AggieMD04 said:

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There are also a multitude of bad side effects. Talk to anyone who has had to take malaria prophylaxis for travel.

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Honest question, since this is not my field of medicine. When antimalarials are given for prophylaxis, is there some sort of screen first, like a baseline EKG, or is that not necessary because of the dosage or frequency of use of the medication?

I read somewhere that some places have substituted doxycycline for the Z Pak in order to avoid the QT interval problem. Thoughts?

MY personal experience was no screening at all for anti malaria prior to travel to an area where it was recommended.

AgLA06 said:

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AggieMD04 said:

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Of course, no one would be intentionally giving this medication to a child. But remember, in my setting, I'm seeing kids who accidentally get into family medications not infrequently.

With regards to potential dangers, while many people can take hydroxychloroquine with no serious danger, there are specific patient populations that could have major problems with it. For example, it is a QT prolonging drug, which basically means that it keeps your heart from resetting between beats as quickly as it usually would. In most people, that probably isn't a problem, but if you are already taking another medication that also prolongs your QT interval (of which there are more than a few), or if you're a person that already has a genetic prolonged QT, the effects are additive. Once someone's QT interval gets too long, the heart freaks out and goes into a deadly dysthymia. This can kill you before you even make it to a hospital. I know this sounds extreme, but it is a real risk to consider. To top it all off, azithromycin, the other drug they are combing with hydroxychloroquine, is ALSO a QT prolonging medication. So I see why there is hesitation here to just prescribe it as a prophylactic, especially to a mildly symptomatic or symptomatic patient who statistically is likely to get better on their own anyway.

Besides that, it is an immunosuppressive drug, and, again, in a patient that already has some form of immunosuppression, this could cause major problems. The worst part of this, is that COVID-19 already reeks havoc on your immune system anyway, so no one is quite sure if adding this to the mix is the best plan.

There are also a multitude of bad side effects. Talk to anyone who has had to take malaria prophylaxis for travel.

Don't get me wrong. I want this stuff to work as much as any other doctor, but there is this whole pesky "First, do not harm" thing that we all have to abide by, and I think we owe it to our patients to make sure what we are doing isn't harmful first. And again, I mean that for asymptomatic or mildly symptomatic patients where proven benefit has not been seen yet.

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From the outside looking in, I'm not following your reasoning. It appears to be a lot of could happen and might happen as potential down sides when the patient does have Covid.

Sure seems the do no harm would come into play here for the opposite reason. If you're seeing them in the hospital their odds aren't good. Sure seems your doing more harm by not treating them with the best option of medication simply because you don't like it "because maybe" it might do harm when it's more likely the virus will kill them if you don't.

Almost exactly the scenario Rev mentioned about doctors earlier that ruffled some feathers.

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I feel like you missed the last sentence, he's questioning the potential benefits vs the side effects in patients that only have mild symptoms.

Unfortunately it seems like we're seeing the most benefit when this is administered early, or there's also the possibility it's appearing to be effective in folks who weren't going to show serious symptoms either way.

buffalo chip said:

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alittleright said:

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MY personal experience was no screening at all for anti malaria prior to travel to an area where it was recommended.

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A large neighborhood group traveled twice to different sub-Sahara African countries with malaria issues. Our entire group were prescribed Plaquenil for the two trips. We went to a travel doctor for those trips, but everybody received the same prescription. I do not recall any problems and did not hear of any among our groups.

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I posted this on another thread. I worked for a company that sent people to work offshore. Ocassionally that would be somewhere offshore in Africa. Lots of vaccinations and malaria preventatives. Had a guy tell his co workers that he was having dreams of committing suicide. So we get a call from the onsite superintendent. I start doing some internet research and call our company doctor, thats when I learn plaquenil can have some weird side effects. He suggested getting him home as quick as possible. Guy having the suicide dreams swears he isn't thinking about suicide, just dreaming about it. We get him out of there asap out of an abundance of caution. I believe one of the other side effects we learned of was vivid dreams. So, he had a little bit of a combination of two side effects. This is very rare as I understand it.

