George A. Sprecace M.D.,
J.D., F.A.C.P. and Allergy
Associates of New
London,
P.C.
asthma.drsprecace.com
Health Alerts
- - - - - - - - - - - - - - - - - - - - - -
FOR BOTH OLDER AND YOUNGER ATHLETES
WHO ARE SUBJECT TO CONCUSSONS...AND THEIR RESPONSIBLE COACHES AND
PARENTS: you are not only out of your head -
you are OUT OF YOUR MIND for allowing these injuries to occur. GS
I'VE TOLD YOU ABOUT "LONG
COVID", ABOUT ITS FREQUENCY, ITS SCOPE OF ILLNESSES AND ITS DURATION. NOW COMES THIS INFORMATION.... STILL REFUSING TO GET COVID-19
VACCINATIONS? Sounds STUPID to me. GS
PRIOR AUTHORIZATION: THE UNLICENSED
PRACTICE OF MEDICINE. Organized and private physicians
should SUE THE BASTARDS. And they should also share this
problem with their patients and with the public. Meanwhile, Health Care is on a
down-hill spiral. GS
AS I WAS SAYING...FOR THESE MANY
DECADES. The most critical and easily treated
of these conditions is Essential Hypertension. And it is too often poorly treated by both physician and patient. BEWARE! GS
NOT "TO YOUR
HEALTH"! "PRIOR AUTHORIZATION" REQUIREMENTS ARE TOO OFTEN A BASTARDIZATION OF YOUR
HEALTH CARE NEEDS AND OF YOUR PHYSICIAN'S EFFORTS. WAKE UP! GS
A PATIENT LABEL OF "PENICILLIN
ALLERGY" IS IMPORTANT WHEN IT IS TRUE...AND IS EVEN MORE IMPORTANT WHEN IT
IS FALSE. AND OVER 80% OF PATIENTS WITH
THIS LABEL ARE FOUND TO BE FALSELY LABELED WHEN TESTED. In the past, Penicillin
Testing was cumbersome and expensive, involving scratch and intradermal testing
followed if negative by graded direct challenge. Now, graded direct challenge has
been found to be safe and effective in most cases. Why is this knowledge important?
Because it will allow a patient to be prescribed penicillin instead of less
effective and more troublesome antibiotics. Score One For Both Patient and
Physician. GS
HIGH BLOOD PRESSURE: MOST EASILY TREATED... OFTEN THE LEAST EFFECTIVELY
TREATED - BY PATIENT AND BY DOCTOR... AND THE MOST CONSEQUENTIAL IN
TERMS OF DECADES-LONG SIDE EFFECTS. NO JOKE. GS
THERE ARE FEW THINGS THAT MIGHT
RENDER ME SPEECHLESS. This is ALMOST one of
them. To all the teachers, school
administrators, doctors, "therapists", politicians and even parents
who allow and enable this travesty: A POX ON ALL YOUR HOUSES. GS
"ALPHA GAL ALLERGY." THIS ALLERGIC DISORDER GENERALY BEGINS AFTER A BITE
FROM A "LONE STAR TICK" AND SEVERAL HOURS AFTER EATING MEAT OR DAIRY. The symptoms are classically
allergic with a GI component. GS
REMEMBER MY COMMENT ABOUT LARGE
SEGMENTS OF THE CURRENT TWO YOUNGER GENERATIONS? "A PANDEMIC OF STUPIDITY". Nowhere is this more evident than in
the attitude of too many toward vaccines and vaccinations. WAKE UP...FOR YOUR SAKE AND FOR
THOSE AROUND YOU! GS
NOW HEAR THIS... In over 67 years as a physician,
witnessing the development of Great medications for High Blood Pressure - one
of man's most common illnesses - I have also found it to be one of
the most poorly treated diseases by both patients and physicians. The reason: inattention to necessary
details. The results: other serious and
avoidable illnesses, including Dementia. "Can You Hear Me Now?" GS
AND WHAT ABOUT THE MANY MILLIONS OF
ABORTIONS: THE INTENTIONAL KILLING OF A HUMAN BEING? "REPRODUCTIVE RIGHTS"? NO.
DESTRUCTIVE CRIME AGAINST HUMANITY. HOW DO YOU FEEL ABOUT THAT? GS
AS OUR FAVORITE GERMAN SERGEANT USED TO SAY: " I KNOW NOTTTHHIINK" ABOUT THIS SUBJECT.
But You should know about it BEFORE you consider getting a tattoo.
AND STILL MORE: AN INCREASING NUMBER OF HOSPITALS ARE NOW
REQURING PAYMENT FOR NEEDED SURGERIES BEFORE THE OPERATION. Does all of this lead
to ERRORS, INJURIES AND DEATHS? YOU BET IT DOES. And as bad as all of
this is, there are also the rising number of Malpractice Suits and gigantic
awards. What to do? I'm not
sure. But of one thing I am sure: THE FIRST RULE OF SERVICE IS SURVIVAL.
"PRIMUM NON NOCERE" REFERS TO THE DOCTOR ALSO. Maybe that's the
treatment, for both doctor and patient. Maybe then the remaining parties to
this developing disaster will be motivated to bargain in good faith - for a change. GS
NOW
READ THIS! If
you think you have a true emergency as listed in this article...GO TO
THE ER - BY 911 - OR CERTAINLY WITHOUT YOUR DRIVING. On
the other hand, if you DON'T THINK YOU HAVE AN EMERGENCY, but you just can't
contact your personal physician, bring a good book...for you are going to wait
a Long Time after you are triaged. Personal
note: one of the services I render to all my patients is 24/7 phone coverage,
over three phones. My patients don't abuse that service.
A MAJORITY OF AMERICANS KNOW
PERSONALLY THAT OBESITY IS A CHRONIC DISEASE. AS YOU CAN READ HERE, THE NEWER
DRUGS HAVE NOT CHANGED THIS FACT. BE AWARE...AND BE COMPLIANT WITH THE
FULL PLAN OF CHRONIC TREATMENT. GS
THIS NEWS HAS BEEN ADDRESSED HERE
RECENTLY. IT COULD BE ONE OF THE MOST IMPACTFUL HEALTH ADVANCES IN DECADES; "NEW RESEARCH: THE LESS
ALCOHOL, THE BETTER",
by Carla K. Johnson (AP Medical Writer, in The Day Tuesday, April 30, 2024,
pA2). REALLY! GS
- - - - - - - - - - - - - - - - - - - - - -
AS A SPECIALIST IN ALLERGY AND CHEST
DISEASES PRACTISING COORDINATIONOF CARE FOR MY PATIENTS AS AN INTERNIST, I serve in a system of Theft of
Services and of interference from insurance people practising Medicine without
a licence. It is a system that benefits my
patients but no one else except the insurance companies and the permanent
Federal Bureaucracy. This is NOT STUPIDITY. It is
Designed and Perpetuated that way. And it is getting worse for patients
daily. Health Care Providers have been made poweriess to help. THAT LEAVES YOU, THE PATIENT. GS
A RAY OF HOPE: THE FEDERAL
GOVERNMENT ACTUALLY ON TARGET WITH SOMETHING NEEDED. Now let's see them re-define and
re-assert the Federal Law regarding Emergency Room requirements: EMTALA. And look at the growing tendency for
ER's to become "cash cows" by performing medically inappropriate but
very expensive tests. GS
Upon completing my three year Medical Residency in Internal Medicine at
Roosevelt Hospital in NYC, 1960, my Chief of Medicine - Dr. Arthur
Antenucci - invited me to remain for a Fellowship to research his
planned study of Colchicine for other conditions besides Hyperuricemic
Gout...including ASHD.
But I decided, by then a married man, to serve my Army requirement:
Captain, Medical Corps, Frankfurt, Germany, 1960-62, with my young
family.
He was an excellent physician and diagnostician. Was he also prescient?
AND REMEMBER THE MESSAGE OF A PRIOR
OFFERING IN THIS SECTION: ANY DEGREE OF ALCOHOL INTAKE
INCREASES CARDIOVASCULR RISK. THE "PROTECTIVE EFFECTS" HAVE NOT HELD
UP. GS
UNTIL RECENT YEARS, RACISM WAS
DECLINING IN THIS COUNTRY, BEING REPLACED BY A SENSE OF FELLOWSHIP. That is now being reversed, the more
racism and re-targeted inequality are discussed, demanded and enforced.
.STUPIDO. STUPIDO. STUPIDO. GS
Oh-Oh. JUST WHAT WE NEED: MORE HORNY MEN. See: "New Data Support
Viagra For Alzheimer's Prevention". Now, let's not jump to conclusions! 1) Why do men who use Viagra NEED
Viagra? What is their Testosterone level? And what is the role of the woman
(women) in their Kabuki Dance? 2) Be aware of the likelihood of
increased demands, increased unfaithfulness, increased rapes, increased STD's,
increased Abortions and increased maternal deaths. SO FOLKS, ESPECIALLY WOMEN - LET'S
THINK ABOUT THIS.... GS
AS YOU KNOW FROM PRIOR WEB-SITE
VISITS, ESPECIALLY TO THE "HEALTH ALERTS" SECTION, I HAVE BEEN
ADDRESSING "LONG COVID". If you may have it, this information
should help. If you don't have it, you Don't Want
It ! Get properly immunized. GS
THE FOLLOWING REPORT APPEARED IN THE
WASHINGTON POST RECENTLY. "Adults who use marijuana daily
are 25 percent more likely to have a heart attack than those who don't use it, according to research published in
the Journal of the American Heart Association and funded by the National
Institutes of Health. The study also found a 42 percent
increased likelihood of stroke linked to daily marijuana (cannabis)
use." "Can you hear me now?" Or are you already too STONED? GS
AS I HAVE BEEN SAYING...
The present "system" is not only grossly UNFAIR to those physicians
acting as gatekeepers...but it is also STUPID, as it facilitates the
breakdown of that "system".
And it is not only primary care physicians and diagnosticians who are
living this. but more and more patients who are finding it impossible
or grossly delayed to get needed care.
MORE ON THE PANDEMIC OF STUPIDITY
AMONG YOUNG PEOPLE -NOW SPREAD TO THE MEDICAL PROFESSION! How could this have happened? Well, IT HAS! So whether it's this abomination or
Any Medical Care that you seek: "Caveat Emptor". The delivery of
health care is now in clear decline. GS
DO YOU WANT TO KNOW THE FACTS
ABOUT MARIJUANA, TO AVOID USING IT OR TO STOP USING IT? Or are you a member of the Pandemic
of Stupidity among young people today? GS
OF ALL THE YOUNGER PEOPLE, THROUGH
AT LEAST THEIR 20'S, DEMONSTRTING A PANDEMIC OF STUPIDITY, those who refuse to vaccinate their
children for common and deadly childhood infections like Measles are the most
irresponsible. They mindlessly care neither for
their own kids nor for the friends and contacts of those children. SHAME. GS
REGARDING "ASSISTED SUICIDE", HERE IS A PHYSICIAN, A FATHER AND A MORAL MAN WORTHY OF THOSE TITLES.
And his diagnosis of the problem is RIGHT ON TARGET. LifeNews.com Pro-Life News Report
GS
ANOTHER PHRRHIC "VICTORY" FOR ORGANIZED MEDICINE.
Sounds like more stick than carrot, and also not until 2027!
We physicians and other healers Get No Respect.
GS
Update on Federal Prior Authorization Reform
Yesterday, the Centers for Medicare & Medicaid Services (CMS)
released a final rule that makes important reforms in prior
authorization (PA) programs for medical services. The rule addresses PA
in government-regulated health plans: Medicare Advantage, state
Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service
programs, Medicaid managed care plans, CHIP managed care entities, and
Qualified Health Plan (QHP) issuers on the Federally Facilitated
Exchanges (FFEs).
The initial read suggests that CMS has taken important steps toward
right-sizing the PA process by addressing both technological and
operational requirements. Among the technology provisions is a
requirement that impacted payers support an electronic PA process that
is embedded within physicians’ electronic health records (EHR)—bringing
much-needed automation and efficiency to the current time-consuming,
manual workflow. In addition, CMS is curtailing payers’ PA processes by
mandating shortened PA processing timeframes and significantly
enhancing transparency around PA, including requirements for specific
denial reasons and public reporting of program metrics. CMS is also
requiring that payers provide physicians and patients more PA-related
information.
CMS notes enforcement of its policies, particularly around Medicare
Advantage payers, can include CMS sanctions and civil monetary
penalties. CMS received considerable feedback on the effective date of
its policies, including some concerns regarding technology challenges.
The majority of CMS’ policies will go into effect January 1, 2027.
PS.
Herewith, the usual official rose-colored-glasses statement.
IT WAS IN 1990 THAT, AFTER 30 YEARS
AS AN AMA MEMBER, I RESIGNED MY MEMBERSHIP: "ORGANIZED MEDICINE" WAS
BECOMING AN OXYMORON IN ITS EFFORTS TO REPRESENT
AND DEFEND DOCTORS AND THEIR PATIENTS. NOW, MEDICAL ORGANIZATIONS LIKE THE
AMA, THE ACADEMY OF PEDIATRICS AND THE ACP HAVE TOTALLY LOST THEIR WAY. PLEASE REVIEW THIS VIDEO. THEN YOU
DECIDE. THEN DO SOMETHING! GS
THIS STATEMENT, AS WELL AS THE
SEVERAL OTHER ARTICLES I HAVE POSTED RECENTLY IN THIS SECTION, DESCRIBES AN
AMERICAN HEALTH CARE SYSTEM RAPIDLY APPROACHING A CONDITION OF "IN
EXTREMIS". AND DON'T GIVE ME THE BS ABOUT OTHER
NATIONS' SYSTEMS BEING BETTER AND OFFERING A BETTER EXAMPLE. THEY DO NOT! What American citizens and patients
need now is a total re-invention of a totally distorted "system" that
has become a massive Cash Cow called the "Managed Care Industry"
and a similarly massive Bureaucracy that creates and enforces rules to sustain
that Industry at the expense of those who generate their "stock in
trade": Health Care. WHAT TO DO, in no particular order. 1) Remove the Profit Motive in
Health Care Delivery, and replace it with a system that is Not-For-Profit but
that reimburses All of its "providers" fairly and is adequately
reflective of the decades of talent and work they continue to provide for their
patients. The current "system" is distorted, unfair and inadequate. 2) Devise a "One Payor
System", comprising both the Federal and State Governments, that provides
for all expenses incurred, but that leaves to the System to monitor
compliance. 3) By this time the reader starts to
see a system analogous to the structure and function of our national
Military. 4) In fact, having served in the
Army Medical Corps, that is what I would propose - both in structure and
function. 5) Regarding function, that is
providing health care to our citizenry, I would also recommend the Military
system of Triage: medical services provided - or not provided - according to
HEALTH CARE NEED ONLY...not according to desire or ability to pay. That would
certainly include access to "diagnostic services". 6) The current "system"
came aborning in the mid-1960's with passage of the Medicare Act, quickly
fostering implementation of the in-hospital "Three Day Blue Plate
Special", all at Medicare insurance expense. Do you get the picture? 7) The Pharmaceutical Industry would
have to NEGOTIATE medicine fees and costs with the government payors, something
that was made specifically ILLEGAL by the Medicare Act of the early 2000's.
Wonder Why? 8) That rank of the Legal Profession
that thrives very well by bringing Malpractice Suits, over 70% of which are Won
by the defendant "provider", but all of which pay the lawyer
handsomely, would have to be reorganized - since a massive amount of health
care costs are generated by providers to protect against such suits. NOW WHO DO YOU THINK WOULD BE
ADVOCATES OF SUCH A MASSIVE CHANGE IN OUR CURRENT "HEALTH CARE
SYSTEM"? YOU ARE RIGHT! So: "Your mission, if you
choose to accept it..." Or will we have to wait for people
dying in droves in the streets, as occurs in many other nations? GS
AND MORE ABOUT THE STEADY
DECLINE IN HEALTH CARE DELIVERY...AND IN THE HEALTH CARE
PROFESSIONS THEMSELVES. What is needed now is analogous to
the challenge facing the winning side in WW l and then in WWll in dealing with
a destroyed opponent. In 1919 their choice was Punitive
and Wrong... and was soon devastating. In 1948 their choice was the
charitable Marshall Plan...and it made all the difference. What the Health Care System needs
now is an all-encompassing "Marshall Plan", supported by Federal
government but produced by providers, payors
and especially by prospective patients - aka all of us. The likelihood of this happening?
Zero until Americans return to a UNITED government to replace the Disaster
of recent years. WELL, THIS IS 2024. FOR THIS AND FOR
SO MANY CRITICAL ISSUES FESTERING AT THIS TIME, THIS IS OUR CHANCE. "TO YOUR HEALTH!" GS
MORE ON THE DECLINING HEALTH
PROFESSIONS AND ON HEALTH CARE DELIVERY IN GENERAL. But I have always considered Suicide
a very unfortunate and unnecessary defeat and failure for the person and for
his family and friends. We all can do better, for ourselves
and for those around us. We are, after all, our brothers' keepers. GS
AS I WAS SAYING... WHETHER FOR THOSE PHYSICIANS LIKE
MYSELF WHO ARE STILL RESISTING, OR FOR THOSE WHO HAVE GIVEN UP AND GIVEN IN, THERE ARE MORAL, PHYSICAL AND
FINANCIAL HAZARDS FOR THE PHYSICIAN...AND IMPEDIMENTS TO HEALTH CARE FOR THEIR
PATIENTS. AND ONLY THE PATIENT-PUBLIC CAN DO
ANYTHING ABOUT IT. "CAN YOU HEAR ME NOW?" GS
CLEAR AS MUD. But what has been clear to those of
us who treat patients for anything is that a strong majority of the public are DEFICIENT IN VITAMIN D, regardless
of their medical needs. Thus we test all of our patients for
25-OH Vitamin D levels...and we treat all patients with a level below 30 with Vitamin D3. It should also be known that Vitamin
D is one of four vitamins (A, D, E and K) for whom excess levels can be
toxic. For Vitamin D, that excess level is
100. GS
SOUND FAMILIAR? I'VE BEEN SAYING THIS FOR A LONG
TIME, INCLUDING IN THIS SECTION. And don't forget: now there is an
entire industry of "Legitimate" growers and sellers (small and
gigantic), as well as State and Federal governments who have become
"Pushers". THINK...while you still can. GS
THIS QUESTION IS FOR SICK PEOPLE: DO ANY OF YOU STILL THINK THAT I'M EXAGGERATING MY
DIAGNOSIS OF TODAY 'S HEALTH CARE DELIVERY? Then read: "What's My Doctor
Doing On A Picket Line", by Scheiber (in NYTimes December 3, 2023,
Sunday Business, p1). Now that the diagnosis has been
established, let's start considering Treatment. GS
- - - - - - - - - - - - - - - - - - - - - -
DON'T CONFUSE THESE TWO REAL ISSUES,
although they can certainly co-exist. And both can be victim to Isolation,
both self-imposed and applied by those around them - precisely when these
patients need connection the most. So: Help Someone around you...and in
the process help yourself. GS
"READ IT AND WEEP"...AND
THEN GET ANGRY! For this is what you're paying for
with your excessive health insurance premiums coupled with your excessive
co-pays and deductibles - and your denials and delays and prior authorizations
and medication substitutions by insurance company personnel practising Medicine
without a license. And for this is what you are likely
getting by default from an upset and distracted physician - if you can get his
or her attention at all. Read this important article in toto.
Then Act...in support of your health care provider and in complaint to your
legislators. "The Life You Save May Be Your
Own". Read: "THE 15-MINUTE PATIENT
VISIT: IT'S TIME FOR A NATIONAL STUDY", Editorial by Richard L. Byyny
M.D.,FACP, (in The Pharos of Alpha Omega Alpha Honor Medical Society,
Autumn 2023, p3). GS
- - - - - - - - - - - - - - - - - - - - - -
AS I HAVE NOTED BEFORE IN THIS
SECTION, PEOPLE NEED PEOPLE. You might start by reviewing the
classic book "TOUCHING" by Ashley Montagu. GS
MEDICAL GASLIGHTING"... A FANCY TERM FOR THE LOUSY MEDICAL CARE BECOMING
ALL TOO COMMON OUT THERE. Read this article in its entirety. It has a lot to teach you about demanding attention
and proper medical care - besides "rattling the cage". As medical students, we were taught
that the three most important physician attributes for their patients
were: Ability; Affability; and
Availability...IN REVERSE ORDER. Nothing has changed in the requirements
between physician and patient since 1953 when I entered Medical School -
and now, as I continue to practice Medicine in this, my 66th year in this
vocation. GS
AND IT IS NOT ONLY MEDICARE. IT IS
THE ENTIRE HEALTH INSURANCE PAYMENT SYSTEM, AS THOSE COMPANIES INSIST ALSO ON
PRACTISING MEDICINE WITHOUT A LICENCE. Don't expect the physicians and
their organizations to address this crisis effectively. Physicians themselves have little
political influence...and their organizations have been chronically
ineffective. PATIENTS: HEAL THYSELVES
POLITICALLY. GS
SHAKESPEARE WAS RIGHT ABOUT
SLEEP. "TO SLEEP.
PERCHANCE TO DREAM. AH, THERE'S THE RUB". Restful Sleep is a critical part of
Health, throughout life and also toward the end of our mortal life. Pay attention to do whatever is
necessary to guarantee it for yourself - NOW AND FOR THE REST OF YOUR
LIFE. GS
EVERYTHING IN LIFE IS A "RISK
TO BENEFIT ANALYSIS". Even if offered for "medical
indication", this new information about MARIJUANA substantially INCREASES
THE RISK. GS
''THESE ARE THE TIMES THAT TRY MEN'S
SOULS". The challenging times for Thomas
Paine are being repeated in modern form - and no less dangerously . The common reaction for many people
is a combination of Anxiety and DEPRESSION, which can be the entry to even more
serious mental problems - and tragic outcomes. The reports which follow may be of
help. GS
EVERYTHING HAS BECOME POLITICIZED IN AT LEAST THE LAST DECADE, INCLUDING SCIENCE AND HEALTH
CARE. This is a Disaster for these two
formerly dependable professional endeavors, benefiting the charlatans and fools
and liars who have always been around - and confusing and damaging all the
People who have depended on those professionals until now. The most recent areas where this is
becoming rampant are the COVID treatment saga, Climate Change, and now the
steady Decline of Health Care Delivery - the latter through the developing
substitution of inadequately trained substitutes, the antagonism of third party
payors practising Medicine without a licence, and the overregulation and
over-documentation requirements imposed by the Bureaucrats. WHAT TO DO? BECOME AND STAY INFORMED. KNOW AND
DEMAND YOUR RIGHTS. AND VOTE YOUR PERSONAL INTERESTS, NOT THOSE OF THE
POLITICIANS. AND IF NECESSARY...SUE THE BASTARDS
! GS
BEFORE SEEING THIS REPORT, I HAD READ ANOTHER REPORT ANNOUNCING A FURTHER 3% REDUCTION IN PHYSICIANS' REIMBURSEMENTS... A BUMMER !!. THEN THIS ANNOUNCEMENT CAME UP. THIS IS GOOD !! "What the world needs now is Love, sweet Love...." AND MENTAL HEALTH CARE.
MORE ABOUT THE CHANGING ENVIRONMENT OF THE PRACTICE OF MEDICINE.
These
insights are offered, not for the assistance of practicing physicians,
but for decisions of patients when seeking and choosing physicians. That has always been a big deal, and now more than ever. "The life you save may be your own."
THE CLEAREST AND MOST INFORMED
ADVICE YET ABOUT OUR FUTURE WITH COVID. And don't be swayed by hysterical
warnings about the side effects of COVID vaccines. IT'S NOT THE VACCINES YOU WANT TO
AVOID. IT'S COVID INFECTION AND LONG COVID ! GS., M.D
ATTENZIONE!
