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from Ocean County Woman - January/February 2021

by The County Woman

Legal Professionals

Medical Professionals Medical Professionals COVID-19 and the Digestive Tract

By Jill Collier, M.D. Medical Director Endoscopy Center of Toms River

COVID-19 is an illness caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although widely known to affect the respiratory system, in many cases gastrointestinal symptoms may play a role or be part of the presentation. It is important for the general population to recognize these symptoms in order to act upon them with appropriate testing and quarantine.

What gastrointestinal symptoms are seen with COVID-19 infection?

Although fever, loss of taste, cough, fatigue and shortness of breath are common presentations of COVID-19 infection, gastrointestinal symptoms are frequently noted. Complaints of loss of appetite, nausea and diarrhea are often seen in infected patients. These digestive symptoms may be noted in combination with typical respiratory symptoms, but some patients will experience the intestinal symptoms first or as their only manifestation of the illness.

How is COVID-19 transmitted?

COVID-19 is thought to be transmitted by respiratory droplets. This has led to the widespread advice to wear face coverings such as masks and to safe distance with six feet between individuals to prevent transmission. In addition, the virus is believed to remain viable on surfaces and therefore strict hand washing and avoidance of touching surfaces which may have harbored the virus is also recommended. Recent studies have also revealed that the virus can be detected in stool specimens of infected patients. In addition the virus may continue to be detected in the stool well after the respiratory symptoms have resolved.

How are the digestive symptoms of COVID-19 treated?

Symptoms of diarrhea can be treated with over-the-counter medications like loperamide. Hydration is important so patients are encouraged to drink fluids. Symptoms of nausea can be treated with prescriptions to reduce nausea. If patients are unable to maintain hydration orally, intravenous fluids may be required.

How does COVID-19 affect the liver?

Many patients hospitalized with COVID-19 are noted to have elevated liver enzymes upon blood testing. Those who progress to the more severe lifethreatening stage of multisystem organ involvement may experience further deterioration in liver function. Patients with underlying liver diseases like cirrhosis do not appear to have an increased risk of contracting the virus, but like anyone with poor health or advanced age, their prognosis may be worse.

Do patients with inflammatory bowel disease (IBD) have an increased risk of COVID-19 infection?

Many patients with ulcerative colitis and Crohn’s disease take medications that suppress their immune system. These patients are also more likely to be hospitalized for their disease or to be seen at medical facilities for infusion therapies. Despite this, studies have not shown any increased risk of contracting the infection, or adverse outcomes. Adverse outcomes continue to be associated with other concurrent medical issues such as diabetes and advanced age. It is not recommended for patients with IBD to stop their medications, unless in the setting of documented COVID-19. All patients with flares of their IBD should be tested for COVID-19 infection.

I am scheduled for a colonoscopy or an endoscopy, will I be at increased risk?

Currently in New Jersey all patients undergoing elective procedures such as endoscopy and colonoscopy are required to have testing for SARS-CoV-2

During this troubling time the doctors and staff at Gastroenterologists of Ocean County remain available to care for your needs. We offer telemedicine visits as well as in person visits for screened patients. Our endoscopy centers remain open for procedures , with pre-procedure COVID testing as mandated. Please call if you have any questions or concerns 732-349-4422

infection. This is obtained through nasal swab or saliva to detect active infection via polymerase chain reaction (PCR). This is one of many ways patients and staff at endoscopy facilities are protected. In addition, routine measures of masking, safe distancing, thorough facility cleansing and universal personal protective equipment (PPE) for staff are required. It is not recommended for patients to delay needed care during the epidemic as this may lead to adverse outcomes.

In conclusion, COVID-19 can be understood as a viral illness with potential to affect not just the respiratory system but also the digestive system. If you think you may have contracted the infection, you are advised to call your health care provider, who can direct you to proper testing.

• Colonoscopy and colon polyp removal • Colon cancer detection and screening • Rectal bleeding evaluation • Ulcer pain evaluation and treatment • Swallowing disorders

Omar Tamini, mD Jill COllier, mD eDgar BigOrnia, mD KenneTh glazier, mD Jai mirChanDani, mD Teresa menaDier, mD

• Endoscopic treatment of hemorrhoids • Capsule Endoscopy • Breath testing • Esophageal and anorectal manometry

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A Division of Allied Digestive Health

Financial Management Emotional Investing

“Only when you combine sound intellect with emotional discipline do you get rational behavior.” - Warren Buffet

We like to think that since the advent of modern portfolio management practices, investing in stocks and bonds has become a cerebral, analytical process with no room for emotion. The truth is that most investors, even institutional investors, are buffeted (no Pun intended) by emotional turbulence from time to time, and that truth is reflected in the volatility of the financial markets.

