IM Doc pt 37

May. 31st, 2022 02:35 pm
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April and May 2022 Naked Capitalism posts and comments featuring IM Doc.

Since Covid is winding down as a theme there, I'll be selecting IM Doc's comments for those that relate to medical issues. The first one, though, is quasi-medical but just too good to pass up:

IM Doc
One thing is for sure. I would be very very careful about medical evaluations done over TV or magazines. There is nothing like seeing and feeling the patient’s body and organs in your own hands and eyes. There are exceptions to this. Diagnosis of dementia and other neuro problems is often patently obvious just by watching behavior on TV. For example, Joe Biden – his neurologic issues are apparent for any trained eye to see – the marked change from baseline, the irrational bursts of anger, the gradually worsening and severe gait disturbance ( that particular type is very associated with dementia), the slouch when he walks, the way he holds his face/eyes, the confusion, getting lost in speech, having his family or handlers constantly cover for him, etc . A bunch of disparate symptoms that are behavioral and obvious are apparent. If this type of patient showed up in my office, after a few minutes of observation, I would order a neuro-cognitive evaluation instantly.


  1. IM Doc

    Impressive.

    A paper written by Dr. Fauci and 2 others. Dr. Fauci himself is listed as the corresponding writer.

    As I have repeatedly stated for the past 2 years, when one looks at any of the standard textbooks of Infectious Disease, this “lack of herd immunity” concept is front and center in the chapters on Coronaviruses and even other respiratory virus families. This is nothing new. This has been settled science for decades.

    Coronaviruses, influenza viruses, and other respiratory viruses simply do not behave with herd immunity the way others such as measles and smallpox do. They just do not. It is not in their nature. Those of us who have taken care of flu patients all of our lives know this. It has been just horrible watching this complete misconception that COVID has herd immunity being preached by our media for the past two years. And both sides have been doing it. One side is all about vaccine immunity – the other is natural immunity. HINT – Vaccine immunity will not last but neither will natural immunity. There is debate about which would last longer, but both sides have been completely out of line professing this for the past 2 years. Anyone who had bothered to read a word in these textbooks would have easily been able to predict the failure of the vaccines to decrease transmission and infection. But they also should know that infection based immunity will not last either.

    WHAT WILL HAPPEN – is as time goes on, we will build up enough immunity to decrease our immune response to future variants in the deep hard drives of our immune system. That will allow us to get sick ( and get sick we will ) but will not be sending us to the hospital. But again, we will still be passing this around for the rest of humanity. And each of us will get sick repeatedly as we do so. But eventually it will be just an illness that we live with just like Coronavirus OC43. The issue is getting from where we are now to that point. OC43 was almost assuredly birthed into the world in the 1890s as the Great Russian Flu. And here we are 130 years later – and it is still being passed around to every human on this planet. And HINT – it took 12-15 waves in the 1890s during the acute pandemic phase for this to calm down. We have now had 3 waves with COVID. Wuhan, Delta, and Omicron. And 2nd HINT – the succeeding waves in the 1890s were variable in their virulence – It was not a step wise progression down in virulence.

    I am so sorry to be be the bearer of bad news. Since OC43 was likely the only other wide Coronavirus pandemic in living memory, it is what we have to compare COVID to. If the comparison holds up, we still have quite a ways to go and there will likely be multiple future waves and variants – some easy and some not so fun. Introducing a non-sterilizing vaccine into this mix is one of the most unique medical experiments ever conducted. I am going to be very interested to see how this all works out.

    The other critically important outstanding issue about SARS COV2 that is still outstanding is the exact damage it is able to convey on its victims and the penetrance of this damage in the population. This is a very important issue – and is COVID specific. We just do not know yet.

    I do not know about you, I find it almost alarming that 2 years into this, Dr. Fauci is writing a paper about an assertion that should have been known by our authorities on DAY 1. Believe me – this was being discussed in Infectious Disease and other medical conferences from Day 1. And he is writing this as if this is a new thing. Downright alarming.

Questa Nota

Hunter Biden Laptop is the biggest scandal since Watergate.
The walls are closing in.
The real crime is the coverup.
Did I forget to mention that the walls are closing in?