TO ALL PATIENTS AND FUTURE PATIENTS...aka ALL OF US... As a physician in continuing medical
practice for over 66 years, I can tell you that Health Care Delivery is going
down the tubes because of the constantly increasing pressures imposed by the
third party payors (or non-payors), the often mindless government regulators,
and the armies of "Suits" charged with implementing all of this. And this is despite our best efforts
to represent and protect our patients. So: deal with the system with this
in mind, hopefully with some personal help. Assume nothing. Request - and then
demand attention and dialogue. GS
- - - - - - - - - - - - - - - - - - - - - -
RABIES. REMEMBER: IT IS STILL CRITICAL TO GET THE RABIES SHOTS AFTER AN EXPOSURE OR QUESTIONABLE EXPOSURE. A matter of Life or Death.
...IF YOU NEEDED YET ANOTHER REASON
FOR GETTING RID OF ALL THAT FAT. Hint: You may not Die from it.
Worse, you may Live with it and with its consequences. GS
NOW HEAR THIS ! This is Real. I have two
patients, currently and recently hospitalized, chronically and now acutely ill,
who were denied red blood cell or blood transfusions despite having blood
levels below 8 - well into a critical level. And I was told that it was
"Standard of Care". SINCE WHEN? Or is this ad hoc rationing? In any case, please help if you can. GS
BEWARE ! Rabies can be prevented if treated
properly and immediately. But it is otherwise FATAL. Are some dog owners becoming as IRRESPONSIBLE
as some parents regarding immunizations? GS
THIS IS IMPORTANT, ESPECIALLY FOR
PARENTS AND ATHLETIC COACHES. You have decisions to make for the
children under your care, decisions that will impact their quality of life -
and duration. Either prohibit collision sports
entirely...as I did with my sons. Or, regarding concussions, ONE AND DONE ! GS
MORE ON THE "ALPHA-GAL"
LONE STAR TICK ISSUE. Bottom Line: DO YOUR BEST TO AVOID
ANY TICK BITES. One trick: shower and self-exam
right after any contact with wooded areas. Also check your pets. GS
NOW HEAR THIS ! 1) See the recent article: "NUMBER
OF PEOPLE WITH LONG COVID COULD BE VASTLY UNDERESTIMATED", by Megan
Brooks (www.medscape.com, August 28,
2023). 2) See the recent article: "ATOPIC
DERMATITIS LINKED TO INCREASED IBD RISK IN ADULTS AND KIDS", by
Valerie DeBenedette (JAMA Dermatology, August 30, 2023). "WHO KNEW?" GS
LISTEN UP, NEW ENGLANDERS ! These are things that we do fairly
regularly, especially in the summertime on our coasts. CONSIDER THIS: Just about everything
we decide to do entails a "Risk to Benefit" analysis. LISTEN UP ! GS
HERE IS AN EXCELLENT COLLECTION OF
SLIDES AND DESCRIPTIONS OF IMPORTANT ILLNESSES, ESPECIALLY OF CHILDREN. IF THIS DOES NOT GET YOU TO HAVE
YOUR KIDS PROPERLY VACCINATED, YOU ARE TOTALLY IRRESPONSIBLE. GS
AS WITH SO MANY OTHER MEDICAL
CONDITIONS, OBESITY IS MULT-FACTORIAL. It must be treated as a Problem to
Be Solved...not as a "sin" to be atoned for. But it still must begin with
"Fast and Processed Foods and Drinks - NO...and The Mediterranean Diet...YES. GS
"ORGANIZED MEDICINE" is an Oxymoron. To paraphrase Shakespeare: "Tis a tale as told by an idiot...full of sound and fury, signifying nothing".
That's why, after 30 years as a member of the AMA, I resigned in 1990. Health Care Delivery for patient and "provider" is in a steep decline. What say you and your colleagues?
YES, I HAVE HAD A FEW PATIENTS WITH
THIS CONDITION. One of the best diagnostic hints is
the several hour delay between the food intake and onset of symptoms... as well as a history of tick bite -
if recognized. A blood test is available to aid in diagnosis. Treatment consists of the usual
modalities...and avoidance of the incriminated food types...more easily said
than done. GS
Alarming Uptick in red meat allergy
This
month in tick news: these blood-sucking arthropods, whose reputation
was already at a pop-quiz level of contempt, are making headlines once
again. If you haven’t heard of the tick-borne illness alpha-gal
syndrome (AGS), you’re not alone. The CDC estimates 42% of clinicians
may have missed the memo on this potentially life-threatening allergic
condition. But new AGS prevalence data from the CDC suggest it’s time
to pay close attention. What is AGS? It’s an allergic reaction to
primarily red meat set in motion by a tick bite. A lone star tick
carrying alpha-gal, an oligosaccharide found in most mammals, but not
humans, infects a person. That person then experiences an immune
reaction when they later eat alpha-gal-containing food (eg, pork, beef,
venison, gelatin, dairy products). That reaction—typically occurring
several hours after the consumption of the alpha-gal—results in vague
symptoms like hives, shortness of breath, and GI effects, rendering
this syndrome difficult to diagnose (and on brand with other perplexing
tick-associated illnesses). Severe reactions even include anaphylaxis. If
you haven’t yet seen a patient with AGS, you may soon. The CDC reports
110,000 confirmed cases between 2010 and 2022 but estimates the actual
number could be closer to half a million. And it’s not a Texas thing.
“Lone star” describes the tick’s star-stamped shell. Its US prevalence,
as shown here, is concentrated in the East but stampeding out West like
a tick-borne gold rush. Key takeaways The CDC urges clinicians to
educate themselves on AGS to improve stats like this one: Nearly 80% of
people with AGS go undiagnosed for the first seven years. Scientists
haven’t developed a cure or a vaccine (yet). Treatment is tick bite
prevention and avoidance of allergy triggers. Patients with AGS may
need to go cold turkey (or fish or chicken) on red meat. With avoidance
of allergy triggers and dodging of subsequent tick bites, AGS typically
clears up after two to three years. But it could also last a lifetime.
FYI. It's too bad, but not fatal, that
the most recent generations have allowed their ability for human relationships
to remain vestigial under their slavish dependence on their I-Phones and
related gizmos. They are far from "all connected". GS
ALL THE MORE REASON TO AVOID THE
INFECTION, HOWEVER MILD. If that goal has proven impossible,
I would seriously consider the use of Dexamethasone in effective dose and
duration for the treatment of the infection, however mild.....as I began
recommending in March of 2020. That recommendation was finally accepted by
medical community leadership in July of the same year. GS
"THERE'S A FUNGUS AMONG US." And
it could be deadly, especially for persons with suppressed immune
systems: organ transplant; cancer treatment; autoimmune disease
treatment; COVID-19....
What is Worse: proper diagnosis is often not thought of, is delayed, is inadequately treated...and is consequently Fatal.
All the reason why THE PATIENT SHOULD 666SUGGEST TO THE PHYSICIAN; "Could it be a Fungus?"
EVIDENTLY TRUE, BUT NOT OUTWEIGHED
BY REGULAR FACE-TO-FACE SOCIAL INTERACTION. In addition, the power of human
TOUCHING has long been reported, most notably in the classic work of Ashley
Montagu: "TOUCHING. THE HUMAN
SIGNIFICANCE OF THE SKIN", 1971. This fact was re-discovered in the
June 2022 edition of National Geographic: "The Power of Touch". GS
MORE ON THE STATE OF HEALTH CARE -
AND EXPECIALLY ON THE PROFESSIONAL AND PERSONAL HEALTH OF PHYSICIANS AND OTHER
"PROVIDERS". Read this if you think that I have
been over-reacting: "STANDARD OF CARE: The
Corporatization Of American Health Care....", by Eyal Press ( the NY Times
Magazine, June 18, 2023, p42). GS
- - - - - - - - - - - - - - - - - - - - - -
NOW HEAR THIS:
Adequate
sleep, in quantity and quality, is one of the best determinants of
physical and mental health and of longevity. under any person's
control. Don't mess with this.
FOR ANYONE WHO HAS TRIED TO ACCESS
THE HEALTH CARE SYSTEM IN BEHALF OF HIMSELF OR HIS FAMILY, you have at least begun to discern
that the Health Care System in this country is in serious decline. It had
been going in that direction over at the last decade - but the COVID Pandemic
has fast-tracked the process. The primary reason is the take-over
of medical care and its professionals by the profiteers, who place the bottom
line ahead of everything else, and by the government unelected bureaucrats,
whose stock in trade and mechanism for control is an unending demand for
DATA. The related battles leave the
practitioner with less and less time to Practice Medicine in a patient-centered
way. The reader is referred to my prior
reports on this subject. Now comes an excellent article by
Eyal Press entitled "Standard of Care"(NYTimes Magazine, June 18,
2023, p42). Please read it. See also the extended notice in the
same edition of the Sunday Times by "ADVOCACY.WEARFIGS.COM. One thing is certain. The Health
Care Providers are in no position to address and reverse this trend, by virtue
of their commitment to their patients and their consequent personal
vulnerability. The Patient - Public will have to
protect and assert their own interests by all means. The time is now. GS
- - - - - - - - - - - - - - - - - - - - - -
FASCINATING ! "DO NOT GO GENTLE INTO THAT
GOOD NIGHT. RAGE, RAGE AGAINST THE DYING OF THE LIGHT". (Dylan
Thomas). GS
SO: WHAT'S A PERSON TO DO WHO DOES NOT HAVE "LONG COVID", AND WHO MAY NOT EVEN HAVE KNONWINGLY HAD THE COVID INFECTION? Although
this situation may change at any time if a new variant develops, things
have become fairly quiet now...allowing in my opinion the more
discretionary use of masks, mass contacts and travel. BUT CONTINUE TO RECEIVE THE AVAILABLE BOOSTERS FOR WHICH YOU QUALIFY.
AS A CERTIFIED INTERNIST WHO TAKES
PATIENTS ONLY FOR ALLERGIES AND CHEST DISEASES, I also practice Coordination of
Care. wherein I follow my patient's other medical issues and intervene when
necessary. But I must admit that Polycystic
Ovary Syndrome has gone under my radar. No Longer. Please read this
report. GS
SPEAKING PERSONALLY, THE MEDICAL
PRACTICE OF PATIENT CARE IS AS STIMULATING AND PERSONALLY REWARDING AS EVER. But the ABUSIVE and constantly
increasing documentation requirements, the constantly increasing third party
unqualified interference with that patient care, and the long-standing and
increasing financial "adjustments" to allowed payments - aka
"theft of services", is leaving physicians with two options:
retirement or non-medical career change; or pre-mature death from resentment
and-or anger. Patients think (if they think at
all) that they can weather this storm without trying to change this malignant
system. Think Again. GS
WITH MORE AND MORE EVIDENCE EVERY
DAY, IT IS CLEAR THAT HEALTH CARE
DELIVERY IN THIS COUNTRY IS IN SERIOUS DECLINE IN BOTH
QUALITY AND AVAILABILITY WHILE THE PROFIT MARGINS OF HEALTH
INSURANCE COMPANIES AND "BIG PHARMA" CONTINUE
TO RISE. Among the reasons for this state of
affairs: 1: the take-over and buy-out of our
government legislative and administrative agencies by the "Fifth
Estate"...the Lobby Industry of those companies / industries. 2) the shameful failure of the
"organized" Health Care Professions to act as effective patient
advocates for decades since they decided to try to be "at the table"
with the decision makers - instead being left "under the table". 3) the default position of too many
practitioners to secure their own interests if self-employed or to allow
themselves to be bullied into submission by the "suits" whose
critical interest is the bottom line. 4) The stresses imposed by the
COVID-19 Pandemic accelerated this process; it did not cause it. WHO AND WHERE ARE THE PATIENT
ADVOCATES? Nowhere to be found, except by those
fortunate patients who have been able to find and maintain a relationship with
an actual physician - advocate. YES: IT WILL GET WORSE...AND IT MAY
NOT GET BETTER. "CAVEAT EMPTOR",
especially at Election Time. GS
- - - - - - - - - - - - - - - - - - - - - -
THE COVID-19 PANDEMIC IS NOT OVER. Read this and weep. Then WISE UP! GS
AS I HAVE REPORTED HERE IN THE PAST,
THERE IS AN EPIDEMIC OF VITAMIN D DEFICIENCY IN OUR POPULATION. We have been testing Vitamin D
levels in all our patients for many years. And we correct low levels with
Vitamin D3. GS
COVID INFECTION IS NOT OVER. This article is right on
point. "Why Is One Dose Suddenly
Enough for The mRNA COVID Vaccines? by John P. Moore, PhD., May 2, 2023. (Spoiler Alert: IT ISN'T). GS
THERE HAS BEEN A LOT OF ACTIVITY AND PROGRESS IN THE TREATMENT OF MIGRAINE IN RECENT YEARS.
Here is something else to know. A substantial proportion of Migraine patients also have allergies, although Migraine is not considered an allergic disease. However,
effective treatment of their allergies results very often in
substantial help with the Migraine frequency and severity. My patients
have reported that many times in my experience.
IT'S AN EPIDEMIC. For at least 10 years, our routine
testing of all of our patients for Vitamin D level has uncovered a moderate to
marked deficiency in at least 80% of them. We treat them with Vitamin D 3. Here is another of many reasons to
treat Vitamin D deficiency. GS
ALRIGHT, "PICKING THE RIGHT
PARENTS" IS TONGUE-IN-CHEEK, but potential parents considering
family longevity is not. You know all of this. Now what are
you doing about it for yourself? GS
THE NEWEST INFORMATION ON "LONG
COVID" which affects about 10% of COVID
INFECTION patients, regardless of the initial infection's severity.
YOU DO NOT WANT THIS. SO: DON'T BE STUPID: TAKE REASONABLE PRECAUTIONS; GET THE
VACCINE AND BOOSTERS. GS
- - - - - - - - - - - - - - - - - - - - - - COMPARE THIS WITH YOUR CURRENT
"LIFE-STYLE". And Life Expectancy should not be
the most important variable. Quality of Life should be, since
heart trouble and diabetes and effects of obesity, etc. are no fun to
live with, to whatever age and the worse the longer you live. To this list of Factors I add one
more: Picking The Right Parents. GS
TIME FOR ANOTHER
EDITION OF POT POURRI: STORIES, FACTS AND
ISSUES THAT SHOULD CONCERN US ALL, WHETHER AS SCENTS OR STINKS. For further reading, I
give the general source. Check out Google for specificity. 1) Sorry: NO alcohol
is good for your health.(WSJ, April 1-2, 2023) (The Day, April 1, 2023). 2) While "Sam
Altman Builds Our AI Future" (WSJ, April 1-2, 2023), "A Six-Month AI
Pause? No, Longer Is Needed. (WSJ, April 1-2, 2023) 3) "DEI At Law
Schools Could Bring Down America", the latest - at Stanford School of Law
- on THE WOKE FOOLS (WSJ April1-2, 2023). 4) "More Say
Colleges Aren't Worth The Cost".(WSJ, April 1-2, 2023). Neither are
today's high school "graduates" mature and educated enough to benefit
from higher education. AMEN. 5) "How Cigna
Saves Millions By Having its Doctors Reject Claims Without Reading Them."
And how "doctors" prostitute themselves. (www.ctmirror.org, 3/25, 2023). 6) "Zero Dems
Vote For Parents' Bill Of Rights" in the House of Representatives".
(republicannews.org, 3/29, 2023). 7) "When Big
Business Married Big Government" (WSJ, March 27, 2023) Shades of the
same situation in Nazi Germany in the 1930's and 1940's. 8) "Coupes Just
Don't Want To Have Kids". (The Day, March 24, 2023. Now see "The End
Of The World Is Just The Beginning", by Peter Zeihan (Harper
Business, c 2023). "Populations are both shrinking and aging". 9) "Awash In
Federal Money, State Lawmakers Tackle Worsening Youth Mental Health"
(ctmirror.org, March 19, 2023). Money certainly will
not reverse this debilitating trend in the face of abortions, single parent
families, lack of parental commitment, lack of parental support and
empowerment, addictions d'jour, addiction to social media that simultaneously
rob a young person of his or her childhood and supplant it with nothing of ethical
/ moral value. A Disaster. 10) "Doctors Are
Being Driven Out Of Primary Care" (The Day, March 15, 2023).And that's
just the tip of the iceberg that the Health Care Professions are being driven
into. I know. I deal with it every day in this, my 60th year or private
practice of medicine. Never this bad. I sincerely hope that
the above does not "drive you to drink". GS
- - - - - - - - - - - - - - - - - - - - - -
Once more with feeling:
YOU DON'T WANT THIS ! SO GET YOUR VACCINES AND
BOOSTERS. AND PROTECT YOURSELVES.
IT'S NOT OVER. GS
FINALLY ! THE CATHOLIC CHURCH AND ITS FAITHFUL
LAITY ARE UNDER EXISTENTIAL ATTACK. The Lenten message insistence on
practising mercy and forgiveness cannot mean individual or collective suicide
by inaction. "WORK AS IF IT ALL DEPENDS ON
YOU. PRAY AS IF IT ALL DEPENDS ON GOD" (St. Augustine). GS
ALTHOUGH I AM A
"SPECIALIST", I ALSO PRACTICE "COORDINATION OF CARE" FOR MY
PATIENTS, including 24/7 availability by phone. As such, I also encounter some of
the OUTRAGEOUS PROBLEMS described by this Primary Care physician - despite the
fact that I am in my 60th year of my own private practice. AND IT IS GETTING
WORSE FOR ALL OF US, DAY BY DAY. SHOULD YOU THE PATIENT CARE?
YOU BETCHA !!! GS
INTERESTING AND HELPFUL WITH REGARD TO
EVALUATING AND TREATING "REACTIONS TO COVID VACCINE SHOTS" Unnecessary Treatment as an allergic
reaction can further confuse the situation. GS
EVER SINCE CONDUCTING A NON-STOP
THREE HOUR INTERVIEW WITH A SCHIZOPHRENIC PATIENT ASSIGNED TO ME AS A MEDICAL
STUDENT, I generally avoid getting into the
weeds of Psychiatry. BUT THIS IS IMPORTANT. GS
JUST WHEN YOU THOUGHT IT'S SAFE TO
GO OUT...(IT'S NOT),,, we must join the health care
professionals in worrying about BIRD FLU: AVIAN INFLUENZA -
especially the H5N1 STRAIN. It's mortality rate in humans has
been 56%, vastly higher than that for COVID -19. The following are articles on this
subject, especially the first:
"The
Next Pandemic Could Be Deadlier", by Zeynep Tufekci, (in NYTimes
February 5, 2023, Opinion, SR p8).
What
Bird Flu Reminds Us About Influenza Pandemics",
by Amesh Adalja, M.D. ( February 16, 2023).
Influenza
Pandemic, 1918-1919 (Google).
GS
- - - - - - - - - - - - - - - - - - - - - -
MORE REASONS TO FOLLOW THE MEDITERRANEAN
DIET, WHICH INCLUDS VERY LITTLE RED MEAT. GS
HERE IT IS, AS PROMISED: THE
STATE OF HEALTH CARE IN AMERICA: FEBRILE AND IN PAIN. First of all: who am I to presume to
speak for this massive subject, which consumes about 18% of America's Gross
National Product...and growing. "WITH GRADES LIKE THAT,
THE ONLY WAY YOU'LL GET INTO MEDICAL SCHOOL IS AS A CADAVER". Well, that was never me. I was accepted into Medical School
after three years of College. I graduated Medical School after 4
years. I served three years in internship
and Internal Medicine Residency. I served two years in the U.S. Army
Medical Corps as a Captain responsible for a 20 bed general medical and
cardiology ward in the 97th General Hospital, Frankfurt, Germany. I served nearly two years in an
Allergy and Clinical Immunology Fellowship. I have served 60 years in private
allergy and chest disease practice, and continuing. I have worked in Primary Care and in
Emergency Care practice. I have served as President of the
New London County Medical Association. But enough about me. Let's talk
about the Health Care we all depend upon, and which is now fraying badly- and
perhaps irreversibly. First, the Subject of all of this
attention: THE PATIENT.
50% OF
ALL DISEASE, ILLNESS AND NEED FOR MEDICAL CARE IS LIFE-STYLE RELATED - AND
COULD BE MODIFIED OR REVERSED BY CHANGE IN LIFE-STYLE.
What
can generally not be changed is Heredity and the patient's formative
environment - at least not yet.
What a
person should spend much more time considering is the possible Toxicity of
his or her work environment; not only the asbestos kind, but also the
mental/emotional stress kind...also toxic and a high interest mortgage on
your future.
The
same relates to 'life-style: active, sedentary, risky (as including
alcohol and drug abuse)....
The
presence or absence of LOVING RELATIONSHIPS, including with one's
God.
Now for the HEALTH CARE
PROFESSIONS. A) Traditional / Optimal: MD; DO,
and the many formal Specialties, all embracing Education, Training and
Experience. B) The Nursing Professions: LPN, RN,
NP, APRN. Much more limited education, training and experience - But of
great value when associated directly in practice with a Traditional colleague.
When allowed to work independently, they know what they know. They do not know
what they do not know. C) Unfortunately, some
"leaders" in these fields are now allowing the rigorous and necessary
education / training to be diluted with constructs like "Woke" and
"Equity" vs. Equality and Meritocracy -
which actions can only dilute and pollute the ultimate product. D) Mechanisms of Compensation: Pay
for services rendered - best effort Vs. Pay for "Quality and
Outcome"...aka become an Insurer of the patient's health care and results. E) Private Practice vs. Employee (
reward for spending less time with patient vs. penalty for spending more time -
I kid you not). F) The World of Health Insurance:
Profit Motive; Prior Authorization; Delay.... G) Regulatory requirements and
Abuse. The Results To Date: Reduced quality and preparation of
Candidates. "Nine to Five" mentality. Depression. Burn-out. Suicide Inability or Delay in contacting
one's "Provider" - itself a derogatory term. (The three most
important attributes of a physician for his patient are Ability, Affability,
and Availability.) Leaving medical practice, adding to
present and future inadequacy of numbers of Medical Professionals. WHAT TO DO? 1) Educate yourself on the above. 2) DO YOUR PART, AT LEAST FOR
YOURSELF. 3) FIGHT LIKE HELL...RATTLE THE
CAGE, WHEN YOU PERCEIVE SOMETHING WRONG WITH YOUR HEALTH CARE: QUALITY,
QUANTITY, ATTITUDE....
"I'm Mad As Hell - And I'm Not Gonna Take It Anymore". 4) TRY TO STAY OUT OF THE EMERGENCY
ROOM, which today reminds me of the "Three Day Blue Plate Special"
hospitalization epidemic in the early years of the Medicare Act. As my Italian piano professor used
to say: "CATCH ME WHAT I MEANS?" GS
- - - - - - - - - - - - - - - - - - - - - -
Itchy Rashes: Is It Allergic or Irritant Dermatitis?
I DON'T THINK THAT KATE SMITH EVER
MINDED THIS: IT'S NOT OVER 'TIL THE FAT LADY SINGS". She certainly has not sung yet. I have treated more cases of
COVID-19 in the last 6 months than in the entire prior two years. Continue to take precautions. Get
your boosters ! "CAN YOU HEAR ME
NOW?" GS
HERE IS GOOD NEWS REGARDING AGE-RELATED
MEMORY DECLINE. And it appears to be true regardless
of genetic inheritance. Of course, it is related to life-style
activities, which each of us can decide to modify in the interests of a much
better later life. One change which should be
implemented immediately is the use of alcoholic beverages. More research finds
No Benefit from alcohol - actually the reverse! Both the quantity and the quality of
your later life turns out to be IN YOUR HANDS. That's a Gift which you can
accept or squander. GS
THE FOLLOWING IS AN INFORMED AND
EXPERIENCED COMMENTARY ON SUDDEN COLLAPSE - DRAWING ON THE RECENT DAMAR
HAMLIN EXPERIENCE. To personally help save a human life
is a most valuable life experience. See: "Damar Hamlin's Cardiac Arrest: Key
Lessons", byi Robert Glatter, M.D. et al, medscape.com, January 19,
2023.
