Covid-19 Update Aggie Physician

1,284,185 Views | 3660 Replies | Last: 2 yr ago by tamc91
cbr
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AG
BiochemAg97 said:

cbr said:

honestly, until we have detailed consistent credible info on:

1) communicability and means of communication
2) rate of serious hospitalization symptoms
3) fatality rate
4) rate of reinfection/recurrence of symptoms/complications/serious permanent issue
5) rate and duration of immunity among recovered patients
6) likelihood and timing of vaccine or widely available effective treatment

then no one can make good decisions about their health or their business.

and this information exists. it's been 5+ months.

the information is not getting to the public. why the hell not?


For 1,2,3 I think we have some pretty good information. Unfortunately, the media and others seem to bombard us with confusing information as well. Spread is by droplets, but non scientists keep saying "airborne" and "aerosol" which have a specific meaning that is different than droplet. 2 and 3 are being pushed way lower by the antibody testing results, into the range of 0.5 for deaths which is where some have been predicting since the beginning.

4) rate of reinfection is minimal if at all. SoKo data shows the positive qPCR tests were not picking up live infectious virus. No idea why WHO is freaking people out with "no evidence of immunity" other than trying to prevent countries from using "immunity passports".

5) we don't know how long immunity lasts because we haven't had people immune for long enough. Best answer is at least this long. And we can't wait to know that because it will take as long as immunity lasts to find out. Is it at least a year? That will take a year to find out.

Timing of vaccine will take as long as it takes. Oxford group is saying they will have theirs in 6 months (because they are short cutting/accelerating clinical trials). Fauci is saying 18 months because that is when the trials for the vaccine NIAID is supporting will be finished, but it is also the least tested platform and will take the most trials to prove out. Others may finish sooner.

We may know more on effective treatments in a few weeks. Some of the clinical trials are scheduled to finish at the end of April.
thank you for your post, i appreciate your insight on it. very much.
cbr
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AG
Let me ask this :

If there were any truth to the **** i was hearing in january, while china was enacting zombie apocalypse scenes, and certain scientists getting murdered, arrested, and dissappeared....

And if in fact this virus does have 'staged gain of function' or does hang around and flare up systemically in the host the rest of their lives, like a herpes or aids, who would know? Would it just be cutting edge bioresearch labs with access to key research data? Or Would any competent research lab figure it out by now? Would the general medical community or university or private labs figure it out? Would treating physicians be able to tell?

Is it medically possible to hang around this long without it becoming obvious in the patient population?

I took this crap pretty seriously in january.

My sources have dried up

It certainly doesnt look like its that bad now, 4 months later. I pretty well put those rumors behind me long ago. But it would be nice to know what the possibilities are. Its too far outside my expertise to evaluate myself.
Reveille
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AG
Today's update!

https://www.facebook.com/1998386763777604/posts/2680457832237157/?sfnsn=mo
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
3rd Generation Ag
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One thing confuses me. My Zinc tablets are 50 mg and I have been taking them since you first recommended. Should I go to every other day or try to cut them in half? Or just wait and get a smaller dose bottle next time.
BiochemAg97
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3rd Generation Ag said:

One thing confuses me. My Zinc tablets are 50 mg and I have been taking them since you first recommended. Should I go to every other day or try to cut them in half? Or just wait and get a smaller dose bottle next time.
50 mg doesn't hurt. It is water soluble and will flush excess from your system. I wouldn't go every other day.

As far as I've seen, 50 mg is pretty standard for OTC zinc supplement. If you take a multivitamin, check it for zinc too. I've typically seems around 10 mg in the multi. And no, the combination isn't too much zinc either. But if you want to take less zinc, you could just go with what is in your multi.
Reveille
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3rd Generation Ag said:

One thing confuses me. My Zinc tablets are 50 mg and I have been taking them since you first recommended. Should I go to every other day or try to cut them in half? Or just wait and get a smaller dose bottle next time.
It doesn't matter too much. The amount of zinc is very debatable. Just as long as you have some on board. I take 50mg but have for some time. I miss a few days here and there because it can make you nauseous if you take too much zinc. Just a little Zinc is usually sufficient.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
maroonbeansnrice
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3rd Generation Ag said:

One thing confuses me. My Zinc tablets are 50 mg and I have been taking them since you first recommended. Should I go to every other day or try to cut them in half? Or just wait and get a smaller dose bottle next time.
50mg upsets my stomach I have found. Cut them in half for 25mg a day.
“It ain’t like it used to be.”
-Jimbo Fisher
Reveille
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Today's update!

https://www.facebook.com/1998386763777604/posts/2681375955478678/?sfnsn=mo
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Big Al 1992
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With some of the literature talking about strokes, would you recommend 81 mg QD aspirin or does it have same negative potential as ibuprofen?
BiochemAg97
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Big Al 1992 said:

With some of the literature talking about strokes, would you recommend 81 mg QD aspirin or does it have same negative potential as ibuprofen?
aspirin is an NSAID just like ibuprofen and would have a similar effect on ACE.

