squatty potty is a stool that raises your knees above your hips to put you into a squat-like position when you are having a bowel movement.

The lower bowel is “kinked” when a person sits on a toilet. That forces you to work harder to push out the ?. Squatting relaxes the puborectalis muscle more and straightens out the colon, giving the ? a straight route out. As a result, bowel movements are produced with less straining.

Pulse Oximeter

A popular device that can be purchased over-the-counter is a pulse oximeter. It’s a device that can be placed on your finger (or toe) that measures the oxygen saturation level of your blood. Certain smart watches available on the market can also measure oxygen concentration of blood.

It is non-invasive, not painful, rapid, easy to use, and the measurements can be performed in the comfort of your own home.

These devices have become popular during the time of COVID-19 pandemic when knowing oxygen concentration of blood is crucial. A typical pulse oximeter also provides a reading of the heart rate.

Pulse oximeters measure changes in light absorption in blood. Amount of oxygen in the blood is measured with small beams of light passing through the blood in the digit being measured.


Healthcare professionals often use pulse oximeters to monitor blood oxygen levels of people who suffer with lung diseases (such as COPD, asthma, lung cancer, pneumonia), heart diseases (such as heart failure, coronary artery disease, or congenital heart disease), sleep apnea, and anemia. This is done at the hospital, the office, during sleep studies, during medical procedures that require anaesthesia, or at home.


How to take a reading at home

  1. Remove nail polish from the digit you are using for measurement.
  2. Make sure your hand is warm, relaxed, and below heart level.
  3. Place the device on your finger, earlobe, or toe.
  4. Keep the pulse oximeter on the digit as long as necessary to obtain a measurement. Fingertip readings may be delayed by 30 seconds and toe readings by 90 seconds.
  5. Remove the device once the test is over.


Pulse oximetry readings

An oxygen saturation level of 95 percent or greater is considered typical for most healthy people.

A level of 92 percent or lower can indicate potential hypoxemia, which is a seriously low level of oxygen in the blood and considered a medical emergency.

Various factors can affect readings, including a person’s skin tone, poor arterial blood flow in the measured extremity, low blood pressure, low temperature of the measured extremity, hypothermia, nail polish, artificial fingernails, motion, and exposure to excessive light.


pain relievers

Whether a headache, toe pain, or a muscle ache after a prolonged tennis game, many of us has found our way into our local pharmacy with intentions to purchase over-the-counter pain medications.

Most people expect over-the-counter pain medications to be safe. However, there are several important side effects everyone should be aware of.

Two common examples are pain and fever reducing medications. These two medications can be found alone or purchased bundled with other medications in one pill for multi-symptom relief.


Acetaminophen (Tylenol)

–        Used for pain and fever

–        Although this medication is found over the counter, it has a black box warning issued by the FDA of “hepatotoxicity”, which means this medication can be toxic to the liver. This means there is a risk of acute liver failure which can lead to liver transplantation or death especially in doses of greater than 4000mg per day

–        This medication should be avoided by patients with history of prior allergic reactions to this group of medications and patients suffering from severe active liver disease

–        Caution must be taken if patient chronically uses alcohol, is dehydrated, malnourished, or has kidney disease

–        Adverse reactions to acetaminophen include anaphylaxis (severe allergic reaction), hypersensitivity reactions, rash, liver toxicity, acute kidney injury, chronic kidney disease if taken for a long time, anemia, and low platelets


Ibuprofen (Motrin, Advil), Naproxen (Aleve)

–        These medications belong to a class of medications called NSAIDS (Non-Steroidal Anti-Inflammatories)

–        They are used for treatment of pain, fever, and some inflammatory conditions such as arthritis

–        These medications also have a black box warning issued by the FDA.

o   Use of NSAIDs increases risk of serious and potentially fatal cardiovascular thrombotic events (such as heart attack and stroke)

o   NSAIDs also increase risk of serious and potentially fatal gastrointestinal adverse events that include bleeding, ulcers, and perforation of the stomach or the intestines.

  • Elderly patients and patients that have history of peptic ulcer disease or gastrointestinal bleeding are at a greater risk for serious gastrointestinal events.

–        Serious reactions reported with use of NSAIDs include

o   Gastrointestinal bleeding, ulceration, and perforation

o   Heart attack, stroke, blood clots

o   Hypertension

o   Heart failure

o   Kidney failure (many different types)

o   Liver toxicity

o   Anaphylaxis, allergic reactions including Stevens Johnson Syndrome

o   Bronchospasm

o   Rashes including sensitivity to light

o   Low platelets, Anemia, and low white blood cell count

o   High potassium

o   Abdominal pain, nausea, constipation

o   Ringing in the ears

Please consult with your doctor prior to taking any medications over the counter.


Buyer Beware!

The team of Concierge Medicine of Jupiter


pain relievers

ANTIBIOTICS are medications that are used to help us fight BACTERIAL infections.

When antibiotics are used to fight BACTERIAL infections, they help us recover, shorten duration of bacterial illness, and can save lives. It is appropriate to treat bacterial illnesses with appropriate antibiotic therapy. The type of antibiotic that is used to treat a bacterial infection depends on the type of bacteria, the location of the infection in the body, and most importantly, it depends on the patient’s specific needs.

Antibiotics are not meant to treat VIRAL infections. Not only are the antibiotics not effective if used in the wrong context, but they can cause harm. Different antibiotics have different side effects. Some people can develop allergic reactions to antibiotics that can be life threatening. Other antibiotics can alter the rhythm of the heart and can cause a life-threatening arrhythmia. There are antibiotics that can cause liver failure, kidney failure, and/or failure of other organ systems.

When antibiotics are used inappropriately, we suffer a great cost both personally and as a society. Overuse or misuse of antibiotics leads to antibiotic-resistance. What that means is that bacteria “learn” how to evade the antibiotic mechanisms of action and the medication is no longer effective when you really need it most. Consequences of this include longer duration of illnesses, more severe illnesses, more doctor visits, use of stronger antibiotics with more side effects, and higher chance of dying from a bacterial illness.