August 30, 2020 / View as Webpage
Your Weekly COVID-19 Updates
Paradise Valley Medical Clinic, Douglas M Lakin MD
9977 N 90th Street, Suite 180, Scottsdale, AZ 85258
480.614.5800 (ph), 480.614.6322 (Fax)
PLEASE READ THIS ENTIRE DOCUMENT AS IT IS OF
IMPORTANCE TO ALL PATIENTS

"We will be emailing you weekly during the COVID-19 PANDEMIC. We will provide you with the latest information and instructions to deal with the current outbreak as it develops in Phoenix."
 We Offer Telehealth And In-office Visits During The
COVID-19 Pandemic.
Please Call Us If You Need Medical Assistance.
480.614.5800
We Are Here For You!
Dr. Lakin's Office 2020 Flu Vaccine Clinic!

Starting Wednesday, September 2, 2020

Call Us To Schedule Today!
480.614.5800
Getting a flu vaccine is even more important this year to safeguard your health.

Clinics will take place each Wednesday from 8am -10am &
1pm - 3pm, alternating between morning and afternoon each week for your convenience.

For more details:

For CDC 2020-2021 Flu vaccine information > > > CLICK HERE!
FROM THE DOC

COVID-19 DECLINING IN ARIZONA …BUT ARIZONA STATE UNIVERSITY SHOWING 500+ CASES 
 ZERO NEW CASES THIS PAST WEEK IN OUR OFFICE

COVID-19 TESTS RESULTS ARE BACK
IN 2 DAYS
…….
 
LEVELS ARE LOWER AND DROPPING, BUT WITH OPENING OF ARIZONA STATE UNIVERSITY, THERE IS ALREADY A BUMP WITH 500+ CASES AND MORE TO COME. THIS WILL LEAK INTO THE GENERAL COMMUNITY, AND WE WILL SEE AN OVERALL BUMP.
 
THE TIME OF INCREASED RISK IS WHEN CASES ARE LOW BUT RISING IN THE BACKGROUND BEFORE WE ARE MORE AWARE….SO BE VIGILANT.
 
IF IN-PERSON CLASSES RESUME SEPTEMBER 9th FOR CHILDREN IN THE PUBLIC SCHOOLS, WE WILL SEE ANOTHER BUMP, AND THEN INTO THE WINTER WE ANTICIPATE MORE AS WELL. 
 
THE TIMING OF THE FALL/WINTER RISE IN CASES IS UNKNOWN, BUT ARIZONA WILL BENEFIT FROM COOLER TEMPERATURES AND MORE ABILITY TO BE OUTSIDE AND DISTANCING.
 
REMEMBER…. BEING OUTDOORS AND DISTANCING ARE THE #1 EFFECTIVE METHOD FOR LESSENING EXPOSURE AND RISK.
 
WE ARE SEEING THE BENEFITS OF BROADER EFFORTS TO DISTANCE AND WEAR MASKS…BUT IF YOU ARE LETTING YOUR GUARD DOWN……PLEASE KEEP IT UP. 
WE NEED TO CONTINUE TO BE MAXIMALLY VIGILANT! 
 
ZERO POSITIVES IN WEEK 22 IN OUR OFFICE…. TESTING IS NOW RETURNING IN 48 HOURS!!!  GREAT NEWS!!!

 
REDUCE RISK BY REDUCING CONTACTS!!!!   Continue to do this. You will not eliminate risk even while the prevalence of the virus is lower in the community, but reducing your exposure remains highly effective.  You never know who has COVID. 
I personally know with certainty of a person who traveled by air with brand new COVID. People are doing this unknowingly all the time so please be aware.
Please continue to be vigilant!
   
Distancing is most important……wearing a mask is helpful too, so continue to do both. This website offers useful metrics to follow the course of COVID in MARICOPA COUNTY.  To monitor go to: https://covidactnow.org    
 
Outdoor interactions remain most acceptable as it is 20 times less likely to get COVID with outdoor as opposed to indoor exposures. This means 1 minute indoors exposure is equivalent to 20 minutes outdoors.
 