However, there is some more recent literature where they have been using NSAIDs in COVID patients. The thinking is that once you have enough of a viral load, small changes in the amount of ACE receptor isn't going to change much.

So, the question becomes why are you taking aspirin?
Heart and stroke risk regardless of COVID - keep taking
Concerned with COVID caused stroke - maybe wait until you have COVID

I am not a doctor and this is not medical advice. You should consult your regular doc before changing medications.
Marcus Aurelius
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Rev any anecdotes on day 1-2 HCQ treatment for COVID-19? Getting this ? a lot. I'm not seeing these folks that early.
Reveille
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Marcus Aurelius said:

Rev any anecdotes on day 1-2 HCQ treatment for COVID-19? Getting this ? a lot. I'm not seeing these folks that early.
Yes i have had quite a few. Most impressive being a 91 year old with diarrhea for a day than spiked a 103.1 fever with cough and some mild shortness of breath the next day. Daughter did not want to go to hospital because she was afraid they would never see him again, since they don't allow visitors in hospital. He lives with daughter and we all three discussed it. He has history of A-fib so instead of Zithromax we used doxycycline. (I have done this twice him and a lady with a history of prolonged QT who I called the cardiologist for. He said not to worry just don't use zithromax it is more dangerous than the HCQ. So i substitute doxy) This guy really kind of scared me though being at home at 91 and I didn't have a pulse ox or reliable vitals since this was a televisit.

I gave strong warnings to ER if fever increases, palpitations, tachycardia, chest pain or increasing shortness of breath. Daughter and him really wanted to try this at home first so we agreed. He started on this around noon that day. I called him and daughter after work about 8 pm he had 102.1 temp still and still generally felt bad but says he thinks he is breathing better. Next day at 9 am i called and he had 100.5 temp but diarrhea and cough were improving some. No shortness of breath at that time. Next morning i called at 9 am daughter said he was afebrile and felling fine. Only symptom was a mild cough. I got him on the phone and he was eating breakfast and told me he feels normal. I said wow that's really impressive but lets make sure nothing else happens today. I forgot to call that evening but did call the next morning and he said he is fine and cough is almost resolved.

Another is a 52 y/o with diabetes, HTN, hypercholestemia, obesity and history of coronary stent. He came in with 3 days of fever, cough, shortness of breath. He actually presented to my clinic unfortunately. He had a pulse ox of 92%, temp 103.4, BP 146/94, pulse rate 104 and respiration rate of 22. His chest X-ray in the office looked terrible and bilateral peri-hilar infiltrates with a ground glass appearance. He could barely talk in the office and we had use a wheelchair to get him to X-ray. He looked really sick. I told him that clinically he has covid-19. He had that scared look in eyes back at me that all of doctors have seen when like when you tell someone they are having an MI or CVA. He said "I know I do! I have been sick 100 times in my life and never felt anything like this. I feel like I am being hung from the ceiling and beaten with sticks like a pinata."

He also did not want to go the hospital I told him to go get tested, isolate and we will try the HCQ/zithromax. I called him after work about 9 pm and asked how is doing. He said "I'm still breathing but that's about it." Still had fever of around 103 that night. I called in the morning and was breathing better. Pain was better and fever down to 101. That night about 6 pm he was afebrile pains were gone, still coughing and mildly short of breath. But voice on phone now sounded normal. Next day he felt fine but still coughing. He actually never went and got tested. Told me he felt too bad to mess with it, so we ran antibody testing weeks after which was positive.

Few others but those are most impressive as they had risk factors and were clinically pretty sick at the time but responded very rapidly. My feelings are if us in the community jump on this we have a good chance to stop it before it gets severe, I have spoke with a number of primary care doctors and we are similar anecdotal results. I know if I catch it I will be treating it as soon as possible with HCQ/Zithromax.

