Musings from my call weekend.......

22,161 Views | 126 Replies | Last: 3 yr ago by ramblin_ag02
planoaggie123
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AG
Marcus Aurelius said:

Mixture. Alot of younger people. Eye opening. Seems opposite of original outbreak.
Young people that are obese or comorbidity?

Or seemingly fully healthy young people? If fully healthy that would be concerning if its in high #s as a percentage.
Marcus Aurelius
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There are so many - not all of them mine. But I'd say. Mostly, unvaccinated heavier with comorbidities (though not all). We do have a 84 y/o vaccinated lady with break thru illness in ICU.
Charpie
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Lots of this on this thread.
Ol Jock 99
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The_Fox said:

Marcus Aurelius said:

Mixture. Alot of younger people. Eye opening. Seems opposite of original outbreak.


Young people? As in young men like would be in a Marine infantry company or division 1 athletes?
Have you looked at America in the past, I don't know, decade? Why bother asking about the extreme exceptions.

Trust me, I get the denial. I wasn't "all that fat" either. Yet here I am, 50 pounds down, and could honestly probably lose another 20. But I wasn't "all that fat".
TarponChaser
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Ol Jock 99 said:

The_Fox said:

Marcus Aurelius said:

Mixture. Alot of younger people. Eye opening. Seems opposite of original outbreak.


Young people? As in young men like would be in a Marine infantry company or division 1 athletes?
Have you looked at America in the past, I don't know, decade? Why bother asking about the extreme exceptions.

Trust me, I get the denial. I wasn't "all that fat" either. Yet here I am, 50 pounds down, and could honestly probably lose another 20. But I wasn't "all that fat".

I'll say this- I've never been in denial about it. I'd get fed up, lose a bunch of weight, then pretty much without fail the pain in my knees and back (I have 2 herniated discs, L4/L5 and L5/S1) would flare and I'd have to stop working out and I'd backslide and gain weight back and get into a "fck it" mode and then gain it all back. Not a good cycle for my body or mental health.

All of those times were with highly restrictive diets and hardcore workout programs. Honestly, not realistic for long-term maintenance.

I've finally had to realize that I have to be more moderate in my workout routines and stop trying to lift heavy, be more realistic in diet, and accept slow, measured progress. That being said, I'm also realistic- I'm shorter than you at 6'3" but I don't see any way I could get below about 260-265. I had one of those body-fat percentage measurements done using the BIA analysis and lean body mass was around 240# so at 15% body fat I'd weigh 275 and I don't think I can realistically get much below that. But I still need to lose a lot of weight to get there.

I'm also not going to claim that I'm "big-boned" or any BS like that.

I didn't get here because of any sort of hormonal or psuedo-medical issue. It's years of enjoying really good food & drink, poor discipline, and just not adjusting my mindset to be realistic and moderate. I'm sure there are people who have legit hormonal or medical issue causing obesity but that's got to be in the single-digits for the percentage of obese people.

And the entire mindset behind "healthy at any weight" or this gargantuan land manatee "model" (Tess Holliday) being at all healthy or a role model is so patently absurd there's no defense for their positions. I'm not saying she should be attacked or people be mean to her but let's not delude ourselves or society in saying that she should be emulated in any way whatsoever.
Aust Ag
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Marcus Aurelius said:

There are so many - not all of them mine. But I'd say. Mostly, unvaccinated heavier with comorbidities (though not all). We do have a 84 y/o vaccinated lady with break thru illness in ICU.
What are the death numbers looking like compared to say, 6-8 months ago?
wbt5845
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Marcus Aurelius said:

All (except one 74 y/o) pts under 45, unvaccinated and morbidly obese.
Sounds heartless, but Darwin doin' work.
wbt5845
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planoaggie123 said:

Good point.

We see it in the swimsuit magazines etc.
Yeah, I understand the backlash against the Cosmo version of attractiveness that has caused negative body images for decades.



