IM Doc pt10
Aug. 31st, 2021 05:24 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
temporaryrealityIM Doc My understanding from other literature – that it is bridging with LOVENOX ( unfractionated heparin) or plain old-fashioned subcutaneous heparin at therapeutic dosing for a few days – then either XARELTO or ELIQUIS for as long as deemed necessary. ( Needless to say, none of these drugs have been approved for this usage).
I have done this a few times, with patients who have any history of blood clotting issues (factor v leiden, etc.) , unexplained deep vein thrombosis or pulmonary emboli who have received ANY of the COVID vaccines. Early on, I had a few people who developed blood clots (so far just DVT thankfully) around the time of their injections. But have also had a few who had atherosclerotic events immediately around their vaccine (very unclear if this is correlative).
This is another reason why I am concerned about the football stadium parking lot approach to these vaccines. There are any number of people who really should be talking to their physicians about potential problems. Of course, that would assume their physician has a clue about what the side effects even are. There are so many who are just on auto-pilot – Vaccinate everybody – and Vaccinate NOW!!!
Isotope_C14 Thank you for your well informed response IM Doc!
What is your take on the MMR 2 correlation (Titer of mumps) vs. COVID symptom severity?
https://mbio.asm.org/content/11/6/e02628-20
^ this link was found by user name Cojo
https://asm.org/Press-Releases/2020/November/MMR-Vaccine-Could-Protect-Against-COVID-19
I’m fascinated by this, and the fact that this is an already established safe vaccine that could be used at least to mitigate symptoms, especially in the case of older folk, that probably didn’t get MMR due to the fact that they were children at a time when the vaccine didn’t exist, and therefore didn’t get it.
IM Doc I have looked into this question. I do not think we have enough data one way or the other to make valid assertions. It is an interesting concept – and very unclear how that mechanism would work – but we just do not know enough. Like many other things in this pandemic, I am certainly hoping someone somewhere is really looking into this in a way that will clarify the answers.
Isotope_C14 Thank you for your reply!
I’m reasonably sure that as there is no financial gain in answering this question, and that the Ferrengi that run the show will make sure we don’t have an answer any time soon.
I suspect looking at the numbers in Argentina in the next 2-3 months may be informative, since they are deploying this vaccine there – at least according to my co-worker who has a mother and sister there who were both vaccinated with MMR 2 in the last 2 weeks.
I thought the “Western Democracies” would love to help the global south, but apparently that isn’t the case.
Three Skies IM Doc, Dr. Robert Gallo discussed the Oral Polio vaccine’s possible benefits
too. https://www.youtube.com/watch?v=rHvV81ZB-fk. The Gallo part starts at 40:00.
He touches on the politics of the funding of the research.Cuibono here is an interesting look into this SORT of question from a broad view:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30742-X/fulltext
Carla IM Doc — given the recent information (in CNN link above, and elsewhere) about low-dose aspirin apparently being somewhat protective against infection with Covid-19, and also protective against severe disease, do you think it possibly wise for adults to take low-dose aspirin for one or more days before receiving Astra-Zeneca or any other Covid-19 vaccine?
With regard to the progesterone/COVID link. [https://www.dailymail.co.uk/sciencetech/article-9381227/COVID-19-Injecting-MEN-female-hormone-progesterone-reduce-infection-severity.html]
As an internist, this has been something I have grappled with for about the past 10 years when this phenomenon appeared out of nowhere out of the ether.
I think most people would be absolutely shocked if they knew how many middle aged women were being placed on TESTOSTERONE for very flimsy reasons. The testosterone dosing is often much more than I would dream giving a male patient with documented low testosterone levels.
The testosterone is often given with rather large doses of estrogen and even bigger whopping doses of adrenal hormones. I have never really understood what is the purpose behind this – other than many believe it makes them “feel better”.
Needless to say, this regimen completely negates any effect progesterone would have, not only on COVID but many other things. It also puts these women at extreme risk for many other medical problems – situations which I have seen with my own eyes repeatedly.
And the medical profession looks down the nose on physicians who are using ivermectin for COVID off label while this is going on all around them.
Sometimes, I wonder what is happening to my profession
Robert Hahl Twenty years ago it was popular to put post-menopausal women on Prempro, a mixture of estrogen and progesterone, ostensibly to prevent bone loss and heart attack, but really to improve sexual performance (citation: personal communications from my wife). The Nurses’ Health Study spoiled all that, by showing Prempro gives no benefit for heart or bone, and the whole business dried up for American Home Products almost overnight.
