COVID-19 Testing and Consultation
In these unprecedented times, we would like you to know that Balboa Pediatrics is open. We are also available for consultation regarding the COVID-19 pandemic. We offer COVID testing conveniently done outside in our parking lot by appointment. We have been fortunate to be able to offer our patients and their families different testing options with reliable and quick results.
We would like to address the Coronavirus Pandemic. As you know, this new virus is spreading throughout our community, the USA and the world. Many public health measures have been instituted to try to slow its progress. Please take these measures seriously. The virus is carried on vapor droplets which come out of the noses and mouths of infected people when they breathe, sneeze or cough. They can remain in the air for a short while and thus can be breathed in. That is why masks are so important and it is recommended to try to keep at least 6 feet of distance between you and others. The droplets can also fall onto surfaces or be placed there by the hands of an infected person. Someone else can then pick up the virus with their hands and move them to their nose and mouth, where it can enter the body. That is why hand washing and keeping your hands away from your face are being stressed so much. Once taken in, there is an incubation period of between 2 and 14 days. The symptoms are very variable ranging from none to fever or GI symptoms to headache or loss of taste or smell or those of a mild cold to severe respiratory difficulty. Most people (about 80%) get a mild illness. Seniors, people with underlying health conditions, especially those that affect the immune system, and pregnant women seem to be at greater risk than others of suffering severe illness. Young healthy people can get very ill, but fortunately in significantly lower percentages. Because the virus has a tendency to infect the lungs, a form of pneumonia or Acute Respiratory Distress Syndrome develops in those with severe disease. Treatment is mostly supportive, but several medications are being tested and show some promise as curative or possibly preventive. In addition, work is being done on a vaccine, which as a matter of fact, has already been injected into the first people as part of safety and efficacy studies. Based on observing other countries, the experts are predicting that the number of cases and therefore the number of people with severe illness is going to go up significantly over a period of time, before it goes down. Now and for some time to come, it is very important to wear a mask, practice social distancing and hand washing as much as possible.
Here at you pediatric office, we have been adapting to the ever-changing medical situation. Initially, in March, the office was closed to all patients, except those we deemed to have the highest need to be seen in person. Our office was staffed by just one or two doctors and a limited staff to keep the total number of people and therefore possible Covid exposure to a minimum. Our focus at that time was how to provide safe and comprehensive medical care while still abiding with government and CDC recommendations. As restrictions lifted, we began seeing more patients in the office and developed protocols to keep patients and staff safe. This has included screening all appointments for Covid related symptoms, providing protective equipment to our staff, requiring the wearing of masks for all who come into the office, temperature checks upon entering, limiting one parent per child in office, separating rooms for well visits from those used for sick visits, extensively disinfecting each room and all surfaces between visits and spacing office visits to permit the recommended social distancing. We are trying to discourage patients from coming in, unless it is necessary.
TELEMEDICINE HAS ARRIVED
In addition to the steps taken above and in keeping with the rules of social distancing, which are designed to decrease the spread of COVID-19, we feel it is necessary to find alternatives to office visits. Our office has always prided itself on a personal, hands-on office experience, however it became clear that unusual circumstances called for a different approach. Telemedicine, which includes both telephone and video contact, has been used in certain settings for a long time. As the pandemic has continued, Telemedicine has become recognized and recommended by most medical organizations as a reasonable alternative to in person office visits. Insurance companies have followed these recommendations by approving payment for this type of appointment.
During the last two months we have provided Telemedicine visits and learned that many types of problems can be handled successfully this way. While there is no replacement for the physical exam, all the doctors have been trained in taking a comprehensive history and performing a thorough visual exam. The telemedicine appointments have reduced the risk of exposure by decreasing the volume of patients in the office at any one time, resulted in fewer urgent care and emergency room visits, and has provided better continuity of care by documentation in our electronic medical system. Many patients, especially those with increased risk factors, have expressed relief that they did not have to leave their home to receive medical care.
AFTER HOURS CALLS
We would also like to inform our patients that in the future, after hour phone calls will be handled in the same manner as Telemedicine calls during office hours. The office doctor on call will take a history to get all pertinent information, provide video services when necessary, and give appropriate medical recommendations. The details of the call will then be documented in your child’s electronic medical record and communicated to your primary doctor. This telemedicine visit will then be submitted to your insurance carrier for billing. We understand that this is different from our previous practice policy, however we believe that this change will result in better, more comprehensive, and safer medical care in these very unusual times.