GS
- - - - - - - - - - - - - - - - - - - - - -
THE FOLLOWING ARE GOOD REFERENCES TO
MORE INFORMATION ABOUT COVID-19, ITS VARIANTS - AND A POSSIBLY RELATED NEW
DISEASE. They all appeared recently in
medscape.com - a good source of new medical
information.
"Paxlovid
Prescribing Concerns For People 65+ Revealed in Medscape Survey",
by Damian McNamara, MA, Jan. 18, 2023.
"What
Older Americans Need to Know About Taking Paxlovid", by
Judith Graham, Jan. 19, 2023.
"VEXAS
SYNDROME: More Common, Variable, and Severe Than Expected",
by Randy Dotinga, Jaqn. 25, 2023.
SEE : "THE COMING
COLLAPSE OF THE U.S.HEALTH CARE SYSTEM", by Robert Glatter, M.D.
and Peter Papadakos, M.D. This is REAL, folks. And it doesn't even mention the
constantly increasing abusive, self-serving and often duplicative demands being
made by Medicare and by commercial health insurance payors for
"records" and for professional documentation - even on a quarterly basis
when the only datum that has changed in the interim is the professional's
Age. To this add the abuse of
requirements for "Prior thorization" before a physician-prescribed
service or substance can be paid - and therefore made available to the patient. The sum total of this is substantial
increases in the payor's bottom line at the expense of the professionals
providing the health care services. The Losers here: the Patients and
their Care-Givers. This cannot be sustained. Thus:
"THE COMING COLLAPSE...." Physicians and other Health Care
Providers do not have the political power to correct this. ONLY AN IMPATIENT PUBLIC DOES.. But
they do not have much time. GS
ALL OF THIS IS TRUE AND NECESSARY. ALSO NECESSARY IS PERMITTING GREATER
LATITUDE FOR INVOLVED PROFESSIONALS TO BREACH PATIENT CONFIDENTIALITY AT
TIMES, IN ACCORDANCE WITH THE HOLDING IN
THE TARASOFF CASE., WITH WHICH TOO MANY MENTAL HEALTH PROFESSIONALS APPEAR TO
DISAGREE. GS
OK, NOW IN SPITE OF YOUR BEST
EFFORTS...YOU HAVE "LONG COVID". NOW WHAT? Don't Panic. Adapt. Listen to your
body. It talks to you...and sometimes it yells at you when you don't listen. Especially read the last part of
this report, which is encouraging for the long term (ie. one-plus years). Above all: try to avoid catching it
any more. And SEEK OUT THE INCREASINGLY EXPERIENCED MEDICAL HELP! GS
"Just suck it up" is NOT a treatment. Nor is "Just say 'no'".
Physicians
have just as much professional responsibility to Diagnose and to Treat
PAIN, as they have to treat fever or bleeding or chest pain. And it
does Not help to intimidate physicians with such onerous prescribing
regulations that some decide to surrender that responsibility entirely
for self-defense. The Opioid Crisis is the fault of our Chinese enemies and of the Drug Cartels - and Not of the Health Care Professions. ANOTHER WRONG DIAGNOSIS BY GOVERNMENT, WHICH PREFERS TO "DIAGNOSIS" AND "TREAT" WHAT THEY CAN INSTEAD OF WHAT THEY CAN'T.
THERE IS A GREAT DIFFERENCE BETWEEN BEING AN EMPLOYEE AND BEING SELF-EMPLOYED. THERE
IS A GREAT DIFFERENCE BETWEEN BEING A SLAVE TO A COMPUTERIZED CLINICAL
PRACTICE AND CONTINUING TO PRACTISE MY HANDWRITING....
All in this article and in the Comments ARE TRUE.
But
I will continue to practice Medicine into my 90's as long as I ENJOY IT
AND MY PATIENTS...ACTUALLY FRIENDS OF DECADES DURATION. Meanwhile,
I will continue to wish upon my tormenters the wish my wife created for
the select:: "MAY THEY GET A PERMANENT CASE OF "JOCK-ITCH".
THE MOST UNBELIEVEABLE AND
OUTRAGEOUS PART OF THIS REPORT IS NOT THE ARROGANCE AND STUPIDITY OF SOME OF
OUR CURRENT POPULACE., BUT THAT OF SOME OF OUR "MEDICAL
PROFESSION". "CAVEAT EMPTOR" IS
CERTAINLY NO LONGER ENOUGH FOR THE REST OF US TO PROTECT OURSELVES AND OUR
CHILDREN. "THROW THE BASTARDS IN
JAIL" IS MORE APPROPRIATE AND NECESSARY. . GS
Not
for an entire population of poor souls who, having missed / been denied
the interpersonal tools with which to construct a meaningful life,
simply want to STOP THE WORLD. I WANT TO GET OFF".
What a Shame. But that's what happens when one generation - the "ME's" abandon another generation - their children. And no magic medical potion will correct it.
REGARDING THE NEWLY DEFINED "FAUCI DERANGEMENT SYNDROME", defined by me and first described in the Rapid Response offering of December 2, 2022 regarding the offering of Froma Harrop, I offer now the following: "Fox Op-Ed: Dr. Rand Paul: "The Arrogance Of Anthony Fauci" (in Fox Op_Ed, , January 7, 2022).
However, both of these are retrospectives. And Dr. Paul, an ophthalmologist, certain knows that "Hindsight is 20-20."
For
a contemporaneous view of what was happening directly as decisions
regarding the Pandemic of Covid-19 were being made...with limited
knowledge and apparently increasing and unlimited attack rates, see my
Rapid Response offerings on my web-site dated through March and April,
2020 - and beyond. That is the fair and proper analysis - for the ages.
Of course, there will be more Hindsight to come.
GS
- - - - - - - - - - - - - - - - - - - - - -
THERE IS NO WAY TO
"SUGAR-COAT" THIS. See the excellent in-depth article
by Jeffrey A. Tucker in the October 2022 edition if Imprimis entitled:
"THE ECONOMIC DISASTER OF THE PANDEMIC RESPONSE". Structured resembling a medical
autopsy, this author does the same thing as does the pathologist: cutting
through skin, muscle and bone to study what really happened as the result of
the Lock-Down of the Pandemic. And, as was the case in 19th century
Medical Science before the miracles of the 20th and 21th centuries, the autopsy
was the most important tool to promote man's understanding of himself in health
and in disease. Given the state of the current
American Economic and also Political body-politic, we had better apply similar
tools to this very seriously ill patient before the need for an autopsy. President Trump is quoted to have
said in April, 2020: "I'm not going to preside over the funeral of the
greatest country in the world". If not, America must LEARN from the
lessons being provided by this still seriously ill patient. GS - - - - - - - - - - - - - - - - - - - - - -
"MEANWHILE, BACK AT THE
RANCH", THIS FOLLOWS DECADES OF 50%
"ADJUSTMENTS" (READ "THEFT OF SERVICES") TO PHYSICIANS'
"FAIR AND CUSTOMARY CHARGES" FOR MEDICAL CARE, ANNUAL FURTHER REDUCTIONS IN
PAYMENTS, INCREASING AND INCREASINGLY BURDONSOME PAPERWORK (SOME ONLY MAKE-WORK
FOR THE BUREAUCRACY)....AND THE COMMERCIAL HEALTH INSURANCE COMPANIES HAVE
FOLLOWED THE LEAD OF MEDICARE IN THIS DOWNWARD SPIRAL. A day of decision has already come
for hundreds of thousands of private practising physicians - and is imminent
for many others. FOR YOUR INFORMATION. GS
THE VACCINES WORK, AS DO THE
BOOSTERS - IF THEY ARE PROPERLY BOOSTED. They are Not 100%, but they are
worth-while in helping to avoid getting Covid...WHICH YOU DO NOT WANT! GS
ADHD APPEARS
TO HAVE INCREASED SUBSTANTIALLY IN INCIDENCE, TOGETHER WITH GREATER
UNDERSTANDING OF ITS IMPACT ON ADULTS - AND TOGETHER WITH
TREATMENT APPROACHES. See the following offering for an
introduction to this important infirmity. GS
ALRIGHT...SO WHAT DO WE DO NOW IF
WE KNOW OR SUSPECT THAT WE HAVE SYMPTOMS OF "LONG COVID"? 1) TRY TO GET AN APPOINTMENT WITH A
"LONG COVID" FACILITY IN A TERTIARY MEDICAL CENTER.
GOOD LUCKWITH THAT. 2) HAVE A GOOD AND INTERESTED
DIAGNOSTICIAN DO A COMPLETE MEDICAL EVALUATION - BEGINNING WITH A COMPLETE
MEDICAL HISTORY - AND LOOKING ESPECIALLY FOR SIGNS OF INFLAMMATORY
PROCESSES IN ALL ORGAN SYSTEMS. 3) TRY TO ENTER A CLINICAL
INVESTIGATIVE STUDY ON THE SUBJECT...IF YOU DON'T MIND BEING IN THE
"CONTROL GROUP" WITHOUT TREATMENT FOR AT LEAST PART OF THE
TIME. THAT STUDY SHOULD BE INVESTIGATING THE USE OF
ADRENOCORTICOSTEROIDS (ESPECIALLY DEXAMETHASONE) IN MODEST DOSES FOR AT LEAST
SEVERAL WEEKS. 4) RESULTS SHOULD BE MONITORED BY
APPROPRIATE TESTS...DEFINITELY INCLUDING THE PATIENTS' CLINICAL (SUBJECTIVE)
RESPONSE OVER TIME. 5) AND REMEMBER: THIS IS MEDICINE,
NOT ROCKET SCIENCE.
"ABOVE ALL, DO NO HARM".
BUT TRY TO DO SOME GOOD. GS
WHAT HAS BEEN CLEAR TO ME FROM THE
OUTSET (MARCH, 2020), AND WHAT ULTIMATELY BECAME CLEAR AND ACTIONABLE TO THE
EXPERTS (AROUND JULY, 2020), IS THAT COVID-19 DOES ITS GREATEST
DAMAGE THROUGH AN OVER-REACTION OF THE IMMUNE SYSTEM'S INFLAMMATORY
MECHANISMS. That was true initially and
continues to be true now, as patients contract specific organ damage, Long
Covid and multiple attacks of the infection - with increasing mortality. Since the beginning I have treated
this condition with Adrenocorticosteroids (specifically Dexamethasone. finally
recommended in July, 2020.) GS
IF THERE EVER WAS A STATEMENT
THAT IS ENTIRELY ON POINT. AND IF THERE EVER WAS A STATEMENT
THAT SHOULD BE HEARD AND STUDIED BY EVERY CHILD FROM AGE NINE TO AGE
THIRTY. "TRUE, TRUE, AND
RELATED". GS
BEWARE!
THE NEW CROP OF PHYSICIANS MAY BE DANGEROUS TO YOUR HEALTH WHILE THEY
SEARCH FOR THEIR OWN IDENTITY. The Oath of Hippocrates, by
Hippocrates, says it all - but it is not good enough for new doctors, for the
AMA, ACP, AAP, ACOG, Boston Childrens Hospital, etc. etc. SHAME. GS
THIS IS WHAT THE
INTRODUCTION OF POLITICS AND LIES DOES TO THE SEARCH FOR FACTS,
SCIENTIFIC OR OTHERWISE: DRIP. DRIP. DRIP. But as with "Pis
and Pus", the Truth Must Come Out. My expectation of the
Truth?
that
"Gain Of Function" research was performed and underwritten by
American scientists together with China long after it was prohibited in America
in 2015; and that it produced the virulent Covid 19 Pandemic. And that
China suppressed its (likely) accidental lab leak release for a critical
time within which its knowledge could have avoided the Pandemic.
that,
as consequential to the health of the American nation as the pandemic has
been, the *Biden Presidency was stolen through a variety of illegal
actions, both governmental and private.
LOGICAL. Of course, "...anxiety, depression,
worry and stress" are no good for anybody or anything. But they
also impair the Immune System, which can lead to a more severe and prolonged
viral infection. The Message here: don't go through life being
"Outcome Oriented": "What if...this". What
if...that? Instead, be "PROCESS ORIENTED: This is the
problem. This is how I approach it". Then see what happens. GS
YOU ALREADY SHOULD KNOW MY POSITION
REGARDING ANY USE OTHER THAN THE CONTROLLED USE OF MEDICAL MARIJUANA. It is a potent drug in its own
right, particularly regarding its cognitive and mental effects and especially
in persons already in some way so affected. It is an entry - level drug to the
use of illicit and much more powerful and lethal drugs. It thwarts personal psychologic growth
and development, particularly for the recent generations already adversely
affected by their upbringing and surroundings. And it is an uninformed and also
cynical / self-serving action by political agents to legalize and promote its
use for political and financial benefit. I am also disappointed with the
leadership of the City of New London, Connecticut who have embraced this
approach when the enabling Federal legislation gives local - regional
authorities to opt out of legalizing its non-Medical use. Look up a massive medical study
being undertaken in the United Kingdom: "Cannabis and Me", Study
by Dr. Marty D. Forti and reported by Siobhan Harris in MedScape U.K. September
5, 2022. DON'T BE "STUPIDO, STUPIDO,
STUPIDO ! GS
- - - - - - - - - - - - - - - - - - - - - -
WRONG. How politicized journalism distorts
actual news and facts. This Title is Not Supported by the
facts reported in the article itself. At least not yet. Meanwhile - and as usual - tie
viruses continue to stay one step ahead of the Science and the
"science". GS
WHY YOU DON'T WANT TO GET COVID IN
THE FIRST PLACE. But if you've already had it, keep
up with your personal protections (mask, avoiding crowds...) and get the
boosters. GS
THE COVID-19 PANDEMIC: We still have much to learn
about where we've been, where we are and where we are headed. But except for chiding Dr. Fauci for
at a few times seeming to allow intimidating political interference to modify
his medical judgment, he performed well as our chief physician - in my
opinion. You can read much more about my
professional opinions as they were developing and were being shared on this
Rapid Response section nearly daily since February, 2020. The current full-bore efforts to
have him "tarred and feathered" or "drawn and quartered"
are - again IN MY OPINION - political or stupid...or both. GS
"WHAT'S IT ALL ABOUT,
ALFIE?" Specifically, what's the most recent
CDC action ON COVID all about? In general, i's about the politics
of self-preservation in the face of massive and uninformed public
reaction. PLEASE READ THIS ARTICLE IN ITS
ENTIRETY TO REALIZE WHAT IS REALLY AT STAKE. Then watch it happen. GS
...to which I say to those "70%
of Americans" who care not a bit about the 1 million Americans who have
died and those who will as a consequence become infected: "STUPIDO. STUPIDO.
STUPIDO". GS
"TRUE, TRUE, AND
RELATED". A great deal of information
regarding COVID-19, both current and beginning in February, 2020, may be found
on the "HEALTH ALERTS" category of this web site. This risk to all of us is IN NO WAY
OVER, as explained most recently in the following article: "Fauci Warns Of 'Trouble' For
Those With BA.5 Variant If Not Up To Date On Vaccines",
by Lindsey Bever (in Washington Post and The Day, August 6, 2022). Don't BE STUPID!. GS
THE COVID-19 PANDEMIC: NOWHERE
NEAR OVER! And now would be a good time to
revisit where we have been...in the process of having lost nearly one million
fellow Americans to this infection. As I reported recently, I have
reviewed two excellent compilations of our experience to date: "The Desperate Hours",
by Marie Brenner; and "Silent Invasion",
by Dr. Deborah Birx. In addition, please see my own Rapid
Response offerings in this web site on the subject, having begun in February,
2020 and continuing uninterrupted since then...including in the Category
entitled "Health Alerts". In fact, as early as February 29,
2020 I chose Dr. Birx as my particular expert source for information on
the subject. Good choice, as you will see from reading her book. You will also
be disappointed - although not surprised - at how deeply crass Politics had
quickly entered into all the deliberations at the Federal (and also the very
personal) level, to the confusion and detriment of the average American. You
will also see how early I had diagnosed the pathophysiology of this infection -
Inflamation Overload - and the optimum treatment - adrenocorticosteroids,
particularly Dexamethasone (March 28, 2020). Unfortunately, this was not
embraced by the experts - who were awaiting the results of their
"double-blind cross-over studies" - until July, 2020 - to the further
detriment of Americans. There are and continue to be many
heroic stories here, especially involving the health care providers in the
trenches and the war-time footing employed to develop vaccines in record
time. But there are also many lessons to
be learned about human nature run amok, as usual.
WILL WE EVER LEARN??? We will surely have future opportunities /
challenges. GS
- - - - - - - - - - - - - - - - - - - - - -
THIS IS ESPECIALLY FOR YOU VACCINE
DENYERS. BIG MISTAKE. GS
"BACK TO THE FUTURE". Sorry, but that is where we are,
with the current capabilities of this Pandemic for transmission, for illness
and for "Long Covid"...and given the increasing resistance of the
public to common sense and proven safeguards. If you need convincing, please
follow my current review of the last 3 1/2 years since Covid-19 was presented
to the world by and from China. My sources, which I am reviewing
chronologically and in tandem, are the following: 1) "THE DESPERATE HOURS: One
Hospital's Fight To Save A City On The Pandemic's Front Lines",
by Marie Brennner. The city: New York City. The
Hospital: New York - Presbyterian Hospital System. 2) "SILENT INVASION -
The untold story of the Trump Administration, Covid-19, and preventing the next
Pandemic before it's too late", by Dr. Deboran Birx. 3) My
detailed observations, beginning in late February, 2020 and reported since then
in the Rapid Response section of my web site. 4) The Category of this web site
entitled "Health Alerts". Throughout this continuing saga,
there are plenty of examples of heroes and of goats - at times exemplified by
the same person at different times. Will that situation improve? Not
likely, as long as we are dealing with fellow human beings. All the more reason for each of us
to study and to come to our own decisions regarding how to protect ourselves
and ours. The on-going experience of the last years will help. GS
- - - - - - - - - - - - - - - - - - - - - -
YOU DON'T WANT ANY OF THIS. PROTECT YOURSELF AS ORIGINALLY. IT IS NOT OVER!
- - - - - - - - - - - - - - - - - - - - - - SO THERE IS HOPE FOR THE FUTURE FROM
AT LEAST ONE IMPORTANT SEGMENT OF SOCIETY: MY NEW FELLOW PHYSICIANS. GS
THIS IS A WELCOME REMINDER,
ESPECIALLY AFTER THE RECENT UNFAIR BROADSIDE PROVIDED BY TUCKER CARLSON. Dr Fauci provided as good medical /
practical advice regarding the then - raging pandemic - amid constantly
shifting sands - as anyone could have provided. His error, assuming he had a choice,
was providing that advice within the context of the highly political daily
Trump Covid Show. See my contemporaneous comments
offered during the entire period on this Rapid Response section since before
the Spring of 2020. GS
THIS ARTICLE, CERTAINLY ABOUT PERSONAL
HEALTH, WOULD BE HELPFUL IN ANY AGE. But it is especially useful for the
most recent generations who have grown (but not "grown up") lacking
the ability to develop and conduct interpersonal relationships - thanks to
their total reliance / addiction to their gizmos and their "social
media". They may mature by their thirties - if they come to realize
what "maturity" really is:InterpersonalRelationships. GS
COVID-19 AND THE NEWER VARIANTS:
TO TEST AND WHEN AND HOW TO TEST. This information, properly obtained
and whether reported or not, can help you protect those around you. GS
HERE WE GO AGAIN!
DON'T BELIEVE YOUR EDUCATION, TRAINING AND EXPERIENCE. WAIT FOR THE
SCIENTISTS TO DO THEIR CONTROLLED STUDIES.... Beginning shortly after March, 2020,
when information about COVID-19 illnesses began to be reported, I began stating
and writing in this section that the pathophysiology being observed was
entirely consistent with over-reaction of the Inflammatory elements of the
Immune System, aka Sepsis and Cytokine Storm...and that the treatment needed
was adequate doses of adrenal steroids, particularly Dexamethasone. That advice
was resisted and ignored and "studied" throughout the following four
months...until July of that year when the powers that be declared that
Dexamethasone was a treatment of choice. It has continued to be a treatment of
choice since then for acute COVID-19. Now comes LONG COVID, which often is
worse in duration, in severity and in multi-organ distribution of symptoms. And
should we wait - again - for the "double - blind crossover studies"
to treat our patients? Not I. GS
IF "ALL POLITICS IS LOCAL",
THERE CAN BE NOTHING MORE LOCAL THAN ONE'S PERSONAL HEALTH AND ACCESS TO HEALTH
CARE. However, "Woke ideology and
policies have become quite literally a hazard to your health." With much documentation, in addition
to recent comments offered by myself in this section, please see: "Keep
Politics Out Of The Doctor's Office", by Stanley Goldfarb, M .D.. (in WSJ April 19, 2022, Opinion,
pA15). I always thought that adherence to
the command "PRIMUM NON NOCERE: FIRST, DO NO HARM" was a
no-brainer. No longer, given the new leadership of several of our
national medical organizations, and given what and how medical students
are now being taught. So now the new command must be
"CAVEAT EMPTOR: LET THE BUYER BEWARE". More Shame on the current
national leadership and on the current generations. GS
- - - - - - - - - - - - - - - - - - - - - -
ADHD:
NOT ONLY A CHILD'S PROBLEM...BUT A LIFE-LONG TREATMENT CHALLENGE. And It is Treatable, with great
personal results. GS
See the important article entitled "Keep Politics Out Of The Doctor's Office", by Stanley Goldfarb (in WSJ April 19, 2022, Opinion, pA15). SHAME
on key medical organizations like the AMA, the ACP and the American
Academy of Pediatrics, whose leadership has gone to the Dark Side. Can It Be...that Stupid kids become Stupid doctors?
Yesterday,
Health and Human Services Secretary Xavier Becerra extended the Public
Health Emergency determination for an additional 90 days, effective
April 16th. This is the ninth such extension since the original
declaration.
In addition, the mask mandate on planes and public transportation has been extended for two weeks, until May 3.
- - - - - - - - - - - - - - - - - - - - - -
EVERY CHOICE IN LIFE ENTAILS A "RISK-TO-BENEFIT"
ANALYSIS, EVEN WALKING ACROSS THE STREET. The decisions are better when one is
Informed. In my opinion, the risks involved in
taking the Covid Vaccine are greatly overstated vs. the prospect of getting
Covid infection. This position is supported by facts
discussed in a recent article in the WSJ: "Low Heart Risk Seen In Covid
Vaccine", byi Lovtus and Onque (April 12k, 2022, pA3. A quotation from a investigator in
this article: "It's much more important to take the vaccine than it is
to worry about the side effects". Meanwhile, more aboutthe
risks associated with getting the infection."Higher Risk for
DVT, PE, Bleeding Seen After COVID-19; Long-Term Risk for VTE Recurrence May Be
Low", in ACP Internist Weekly - Coronavirus, April 12, 2022. . "Can You Hear Me Now?" GS
AS A NEW CORONA-19 VARIANT FINDS ITS
WAY HERE FROM EUROPE, a review of where we have been in
the last two years is a public service. The NYTimes can still rise to the
occasion...when it finds news that it deems "fit to print". See: "LESSONS FROM A
PANDEMIC", by Goldstein and Otterman (in NYTimes March 20, 2022,
Metropolitan WC, pp6-11). GS
- - - - - - - - - - - - - - - - - - - - - -
PATIENTS BEWARE: IT'S A JUNGLE OUT
THERE;..AND YOU ARE A TASTY MORSEL. If you are in a treatment cage,
Rattle it ! If you are not, do your best to stay out.