Now, it well known that testosterone makes women horny (cite: id). It seems to me that the only mystery here is what doctors claim to be prescribing it for, not why.
grayslady Every woman has natural testosterone–levels vary, and blood tests are not the best method of finding out if you have the correct amount. Testosterone definitely plays a part in overall balance for mental health and it doesn’t have to do with sex drive; it has to do with aggression. When I first started HRT for menopause, many years ago (I only ever used bioidentical estrogen), I became unable to cope with small life disruptions that I would previously have tackled handily. My doctor added a small amount of testosterone to my program and it made all the difference. We agreed that I could chop the tablets in half until I found the right level–an approach I recommend, since a little goes a long way.
Unfortunately, bad products from big pharma and the resulting studies that frightened doctors away from recommending HRT have left many menopausal women miserable. Anti-depressants are the worst thing that can be prescribed since they, inevitably, don’t work. The mental issues have to do with hormones, not serotonin re-uptake. A certain amount of testosterone is important for women, but getting to the right level is something that needs to be worked out between the woman and her doctor. For some women, it can take years for the body to readjust after menopause, so any program should be monitored annually for correct hormonal balance.
IM Doc I completely understand what you are talking about – and it is a genuine problem. Many post-menopausal women are miserable. And that is my concern about any of these hormone approaches – too little attention is paid to what it is doing to the patient over time and the follow up is often atrocious. In many of our big cities, this is being done in strip mall fly by night kind of clinics. And that leads to tragedy – which is often what I see. And to my point above – the whole issue about the protective effect of progesterone is completely obliterated in these patients – their own native progesterone production could never compete with the often godzilla sized doses of testosterone, DHEA, and estrogen.
When I give a patient any medication for a non-approved indication, I tend to be very careful.
This is not a standard ‘flu.’ It has a ‘long covid’ component that has just been seen and not analyzed yet. Why? Because we are just at the beginning of this new malignancy. If ivermectin does constrain the extent of damage the ‘long covid’ component of the disease inflicts, then it is going to be important for future complications, social cohesion, economic productivity, etc etc.
Plain old ivermectin is now in the generic stage of life. I would not be surprised to see Big Pharma try to steal ‘rents’ from the public for a reformulated ivermectin.
Lambert Strether > I would not be surprised to see Big Pharma try to steal ‘rents’ from the public for a reformulated ivermectin.
Good point. Patented, if possible.
Baldanders “Merck, known as MSD outside the US and Canada, markets ivermectin as Stromectol for human use to treat onchocerciasis and intestinal strongyloidiasis. In a 4 February press statement Merck noted that its own analysis revealed “No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies,” as well as a lack of “meaningful evidence” for clinical activity or efficacy in patients.
Merck also cited a “concerning lack of safety data in the majority of studies.” Both EMA and FDA noted that clinical trials are ongoing examining the use of ivermectin for prophylaxis or treatment of COVID-19.”
Might be difficult to do after those statements..
https://www.raps.org/news-and-articles/news-articles/2021/3/no-ivermectin-for-covid-says-ema
Cuibono yeah, the Merck statement really changed my mind.
pjay >“No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies,” as well as a lack of “meaningful evidence” for clinical activity or efficacy in patients.
So what is “meaningful evidence” here? What do we mean by a “scientific basis”? Are none of the data from the clinical observations by highly qualified medical professionals listed in Lambert’s six articles above “meaningful”? Why not? And are “large randomized clinical trials” the *only* basis for making “scientific” claims here? Or more importantly, the *only* legitimate basis for considering a potentially promising treatment that is at the very least safe (the misleading implications about dosage in this article to the contrary)?
IM Doc I would let everyone know that Merck is also in the final stages of approval for a brand new oral anti-COVID agent – that will possibly be hitting the market soon – assuming it is approved.
This downplaying of other drugs like this, especially in your own company’s arsenal, is standard operating procedure in the pharma industry. The difference now is it is being played out for the world and not just the medical community. I have seen this repeatedly done over the years.
They will do everything they can not to cannibalize the market for their new, expensive upcoming agent – if that includes torpedoing their older drugs – so be it.
They are all pretty much total slimeballs.
As far as safety – it has literally been given over the years in multiple billions of doses – and has a vanishingly small side effect and complication profile. Much less problematic than things like remdesevir or even these vaccines. I have not a clue what they are talking about there. I have seen no studies with any kind of safety issues elucidated.