Telehealth appointments may be useful for different areas of pediatric medicine, including, but not limited to:
ADHD medication checks
Mild respiratory symptoms
As always, if it is medically indicated that your child come to the office or if you would just feel better to have your child seen in person by a doctor, you will, of course, be given an appointment in the office. On some occasions, telehealth will be a good choice. We will try to accommodate your preference.
If you have any questions, please do not hesitate to call.
Wash your hands as much as possible, wear masks, keep your hands away from your face and practice social distancing.
Telemedicine visits will be billed in the same manner as regular office visits. Deductibles and copayments will still apply.
Letter from Dr. Irwin Bruckner
Dear Patients of Irwin,August 16, 2019
I hope this note finds everyone well and enjoying the summer. I am writing to inform you that as of January 1, 2020, I will be making a significant change in my status in the office. My schedule will be cut back to two half-days per week, probably Wednesday and Thursday afternoons. Unfortunately, after making that change, my limited availability will preclude me from being able to continue functioning as your primary doctor. My hope is that you will want to choose one of the other doctors in our office to take over that role. If so, please designate who you would like to be your primary physician and the change will be made on January 1st. That will mean that when you call in for advice, your message will be given to that doctor and your regular checkups and your financial arrangement will be with that doctor as well. If you have a special need to see or speak to me, please ask and I will do my best to help. Mostly, I will be doing sick visits, but until you feel totally comfortable with your new doctor, I will be available to do a limited number of checkups, if that is your choice. For those of you who have enjoyed Thursday evening appointments, either I will be available or one of the other doctors will take over that time slot. When I am in the office, I will be glad to see you for an office visit, talk on the phone or maybe just catch up on things conversing in the hallway, but I encourage you to get to know your new primary physician as much as possible. Hopefully, before long, you will have developed a solid, trusting and friendly relationship. I have great respect for the other doctors and know they will take high level professional care of you and your family. Some of them are already fairly busy with their current patients, so let me make a pitch for the two newest members of the office. Dr. Miriam Chan and Dr. Julia Bruckner are both receiving rave reviews from patients. I find them smart and caring and incredibly well trained. They have lots of time in their schedules to fit you in and spend generous amounts of time getting to know you and allowing you to know them. Ultimately, our goal is for you to find someone whom you trust and enjoy seeing in the office, regardless of which doctor you choose. We will help in any way we can to make sure that happens.
I want to add that it has been an absolute pleasure getting to know you and participating in the care of your children. There is nothing better than watching them grow and develop and transform from infants into mature, productive adults in what feels like about a minute. I am honored by the trust you have placed in me and I have loved our relationship. I have enjoyed and still enjoy every minute of my doctor-patient interactions, but it is time for a next chapter in my life. It is with mixed feelings that I am excitedly going on to explore new things, but I am sad, because I am not ready to say good-bye. I will be around to watch with great interest what the future holds for you and your children. I wish you the best of luck.
Flu shots have arrived! We're setting up a tent in the parking lot to keep you (and our staff) as safe as possible during your flu shot visit. Appointments are a must, call us today for more information!
MEASLES OUTBREAK updated May 31, 2019
The first and most important piece of information is DO NOT PANIC. At last report, there have been 47 cases of measles so far in the Los Angeles area, including 3 ongoing outbreaks. The odds of exposure are still relatively small, but the number of cases is expected to grow. Measles can be very dangerous. Although according to the CDC up to 1 in 500 cases of measles may be complicated by encephalitis (swelling of the brain) and death, the majority of people who contract the illness will be fine. The odds that your child will catch measles and then suffer a devastating outcome are small. Despite that, it is prudent to take appropriate measures.
Immunization with the MMR vaccine is the only effective means of preventing measles. There is no isolated measles vaccine, so the MMR vaccine is the only option. It is safe and very well tolerated with about one percent of patients getting a fever and/or a pink rash a week to ten days after the shot. The symptoms of measles are the hallmark pink rash covering the entire body accompanied by cough, runny nose, pink eyes, fever, and aches.
If you think your child may have the disease, please call the office and ask to speak to one of our advice nurses. The formal recommendation from the Public Health Department is to make arrangements to see your child in a way so as to not expose any other people. We have made provisions to test your child in an expedited fashion. Please do not come to the office without making prior arrangements.
