DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JULY 11, 2020.
Tag Archives: Dr. C Opinions
PRESCRIPTION DRUGS: “ON MEDICATIONS IN GENERAL”
Several ideas apply to ALL MEDICINES. Terminology should be clarified. Medicine, Pharmaceutical, and Drug, in my mind are equivalent.
The term “drug” is pejorative, and I try to use it so. The term “Pharmaceutical” is too long, leaving me with “medication”.
There are some Practical points. You should look at your prescription when you first get it, to make sure it is the right one. Yes, pharmacists rarely make some mistakes. They are human.
You should ask the Pharmacist if she knows WHERE the drug was manufactured. Foreign countries, especially China and India, are less reliable, and the USA is safer. The original Brand Name drugs are more often domestically produced, but even these are being “offshored”.
Next, check the prescription date and expiration date.You should get a ” SHELF LIFE” (the difference between the two) of about 2 years, otherwise, you might ask the pharmacist the next time to give you the “best dating” in his stock.
Store your medications in a cool, dark, dry place in order to prolong their life. Light, heat and moisture degrade most compounds. Remember the O.J. Simpson case? Part of the reason he was acquitted is that a critical DNA sample was stored in a plastic bag, which retained moisture, rather than a paper bag, which is recommended because paper is porous, and allows moisture to escape.
You should follow the suggested TIME to take the medication, because there is almost always an optimal time to take a given medication.
CHRONOPHARMACOLOGY is an emerging field, which is finding that more than 50% of medications are TIME SENSITIVE in their effect in the body. This is an unimportant, academic consideration for most Patients, given the high THERAPEUTIC WINDOW (dosage latitude) of most medications, the mild illness of most patients, and the disinclination of most Doctors to add one more detail onto their already heavy load.
In discussing the medicines in my cabinet and a few other important ones, I will be addressing TIMING.
What about OUTDATED MEDICATIONS? As discussed by the following article from Harvard, the dating is not critical except for liquids, and a few others, like Tetracycline.
This is fortunate, given the expense of medications today. What if I drop a pill on the floor, at home. I usually pick it up and take it. if i just dropped it, unless it is very inexpensive.
What if a pill sticks in your throat, like happens to me a lot? I drink water first, to moisten my throat to make it slipperier.
Next, I take a good sip of water, try to swish it back and go back with my head to accelerate the pill backward, and think confidence. Certain sizes of pills are my nemesis and i have to break them in two.
Please follow Dr. Cs Medicine Cabinet in future postings of DWWR.
–Dr.C.
OPINION: FACE MASKS AND SHIELDS TO PREVENT COVID
My main exercise for the day is a 45 minute fast walk around my community.
Hat – check. Sunglasses – check, FACE SHIELD – check.
Yes, face shield. The shield has the advantage of allowing me to talk, plus being more comfortable to wear. I clean it with a woolen cloth on one side and cotton on the other, hoping for a condenser electrostatic effect (I’m open to suggestion from engineers).
If I cough, any large particles of mucus would impact the shield, leaving only tiny aerosol particles to escape around the edges into the environment to endanger others.
It is Saturday today, and I pass a man and a woman pushing a baby buggy, and give them wide berth. I don’t consider 6-feet far enough distancing. 12-18 feet would be better, since, at 88-years of age, I am at least 2-3 times more susceptible.
A 12-year old zooms by me on a scooter. His age predicts less viral effluent, and the exposure time is less. I then go by a large collection of 20-year olds, Wide berth again, and, holding my breath, continuing to walk fast.
As I walk, I breathe air in through my nose, and out through my mouth. I feel the warmth (and purity) of the exhaled air, which may push aside and dilute any contaminants coming from the outside.
Another group of young adults! Well, maybe the risk is not as bad as the numbers would indicate. Odds are there would be only one spreader in the group, and the healthy ones would act as particle filters for me.
