At MD 2.0, we provide patients with superior primary care. We want to be the first to know about any health concerns that may arise. Primary care is performed and managed by your personal physician, Dr. Poncy or Dr. Lubarsky who are available to you 24/7.
Drs. Lubarsky and Poncy believe in more than just treating you when you are sick. Our preventative medicine doctors want to ensure you are healthy year round by promoting a healthy lifestyle, yearly executive level physical exams, and helping to prevent disease.
At MD 2.0, our concierge physician practice focuses on providing high quality care and individualized attention to each patient. Our model allows us to spend more time with each patient, allowing us to work closely with you on prevention, diagnosis, and treatment of diseases and complex illnesses.
Board Certified Internist in Jupiter, FLDr. Amir Lubarsky's love of medicine allows him to listen compassionately and intently to his patients in order to provide the best outcomes.
Board Certified Internal Medicine Doctor in Jupiter, FLDr. Morgan Poncy is a board certified internist who was raised in the Jupiter area.
The middle-of-the-night phone call from the man’s 91-year-old father was frightening.
“Call the police! They’re trying to kill me!”
“Who’s trying to kill you?”
“These people. They’re holding me captive, they’re starving me to death.”
Except “these people” were doctors and nurses, and the older man was in the hospital being tested for a possible stroke. He hadn’t had one, but during the brief two days he’d been in the hospital, he’d acquired a little-known condition called hospital-acquired delirium.
Our concierge doctors are aware of it, but few outside the medical community have heard of it unless it has happened to their loved one.
The hallucinations may range from mild to outrageous.
They can imagine they’re fighting a war they were never in; they’ve been captured by spies and spirited out of the state or even the country; that their nurses and doctors are trying to kill them. These delusions are absolutely real (and terrifying) to them, and no amount of reasoning can argue them out of it, and often result in attempts to escape their “captors.”
At the other extreme, patients may become withdrawn and unresponsive. Other symptoms may include confusion, disorientation, altered states of consciousness, or an inability to focus. Or the patient may change personalities, from a normally easy-going personality to angry or combative, for example.
The main difference between hospital-acquired delirium and dementia is the time period of onset. Dementia slowly progresses over the course of months or years. Although up to 40 percent of those with dementia can also suffer from delirium, the latter syndrome occurs suddenly in patients who were otherwise perfectly lucid prior to entering the hospital. It can develop in a matter of hours or days following admittance.
A common occurrence
According to a report Harvard Health Publishing, hospital-acquired delirium is the most common complication of hospitalization among older people, although it can occur in patients of any age. It is most prevalent in those who undergo such major surgeries as hip replacements or heart surgeries, or who were admitted to an intensive care unit. In fact, the syndrome was originally called ICU delirium.
The prognosis for recovery is mixed. Most people return to normal within a week or two after returning home. One study, however, found people over age 65 admitted to a hospital and diagnosed with delirium were more likely to die within a year than those who hadn’t. And the episodes of delirium may continue for months after discharge in up to a third of patients.
There are many reasons why a patient might slip into hospital-acquired delirium. These include:
- Sleep deprivation—The constant noise, lights, interruptions, and general activity in a hospital setting can make a peaceful night’s sleep impossible. This naturally leads to a confused mental state.
- Undiagnosed infections—Many untreated infections can cause delirium. Urinary tract infections are the most common culprit in a hospital setting.
- Dehydration—It may sound too simple, but dehydration can lead to delirium.
- Drug reactions/interactions—Older adults often take multiple medications, and new ones may be introduced at the hospital, causing unforeseen reactions or interactions. This is especially true with certain categories of drugs (e.g., antihistamines, antidepressants) that can trigger side effects, including delirium. Conversely, the sudden withdrawal of medications can also cause such a reaction.
How to help
It’s important that hospital staff rule out physical causes for unusual behavior in a patient, such as treating infections or performing tests for a possible stroke, for example. Be sure they know that the use of physical restraints and sedatives are not recommended, because they can increase the patient’s agitation.
But there are ways you can help.
- Try to spend as much time as possible with your loved one. If pandemic restrictions prevent in-person visits, at least make sure they have such necessary items as glasses, hearing aids, and dentures. Bring family photos or other familiar items to help reorient them. Make sure they have their phone and charger available and call them as often as possible.
- Ask the staff to minimize sleep deprivation, waiting until morning to do blood pressure checks or give medication, for example. Also ask to lower and to keep noise to a minimum at night to allow for restful sleep.
- Encourage exercise. Even a brief walk down the hall two or three times a day will help.
- It’s important not to panic if your loved one becomes delirious following a stay in the hospital. If you tell them their hallucinations are not real, they likely won’t believe you. Remain calm, reassure them you are there to look out for them, and try to calmly redirect their thoughts into their surroundings.
Remember, once they are out of the hospital setting, they will most likely return to normal.
From the onset of the coronavirus pandemic, it became clear the majority of those most affected by COVID-19 infections were adults over the age of 65. The severity of the illness and deaths decreases in younger people. Many began to believe we didn’t have to worry about children when it came to the virus.
Children may be carriers and able to infect others. But many thought if they should become ill, in most cases they’ll exhibit either mild symptoms or none at all.
Our concierge doctors want to warn you that this is a misconception. At least 120 children in the U.S. have died from COVID-19. And a new study last month at the Children’s Hospital of Philadelphia (CHOP) found a disturbing result of coronavirus infection in children. They found elevated levels of a biomarker (C5b9) related to blood vessel damage, even in those with minimal or no symptoms.
