Posted onDecember 27, 2020|Comments Off on Should You Consider a “Dry January”?
Goodbye to you. Maybe see you in February.
I’ve run across a number of people who slowly increased their alcohol consumption over months or years, not realizing it was causing or would cause problems for them. Alcohol is dangerous, lethal at times.
From a health standpoint, the generally accepted safe levels of consumption are:
no more than one standard drink per day for women
no more than two standard drinks per day for men
One drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof distilled spirits (e.g., vodka, whiskey, gin).
Dry January was conceived in the UK in 2012 or 2014. The idea is simply to abstain from all alcohol for the month of January. The Alcohol Change UK website can help you git ‘er done. Many folks notice that they sleep better, have more energy, lose weight, and save money. There are other potential benefits.
If you think you may have an unhealthy relationship with alcohol, check your CAGE score. It’s quick and easy.
Alternatively, if you make a commitment to a Dry January but can’t do it, you may well have a problem.
PS: I did the Dry January in January 2020. The only definite change I saw was that I was more productive. E.g., I blogged more regularly, worked out a bit more. The lesson for me is that alcohol makes me a little lazy. At three weeks in, I started thinking maybe I was able to fall asleep sooner but still woke up often, as usual. I also lost three pounds of body weight fat, but had consciously cut back on food intake.
Mediterranean diet (MD) has been related to reduced overall mortality and improved diseases’ outcome. Purpose of our study was to estimate the impact of MD on duration of admission, financial cost and mortality (from hospitalization up to 24 months afterwards) in elderly, hospitalized patients.
Research Methods & Procedures:
One hundred eighty three elderly patients (aged >65 years), urgently admitted for any cause in the Internal Medicine department of our hospital, participated in this observational study. Duration of admission and its financial cost, mortality (during hospitalization, 6 and 24 months after discharge), physical activity, medical and anthropometric data were recorded and they were correlated with the level of adherence to MD (MedDiet score).
Results:
In multivariate analyses, duration of admission decreased 0.3 days for each unit increase of MedDiet score (p<0.0001), 2.1 days for each 1g/dL increase of albumin (p=0.001) and increased 0.1 days for each day of previous admissions (p<0.0001). Extended hospitalization (p<0.0001) and its interaction with MedDiet score (p=0.01) remained the significant associated variables for financial cost. Mortality risk increased 3% per each year increase of age (HR=1.03, p=0.02), 6% for each previous admission (HR=1.06, p=0.04) whereas it decreased 13% per each unit increase of MedDiet score (HR=0.87, p<0.0001).
Conclusion:
Adoption of MD decreases duration of admission and long-term mortality in elderly hospitalized patients with parallel reduction of relevant financial cost.
The clinical efficacy and utility of ivermectin in SARS CoV-2 infected patients are unpredictable at this stage, as we are dealing with a completely novel virus. However, repurposing existing drugs as possible COVID-19 treatment is astute usage of existing resources, and we await results of well-designed large scale randomized controlled clinical trials exploring treatment efficacy of ivermectin to treat SARS-CoV-2.
The authors of this letter mention current clinical trials (~38) with a dose [presumably by mouth] ranging from 200 to 1200 mcg/kg body weight, for a duration of 3–7 days, which is showing promising results both in terms of symptoms as well as viral load reduction. Another article mentioned the usual treatment dose is 0.2mg/kg on day 1 and day 3 followed by Days 6 and 8 if not recovered.
The authors cite the Broward Health hospital system study from South Florida. In this small pilot study, hospitalized patients treated with ivermectin had a better survival rate compared with “standard care,” whatever that was back in Spring 2020. The ivermectin-treated patients received “at least one dose” of the drug at 200 mcg/kg, by mouth. Has this report been peer-reviewed and published yet? If not, why not? (Update on Sept 3, 2021: the article was published in Chest in Oct 2020. The protocol was a single dose of ivermectin 200 microgram/kg by mouth, presumably early in hospitalization, with a second dose seven days later at the discretion of the physician.)
Moving on…
One small study (probably 60 each in the treatment and placebo groups) found that 12 mg ivermectin by mouth once a month impressively protected healthcare workers against COVID-19.