Do know that if you have maximum interactions (multiple meals out, casino visits), such behaviors with multiple and repeated outings and interactions raise COVID RISK? Read this article on how to approach different locations you might consider exploring and to understand risks and ways to reduce risks.  https://www.erinbromage.com/post/the-risks-know-them-avoid-them
 
 
Current COVID ANTIBODY (BLOOD) tests show approximately 6%+ of people in Arizona have had a COVID infection. This is a low percentage. Current testing IN OUR OFFICE this past week, continues to show very little asymptomatic COVID among our patients.  Only 0.5% of COVID ANTIBODY (BLOOD) tests are positive in our patients. 
 
I DO NOT ADVISE COVID antibody testing to determine your status as we have a virtually ZERO SIGNAL (0.2%) FOR PREVIOUS COVID INFECTION among our patients. IF YOU ARE CONVINCED YOU HAD UNDIAGNOSED COVID IN THE PAST TWO MONTHS, we will continue to do the COVID ANTIBODY TEST for any patient that is concerned about past infection or current immunity.
 
The BLOOD TEST will identify people who have had COVID infection in the past and who now have immunity from infection.  The exact degree to which this immunity is effective is unclear, but we believe that people who are COVID POSITIVE BY BLOOD WORK will have protection for at least several months or longer.
 
ANTIBODY BLOOD TESTING IN OUR OFFICE, AT SONORA QUEST WITH THE EUROIMMUN TEST, IS EXTREMELY ACCURATE.  
 
  
It is 99.5% likely you HAVE NOT HAD COVID…. that is what we are seeing in our patient test results.
 
NASAL TESTING RESULTS ARE NOW RETURNING IN 48 HOURS DUE TO INCREASED CAPACITY AT SONORA QUEST.   
 
Nasal testing for acute COVID infection is available at the office. Few requests so fewer tests. Feel free to check your COVID if you have any reason for concern.
 
Alternative testing sites will be listed weekly and expanded. You can find them on our website on the rotating screen and the list is linked below as well. 
 
LOCATIONS FOR COVID TESTING OTHER THAN OUR OFFICE…SEE OUR UPDATED LIST:
 
How To Proceed Day To Day In ARIZONA ……?
 
For low and medium risk patients during this time:
1.     Continue to maintain physical distancing when in public spaces or with groups of friends/family.  This remains the most important preventive strategy…. far better than even masks.
2.     Wear a mask or face cover in closed spaces. In open area spaces, masks are not necessary if space is maintained.  This is done more to protect the community than it is to protect ourselves.  When you wear your mask, you reduce the possibility that you will spread COVID unknowingly.  When the people in your immediate community wear their mask, they are preventing the spread from them, to you.  Encourage others to wear a mask for all our protection.   
 
Some cloth masks are not particularly effective and masks with valves are ineffective…these are to be avoided.
IN ORDER OF RELIABILITY AND HELPFULNESS
·        THICK CLOTH MASK
·        SURGICAL MASK
·        KN-95 VERTICAL DUCKBILL MASK
·        N-95 ROUND MASK
NOT ACCEPTABLE (THESE ARE NOT PROTECTIVE):
·        THIN CLOTH MASKS OR GATERS
·        MASKS WITH VALVES
3.     Do repeated hand cleansing and washing…. This is critical to prevent silent spreading of COVID.
4.     Protection of the eyes is a consideration. Data on this is supportive but not conclusive as to the degree of protection.
5. Expanding your interactions can begin to take place, following the above preventive strategies and considering the following risk profiles.  Do observe the places you are going to make sure they are maintaining appropriate practices.  If you do not see people interacting appropriately, you should reconsider your exposures in such venues during this time of transition to higher levels of community COVID. Until it is clear what level of increase, we are seeing, we must remain conscientious:
a.  Open air venues/public spaces (parks/trails/patios/open air malls) provide excellent ventilation and have a low risk of spread.
b.  Stores that are large/cavernous, which allow for distancing, and which demonstrate proper protective practices among their employees are lower risk.
c. Smaller businesses that are employing excellent protective practices and which provide for distancing are lower risk. Do not linger longer than necessary in such public spaces…. conduct your business and leave.
d.     Read this practical guide about public spaces & exposure…. https://www.erinbromage.com/post/the-risks-know-them-avoid-them
6.     If you have symptoms of any sort that might concern you for COVID…. get tested so that you know your status.
7.     If you are doing all the above and are not in a high-risk group (see below) then you can expand the amount of activities and outings you participate in over the coming weeks.  High risk patients should continue to limit activities to a greater extent.
 