But then they overcompensate with just hideously unhealthy people.



There are plenty of healthy, reasonable women out there that can be used for role models. If nothing else, the most recent Olympics have shown us plenty of active, muscular women that show great health.
Marcus Aurelius
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Aust Ag said:

Marcus Aurelius said:

There are so many - not all of them mine. But I'd say. Mostly, unvaccinated heavier with comorbidities (though not all). We do have a 84 y/o vaccinated lady with break thru illness in ICU.
What are the death numbers looking like compared to say, 6-8 months ago?
Good question. Observation - it seems that less are requiring ventilation, thus less deaths. I haven't read any new published data. That's likely due to younger population and the earlier administration of toci. Those that require vents - no difference in mortality from beginning. Around 90% +/- 5%.
dubi
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Toci?
Marcus Aurelius
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tociluzimab. it is an IL-6 inhibitor, anti-inflammatory, traditionally used for rheumatoid arthritis. Since covid cytokine storm has been shown to be driven by, among other molecules, IL-6, it has been used against covid. Initial trials were pos, then not much benefit. However, newer research show its usage earlier in the stage of covid infection, i.e. when pts are admitted with hypoxia and elevated inflammatory markers, shows less need for mechanical ventilation which is a harbinger of death with covid. If you are interested - see my saga of threads re this drug I have been posting since 3/20.
ramblin_ag02
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Marcus Aurelius said:

billyjack2009 said:

What's the latest, doc? (Marcus)
It's exploding here and at my hospital. 2 units almost full with it now. Very discouraging. Same type pts as I posted in the OP.


My hospital is small. We've been seeing outpatient Covid but not much requiring hospitalization.

Hats off to you. I can't imagine how frustrating it would be to walk into a full day of dozens of Covid inpatients and ICU patients knowing that it is easily preventable with a free and widely available vaccine. It would be hard to motivate myself for 12 hours in a row killing myself taking care of people who wouldn't take the most basic step to protect themselves. It's like smoking and COPD or poor diet and diabetes x 1000. So many patients expect us to sacrifice our time and effort and spend a fortune to move heaven and earth every time they get sick, but they are entirely unwilling to do the smallest thing to prevent the problem.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
planoaggie123
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I think this is well stated. Not just with this virus but in all thingspeople want to live flippantly and expect modern medicine to save them when needed.

I know there are ethics etc but part of me thinks hospitals should set up tents outside their main building and have it be for COVID. Don't want the vaccine? Fine. 100% your choice (that has and will remain my stanceno mandates). However, get sick and you will be staying in this tent and we will see what we can do. This virus seems to be so clear (outside of some VERY rare cases) about who it hurts the worst and those people still refuse to get it or acknowledge their own health status. Tell people the care levels for COVID are being decreased, prob see another boost in vaccinations.
SamHou
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So would normal use of an IL-6 inhibitor increase your likelihood of getting COVID with mild to moderate symptoms because you're on an immunosuppressant, but decrease your likelihood of severe issues because of the same properties?
Marcus Aurelius
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Frustrating it is. I have a 70 y/o with RA immunosuppressed. Just got intubated for covid. Not vaccinated. Her rheumatologist told her she was too "high risk" for the vaccine. I would argue the total opposite. Now she is facing 10% survival odds.
dubi
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Marcus Aurelius said:

Frustrating it is. I have a 70 y/o with RA immunosuppressed. Just got intubated for covid. Not vaccinated. Her rheumatologist told her she was too "high risk" for the vaccine. I would argue the total opposite. Now she is facing 10% survival odds.
WOW. I hope that rheumatologist seems the error of their ways and contacts any other "high risk" patient and says I was wrong.
ramblin_ag02
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Right?!! Everyone "too high risk" for the vaccine is at much higher risk from COVID. All of my patients on monoclonal antibodies for various reasons are being told not to get the vaccines by their specialists, and it's irritating. They won't be the ones taking care of them when they end up in the hospital.
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03_Aggie
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ramblin_ag02 said:

Right?!! Everyone "too high risk" for the vaccine is at much higher risk from COVID. All of my patients on monoclonal antibodies for various reasons are being told not to get the vaccines by their specialists, and it's irritating. They won't be the ones taking care of them when they end up in the hospital.