Another study: “Two-dose ivermectin prophylaxis at a dose of 300 μg/kg with a gap of 72 hours was associated 73% reduction of COVID-19 infection among [hospital] healthcare workers for the following one-month. Further research is required before its large scale use.”
A small study in Barcelona found no benefit from a single standard dose (200 mcg/kg) of ivermectin in patients hospitalized with severe disease. They suggest that a higher dose might be useful.
I’ve spent about 90 minutes on my day off trying to figure out if I should prescribe ivermectin to my hospitalized patients. My conclusion is that we need more and better data before it’s ready for prime time. I agree with Dr Ananda Swaminathan, who probably spent many hours more on the subject:
Evidence for the use of Ivermectin is based on in vitro [lab studies, not living animals], prophylaxis, clinical, safety, and large-scale epidemiologic studies (heterogenous populations in multiple different settings) BUT…
Many of the trials thus far are methodologically flawed without enough information about baseline demographics, multiple primary outcomes, soft/subjective outcomes, convenience samples, and unclear definitions, just to name a few
Additionally, a valid concern in evaluating the literature is that many of the trials have not yet passed the peer review process and are in pre-print format
Although Ivermectin is cheap, readily available, with a fairly safe side effect profile, based on the evaluation of the literature above, at this time, Ivermectin should not be recommended outside of a clinical trial to ensure we get a true answer of effect
Ivermectin is interesting, there is certainly signal to evaluate further, but in our desire to want a treatment option, let’s not continue to do the same thing over and over again, as we saw play out with Hydroxychloroquine
Like they say, “more studies are needed.”
Steve Parker, M.D.
PS: Something you can do to help prevent and survive COVID-19 is to get and stay as healthy as possible. Let me help:
Posted onDecember 10, 2020|Comments Off on Where Do You Go For Satisfaction After Injury by the New COVID-19 Vaccine?
No, you won’t have to inject the vaccine yourself
I know it’s a little early to be asking that question. Within a year, an unknown number of you will be asking. Where do you go for satisfaction? The “National Vaccine Injury Compensation Program.” Forget about suing the vaccine manufacturer, distributor, or medical practitioner who jabbed you. They got the federal government to absolve them of liability in most cases.
As far as I know, this program only applies to U.S. residents. Perhaps only U.S. citizens.
The following is verbatim from the NVICP web page, not my words:
Vaccines save lives by preventing disease.
Most people who get vaccines have no serious problems. Vaccines, like any medicines, can cause side effects, but most are very rare and very mild. Some health problems that follow vaccinations are not caused by vaccines.
In very rare cases, a vaccine can cause a serious problem, such as a severe allergic reaction.
In these instances, the National Vaccine Injury Compensation Program (VICP) may provide financial compensation to individuals who file a petition and are found to have been injured by a VICP-covered vaccine. Even in cases in which such a finding is not made, petitioners may receive compensation through a settlement.
How does the VICP work?
The National Vaccine Injury Compensation Program is a no-fault alternative to the traditional legal system for resolving vaccine injury petitions.
It was created in the 1980s, after lawsuits against vaccine companies and health care providers threatened to cause vaccine shortages and reduce U.S. vaccination rates, which could have caused a resurgence of vaccine preventable diseases.
Any individual, of any age, who received a covered vaccine and believes he or she was injured as a result, can file a petition. Parents, legal guardians and legal representatives can file on behalf of children, disabled adults, and individuals who are deceased.
What is the process?
An individual files a petition with the U.S. Court of Federal Claims.
The U.S. Department of Health and Human Services medical staff reviews the petition, determines if it meets the medical criteria for compensation and makes a preliminary recommendation.
The U.S. Department of Justice develops a report that includes the medical recommendation and legal analysis and submits it to the Court.
The report is presented to a court-appointed special master, who decides whether the petitioner should be compensated, often after holding a hearing in which both parties can present evidence. If compensation is awarded, the special master determines the amount and type of compensation.