Don’t you miss Carl Bernstein? /s

 
  1. Yves Smith

    This is slow and grinding too. Apparently what is on it is super bad, and now we also have the press willing to take up his China connections too, which also appear to have some lucre attached.

    Gossip from IM Doc, from an admitted R source:

    2 interesting patient conversations this week. One was a different retired US SEN than before. GOP. Informed me he expects Biden to be impeached before the end of the year or at a minimum to suffer grave political consequences. “The Dems will have to – once the contents of that hard drive start coming out….I am an old cynical burned out guy – but what I am hearing is even making me want to vomit.”

In this post, Lambert embeds his usual graphs and whatnot, and quotes IM Doc on the counting of patients in official figures. I don't feel like trying to extract the context and the quote, so if you're interested, please just click through: https://www.nakedcapitalism.com/2022/04/200pm-water-cooler-4-7-2022.html.

  1. Lou Anton

    This country, man. We got an incredible demonstration of universal healthcare for a single issue (thanks Trump, for real), and now we yank it back and send people to Painville.

    We get these small glimpses of good things, only to have them choked off ASAP. It’s the one bipartisan thing. Don’t let the proles have even a modicum of prosperity.

     
    1. IM Doc

      I have had multiple COVID positive patients this week – all fairly ill. All vaccinated. Many boosted.

      Although none of them have been critically ill, I did believe that 8 of them met the threshold for Paxlovid. Not one of them could actually obtain the meds. We either had a pre-authorization from hell, rationing pharmacies with their own criteria for the drug, or inability to afford the outrageous co-pay.

      Alas, back to the old standbys of IVM, Zinc, Fluvoxamine and inhaled steroids. They do seem to work much better than the Paxlovid anyway. Although even the inhaled steroids are now specifically NOT being paid for by some insurance companies for COVID. They too are very expensive and there is a sudden critical shortage of at least one of them.

      What a tragic joke this has become.

      People should really read this whole tweet. It is exactly what patients go through all the time when COVID happens in a big corporate medical system. I thank God daily that I am no longer part of those monstrosities. The harrowing part of his tweet was how much it was going to cost him to get the monoclonal antibodies. I just see flashes in my mind of all my patients who are already struggling to make ends meet. And the wait because the center was “crazy busy” all of a sudden. This has all the potential to be a tragedy of extreme proportions. I do not have a good feeling about all of this.

IM Doc has an entire large-ish very vaxxed family (3-4 shots each) that went to the Star Trek convention and all now have Covid. He adds that George Takei had been putting up hateful tweets about the unvaxed and he was at this convention:

Here's Yves, being dense ("They're not wearing masks!") rather than astute ("They're vaccinated!) - but anyway...

Yves Smith

IM Doc reports that all of his Covid patients in the last month were vaxxed, the majority triple or four times vaxxed.

The ones who are not getting Covid are masked service workers. The ones who are getting Covid are people who are going to restaurants, parties, conventions, weddings, and not wearing masks.

People who get Covid are now overwhelmingly the vaxxed who have abandoned Covid precautions.

So your position is illogical. You should be avoiding venues where people go unmasked, period, unless your exposure is brief. I consider grocery stores at off hours (store pretty empty and I am wearing a N95 mask) to be OK.

 
  1. playon

    I have a case of COVID-19, I first felt the symptoms on Saturday. I am triple vaccinated and have been wearing a mask whenever I go out for almost two years. There were a few times when I did put myself in risky environments as part of my work, but none of those times were recent enough to account for this current infection. I often remove my glasses when shopping as they tend to fog up, so that may have been how I became infected. It feels like a bad flu (I am 70 but in fairly good health).

    I tested myself with a rapid home test kit which was negative, but the symptoms are classic COVID, particularly the loss of smell, along with sore throat, dry cough, fatigue etc. So I went to the local hospital where they had set up a COVID testing clinic, only to find a sign on the door that read “the COVID clinic is permanently closed” — darn — I forgot that the pandemic is officially over…

     

Various Covid Updates

Posted on April 23, 2022 by 

While the lack of any big Covid news absent the Administration’s foot shuffling when its mask mandate was shot down, that does not mean Covid should be ignored. Our Covid brain trust and readers have been sending news.