Would they be the ones taking care of them if they recommended the vaccine and it caused them to end up in the hospital?
cbr
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Please keep the morale up among well-meaning medical professionals.

The informational arm of 'the medical community' is responsible for reasonable people refusing these vaccines. There is no credible, reliable public source of information anymore to assess the risk or benefit of these vaccines. Only that people who have been proven to be crooks and liars are pushing it, hard, for whatever reasons, without demonstrating that they are either safe or effective.

The crisis of truth is real. For me, the only reliable information is anecdotal, personal information from doctors, and their input is evenly divided between - most people should vaccinate, versus noone should take those shots.

None of that is your patients' fault.
ramblin_ag02
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No, I'm the one who takes care of them when they end up in the hospital. I've had dozens of COVID patients in the hospital in the last year and several COVID deaths among my patients. I haven't had one serious complication to the vaccines. So your question reveals a poor understanding of the risks of disease compared to vaccination
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Ol Jock 99
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ramblin_ag02 said:

No, I'm the one who takes care of them when they end up in the hospital. I've had dozens of COVID patients in the hospital in the last year and several COVID deaths among my patients. I haven't had one serious complication to the vaccines. So your question reveals a poor understanding of the risks of disease compared to vaccination
TarponChaser
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Marcus Aurelius said:

Frustrating it is. I have a 70 y/o with RA immunosuppressed. Just got intubated for covid. Not vaccinated. Her rheumatologist told her she was too "high risk" for the vaccine. I would argue the total opposite. Now she is facing 10% survival odds.

I'd be curious as to the rationale behind that position.

I mean, I suppose the thinking would be that the vaccine could cause her to get so sick as to die that it's better to isolate and try to avoid exposure (a fool's errand) than vaccinate.

But that's precisely the kind of person I would urge to get vaccinated.

For example:
- both of my parents in the 70's though very healthy otherwise got vaccinated
- my FiL (age- 76) who is a total disaster, diabetic, in the early stages of dementia, whom we financially support, and I'll not get into all of it but I can't stand the POS and he needs to die in a fire - got him vaccinated
- my MiL (age- 74 & divorced from my FiL since 1979) she's also a health disaster - she's vaccinated

All of 4 of them absolutely need to be vaccinated.

However,
- my sister (39), no health conditions whatsoever. Former collegiate swimmer, runs 2-3 marathons per year, consistently runs 25-30 miles per week or more when she's not in marathon specific training. She also does triathalons. BMI is nowhere near overweight
- my BiL (39), no health conditions whatsoever. Not the workout freak my sister is but he's a runner and typically does about 20 miles per week. He's about 6'1" 175 which puts his BMI at a healthy 23.
- my brother (41), former college football player, BMI would have him as overweight to borderline obese at 5'11.5" 215 (30 BMI) but considering the fact he's got visible abs, no other health issues other than the knee & shoulder stuff from football injuries. Works out pretty hard core. Had covid right before Thanksgiving.
- my SiL (33- I think? She's his second wife and younger by a decent amount) - she's very fit but frankly she seems to ALWAYS get sick, had covid right before Thanksgiving
- my nephew (17 in 2 weeks) - my brother's oldest - would also be considered overweight as he's a shade under 6'0" and about 210. He did have asthma when he was younger but appears to have outgrown it; he's also got visible abs and is definitely in shape as a pretty good HS football player (he's about to be a junior and getting interest from FCS and DII programs) and runs track. Had covid before Thanksgiving (he was patient 0 for my brother's family)
- my niece (16 next week) - my brother's youngest. Definitely not overweight at all. She's about 5'8" and pretty skinny. I can't estimate weight for women/girls. She's a pretty decent tennis player. Had covid around Thanksgiving.