The Court orders the U.S. Department of Health and Human Services to award compensation. Even if the petition is dismissed, if certain requirements are met, the Court may order the Department to pay attorneys’ fees and costs.
The special master’s decision may be appealed and petitioners who reject the decision of the court (or withdraw their petitions within certain timelines) may file a claim in civil court against the vaccine company and/or the health care provider who administered the vaccine.
Parker here again. I’d never heard of a “special master” before. Makes me think you’re a slave when you enter the system. I searched the “covered vaccines” but didn’t see the COVID-19 vaccines. But I bet they’re covered.
Don’t label me as anti-vaccine in general. I am not. As a child I got the vaccines for polio, measles, mumps, rubella, tetanus, and probably diphtheria, maybe others. I took the hepatitis B vaccine as an adult because I’m exposed to blood from my patients. I’m due for another tetanus booster and will take it without reservation.
I’ve got risk factors for more serious COVID-19 disease: age 66 and hypertension. After reviewing what little data are available from the Warp Speed vaccine trials, I’m not convinced the vaccines are safe enough for me. I’ll take my chances with the virus rather than the vaccine. I’m not afraid of dying from COVID-19; if that happens I’ll be in heaven with Jesus. I’ve lived a full and lucky life, blessed by a wonderful wife, fantastic children, good health, missed Viet Nam by a few years, no major economic upheaval. My biggest concern about catching the virus is the burden it would lay on my co-workers if I’m off-duty for 1 to 3 weeks.
That said, if I were older and had other co-morbidities, I might take the vaccine now. When we have more long-term data on vaccine safety, I might take the vaccine. It could take up to a couple years before we have that data.
Steve Parker, M.D.
PS: I’m doing everything I can to optimize my health and immune system, including weight management and regular exercise.
I’m wrong about the NVICP compensating you financially if injured but the current COVID-19 vaccines. The correct program seems to be the CICP: Countermeasures Injury Compensation Program. File your claim within a year of vaccination.
Posted onDecember 9, 2020|Comments Off on Will Your Proton Pump Inhibitor Cause Dementia?
I have nothing against Prilosec in particular. It can be very helpful.
We have two major classes of drugs that reduce acid production by the stomach. The first was H2 blockers, the granddaddy being Tagamet (cimetidine). Tagamet was the first PPI (proton pump inhibitor) on the market in the U.S., probably 25-30 years ago. Several H2 blockers are are available without a prescription. The second and later class of acid-reducing drugs is the PPI. These are more potent than H2 blockers. Because of H2 blockers and PPIs, and the discovery that H. pylori causes many ulcers, we have many fewer patients requiring surgery for upper gastrointestinal ulcers. Surgery like vagotomy and pyloroplasty. Once the ulcer heals, most folks don’t need to take a PPI for the rest of their lives.
There are reasons our stomachs produce acid. One is that the acid helps kill pathogens in our food before they make us sick. Another is to start the digestion of proteins we eat. You can imagine that drastically reducing stomach acid production has some potential adverse effects.
A German population study a few years ago linked PPI usage with higher risk of dementia.
A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).
“Sweat Pea, why don’t you ask you doctor if it’s safe to stop that PPI you’ve been taking for the last six months?”
The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.
I don’t know about Germany, but there’s evidence that the incidence of dementia has been decreasing lately in the U.S. I’m guessing that the use of PPIs has been increasing over the last couple decades. So this doesn’t fit with the PPI-dementia theory.
Posted onNovember 30, 2020|Comments Off on CA Filipino Nurses in Hospitals Disproportionately Affected By #COVID19 #Coronavirus
New York Governor Cuomo was sending COVID-19 patients to nursing homes from the hospital, to help spread the infection, I guess.
<p class="has-drop-cap" value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80">I work with and respect,many Filipino hospital nurses in Arizona. I wonder what % of California hospital nurses are Filipino. I figure there are federal government programs that facilitate immigration of Filipino nurses to the U.S.I work with and respect,many Filipino hospital nurses in Arizona. I wonder what % of California hospital nurses are Filipino. I figure there are federal government programs that facilitate immigration of Filipino nurses to the U.S.