AND HAVE AN ADVOCATE. That should be your physician; but he /
she may also be encaged.by their relationship with the hospital. I am in my 59th year as a private
practitioner in New London - and counting. Not easy. A fight every day for my
patients. But i won't enter the jungle. GS
I REPEAT MYSELF, AND NOT FOR THE
LAST TIME: YOU DON'T WANT COVID-19 INFECTION TO ANY DEGREE...ALSO
BECAUSE YOU DON'T WANT "LONG COVID"! See the excellent article in the NY
Times, February 27, 2022, CT. Metropolitan section: "Fighting Long
Covid To Conduct Again", by Sharon Otterman. And if you think that you may have
"Long Covid", re-read the article implicating the Vagus Nerve.- and
look up "Dysautonomia". That may be the target of this
syndrome, and Inflammation may be the mechanism - even after all of the virus
is gone. If so, prolonged treatment
would be based on that pathophysiology. GS
- - - - - - - - - - - - - - - - - - - - - -
VERY INTERESTING. STAYI TUNED.
MEANWHILE, DON'T GET COVID-19 INFECTION! GS
THIS IS IMPORTANT. IN DIAGNOSTIC MEDICINE, THE
CAREFULLY DOCUMENTED CLINICAL PICTURE IS ALWAYS AT LEAST AS IMPORTANT AS THE
BATTERY OF TESTS, THE CHOICE OF WHICH SHOULD BE GUIDED BY THAT CLINICAL
PICTURE. That takes time, attention, and
experience. three factors decreasing in availability in today's Medicine. PATIENTS, YOU MUST STRONGLY ADVOCATE
FOR YOURSELVES "THE LIFE
YOU SAVE MAY BE YOUR OWN". GS
- - - - - - - - - - - - - - - - - - - - - -
FOR YOUR INFORMATION. In view of the abuse to which the
application of this "therapy" has been subjected, this is the only
effective approach to protecting confused young people. GS
THE EPIDEMIC OF VITAMIN D DEFICENCY
IS OLD NEWS TO US. But its connection with COVID-19
infection severity is more recent. Get tested (25 OH Vitamin D)..If
deficient, get treated (Vitamin D3). GS
HERE'S HOPING THAT YOU HAVEN'T
GOTTEN COVID INFECTION, IN ANY DEGREE OF SEVERITY. But, in case you have, a lot of
medical information is coming out about "Long Haul Covid", aka. "PASC: Post-Acute Sequelae
of COVID - 19". The following facts are presented in
the following articles. 1) "Omicron Ramps Up
Concerns About Long COVID, Its Causes", by Ungar and Tanner (inThe
Day, February 1, 2022): a) brain fog, fatigue, memory loss,
pain, sensory loss, shortness of breath; insomnia...symptoms can be old or
new; b) may occur in over 30% of COVID
cases, of whatever original severity; c) may have an auto-immune
mechanism; more in women than in men; women generally produce more
auto-antibodies: d) micro-clots in various organs and
tissues might also be a mechanism; e) vaccination my reduce the chance
of getting PASC; f) usually diagnosed several weeks
after the acute encounter; g) may be caused by infection viral
remnants and their promotion of inflammatory responses in various tissues; g) may be promoted by re-activated
Epstein-Barr Virus (the cause of Infectious Mononucleosis); h) seems more likely in patients
with type ll Diabetes Mellitis; i) may promote or enhance Chronic
Fatigue Syndrome. No Treatment So Far. 2) "New Research Hints At 4
Factors That May Increase Chances Of Long Covid", by Pam Belluck (in
NYTimes January 30, 2020, p18): a) may depend on the level of
residual RNA - the viral load of the original infection; b) the involvement of
auto-antibodies; c) possible activation by EB virus; d) possible involvement of Type ll
Diabetes. 3) "Long COVID Is Real, And
Many Real Questions Remain", by Damian McNamara (in Medscape.com,
January 28, 2022. 4) "COVID Brain Fog A 'True
Neurologic Condition'", by Pauline Anderson (in Medscape.com, January
24, 2022): a) researchers found abnormal
antibodies in both blood and brain, suggesting a systemic inflammatory
disorder; b) 77% of patients with cognitive
PASC had cerebro-spinal fluid abnormalities, compared with 0% in cognitive
controls. 5) "A Possible Tool For
Predicting Who Will Experience Long COVID", from University Hospital
Zurich (in MedicalXpress Breaking News And Events, January 26, 2022): a) 82% of PASC occurred after severe
COVID infection, vs. 54% after mild infection; b) Patients with PASC were found to
have developed lower immune IgM and IgG blood levels; c) Patients with Asthma and older
patients were more likely to get PASC. 6) "Q&A: Long COVID
Symptoms, Management, And Where We're Headed",
by Damian McNamara (in Medscape.com, February 4, 2022)... a very good summary of what is known
to date. STAY TUNED. BETTER YET: DO NOT GET THIS INFECTION! GS
- - - - - - - - - - - - - - - - - - - - - -
THIS IS A GOOD ARTICLE THAT ANSWERS
A LOT OF QUESTIONS...ESPECIALLY WHY YOU DON'T WANT COVID! GS
"IT AIN'T OVER 'TIL IT'S
OVER"....AND IT IS CERTAINLY NOT OVER!
THE COVID-19 PANDEMIC, THAT IS.
Here are some interim
"bottom-lines", supported by many excellent articles in the WSJ, the
NYTimes and elsewhere.
Viruses
keep mutating. That's What They Do! And the more hosts they have, the more
they mutate.
The
more potential hosts (ie. All of Us) are vaccinated, the fewer hosts and
the fewer mutations.
The
fewer hosts and viral mutations, the sooner we go from Pandemic to more
manageable Endemic. See: "VariantsVs. Vaccines: The Covid
Race To Watch", by Hernandez, Toy and Douglas (in WSJ January 18,
2022, Journal Report, pR1).
The
vaccines Work: fewer cases, milder cases. But they require boosters to
maintain effectiveness.
The
large majority of cases, especially serious cases, HAVE NOT BEEN
VACCINATED. FOOLISH!
Effective
masks (ie. N95 and similar) are helpful in reducing transmission of virus.
Use Common Sense.
You do
not want to get this infection, mild or otherwise.
Mild can also lead to "Long Covid". And for "Severe",
see: "In Covid Ward, 2 Nurses Race To 36 Patients", by Joseph
Goldstein (in NYTmes January 16, 2022, pA1). Read it and Weep.
"Long
Covid" is Real, potentially debilitating, potentially long-term, and
poorly understood and treated so far. Check out recent articles in http://www.medscape.com (Pauline
Anderson; Damian McNamara, MA).
"CAN YOU HEAR ME NOW?"
GS
- - - - - - - - - - - - - - - - - - - - - -
"EPISODIC SUDDEN DIZZINESS,
WEAKNESS, LIGHTHEADEDNESS AND COLLAPSE = "ORTHOSTATICHYPOTENSION".
It's upsetting and vexing,
dangerous...and difficult to diagnose and to treat.
Here is a good article on this
challenging subject.
(It was there all the time:
"unswaustralia health news and what causes long covid...")
AS I HAVE BEEN SAYING AND WRITING
FOR A LONG TIME: YOU DO NOT WANT TO GET THIS DISEASE!
For even a mild case can lead to
prolonged and debilitating symptoms and organ injuries of "Long
COVID".
What I have also been saying and
writing since March, 2020 is that much of the pathophysiology of this disease
is the direct result of a gross over-reaction of one part of our own Immune
System: the Inflammatory System. I also stressed the importance of using
adrenocorticosteroids promptly as an integral part of treatment. That
recommendation was not generally implemented until July, 2020 with
Dexamethasone!
Too slow. Too bad for many
patients.
Now comes this report about Long
COVID, its likely cause and logical treatment.
See: .............................
GS
- - - - - - - - - - - - - - - - - - - - - -
RR#1 A BOOK REVIEW.
More confusion...or clarification? You decide.
Meanwhile, TAKE CARE OF YOURSELF, as I keep documenting in this "Health Alerts" website Category.
GS
A BOOK REVIEW: “THE REAL ANTHONY FAUCI” BY ROBERT F. KENNEDY, JR. (SKYHORSE PUBLISHING, 2021)
AN EXPOSE’ – AND MUCH MORE.
AN AUTHOR COMMITTED TO UNCOVERING …
WHETHER
THIS IS AN OUTLIER OR NOT IN THE AUTHOR’S CONTINUING QUEST FOR TRUTH,
IT IS NOT DISPASSIONATE - BUT IS RATHER FILLED WITH HYPERBOLE ON
STEROIDS – VITRIOLIC VENDETTA – PERSONAL AND PROFESSIONAL CHARACTER
ASSASSINATION – PERSONAL ANIMUS - A DUMPSTER DIVE OF INVECTIVE, SCORN
AND PEJORATIVE COMMENTS.
IS FAUCI A TRAINED SCIENTIST? IS FAUCI
A BUREAUCRAT? IS FAUCI LEADER OF A MASSIVE GOVERNMENT AGENCY? IS HE A
PRIME NEGOTIATOR WITH MASSIVE PRIVATE BUSINESSES? DOES HE HAVE TO
COMPROMISE TO ACHIEVE WORTHY GOALS? YES TO ALL. AND LOOK UP A
NARRATIVE OF DR. FAUCI’S LIFE AND WORK TO DATE.
THE MASSIVE
NUMBER OF “ENDNOTES” ARE MOST OFTEN PERSONAL AND UNVETTED COMMENTS FROM
LIKE-MINDED SUPPORTERS AND MEDIA. TO EVALUATE THEIR VERACITY WOULD
REQUIRE YEARS OF RESEARCH AND A DOCTORAL THESIS.
CHAPTERS 4,5,AND 6 DISCUSS AN ALTERNATIVE UNIVERSE FOR HIV, AIDS, AZT AND THE ROLE OF HOMOSEXUALS. ANY TAKERS?
CHAPTER 7-9, PARTICULARLY INVOLVING RESEARCH WITH CHILDREN, REQUIRES FURTHER INVESTIGATION – INCLUDING CRIMINAL INVESTIGATION.
THE
INFORMATION REGARDING AUTHORIZED BIOLOGIC WARFARE RESEARCH, PROBABLY
INCLUDING “GAIN OF FUNCTION” RESEARCH AND THE DEEP INVOLVMENT OF CIA
AND RELATED AGENCIES, MAY WELL BE THE REASON FOR THE RETICENCE OF DR.
FAUCI TO DISCUSS “GAIN OF FUNCTION” RESEARCH.
IF ONLY A SMALL
PART OF THE CHARGES BROUGHT IN THIS BOOK ARE TRUE, MOST OF WASHINGTON
LEADERSHIP HIERARCHY SHOULD BE CHARGED AND LIKELY CONVICTED OF “CRIMES
AGAINST THE STATE”. AND DR. FAUCI MIGHT BE ONE OF THEM.
SO
LET’S SEE IF DR. RAND PAUL OR SENATOR TED CRUZ OR THE NUMEROUS OTHERS
CURRENTLY ENGAGED IN THE SEARCH FOR TRUTH WHILE PRODUCING CHARACTER
ASSASSINATION OF DR. FAUCI WILL TAKE THIS ENTIRE MATTER INTO THEIR
PURVUE.
AS FOR AUTHOR ROBERT KENNEDY JR, “…THE STORY IS FAR FROM OVER…I WILL CONTINUE WRITING CHAPTERS AND MAKING THEM AVAILABLE…”
I HAVE A SUGGESTION: IN THE FUTURE, TRY A DISPASSIONATE APPROACH..
THE STATE OF SCIENCE AND THE STATE
OF GOVERNANCE ARE BOTH PRECARIOUS. AND THAT'S DANGEROUS.
Here I address only the State of
Science, both Applied Science in the form of Health Care and the Response to
the Pandemic, and Physical Science currently applied most critically to Climate
and Global Warming.
Articles
and comments on Global Warming are posted on "The Arctic and Global
Warming" category of this web-site.
The
current and projected State of Health Care delivery is discussed most
recently in my Rapid Response offering of January 2, 2022: "The
Health Care System Is Sick...And Worsening".
As for
the effect of scientist / politicians on "Science", see the
following articles.
Could this have been avoided?
Probably not, when the entire nation was faced with a Pandemic in response to
which any approach would result in serious costs as well as benefits - with no
Solomon in sight.
In such a situation, what is an
individual and family to do? Informed Common Sense and Self-Interest.
I have been trying, since March,
2020, to promote that approach - on this web-site and in my medical practice.
GS
- - - - - - - - - - - - - - - - - - - - - -
SOUNDS REASONABLE TO ME.
Add common sense precautions as
noted elsewhere...and you have "done the doable".
This requires a careful and complete
read, for the thoughts and advice of its hero (Dr. Joseph Ladapo) are not
intuitive.
He does offer some practical advice:
"...only people who have Covid
symptoms and a risk factor...should get tested... For the asymptomatic, the
guidance discourages testing, saying it is unlikely to have any clinical
benefits".
"Florida's permissive policies
didn't stop Covid, but neither did other states' restrictive ones. It's an open
question whether lock-downs, masking, forced vaccination and the rest have
conferred any benefit at all."
My continuing advice:
Get
fully Vaccinated:
Use a
proper mask when unavoidably near others;
Avoid
crowds and unnecessary close encounters, public or private;
Treat
new medical symptoms, particularly respiratory, with common sense
approaches known to all. And Monitor!
Consult
with a physician regarding any particular concerns: treatment, testing....
Bottom Line: you Do Not Want This
Disease, if at all possible.
HERE IS SOMETHING THAT I KNOW PRACTICALLY NOTHING ABOUT... except that I know there is a great deal of Bipolar Disorder out there - and that it creates life-long havoc for people.
I offer the attached article as the Beginning of analysis of this subject by interested people - NOT THE END.
"IT IS A RIDDLE WRAPPED IN A
MYSTERY INSIDE AN ENIGMA".
This statement, expressed by Winston
Churchill in 1939 regarding the intentions of Russia, also describe
the role and timing and selection of
available testing for the Pandemic infections.
Now comes a small study, by
evidently reputable investigators and carefully performed, comparing the rapid
test and the PCR test. It has yet to be peer-reviewed. But given the confusion
embracing the public on this vital matter, it bears attention.
See: "Study Raises Doubts
About Rapid Covid Tests' Reliability In Early Days After Infection" (reported
by matthew.herper@statnews.com
@mattherherper, January 5, 2020).
I have no personal knowledge or
expertise in this subject of choice and timing of tests. But here are the
results reported.
The
rapid nasal test is not Positive early on despite presence of Infection.
But a Positive test means Infection.
A
rapid Throat test would likely be more effective; but being more
complicated it is not recommended for the lay person.
Omicron
infection does Not Involve the sensory organs. It's symptoms are generally
milder and more flu-like.
The
PCR test is slower, but if Positive is more reliable for Infection and
transmissibility. But it may be too sensitive, and may produce false
positives.There have been negative rapid nasal tests 1-2 days after a
positive PCR.
SO: WHAT TO DO? THIS IS WHAT I WOULD
DO...NOT ADVICE OR PRESCRIPTION!
1) USE PERSONAL COMMON SENSE
REGARDING THE LIKELIHOOD OF EXPOSURE DESPITE CAUTION.
2) USE CLINICAL JUDGMENT (yours and
that of your physician) regarding any symptoms - very variable.
3) If you decide to test: a) do a
rapid nasal test and a PCR initially; b) if the rapid nasal test is Positive,
you have Infection;
c) if the rapid nasal test is
negative initially, repeat that test if the PCR returns Positive, although not
necessary if the PCR is negative.
4) EXPECT CHANGES IN ALL OF THIS AS
MORE FACTUAL INFORMATION BECOMES AVAILABLE.
That's just the way it is. But
again: Protect yourself. You do Not want to get this infection!
And GET VACCINATED.
GS
- - - - - - - - - - - - - - - - - - - - - -
I AM A REGULAR READER
OF CHRIS POWELL'S ARTICLES AS POSTED IN THE DAY
But check out the column that appears in the
January 11, 2022 edition entitled, "Vaccine definition was changed". What happened?
As might be expressed
by one of our robo-call "friends": WHAT THE HELL YOU ARE TELLING
ME?
"Don't get the
vaccine?"
"Too many side-effects?"
"Pharmaceutical
Industry too influential?"
We need to treat the
World even before treating our citizens?
This is an unusual
opinion piece for Mr. Powell - and it is not helpful for people trying to make
personal decisions.
Remember: all of Life requires
Risk to Benefit analyses.
Here the current
information and the scientific Facts are clearly in favor of Getting
Vaccinated!
You Don't Want This
Disease and its ability to throw your Immune System into harmful
overdrive.
GS
- - - - - - - - - - - - - - - - - - - - - -
LET'S HEAR IT FOR THE MEDITERRANEAN
DIET - WHICH ONCE AGAIN WAS DECLARED THE BEST BY
IF WE EVER NEEDED JOE
FRIDAY, IT 'S NOW: "JUST THE FACTS, MA'AM. JUST THE FACTS". Misguided - and
infected - by a mountain of mis-information and just plain lies, too many
people who should know better (in addition to members of our Stupid younger
generations) are succumbing unnecessarily to a DISEASE THAT YOU DO NOT WANT TO
GET!!
- - - - - - - - - - - - - - - - - - - - - - FYI: A LOT OF GOOD AND TIMELY INFORMATION.
Get fully vaccinated, mask up with effective masks (N-95 or surgical), avoid crowds...and USE COMMON SENSE. That's much more important than unnecessary "rapid testing".
GS
January 5, 2022 Distribution: All Yale New Haven Health System Employees and Medical Staff Message from the Chief Clinical Officer Dear Colleagues, This
fourth surge triggered by the omicron variant of COVID-19 is creating
immense stress on our communities, our healthcare workers, and our
institutions. The fundamental issue is that the explosive spread is
resulting in significant hospitalizations that will likely exceed our
previous peak in March 2020, at a time when our healthcare workforce is
also being stressed due to community COVID-19 infections. Based upon
international reports with omicron, I am hopeful that our eventual peak
will come quickly, and be accompanied by a rapid drop-off. We are
currently finding that of our COVID-19 admissions, between 70-80% are
unvaccinated, and of the 20-30% of admitted patients who are
vaccinated, 80% did not receive a vaccine booster. This is clear and
local data emphasizing that vaccination and boosters are hugely
effective in preventing the worst consequences of COVID-19. Key updates: •
Our Emergency Department teams are experiencing immense patient
volumes, and are exhibiting immense creativity in sending as many
patients as humanly possible home with follow-up to ensure that
inpatient beds are being used optimally. •
It is critical to communicate that our EDs and Urgent Cares should not
be used to obtain COVID-19 testing – symptomatic patients should be
directed to use home tests or community PCR testing to minimize
unnecessary patients coming to our EDs. •
Our surgical and procedural leaders are carefully reviewing all
scheduled procedures through a clinical lens to ensure that our teams
across the system are not overloaded. Ensuring access to time-sensitive
scheduled care is essential to our ability to ensure we serve our
communities’ health needs. •
Our ambulatory enterprise is shifting once again to prioritize the use
of telehealth to minimize the risk of exposure and viral spread. These
areas are critical to caring for patients with COVID-19 in the
community setting and reducing unnecessary visits to our Emergency
Departments and subsequent hospitalizations. •
Our Human Resources team, in close discussion with our operational
leaders, have developed innovative ways to address our ongoing staffing
needs, which will be communicated through operational channels over the
next 24 hours. •
Our COVID-19 testing enterprise has modified its testing rubric to
ensure adequate availability of COVID-19 PCR tests for symptomatic
healthcare workers. Healthcare worker testing can be accessed at
https://ocucovidtesting.ynhhs.org. The most recent guidance regarding
healthcare worker testing and return to work is available here. •
It is very clear that COVID-19 vaccine boosters have a substantial
impact on reducing COVID-19 infections, severity of illness,
hospitalization, and death. At present, our Occupational Health
department estimates that roughly 40 percent of our healthcare workers
have received a vaccine booster. Those who have not been boosted should
do so as soon as possible. For YNHHS employees, healthcare worker
booster appointments can be accessed within Infor. For members of the
Medical Staff who are not employed by the System, the vaccination
clinics can be accessed at https://vaccinepartner.ynhh.org. •
Those who received a vaccine booster outside the Health System can send
in proof of booster dose administration to vaccineinfo@ynhh.org. •
In addition the availability of sotrivimab, (the monoclonal antibody
therapy that is effective against the omicron variant) and paxlovid
(the very effective oral COVID-19 antiviral drug), our Care Signature
group and pharmacy teams have added a pathway to support the ordering
of molnupiravir, another oral antiviral COVID-19 drug. A detailed memo
is available here, with Tips and Tricks available here. The pathway for
adult ordering is available here. The pathway for pediatric ordering is
available here. I
know this latest surge is taking an enormous toll on you all and our
communities. We will do all we can to help support the front lines as
we navigate what will hopefully be a short, and final surge in this
immensely long and painful pandemic. With respect, Thomas J. Balcezak, MD Chief Clinical Officer Yale New Haven Health
- - - - - - - - - - - - - - - - - - - - - -
AND MORE...
Do you want to chance this? No? Then GET VACCINATED!
IN THE PAST DECADES OF RAMPANT AND DEADLY SOUTHERN STATE RACISM, I created a diagnosis to describe it: FOCAL IDIOPATHIC IDIOCY. Focal because it was targeted toward all Blacks and only Blacks. Idiopathic because there appeared to be no known cause. Idiocy...a well-known condition that appears to becoming pandemic in our younger generations.
Unfortunately, here is a young person, ordinarily of great talent, who has contracted the disease.
IN ADDITION TO ALCOHOL'S MINIMAL IF ANY BENEFICIAL EFFECTS ON CARDIOVASCULAR HEALTH, its intake definitely contributes to the epidemic of Obstructive Sleep Apnea, a real health hazard.
Happy Holidays from all of us at
Northeast Medical Group
Your care team at
Northeast Medical Group is here to help you navigate the winter months --
especially when respiratory illnesses and COVID-19 infections are on the
rise.
We hear you
Our offices are
fielding many questions from patients, wondering how best to get the care
they need. We have gathered the most frequently asked questions to guide
you through the season.
What
should I do when I have a respiratory illness like a cold, the flu or even
COVID-19?
Call the office first. We always recommend that you call your primary care
clinician’s office so they can help you schedule the most appropriate type
of visit. Keep in mind that we want to keep all of our patients and staff
as healthy as possible. So, when you call with cough, fever, runny nose or
similar symptoms, we will help you schedule a video visit with your clinician.
During the video visit, we will discuss testing or treatment that may be
needed. If necessary, your clinician may recommend that you have a COVID-19
and/or flu test done at another location to help pinpoint the
reason for your symptoms.
If you choose to be evaluated or tested in a location outside of our
NEMG/Yale New Haven Health system, your PCP may not be aware of your
results and we do suggest calling if the test is positive and you need
follow up care.
What is the current status of being able to get a COVID-19 test? Are
there circumstances that get higher priority?
As of today, the demand for COVID-19 testing is very high across our Yale
New Haven Health sites. Same day or next day appointments are extremely
limited. This is true for sites all across Connecticut at this time. Due to
very high demand for testing, Yale New Haven Health testing sites are prioritizing
testing for patients who need pre-procedural testing, healthcare workers,
and those who are experiencing COVID-19 symptoms. Appointments will be
limited for patients who need testing for travel or recreational purposes
to ensure access for these other groups. You may schedule your appointmentat
a Yale New Haven Health site. Connecticut, Rhode Island and New York offer
testing locations as well:
For
individuals without symptoms, and no definite exposure to someone having
COVID, we recommend the use of home testing.