Anyway, all of them got vaccinated and frankly I'm not sure they needed to at all. It's clearly their call and I'm not judging them for doing it but except for my SiL they're all the lowest of the low-risk.
ramblin_ag02
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Also, when patients are "too high risk" for the vaccine, the concern seems to be that the vaccine will interfere with their current treatment, not that the vaccine will make them sick. So if someone is on a monoclonal antibody for rheumatoid arthritis, migraines, COPD, or whatever, there is some worry among specialists that the vaccine will interfere with those treatments. I have no idea why this idea is prevalent, as I have seen nothing in any literature about it. But I've noticed many specialists recommending their patients on monoclonals not get vaccinated for this reason.
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03_Aggie
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ramblin_ag02 said:

No, I'm the one who takes care of them when they end up in the hospital. I've had dozens of COVID patients in the hospital in the last year and several COVID deaths among my patients. I haven't had one serious complication to the vaccines. So your question reveals a poor understanding of the risks of disease compared to vaccination


You spoke specifically of people who were considered high risk, for both the vaccine and the disease, being advised by their specialist. I presume their specialists are also Doctors? Are you saying their Doctors, specialists with their disease, are also not well versed in understanding the risk to their patients as it relates to the vaccines v the disease?

I'm genuinely curious to what vaccination numbers look like for people with known autoimmune disorders?
ramblin_ag02
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AG
Sorry, I clarified my comment about people "high risk for the vaccine" in the post above.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
wessimo
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Talked to a Houston ER doc yesterday and he shared the following:

- Yes, hospitals are are full as the news reports are saying. Rural hospitals are used to being able to send patients to Houston but are now getting told to find somewhere else to send them.

- 99% hospitalized are unvaxed.

- Staff are burnt out and angry about the lengths they are having to go to treat people for an easily preventable disease.

- A bit of irony - many patients report not wanting the "experimental" vaccine, but once hospitalized they want every experimental treatment available.
TarponChaser
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Except the Med Center folks are saying they're not at all full. Especially in the ICU.
Forum Troll
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Just because TMC has super duper surge capacity still available doesn't mean its not full.
htxag09
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Or staff with the current climate to use those excess capacities if needed
Fenrir
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2 months ago (pre surge) my aunt had a stroke. None of the DFW area hospitals were able to transfer her in. Covid is probably making things worse, however there was a staffing issue before.

Anecdotal I know but I know of nurses leaving much higher paying hospital jobs less stressful positions.
TarponChaser
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Forum Troll said:

Just because TMC has super duper surge capacity still available doesn't mean its not full.

As of Friday TMC was only 65% full. And that didn't account for surge capacity. Only about 25-30% of those beds were covid cases.
ramblin_ag02
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Related thoughts:
I've still yet to have anyone, vaccinated or not, refuse any experimental treatments after testing positive for COVID (remdesivir last year, regeneron now)

Per our CEO, a patient in rural Texas presented to a small hospital with renal failure and acute heart issues. That hospital called 60 other facilities in 4 states and no one would accept transfer. Patient died still in the small hospital that couldn't do dialysis. There was a big emergency meeting at the state level to address staffing concerns. It seems to be the worst with nursing staff and it's a problem everywhere
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
TarponChaser
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Boom


htxag09
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AG
TarponChaser said:

Forum Troll said:

Just because TMC has super duper surge capacity still available doesn't mean its not full.

As of Friday TMC was only 65% full. And that didn't account for surge capacity. Only about 25-30% of those beds were covid cases.

Pretty sure phase 2 and 3 are surge capacity. So 65% full includes phase 2 and 3 capacity. It's over standard, phase 1, capacity. Yes, they can add additional capacity over phase 3, that's not included.

Also, not sure "only" applies to 25-30% being covid. That's quite a bit of additional strain on a system
Righteousgemstone
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This is simply not true
 
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