Filipino nurses in particular were found, as of September, to represent a third of the nursing population’s COVID-19 deaths, despite only making up 4% of all nurses in the United States. National Nurses United believes the death count has gone up since then.
A report release in September by National Nurses United, the country’s largest nurses union, found that California is leading in COVID-19 infection rates amongst health care workers nationwide. The Golden State reported 35,525 infection cases, followed by Georgia at 17,317, then Florida at 16,380. California ranks third in overall health care worker deaths, behind New York and New Jersey.
“A lot of Filipino nurses hold bedside positions,” explained Elizabeth West, a Sacramento registered nurse of Filipino decent who became infected with COVID-19. “We are right next to the patient when they get intubated… when they go into cardiac arrest… we are the first ones there.”
Posted onNovember 29, 2020|Comments Off on Olive Oil Lowers Cardiovascular Disease Risk
Olives, olive oil, and vinegar: classic Mediterranean foods
A new analysis of the Nurses Health Study confirms the headline above. Olive oil, of course, is a primary component of the healthy Mediterranean diet. From the American College of Cardiology:
Higher olive oil intake was associated with a lower risk of CHD [coronary heart disease] and total CVD [cardiovascular disease] in two large prospective cohorts of US men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD.
***
This study of well-educated health professionals is the first in the United States to show the relative value of higher intake of olive oil for preventing CHD and CVD. It was conducted in the era that margarine was primarily trans fatty acids and would not apply to the present soft and liquid margarines. The benefit attributed to olive oil is not simply the substitution for saturated fatty acid. The modest benefit of olive oil in the United States occurred at relatively low olive oil intake (average 12 g/day). In contrast, the Mediterranean diet generally has over 25 g/day. In European studies, a healthy cohort had a 7% reduction in CHD risk for each 10 g/d increase in olive oil; extra virgin olive oil reduced cerebrovascular events by 31% in a high-risk group, and regular olive oil was associated with a 44% lower risk of CHD after about 7.8 years in Italian women survivors of an MI. Amongst the benefits of olive oil include positive effects on inflammation, endothelial function, hypertension, insulin sensitivity, and diabetes.
Posted onNovember 21, 2020|Comments Off on Vitamin D Seems to Play a Role in Preventing Severe Illness and Death From #COVID19 #Coronavirus
If you have to be on a life-support breathing machine (ventilator), this qualifies as severe COVID-19 disease. Ventilator is at the bedside out of the picture. To tolerate the tube in your throat, you’ll be in the “medically-induced coma” you read about in the news.
After studying global data from the novel coronavirus (COVID-19) pandemic, researchers have discovered a strong correlation between severe vitamin D deficiency [based on blood levels] and mortality rates.
Led by Northwestern University, the research team conducted a statistical analysis of data from hospitals and clinics across China, France, Germany, Italy, Iran, South Korea, Spain, Switzerland, the United Kingdom (UK) and the United States.
The researchers noted that patients from countries with high COVID-19 mortality rates, such as Italy, Spain and the UK, had lower levels of vitamin D compared to patients in countries that were not as severely affected.
Our bodies have two source of vitamin D. Our skin can make it if given sufficient exposure to sunlight, or we can ingest it. Many folks don’t swallow and/or absorb enough of it, or don’t get enough sun exposure.
I’ve never been to Europe and readily confess I don’t know much about it. I figured the UK doesn’t get much sunlight, but Spain and Italy do (at least southern Italy). Maybe the heavy air pollution in northern Italy—e.g., Lombardi—blocks out the sun.
Not a lot of sunlight penetrating through this forest
The researchers say that vitamin D keeps the immune system from over-reacting to the virus infection. A hyperactive immune system response causes widespread inflammation, which in turn damages various body tissues, leading to severe illness and sometimes death. This is the “cytokine storm” you may have heard about. That’s the theory anyway.
I never knew vitamin D was involved in the immune system, or if I did, I forgot. Like most physicians, my interest in vitamin D relates to calcium metabolism and bone health/fracture prevention.
