Tag Archives: Medicine

MEDICINE: UNDERSTANDING ‘LONG COVID’ SYNDROME

The risk of COVID-19 has been largely communicated only in terms of deaths and hospital capacity, with recovery and survival conflated with each other. Around one in three people with symptomatic COVID-19 still experience symptoms 12 weeks after onset (1). Long Covid can be experienced by all age groups and not only those with acute severe disease. The debilitating symptoms are wide-ranging, multisystemic, and predominantly fluctuating or relapsing. There is still much to understand about Long Covid, but what is not well understood should not be ignored.

Long Covid is likely the first illness in history that has been defined by patients through social media platforms such as Twitter and Facebook. People with Long Covid formed a movement that demanded recognition of what was happening to them. During the first wave of the pandemic in 2020, online testimonials of prolonged symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were the only source of reassurance to others with a similar experience, including this author (2). In the absence of any guidance or recognition about the possibility of a persistent illness, peer support is all that people with Long Covid had. Many previously healthy and active people described persistent symptoms of the acute illness that fluctuated, with new symptoms appearing weeks later. In many countries, most nonhospitalized people did not have lab confirmation of SARS-CoV-2 infection owing to lack of access to community testing, so their symptoms remained without a diagnosis.

By summer 2020, thousands were joining social media support groups. A common theme started to emerge: lack of recognition by the medical profession. Patients, including doctors, with Long Covid were consulting their health care providers, and their symptoms were commonly minimized, dismissed, or labeled as anxiety (3). A narrative emerged of people struggling to make sense of their symptoms and forming their own groups to understand and research what was happening to them in an international citizen science movement (4). The testimonials of people living with Long Covid demonstrated themes of stigma and discrimination.

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DR. C’S JOURNAL: EFFECTS & SYMPTOMS OF LONG COVID

COVID-19 is admittedly a pandemic and has caused much economic and social disruption in the world. Now we learn that it may not be over after a few of weeks of illness. LONG COVID is now an accepted syndrome.

You can tell because of the many clinics for handling it being set up by the NHS in England, and millions in research money being directed towards a solution.

The most disturbing thing to me is that infected but asymptomatic or mildly ill people may get this condition, and have one or more symptoms for a long time .Certainly, those more seriously ill develop long Covid symptoms more commonly.

Long Covid is taking its place with chronic fatigue syndrome, posttraumatic stress disorder and post ICU syndrome as poorly understood conditions. They may in fact be taking place simultaneously, even if they are not identical.

The cause  can  be due to continuing viral infection in older or immune compromised individuals. Vascular damage is another reason that could account for the widespread involvement of practically any organ system that doesn’t go away after a few weeks.

Structural damage to the alveoli of the lungs and other organs can also play a role, which would account for shortness of breath as a prominent persistent symptom. Although it has not been highlighted in the articles that I have read, auto immunity can also be playing a role in long Covid.

This would go along with The myocarditis rarely caused by the mRNA vaccines; perhaps some of the protein sequences of the spike proteins have similar shapes to some human tissues. Name a symptom, and you’ll probably find it listed among the 50 odd symptoms mentioned in the Wikipedia article on long Covid, which is appended to the end of this article.

The most prominent symptoms include extreme fatigue, mental fog, and shortness of breath. Treatment is mainly supportive and general. After ruminating on this condition, it’s going to be quite a while before Yours truly wants to breathe in other peoples air spaces; I plan to continue masking in public, distancing and avoiding large groups.

That being said, I am planning to go out to eat dinner tonight, and can hopefully be placed at the edge of the room. I will inquire as to the vaccination status of our waiter. The people at my table will all be doubly vaccinated, which is not complete assurance of safety, but will help make me feel relatively comfortable.

I also plan on getting a booster shot as soon as it is available. Hopefully, the vaccine incorporating the special mutations of the delta virus will be soon available. You don’t want to be infected by this nasty, promethian shape-shifter. Take care.

–Dr. C

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VIEWS: IS U.S. HEALTHCARE SYSTEM BROKEN? (HARVARD)

Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.

Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.

The cost is enormous

  • High cost, not highest quality. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is relatively low in the US.
  • Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.

Access is uneven

  • Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
  • Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
  • Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.

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Dr. C Commentary:

Please refer to the DWWR Posting on “concierge doctors” for my rant on the current healthcare system, which I will not repeat.

The truth is more nuanced. All countries are having trouble of one sort or another with their healthcare systems. This is due to the inherent expense of today’s top flight medicine. The very best care requires costly high technology and drugs that are intrinsically hard to produce. And you have to know where to look. I am very thankful for my medical degree, and that I have kept up with current advances.

You would probably need a Government entirely of physicians to develop the willpower to do something for health, which always starts with PREVENTATIVE MEDICINE, A hard sell, given that you must spend money and effort to block something which will probably, but may not always, occur.

There is low hanging fruit. Why are sugary drinks not heavily taxed, since they produce obesity which causes a lot of costly medical disorders, such as diabetes, inflammatory diseases, and cancer, but not everybody all the time?

Why is efficiency of telehealth not more widely embraced, but stymied by moneymaking lobbiests and lawyer powered difficulties, in addition to Patient’s and doctor’s old habits?