So far, not a single young person had a mask on. They are probably just thoughtless young people, and not necessarily “objectors” believing that mask-wearing is a sign of submission. As Peggy Noonan said in her column in today’s WSJ:
“…IT’S A SIGN OF RESPECT, RESPONSIBILTY AND ECONOMIC ENCOURAGEMENT”.
Going forward, we must all do our part to reduce the likelihood of another Covid surge. WEARING A MASK PROTECTS OTHERS.
I finally spied 2 masks! They were fitted on 2 ceramic lions flanking a front door. It is true that felines can catch Covid. But ceramic ones?
I thought I was walking fast, but was overtaken from the rear by a long-legged young lady. She passed within 4 feet of me, and of course had no mask on. I only hope she didn’t have Covid, and that my shield worked.
On the subject of the effectiveness of wearing a shield, while walking I tune into the odors along the way. I use the odors as surrogate aerosols, especially a recently fertilized curbside flower bed, I compare walking by the flowers, with and without my face shield, and find that the shield reduces but does not eliminate the odor. For more distant odors, like a barbecue, it does not make a difference.
Perhaps the shield, like the prow of a ship, pushes aside STREAMS of particle-laden air. Like coughing or talking nearby. But if the particles (yes, odors are nanometer particles) are well mixed with the air, there is no effect. Air must be breathed, after all.
There are a couple of other things I practice on my walk. I exercise my EYES by looking into the DISTANCE as much as possible. I try to walk as erect as I can. Gravity, my friend in grounding many big Covid-containing mucus particles, tries to bend me over.
The BOTTOM LINE, until more information is available), is: SPREADERS WEAR MASKS, SUSCEPTIBLES WEAR SHIELDS. Of course, hand-washing, social-distancing, coughing into your elbow, and staying at home, especially if sick, are all still important admonitions.,
-Dr. C.
THE HEALING POWERS OF YOUR POSITIVE ATTITUDE
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
From “Do Not Go Gentle Into That Good Night” by Dylan Thomas
My brother recently sent me a video featuring a confident man with a famous last name and a winning message: You beat Covid by fighting it. I would like to comment on several recommendations in his inspiring speech.
It is usually best to approach a problem with a POSITIVE ATTITUDE and a PLAN (1). This is particularly true with the ravages of old age (my area of expertise). Memory loss? Try to memorize poems. Balance loss? Practice standing on one leg. However………….
One person’s good experience is not a medical study. Medicine calls it a testimonial. This applies to my individual experiences as well. Going forward, I will be recounting many personal experiences with common diseases and conditions. Be careful about applying my solutions to your condition.. EXERCISE CRITICAL THINKING.
Be especially careful not to equate fame with medical expertise.
Mr. Cuomo’s result, if indeed the outcome was changed by his efforts, was most likely influenced by a powerful PLACEBO effect (2) which can be associated with striking outcomes, as we know from countless inspiring testimonials of “hopeless” cancer and other terminal conditions.
Even if we KNOW a treatment is likely due to the placebo effect, it remains effective. I don’t believe I’m doing harm with my speculations.
A couple of generations ago, confidence in doctors was much greater than it is now. We had fewer effective treatments, but surprisingly good results. As medical information of various quality proliferates and medicine loses prestige, it it is losing a valuable tool. Still, we have the placebo effect.
Mr. Cuomo was fortunate to have a good, positive doctor, and to believe in him. Positive affect is powerful.
FEVER is not the virus incarnate, but the bodies RESPONSE to the virus. Fever survived the culling of evolution because it confers a survival advantage, and is helpful.(3) Viruses replicate less rapidly at higher body temperatures.
I always told my patients: “ if you are stuck with the infection, enjoy the fever”. Of course high fevers, above 104 degrees F should be reduced.
I’m not sure that Covid patients should hold their breaths to “fight the virus”, although the length of time you can hold your breath is a good measure of breathing difficulty. Blood CO2, the main driver of dyspnea (shortness of breath), must not be allowed to accumulate. The accompanying hypoxemia (low blood oxygen ) is not desirable either.