I was in the Peace Corps in Honduras after college. They gave us Aralen to take weekly, as a malaria prevention. Some older volunteers told us it could cause weird, vivid dreams. I never had any dreams about suicide or anything close to that, but I definitely had some of the most bizarre dreams I've ever had. I actually wound up keeping a journal by my bed so I could write them down if I woke up and remembered them.

a lot of people experience crazy lucid dreams when taking anti-malarials. A guy who traveled with me to Africa for work once woke up sweating and screaming thinking he was being attacked by monkeys.

No, but I don't have to prescribe a ton of medications from the ER in general.

Many of my low income former students head to the ER for everything. It is their family doctor.

They gave us Malarone when we were working offshore in Africa. It messed some people up pretty good. I only had intense dreams for a couple of weeks then was fine. Glad they did not EKG me because I have a naturally abnormal signal though a gazillion other tests have confirmed my heart is normal and healthy.

Boring Username said:

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This epidemiologist is making the point that if we only sheltered the most vulnerable and the rest returned to normal lives we could exterminate this viruses a lot sooner. Of course we dont want to overwhelm the healthcare system, but I am curious if there are prudent risk we could take to try to achieve an optimum curve rather than just flatten it as soon as possible?

https://www.thecollegefix.com/epidemiologist-coronavirus-could-be-exterminated-if-lockdowns-were-lifted/

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He gives the nursing home example & talks about.hers immunity by letting the kids go.to.school.The first thing that popped in my head was that many of the workers in the nursing homes have kids. It would still get to them. Or is my line of thinking off?

emando2000 said:

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Boring Username said:

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This epidemiologist is making the point that if we only sheltered the most vulnerable and the rest returned to normal lives we could exterminate this viruses a lot sooner. Of course we dont want to overwhelm the healthcare system, but I am curious if there are prudent risk we could take to try to achieve an optimum curve rather than just flatten it as soon as possible?

https://www.thecollegefix.com/epidemiologist-coronavirus-could-be-exterminated-if-lockdowns-were-lifted/

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He gives the nursing home example & talks about.hers immunity by letting the kids go.to.school.The first thing that popped in my head was that many of the workers in the nursing homes have kids. It would still get to them. Or is my line of thinking off?

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No, That is why I think that a lot more people have been infected than we realize. If someone that literally never leaves their room gets it and spreads it to 80 people then there is no way someone going to the grocery store has not been exposed to it. The key it to get exposed to it in a low dose.

Many people that work at nursing homes have more than one job. They may work at a nursing home one day a week, but work 3 shifts at a hospital as well where they get exposed to it.

Bondag said:

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emando2000 said:

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Boring Username said:

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This epidemiologist is making the point that if we only sheltered the most vulnerable and the rest returned to normal lives we could exterminate this viruses a lot sooner. Of course we dont want to overwhelm the healthcare system, but I am curious if there are prudent risk we could take to try to achieve an optimum curve rather than just flatten it as soon as possible?

https://www.thecollegefix.com/epidemiologist-coronavirus-could-be-exterminated-if-lockdowns-were-lifted/

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He gives the nursing home example & talks about.hers immunity by letting the kids go.to.school.The first thing that popped in my head was that many of the workers in the nursing homes have kids. It would still get to them. Or is my line of thinking off?

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No, That is why I think that a lot more people have been infected than we realize. If someone that literally never leaves their room gets it and spreads it to 80 people then there is no way someone going to the grocery store has not been exposed to it. The key it to get exposed to it in a low dose.

Many people that work at nursing homes have more than one job. They may work at a nursing home one day a week, but work 3 shifts at a hospital as well where they get exposed to it.

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This is part of the reason Lubbock has taken a huge nursing home hit. My dad works with nursing home patients and he said the aids that work there often work at multiple homes, sometimes on the same day.

Bondag said:

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emando2000 said:

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Boring Username said:

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This epidemiologist is making the point that if we only sheltered the most vulnerable and the rest returned to normal lives we could exterminate this viruses a lot sooner. Of course we dont want to overwhelm the healthcare system, but I am curious if there are prudent risk we could take to try to achieve an optimum curve rather than just flatten it as soon as possible?

https://www.thecollegefix.com/epidemiologist-coronavirus-could-be-exterminated-if-lockdowns-were-lifted/

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He gives the nursing home example & talks about.hers immunity by letting the kids go.to.school.The first thing that popped in my head was that many of the workers in the nursing homes have kids. It would still get to them. Or is my line of thinking off?