Fresh from IM Doc:

62 patients who are COVID positive – either ill themselves or found during testing or primary contacts. Again, zero unvaccinated. Of the 62 -35 were primary vaccinations, an additional 11 are with one booster – and the other 16 were 2 boostered. I had no partial VAX or J&J this week.

ZERO unvaccinated. That makes 7 weeks of not seeing a single unvaxxed patient. Colleagues all over America are reporting similar issues – usually less than 5% unvaxxed are being reported.

Something is going on. I do not believe for a minute it is because the unvaxxed have decided not to seek care. Nor is it young and healthy excuse – many of the positive vaxxed patients are young and healthy.

I am becoming increasingly concerned that this may go pear-shaped if/when a more noxious variant emerges.

And another alarming issue is rearing its ugly head again. THIS TIME MUCH EARLIER. This did not start last year until the mid to late summer. I have had to admit 3 patients this week – all adults – all 3 with RSV pneumonia. All 3 fully vaxxed and double boosted for COVID. One of these was a little old lady with DM – the other 2 were young men, healthy and robust. All had severe pneumonia. I have never admitted an adult with RSV until the COVID vaccines. Not once in 30 years. Here we go again.

Thankfully, so far, the COVID has been pretty mild. None required admission this week. However, I am certain that at most 5-10 were reported to the health officials. Severe under-reporting is going on. THERE IS A REASON THE CDC and BIDEN PROVIDED AMERICA WITH THE FREE TESTS – AND IT HAS NOTHING TO DO WITH PATIENT CARE.

Needless to say, it’s not encouraging to see the vaccinated feeling sick enough that they need to see doctors. Regarding the apparent underrepresentation of the unvaccinated, it may be that they are on average more cautious than the vaccinated, who were sold repeatedly on the idea that being vaccinated protected them from getting Covid, or at least from getting all that sick. While the plural of anecdote is not date, the two unvaccinated people I know are insanely careful, hardly seeing anyone and well masked when they do.

Lambert’s Covid data wraps have shown the MA wastewater count rising to a level that was at the high end for all waves before Omicron. It had fallen off this week, but that may be an artifact of Easter/spring vacation holidays.

Additional cheery news:

 

 

Note this hypothesis could also help explain what IM Doc is seeing: individuals who got asymptomatic cases (as in they may not have realized they contracted Covid) before now getting symptomatic ones.

More variants and more waves:

 

And it’s growing!

 

Scientist GM points out this wave is a month ahead of schedule. He also points out the inconsistency in Gottlieb’s carrying water for the Administration:

In the meantime, in the US, we have some not nice subvariants to watch (hat tip guurst):

 

 

 

So it’s too early to even try to call trajectories, but these emerging variants have the potential to cause yet more trouble, particularly in the US, where we are again throwing caution to the wind.

____

There's plenty to chew on in the following post (more than just IM Doc's comment, which'll put you off pharmaceuticals if you aren't already, that follows):
 

Will Pfizer’s Paxlovid Be the Game-Changer that Saves Biden’s “Test to Treat” Program?

IM Doc

I will add a real time story.

This is going on in my office now as I speak.

An 82 year old fairly healthy woman with AFIB that is well-controlled was found to be COVID positive on Easter Sunday. She had very very minimal symptoms. She is quadruple vaxxed – with her 4th booster being given on 4-2. I would never have started her on PAXLOVID myself as she is not what I would call high risk.

Patient is at baseline on OXYBUTYNIN for bladder control from her urologist and trazadone for sleeping at night ( this is an SSRI). She is also on FLECAINIDE for atrial fibrillation.

Unfortunately all three of these agents are contraindicated with ritonavir. Those of us who have worked around AIDS patients know that this is not a drug to be blown off. Even one dose can set off problems if you happen to be on the wrong other agents.

She is in my office right now with a condition known as angioedema. Her cheeks and her neck are profoundly swollen and she has some mild swelling of the tongue. Have seen this a couple of times with ritonavir in AIDS patients as well. It is listed as one of the common problems with Paxlovid. And it can kill someone if it happens quickly or dramatically. Yes, it can.

She is being admitted at this moment.

She was in the medical system on Easter Sunday. One provider saw her – and another prescribed the drug without looking at her chart. Having this drug handed out by pharmacists who may or may not appreciate the problems puts shivers down my spine. THIS DRUG IS NOT AN M&M.


