Covid-19 Update Aggie Physician

1,248,793 Views | 3660 Replies | Last: 1 yr ago by tamc91
ttuhscaggie
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Saw an asymptomatic patient wearing a homemade mask in clinic today. Actually the majority of my patients are wearing masks now which is probably a good thing, but the thing is, as she was giving me her history the mask was rubbing up and down over nose. Apparently it was itching her so she proceeded to reach up, pull her mask down and rub it... with her hand. Smh
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Player To Be Named Later
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Went to get something from self pickup at Walmart earlier, wearing a mask.

Only saw 2 other people wearing one and the young guy working out front had one..... covering his mouth but not his nose.
Mark Fairchild
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Thanks for taking the time for an AGGIE engineer/layman question. Thank you for all you are doing. You are in our prayers every day and night.
Gig'em, Ole Army Class of '70
Mark Fairchild
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It's definitely going to be a huge learning curve for us all!
Gig'em, Ole Army Class of '70
Jetpilot86
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Found this article on another chat board I frequent. I have 0 knowledge of it's viability but I'll leave it here so the smart people in the thread can decide if/how it applies.

Never mind, this thread is getting as bad as the Tears thread for "Germans bombing the Moon". I'm laughing at myself on that.

I see where one of the smart people I was talking about weighed in on this back on page 47....

Carry on....
Exsurge Domine
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Jetpilot86 said:

Found this article on another chat board I frequent. I have 0 knowledge of it's viability but I'll leave it here so the smart people in the thread can decide if/how it applies.

http://web.archive.org/web/20200405061401/https://medium.com/@agaiziunas/covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-91182386efcb


I saw on Twitter it was pulled from Medium because a bunch of docs said it was bs.
Reveille
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ttuhscaggie said:

Saw an asymptomatic patient wearing a homemade mask in clinic today. Actually the majority of my patients are wearing masks now which is probably a good thing, but the thing is, as she was giving me her history the mask was rubbing up and down over nose. Apparently it was itching her so she proceeded to reach up, pull her mask down and rub it... with her hand. Smh


Lol I have seen this more than once. Or they pull down the mask to talk! Ugh!
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Reveille
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Here's today's update!

https://www.facebook.com/1998386763777604/posts/2662736010676006/?sfnsn=mo

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Pasquale Liucci
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Hey Doc, Scott Gottlieb's tweets seem to indicate some expectation of seasonality with the warmer weather and a return of virus in the fall. From what you are hearing in medical circles is this a realistic expectation or too optimistic?

Thanks for everything you are doing by the way. Hope you realize how impactful it is for you to pass this kind of practical insight along daily.
Tailgate88
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nm the German moon bombers are out in force tonight. My bad.
Gary79Ag
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Tailgate88 said:

I have no idea what the qualifications of the author are but am interested in our doctor's opinions on this article.

http://web.archive.org/web/20200405061401/https://medium.com/@agaiziunas/covid-19-had-us-all-fooled-but-now-we-might-have-finally-found-its-secret-91182386efcb
Then read the last few pages starting the middle of page 47.
HotardAg07
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I think it was unnecessary to attack doctors who want to see more solid proof on HCQ as academic types who don't see patients and suggest that they don't care about people.

I've read all your posts and been a big supporter, but that bit turns me off.
FriscoKid
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Friend from our church small group is COVID positive in Frisco.

Talked to her husband and wanted her to get a prescription for HCQ +zinc. Sounds like her doc just told her to go home and rest. She is 65 and has COPD. Hasn't smoked in over a decade, but it still lingers apparently. Does anyone have advice on how to get her to a doc that might be able to help?

She might be OK and just beat this thing, but she also checks all the boxes for someone that will end up in the emergency room in a couple days.(and she's getting worse) I think she is on day 7 or 8 from symptoms.

I'd like to get her to another doc if possible. Any suggestions?


Edit: PM me if you are willing to see her. She's not critical at all right now, but I'm getting worried. Thanks.
Old RV Ag
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HotardAg07 said:

I think it was unnecessary to attack doctors who want to see more solid proof on HCQ as academic types who don't see patients and suggest that they don't care about people.

