DR. C REVIEWS MAJOR MEDICAL NEWS FOR THE WEEK ENDING JUNE 20, 2020.
Eliquis nicely illustrates my contention in the Overview of Metabolism, that the body is a vast collection of pathways, or “supply chains”. Eliquis blocks a critical enzyme in the pathway leading to coagulation, or clotting” as the product.
Why in the world you want to block clotting? The staunching of blood flow, clotting, has saved countless hordes of early, Paleolithic humans, and continued useful through the bloody Roman and Medieval times, right through the violent 20th Century.
Recently, however, wars are becoming somewhat less popular, and eating excessively more popular, leading to a strange situation. Our evolutionarily-preserved CLOTTING mechanism is now leading to MORE problems than it is solving.
Obesity and type 2 Diabetes are leading to the production of so much fat, that it has to be stored in our arterial walls, clogging the blood flow to our Hearts and Brain, among other areas. This, and the somewhat surprising trend towards longer lives has led to an increase in a variety of age-related illnesses.
When I reached 80 years of age I developed Atrial Fibrillation, a condition leading to a tendency to form clots in my quivering atria, the upper chambers of my heart. To decrease the likelihood of clots getting into my blood stream, lodging in my brain and causing STROKE, my cardiologist started me on Eliquis, an anti-coagulant/blood thinner.
Drugs have three names. The proprietary name, Eliquis in this case, is given by the patenting company to be memorable; q,z,and x are popular letters. The second is the FDA drug name, Apixaban. The drug name often gives the doctor a clue as to its type: xaban refers to inhibiting (banning) of factor 10a (Xa). The third name is a chemical name of interest to biochemists and drug researchers.
When I started the Eliquis, at first unknown to me, I started to bleed internally, leading to a drop in my hemoglobin down to 8.6. I will go into this story when I start going through “how to read your laboratory report”.
I found that reducing my Eliquis from 5mg. to 3.75 mg. allowed me stabilize my hemoglobin by taking extra iron, which I will discuss later.
The doseage selected when the drug company markets a drug is fairly arbitrary, and usually involves round numbers. Interestingly, there is a 2.5mg. Eliquis, which is given if you meet 2 out of 3 criteria. I meet only one and am only 5 pounds shy of the second, in case you think (like my cardiologist does) that I’m taking a risk.
I believe that, whenever you are given a medication, you should be educated about the medicine, and the problem it is intended to benefit. Today’s physician often does not have the time to do this. The internet, including this website, offers a corrective.
I am trying my best to be helpful to you as a Patient Advocate. You and I both must have a doctor to rely upon. But to get the most out of our care, WE MUST BE INFORMED.
“Life is nothing but an electron looking for a place to rest”.
Overview of Metabolism – Seeing an Essence of Nanosystems in the Hum of a Vibrant City; the Skyscraper as Catalyst, and Thought as Electron
What did it take to bring the world to its’ knees? SARS-CoV2? We will never know, because we instituted DISTANCING to control the virus because the projected number of deaths were unacceptable.
The distancing and isolation did hold the number of deaths, still large, below projection. However, it DEVASTATED our Economy.
OUR WORLD is a massive, cooperative, interdependent system, with hubs, factories, supply chains and a myriad of products. It is a COMPLEX SYSTEM.
I would like to use the world as an analogy, and compare it to another Complex System, the HUMAN BODY.
Our bodies are essentially a large pile of chemicals (mostly proteins) in a sack, our skin. These chemicals are constantly interacting with each other. If they grow to larger, more complex chemicals in a process we call anabolism, we take in more chemicals and energy by eating, and get bigger. If our chemicals get less numerous and complex in a process we call catabolism, we lose weight and get smaller.
Some of the proteins in our bodies are ENZYMES, and bring other proteins CLOSER TOGETHER, so that they can LINK TOGETHER become more complex and PRODUCE things. Enzymes are a sine qua non of life. Without enzymes, life would slow so much as to be impossible.
Let’s go back to our Society, Before Covid.
Vast numbers of people are cooperating in close proximity, working together with machines, often supplied by other people far away, making things. This process takes place most efficiently in CITIES, where people are in closest proximity, doing things together.
Enter Covid. This interdependent process stops. What things that are produced are made to fight Covid. It is just like one of our cells infected by Covid: we have been HIJACKED by the virus!
Lets’ GO BACK TO OUR CELLS. Our METABOLISM is like our teeming, cooperative CITIES, with SUPPLY CHAINS, factories and products. Our PROTEINS NEED PROXIMITY to function.
Some Proteins are at a critical HUB, and comprise a RATE-LIMITING step in the production line.
Many Vitamins and nutrients are COENZYMES, and act to ACCELERATE critical supply lines.
If the Hubs are OUT OF BALANCE and OVERACTIVE, many MEDICATIONS act to BLOCK THE ACTION of an enzyme to bring the system closer to balance.
Thus coordination, cooperation and careful monitoring to PREVENT A PROBLEM is superior to letting it break down and correcting the imbalance.