Not medical-related, but still entertaining:

  1. IM Doc

    I would add this comment from an 85 year old patient this AM.

    “When I was a young mother, I took my kids to see Mary Poppins about 6 times…..Never in my wildest dreams would I have expected to see a government official do a Mary Poppins singing routine about a subject that is so consequential as censoring and first amendment rights….Did anyone screen this person?…..Did anyone realize what a complete moron she appears to be?…….

    And then the kicker that I am hearing all the time now from my patients……..”I am going to vote GOP for the first time in my life, just to make sure these clowns have some kind of oversight…..How embarassing…..”

    I had no idea what she was talking about. I had to go look it up. I almost spit out my coffee when I saw the Mary Poppins song……Whoever that woman is – she really is a joke. It really struck me as a sign of a once great power entering its terminal decline. It is almost palpable.

    I cannot tell you all how just completely unusual it is for me to have patients talking politics like they are now. And each month that goes by, it appears to be getting bleaker by the minute for the Dems. This lady above is a life long Dem.

Yves Smith

Boosters do little to nothing to prevent infections. They prevent hospitalizations. And Omicron and BAs that ought to be named variants but aren’t largely escape the vaccines. The latest from IM Doc, and his reports for the last two months have been like this save everyone in his hospital being sick:

We now have an entire urgent care staff – including 2 MDs – who are all COVID positive. I am not just swamped – I am torpedoed.

Cases in my practice last week were up again – 88 in total. Not a single unvaxxed patient, 48 double vaxxed, 22 with one booster, and 18 with 2 booster. No vaxxed, No J&J, and no partial vaxxed.

Thankfully, no admissions. Just like last year, long phase of very mild illness.

One theory I have heard and made me think – is maybe all the unvaxxed vulnerable have died and all the unvaxxed we have left are young and healthy. I do not think so – still seeing lots of unvaxxed with risk factors in the office every day.

I have now gone two months without seeing a single unvaxxed patient. In an attempt to see if somehow this was just me, I contacted family practice docs in each of our surrounding counties with much lower VAX rates – on the order of 30-40%. Both had the same story – the absolute number of cases was WAY higher than this time last year……but in one county he had seen only 1 unvaxxed patient since MAR 1, the other county doc had seen only 7.

Something is very very wrong. Again, cases are way higher than last year and virtually all are among the VAXXED. I learned this week that in the official reporting, all of the double vaxxed only patients are being sent in as UNVAXXED – so it appears our unvaxxed rate is about 50%. But as I have explained above, that is completely misleading. The truly UNVAXXED are not the problem here. Furthermore, the numbers being reported are doing good to being 1/6 of the total. Almost all are on home or rapid tests. But unfortunately, as of this weekend, on the Drudge Report running 7 day counter – we are now seeing higher official numbers than last year. You just have to multiply by 6 on this years’s number to get close to accurate – so we are in a whole new world.

Now, I have attached an article from the paper over this weekend [contains anecdotes of many getting Covid and isolating]. Please note – this is in stark contrast to last year. I tracked down the first article of the year last year of an “unexpected surge” – which was published the week after JULY 4 – so we are two months ahead. The cases were MUCH lower last year – and we were still in the “vaccines have solved everything” mode.

All I can say is that quite a few of early vaccine publicity materials such as ones that said HCWs would become “bulletproof” did not age well – and would be considered misinformation today. These people are never going to be able to take back this stain on the reputation of public health. “Vaccination is like a superpower”…..and the nurse explaining that she was doing the VAX to get to visit her mom.

Again, in the attached article – one year later, the NH [nursing home] is in lockdown – and has been since March. Multiple patients from there with COVID in and out of the ER and hospital. All quadruple vaxxed.

Now, the scary part. The doctor’s meeting this last week was on FRI – everyone is noticing this too. Almost universally, the positive patients are vaxxed/boosted. And at my medical conference, this same pattern is being noted everywhere. The medical conference speaker had a long talk about Original Antigenic Sin and how this may be playing a role. There was also an open discussion about withholding the 4th shot until June – because JUL and AUG historically have been the bad months – and the shots are doing well to last a month. Also – a big discussion ensued as to whether the truly unvaxxed were safer in their current status. Still no resolution there – lots of arguments back and forth.