I've read all your posts and been a big supporter, but that bit turns me off.
I agree with this - Doc that was a bit over the line and to me indicates fatigue, stress, etc. could be setting in. Everyone here is very appreciative of your efforts but we don't want to see you push it too hard. Might take a break and step back. We're all in this together.
Reveille
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HotardAg07 said:

I think it was unnecessary to attack doctors who want to see more solid proof on HCQ as academic types who don't see patients and suggest that they don't care about people.

I've read all your posts and been a big supporter, but that bit turns me off.


I didn't mean it come across like that! Should have worded it different. In no mean did I intend to imply that academia don't care about patients! Sorry if it was taken that way.

I intended to imply that they have a different perspective on Medicine from those in clinical world.

All doctors depend on research and I have been involved in research studies in the past. I don't have the patience to do then and all if the paperwork is terrible!

I admire those that do because they give us the clinical information we need to make educated decisions in our patients. But my point is in a pandemic you don't have time to wait in certified studies and have to rely on the clinical outcomes and experienes of your colleagues.

I know from working at UT Southwestern that there are many who simply will not believe anything without good studies to back it up and that's ok that's your way.

But coming on TV and saying that the clinical data is quakery or anecdotal is beletting so our clinical experience with patients!
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
AggieAuditor
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Great response.

As I read your update I thought about what it's like for people in wartime. Yes you want to think and strategize and make the absolute best decision, but there is no time for that. You get seconds to try and make the best decision you can to save people.

FWIW I agree with you. There is a time, place, and need for complete, conclusive studies on what works and doesn't work. In the middle of war is not the time or the place for those studies. If I'm on deaths door, I want a doctor who is willing to throw the kitchen sink at me to keep me alive. I don't give a damn about protocol.
Zobel
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The big lie being perpetuated by the politics in this scenario is that the two "sides" are in opposition. They're not, they are parallel and mutually reinforcing activities.
VaultingChemist
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I am taking large daily doses of potassium citrate for the prevention of kidney stones by raising the pH of the urine. Will this treatment have any effect on Covid-19, since the virus does appear to attack the kidneys?
maroonbeansnrice
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Doc, you didn't say anything that should have offended anyone. Your example toward the end was right on the money. If they or their loved one had Covid-19 and are in a high risk group and/or were already bad off, you are damn right they would want access to HCQ, proven or not. You're the kind of doctor I want taking care of me and mine. And as you also correctly pointed out there is a time for double-blinds, but we are in uncharted territory and need to cut through the normal slow moving processes.

Folks (the critical few), lighten up. The man is seeing patients during all this, and I'm sure he is dead tired when he gets home, yet he takes the time as a Good Ag and is posting sane and informed answers and updates for our benefit.
“It ain’t like it used to be.”
-Jimbo Fisher
Jerkin_my_durkin
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There is absolutly nothing wrong with what Rev said
hillcountryag86
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If my kid's on the table, I'll take Coates' advice in a heartbeat over a clinician who needs more data.
3rd Generation Ag
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I wish my friend in Oregon had a doctor like Rev. She has been told there is no treatment and nothing to do but take tylenol and wait it out. Her husband is in the hospital and has tested positive twice. He is the stroke patient I mentioned earlier. He is only getting liquids and tylenol. It could be because of his fragile state. But Shawnna is a healthy active 70. She is now home alone with fever, fatigue, cough and shortness of breath. Doctor said was sure she has it, not going to use a test for her and to stay in (which she already was) and take vitamin C and tylenol. Not to come to the hospital unless her fever goes over 100 and even then they will only give her the same things she can do at home. She is alone you understand. She trusts her doctor who told her there were no treatments for Covid and pretty much just hope for the best. I know I am not a doctor but I told her she must aslo monitor her 0xygen level.

How I wish she had Rev for a doctor.
Jetpilot86
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I've had multiple stones, calcium oxalate, and cutting sodium out of my diet at my urologist's request has kept me stone free for 16 years. I drink more water than I used to also, but avoiding high salt levels will help with the stones.
FriscoKid
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FriscoKid said:

Friend from our church small group is COVID positive in Frisco.