High risk groups include:
·        Age 75 or over
·        Obesity (BMI 40 or above)
·        Lung disease (emphysema/COPD) or current significant smokers
·        Chronic kidney disease (Stage 4 disease or greater)
·        Diabetes…. not well controlled
·        Congestive Heart Failure
·        On immune suppressing medications for cancer or rheumatological/inflammatory conditions
 
Medium Risk groups may want to be more cautious but can increase activities. These include:
·        Men Age 65 to 75
·        Hypertension
·        Diabetes…well controlled
·        Asthma
·        Obesity (BMI 35 or above)
 
Know that our office is responding to COVID, and we are here to help. Reach out for assistance if you are not feeling well. We will develop a plan of action for you to move forward.
 
 
Yours in good health,
Dr. Lakin
 
 
RECOMMENDED LINKS IN THIS NEWSLETTER AND IN GENERAL FOR COVID INFORMATION:
 
INTERNET SITES WITH BEST INFORMATION:
 
Risks with different activities…how to gauge risk:
 
Accurate US statistics by age on COVID infections:
 
What we can expect of COVID in next 1 year:
 
Can follow here for ARIZONA UPDATES DAILY and best trending information to know what is out in the community:
 
Most informative graphics:
 
Get your Mask up to N95 Level:
 
If you have symptoms of COVID…. you can run through a simple checklist on-line to see if you should be concerned:
 
Understanding the various vaccines under development:
 
 
TOP PODCAST DONE WEEKLY BY DR. MICHAEL OSTERHOLM (UNIVERSITY OF MINNESOTA)  
 
He is a world-renowned epidemiologist who was credited with first elucidating TOXIC SHOCK SYNDROME in the 1980’s, and he provides comprehensive and understandable/actionable ideas related to COVID:
 
Listen to this week's PODCAST HERE:
 
Summary of Dr. Osterholm’s Thoughts:
·        Viral Gravity: The virus works at its own pace and time. It will seek out people to infect. Nobody is risk free, all situations have some risk, and ‘everyone’s bucket leaks.’
·        Assess the risks of various activities and choose accordingly.
·        Physical distancing is the most important method of avoiding infection. Far and away the most effective.
·        Masks are somewhat effective…. use them.
·        We are in the 5th inning of a 9-inning baseball game…. So be patient and continue to be vigilant.
·        This is not like the flu pandemic of 1918. There will not be a quiet summer and second wave in the fall…. the summer will not let up, and we will see various locations coming and going with increasing and decreasing infection and risk.
 
 
According to Dr. Osterholm This Week……
 
If we continue at our current level of restriction (which is limited and uneven) we will see:
 
·        A slow decline in cases for 1-2 months, then a significant upsurge in cases to 100,000 per day or more this fall and winter and beyond.
·        More testing will not be the answer to the spread of COVID 19. “Smart” testing…in appropriate settings, along with behavioral changes of the public, will help solve the problem.  More testing without changes in behavior will not effectuate change.
·        An Immunization will 99% not be available by October. The hope is for a vaccine in the early part of 2021.
·        The immunization will work, at best, 60%.
·        Proper behavior is the most effective means of limited COVID.

 
8/23/2020 Survey Results
Patient Survey:
 How Are You Adapting To Wearing
a Face Mask?

Fine, doing it to protect others and myself.
85%

Ok,.... It's a struggle, but I am wearing it.
14%

Dislike it, but wearing it occasionally.
1%

I know I should, but I am not wearing one.
0%
New Survey: During the pandemic, how Important is exercising to you?
Very Important, to stay physically and mentally fit.
So, so... exercise when I can.
Would like to, but don't have the time.
Not important in my life.
"Please Wear Your Masks In Our Office!"
In order to keep the infection rate down, it’s important that we continue to stay home, practice physical distancing, wash hands regularly, and wear a mask if you must leave your home. At our office, we are following CDC guidelines and strive for ways to keep our patients and staff safe.
We are requiring that all patients and visitors entering our offices cover their nose and mouth.
You can do this with a scarf, a homemade cloth mask, or your own surgical mask.
Masks have been shown to decrease the spread of coronavirus from infected people, even those who do not have symptoms.
We have a limited supply of paper mask and will make these available to patients while they last, however, we strongly encourage you to bring your own covering.
 