And then there are the jealously guarded  American freedoms to do stupid things, such as avoid vaccines and masks, even in a prodigiously expensive and dangerous Covid  epidemic.

Given human nature, a complete solution would seem to be impossible, and we should content ourselves with minor victories wherever they can be attained.

Embrace sleep, diet, and exercise, and KEEP HEALTHY.

–Dr. C

HARVARD: ‘NANOBODIES’ EVOLVED FROM SYNTHETIC ANTIBODY FRAGMENTS

A new approach developed by Harvard Medical School researchers uses yeast to rapidly evolve synthetic antibody fragments called nanobodies with the aim to find variants that are effective at binding to selected antigens, including SARS-CoV-2. The antibodies are intended for use in diagnostic tests and disease treatments. Read the full story: https://hms.harvard.edu/news/antibody…SHOW LESS

DR. C’S JOURNAL: ASTHMA – DIAGNOSIS & TREATMENT

Asthma is a lung condition with narrowing of the airways, especially on exhalation, or breathing out. This narrowing leads to the musical sound on breathing the air out of the lungs that I heard so often with  my stethoscope and over the phone, when I was in active allergy practice. With an asthma attack, the blockage to airflow can become severe enough to dangerously raise the carbon dioxide concentration in the blood stream, and lower the oxygen content.

Many attacks occurred at night .Over the phone, I had older kids and adults take a deep breath, and count from 1 to 30 as rapidly as they could. If they could count out loud to 30 with one breath, at least the obstruction and attendant blood gas changes were not usually serious at that moment in time. That helped me decide whether or not I had to see them in the emergency room.

Asthma is an inflammatory condition of the lining of the airway that stimulates the smooth muscle surrounding the airway to constrict and obstruct flow of air, particularly on exhalation. Early on in my medical practice the main pathology was thought to be overactive airway muscles, and the main effort was to relax those muscles so that breathing could be easier. This was typically done with adrenaline injections, or the inhalation of adrenaline-like agents such as albuterol.

More sustained opening the airway was accomplished by oral theophylline. As time went on, it became  known that its effectiveness required a certain blood level. We had an HPLC machine in the office to measure this. 5 to 10 µg per milliliter was required for relief, and anything over 20 µg per milliliter was dangerous. Many cases of convulsions have been recorded in people with excessive blood levels.

We were always aware of the fact that cortisone medications would relieve asthma, but regular use of these drugs caused worrisome side effects such as interference with growth in children, osteoporosis, weight gain and loss of sleep or other problems. Most worrisome was the possibility of adrenal insufficiency and sudden death. We used Cortisone only as a last resort.

There was a group of young children especially 1 to 6 years of age that developed extreme asthma a few days after they developed a common cold. I found that giving prednisolone for two or three days at the start of a runny nose would block the advent of this asthma, without suppressing the adrenal gland. Three days of prednisone was also used to blunt severe attacks.

The excellence of Cortisone in the treatment of asthma should’ve told us that inflammation was a particularly important factor. It is now known that Asthma is not a disease of airway smooth muscle sensitivity per se, but rather a chronic inflammation of the airways that causes the muscles to be irritable.

Asthma is more common in allergic individuals, particularly when they are young. For this reason, the allergies are treated by avoidance of exposure to such things as cats, dogs, house dust and pollen.  Allergy injections to the skin test positive items is also useful.
Currently,  asthma is treated by inhaling special cortisone  preparations and long acting bronchodilators.

The chain of chemical reactions that cause asthmatic airway inflammation has become apparent over the years. Drugs to block these are available, and include special antibodies can be exceptionally expensive; but very effective.

The youngest of my former partners is still practicing Allergy, and almost never has to deal with acute severe asthma.
The beast has been tamed, if not conquered.

—Dr. C.

Mayo Clinic Article

MEDICINE: ‘AI’ CAN PREDICT RHEUMATOID ARTHRITIS

DR. C’S JOURNAL: TIMING IN HEALTH AND MEDICINE

Timing is important in everything we do, and of course is important to health and how our bodies function.  It is a vast subject, and the only thing I can do here is to give you some ideas that might be helpful.

Your body will perform best for you if you have a daily routine; waking up at the same time every morning, and going to bed at the same time every evening keeps your circadian rhythm from getting confused. Of course, getting a good nights sleep is excessively important to your health. If you have trouble going to sleep at night or staying asleep, you can get all kinds of information over the Internet on “sleep hygiene”.

If you are an international traveler, jet lag is very important because the circadian rhythm is disrupted when you change time zones. The Internet is a rich source of information on how you might or rapidly get back into your routines. Timing of bright light and melatonin are involved.

Your metabolism also has a routine, and drugs work by targeting certain receptors, which cycle, depending on when their function is needed. “ Chronopharmacology” is a slowly developing science that will someday-if doctors, perhaps with electronic help, can ever get enough time to properly take care of the patients- be very important. As an example, certain cancer therapies vary significantly in their effects, depending upon the time of day they are given.

When I was a practicing Allergist, I took care of many Asthma patients. In the 60s and 70s there were few drugs to treat asthma, which is predominantly a nighttime disease. Giving medications, such as Theophylline, at the right time was therefore very important.

Finally, if you have any choice, you might arrange for your surgery during the first half of the day. Surgeons make less errors in the morning, when their minds are well rested.

—Dr. C.