They also found a high proportion of children with SARS-CoV-2, the coronavirus that causes COVID-19, were also diagnosed with a condition called thrombotic microangiopathy (TMA). TMA leads to clots in small blood vessel. It has been linked to severe COVID-19 symptoms in adults.
“We do not yet know the clinical implications of this elevated biomarker in children with COVID-19 and no symptoms or minimal symptoms,” co-senior study author David T. Teachey, MD, said in a news release. Teachey is the Director of Clinical Research at the Center for Childhood Cancer Research at CHOP.
“We should continue testing and monitoring children with SARS-CoV-2 so that we can better understand how the virus affects them in both the short and long term,” he added.
There’s still a great deal we don’t yet know about this novel coronavirus, including why it affects both children and adults in varying degrees. At least 30-40 percent of adults, for example, show minimal or no symptoms at all. They still can transmit the infection to others, however.
Despite having a higher viral load, children are even less likely to exhibit symptoms. This means children tend to have a larger amount of the virus in their upper respiratory tracts than adults. Does that mean they can transmit the virus even more readily than adults?
Again, we don’t know for sure. But a recent Harvard Health paper warns “the presence of high viral loads in infected children does increase the concern that children, even those without symptoms, could readily spread the infection to others.”
One thing we do know is a small number of children can have severe effects. One of these is a new condition. The Centers for Disease Control and Prevention (CDC) calls it “multisystem inflammatory syndrome in children,” or MIS-C. It now seems to have affected approximately 300 children in the U.S, at least five of whom have died.
Originally, doctors thought there was an unusual outbreak of a rare form of Kawasaki’s disease. The symptoms reported were similar (persistent fever, rash, and inflammation of the blood vessels). It has now, though, been connected specifically with the SARS-CoV-2 virus.
“This [MIS-C] is a new childhood disease that is believed to be associated with [COVID-19], and it can be lethal because it affects multiple organ systems [including] the heart and the lungs, gastrointestinal system or neurologic system,” neonatologist Alvaro Moreira said in a statement. Moreira is an assistant professor of pediatrics at The University of Texas Health Science Center at San Antonio.
His team reviewed 662 cases of MIS-C worldwide between January and July of last year. They found more than half of the children studied suffered heart damage as a result of the condition. These children may require lifelong care and treatment, United Press International (UPI) reported in September.
“Evidence suggests that [these] children . . . have immense inflammation and potential tissue injury to the heart, and we will need to follow [them] closely to understand what implications they may have in the long term,” Moreira concluded.
Further study needed
Researchers in the CHOP study were surprised to find the biomarker C5b9 present. They found it not only in children with severe symptoms of COVID-19 and MIS-C, but also in those with minimal or no symptoms.
“Although most children with COVID-19 do not have severe disease, our study shows that there may be other effects of SARS-Cov-2 that are worthy of investigation,” Teachey said.
“The most important takeaway from this study is we have more to learn about SARS-Cov-2,” he concluded. “We should not make guesses about the short- and long-term impact of infection.”
Neither of the two vaccines approved for adults have been tested in children under age 12. It could be a long wait until kids get protection from the virus.
In the meantime, we urge parents to take the same precautions with their children that they do with themselves. Socially isolate as much as possible, frequently wash your hands, and wear masks when outside the family circle.
My husband and I have been patients of Dr. Poncy for over ten years and have been extremely pleased and happy for him. He is not only a brilliant internist, but also a wonderful person. Now that he and his partner, Dr. Lubarsky, have opened the concierge practice it is better than ever. The nursing staff is superlative as is the front office staff. The office is very well appointed and comfortable. We feel very fortunate to have such a competent and caring physician.
About 11 years ago, I first met with Dr. Poncy. I came away from my appointment with him confident he understood my problem and contributed some thoughtful suggestions. Over the years, he has never changed. The outstanding staff Dr. Poncy has put together, along with his partner, Dr. Lubarsky, are the best! I honestly feel, when I have an appointment, it is like visiting "family".
I recommend Dr Lubarsky emphatically. He is a true professional: thorough, compassionate and an excellent diagnostician!
We have been concierge members for only 6 months but so far we have been very pleased. The office atmosphere is very relaxed and the doctor is able to give us the time we need. Time in the waiting room is minimal and we have been able to obtain spur of the moment appointments with no difficulty. We are happy that we joined
The new practice has a very warm, friendly, feeling to it. We don't have long waiting times. Everyone is very prompt.
I have been a patient for over 30 years. I actually look forwarded to a visit. Pleasant, professional in every way, I consider myself very lucky.
A great Dr. & great staff, minimum wait time. Spends as much time with you as you need. Same day appointments.
Dr. Poncy has been my primary care doctor for over 8 years. I've known Dr. Poncy for over 8 years. My neighbor recommended him for my diabetes and heart problem. The staff at Dr. Poncy's office is always very pleasant and Dr. Poncy is very patient to my concerns.
I have been a patient of Dr. Lubarsky since 2004. He has been such a great physician to me and my wife for several years. Recently, I was hospitalized at Jupiter Medical Center. My wife contacted him and he immediately responded and came to the hospital. Without Dr. Lubarsky's support, I don't think I would be at the health level I am at today.
I'm a big fan of Dr. Lubarsky! After moving from New York, I researched area Internist throughout Jupiter and Palm Beach Gardens. Dr. Lubarsky was a home run!