This I can tell you. We already have entire countries, Denmark, Sweden and Norway, abandoning their VAX programs – clearly largely because of what we are seeing. But there is something all of a sudden missing from press articles – that has been there for.a year – look at this attached one from small town America – not a word about getting vaccinated or boosted – not a peep. Not a peep about the advantage of vaccination, etc. I think the lack of mention is the first step.

Just look at these three random large articles. For a year now – every article would be stuffed with either entreaties to be vaccinated or jeremiads against the losers who were not. All of a sudden the past few weeks – NOTHING OF THE SORT.

I may be cynical from years of Big Pharma PsyOps. But something is up. I think there is growing realization of a big problem.

https://www.dailymail.co.uk/news/article-10772223/Weve-not-seen-WORST-Covid-warns-Microsoft-billionaire-Bill-Gates.html

https://www.jpost.com/health-and-wellness/coronavirus/article-705505

https://www.jpost.com/health-and-wellness/coronavirus/article-705669

8E8E0683-244B-46FE-9BB1-9E6A6E27C280.jpeg

 

Re a tweet about the White House correspondents' dinner superspreader event:

IM Doc

I saw this response to the Dr. Ding tweet above about the WHCD superspreader event. Apparently, they did not want to use some types of mitigating equipment because of the blue light this may throw off. It would tend to make someone like Biden sickly and they did not want to give anyone any ammunition.

https://twitter.com/GopSux2/status/1519692895988686849

Hey guys, FYI, as a physician, having an 80something actually get COVID is a real good way of having someone look sickly and whitish. It is called the 6 foot eternal dirt nap.

I swear, there are days I just cannot believe what I am reading.


IM Doc

Regarding Dr. Wachter –

He is considered the founder of the type of physician today we know as “hospitalists.” These are internists that work only on admitted patients in the hospital.

This movement replaced the “Marcus Welby” approach to medicine that had been present since William Osler where your own personal physician took care of you in the hospital. There are vanishingly few left that practice the old time medicine.

This was all done in the name of “efficiency” and “cost-savings”. It has taken about a generation for this to come to fruition but it is now almost universal. I could never tell there was any kind of cost savings or efficiency. A brand new doctor sees a patient in the hospital with all kinds of medical issues and before you know it tens of thousands of dollars of tests are ordered – and there are 5 or 6 subspecialists on the case instantly. A lot of reinventing the wheel to the tune of tens of thousands of dollars.

I cannot tell you the level of peace of mind that occurs when I go and see people in the hospital. They see a friend, someone they trust and know – and someone they know will keep an eye on them. The hospitalists are often excellent doctors, but are on shift work, change every day, and who knows what happens with the hand offs.

So when you are in the hospital with your elderly family member – and you are seeing a different attending physician every day, and no one seems to know exactly what is going on and chaos reigns – you can think people like Dr. Wachter. I have had the privilege of being the adult caregiver for 3 elderly family members in big cities the past 2 years – and even I, a long-time internist, was whomperjawed by the chaos.

The current trend being championed by Dr. Wachter is to even increase efficiency more by having these groups of hospitalists bought up by hedge funds and big corporations. If I am not mistaken, he has a huge share in one of the larger ones ( or at least did – I may be wrong about that).

Additionally – Dr. Wachter was one of the big pushers of the electronic health record as it is today. So again, be very grateful for him, when you are in your doctor’s office and they never bother to look at you and instead are typing into a computer the whole visit.

As such a veritable genius, Dr. Wachter is therefore entitled to all the amenities that come with being a member of the medical version of the PMC. Similar to all the members of the various boards of medicine. They have the Boards buy multimillion dollar condos for people like him to stay in, they all fly first class, and generally get to pontificate from afar on how to care for patients while never deigning to touch a patient ever.

All of this can be researched at a blog called drwes.blogspot.com. Dr. Wes is an example of someone who truly has courage. He has documented each and every one of these abuses for longer than a decade.

Just my 2 cents about your current honoree.
 