Talked to her husband and wanted her to get a prescription for HCQ +zinc. Sounds like her doc just told her to go home and rest. She is 65 and has COPD. Hasn't smoked in over a decade, but it still lingers apparently. Does anyone have advice on how to get her to a doc that might be able to help?

She might be OK and just beat this thing, but she also checks all the boxes for someone that will end up in the emergency room in a couple days.(and she's getting worse) I think she is on day 7 or 8 from symptoms.

I'd like to get her to another doc if possible. Any suggestions?


Edit: PM me if you are willing to see her. She's not critical at all right now, but I'm getting worried. Thanks.

Still asking. Maybe I'll word it differently. What should the husband present to her doctor and how should he present it so that her doc would consider prescribing the cocktail (if there isn't a medical reason why he shouldn't)
Player To Be Named Later
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The way that it seems a lot of places are treating this is damn near criminal IMO. It seems so many are stuck in "how we've always done things" and refusing to think for themselves and outside the box.

I'm hearing of way too many people basically being told "well, sorry about your bad luck".
88planoAg
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Player To Be Named Later said:

The way that it seems a lot of places are treating this is damn near criminal IMO. It seems so many are stuck in "how we've always done things" and refusing to think for themselves and outside the box.

I'm hearing of way too many people basically being told "well, sorry about your bad luck".


It might also be that it is Oregon. This issue has been politicized in many places.
BiochemAg97
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Reveille said:

HotardAg07 said:

I think it was unnecessary to attack doctors who want to see more solid proof on HCQ as academic types who don't see patients and suggest that they don't care about people.

I've read all your posts and been a big supporter, but that bit turns me off.


I didn't mean it come across like that! Should have worded it different. In no mean did I intend to imply that academia don't care about patients! Sorry if it was taken that way.

I intended to imply that they have a different perspective on Medicine from those in clinical world.

All doctors depend on research and I have been involved in research studies in the past. I don't have the patience to do then and all if the paperwork is terrible!

I admire those that do because they give us the clinical information we need to make educated decisions in our patients. But my point is in a pandemic you don't have time to wait in certified studies and have to rely on the clinical outcomes and experienes of your colleagues.

I know from working at UT Southwestern that there are many who simply will not believe anything without good studies to back it up and that's ok that's your way.

But coming on TV and saying that the clinical data is quakery or anecdotal is beletting so our clinical experience with patients!
Right now, there are clinical trials on multiple drug/drug combinations and the data from those trials will be helpful. From those trials, we should get a better understanding on which patients can be most helped by HCQ or ivermectin or Remdesivir or whatever else comes up. We should have a better understanding of dosages and how quickly to see an outcome, etc.

I am sure Rev and the other front line docs would love that information and guidance that says if symptoms presented in the last 2 days take this, if they are at this stage take that, and if they are at this stage take this other one. Possibly even, if exposed take this. But they are treating patients now with the best info they have now, which is likely HCQ+Zpac+zinc.

On the other hand, the docs on the WH task force also have to look at other things like drug supply. So, they would like to tap the breaks on prescribing to everyone who thinks they were exposed (I'm sure docs like Rev aren't going that far, but it is the extreme case and we may eventually get there, especially with the trial in prophylactic use for healthcare workers in NY) because if everyone starts taking it, there may not be enough short term for the people who would benefit the most.

Everyone wants what is best for the patients. Everyone wants the data to guide the decision making process. By the scope is different at different levels. Front line docs are looking at the patients right in front of them. Task force docs are looking at all the patients and what is the best overall outcome.
BiochemAg97
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88planoAg said:

Player To Be Named Later said:

The way that it seems a lot of places are treating this is damn near criminal IMO. It seems so many are stuck in "how we've always done things" and refusing to think for themselves and outside the box.

I'm hearing of way too many people basically being told "well, sorry about your bad luck".


It might also be that it is Oregon. This issue has been politicized in many places.
The media certainly has an obsession with the total number of deaths this last few days. "Deaths are being undercounted because we aren't testing dead people for the virus and the real death rate is much higher" vs "deaths are being over-counted by attributing unreleased deaths to COVID-19".