It has worked amazingly well for my patients. I have had a marked drop off in people being admitted to the hospital. If our government agencies forbid its off-label use for COVID – they are really going to open up an entire can of worms. The common uses of dozens/hundreds of drugs in an off-label manner is staggering. The FDA simply cannot take the risk to forbid JUST ivermectin for off-label use.
the following, while not Covid-specific, is of medical-care interest, so I include it here]
Whoo Hoo! Finally took possession of my special medicare decoder …uh, code. And the suicide pill in case Putin tries to get ahold of it – OK, there was no suicide pill – I just have to kill myself with whatever implements are handy.
Only one case today. A couple, who worked for Kaiser, had retired. They couldn’t understand why they were paying 148 dollars to medicare Part B when they had Kaiser insurance (the health insurance they had held their whole working careers). Kaiser does apparently have retiree health insurance for some of its “higher end” employees. I doubted that these clients qualified. So I went through the whole process of generating medicare.gov website user names and passwords, and it was as I suspected. Kaiser was no longer insuring them as employees (because they were now retired), and Kaiser was not insuring them as retirees. The pair were insured under a medicare advantage plan, which in this case happened to be a Kaiser medicare advantage health plan. Easy to understand how the clients would think they were still being insured by Kaiser, and that the medicare premium wasn’t actually paying for anything.
This confusion about advantage health plans being medicare is a rather common problem.
flora Interesting that Kaiser or who ever enrolled them in Advantage plan without their input, instead of letting them decide for themselves whether to enroll in an (so-called) Advantage Plan (so-called) instead of into a traditional Medicare Medigap “Part” plan. The confusion seems by-design to benefit the private insurance companies, imo. (As you know, the $148 dollars is probably the Medicare Part B premium that applies to everyone, usually auto-deducted from the retiree’s SS monthly payout. (so-called Advantage Plans (so-called) don’t eliminate the traditional Medicare Part B requirement.
flora adding: your clients will have to now wait until next Jan-March to change back to a tradtional Medicare Medigap plan if they so desire.
IM Doc You would simply not believe the huge number of patients that are on “Medicare Advantage Plans” – end up having a stroke, broken hip, etc., and then need to be admitted to a rehab unit for further care.
EXCEPT – Medicare Advantage Plans – almost universally do not pay for Rehab units – or SNU care. Seriously – not making this up.
So the hospitals cannot send them home – and I have had any number of patients either get rehab as an inpatient in the hospital – or WAIT until the 1st of the month when they can change back to regular Medicare and go to the rehab unit.
It is all a big joke – and all a big scam – to skim funds off of people’s Medicare benefits to fund the multimillion dollar executive salaries. When this started to happen about 8-10 years ago was when I knew in my heart the whole system had jumped the shark.
Seniors – if you are having to be bribed to sit through a presentation with a steak dinner – you are by definition the chump in the transaction – please please do not sign up for these things – they are a complete disaster when bad things really happen to you.
We hear alot about the Flu of 1918. This is a very bad analog for our current issues for any number of reasons.
There is indeed an analog that we can look back to – the “Russian” or “Asiatic” flu of the 1890s. From its inception – the physicians of the day realized that it was much different than any other influenza – read William Osler’s first textbook of internal medicine in the flu section written in the first decade of the 20th century for an idea on that. And it almost assuredly was not a FLU or influenza at all.
Modern research and genetic/virology studies have shown it almost assuredly was Coronavirus OC43 – that is still floating around with us today.
More than 100 years after the initial pandemic, this organism causes upper respiratory infections in millions/billions every year, and is responsible for the deaths of hundreds/thousands globally each and every year – mostly old and infirm.
The organism had its way with humanity in the 1890s – coming back wave after wave after wave – likely representing variant drift until we as a species and the viruses settled into a new relationship and a new reality.
Humanity did not know what viruses even were then – this illness was blamed on “Miasma”. But they tried everything known to medicine at the time to stop it – social distancing, quarantines, recuperation facilities, even masking (to a much smaller degree than we are now) and NOTHING worked.
But things eventually settled down. But not without the social, political and economic chaos that almost always accompanies pandemics.
I am afraid this is where we are today. Unlike the 1890s, we have the possibility of anti-virals and the possibility of vaccines ( the jury is still out on both – the verdict on the vaccines will be coming in the next few months – again the studies showing case number reduction is what we have – and is worthless – morbidity, hospitalizations and death are what are important – and the data there is completely unclear ).