IM Doc

Just one of many reports on Dr. Wes website about the current honoree Dr. Wachter –

https://drwes.blogspot.com/2016/01/love-ethics-and-quality-assessment.html

Again, I point out – these are the physicians that our media go to for enlightening discourse about medical issues.
 

IM Doc

Regarding the list of things Americans are concerned about in this election cycle. COVID being on the bottom of the list, and Ukraine being nowhere.

#1 – Inflation

#2 – AFFORDABLE HEALTH CARE.

Excuse me, Americans, for being so insolent, but OBAMACARE was engineered to make Health Care both more affordable and more accessible. It was even called the “AFFORDABLE” Care Act.

Why would you have the nerve to have that be your #2 concern on the list after all that Obama did for you? How dare you?

I will say it again – Obamacare has done nothing to make health care more affordable in any way. Indeed it is the exact opposite. I have never in my life had so many “insured” going without needed care. And who would have thought we would have needed so many “GoFundMe” pages for patient’s health issues after Obamacare.

It is just another example that if you wait long enough – the truth will eventually come forth.

Obamacare has been the single biggest debacle/disaster in politics in my lifetime. I see multiple patients daily suffering under the load. It is one of THE big reasons why this life long Dem will no longer vote for any Dem again until there is a major clean up.

Reply ↓
  1. Eudora Welty

    I am doing some temporary work in a high-tech cancer center in support for patients.
    Some anecdotes:
    — A patient said, “I was hoping I could finish chemo before my money ran out, and that didn’t happen, my money ran out, but at least I still have my job and my dog (and my life).”
    –A patient had to do the Medicaid spend-down, and (due to needing a Bone Marrow Transplant) NOW has to raise $50,000 via Gofundme for post-transplant 24-hour personal care? Maybe someone can enlighten me, but I wonder if she could have placed the funds she needed to spend-down into a post- transplant personal-care fund, rather than have to become broke on purpose and then have to ask for money. Also, Medicaid will pay for cancer-center-sponsored housing after the transplant but will not pay for 24-hr personal care.
    –A man who worked in construction had to retire and go on Medicaid in order to be able to finance the bone-marrow transplant. I’m surmising that his company’s insurance doesn’t cover such transplants.
    –Finally, the capper to me: Patient #2 above asked her doc, what if I don’t do the transplant? Apparently, a bone-marrow transplant is standard of care for Multiple Myeloma. The doc said, “You will be in a lot of pain, and you will die.” I guess there are no options besides a transplant?

    Our health-care safety-net is abysmal.

    Reply ↓
      1. Samuel Conner

        There’s a liquid asset test for eligibility for Medicaid, and if you have too many liquid assets, you have to get rid of them before you can enroll. One’s home equity is not included in the spend-down requirement, but I believe that Medicaid gets a lien on it.

        It would seem to me to make more sense to permit immediate enrollment with the placement of the surplus assets into some kind of trust or escrow to be used to reimburse Medicaid. Then one could start treatment immediately.

        Looking from the outside, it has a bit of the feel of a Kafka nightmare. I imagine that it’s much worse in lived experience.

        It’s hard to not believe that They really do want us to die.

        Reply ↓
        2. Ed Miller

          Not just liquid assets. A farmer’s widow needs to divest everything, including any portion of the farm, and get on Medicaid. My spouse’s mother had this problem in MN. Her care would have nearly bankrupted her children and their families if she still had a financial interest in the farm.

          Reply ↓
          1. Objective Ace

            Also worth noting that this is gamed by the already well off. Placing the home in a life trust so your heirs can inherit it without the government seizing it.

            *Not a lawyer, but this is what my wife’s parents told us after consulting with a lawyer

            Reply ↓
      2. IM Doc

        It has varied in different states where I have been.

        In general, in order to qualify for Medicaid benefits – you have to have reached a certain threshold of liquid assets. So, if you have a let’s say 50K savings account, every bit of that has to be gone before you qualify for Medicaid.

        This becomes a real problem with elderly demented patients who have some assets, but who could never afford nursing home care without Medicaid – but sorry – you have 8K in the bank or whatever. Absolute nightmares I have seen over my life.