Does it really matter right now? We are looking at rates and curves to inform how long we stay locked in our houses. As long as we are consistent with our counts, the curves will make sense.

We can worry later about what the actual case mortality rate was.
AgLA06
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AG
aggiengeorgia10 said:

There is absolutly nothing wrong with what Rev said


Yep. If what he said gets under someone's skin. It's probably time to look in the mirror and ask why.
Reveille
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BiochemAg97 said:

Reveille said:

HotardAg07 said:

I think it was unnecessary to attack doctors who want to see more solid proof on HCQ as academic types who don't see patients and suggest that they don't care about people.

I've read all your posts and been a big supporter, but that bit turns me off.


I didn't mean it come across like that! Should have worded it different. In no mean did I intend to imply that academia don't care about patients! Sorry if it was taken that way.

I intended to imply that they have a different perspective on Medicine from those in clinical world.

All doctors depend on research and I have been involved in research studies in the past. I don't have the patience to do then and all if the paperwork is terrible!

I admire those that do because they give us the clinical information we need to make educated decisions in our patients. But my point is in a pandemic you don't have time to wait in certified studies and have to rely on the clinical outcomes and experienes of your colleagues.

I know from working at UT Southwestern that there are many who simply will not believe anything without good studies to back it up and that's ok that's your way.

But coming on TV and saying that the clinical data is quakery or anecdotal is beletting so our clinical experience with patients!
Right now, there are clinical trials on multiple drug/drug combinations and the data from those trials will be helpful. From those trials, we should get a better understanding on which patients can be most helped by HCQ or ivermectin or Remdesivir or whatever else comes up. We should have a better understanding of dosages and how quickly to see an outcome, etc.

I am sure Rev and the other front line docs would love that information and guidance that says if symptoms presented in the last 2 days take this, if they are at this stage take that, and if they are at this stage take this other one. Possibly even, if exposed take this. But they are treating patients now with the best info they have now, which is likely HCQ+Zpac+zinc.

On the other hand, the docs on the WH task force also have to look at other things like drug supply. So, they would like to tap the breaks on prescribing to everyone who thinks they were exposed (I'm sure docs like Rev aren't going that far, but it is the extreme case and we may eventually get there, especially with the trial in prophylactic use for healthcare workers in NY) because if everyone starts taking it, there may not be enough short term for the people who would benefit the most.

Everyone wants what is best for the patients. Everyone wants the data to guide the decision making process. By the scope is different at different levels. Front line docs are looking at the patients right in front of them. Task force docs are looking at all the patients and what is the best overall outcome.
I agree completely!

Look I want to first say I love the researchers GOD BLESS them for what they do! My blog is based off me readings studies done with millions of hours of their hard work. I have been involved in research and it is definitely not for me. But someone has to do it. In NO WAY did i intend to let people believe that they do not care for their patients. I completely apologize to anyone in research that took it that way. We in clinical world work closely with them. I still sometimes find patients for trials for some of my academia colleagues.

Researchers LOVE medicine and they CARE for their patients they just believe in only using the scientific method on which we are ALL trained. They have a more scientific way of looking at things. And lets be honest sometimes we in the community think we have a solution to a disease and we ARE PROVEN wrong by them. This has happened in the past many times and we are thankful for data to guide us to treat our patients better.

If and when they have a proven treatment whether it is ivermectin, HCQ+Zpak, Remdesvir I really don't care I will immediately switch to the one proven the most beneficial.

I agree with guy saying the media is making it look we don't work together be putting people on TV that are making irresponsible statements.

However, in the blog I was responding to people not understanding how the medical community looks so confused with opinions being different. The responsible researcher should not go on TV and say it is quackery or irresponsible to be using HCQ/Z-pak. His response should be while is shows some promise these are small and mainly non-randomized trials so more data is needed before we can recommend this.

The responsible clinician shouldn't say we don't need double blinded controlled randomized trials we already have a cure! That is also just as irresponsible. We all need as much information as possible.. He should say these results of trials we have are extremely promising. Currently it is the best treatment we have available for early in the disease so if you catch COVID-19 this is a discussion should have with your personal physician to see if you are a candidate for treatment.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reveille
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AG
BiochemAg97 said:

88planoAg said:

Player To Be Named Later said:

The way that it seems a lot of places are treating this is damn near criminal IMO. It seems so many are stuck in "how we've always done things" and refusing to think for themselves and outside the box.