One thing is for sure – this is going to be an interesting ride the next few years.
I discuss with my patients dozens of times daily – the things we know will help – GET LESS FAT, GET LESS DIABETIC, EXERCISE like a FIEND, VITAMIN D , SUNSHINE and plenty of sleep.
And we as a society – must somehow find ways to begin tried and true public health issues – like vigorous testing and quarantine. We have had a clear fail on this up until now.
Buckle up and be safe everyone.
Russia may have developed a terrific Covid vaccine, CoviVac. RT reported on this vaccine recently:
https://www.rt.com/russia/517024-russia-third-vaccine-dead-virus/
…The vaccine is based on the most traditional technology that has been around for a long time and is widely used throughout the world, Aidar Ishmukhametov, the director general of the Chumakov Scientific Center, told RT.
“Globally, almost 100% of vaccines contain either deactivated or live pathogens,” he said, adding that the one developed by his center contains an ‘inactivated’ (dead) coronavirus. This type of vaccine simulates a natural infection process, introducing the immune system to the virus and “teaching” the body to fight the pathogen without the risk of it spreading through the body and causing disease, he explained.
…“Since we are talking about a whole-virion vaccine, the deviations in the genetic sequence – something one is calling different strains or different variants – are insignificant and amount to less than one percent. So… it would be weird to think that a whole-virion vaccine might fail to work against new strains, considering how small the differences are,” he said.
CoviVac received national approval in Russia while still in the second phase of clinical trials. It now has to go through the third phase so the developers can precisely assess its effectiveness, according to Ishmukhametov. However, the first trials have already shown that it has no side effects, he said.
“The most important thing is that at this point we have a vaccine that definitely has no side effects,” he said, adding that, out of 300 volunteers, none reported any symptoms except for occasional soreness around the injection site.
**********
Unfortunately, CoviVac probably won’t be available in the U.S.
IM Doc I would take that vaccine in a flash if it were available here – and I would be encouraging all around me to do so.
I do not have the same feeling about our current options – and have wondered why we are not working on something similar to this.
And you are right – Hell will freeze over before a Russian vaccine is available here. Especially if folks like Rachel Maddow are still allowed on the national airwaves.
With regard to the CDC chief almost breaking down in tears.
I am very likely what would be called old school. I embrace that.
I have been rather perturbed all year by the physicians and nurses and health care workers going on the national news and breaking down in tears. That is of course in between production of TikTok videos, many of them done in crowded hospital areas – WITH PATIENTS WAITING FOR CARE WATCHING THE FESTIVITIES.
The very first rule of public health is that fear and panic are the primary enemies. I learned that as a very young physician in the middle of the AIDS crisis – we were allowed to grieve and weep all we wanted in private but to do that in front of patients was unthinkable. It is an age old trait in excellent physicians that is called equanimity. You must be seen as the captain of the ship – no matter how bad things look, patients and their families are looking at you to keep your cool and be strong. The founder of my own specialty, Sir William Osler, penned a very famous graduation speech about this very subject – Aequanmitas – if anyone is interested. I may be forced to send a copy to the CDC after today’s performance.
My now long-deceased Chairman of Medicine must absolutely be doing RPMs in his grave – despite the heroic actions by many, it has been a very poor showing by medicine all year for those to vent for all to see. Thankfully, none of my residency colleagues and certainly none of my years of students have been involved in this display.
Again – I quote the Jedi Master Yoda –
Fear leads to suffering, suffering leads to anger, and anger leads to death.
Fear is the first step on the way to the dark side of the Force.
Riverboat Grambler Ready good comment, but if I may quibble on behalf on the green puppet: “Fear leads to anger. Anger leads to hate. Hate leads to suffering .”
“AstraZeneca: German team discovers thrombosis trigger DW (David L)”
Is it Heparin? They won’t say in the article. My bet is heparin. (Not the trigger, but the cheap treatment)
Supposed to get AZ on Wed morning. Last weeks vaccinations that were supposed to be done in Berlin were rescheduled for this week. My research group, by Wed will be 100% first dose AZ, with followup doses in June.
Case count is up to almost 100 per 100k in Berlin, Thuringia is still awful at over 200 per, and a lot of other German regions are above 100 per.
For those that think “German efficiency” is a thing, it is just hard-work propaganda. This place is terrible at doing anything besides generating paperwork.
Vaccine rollout has been done in perfectly German style…