But if a little emotionalism when it comes to investments is unavoidable, too much emotion can be hazardous to your wealth. Here are four symptoms of problem emotions, financial behavior that is inconsistent with sound investment practice. • Fear of loss. Investors are generally motivated by fear or by greed. Behavioral scientists have learned that, for many people, the pain of loss is larger than the sense of satisfaction from a gain of the same size. Similarly, some investors will accept larger risks in order to avoid a loss than they will in seeking a gain. Taken to an extreme, fear of loss leads to investment paralysis. An excessively risk-averse investor may park funds in ultra-safe, low-yielding bank deposits or short-term Treasury securities until a decision is made, accepting long periods of low returns. Or winning investments may be sold off too quickly in an attempt to lock in gains, while losing investments manage to stay in the portfolio indefinitely. • Following the herd. It’s difficult to be a contrarian, to find value that everyone else has overlooked. Many people find it easier to go with the crowd, to own the current hot stock or hot mutual fund. At least that way, if the investment does poorly, one has plenty of fellow sufferers with whom to commiserate. But when “crowd” is defined as one’s family and friends, the crowd’s investment goals may be very different from one’s own. • Hair-trigger reflexes. Markets move on news. In many cases, the first market response is an overreaction, either to the up side or to the down. Sometimes “news” is only new to the general public, and it’s already been reflected in the share price through trading by those with greater knowledge. The true importance of any news event can only be discerned over the longer-term. Generally, it’s better to watch the market react to news than to be a part of the reaction. Remember that market dips may present the best buying opportunities but they’re also the toughest times, emotionally, for making a commitment to an investment. • Betting only on winners. Some 85% of the new money going into domestic equity mutual funds goes to funds with Morningstar ratings of four or five stars, according to one estimate. This may be one reason that the government requires this disclosure for investment products: Past performance is no guarantee of future results. The disclosure is required because it is true. High returns are usually accompanied by high risks; ultimately, those risks may undermine performance.

Abnormal returns, whether they are high or low, tend to return to the average in the long run. Investing on the basis of the very highest recent returns runs a significant risk of getting in at the top of the price cycle, with a strong chance for disappointment.

To avoid impulsive decisions that may be tainted with emotion, one needs an investment plan. The best way to moderate the impact of stock and bond volatility in difficult markets is to own some of each. Assets do not move up down in lockstep. When stocks rise, bonds may fall. Or at other times, bonds also may rise when stocks do. The movements of each asset class can be mathematically correlated to the movements of the other classes. Portfolio optimization involves the application of these relationships to the investor’s holdings. Expected returns need to be linked to the investor’s time horizon. Longer time horizons give the investor more time to recover from bad years, more chances to be in the market for good years. We like to say it is time not timing that is most important

when developing a portfolio for a client.

Wishing all a very Happy, Prosperous and above all a Healthy 2021!

Ira J. Brower

Our focus is where it should be… On You. On Your Family. On Your Future.

Lifestyle & Money Management Trust & Estate Planning Investment Services True independence and understanding are at the core of our unique value proposition. Caring for and thoughtfully guiding our clients has created the strong trusting relationships we have nurtured over many decades. That’s why so many people rely upon our independent company for wealth management and trust & estate services: Garden State Trust Company. To learn how we can focus on you and your family, contact Adam Brower or Siobhan Connolly.

2101 Highway 34 South • Suite A • Wall, NJ 07719 732.255.5000 | gstrustco.com

Embracing Your Inner Beauty with an Integrated Approach to Women’s Health

Intuitive Women’s Health is a unique femaleprovider practice. We are honored to provide OB/GYN services to women of the South Jersey community.

Dr. Natalia Rezvina strives to provide competent, compassionate, and individualized care for women of all ages—from adolescence to menopause.

Only a woman can fully understand and relate to another woman’s concerns about PMS, painful sex, leaking urine, heavy periods, pregnancy aches and pains, and many other challenges we face in everyday life.

Uninsured or Underinsured?

You can qualify for a free preventative exam, Pap smear and mammogram screening through the CEED program at Shore Medical Center.

Natalia Rezvina

Dr. Rezvina completed her residency in Obstetrics and Gynecology at University of Medicine and Dentistry of New Jersey in 2006. She is a well- respected Ob/Gyn physician servicing patients from Ocean, Atlantic, and Cape May Counties.

She specializes in treating pelvic prolapse, urinary incontinence, painful intercourse, minimally invasive surgeries to treat variety of GYN problems. Natalia Rezvina, MD, FACOG

Dr. Rezvina is known as “baby whisperer” at the maternity unit at Shore Medical Center. Her primary C/S rates are the lowest among all Ob/Gyn providers in the Department (13-25 %).

Uninsured or Underinsured?

We participate in the Cancer Education and Early Detection (CEED) Program at Shore Medical Center, which coordinates FREE GYN EXAM, PAP SMEAR, and MAMMOGRAM.