And FYI I really appreciate all the updates you and the others at the hospital have been giving us. It gives me a lot of insight to how things are going after they get admitted and results you all are getting with treatments in the hospital.
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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Today's update!

https://www.facebook.com/1998386763777604/posts/2682318132051127/?sfnsn=mo

Biochemag97 I might need you to check my work on these biochem pathways.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Aggieland Proud
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AG
Thanks to all of you for the info during the past weeks/months!

After reading these everyday, I feel like I have a ringside seat during this moment in history.
chris1515
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Do you have more detail on that comment about 100% of the ICU patients under 75 having a Vitamin D deficiency?

That is eye popping...what?
Player To Be Named Later
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Is it possible that one of the other underlying conditions that is putting people in ICU also causes Vit D deficiency or the serious disease process that has landed them there has depleted Vit D stores in the body?

Just thinking out loud if it is more that than a Vit D deficiency helping to cause a trip to ICU?

That said, think I'll add a Vit D to my supps
Complete Idiot
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chris1515 said:

Do you have more detail on that comment about 100% of the ICU patients under 75 having a Vitamin D deficiency?

That is eye popping...what?
This study suggests 42% of all Americans are Vitamin D deficient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/

Doesn't really diminish the impact of "100%".
BiochemAg97
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Nvm
BiochemAg97
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Player To Be Named Later said:

Is it possible that one of the other underlying conditions that is putting people in ICU also causes Vit D deficiency or the serious disease process that has landed them there has depleted Vit D stores in the body?

Just thinking out loud if it is more that than a Vit D deficiency helping to cause a trip to ICU?

That said, think I'll add a Vit D to my supps
Could be either cause (low Vit d makes hosp more likely) or effect (disease causes drop in Vit d). I recall some studies from years ago that showed infection causing a drop in Vit C levels, so disease causing a drop in Vit D isn't unreasonable.

Either way, Vit D supplements won't hurt. Having extra Vit D could either be protective or given you more of a drop before you get low.
Player To Be Named Later
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Good info. I'll just take a Vit D supp and keep spending a lot of time working outside.
Tom Cardy
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For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
BiochemAg97
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Kick-R said:

For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
Vit D is fat soluble so it doesn't get pissed out like B and C. So you could take 1 every other day if you want to average 1000iu. I have 1000iu I take daily and it keeps my levels in the normal range when the doc tests it each year.

Also pretty hard to OD on Vit D. Even at 4000 iu a day doesn't develop toxicity. You would probably need something like 40,000iu per day for months to develop toxicity.


As an interesting side note, my pest control guy uses a rat poison that is high dose Vit D to cause toxicity in the rats because once the rats metabolize, it doesn't hurt the birds. Kinda nuts, so maybe good to avoid toxicity.
Tom Cardy
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I was borderline deficient 2 years ago but haven't been tested since. Been trying to get more sun anyway during the day.

Thanks for the insight! Avoiding toxicity is definitely a priority.
Gary79Ag
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Kick-R said:

For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
Just an FYI, but my doc prescribed me to take 125mcg(5,000iu) of Vitamin D3 daily. I've been taking that dosage for the past several years and I'm still here, so there's that...
JYDog90
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BiochemAg97 said:

Kick-R said:

For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
Vit D is fat soluble so it doesn't get pissed out like B and C. So you could take 1 every other day if you want to average 1000iu. I have 1000iu I take daily and it keeps my levels in the normal range when the doc tests it each year.

Also pretty hard to OD on Vit D. Even at 4000 iu a day doesn't develop toxicity. You would probably need something like 40,000iu per day for months to develop toxicity.


As an interesting side note, my pest control guy uses a rat poison that is high dose Vit D to cause toxicity in the rats because once the rats metabolize, it doesn't hurt the birds. Kinda nuts, so maybe good to avoid toxicity.


So rat poison is a good thing to take. Just watch the dosage. Got it.








KIDDING! Do not under ANY circumstances take rat poison.
Formerly Willy Wonka
Bondag
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Willy Wonka said:

BiochemAg97 said:

Kick-R said:

For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
Vit D is fat soluble so it doesn't get pissed out like B and C. So you could take 1 every other day if you want to average 1000iu. I have 1000iu I take daily and it keeps my levels in the normal range when the doc tests it each year.

Also pretty hard to OD on Vit D. Even at 4000 iu a day doesn't develop toxicity. You would probably need something like 40,000iu per day for months to develop toxicity.


As an interesting side note, my pest control guy uses a rat poison that is high dose Vit D to cause toxicity in the rats because once the rats metabolize, it doesn't hurt the birds. Kinda nuts, so maybe good to avoid toxicity.