REMEMBER IF YOUR ARE ILL AND CONCERNED
YOU MAY HAVE COVID INFECTION:
Contact the office via phone or email 
480-614-5800

We will contact you and review a plan of action for you.
•          Since most people will have mild symptoms (80+% will do well with cold symptoms only), very little will be done other than routine measures to treat a cold.
•          If you need to be seen we will consider a video visit or see you at a time designated for such visits.


So we can appropriately schedule your visit with Dr. Lakin,
please be sure to complete our
Appointment COVID-19 Pre-screening Questionnaire.
ATTN PATIENTS:
Dr Lakin is using FaceTime ,
WhatsApp and Zoom to connect with you
for a 'Telehealth' visit. You can connect using your iPad, iPhone, android phone, a laptop, or a PC with a camera.

Please watch these videos so you can be prepared and know how to connect with Dr Lakin for a 'Telehealth' visit.

CLICK ON THE PICTURES
We Are Here to Take Care of Your Healthcare Needs.
We Are Here to Serve!
 
Our office is using all techniques to reduce exposure to a minimum during your visit. These include: 
·        Temperature checks of all patients and staff.
·       Masks for all people in the office.
·       Cleansing of hands and surfaces repeatedly.
·       Multiple Super-HEPA filters to filter out potential virus and particles in the office.
·       High Level UV light air cleansing in the office to eliminate bacteria and viruses in the air.
 
  We have expanded our Telehealth Visits during increased COVID-19 cases, but are still seeing patients in the office.  
In addition, we are connecting with you via
phone, fax, email, and telehealth.
 
 
OUR CURRENT UPDATED
OFFICE SCHEDULE
 
DOORS OPEN     
7AM - 4PM Monday through Thursday
7AM - 11AM Friday
DO NOT JUST ‘DROP IN’…YOU MUST HAVE A SCHEDULED APPOINTMENT FOR THIS COMING WEEK.
 
IN OFFICE APPOINTMENTS: MONDAY - FRIDAY
ARE BEING ADJUSTED…..WE WILL CALL YOU TO CONFIRM IF APPOINTMENTS WILL BE KEPT OR CHANGED TO A TELEHEALTH VISIT
 
MONDAY - FRIDAY from 10:30AM - 12 Noon
We will be conducting TELEHEALTH/PHONE visits with patients.

MONDAY - THURSDAY
WE WILL BE SEEING POSSIBLE COVID-19 PATIENTS 3:00PM - 4:00PM (IN YOUR CAR…APPOINTMENT ONLY…. IN PROTECTIVE GEAR)
 
   COVID-19 SUMMARY:
 
REDUCE RISK BY REDUCING CONTACT WITH THE VIRUS
 
REDUCE CONTACT WITH THE VIRUS BY:
1.   Washing hands frequently….20 seconds is advised, but any hand washing is helpful.
2.   Wear a mask or face covering when out in public.
3.   Use hand cleanser in between washings…if available.
4.   Clean your cell phone daily with a cleansing wipe or UV light.
5.   Shower or bathe daily.  Twice daily if you want to feel more relaxed.
6.   Do not Pick Nose, Rub Eyes, or Pick Teeth with your fingers
7.   Do not go out or to work if you are ill…. or think you are ill.  If you are unsure, check your temperature. If over 99.8 you should not be going out.
8.   If someone in your house is ill, treat them as though they have COVID.  Have them get tested and you should quarantine as well.
9.   Stay away from people who are sick with COVID. Only caregivers should be in contact with COVID patients and they practice high level cleaning to prevent spread.
10. Maintain physical distancing practices, avoid getting within 6 feet of people (other than immediate household occupants)
11. Limit your activities to the minimum interactions you can do to maintain your daily living.
12. Leave mail and other paper products for one to two days on the shelf or in the garage (outside the house) …then bring them in after sitting for 24-48 hours to reduce the potential for transmission.
13.  Groceries cleaning should be considered, although not as strict as initially indicated when the pandemic began.   See this video link for excellent detailed information:   Click Here
 