I hope that this Overview will be helpful. I will go through my MEDICINE CABINET to discuss a few of the 20,000 or so Medications approved by the FDA. I will also VIEW THE TEST RESULTS from my LABORATORY TESTS. NORMAL results show a SYSTEM IN BALANCE. Abnormal results show inefficiencies in the metabolism (supply chains, hubs), which need correction to restore balance.
— Dr. C
Chronic nasal congestion, the constant condition of not being able to breathe through your nose, can be a major problem, interferes with sleep (often via sleep apnea), undermining one of the 4 pillars of health (sleep, diet, exercise and intellectual stimulation). Well, maybe a second one as well, since it is hard to function intellectually when you are sleepy all the time.
Chronic nasal congestion in kids is often due to allergy and associated ADENOID (located at the back of the throat) ENLARGEMENT. Adenoids can cause sleep apnea and pulmonary hypertension, ear infections and sinusitis.
If left untreated, the bones of the face don’t grow properly, and the constricted bony structures can lead to later problems. Nasal polyps can be a factor in nasal airflow blockage, and their removal may benefit the blockage.
If associated with sinusitis and aspirin (aspirin is rarely used in children anymore because if Reyes’ Syndrome) sensitivity, the combination is known as “sampters’ triad. Regrowth of the polyps is common and aspirin desensitization may be helpful.
ALLERGIC RHINITIS is treated by avoidance, medication and desensitization. SINUSITIS can cause chronic nasal blockage. Both medical and surgical treatments are useful.
One-sided nasal blockage raises a red flag. One of my young patients had pushed a rock into his nose, which I then removed. Nasal polyps can be on one side, and can be removed, NASAL SEPTAL DEVIATION can cause one-sided nasal blockage, and if severe can be surgically corrected.
The nasal tissues are “erectile tissues” I have a nasal septal deviation to my left side. I SLEEP ON MY SIDE to CONTROL my SLEEP APNEA (more when I get to that subject, which certainly qualifies as a chronic problem), When I sleep on my right side, I don’t breathe as well since my “good side” is down and becomes study.
Those lucky people who breathe freely on both sides, and who sleep on their sides, may possibly be aware that the DOWN SIDE (my good side, above) blocks up. It seems that the nasal tissues are “erectile tissues” body wants to REST one side at a time, and the down side is easier, since gravity pools the blood there.
Nasal tissues are under the control of the autonomic nervous system, decongest (nasal passages are open) with the alarm (fight or flight, “sympathetic”) reaction, and do the opposite (tissues congest, nasal passages close) when the “parasympathetic” takes over after a meal, when you are “vegetating”. in front of the TV
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.,
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.
Vitamins and minerals, as we all know, are of critical importance to our health. Gone are the days when scurvy(vitamin C) was the scourge of the high seas, and rickets (vitamin D) was common in the children of smoke-filled industrial cities with insufficient sunlight.
We are in a state of such overabundance that many medical authorities feel that vitamin supplementation merely makes our toilets healthier.
Covid 19, with a deficit of prevention and treatment options, has forced a new appreciation of the role of our immune systems in fending off Covid, and future viral plagues that are certain to follow. Optimum Health has never been more important.
A May 4, 2020, British Medical Journal (BMJ) article highlights the role of vitamins C and D, and minerals, especially Zinc, in functioning of our immune systems. Here are several highlights from the article:
- Foods that are naturally abundant in vitamin C such as broccoli (60 mg/100 g), blackcurrants (130 mg/100 g), fortified breakfast cereals (up to 134 mg/100 g) and oranges (37–52 mg/100 g)45 should be made accessible to older individuals who are most in need of their nutritional benefits.
- In the UK 5.5% of men and 4% of women 65 years and over (around 1 in 20) presently have zinc intakes lower than the lower reference nutrient intake (the level below which deficiency could occur).46 The consumption of foods naturally abundant in zinc such as canned crab (5.7 mg/100 g), canned shrimps (3.7 mg/100 g), canned adzuki beans (≈2.3 mg/100 g) and boiled eggs (1.3 mg/100 g) should be encouraged as a supplementation strategy to reinforce immunity.
- Tolerable upper intake levels (ULs) are intake levels which should not be surpassed as toxicity problems could appear.47 For vitamin D a UL of 50 µg/day is advised and for zinc a UL of 25 mg/day is recommended. 47 There is insufficient evidence to establish UL for vitamin C, but available human data suggest that supplemental daily doses of up to about 1 g, in addition to normal dietary intake, are not associated with adverse gastrointestinal effects.47 Not having an adverse effect, however, is not necessarily indicative of a benefit either, and ongoing trials are warranted.
- Among those with established respiratory conditions or pneumonia, specific nutrients such as vitamin C, D or zinc could be considered as potential adjuvants to conventional treatment pathways.
Susceptible people, particularly the old, should use every safe measure to stay well.
– Dr. C
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.