Below you will find the most recent MMR recommendations:
If your child is over one year old and has not been immunized, please make an appointment to come in for the vaccine as soon as possible.
If your child has already received two doses of the MMR vaccine, there is nothing to do.
If your child had the first dose, usually given at around a year of age, but he/she is not yet four years old and therefore has not yet received the second dose, the official recommendation is still to do nothing. You can receive the second dose early, as soon as four weeks after the first dose, but the evidence is not clear whether the early dose will give the same long term protection as when it is given between four and six. (We could discuss a third dose at some time in the future, if more information becomes available.) The statistics are that 93% to 95% are protected after one dose and 97% to 99% are protected after two doses. Upon discussion with Infectious Disease Specialists at CHLA as well at the Public Health Department, our recommendation is to just stay on the regular schedule, but we will accommodate individual patient requests.
If your child will be traveling internationally the new official recommendation from the CDC is that they should be protected against measles.
Before traveling internationally,
Please plan accordingly and schedule an appointment to discuss vaccination at least 2 weeks prior to traveling.
If your child is over six months and under one year, it is safe to give the MMR early. In order to achieve full protection, however, you will still need two more doses of the vaccine, one given between 12 - 15 months of age, with the booster between four and six years.
In regards to parents, if you were born between 1969 and 1985, you should consider getting a booster MMR vaccine. As long as the supply lasts and can accomodate our patients first, we are able to provide the vaccine for parents in our practice. We are not be able to bill your insurance for the shot, however. The price is $125. If there is limited supply, we will prioritize the children. If you have further questions, please call the office.
The doctors of suite 326
Dr. Alison Mann has moved
April 8, 2019
Sadly, this note is to acknowledge that as of June 1, 2019, after seventeen years in our office, Dr. Alison Mann has chosen to relocate to Laguna to be closer to her parents. They will help with Mark and Chris, providing a more family oriented, loving environment for the boys, and life will be a little easier
for Alison and Darren. We are going to miss Alison’s sweetness, generosity, positivity, and energy. We wish her and her family all of the best in their future endeavors. We know that her patients will miss her amazing pediatric care. The remaining doctors will be available to step in for Dr. Mann and will try to live up to the standard she has set.
You will be asked to choose one of the other doctors to be your primary physician. Your regular check-ups and most of your visits will be with that doctor. As you have experienced before, at times when your primary doctor is unavailable, you will be free to make an appointment with any of the other doctors in the office at that time. As was the case with Dr. Mann, your bill will come from your primary physician, regardless of which doctor you may have seen. All of the doctors are providers on the same insurance plans, so coverage should not be a problem regardless of which doctor you choose.
You probably have gotten to know some or all of the other doctors already, which hopefully will make your choice easier. There are a few things you should take into consideration. We are very proud that Dr. Miriam Chan came to our office in November and Dr. Julia Bruckner will be joining the practice in July. They are both smart, enthusiastic and caring doctors, as well as truly nice people, who will have plenty of time to spend with their patients and their families. When selecting your new primary doctor, please keep in mind that Dr. Irwin Bruckner has been reducing his hours in the office, and Dr. Daniel Bruckner and Dr. Cathy Marshall are already very busy. Scheduling appointments with those three may be a little more difficult. In any case the choice is
totally up to you. Each of us would be very pleased and happy to welcome Dr. Mann’s patients into our practices.
We know you are probably disappointed with this news and may find the decision of choosing a new primary pediatrician difficult. We would like to make this as easy as possible for you. Please feel free to call Dr. Mann, any of the other doctors, or our staff if you have any questions. We ask that you make this decision at or preferably before your first visit to the office after Dr. Mann departs. You can access a simple form on this site, which will be very easy to fill out and mail in to make your designation. We look forward to continuing
to provide the best pediatric care possible to your children.
These days, between schools, camps, travel and sports teams, there seems to be a form for every situation. If your child has had a check up in the past year, we can absolutely fill out these forms. If they have not had a recent check up, please call the office to make an appointment as we cannot fill out school/camp/sports forms without check up in the past year. We strive to complete these forms within 3 - 5 business days, but we understand that sometimes a form appears that was due yesterday! We are happy to oblige, but there is a $15 charge for forms that must be completed the same day.