IF YOU ARE SYMPTOMATIC AND HAVE BEEN TOLD YOU MAY HAVE COVID ……BUT TESTING HAS NOT BEEN DONE YET …….DO AS FOLLOWS:
·        Self-Quarantine for 14 days from the start of illness and FOR at least 3 days after fever and major symptoms have resolved. 
·        Do not share a bathroom with housemates if possible. Use your own bathroom.
·        Do not share utensils with others and clean your own utensils and/or use paper/disposable eating materials.
·        Wait 1 day to wash the clothing you wear. Clothing can be washed after sitting out for 24 hours (virus is not transmissible at that point via clothing).   Others can wash your clothes using this approach.
·        Avoid sharing living spaces with housemates, to the extent your living situations allows.
·        Wash your hands frequently. Use cleanser on surfaces frequently.
·        Wear a mask & gloves when in the presence of others. Wear when you are with others as much as possible.
·        Shower/bathe twice daily if possible.
·        All household contacts should self-quarantine as well with only minimal outside interaction.
 
MORE EXPANSIVE TESTING IS CURRENTLY AVAILABLE IN OUR OFFICE. Results within 24-36 hours generally.
It is being done at the end of the day, in your car, by myself…. wearing protective gear. 
IF YOUR ARE ILL AND CONCERNED YOU MAY HAVE COVID INFECTION OR SIGNIFICANT COVID EXPOSURE:
Contact the office via phone or email first for instructions:
480-614-5800
 
Please do not walk into our office if you think you have COVID infection. We will not see you in the office. Only in your car, and with that, you should contact the office to be seen end of day.
If you think you have COVID and are truly short of breath, you need to go to the Emergency Room, not to our office. We are not equipped to handle low oxygen levels.
 
WHAT IS OUR CURRENT EXPECTATION FOR THE COURSE OF COVID?
At this point in time there are many uncertainties about the course of COVID in the US and in Arizona, but I can provide some educated speculation:
 
·       Nationally…. a slow decline in cases for 1-2 months, then a significant upsurge in cases… to 100,000 per day or more this fall and winter.
·       Arizona is likely to do better generally than cold weather states, but we will still have a significant surge due to back to school for younger kids and college kids.
·       Travel back to Arizona is best done sooner rather than later for those who live back East, as we anticipate a significant rise in cases as we move into the late fall and winter.
·       Influenza will complicate the picture during the fall, winter, and early spring, making it more difficult.  That said, we anticipate a milder flu season this year (still, we recommend the flu shot to prevent infection).
 
 
COVID KIT:
 
This is what you should have at home to prepare for possible COVID, to monitor yourself if you were to get infected:

DIGITAL ORAL THERMOMETER: MANY BRANDS ARE FINE…HERE IS ONE EXAMPLE:
 
PULSE OXIMETER:  TO CHECK OXYGEN LEVELS. MANY BRANDS ARE FINE...HERE IS ONE EXAMPLE:
 
 
OTHER ITEMS FROM THE HOME MEDICAL KIT:
 
·       TYLENOL, ADVIL, OR ALEVE
·       Sudafed 30mg tablets
·       Chlorpheniramine 4mg tablets
·       Robitussin DM syrup
·       Imodium AD
 
COVID COURSE:

THREE PHASES OF COVID:
·       JAILBIRD Day 1-10
·       PAROLE BIRD 11-17
·       FREE BIRD 17+
       
JAILBIRD:  STRICT QUARANTINE......  10 DAYS FROM DATE OF FIRST SIGNIFICANT SYMPTOMS IF OBVIOUS OR FROM DATE OF TESTING IF UNCERTAIN BASED ON SYMPTOMS
 
PAROLE BIRD: DAY 11-17…. VERY CAREFUL WITH ALL ATTENTION TO MASKING, DISTANCING, HAND CLEANSING: NEXT 7 DAYS AFTER QUARANTINE
 
FREE BIRD: DAY 17 AND BEYOND..... NO RESTRICTIONS.
Although I do not recommend testing to prove the virus has cleared after infection, if you have testing and are clear, then the above protocol is not applied.

CARING FOR YOURSELF IF YOU THINK YOU MAY HAVE COVID OR IF YOU HAVE BEEN DIAGNOSED WITH COVID:
Most Common Symptoms
They consist of the same set of symptoms as the common cold/rival respiratory syndrome, but they are worse.
 