If I have a positive home COVID-19 test, do I need to get a PCR test?
Home tests allow you to obtain a result quickly and conveniently. Most home
tests detect cases about 85 percent of the time (true positives). The
likelihood of a test being a true positive rises when you have symptoms
that are suggestive of COVID-19. The false positive rate, or likelihood
that the test is positive when an individual does not actually have
COVID-19, is quite low, especially when there are suggestive symptoms
present. Therefore, if you have a positive home test in the setting of
having symptoms, our clinicians at NEMG will regard this as a positive test
without need for further testing.
What do I do if I test positive for COVID-19?
Call for advice, if needed. If you have underlying medical problems, are
over the age of 65, or are unvaccinated, call your clinician’s office to
arrange a video visit. We recommend purchasing a pulse oximeter to check
your pulse and oxygen saturation. Oxygen saturation levels are generally
95-99 percent in those without chronic lung disease, and if yours is
repeatedly less than 94 percent, you should be evaluated. Regardless of
your symptoms, it is very important to isolate yourself within the house
for 10 days to avoid affecting others in your family or community.
What if I have a routinely scheduled appointment with my clinician, but
now I have symptoms?
Call before you go. We want to keep all of patients and staff healthy.
Respiratory illnesses such as colds, flu and COVID-19 spread easily from
person to person. That’s why if you have respiratory symptoms the day of
your appointment, please call the office and let them know before you
arrive. Depending on your symptoms, a video visit may be best – and we can
help you schedule one. Or if you tested negative for COVID-19 within the 24
hours leading up to your appointment, we can still see you. But, again, let
us know ahead of time. These extra precautions are important to keep
everyone as safe as possible.
What should I expect when I come to the office?
Safety precautions. Be prepared to answer a few quick questions when you
arrive about your symptoms or any recent tests. We require that our
patients continue to wear appropriate masks in our offices, as required by
state mandate. Masks must be worn at all times during the visit, even when
waiting alone in the exam room. We also follow social distancing
guidelines, keeping people six feet apart when in our waiting rooms. We are
diligent in moving patients into exam rooms with their clinicians as
quickly as possible. At this time, we are unable to allow visitors to
accompany patients except for one caregiver or person providing
assistance.
How can I stay safe from COVID-19 and other respiratory illnesses during
the holiday season?
Wear masks, wash your hands, and travel only when necessary. We recommend that
people wear masks when participating in indoor activities as well as when
with others who are not part of your immediate family. Consider using home
COVID-19 tests before traveling or attending larger events or even smaller
indoor gatherings. Note that availability may be limited due to high
demand. Check the CDC’s travel
recommendations by destination or the state department of public
health about what to expect when you travel over the holidays.
A CLOSE CASE, THE GREATER GOOD...AND THE POPE'S STATEMENT.
Vaccines reportedly incorporate aborted fetal tissue. The Pope offered an allowance in this critical circumstance. Health care workers in contact with patients must be vaccinated. Common Sense and necessary medical practice!
While
high-profile commentators and politicians continue to scream about some
dastardly national scheme to rob us of our freedoms with COVID-19
restrictions...as the numbers of cases and deaths continue to
mount...reliable scientific findings continue to support logical
controls. See: "Pfizer Booster Eases Risk From Omicron, Israeli Study Says", by Dov Lieber (WSJ December 13, 2021, U.S. News, pA6). "A
booster shot...provides good protection against severe illness from the
Omicron variant, while those without a third shot are highly
vulnerable, according to a new Israeli study."
CAN YOU HEAR ME NOW? Get the Vaccine. Get the booster. Use the mask when in close contact with others. Avoid crowds. Wash hands frequently. Use Common Sense. DON'T BE STUPID!
GS
- - - - - - - - - - - - - - - - - - - - - -
AS I HAVE BEEN SAYING. No time for selfishness and stupidity.
HERE IS AN EXCELLENT VIDEO REPORT ON THE OMICRON VARIANT / COVID INFECTION. It continues to demonstrate the Importance of vaccination and protective measures. THIS PANDEMIC IS NOT OVER!
This serious and deadly infection came upon us - and may have been intentionally delivered to us - in late 2020. This
nation mobilized onto a quasi - war footing in 2021 under the
leadership of President Trump...and also produced an effective vaccine
in Record Time. The vaccine continues to be effective against new
variants.
But the danger and the spread remain, especially for those who stupidly and selfishly refuse to take the vaccine...and who even refuse to take simple and logical precautions like masking and avoiding crowds. Add
to this the fact that at so many levels - including in scientific
circles - this matter has been politicized beyond recognition. SHAMEFUL. And
also STUPID, especially for otherwise winning Republicans. "Personal
Freedom" and "Economics" will lose out to Public Health, to
selflessness on behalf of family and neighbors, and to Common Sense.
THIS THREAT IS NOT OVER. GET VACCINATED. GET BOOSTED. TAKE SIMPLE AND REASONABLE PRECAUTIONS. DON'T BE STUPID!
GS
- - - - - - - - - - - - - - - - - - - - - -
MOST CHOICES IN LIFE INVOLVE A RISK-TO-BENEFIT ANALYSIS. MOST OF US GET USED TO THAT QUICKLY.
There is a very useful saying in Italian: "CHI MI LO FAR' FARE?" "WHO MAKES ME DO IT"? A
steadily increasing number of physicians are asking themselves this
question in these recent and current years, as they find themselves
mumbling: "I don't get no respect."
And they (we) don't. We find ourselves increasingly playing second
fiddle to the Suits and to the health insurance companies that are
practicing Medicine without a license... given their power of the
purse.
But Not I. I am a diagnostician, a clinician, a people - person...and I Would Rather Fight Than Switch.
Nevertheless, I do have choices, in this, my 65th year of medical practice - in addition to the practice of Health Law. See: "What To Do If You Don't Want To Practice Clinical Medicine", by Allistair Gardiner (in MDLinx.com, November 22, 2021).
So: Don't Cry For Me, Argentina.
GS
RR#3
ABOUT "PRIOR AUTHORIZATIONS".
As I was saying - and am experiencing every day. This is the Patient's Insurance! DO SOMETHING.
We'll add this to the "Chronic Lyme" issue. Just
remember to collect and follow the data, to remember that there is an
approximately 40% "Placebo Effect", and that Science, Medical and
otherwise, never has all of the answers. They specialize in QUESTIONS.
"CHUBBY"?, "PLEASINGLY PLUMP"? "BIG BONED"? Anything but "FAT".
Well,
it's highly likely that - besides the prospects of diabetes mellitis
and osteoarthritis and gerd and obstructive sleep apnea and heart
disease, etc, etc. - you have a high chance of developing or already
having non-alcoholic Fatty Liver Disease, heading to Cirrhosis of the
Liver.
Rapid Response for MONDAY through WEDNESDAY, November 8 through 10, 2021
MORE ON COVID 19 INFECTION AND AVOIDANCE. Please read this report carefully. The temptation for the non-vaccinated to make ANOTHER MISTAKE will be great. YOU DO NOT WANT TO CATCH THIS INFECTION. NO WAY!
MORE INFORMATION ON THIS STILL VERY DANGEROUS "MESS".
Meanwhile, millions of Americans are making this about "me, myself and I": about their "personal freedom", about their "control over my body", about "ME". And cynical politicians are following the perceived votes...damn the facts. Sound familiar? We have been hearing and witnessing this mindset for at least the last two decades. And
WHAT ABOUT PERSONAL RESPONSIBILITY? WHAT ABOUT INDIVIDUAL
RESPONSIBILITY FOR THOSE AROUND US, to the extent that we can help?
What about taking the Vaccine, clearly proven effective and safe, for
those around us as well as for our selves? "FUGGEDDABBOUDDDET".
"Breakthrough Cases Hinder Fight", by Denise Roland (in WSJ November 8, 2021, pA18). Yet another reason why we should all get vaccinated - and why we should also receive current and probably future Boosters.
GS
- - - - - - - - - - - - - - - - - - - - - -
A LOT OF GOOD INFORMATION ABOUT COVID-19 AND VACCINES...BUT NOT FOR A CURSORY READING.
"COVID
Vaccine Mandates And The Question Of Medical Necessity", by Klausner
and Kojima, M.D. (in medpage today, November 2, 2021).
Bottom Line.
"For those who have not been infected with COVID-19, vaccination is an absolute medical necessity."
"...people
who have recovered from COVID-19 are at least equally protected
compared to fully vaccinated COVID-naive people. Therefore, vaccination
in those who have recovered may not be medically necessary."
Proving
prior infection is not difficult. Tests based upon the polymerase chain
reaction (PCR) are considered the most accurate.
Based
upon available data and "hunch", I would for now avoid the "Mix and
Match" approach and would stay with a booster of the original type
received...even if it means a delay of weeks in receipt.
Over a third of Americans are overweight, mainly obese (BMI of 40 or more). The only thing the remaining 2/3 of people can agree on is to criticize Them as it's being their fault. And the experts in metabolism and obesity can't even agree on this.
See an excellent paper on the subject that puts the entire mess in perspective...warts and all. It is reviewed in the following piece: "Obesity Paper Has Diet Researchers Riled Up", by Sophie Putka (MetPage Today, October 12, 2021).
The one thing that most will agree on is that, for a variety of known and unknown reasons, the Mediterranean Diet
is the Best program of the hundreds of offerings out there. That's what
I use with my patients, and that is what I live myself.
GS
- - - - - - - - - - - - - - - - - - - - - -
HOW MANY WAYS CAN I SAY IT?...
YOU DON'T WANT THIS INFECTION! GET PROPERLY VACCINATED!!
"The
findings underscore the continuing need for masking and regular testing
alongside vaccination...they can be carrying similar amounts of virus
and could potentially spread the virus to other people."
"CAN YOU HEAR ME NOW?" This is no time for uninformed obstinacy.
GOOD ADVICE FOR ALL, ESPECIALLY FOR THE NEARLY 40% OF US WHO ARE OBESE. And it is good advice whether or not it raises HDL cholesterol, mainly determined by heredity.
GS
How to Raise Your Good HDL Cholesterol By Dr. Mehmet Oz and Dr. Mike Roizen, MDs
New
research reveals that having an HDL cholesterol level of 55mg/dL or
higher helps your gut biome block common inflammatory signals so they
don't damage the liver. For the 25% of American adults with
non-alcoholic fatty liver disease, elevating HDL levels can help
prevent serious complications such as cirrhosis.
We also know
that HDL cholesterol serves as a chemical shuttle, moving
heart-damaging LDL cholesterol from peripheral tissues to the liver so
it can be excreted. That helps protect you from atherosclerosis, heart
attack and stroke.
Research shows obesity and other diseases
that trigger chronic inflammation actually turn one healthy form of HDL
from a heart protector to a heart attacker. How do you tamp down
inflammation and elevate your healthful HDL levels?
1. Upgrade
your nutrition. Reduce your processed and total carb intake. One study
found that compared to a high-carb weight-loss diet, folks on a
low-carb diet had double the increase in HDL levels. Eat purple fruits
and veggies and fatty fish like salmon and ocean trout. Studies on
anthocyanins, extracts from purple foods like eggplant, blueberries,
and purple cabbage, show they can boost HDL levels by around 14% to
19%. Another study found that eating fatty fish four times a week for
eight weeks boosts HDL levels significantly.
2. Exercise every
day. In one study, walking for one hour a day for 24 weeks lowered body
mass index and shrank waist circumference, lowered glucose and
triglyceride levels, reduced inflammatory markers, and boosted HDL
levels from 44-48mg/dL. Regular exercise also increases HDL's
antioxidant and anti-inflammatory powers.
3. Lose weight. Over
time, if you improve your nutrition and exercise more, you will shed
excess pounds. Losing just 3% of your body weight can boost your HDL
level significantly. And no matter how you lose weight, you'll see your
HDL level go up once you stabilize your weight at a healthy level.
As
you work to increase your good HDL level, you want to lower your bad
LDL cholesterol and triglycerides. HDL can only transport about a third
of your blood fats. Ditching red and processed meats and all added
sugars and refined grains is essential to bring LDL levels down to 70
mg/dL or lower.
NATURAL INFECTION MAY HAVE A SILVER LINING...IF YOU SURVIVE AND DO NOT DEVELOP A LATE SYNDROME. But this is not Jenner's discovery with cowpox. You can avoid COVID -19 infection with a Vaccine.
ON THE EVENING OF OCTOBER 5, 2021, A ZOOM LECTURE WAS PRESENTED AT L&M HOSPITAL ON THE PANDEMIC by Dr. Onyema Ogbuagu of Yale Hospital. A vast amount of material and study reports were presented. The following is a small percentage of the key points.
The available Vaccines are safe and highly effective. And yet, only 65% if Americans have been vaccinated. Very Poor!
Remdesivir IV is very effective treatment, especially when given early in the course of the infection.
Several
oral agents are also effective. One is Molnupiravir. Others are CAS,
IMD, SOT, Bam...Monoclonal antibodies are effective.
These
are used for treatment of Infection, for post-exposure treatment and
even for prevention in special populations (as for example in nursing
homes).
Low - flow O2 should always be used in hospitalized
patients - and probably in some out-patients. It should always be
carefully monitored.
The available Vaccines are: Pfizer,
Moderna, J&J (one dose, but better with two doses) and Astra
Zenica. Longer intervals between initial doses may be more effective.
"Boosters" (or extra doses) appear to be very effective. Their use in selective populations should be prioritized.
Dexamethasone
early in symptomatic infection was recommended against. As I have been
writing since early in the pandemic and posting on my web-site (Rapid
Response and Health Alerts) I believe this to have been a serious error
early in the course of Pandemic advice - and to a lesser extent
continuing. Cytokine Storm and Sepsis, gross over-reactions of our
Inflammatory System, are driving forces in the pathogenesis of this
disease if it leaves the mild stage.
Serious late and persistent symptoms can follow infection, even asymptomatic infection
YOU DO NOT WANT THIS DISEASE!
GS
- - - - - - - - - - - - - - - - - - - - - -
"WHAT THE HELL YOU ARE TELLING ME?" Granted,
the always - politicizing politicians have been unfortunately joined by
politicizing scientists - to the confusion of the public. But the Facts
are there and they are clear: there Is a Pandemic; it has killed
hundreds of millions of people and has ruined the health of many more;
the Vaccines are Safe and Effective; and this Pandemic is NOT OVER by
any means.
So what are the idiots who wrote and who subscribe to the comments below talking about.? AND YES, ALL HEALTH CARE PERSONNEL MUST BE VACCINATED IF THEY WANT TO GET ANYWHERE NEAR A PATIENT! Am I being clear enough!
IF YOU WANT SOME RELIABLE FACTS (AND OPINIONS) ABOUT AMERICA AND THE COVID-PANDEMIC, read the new book by Dr. Scott Gottlieb (former Commissioner of FDA and close confidant of the White House on these matters): "UNCONTROLLED SPREAD: Why COVID-19 Crushed Us And How We Can Defeat The Next Pandemic" (Harper Collins, 2021).
The following are some key points that I gleaned from reading this expose.
Failure
of national preparation for a pandemic by at least two prior
administrations (Bush ll and Obama) despite several serious near -
pandemics since 2001.
Persistent subterfuge and failure to abide by international agreements by China - a Rogue Nation.
Willful Neglect of responsibilities by WHO in favor of good relations with China.
Only partial recognition early (December 2020, January 2021) by the Trump administration of the possible scope of this pandemic.
Failure of CDC to rise to the needs presented - a Systemic / Structural failure...and also a concern with self-dealing.
No
adequate Testing available early and for too long, leading meanwhile to
an explosion of cases before realization of the Scope of the problem.
Incorrect
early guesses regarding mode of spread (contact vs. aerosol) leading to
emphasis on ineffective foamites and decreased reliance on Masks.
Shortage of basic equipment in the greatest nation in the world.
Instead of international cooperation...every nation for itself.
Mixed
messaging throughout, reflecting the above state of information and
insight, and resulting in loss of credibility with the public.
Great
Rapid Development of vaccines, "Warp Speed". with cooperation of
Government and Private Industry. But lost opportunities for earlier
cooperation with national pandemic needs.
Finally recognition of National Security At Risk, requiring total involvement of all Intelligence Agencies.
Prepare Now for the next Pandemic...which will probably be Worse.
Work now to reduce / clear the extra Vulnerability of our Under-Classes, especially with regard to Health.
"IS ANYBODY THERE? DOES ANYBODY CARE?" Even after this experience??
GS
- - - - - - - - - - - - - - - - - - - - - -
Rapid Response for SUNDAY, September 19, 2021
NOW HEAR THIS!
HERE IS A COLLECTION OF RECENT ARTICLES WHICH TOGETHER REPRESENT THE "PENTAGON PAPERS" OF OUR GOVERNMENT'S ADMINISTRATIVE FAILURES REGARDING RESPONSE TO THE COVID-19 PANDEMIC.
The bright spots were the early warning given by Dr. Scott Gottlieb and President Trump in January, 2020; the Warp
Speed creation and mass production by the Trump Administration of
highly effective vaccine; and the herculean efforts by our Health Care
System and the troops at the bedside.
The rest reflect yet
another failure of Government Administration, directly leading to much
loss of life and - as bad - loss of confidence in Science. Nearly all
of these articles appeared in the WSJ Opinion section in the last two
weeks.
1) "Covid Confusion At The CDC" 2) "What If Covid Were 10 Times Deadlier?" 3) "The Case for Boosters Is Strong". 4) "The Lives Lost to Undervaccination". 5) "How Science Lost The Public's Trust". 6) "The Death of Science", by Victor David Hanson.
And
the best, a summary book by Dr. Scott Gottlieb: "Uncontrolled Spread"
(Harper Publishing, 2021). The revelations in this book produced both
surprise and anger in me.
WE HAVE BEEN ADDING 25 - OH VITAMIN D TESTING TO ALL OF OUR BLOOD TESTING FOR MANY YEARS - AND HAVE BEEN USING VITAMIN D3 SUPPLEMENTATION FOR ALL THOSE WITH DEFICIENCY.
THE VACCINES ARE SAFE AND EFFECTIVE, INCLUDING FOR PREGNANT WOMEN AND THEIR UNBORN CHILD. (Tests for children under 12 are currently in progress). THE DISEASE CAN KILL. IT CAN ALSO MAIM FOR LONG PERIODS - AS IN "LONG-HAUL COVID". BE RATIONAL, INFORMED, HONEST AND TRUTHFUL WITH YOURSELF WITH ANY OBJECTION. THEN REMEMBER: ALL OF LIFE'S CHOICES INVOLVE A RISK-TO-BENEFIT ANALYSIS. CHOOSE WISELY.
THE ARGUMENT BETWEEN VACCINATIONS FOR ALL AND FREE WILL RE. VACCINATIONS.
After a personal debate ("On the one hand...On the other hand"): 1) I know on no valid religious objection that trumps the personal and societal Good of Vaccinations. 2)
Especially in a pandemic that has killed millions world-wide as well as
locally, every person has a Responsibity to get vaccinated - to protect
himself and those around him. I know of no valid reason not to get
vaccinated: a personal responsibility and in most cases an act of free
will. The exception Requiring vaccination would be in the active Health
Care Field. 3) In all other cases, regarding the above vs. Liberty / Free Will decisions: "LIVE FREE OR DIE"
AS ONE FREEDOM IS LOST OR SURRENDERED, OTHERS WILL BE PROGRESSIVELY EASIER TO LOSE. BEWARE!.
GS
- - - - - - - - - - - - - - - - - - - - - -
THIS PRINCIPLE SHOULD BE CALLED BY ITS PROPER TERM: "TRIAGE", WELL -KNOWN AND CRITICAL IN MILITARY MEDICINE. I
served two years of active duty as a physician in the Army Medical
Corps at the 97th General Hospital in Frankfurt, Germany...where on
each of those two years I was assigned as Triage Officer during three
days of Field Hospital exercises - receiving up to 100 mock casualties
who had to be immediately triaged among four categories ranging from
Immediate Care to Expectant Care (ie.delayed minimal and expecting
death). Tough...but Vital when the crisis presents itself.
VITAMIN D DEFICIENCY EXISTS IN NEARLY EPIDEMIC FORM IN OUR POPULATION. This vitamin is involved in many more metabolic processes besides bone health. Its deficiency can also be involved in some allergic conditions, such as recurrent hives. We have been monitoring this and treating it with Vitamin D3 for at least a decade.
I
saw this article on the internet about super heated water and wanted to
share it with you. I had this happen to me years ago and it scared the
hell out me. I didn't get burned but the water boiled up and out of the
cup. Here is the article.
A 26-year old man decided to have a
cup of coffee. He took a cup of water and put it in the microwave to
heat it up (something that he had done numerous times before). I am not
sure how long he set the timer for, but he wanted to bring the water to
a boil. When the timer shut the oven off, he removed the cup from the
oven. As he looked into the cup, he noted that the water was not
boiling, but suddenly the water in the cup 'blew up' into his face. The
cup remained intact until he threw it out of his hand, but all the
water had flown out into his face due to the build-up of energy . His
whole face is blistered and he has 1st and 2nd degree burns to his face
which may leave scarring.
He also may have lost partial sight in
his left eye. While at the hospital, the doctor who was attending to
him stated that this is a fairly common occurrence and water should
never be heated in a microwave oven. If water is heated in this manner,
something should be placed in the cup to diffuse the energy such as a
wooden stir stick, tea bag, etc, (nothing metal).
General Electric's Response: Thanks
for contacting us; I will be happy to assist you. The e-mail that you
received is correct. Microwaved water and other liquids do not always
bubble when they reach boiling point. They can actually get superheated
and not bubble at all. The superheated liquid will bubble up out of the
cup when it is moved or when something like a spoon or tea bag is put
into it.
To prevent this from happening and causing injury, do
not heat any liquid for more than two minutes per cup. After heating,
let the cup stand in the microwave for thirty seconds before moving it
or adding anything into it. Here is what a local high school science
teacher had to say on the matter: 'Thanks for the microwave warning. I
have seen this happen before. It is caused by a phenomenon known as
super heating. It can occur any time water is heated and will
particularly occur if the vessel that the water is heated in is new, or
when heating a small amount of water (less than half a cup).
What
happens is that the water heats faster than the vapor bubbles can form.
If the cup is very new, then it is unlikely to have small surface
scratches inside it that provide a place for the bubbles to form. As
the bubbles cannot form and release some of the heat that has built up,
the liquid does not boil, and the liquid continues to heat up well past
its boiling point.
What then usually happens is that the liquid
is bumped or jarred, which is just enough of a shock to cause the
bubbles to rapidly form and expel the hot liquid. The rapid formation
of bubbles is also why a carbonated beverage spews when opened after
having been shaken.
- - - - - - - - - - - - - - - - - - - - - -
THIS IS IMPORTANT! DON'T MISTAKE CHRONIC RHEUMATOID ARTHRITIS FOR OSTEOARTHRITIS.
GS
Delayed RA Diagnosis Can Have Serious Consequences
In
a recent continuing medical education-certified activity, Vibeke
Strand, MD, MACR, FACP, and Jon T. Giles, MD, MPH, provided expert
insight into patient-centered approaches for managing rheumatoid
arthritis (RA). This first of 3 PER Pulse™ Recaps regarding this
activity focuses on strategies for providing prompt diagnosis of RA.