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No, That is why I think that a lot more people have been infected than we realize. If someone that literally never leaves their room gets it and spreads it to 80 people then there is no way someone going to the grocery store has not been exposed to it. The key it to get exposed to it in a low dose.

Many people that work at nursing homes have more than one job. They may work at a nursing home one day a week, but work 3 shifts at a hospital as well where they get exposed to it.

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You could isolate the people who work at the nursing home from their families. I would be surprised if it was that common for the nursing home staff to also work shifts at the hospital. However, there are a lot of doctors that will need to see patients in the nursing home, but also see patients in a clinic and at the hospital so there is a transmission route that way.

This was sent to me today regarding using nebulized Hydrogen Peroxide as home treatment for Covid (and other respiratory viruses). For the docs ... a) have you heard of this? and b) do you think it is safe and something that has any merit?

https://articles.mercola.com/sites/articles/archive/2020/04/09/hydrogen-peroxide-therapy.aspx?cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20200409Z1&et_cid=DM501465&et_rid=847453238

Hey doc and docs on here - how is the financial health of your practices? Does staff need anything or support? And got word that today HHS is direct depositing funds from the fed govt to practices based on your Medicare Billings. It is separate from any small business loans - part of the CARES Act earmarked for providers. Are y'all aware of this?

AggieJosh2002 said:

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This was sent to me today regarding using nebulized Hydrogen Peroxide as home treatment for Covid (and other respiratory viruses). For the docs ... a) have you heard of this? and b) do you think it is safe and something that has any merit?

https://articles.mercola.com/sites/articles/archive/2020/04/09/hydrogen-peroxide-therapy.aspx?cid_source=dnl&cid_medium=email&cid_content=art1HL&cid=20200409Z1&et_cid=DM501465&et_rid=847453238

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Surely it won't end up being "that" easy....

Player To Be Named Later said:

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Surely it won't end up being "that" easy....

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Obviously, not a cure or I assume it would be all over ... but curious if it something that could actually help at home in more mild cases

John Francis Donaghy said:

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Bondag said:

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emando2000 said:

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Boring Username said:

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This epidemiologist is making the point that if we only sheltered the most vulnerable and the rest returned to normal lives we could exterminate this viruses a lot sooner. Of course we dont want to overwhelm the healthcare system, but I am curious if there are prudent risk we could take to try to achieve an optimum curve rather than just flatten it as soon as possible?

https://www.thecollegefix.com/epidemiologist-coronavirus-could-be-exterminated-if-lockdowns-were-lifted/

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He gives the nursing home example & talks about.hers immunity by letting the kids go.to.school.The first thing that popped in my head was that many of the workers in the nursing homes have kids. It would still get to them. Or is my line of thinking off?

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No, That is why I think that a lot more people have been infected than we realize. If someone that literally never leaves their room gets it and spreads it to 80 people then there is no way someone going to the grocery store has not been exposed to it. The key it to get exposed to it in a low dose.

Many people that work at nursing homes have more than one job. They may work at a nursing home one day a week, but work 3 shifts at a hospital as well where they get exposed to it.

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The residents of the nursing home aren't the ones spreading it. It's the caregivers.

I don't know how much experience you have with these kinds of facilities, or hired caregivers for the elderly in general, but most aren't trained nurses, in fact very few are unless you're in a very high level care facility. They're mostly minimum wage workers, and have somewhere between little and no motivation to follow any sort of specific directions for any individual "patient."

If you do manage to find a good one, you hold on for dear life, because of they get assigned elsewhere by their agency, you're chances of getting a halfway decent replacement are close to 0.

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And you might be surprised at the number of nurses in these facilities that are foreigners on H1-B visas, and none too few of those from Asia. Not being a xenophobe here, simply stating facts.

Took it once a week for four years when living in what used to be Zaire. This was the 80s. I don't recall any screening and no one in my family suffered any side effects except my father who had slight ringing in ears and permanent hearing loss that might be related. This was chloroquine not the newer hydroxy