        But for younger people, you literally have to be broke to qualify – and I have seen so many gut-wrenching things happen when there is a young dad, for example, who has terminal cancer – and mom and kids have to literally bankrupt themselves (ie the meager amounts they had saved for kids’ education, etc) before Medicaid will pay for dad’s care. There are literally days I want to just crawl up and die. And yes – this exact thing can absolutely happen to those with Obamacare – who can no longer afford premiums or deductibles for whatever reason, and then they get the “benefit” of the “Medicaid expansion.”

        It is tragic on every level. The fact that we had a President and legislators who thought this was a great idea – speaks absolute volumes. I almost have a PTSD reaction when a young working-class father or mother is diagnosed in my practice with bad cancer. I know their future and what their kids will be going through.
         

        IM Doc

        I think I need to make sure we all understand the mechanics of what is going on.

        I see all the commentary online about COVID vaccines or COVID itself causing the stroke of Mr. Fetterman of Pennsylvania. My take on this is that YES – 25-35 year old jocks dropping dead or going down all over the world playing soccer at the rate we are seeing it is very very concerning. These people just really do not do that at near the level we have seen the past 12 months. Something is happening there.

        However, I have seen plenty of 52 year old stressed out, overweight, hypertensive smokers who have gone down with AFIB. Press reports are not talking about his current smoking habits – but he is well known to be a very long standing aficionado of marijuana. I repeatedly tell my patients – in general – one marijuana cigarette does the same damage as 10 tobacco cigarettes to the lining of your arteries and heart – so long-time marijuana smokers are just as at risk of these types of things as tobacco smokers – maybe more so. Add some significant mental stress and a little screaming or throwing phones – and here we go.

        Your atria are the two chambers on the top of your heart. Fibrillation is the term we use when the electrical activity in those chambers becomes chaotic. The atria are NOT the actual pumping chambers – that is the ventricles – but they do prime the pump. When they are fibrilliating they look like jello – instead of squeezing. So, blood does not get pumped through correctly, and can indeed sit there so long it can clot. When that clot gets released, because of the hemodynamics of the arterial system (too long to delve into here) – it is almost always going to end up going to the brain. The middle cerebral arteries to be exact. This is a disaster. These are some of the worst strokes you can have and often cause left or right sided paralysis. If the left side is involved, it will take out the speech centers – and the person is not going to ever be able to talk like they have in the past. It will get better – but it is severe and noticeable for the rest of their lives. Again, these are horrific strokes.

        The pushback into the rest of the body you are describing is congestive heart failure. This can happen in AFIB but not commonly in the acute phase. Blood clots in the legs are rare with this – and would never get to the brain to cause a stroke outside of some very rare altered heart anatomy.

        We should not rush to blame every stroke on COVID or vaccines. I have seen plenty of 52 year old guys in my life with this exact same issue. More often than not “stressed-out screamers”. More often than not profoundly and permanently life-altering.

        As has often been the case with medicine (Chaucer, Dickens, Bronte, Milton and Shakespeare are examples), a non-medical person is the first known writer to have ever described a middle cerebral artery stroke. That honor belongs to King David of Judea. From Psalms 137 – describing perfectly the right sided paralysis and the speech defect that happens in a LEFT middle cerebral arterial stroke.

        If I forget you, Jerusalem,
        may my right hand forget its skill.
        May my tongue cling to the roof of my mouth
        if I do not remember you,
        if I do not consider Jerusalem
        my highest joy.

UK monkeypox alert as health chiefs detect another FOUR cases of killer virus with NO links to Africa — as gay and bisexual men are urged to look out for ‘unusual rash’ Daily Mail. IM Doc:

There is apparently no clue the transmission line in the UK. This virus has a fatality rate of 10%. Only supposed to be mildly to moderately contagious.

Scientist GM’s reply:

Yeah, that means community spread. Not good, but then there haven’t been rampant out of control epidemics of it in Africa, so probably won’t cause the apocalypse it would have if it was a bit more contagious.

Although there is a wrinkle here, which is that smallpox vaccination works against this too, and over time smallpox immunity has been diluting more and more as vaccination against it stopped in the 1970s. So we might end up with the monkeypox adapting better to H2H spread, the boomer generation dying out, and then we’ll have a big problem
 

While it's possible IM Doc might come and post in the last hours of 5/31, I'm making a gamble that he won't, so we're all caught up for now!
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