Below are some highlights:
Individuals may have detectable
levels of RA-related autoantibodies up to 10 years before onset of
clinical disease, but synovial tissue is thought to remain normal in
at-risk individuals until shortly before RA is clinically detectable.1
Since
joint damage can occur in the first few months after disease onset, and
early diagnosis and treatment will prevent the progression of this
damage in 90% of early cases, timely identification of patients with
early RA is crucial.2,3
The following signs and symptoms are
commonly used to classify patients with RA: symptom duration of at
least 6 weeks; swelling or tenderness in small and/or large joints;
positive serology for rheumatoid factor or anticitrullinated protein
antibodies; and abnormal C-reactive protein or erythrocyte
sedimentation rate.4
“We’ve seen where delays in diagnosis and
treatment result in damage to the joints that we can’t necessarily turn
off later down the line.” — Jon T. Giles, MD, MPH
References 1. Scherer HU et al. J Autoimmun. 2020;110:102400. 2. Aletaha D et al. JAMA. 2018;320(13):1360-1372. 3. Allard-Chamard H et al. Clin Lab Med. 2019;39(4):525-537. 4. Aletaha D et al. Ann Rheum Dis. 2010;69(9):1580-1588.
REGARDING FLU VACCINE FOR THE 2021-2022 SEASON. OCTOBER IS A GOOD MONTH IN WHICH TO RECEIVE THIS VACCINE. It is then more likely to cover a late-winter outbreak, as often occurs.
Heart
attack patients often take longer to seek help if they have gradual
symptoms, which may put them at increased risk of death, according to
authors of a study published in the European Journal of Cardiovascular
Nursing.
Gradual symptoms begin with mild discomfort that slowly
worsens, while abrupt symptoms are sudden and cause severe pain. Study
author Sahereh Mirzaei, from the University of Illinois at Chicago, and
her team analyzed data from 474 heart attack patients seen at U.S.
emergency departments.
Symptoms were gradual in 44% and abrupt
in 56% of these patients. Those with gradual symptoms waited eight
hours to seek medical help, compared to 2.6 hours for those with abrupt
symptoms.
A delay of no more than two hours is recommended for
the best outcomes. Waiting longer increases patients’ risk of serious
complications and death, according to the researchers.
Symptoms
were triggered by exertion, such as running, climbing stairs, or
shoveling snow, in 54% of men with abrupt onset and a diagnosis of
ST-elevation myocardial infarction, which is a particularly serious
type of heart attack requiring quick restoration of blood flow to
blocked arteries.
Mirzaei said men with ischemic heart disease
or multiple risk factors such as high blood pressure, diabetes, high
cholesterol, or a family history of heart disease should be aware that
chest pain or discomfort after physical activity or exercise could be a
heart attack.
Dr. Chauncey W.
Crandall is author of Dr. Crandall’s Heart Health Report newsletter. He
is a Yale graduate and is chief of the Cardiac Transplant Program at
the world-renowned Palm Beach Cardiovascular Clinic in Palm Beach
Gardens, Florida. He practices interventional, vascular, and transplant
cardiology.
- - - - - - - - - - - - - - - - - - - - - -
PLEASE NOTE: THIS IS CONCERNING MEDICAL MARIJUANA... NOT "RECREATIONAL" MARIJUANA, FOR WHICH THERE IS NO JUSTIFICATION. It's just STUPID.
THE
FOLLOWING IS A VERY LONG AND COMPREHENSIVE ARTICLE ON THE MANY MALIGN
CAPABILITIES OF COVID-19 INFECTION. I SUGGEST THAT YOU USE IT JUST AS A
REFERENCE FOR SPECIFIC TOPICS OF INTEREST. BOTTOM LINE: DON'T CATCH THIS!
NOW YOUNG CHILDREN ARE SUBJECT TO SERIOUS COVID-19 INFECTION. See
also the position of the American Academy of Pediatrics: that all
children 2 years old or older should wear masks in school; and that
reported medical ill effects of such mask usage are "myths".
In my opinion, the psychologic effects are still to be determined, and should be monitored by parents and teachers.
Updates for Connecticut Physicians, APRNs, PAs, and RNs:
COVID-19 Epidemiology:COVID-19 case rates continue
to rise in Connecticut. All Connecticut counties currently have
either substantial or high levels
of community transmission. Since late July, all Connecticut
SARS-CoV-2 specimens for which variant identification has
been performed are the highly transmissible Delta variant.
Unvaccinated people (including
children unable to be vaccinated) are at greatest risk for SARS-CoV-2
infection. Each infection is an opportunity for the virus to mutate,
spread, and cause illness and death.
Fully
vaccinated people can also
potentially spread the Delta SARS-CoV-2 virus to
others.
Current
evidence suggests that the amount of virus produced by Delta
breakthrough infections in fully vaccinated people goes down faster
than infections in unvaccinated people. Fully vaccinated people are likely
infectious for less time than unvaccinated people.
COVID-19 Vaccines: On Friday, ACIP recommended that people who
are moderately to severely immunocompromised could receive a
third dose of mRNA COVID-19 vaccine.
Evidence indicates that people with
severe immunocompromise don’t always build the same level of immunity
after two doses of mRNA vaccination as people
without immunocompromise, and may benefit from an additional
dose of COVID-19 vaccine.
The
third dose should be administered at least four weeks after the second
dose of the same mRNA vaccine.
Healthcare
providers should talk with patients who are immunocompromised about
whether a third dose is appropriate for them. Patients included in
ACIP’s recommendations can get a third dose of mRNA vaccine. See FAQs
under the recommendations for more information.
DPH
encourages all providers to reach out to patients who may meet the
criteria for an additional dose of a COVID-19 vaccine to support and
encourage them to get the additional dose.
For patients/families who reported having vaccine-associated
myocarditis >90 days ago, CDC plans to reach out to assess long-term
outcomes. Patients could receive a letter and/or other outreach to
gather information and follow-up with healthcare providers for clinical
information.
COVID-19 Control Measures: Given
what we know about the Delta variant, vaccine effectiveness, and
current vaccine coverage, layered prevention strategies, such as wearing masks,
are needed to control transmission of the SARS-CoV-2 virus.
COVID-19
vaccines remain the best “layer” of protection and are highly effective at
preventing severe disease and death.
As vaccination
coverage remains low in some communities, other “layers”, including
masking in public indoor settings and crowded outdoor
settings, remain necessary.
COVID-19 Testing: Who should get tested for COVID-19 infection?
Anyone
(vaccinated or unvaccinated) with COVID-19 symptoms.
People
who have had a close contact with someone with confirmed COVID-19.
Fully vaccinated people should be tested three to five
days following a known exposure and wear a mask in public indoor
settings for 14 days or until they receive a negative test
result.
People who have tested positive for COVID-19 within
the past three months and recovered do not need to get tested following
an exposure as long as they do not develop new symptoms.
Unvaccinated
people who have taken part in activities that put them at higher risk for
COVID-19 because they cannot physically distance as needed to avoid
exposure.
People
who have been referred or asked to get tested by their healthcare provider
or state or local health department.
THE MOST CONSEQUENTIAL STORY UNFOLDING NOW IN AMERICA IS NOT the
*Biden presidency, or the stolen 2020 national election, or the
immigration crisis, or the crises in crime and policing, or the Western
fires, or deaths from illicit drug use, or suicides in disconnected /
"tuned in" young people, or the risk of losing a conflict with China,
or the loss of our longest war in Afghanistan....
No, the most consequential story is again the COVID-19 PANDEMIC! To paraphrase Winston Churchill, it is - if we are lucky - "the end of the beginning". For background beginning in March 2020, see the contents of my web site Category entitled: "Health Alerts". Then check out the following articles that appeared in recent media releases: 1) "Top Biden Health Official: We're 'Failing' On COVID", (Newsmax, August 8, 2021; 2) "What To Do With Our COVID Rage", (NY Times Sunday Review, August 8, 2021; 3) "The CDC Needs To Stop Confusing The Public", (ibid); 4) "The COVID-19 vaccine Quandary", (ibid); 4) "The COVID-19 Vaccine Quandary", by Dr. Robert A. Linden (in the Day August 8, 2021, pB3). 5) "Vaccines And Masks Are the Way Out" (NYTimes Editorial, August 8, 2021.)
My Bottom Line: You
don't want this infection: not asymptomatic, not mildly symptomatic,
not severe, not re-infection, not with lingering debilities, and not
fatal. Everything in Life is a Risk-to-Benefit analysis. Here the
benefit of taking the Vaccine vastly outweighs any risk. In addition,
avoid crowds...and use an effective mask when that is not possible.
Rapid Response for MONDAY through FRIDAY, August 2 through 6, 2021
DAMNABLE,
BY THE DAMNED. ONLY A USSC HOLDING THAT HUMAN LIFE BEGINS AT THE MOMENT
OF CONCEPTION, AND IS PROTECTED FROM THAT MOMENT, WILL SUFFICE.
GS
Subject: University Admits Harvesting Kidneys From Unborn Babies While Their Hearts are Still Beating
University Admits Harvesting Kidneys From Unborn Babies While Their Hearts are Still Beating The
University of Pittsburgh may have inadvertently provided more evidence
this week that aborted babies may be being born alive and left to die
so that their organs may be used for scientific research, according to
the Center for Medical Progress.
THESE ARE THE CURRENT COVID 19 FACTS...AND NOT ONLY FOR THE HOSPITAL STAFF. So please...Wise Up regarding the current vaccines and regarding continued use of masks in populated areas. Thank You.
GS
Dear Colleagues:
We
are fortunate that here in the Northeast, vaccination rates are among
the highest in the country. It’s different nationally, though – the
spread of the Delta variant is resulting in more cases and more
hospitalizations. The large surges are happening in places where
vaccination rates are low, but we are seeing a slight increase even in
our region. The majority of these cases are in unvaccinated people, but
breakthrough cases – where fully vaccinated individuals develop
COVID-19, are also increasing. It’s important to note that the rate of
hospitalization and deaths in fully vaccinated individuals are
extremely low – proving that the vaccines are hugely effective in
reducing severe cases of the disease.
In light of recent
events, it important to remind all employees and medical staff, even
those who are fully vaccinated, to stay home from work if you have any
COVID symptoms. We must do all we can to prevent exposures to our
patients and our coworkers.
The fact that the vast majority
of the recent increase in COVID-19 cases occurs in unvaccinated
individuals supports the importance of mandatory vaccination for all
employees and members of our Medical staff, which we announced 2 weeks
ago. If you aren’t yet vaccinated, please visit the Vaccine Information
Center on the intranet for the latest vaccine clinic schedules and
deadlines for COVID-19 vaccination. Of note, starting this week, our
Occupational Health teams and managers will be granted access to
identify individuals who have not yet been vaccinated. That said,
vaccination status will only be disclosed to Occupational Health, an
individual’s manager, and Medical Staff Administration for members of
the Medical Staff.
Before the end of August, please get
vaccinated, and encourage your coworkers to do the same. Also,
self-monitor for symptoms and err of the side of caution if you don’t
feel well – stay home and get tested. Both of these important actions
are critical to ensuring we continue to keep our patients and
colleagues as safe as possible.
Sincerely,
Thomas Balcezak, MD, MPH Chief Clinical Officer Yale New Haven Health
Rapid Response for MONDAY through SATURDAY, July 12 thtough 17, 2021
"NOW HEAR THIS..."
Please
remember that, in addition to abundant information and commentary about
Covid-19 stored throughout this Rapid Response section since March,
2020, more recent information is posted in the "Health Alerts" section
of this web site. •
"What You Need To Know About the Highly Contagious Delta Variant", by
Bever and Achenbach (in theday.com, July 09, 2021). •
"Pfizer To Seek OK For 3rd Vaccine Dose; Shots Still Protect", by
Lauran Neergaard (in theday.com, July 8, 2021). This Covid Pandemic is certainly not over yet!
GS
- - - - - - - - - - - - - - - - - - - - - -
ON THE ONE HAND.... ON THE OTHER HAND. ? STAY TUNED.
REGARDING COVID-19 INFECTION, THE AFTERMATH... AND VACCINATION.
Infection produces a robust and protective antibody level. The duration of that level is not known.
Vaccination
after actual infection produces Very High antibody levels. It also
produces a stronger adverse reaction to the vaccination. Bottom Line:
except for specific contra-indications: GET VACCINATED!
A small percentage of teenagers who receive the vaccine have been getting a Myocarditis.
"Long-Haul" symptoms after infection are real and troubling. Be aware of that possibility.
This Field in In Flux. STAY TUNED.
"My
Covid Patients Need To See Their Families", by Daniela Lamas,
M.D. YES, THEY DO! The related isolation
over the past year - and continuing even now - has been devastating for
patient and loved ones. We now have enough information and testing
tools to solve that problem.
GS
- - - - - - - - - - - - - - - - - - - - - -
YES, SUCH BREAKTHROUGH INFECTIONS CAN AND DO OCCUR, ALTHOUGH RARELY. So
what do we do? Common
Sense!
"It ain't over yet".
Rapid Response for SUNDAY through TUESDAY, May 23 through 25, 2021
SO YOU MAY NOT DRINK ENOUGH TO GET CIRRHOSIS OF THE LIVER. But that would be the Easy Alternative...and Faster. How would you like to glide into your 70's, 80's and 90's with Half a Brain?
NEWS FLASH: THE COVID-19 PANDEMIC IS NOT OVER YET, NOT IN THE WORLD AND NOT IN THE U.S.A.
Not with the disease - and the new variants - boiling over elsewhere and as close as in Great Britain. Not in the fevered brains of the anti-vaxers. Not
in the faulted calculus of a much greater number of people who never
learned that all of life is a risk / benefit analysis - and who are not
taking the vaccine. Not among the Irresponsibles who don't give a damn.
So: continue to use common sense, and masks and social distancing...and avoid unprotected crowds for another few months.
And Please read, in its entirety, the excellent article by Niall Ferguson entitled: "How A More Resilient America Beat A Mid-Century Pandemic" (in WSJ May 1-2, 2021, Review, pC1). In
addition to relating in great detail the difference between the Asian
Flu pandemic of 1957 and this one, the author clearly describes the
relevant differences between great numbers of today's Americans and
their grand-parents and great-grandparents. And therein lies the
Rub, as well as the lessons to be learned - if enough of us are
educable.
I have a personal story about the Asian Flu and the summer of 1957. On
July 1 of that year, having just graduated from Medical School, I began
a one year Mixed Internship at Roosevelt Hospital in New York City. My
first rotation was in the very busy Emergency Room, which covered from
the Hudson River to Lexington Avenue and from 86th Street to 33rd
Street. Toward the end of that first week, we received a seriously ill
24 year old Greek student right off the boat from Europe. He was dead within 24 hours. Then came the news that he had succumbed to the "Asian Flu", new to us. Then came the order that all of our staff should present immediately to receive a "vaccine". About
half of us could not break away from our duties. The other half
received the vaccine - and half of them promptly became quite ill. We
covered for them for a couple of days. I never caught the Asian Flu. As regards Covid-19, so far so good.
Back to my original message: THE COVID-19 PANDEMIC IS NOT OVER YET.
GS
- - - - - - - - - - - - - - - - - - - - - -
Rapid Response for FRIDAY, May 7, 2021
...AND YOU'LL START TO FEEL ITALIAN TOO. BUONA SALUTA!
This week’s updates for
Connecticut Physicians, APRNs, PAs, and RNs:
COVID-19
Epidemiology: Case rates remain
high in many parts of Connecticut, particularly Fairfield and
New Haven counties, putting unvaccinated people at risk. The B.1.1.7
(“UK”) variant, more transmissible than the “wildtype” SARS-CoV-2 virus,
continues to be our most prevalent variant of concern.
·Vaccine safety monitoring will continue; new information
about TTS (thrombosis-thrombocytopenia syndrome) will be brought to ACIP
as needed.
·A total of 15 cases of TTS, including the original 6 reported
cases, have been reported to VAERS. All cases occurred in women ages
18–59. Reported symptom onset was 6–15 days after vaccination.
Walk-up clinics for COVID-19
vaccination are starting! See ct.gov/covidvaccine/walkup
for >50 vaccine providers across the state that will no longer require an
appointment prior to vaccination. Share this option with patients who find
access to an appointment or online scheduling to be a barrier to
vaccination.
Communications Corner: Want
to improve communications with people “on the fence” about COVID-19
vaccination? Careful and deliberate messaging can increase vaccine
uptake and get us closer to herd immunity and a sense of normalcy. Try
these talking points to increase vaccine confidence.
·The vaccine seems like it was rushed
through. How do we know it’s safe? All three of the currently
available COVID-19 vaccines have passed rigorous safety, effectiveness, and
manufacturing quality standards in order to obtain authorization for use
in the US. As we saw with the recent pause of the J&J
vaccine, CDC and FDA, along with the ACIP, take safety concerns and unexpected
adverse effects very seriously and have made safety of these vaccines
their top priority.
·There doesn’t seem to be an end in sight.
I don’t believe that vaccination will put an end to this pandemic. Vaccination
is another tool, and a very effective one, to help reduce the spread
of infection. Masking, physical distancing, and hand hygiene were our
best tools last year. Now we have the COVID-19 vaccines,
another way to help us fight the virus. Nothing will
put an immediate stop to this pandemic, but increasing the population of
vaccinated people, along with our other tools, will help reduce the
spread and bring us closer to “normal”.
·I feel like I’m doing everything I can
already (masking, physical distancing). I’ve managed to keep myself safe
so far, why take the risk with the vaccine? The
measures we have all been taking in the last year are important. The vaccine
offers another layer of protection so that even if you are accidentally
exposed, you’re protected.
Remind patients that both doses of mRNA
vaccine are needed. CDC and FDA continue to recommend two doses for full
vaccine protection, which does not occur until a full 2 weeks after the final
dose.
COVID-19 Testing: Testing is
essential for understanding if vaccines and other mitigation
measures are working and infections are decreasing. While we
know that vaccines are effective in preventing hospitalizations
and
e illness, continued
testing helps us understand vaccine effectiveness against
infection (even asymptomatic infection), as well as vaccine effectiveness
in the setting of circulating variants. COVID-19 testing should continue
when there is clinical suspicion for COVID-19, regardless of vaccination
status.
Learning Resources to share: Can COVID-19
vaccination affect fertility?
·The American College of Obstetricians and Gynecologists (ACOG)
and The Society for Maternal-Fetal Medicine (SMFM) released a joint statement affirming that
studies do not indicate any adverse effects on female reproduction or
fetal/embryonal development.
ADEQUATE SLEEP IS A VITAL PART OF HEALTH. THE CONVERSE IS ALSO TRUE. The quality of sleep is also vital. In
recent decades there has developed an epidemic of broken sleep, very
often due to Obstructive Sleep Apnea - a condition which is easily
diagnosed and easily treated - if first considered. So: CONSIDER IT.
PUTTING THINGS INTO PERSPECTIVE; AKA "COMMON SENSE". Meanwhile,
all of this is causing even more people to decide not to receive any
vaccine, as some of my patients have been telling me - despite my
advice.
Bottom Line: the minimal risk of adverse reactions
from the vaccine (eg. serious allergic reactions, serious blood
clots...) is far outweighed by minimizing contracting Covid -19
infection - which will be even more likely this Fall and Winter if a
second wave of the Pandemic is facilitated by too few vaccinated
persons. Your Choice. Your Future.
ONCE MORE, WITH FEELING: THIS AIN'T OVER, BY A LONG SHOT. Continue common sense precautions: social distancing, masks when that's not possible, and NO GROUPS.
Rapid Response for MONDAY through WEDNESDAY, April 5 through 7, 2021
COVID 19 INFECTION. ANOTHER OF MANY REASONS WHY NOT TO GET THIS INFECTION - AND WHY TO TREAT IT AGRESSIVELY AT ANY BUT THE MILDEST STAGE. My
educated guess: this, and the other manifestations of diffuse injury in
"Long Haul" patients, are not the results of the virus itself - but of
the excessive response of our Immune System to that invasion (ie.
Cytokine Storm / Sepsis).
Could these be the results of Sepsis - caused injuries incurred during the initial illness? You Bet They Can.
More reasons for considering the use of Steroids during the serious
illness, to stem the gross over-reaction of the Immune System (aka
Sepsis) during that illness.
Please read and follow the recommendations in this Ct. Dept. of Public Health Update. "The life you save may be your own"...or that of a loved one. That includes especially those fully vaccinated.
"NOW IS NOT THE END. IT IS NOT EVEN THE BEGINNING OF THE END. BUT IT IS, PERHAPS, THE END OF THE BEGINNING". (Winston Churchill, after the Battle of El Alamein, November 1942).
********************
GS
This week’s updates for Connecticut Physicians, APRNs, PAs, and RNs: COVID-19
Epidemiology: COVID-19 case rates are rising in Connecticut, as is the
proportion of the B.1.1.7 variant, estimated to be at 40% of new cases.
•
Over 90% of Connecticut’s population lives in a “red alert” town. While
case rates have decreased among persons age 70 and older, they have
plateaued or increased among all other age groups. The 20–29 year old
age group has the highest case rate.
• The B.1.1.7 (“UK”)
variant continues to be the most prevalent variant across CT. This
variant spreads more efficiently than the “wildtype” SARS-CoV-2 virus
and has been found to be associated with increased mortality in the
UK.
• People who are not > 14 days past a full COVID-19
vaccine regimen are at increased risk for infection with COVID-19,
severe disease, and death.
• Vaccine breakthrough cases do
occur, as no vaccine is 100% effective. Vaccine breakthrough cases
should be treated as potentially infectious, and close contacts should
quarantine.
• Clinicians should report cases of
laboratory-diagnosed COVID-19 among individuals > 14 days past their
last dose of a full COVID-19 vaccination regimen. COVID-19 Vaccines: ALL Connecticut residents > 16 years of age will be eligible for COVID-19 vaccination on April 1.
•
The Pfizer-BioNTech vaccine is the only COVID-19 vaccine with EUA for
individuals 16 and 17 years of age.
o 16/17-year-old children should only register for vaccination at sites offering Pfizer-BioNTech. o
16 and 17 year-olds should have a parent/guardian present with them at
their vaccination appointment. Minors under age 18 cannot be
vaccinated by a healthcare provider without parental consent.
•
The Homebound Individual Intake Form can be completed for any
individual who is physically unable to go to a vaccination clinic.
These individuals must also have no prior history of anaphylaxis or
severe allergic reaction requiring the use of an epinephrine
auto-injector (e.g., EpiPen). COVID-19 Control Measures: With
spring break and Easter holidays approaching, travelers should follow
recommendations outlined in Connecticut’s Travel Advisory, which is
consistent with CDC Travel recommendations.
• Interim public health guidance for fully vaccinated people can be found here.
•
If visiting with high-risk, unvaccinated people, all COVID-19 control
measures (masking, physical distancing, hand-washing) should be
implemented even if all visitors are fully vaccinated.
•
When possible, visits should be held outdoors or in well-ventilated
areas. CDC recently updated guidance on ventilation in non-healthcare
settings which can help with decisions on ventilation strategies.
COVID-19 Testing:
•
COVID-19 vaccination does not affect SARS-CoV-2 diagnostic
(molecular/PCR or antigen) testing. Vaccinated individuals with
COVID-19 symptoms should isolate and get tested if indicated.
A
positive antibody test could indicate either previous infection or
vaccination. An antibody test should not be used to assess immunity to
COVID-19 or the need for vaccination in an unvaccinated person.
Reminder
about childhood vaccinations: With the disruption of both in-person
learning and routine well-child visits due to COVID-19, childhood
vaccination rates have declined. Healthcare providers are encouraged to
identify and follow up with families whose children have missed doses
to get appointments scheduled.
Learning resources to share. IPC
(Infection Prevention and Control) practices remain the best defenses
against the spread of COVID-19. CDC’s new infection control training
collaborative, Project Firstline, helps frontline healthcare workers
gain an understanding of infection control principles and confidence to
implement protocols.