Common/Hallmark symptoms:
·        High fever (over 100.4, but can range from 99’s to 104+)
·        Fatigue
·        Cough
 
Other symptoms can include milder issues:
·        Loss of Smell and/or Taste
·        Nausea without Vomiting
·        Sore Throat
·        Aching muscles throughout the body
·        Headache
·        Occasional diarrhea …
·        Nasal congestion (occasional)
 
TREATMENT:
Symptomatic treatment for the most bothersome symptoms
 
·       Plan to: Monitor temperature twice daily and record.  
·       Monitor oxygen levels twice daily and record. If dropping
significantly you should be in touch.

For the oxygen/Temperature:
 
  1. Check your temperature twice daily and keep a log. No temperature is dangerous…adults do not have to worry about this. This is just about monitoring your condition. If you have concerns, be in touch.
 
  1. Check oxygen level twice daily and keep a log. A declining oxygen level can indicate early de-compensation from COVID.  Normal oxygen saturation is 97-100%.   If lower than that it may be normal for you, but the trend is what matters.  If you are declining into the low 90’s, if you are feeling particularly short of breath…then it is time to check at the Emergency Room (which is safe to do!)   If you have concerns…be in touch.

 
Aches and Pains and Fever:
·        Tylenol 650 – 1000mg four times per day is preferred for treating these symptoms, but if not working well, you may use:
·         Advil (Ibuprofen 200mg), 2 – 3 tablets….2 – 3 x per day or Aleve (naproxen 220mg), 1 – 2 tablets...1 – 2 x per day,
·        Drink good amounts of clear liquids (anything you can see through)
 
Sore Throat:
·        Saltwater gargling
1.   Dissolve 1 teaspoon of salt in a glass of warm water.
2.   Gargle for 15 seconds and spit.
3.   Repeat during the day every 2 – 4 hours to relieve pain.
·        Pain relief medications: Advil (Ibuprofen 200mg), 2 – 3 tablets….2 – 3 x per day or Aleve (naproxen 220mg), 1 – 2 tablets...1 – 2 x per day, or Tylenol 650 – 1000mg four times per day.
 
 
Cough:
·        Steam: Either in the form of a hot, steamy shower or using a hot pot of water and covering with a towel and put your head under the towel. Both methods will provide humid air to the irritated air passages and soothe the cough.
·        Cough Syrup: Robitussin DM or Delsym cough syrup can be used to suppress cough.
·        You may require a prescription cough syrup with Codeine.  Contact me if that is the case.
 
 
Sinus Congestion and Drainage (RARE SYMPTOM):
·        Use a decongestant such as Sudafed 30mg, 1 – 2 pills up to four times per day, or use a drying antihistamine such as Chlortrimeton 4mg, up to four times per day. Other cold medications (over the counter) can be used.
·         Claritin, Zyrtec, Allegra will not work for congestion symptoms from an infection. Do Not Use.
 
 
Nausea Treatment:
This is the most difficult issue to treat at home as there is very little one can do to settle the stomach. Coca-Cola with the carbonation eliminated (Flat Coke), Ginger Ale, or Ginger Root…. can be tried, but these are often inadequate, and the key to getting the stomach to settle is getting a good nausea medication.
 
If nausea is persistent, then calling for a prescription medication is often a good idea. Phenergan (Promethazine), Compazine (prochlorperazine), Zofran (Ondansetron) are very effective in treatment.  Sometimes we use them in combination either as a pill or a suppository.
 
The KEYS are:
 
1.   Settling the Stomach…so that liquids can be taken
2.   Focusing on Liquids…so that dehydration does not set in
3.   Eating light foods… if possible (to provide energy for healing). This is not a requirement for healing from an acute GI illness; so, do not feel that the sick person needs to eat food. The only requirement is liquid intake!
 
When to Seek Medical Assistance
•          There is no medication to treat this virus, so the resolution takes time.
Worsening symptoms/Signs of Complications:
•          If you are getting significantly short of breath please be in touch.  If progressive and worsening, you need to be seen and possibly hospitalized.  Best to go the ER if shortness of breath is a significant symptom
 
How Long to Recover
•          The COVID is a viral infection that will generally take from 3–7 days to develop, 3-7 days to improve and then from 3-7 days to completely resolve.
. . . A Moment of Zen
'What A Wonderful World'
Eight amateur musicians met virtually despite the lock-down caused by the Coronavirus Pandemic. Using simple consumer devices and a bit of software
they put together this in a few days, to remind us all that life goes on and
music never stops.. . . Enjoy!