I'm hearing of way too many people basically being told "well, sorry about your bad luck".


It might also be that it is Oregon. This issue has been politicized in many places.
The media certainly has an obsession with the total number of deaths this last few days. "Deaths are being undercounted because we aren't testing dead people for the virus and the real death rate is much higher" vs "deaths are being over-counted by attributing unreleased deaths to COVID-19".

Does it really matter right now? We are looking at rates and curves to inform how long we stay locked in our houses. As long as we are consistent with our counts, the curves will make sense.

We can worry later about what the actual case mortality rate was.
Thank you very much!!!!!

This is exactly what we are doing.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Knucklesammich
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No issue with the wording or the message.

The docs on this forum have been fighting for weeks on end and to think they haven't learned and expanded best practice is plain silly. They are in the heat of a fight and have earned the right to share their experience and have done a great job talking in real terms that everyone can understand.

They've also earned the right to be frustrated by a drug being turned into a totem for or against Presidential incompetence.

I firmly believe if leadership would communicate 50% As well after what has to be a harrowing 10-18 hours of works as one of the verified docs and nurses on this forum we would be in a much better place.
FTAG 2000
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AG
FriscoKid said:

FriscoKid said:

Friend from our church small group is COVID positive in Frisco.

Talked to her husband and wanted her to get a prescription for HCQ +zinc. Sounds like her doc just told her to go home and rest. She is 65 and has COPD. Hasn't smoked in over a decade, but it still lingers apparently. Does anyone have advice on how to get her to a doc that might be able to help?

She might be OK and just beat this thing, but she also checks all the boxes for someone that will end up in the emergency room in a couple days.(and she's getting worse) I think she is on day 7 or 8 from symptoms.

I'd like to get her to another doc if possible. Any suggestions?


Edit: PM me if you are willing to see her. She's not critical at all right now, but I'm getting worried. Thanks.

Still asking. Maybe I'll word it differently. What should the husband present to her doctor and how should he present it so that her doc would consider prescribing the cocktail (if there isn't a medical reason why he shouldn't)

Maybe the TV stations?

In all seriousness though, this sucks. Is there a different doc they can see? Teledoc?
FriscoKid
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AG
AG 2000' said:

FriscoKid said:

FriscoKid said:

Friend from our church small group is COVID positive in Frisco.

Talked to her husband and wanted her to get a prescription for HCQ +zinc. Sounds like her doc just told her to go home and rest. She is 65 and has COPD. Hasn't smoked in over a decade, but it still lingers apparently. Does anyone have advice on how to get her to a doc that might be able to help?

She might be OK and just beat this thing, but she also checks all the boxes for someone that will end up in the emergency room in a couple days.(and she's getting worse) I think she is on day 7 or 8 from symptoms.

I'd like to get her to another doc if possible. Any suggestions?


Edit: PM me if you are willing to see her. She's not critical at all right now, but I'm getting worried. Thanks.

Still asking. Maybe I'll word it differently. What should the husband present to her doctor and how should he present it so that her doc would consider prescribing the cocktail (if there isn't a medical reason why he shouldn't)

Maybe the TV stations?

In all seriousness though, this sucks. Is there a different doc they can see? Teledoc?

He's going to try again today and "demand/request" a prescription.
Irwin M. Fletcher
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AG
Have a question for the docs and researchers on this thread. I have seen a lot of thought leaders stating that this could become a seasonal issue, with an uptick in cases come in the fall. Thus reservations about getting back to a true normal for a while. My question is why did SARS- CoV that caused SARS go away after its first outbreak? Also the same for MERS, these were also coronavirus'. I just want someone on here with knowledge of all these viruses explain why they expect this virus to behave differently once the first wave is put down. Not doubting that that will be the case, I just wanted some clarification. Thank you for your work!

And if the answer is we don't really know at this point, then my question is why did SARS-CoV just die off to never return after its initial outbreak?
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