CT DPH Provider Call-In: As this Friday is
a state holiday, there will be no Provider Call-in this week. Please
join us on April 9 for our next session.
Sincerely, Vivian Leung, MD Infectious Diseases Section Connecticut Department of Public Health
"SCIENCE"
AIN'T WHAT IT USED TO BE, IF IT EVER WAS...A PURE, PRISTINE SEARCH FOR
TRUTH UNBLEMISHED BY THE ALL TOO HUMAN MOTIVES OF ITS SEARCHERS.
The following is Required Reading for all who Want the Truth - and who can Handle the Truth: "Science, Politics, And COVID: Will Truth Prevail?", by Scott W. Atlas, M.D., (in Imprimis, http://www.hillsdale.edu, February, 2021).
COVID-19 AND IMMUNOSUPPRESSED PATIENTS - A SPECIAL CASE.
It is estimated that about 1/2 million people have had organ transplant and are immunosuppressed from treatment. Also, about 11 million people are immunosuppressed from medications given for other conditions. They don't have the same antibody effect from the vaccines - and they should not assume that they do.
"INFORMATION IS POWER". AND THE REVERSE IS ALSO TRUE.
So here is more and continuing information about the status of the COVID-19 PANDEMIC.
1)
"...insufficient data to recommend..." Lack of data is not data of
lack. The Scientists need more humility when dealing with their
Clinician colleagues. Good Luck with that.
2) COVID -19
re-infections are rare, but they do occur, especially in the elderly.
We should all be alert to this possibility. And the differential
diagnosis between this and other respiratory illnesses is often not
easy.
3) A www.medpagetoday article by zdoggmd, dated March 16, 2021, is entitled: "Op-Ed: Did We Hurt Healthcare Workers With Bad Mask Advice".
It seems that was the case, as we "followed the science" instead of
heeding common sense. The "super-spreaders" were not in the ICU, where
highly effective protection was used...but in the ED and other hospital
areas, where less effective or ineffective modalities were used.
4)"When Will It Be Safe To Travel After Getting The COVID-19 VACCINE?" NOT NOW, NOT YET!
5) An article in medscape.com reports that examining asymptomatic
adults for COVID-19 would add another 16 million cases to the number of
infections in the U.S. That would double the number of clinically
diagnosed cases.
6) A Reuters article in medlinx.com notes
that "Blood type A was associated with a greater risk of severe
SARS-CoV-2 in one recent study and a higher risk of contracting the
disease in another."
7) An article in medscape.com reports "AZ
Vaccine Safe Overall But Questions Remain Over Unusual Clots", notably
the very severe "Disseminated Intravascular Coagulation (DIC) and
Cerebral Venous Sinus Thrombosis (CVST). Here again remember: "POST HOC, ERGO PROPTER HOC" is poor logic. But questions also continue regarding the overall effectiveness of the Oxford/AstraZeneca (AZ) vaccine. So: would I take that vaccine if I were in a high impact area? Yes. Remember "Risk To Benefit Analysis".
Wow.
This is becoming a full-time part-time job. But, with reports of as
many as 40% of persons unsure about taking the vaccine, and trusting
their personal physician over the CDC / NIH scientists, I accept the
responsibility to stay current and knowledgeable.
MORE ABOUT COVID-19 VARIANTS AND "LOOSENING OF RESTRICTIONS" IN CONNECTICUT.
Dr. Ko said that he "wouldn't call it a gamble...". Of
course it's a gamble: it's a careful risk-to-benefit analysis between
serious health risks and serious economic / educational / social risks.
We're just starting to see the depth of those other risks...less in
those States that did the analysis and much more in those States that
did not. ALL OF LIFE IS A RISK-TO-BENEFIT ANALYSIS.
Rapid Response for TUESDAY through FRIDAY, March 16 through 19, 2021
HERE IS THE LATEST LIST OF "AUTHORIZED AND/OR VALIDATED THERAPIES" FOR COVID-19 INFECTION...AND THOSE THAT ARE "NOT".
However,
"Insufficient data", that is from "double-blind cross-over studies",
are not necessarily sufficient to ignore interim clinical experience of
many careful and observant physicians at thousands of bedsides. Check out "Vitamin D" as one example. Of
course, there are thousands of other examples of old and continuing
medical treatments discovered with only careful clinical observation.
You can start by reading the classic; "Microbe Hunters", by Paul DeKreuf (1926). And
then there is "Dexamethasone", a corticosteroid which took four months
to receive the IMPRIMATUR of the scientists, while I among others was
discussing its use as a "no-brainer" in March and April of 2020. How
many patients were affected by that delay?
SO NOW, WHEN WE CAN'T DIAGNOSE A CASE, WE'LL ALWAYS HAVE THIS. I hope more diagnostic criteria are forthcoming - or its use will be abused, as the true diagnosis goes undetected.
Rapid Response for TUESDAY and WEDNESDAY, March 16 and 17, 2021
MY CURRENT BOTTOM LINES REGARDING WHERE WE ARE IN THE PANDEMIC - AND WHAT TO DO:
1) UNLESS YOU HAVE A SPECIFIC ALLERGY HISTORY NOTED HERE, GET THE VACCINE ASAP, PREFERRABLY THE TWO-DOSE VACCINE.
2)
IF YOU HAVE A HISTORY OF AN ANAPHYLACTIC REACTION TO A PRIOR VACCINE,
OR A DIAGNOSIS OF "MULTIPLE MEDICATION SENSITIVITY SYNDROME," DELAY FOR
A FEW WEEKS WHILE A POSSIBLE CONNECTION TO POLYETHYLENE GLYCOL ALLERGY
IS INVESTIGATED.
3) EVEN IF YOU HAVE BEEN FULLY VACCINATED AT
LEAST TWO WEEKS EARLIER, AVOID CROWDS AND AIR TRAVEL FOR SEVERAL
MONTHS. AND MASKS AND SOCIAL DISTANCING ARE STILL GOOD IDEAS.
4)
SCHOOL CHILDREN ARE A SPECIAL CASE. FOLLOW THE EXAMPLE AND EXPERIENCE
OF SO MANY PRIVATE SCHOOLS THAT HAVE SUCCESSFULLY AND SAFELY REMAINED
OPEN THROUGHOUT THE PANDEMIC. WE HAVE NOT YET RECOGNIZED THE ADVERSE
EFFECTS ON CHILDREN, OF WHICH THE LOSS OF AT LEAST A YEAR OF SCHOOLING
IS A MINOR PART.
5) BOTH FOR INDIVIDUALS AND FOR SOCIETY, OUR APPROACH AND DECISIONS NEED TO BE BASED ON A RISK-TO BENEFIT ANALYSIS.
6) AND THEN THERE IS THE INFORMATION IN THIS ARTICLE. WE ARE FAR FROM FINISHED WITH THIS PANDEMIC.
GS
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Rapid Response for SUNDAY, March 14, 2021
NOW A "THREE FOOT RULE". Always the need in Politics to be "in control". The "science" is an after-thought. If you're closer than three feet, "you should be in a hotel room."
Rapid Response for TUESDAY through FRIDAY, March 9 through 12, 2021
THE OTHER PANDEMIC, OF WHICH WE ARE ALL VICTIMS. People Really Need People. Touching is critical. And "being connected" through all the gizmos was always One Big Lie.
Please read the landmark book published by Ashley Montague in 1971: "TOUCHING: THE HUMAN SIGNIFICANCE OF THE SKIN".
Rapid Response for TUESDAY through FRIDAY, March 9 through 12, 2021
SO MANY ISSUES. SO LITTLE TIME. But of course I'll do my best.
1)
Receiving Vaccines, any vaccines based upon personal risk, is a GOOD
THING. "Anti-Vaxers" are just plain emotional and/or stupid. They are
also irresponsible as related to childhood vaccinations, which
inactions put all the others at risk. They should be made to pay for
this; eg. mandatory home-schooling.
2) In a Pandemic such as the
present one, Everyone should receive a COVID-19 vaccine, barring a
scientific reason not to - of which there are very few.
3)
Then come the issues of Production and Distribution. The Production
"WARP SPEED" effort and actuality of the Trump administration was
totally successful should be highly praised. The Distribution/
Availability has been fumbled and politicized - and should be taken to
task at the local and State levels. A particularly pithy reaction on
this subject should be read: "Op-Ed: The Ethics Of Vax Schemes and
Schemers", by Arthur Caplan, PhD and Kyle Ferguson, PhD (in
medpagetoday.com, March 9, 2021).
4) And now, what can you do
after vaccination? The CDC has come out with various proposals, both
complex and variable. My advice: the proposals are too broad. Take your
time and use common sense. Once again during this Pandemic year, the
scientists and "scientists" are waxing political.
5) Regarding
the entire issue of "Lock-Downs", a matter of contention from the
outset, the Medical / Scientific professions have also been divided.
See the opinions of Dr. Atlas and Dr. Bhattacharya, both of Stanford
Medical School, as well as the Great Barrington Declaration (with over
50,000 medical and scientific signatories). This debate is all the more
poignant as we see the serious adverse economic and personal effects of
those actions, affecting all of our children and at least 40% of our
adults.
6) And "Lest We Forget": the totally self-dealing
Teachers Unions. For more, much more on this disgrace, see the section
entitled "Public Education Politics" on my web-site.
7) Regarding "Death with Dignity", aka "Assisted Suicide": Another Abomination...like Abortion. See two articles: a)
"Assisted Suicide Lobby Spreads Falsehoods To Promote Systemic
Ableism", by Stephen Mendelsohn (in ctmirror.org, March 8, 2021); b)
"Ireland's Bishops Call Dying With Dignity Bill 'Fundamentally Flawed"
(in cruxnow.com, March 11, 2021). This article has the advantage of
dissecting the many errors and problems included in a piece of
legislation now before the Ireland leaders.
8) Beware "Boom to Bust". We have seen the likes of the current stock market before: in 1929, 1987, 2008. Our
current Federal Legislature, despite the narrowest of margins between
serious differences in political and economic positions, is proceeding
headlong into a likely abyss for the nation. These are not "drunken
sailors". They are INSANE!. See also "When The Boom Turns To Bust", by
Andy Kessler (WSJ March 8, 2021, Opinion, p15).
9)This is
especially true given the challenge of China. This threat, in all its
forms, is much greater than that posed by the USSR at the height of
the Cold War. And who do we have "leading" us? A so-far illegitimate President* Biden.
I never wish away time. But I Can't Wait For November, 2022.
GS
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Rapid Response for SATURDAY and SUNDAY, March 6 and 7, 2021
ANOTHER EXAMPLE OF THE PERFECT BEING THE ENEMY OFTHE GOOD. Dr. Fauci is right on the Science. The Surgeon General is right on the Common Sense. My question: where was the "Warp Speed" regarding the DISTRIBUTION? POLITICS, that's where.
This comes from Dr. Patrick Teefy, Cardiology Head at the Nuclear Medicine Institute University Hospital, London Ont.
1. Let's say it's 7:25 pm and you're going home (alone of course) after an unusually hard day on the job.
2. You're really tired, upset and frustrated.
3. Suddenly
you start experiencing severe pain in your chest that starts to drag
out into your arm and up into your jaw. You are only about five km
from the hospital nearest your home.
4. Unfortunately you don't know if you'll be able to make it that far.
5. You have been trained in CPR, but the guy that taught the course did not tell you how to perform it on yourself.
6. HOW TO SURVIVE A HEART ATTACK WHEN ALONE?
Since
many people are alone when they suffer a heart attack without help, the
person whose heart is beating improperly and who begins to feel faint,
has only about 10 seconds left before losing consciousness.
7. However, these victims can help themselves by coughing repeatedly and very vigorously.
A
deep breath should be taken before each cough, and the cough must be
deep and prolonged, as when producing sputum from deep inside the
chest.
A breath and a cough must be repeated about every
two seconds without let-up until help arrives, or until the heart is
felt to be beating normally again.
8. Deep breaths get oxygen
into the lungs and coughing movements squeeze the heart and keep the
blood circulating. The squeezing pressure on the heart also helps it
to regain a normal rhythm.
In this way, heart attack victims can get help or to a hospital.
9. Tell as many other people as possible about this. It could save their lives!
10. A
cardiologist says: "If everyone who gets this email & kindly sends
it to 10 people, you can bet that we'll save at least one life.
11. Rather than sending jokes, please contribute by forwarding this email which can save a person's life....
12. If
this message comes around to you ..... more than once..... please
don't get irritated.... We all need to be happy that we have many
friends who care about us and we are being reminded of how to tackle...
Heart attacks.... when we are alone.
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PATIENTS WITH ACUTE COVID-19 INFECTION:
This is Important: ASK YOUR DOCTOR ABOUT EARLY ANTICOAGULATION IF YOU NEED HOSPITALIZATION!
"MEDICAL ASSISTANCE IN DYING", "MEDICALLY ASSISTED SUICIDE" AND RELATED DESCRIPTIONS have one thing in common: they are a Damnable perversion of a physician's duty to his patient: "PRIMUM NON NOCERE": FIRST, DO NO HARM. Whatever the watered - down statements currently used by new medical school graduates as substitutes for the Oath of Hippocrates, this concept and promise should remain inviolate by all physicians.
But it is not. Nor, as it seems, are the methods used painless or "merciful". See the article which follows: "Canada's Medical Assistance in Dying = Torturous Death".
MORE INFORMATION ON TREATMENT OF SERIOUS COVID-19 INFECTIONS. Most infections are asymptomatic or mild. But serious infections, usually including chest symptoms like cough and shortness or breath, require prompt identification
and prompt and effective treatment. Identification is aided by
monitoring with an O2 saturation meter, available in most pharmacies,
looking to detect if the level is dropping from a normal of 97-98%
through the 90's and into the upper 80's, even without shortness of
breath. That requires hospitalization and aggressive treatment. The
article from the World Health Organization posted below addresses such
treatment...although still hesitant to discuss a vital part of that
treatment. The treatment modalities mentioned are: a) low dose anticoagulants; b) the prone position, which improves oxygenation. What
is not mentioned, even nearly a year after treatment advice began and
still seven months after Dexamethasone was gingerly embraced, is the
critical importance of adrenocorticosteroids, which I began
recommending in this section and in the Rapid Response section
beginning in April, 2020. For too many months the experts were not "following the science". For more on this you might Google "COVID-19 and steroids". Be Alert. Beware.
Due
to the massive and increasing amount of News (Real, not Fake) now being
generated, largely based upon the Pandemic and by the imminent
departure of President Trump, I will try to offer important issues in
the most cryptic form. My common sources continue to be the WSJ, The
Day, http://www.ctmirror.com, yahoo,com, and my e-mail deliveries from
various sources.
Good News about Cancer.
The overall mortality rate from cancer of all kinds is declining. But
the rate of Breast cancers may be increasing, related to the declining
number of women bearing an sucking children.
About COVID-19 VACCINES.
Making the Perfect the enemy of the Good. Thanks to the habits and
goals of bureaucrats, millions of doses of the vaccines are going
unused or discarded. At one point recently, 14 million doses were
available while only 4 million doses had bee administered. Even health
care personnel are avoiding taking the vaccine, as in one hospital
where only 28% of them had been vaccinated! CRAZY. And regarding
available treatments, many doses of monoclonal antibodies are going
unused despite good evidence of their effectiveness - because they have
not yet been subject to "double-blind cross-over studies. Also CRAZY.
And regarding persons with "Allergies", only those who have reason to
carry Epi-Pens should delay for a few months until more information is
available. All others should be vaccinated asap.
Did President Trump "Incite to Riot?"
The recent articles by Alan Calandro in ctmirror.com and by Lee Elci in
The Day are instructive. It is also interesting that in both cases the
authors, from the Left and the Right, move somewhat to the Center in
their approaches. Can there be Hope? And for both, the answer is "NO".
To paraphrase and update a famous quotation: "I knew Reagan. And Biden, you're not Reagan, a Uniter".
Here are two useful and practical guides to dealing with the Virus, for prevention and for treatment.
1) the article by Lauren Gray in yahoo.com, January 9, 2021 on
"...Popular Face Coverings...."; and 2) "What to do if....", by a COVID
victim - Dr. Nkelruka Orajlaka in yahoo.com, January 8, 2021.
"Lamont vs. New London", by David Collins, in The Day January 14, 2021. What a Shame for all involved.
As for Governor Lamont, and recalling "The Wizard of Oz", he needs a
new Heart. As for the leaders of New London, they need new Guts.
GS - - - - -
- - - - - -
- - - - - - - - - HERE, THE MOST RECENT EXAMPLE OF THE POLITICS OF COVID-19 "SCIENCE". This
proposal, to "delay" administering the second dose of the vaccine,
generally called the Immunizing dose as being the effective one in
immunizations, is all politics and no science.. Shameful - especially by those saying "follow the science".
MORE ABOUT THE COVID-19 PANDEMIC: "ON THE OTHER HAND..."
See the article by Scott W. Atlas, M.D. entitled: "A Pandemic Of Misinformation", (in WSJ December 22, 2020, Opinion, pA17). In
view of the prostitution of the mainstream media during the last five
years, including as we are urged to "follow the Science", my life-long
advice to myself and to anyone else ("cross-read" different sources for
important topics), following the Science and "science" is now much more
difficult and hazardous.
NOW HEAR THIS! HIGH
BLOOD PRESSURE IS ONE OF THE MOST POORLY CONTROLLED ILLNESSES, BY
PHYSICIANS AND BY PATIENTS, DESPITE THE AVAILABILITY OF EXCELLENT
MEDICATIONS FOR LONG-TERM USE.
BEWARE! YOUR FUTURE WELLNESS OR DISABILITY IS IN YOUR HANDS.
- - - - -
- - - - - -
- - - - - - - - - EXCELLENT ANALYSIS OF THE CAREFULLY CONSTRUCTED MESS CALLED "HEALTH CARE".
This
has been obvious for decades. See my numerous commentaries since the
early 1980's (and perhaps earlier - check it out) on this web site and
posted in the local newspaper. A logical mechanism to achieve this
approach - the Health Savings Account - was suppressed in its crib and
since then by the people who have financially benefited most by such
actions. And that does Not include most physicians.
GS
Nothing will change unTIL healthcare is treated for what it is: a commodity.
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- - - - - -
- - - - - - - - - This is a useful article. But
its Pulmonologist contributors continue to suffer - with their patients
- from the same chronic myopia that they have been subject to
since at least the 1960's, when they had an inferiority complex vs.
their English colleagues. That was all the more trend - setting since
those English doctors had and implemented a vendetta against Allergists
in their country...considered competitors by them. Throughout all
the decades since then, during which time I have been a prime witness
while practising Allergy and Chest Diseases, Pulmonologists have been
studiously avoiding any recognition of the central role played by
respiratory allergies - in the form of co-existent Bronchial Asthma -
in at least 30% of their "COPD" patients. That is a term that I do Not
use, in preference to making a Diagnosis of Chronic Bronchitis with or
without Bronchial Asthma and several other illnesses often buried
within the rubric "COPD". The result: their patients too often are
prevented from receiving treatment for the most treatable and often
reversible of their combined conditions. That is a shame. Of
course, after having had me in their midst for 56 years, some of our
regional pulmonologists - but not all - have seen the light. Thank you
for that.
Rapid Response for TUESDAY through FRIDAY, November 17 through 20,
2020
MORE ON NEW INSIGHTS ABOUT COVID-19 PANDEMIC.
1) This article is actually worth studying. It's all about the Central Role of the Immune System - for good and for ill. "'Breakthrough Finding' Reveals Why Certain COVID Patients Die", by Liz Szabo (Kaiser Health News, November 15, 2020). It would have been better for the experts to have realized that in March instead of in July. 2) "How South Korea Avoided A COVID-19 Lockdown",
by Molly Walker, MedPage Today, November 15, 2020. They started much
earlier than did the Western world. And they have a much more compliant
populace. In any case: Good For Them. 3) By contrast, see: "Op-Ed: The Grand Failure Of Managing The COVID Cases",
by Aronoff and Milstein ( MedPage Today, November 15, 2020). They decry
the lack of Central Planning (aka Socialism) vs the Individual
Responsibility and Regionalism that is this country - and that
identified this administration's massive and largely effective approach
to this moving target. "Never Trumpers" never give up. More about that
in another coming RR. 4) And then there is this: "In Health Care, When Is Enough, Enough?", by Rebecca Pieper Esposito, RN (in ctmirror.org, November 19, 2020). Excellent and right on point.
GS
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Rapid Response for SUNDAY, November 8,
2020
LET'S TALK ABOUT OUR CURRENT KNOWLEDGE OF THE COVID-19 PANDEMIC. You can follow all of this in Real Time via the Rapid Response reports which I have posted since late Winter of this year.
1)
"In The Beginning", December 2019 - March 2020, little was known -
except for some Fake News from China, from the World Health
Organization, and from craven politicians like Clinton and Biden while
President Trump took some wise and decisive actions. 2) Whether
from the medical people or from the scientists or from the scientist /
politicians, what we began getting were educated guesses, just-plain
guesses and "projections". Many turned out to be wrong, facilitated by
the traditional worship of too many "experts" at the altar of the
"double-blind / cross-over study" to the exclusion of careful
observation at the bedside, long clinical experience and just plain
common sense. Meanwhile, President Trump successfully mobilized a
massive Public / Private effort, truly a War Effort, to provide needed
medical supplies and hospital beds. 3) Of course, by that time the
entire matter was already politicized during the most consequential
national election year in decades. 4) Quite late, the experts
began to "see the light" - highlighted by their "discovery" of the
effectiveness of Dexamethasone, aka Adrenocorticosteroids - which I had
been yelling / writing about since early April. Check it out. 5)
Beginning quite early in this effort, there became obvious a debate
between "fighting the virus" at All Costs through various forms of
isolation and quarantine vs. fighting the virus through common sense
methods while avoiding the destruction of our national and Personal
economy. That tension continues, partly on valid grounds - but mainly
on the nearly total politicization of the issues. What A Shame that the
Democrats and the Never Trumpers and the Trump Derangement Syndrome
victims thereby have caused tens of thousands of unnecessary deaths -
from the disease and from the "treatment".
But now there is new and documented information on which to base personal and State and National decisions.
a) The delayed but now implemented treatment modalities Work, producing a fatality rate (ie. dying From, not dying With Covid-19) of 0.06%!! b) Active Immunity resulting from having had the infection does produce lasting personal protection. c) Passive Immunity - resulting antibodies - can be effective as a treatment modality for others. d)
The coming vaccines, coming soon, will be effective - they drawing upon
experience derived from vaccine formulation for earlier other Corona
viruses. e) Well over 98% of persons who are infected with the virus remain asymptomatic(!).
NOW HEAR THIS. Use
Common Sense: Social Distancing (6+feet); an effective Mask when that
is not possible or when in doubt; effective Hand Washing frequently; and
AVOID CROWDS!!! For, given the immaturity and self-centeredness of so
many of the recent generations - you will always find some of them in
crowds. The Rest is Politics.
GS
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Rapid Response for SUNDAY, November 1,
2020
IMPORTANT INFORMATION REGARDING TESTING FOR COVID-19 - AND RECOMMENDED ASSOCIATED ACTIONS.
These four authoritative articles are too lengthy to reproduce here - but are posted IN TOTO in the "Health Alerts" section of this web site. THIS IS NOT ONLY FOR MEDICAL AND SCIENTIFIC PERSONNEL, BUT FOR ALL OF US.
Remember:
We all have to live with this challenge for a long time, following
common sense instructions. And yes, a few of us will die. But the vast
majority of us know that's NOT THE END. I'm very sorry for those who
don't - or won't - believe that.