So rat poison is a good thing to take. Just watch the dosage. Got it.








KIDDING! Do not under ANY circumstances take rat poison.
If you do, chase it with aquarium cleaner.
Tx-Ag2010
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Willy Wonka said:

BiochemAg97 said:

Kick-R said:

For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
Vit D is fat soluble so it doesn't get pissed out like B and C. So you could take 1 every other day if you want to average 1000iu. I have 1000iu I take daily and it keeps my levels in the normal range when the doc tests it each year.

Also pretty hard to OD on Vit D. Even at 4000 iu a day doesn't develop toxicity. You would probably need something like 40,000iu per day for months to develop toxicity.


As an interesting side note, my pest control guy uses a rat poison that is high dose Vit D to cause toxicity in the rats because once the rats metabolize, it doesn't hurt the birds. Kinda nuts, so maybe good to avoid toxicity.


So rat poison is a good thing to take. Just watch the dosage. Got it.








KIDDING! Do not under ANY circumstances take rat poison.
You mean unless your doctor prescribes it? My grandpa takes warfarin as a blood thinner.
Old RV Ag
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Tx-Ag2010 said:

Willy Wonka said:

BiochemAg97 said:

Kick-R said:

For someone who hasn't had a blood test recently, What amount of D3 would be appropriate? Smallest tablets are 2000iu, half of that?
Vit D is fat soluble so it doesn't get pissed out like B and C. So you could take 1 every other day if you want to average 1000iu. I have 1000iu I take daily and it keeps my levels in the normal range when the doc tests it each year.

Also pretty hard to OD on Vit D. Even at 4000 iu a day doesn't develop toxicity. You would probably need something like 40,000iu per day for months to develop toxicity.


As an interesting side note, my pest control guy uses a rat poison that is high dose Vit D to cause toxicity in the rats because once the rats metabolize, it doesn't hurt the birds. Kinda nuts, so maybe good to avoid toxicity.


So rat poison is a good thing to take. Just watch the dosage. Got it.








KIDDING! Do not under ANY circumstances take rat poison.
You mean unless your doctor prescribes it? My grandpa takes warfarin as a blood thinner.
I take rat poison (warfarin)
Thomas Sowell, PhD
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As most are aware some scenarios state that maybe 60-80% of people in the USA will eventually test positive for Covid-19. REGARDLESS of the %, other than taking precautions to not catch it, what can those in the high risk group do?

Let's say a 65 y/o overweight person with high blood pressure and type 2 diabetes?
Is the obvious answer: lose weight, do tons and tons of cardiovascular work, and get your A1C levels under great control and lower your sodium intake? I mean like very actively train like you're trying to be a marathon runner so IF YOU GET the virus you're in the best possible position to survive?
Serious question.
If you don't catch it you're all the better for the changes and if you do your survival rates go up significantly?!
Obviously if you're 87 it's more of a challenge.

Thoughts?
Pahdz
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So your scenario posted is similar to my mom. She's 69, overweight, HBP, NOT diabetic though. She walks on the treadmill daily sometimes mixing in rowing workouts on our Concept2 rower. The rest of us are healthy but worry about bringing something back home.
Player To Be Named Later
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I'm "only" 47 and currently working from home. I've been using this time to really bust my tail to drop weight and get healthier. Of course it isn't going to pay dividends anytime in the next week or so, but it needs done and it won't hurt. If nothing else, hopefully I can have myself in a lot better shape should I catch this thing in the 2nd wave.

It's been a real wake up call that's for sure.
Reveille
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chris1515 said:

Do you have more detail on that comment about 100% of the ICU patients under 75 having a Vitamin D deficiency?

That is eye popping...what?
Vitamin D deficiency is becoming a serious risk factor. We as providers need to be checking vitamin D levels more frequently and getting them under control. We know that vitamin D increases the innate immune system and helps fight off multiple respiratory diseases.
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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Player To Be Named Later said:

I'm "only" 47 and currently working from home. I've been using this time to really bust my tail to drop weight and get healthier. Of course it isn't going to pay dividends anytime in the next week or so, but it needs done and it won't hurt. If nothing else, hopefully I can have myself in a lot better shape should I catch this thing in the 2nd wave.

It's been a real wake up call that's for sure.
If everyone takes it serious it will dramatically help the health of this country.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Player To Be Named Later
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Apparently everyone has the same idea that I do right now. Trying to find kettle bells for backyard workouts has proven impossible. One can only throw around so many feed bags and shovel so many loads of dirt into a garden.
Barnyard96
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90% diet.
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