I agree with most of the advice quoted by Mr. Cuomo. Lying on the back has proven dangerous in severe Covid. Taking deep breaths (even if painful) will help keep the alveoli (air sacs) expanded. Change of position is important for the same reason, and adequate fluids, including water, is always beneficial.
So educate yourself as much as you can about your condition. Pick out the best doctor you can find (the subject of a future opinion piece) and place yourself in her care. Enjoy a sense of relief and confidence. Even physicians need the objectivity and support of their own doctor.
Finally, armed with a positive attitude, make the most of whatever placebo effect you are accorded.
—Dr. C.
OPINION: THE ” FOUR PILLARS OF HEALTH AND THRIVING”
Homo sapiens have been around for upwards of 200,000 years and our bodies have evolved to deal with conditions far different than we experience in today’s life.
For about 95% of our species’ existence we have had:
- Far more SLEEP. We were diurnal, going to bed at sundown, awakening at sunrise.
- A more natural and varied DIET. We had to gather or kill what we ate.
- Far more EXERCISE as we walked many miles on most days.
- INTELLECTUAL STIMULATION. Well, here at least we moderns have an advantage, and our brains are better for it, If we get enough Sleep, Diet and Exercise.
Intellectual stimulation is really just a form of exercise. Exercise of the brain; as the brain is in a way like a muscle. If you don’t exercise your muscles, they waste away. If you don’t exercise your brain, your synapses waste away. To overwork a cliche : use it or lose it. Your muscles and brain are very energy-intensive and therefore expensive in evolutionary terms. Metabolic mechanisms have evolved to weed out that which is not needed and not used.
We could then say that there are the “Three Pillars of Health: Sleep, Diet, and Exercise, with the understanding that exercise refers to both muscles and brain. But they are exercised in such radically different ways, and each is prominent at different times in life. Children are reluctant to exercise their brains and are in constant motion. The elderly have much less muscle to exercise, but the aged brain still works quite well if you nurture and use it. So Intellectual Stimulation is best considered a separate category.
SLEEP, DIET, EXERCISE and INTELLECTUAL STIMULATION are then the “Four Pillars of HEALTH and THRIVING”.
These Four Pillars come as a package, reinforce each other, and are intricately interconnected. You can’t afford to neglect one without diminishing the others. But we will be discussing them separately, since they are separately researched and enacted.
Keep tuned.
—Dr. C.
OPINION: THE IMPORTANCE OF VITAMIN D3 SUPPLEMENTS
EVERYBODY should have a SERUM VITAMIN D level!
The medical establishment has been slowly acknowledging that the importance of vitamin D is not limited to just calcium absorption and the bones, or to the athletes and elderly.The lower limits of normal has been slowly creeping up, as has the RDA.
But how much vitamin D you have in your body depends upon your diet, supplements, how much sunshine your skin gets, how much sunshine is screened out ( sunscreen, melanin), and other factors. Measuring the vitamin D serum level tells you directly.
My own Vitamin D level was at first in the low 20’s (ng./ml.), and I raised it to the low 50’s when I started taking 4,000 I.U. daily, the lower limit suggested by the NFL.
Serum Vitamin D levels cost almost $100. Why not just take 4-6,000 I.U.? For me, adding to already nauseating handfuls of pills (to be enumerated later) was unappetizing. I needed a Serum D level to convince me.
But I didn’t need to be convinced of the importance (with hospitalized Covid Patients the VITAL importance) of this amazingly versatile Vitamin. Vitamin D tends to benefit the innate immune system, helping to ameliorate infections when they first hit. It then helps to turn off “the first responder” when the “big gun” adaptive immune system kicks in at 5-10 days. Failure of this shift ( with continuing interleukin production) may contribute to the “cytokines storm” of the seriously ill Covid-19 patient.
Many Doctors, inured to “health food industry” hype, give little attention to Vitamin D. You might need to expressly ask for a vitamin D test on your next visit. I hope you do!
—Dr. C.
Further reading:
Doctors Without Waiting Rooms 