Professor Backman is quoted in the article:
It is hard to say which dose [of vitamin D supplement] is most beneficial for COVID-19,” Backman said. “However, it is clear that vitamin D deficiency is harmful, and it can be easily addressed with appropriate supplementation. This might be another key to helping protect vulnerable populations, such as African-American and elderly patients, who have a prevalence of vitamin D deficiency.
A few days ago, CNN reported that black people are four times more likely to die from COVID-19 than are whites. Here in the U.S., we’ve seen disproportionately high fatalities among blacks living in Chicago, New Orleans, and Milwaukee County, Milwaukee. I’m not the first to wonder if vitamin D deficiency is a contributing factor. I mentioned earlier that our skin makes vitamin D when exposed to sufficient sunlight. But that process is less efficient in darker skin. And folks at more northern latitudes tend to get less sun exposure, particularly in winter. (Lack of sunlight shouldn’t be a problem in New Orleans). We’ve know for years that U.S. blacks have “sub-optimal” vitamin D blood levels. Click for even more reading on this issue if you’re crazy; it’s complicated. Despite low blood levels of 25-hydroxyvitamin D, blacks are not prone to thin-bone osteoporotic fractures like whites and east asians. Some experts suggest that higher rates of diabetes and hypertension in U.S. blacks is related to low vitamin D levels.
What we don’t know is:
If you have COVID-19 and try to augment your vitamin D level with a supplement, will you have a better outcome?
If you are deficient in vitamin D now but take measures to raise your blood level (via food or supplementation), will you be less likely to contract COVID-19 and able to avoid serious illness if you do get sick?
Would the answers to the first two questions depend on whether you have black, brown, white, pink, or polka-dotted skin?
Hey, doc. Tell me something concrete I can do now to improve my odds of surviving this pandemic!
If you’re black of otherwise dark-skinned, I don’t know what to tell you.
If you qualify as a vulnerable person, why not ask your doctor to order a vitamin D blood level (called 25-OH-vitamin D)? If that’s not possible, ask your doc if 1,000 units of vitamin D3/day (cholecalciferol) by mouth is a good idea.
Steve Parker, M.D.
PS: About a week ago I ran across a study finding that pre-sickness use of vitamin D supplements was linked to worse outcomes in COVID-19. I tried to find it a few days later but couldn’t. I’m sorry if this perplexes you. Welcome to the scientific literature and nature of medical practice.
Posted onNovember 20, 2020|Comments Off on Face masks: Panacea or Poppycock? #COVID19
If she got the ‘rona, her mask my protect YOU, whether or not you wear a mask
Here’s an excerpt from the recent Danish study that questions the efficacy of facemarks in preventing transmission of SARS-CoV-2 virus. Note that there were ~3,000 folks in both the experimental and control groups. The experimental group wore surgical masks, so this study says nothing about cloth masks, N95s, or bandanas. Also note this study was done at at time early in the pandemic when mask-wearing by the public was not at all common, quite a bit different from today’s world in many places. The investigators suggest that for face masks to prevent transmission of the virus, the masks need to be worn by already-infected, viral-shedding people.
In this community-based, randomized controlled trial conducted in a setting where mask wearing was uncommon and was not among other recommended public health measures related to COVID-19, a recommendation to wear a surgical mask when outside the home among others did not reduce, at conventional levels of statistical significance, incident SARS-CoV-2 infection compared with no mask recommendation. We designed the study to detect a reduction in infection rate from 2% to 1%. Although no statistically significant difference in SARS-CoV-2 incidence was observed, the 95% CIs are compatible with a possible 46% reduction to 23% increase in infection among mask wearers. These findings do offer evidence about the degree of protection mask wearers can anticipate in a setting where others are not wearing masks and where other public health measures, including social distancing, are in effect. The findings, however, should not be used to conclude that a recommendation for everyone to wear masks in the community would not be effective in reducing SARS-CoV-2 infections, because the trial did not test the role of masks in source control of SARS-CoV-2 infection. During the study period, authorities did not recommend face mask use outside hospital settings and mask use was rare in community settings. This means that study participants’ exposure was overwhelmingly to persons not wearing masks.
Advanced Mediterranean Diet 