1) Aspirin is an ANTI-INFLAMMATORY. The Inflammatory part of the Immune System is excessively active during anything but a mild COVID-19 case! I have been stating this since March in this section. It should not have been rocket science. It
took four months for the scientists and academicians to come to this
realization and to recommend Dexamethasone - a Steroid and an
anti-inflammatory for "cytokine storm". Then came the "need" for
Double-Blind/ Cross-Over studies to "confirm". Must the use of aspirin go through the same labyrinth while patients suffer and die?. "Follow the Science"...but beware myopic scientists.
Rapid Response for MONDAY and TUESDAY, October 19 and 20,
2020
"COVID-19, SEPSIS, STEROIDS..." Academicians still looking for "acceptable evidence" (ie. double-blind, crossover studies, their gold standard). I
hope that experienced clinicians at the bedside have not still been
waiting for this before acting. For it would have cost more lives. See
my statements on the subject beginning in late March in this section
about inflammatory overdrive, cytokine storm, sepsis - and Steroid use.
This is how Science at times can get in the way of education,
training, experience - and common sense in the treatment of our
patients.
This
article describes 5 important insights and treatments for COVID-19
which I have been reporting about on this RR site since they each
became known beginning in March. Particularly the "cytokine storm" and
its treatment should have been an early no-brainer.
That's why
panic and anxiety should have no place as we go forward living with
this challenge for many months to come. Will we all survive? Probably
not. But everything in life is a Risk-To-Benefit analysis. So USE
COMMON SENSE: social distancing; an effective mask when that is not
possible; hand washing; and Avoiding Large Gatherings...where there
will always be some selfish idiots generally between the ages of teens
and thirties. Also, get your Flu shot; and reverse any poor life-style
habits which are much more likely to kill you prematurely. And "DON'T WORRY, BE HAPPY".
GS
Professor of Pharmacy at U of Toronto update on advances made to deal with COVID-19
A professor of Pharmacy at U of Toronto sent this clearly worded update to his family. For
this pandemic there’s a greater chance of survival for those getting
infected 3 months later like June 2020 than those who got infected 3
months earlier say February 2020. The reason for this is that Doctors
and scientists know more about Covid-19 now than 3 months ago and hence
are able to treat patients better. I will list 5 important things that
we know now that we didn’t know in February 2020 for your
understanding.
1. COVID-19 was initially thought to cause
deaths due to pneumonia - a lung infection and so Ventilators were
thought to be the best way to treat sick patients who couldn’t breathe.
Now we are realizing that the virus causes blood clots in the blood
vessels of the lungs and other parts of the body and this causes the
reduced oxygenation . Now we know that just providing oxygen by
ventilators will not help but we have to prevent and dissolve the micro
clots in the lungs. This is why we are using drugs like Aspirin and
Heparin ( blood thinners that prevents clotting) as protocol in
treatment regimens in June 2020.
2. Previously patients used
to drop dead on the road or even before reaching a hospital due to
reduced oxygen in their blood - OXYGEN SATURATION. This was because of
HAPPY HYPOXIA where even though the oxygen saturation was gradually
reducing the COVID-19 patients did not have symptoms until it became
critically less, like sometimes even 70%. Normally we become breathless
if oxygen saturation reduces below 90%. This breathlessness is not
triggered in Covid patients and so we were getting the sick patients
very late to the hospitals in February 2020. Now since knowing about
happy hypoxia we are monitoring oxygen saturation of all Covid patients
with a simple home use pulse oximeter and getting them to hospital if
their oxygen saturation drops to 93% or less. This gives more time for
doctors to correct the oxygen deficiency in the blood and a better
survival chance in June 2020.
3. We did not have drugs to
fight the corona virus in February 2020. We were only treating the
complications caused by it... hypoxia. Hence most patients became
severely infected. Now we have 2 important medicines FAVIPIRAVIR &
REMDESIVIR ... These are ANTIVIRALS that can kill the corona virus. By
using these two medicines we can prevent patients from becoming
severely infected and therefore cure them BEFORE THEY GO TO HYPOXIA.
This knowledge we have in JUNE 2020... not in February 2020.
4.
Many Covid-19 patients die not just because of the virus but also due
the patient’s own immune system responding in an exaggerated manner
called CYTOKINE STORM. This stormy strong immune response not only
kills the virus but also kills the patients. In February 2020 we didn’t
know how to prevent it from happening. Now in June 2020, we know that
easily available medicines called Steroids, that doctors around the
world have been using for almost 80 years can be used to prevent the
cytokine storm in some patients.
5. Now we also know that
people with hypoxia became better just by making them lie down on their
belly - known as prone position. Apart from this a few days ago Israeli
scientists have discovered that a chemical known as Alpha Defensin
produced by the patients White blood cells can cause the micro clots in
blood vessels of the lungs and this could possibly be prevented by a
drug called Colchicine used over many decades in the treatment of Gout.
So now we know for sure that patients have a better chance at surviving
the COVID-19 infection in June 2020 than in February 2020, for sure.
Going
forward there’s nothing to panic about Covid-19 if we remember that a
person who gets infected later has a better chance at survival than one
who got infected early.
Let’s continue to follow precautions, wear masks and practice social distancing.
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Rapid Response for SUNDAY, September 27,
2020
AND, WITH REGARD TO "CYTOKINE STORM" AND ADRENOCORTICOIDS IN COVID-19 DISEASE, permit me to say: I TOLD YOU SO!
STATISTICS HAS NEVER BEEN MY STRONG POINT. But this article is sobering - although the title seems hyperbolic.
See: "COVID-19 More Deadly Than Cancer Itself?" (in www.medpagetoday.com/hematologyoncology)
There are several messages here, all of which should be obvious. 1)
"Straighten up and fly right", so you won't get or worsen all those
"life-style" related "comorbidities" that represent 50% of all
illnesses. 2) Follow medical advice and instructions, especially during these difficult times when adherence is difficult but vital. 3) Don't catch Covid-19! Follow the common sense precautions; don't be STUPID. 4) If you consider yourself to be within one of the groups studied, DON'T
PANIC! Work The Problem. And wait for the next Study that
Clarifies this one. There will surely be one. There always is.
GS - - - - -
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- - - - - - - - -
"IS ANYBODY THERE? DOES ANYBODY CARE?" You had better care...smokers and relatives of smokers alike.
GS
There's No Safe Way to Smoke By Dr. Mehmet Oz and Dr. Mike Roizen, MDs
When
Gomez (John Astin) and Morticia (Caroline Jones) Addams settled in for
a shared hookah session in the 1965 "The Addams Family Meets the
Undercover Man" episode of their TV show, it seemed exotic and daring.
Fifty-five
years later, hookah/waterpipe smoking has become all too common. One
2013 study published in the British Medical Journal found that half of
younger Americans ages 18 to 30 got their tobacco smoke through hookahs.
But that's no way to dodge the dangers of smoking.
For
the first time, a study has evaluated the relative risks of developing
chronic obstructive pulmonary disease (COPD) and lung cancer from
smoking tobacco cigarettes, e-cigarettes, and hookahs. The findings
took our breath away.
The research,
published in the European Heart Journal, found that compared with
nonsmokers, tobacco cigarettes increased the risk of COPD by 704%,
waterpipes by 218%, and e-cigarettes by 194%.
When
it came to lung cancer, tobacco cigarettes blew up the risk by an
astounding 1,210% and waterpipes increased the risk of lung cancer by
122%.
Then there's the finding,
published recently in Nicotine & Tobacco Research, that if you get
COVID-19 and are a smoker, it nearly doubles your risk of progression
to serious complications.
Clearly, there's no way to get around the dangers of smoking tobacco.
But
you can successfully quit. There are a multitude of resources online,
including through the Centers for Disease Control and Prevention and
Dr. Mike’s Cleveland Clinic. Check them out today and breathe easier
for a lifetime.
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Rapid Response for THURSDAY and FRIDAY, July 16 and 17,
2020
WE SHOULD ALL STAY UP-TO-DATE REGARDING OUR OWN MEDICAL CARE... in
a health care delivery environment that now requires each of us to be
our own Advocate - or to have an effective Advocate - who will "rattle
the cage" when necessary. Another article on point: "Slow
Medicine: COVID -19 Exposes What's Wrong With U.S.Healthcare.", by
Michael Hochman, M.D., MPH (in medpagetoday.com,July 6, 2020). Message:
Less is More.
Rapid Response for THURSDAY
and FRIDAY,
April 16 and 17,
2020
MORE ON CORONAVIRUS: MY OBSERVATIONS...
For at least the last
several weeks, I have been sharing my observations on this pandemic and
on the professional and public approaches to it. This is from the
vantage point of a life attentively lived since 1933 - and as a still
practising physician since 1957, in Allergy / Immunology and Chest
Diseases - and also in the Army Medical Corps in a General Hospital. I
report this simply to note that I am not a neophyte making these
observations. So now, let's begin with a review of the Stages of this Pandemic.
Stage
1 consisted of Rumors, partial information, withheld and false
information - from at least early December through January. By
that time, at least President Trump had enough information and insight
to close the American borders to Chinese travelers and then to others.
Stage
2, February, was a gathering storm wherein the Professional Advisors -
as distinguished from the Leaders - provided the history of past
pandemics and the Projections based upon that history and some Facts.
It soon became clear that the Advisors tended to project far into the
future, still based on then - limited Facts...and that they restricted
themselves exclusively to the public's medical needs without regard to
that same public's economic needs. That was probably as it should be.
Stage
3. But there was another story to be told, equally important in the
long run, related to the survival of the same public / patient and of
the entire nation. As more Facts became available, the Projections
became more tenuous and less grave, without change in the approach of
the Professionals. That too was probably as it should be. But no one
should be surprised that those Leaders, charged with serious decision-
making should and would start taking charge. This is analogous to the
Military structure, with the Leaders / Commanders and then with the
Service personnel who Advise but who Do Not Lead.
Stage 4 is
therefore where we are now, where it is clearly inappropriate for the
Professionals to insist on the Medical needs of the patient in their
beds and who resist consideration for the patient on Main Street trying
to feed his or family. It is all the more inappropriate when the
treating Professionals have begun to have serious misgivings regarding
HOW TO TREAT THEIR PATIENTS: Is the pathophysiology of this new
virus infection one of direct invasion or rather one triggering that
blunt weapon of the Immune System called the Inflammatory System. The
treatment would be largely different. Does the ventilator help or
harm? Should the patient's position be supine or prone? Is Oxygen
deprivation the real issue? Has Hypercoagulation been missed? Should
Steroids be a basic part of treatment instead of being maligned? So, the Professionals have enough to do without arguing with the policy-makers dealing with the other patient on Main Street. Here, an interesting report notes that "Dr. OZ Apologizes for Saying Schools Should Reopen Because 'Only 2 to 3 Percent More People Could Die",
(in http://www.yahoo.com/entertainment, April 17, 2020). Once this
Professional decided to comment on Policy, he should not have
apologized. He was rightly reflecting the Fact that - in a crisis
situation - the concept of Triage is basic to planning and to
implementation.
Therefore, what is needed now, in addition to the best
medical care for the greatest number, is a Sense of Proportion, Reason,
Common Sense by the LEADERS, and a healthy regard for Freedom and
Liberty on the part of each of us individual citizens.
What we all are going through should be a humbling experience for all of us: individuals,
professionals, politicians, clergy - all of us. For despite our
education, training and experience through the ages, we know very
little about what is happening to us from this pandemic. "Should be..." is the operative phrase. But is it? Or are we, each of us blindfolded, describing the proverbial Elephant based upon which part of that animal we feel? And are we bravely declaring our "treatments" solely on that basis?
As
individuals, we try to rely on the "experts" and on our leaders. But at
some point, since we are free citizens and since Everything in life is
a "Risk-To-Benefit" analysis, we must make our own choices for
ourselves. Here I refer to a choice between optimal physical health and necessary economic health...between social distancing and work.
As professionals, we must decide how much to base our professional actions on the available Facts, or whether we rely on Projections for far-reaching decisions. Whether it is the pronouncements of the Epidemiologists,
based too often on Projections before the availability of Facts,
extending far into the Future, or whether it is the treatment protocols
of Practicing Physicians -
based upon what they actually know and too little on what they do not
know (eg. the so far unknown pathophysiology of the Coronavirus - and
whether ventilators are actually helpful or harmful), or whether it is
the eternal struggle of Politicians between being helpful vs. self-help, or whether it is the inclination of Clergy to be esoteric vs. down-to-earth useful, a Lot Of Humility is needed at this time. We Need More Than We Are Getting!
And
in the process, Trial and Error - and risking being Wrong - is not only
OK...it is Absolutely Necessary. That is the only way to achieve Truth,
even at the expense of Lives and Reputations and Careers, while
Individuals - you and I - make our own trials and errors, and live or
die by them. That is the greatest Freedom and the most Responsible Action.
SO, LET'S GET OUT OF OUR FUNK AND ENGAGE THIS CHALLENGE.
GS
RR#3
HERE IS AN EXAMPLE OF PRACTICING PHYSICIANS DOING WHAT THEY KNOW - AND NOT REALIZING WHAT THEY DON'T KNOW. In this case, however, they should know or at least suspect, as I indicated weeks ago in this section. The Inflammatory System, an integral part of our Immune System, is a BLUNT INSTRUMENT, too often inclined to over-react to a serious threat - and ending up killing the host before the threat does. That is called "Sepsis" or "Septic Shock". That
is what is what I believe - based on education, training and
experience, is happening here to the sicker patients with Coveravirus. What to do? Treat Septic Shock...AND USE ADEQUATE AMOUNTS OF ADRENOCORTICOSTEROIDS! Still
reluctant? A big mistake for you, the physician...and Lethal for your
patient. Call it "Trial and Error" if you will. But it is based on
solid physiology and pathophysiology. And the stakes could not be
higher for your patient.
Rapid Response for TUESDAY through FRIDAY,
March 17 through 20,
2020
ON THE CORONAVIRUS PANDEMIC. Until
further notice, I will be restricting my RR comments and references to
this subject. Please review rrelated comments already posted throughout
this month.
1) "What To Do If You Have Covid-19", by Ana Radelat (in The Day, March 20, 2020). As is nearly always the case from this journalist for CTMirror.Org, this is informative and useful. 2) The following is a helpful Editorial in The Day (March 18, 2020): "Beware Simple Solutions To Complex Health And Economic Crisis". But
then The Day published an article out of the Mercury News of San Jose,
California: "Test Kits Debacle" (March 17, 2020). Thanks for Nothing. 3) "Ethicists Agree On Who Gets Treated First When Hospitals Are Overwhelmed By Coronavirus", by Olivia Goldhill (in Quartz: qz.com, March 19, 2020). Read it and understand that choices and decisions may have to be made, called "Triage"...as in military circumstances. 4)
The following type of articles are the opposite of Helpful: they can be
harmful. They are totally speculative, especially as regards America in
relation to the rest of the world. And they can easily promote Panic,
often followed by dismissal of the entire matter. Just Human Nature. "Covid-19: How Many People Will Die?" (in mdlinx.com/internal medicine, March 19, 2020) 5) And then there is this; why am I not surprised? "US Officials: Foreign Disinformation Stoking Virus Fears", by Miller and Long, Associated Press, March 16, 2020.
If you are reading this, CONGRATULATIONS! I
have been sharing a vast amount of information and commentary with the
public for decades via this web site (asthma.drsprecace.com).
Furthermore,
my medical practice in Allergy / Chest Diseases, including Coordination
of Care, continues without interruption and with a few appropriate
modifications due to the current situation.
At
this point, here are some personal observations / "guesses" that I have
developed based upon: a) the typical 'hair-on-fire" reportage from the
media; b) the early and continued efforts of the World Health
Organization to plant the current American experience squarely into
that of the World; c) the weaponization of the entire story here for
partisan gain; d) the belief that nothing emanating from China can be
accepted at face value.
A) Even on a good day, very scarce any more, the mainstream media promotes high anxiety and panic - it sells; B
) These two words expressed by President Trump in his recent address to
the nation were right on point:"...foreign virus...." What is
happening in America is a far cry from what is happening in the rest of
the world. There are several reasons for this, including the early
action taken here to exclude Chinese travelers from entering this
country. That is and was impossible for all of Europe and Eurasia,
invaded by millions of migrants - many from the Middle East and from
Africa, episodic hot-beds for viruses like MERS and EBOlA. C) The well-established disease called "Trump Derangement Syndrome" is poised in this election year to break out into an even more virulent form. D)
Although some of the actions being taken on Wall Street and Main Street
are prudent, I suspect that "when the smoke clears" we will have a lot
to regret. E) Imagine if last Fall we were suddenly told that "the
new URI Virus" was breaking out through the country and the world, and
that millions of people were coming down with it - with some actually
dying from it. "URI=Upper respiratory infection", otherwise known as the "common cold". I am not making light of this. But folks, Get A Grip!
Ultimately my only advice is: USE COMMON SENSE!
GS - - - - -
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Rapid Resposne for SATURDAY and SUNDAY, March 7 and 8,
2020
THIS INFORMATION WAS ALSO THE SUBJECT OF A REPORT BY TUCKER CARLSON ON FOX RECENTLY. In how many ways is America vulnerable, thanks to our SWAMP?
Well, here's your answer as far as Diets are concerned. Also, visit our diet and nutrition web site, currently under re-construction: www.medidietresources.com.
Practising Without A Medical Licence! "Wake up America. Insurance Companies Prescribe Your Medications", by Christine Alexandra Bottone, (in ctmirror.org, Feb 22, 2020). No hyperbole: THE GOD'S HONEST TRUTH. Read it'. Weep. And then get Angry and Motivated.
And the Last Stop Is Nowhere In Sight.
GS - - - - -
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Rapid Response for SUNDAY, February 9,
2020
THE "ANTI-VAX MOVEMENT", IN ALL OF ITS MANIFESTATIONS, is much more dangerous than events like Zika and Coronavirus. WAKE UP. AMERICA.
SO YOU WANT TO PAY LESS FOR HEALTH INSURANCE...AND HEALTH?
Now, this is something you should Really Get "Woke" On".
1)
Good Health is your responsibility. Start by "picking the right
parents"...and being the right parents. Choose your mates wisely.
Genetics Counts! 2) At least 50% of illness and health care delivery
is Life-Style related: Obesity, excess alcohol use, smoking, illicit
drugs, sexually transmitted diseases, avoidable stressors, avoidable
adverse occupational exposures.... If that's you, live and die with
it...and don't expect me to pay for it. 3) Don't go to your doctor
with a "national lottery" mentality. Medical Mal-practice is a growth
industry for lawyers, not for doctors. Most adverse outcomes are not
the result of negligence - and don't lead to wins in MM suits. But
that's why over 25% of health care costs are related to "defensive
medicine": physicians and other "providers" trying to protect
themselves by over-testing and over-treating. 4) The "Medical -
Industrial Complex" is massive and growing, consisting of health care
insurers, the hospital industry, the pharmaceutical industry - and your
Government / legislators beholden to all kinds of pay-backs. The
higher the costs, the higher the profits. You the patient, and now the
physicians who are becoming mere widgets in the system, are the fodder.
That's the diagnosis. What is the Treatment?
A) Be aware
of your genetic background, your heredity. Learn from it and adjust
your life and actions accordingly. As an example,women with a family
history of breast cancer should know about their Brac 1 and 2 status. B) Live a prudent life-style. It's easy, safe, responsible and reassuring. C)
Although it is becoming much more difficult, search for and select a
good doctor who can also be a good friend - for life. There are still
some out there, although they are ever dealing with M Outrage at
the stupid, unfair and cynical conditions under which they increasingly
have to operate - even the private practitioners who are still out
there literally fighting on your behalf. D) Be a Knowledgeable
Advocate for yourself - or have one with you at all health care
encounters - especially in hospital ER's or as in-patients. It's a
jungle out there. Ask questions. Demand answers that you can
understand. Rattle the Cage. The time is long gone when you could
"don't just do something; lie there". And demand effective changes in health care costs: Health Savings Accounts that force you to Think about what costs you are incurring. Self-Insure prudently. Government
Negotiations with pharmaceutical companies regarding drug prices -
something that your legislators made it UNLAWFUL for them to do in the
Medicare Act of 2002! I wonder why. And don't expect prior medical problems that are the direct result of irresponsible personal Life-Style to be covered by prospective health insurance policies.
ARE YOU "WOKE" NOW?
GS - - - - - - - - - - - - - - - - - - - -
Rapid Response forTUESDAY and WEDNESDAY,
January 21 and 22,
2020
ONE WAY TO "MAXIMIZE EHR USE": Don't us it. Employ registered nurses and para - professionals and "scriveners"... and pay the fine for EHR non-use... and get back to your trusting patients. Only individual physicians can solve their individual problems, individually.
IN THE CARE OF PATIENTS, DIAGNOSIS IS KEY, TRUMPED ONLY BY CARING. That has been my medical mantra from the outset. That is why I chose the specialty of Internal Medicine. And that is why, 62 years later, I am still looking for the right "key". I'll continue practising until I get it right.
Rapid Response for FRIDAY and SATURDAY, January 17 and 18,
2020
SAD, AND TRUE. What is also true is that physicians and nurses allowed themselves to be compromised all too easily into this siren-song of IT. And MD and RN professional organizations quickly became part of the problem - and profit from it.
THOSE OF US WITH ITALIAN OR OTHER MEDITERRANEAN HERITAGE HAVE BEEN LIVING THIS ALL OF OUR LIVES. Please see my web-site, posted for many years and currently under revision: medidietresourses.com.
MANGIA, MANGIA, MANGIA.
"'TIS A TALE AS TOLD BY AN IDIOT, FULL OF SOUND AND FURY... SIGNIFYING NOTHING".
Is
that what the incessant discussions on Health Care delivery and cost
will be? It will certainly be a prime subject of debate during this
2020 election year. Having been a practising physician for over 62
years and an attorney specializing in Health Law for nearly 36 years, I
have some thoughts on the subject...which I have been sharing on this
web site and elsewhere for decades. See my most recent offering recently posted as a Rapid Response. See also the following articles appearing elsewhere:
"HOW THE GOP CAN WIN ON HEALTH CARE", by Bobby Jindal ( in WSJ January 3, 2020, Opinion);
"NURSES IN AMERICA 'ARE EXPERIENCING HIGH RATES OF BURNOUT'", by Adriana Belmonte (in Yahoo Money, January 2, 2020);
"WHY 'BURNOUT' IS THE WRONG TERM FOR PHYSICIAN SUFFERING", by Wendy Dean et al,(in Medscape Business of Medicine, July 2019);
"DISAPPOINTED
DOCS SAY: MIPS IS NOT WORTH IT", by Elizabeth Woodcock (ibid, August
2019) - (MIPS is "Merit-Based Incentive Payment System")
A
recent article reported that , in a constant effort of hospitals to
monetize EVERYTHING, they were considering CHARGING FOR THE ROOM AIR A
PATIENT BREATHES! Look it up. I read it.
ONCE AGAIN, WITH FEELING:
Physicians,
historically the "Captains" of the health care ship and protectors of
their patients' interests, have been intentionally marginalized - now
widgets in the Medical - Industrial Complex. The too-patient patients have been anesthetized to the current personal and financial brutality. A not-so-patient public is the Only body with the power to effect change. As Bobby Jindal ends his article: "The best way to prevent a government-run health system is to offer solutions that lower prices based on competition and transparency." (Emphasis added).
Rapid Response for WEDNESDAY and THURSDAY,
December 25 and 26,
2019
ALTHOUGH I CONSIDER ALL OF MY RAPID RESPONSE OFFERINGS TO BE A PUBLIC SERVICE, this one really is.
Netflix offers a good scientific study of the effects of ALCOHOL INTAKE. The following are the take-away findings.
Individual
tolerance for alcohol varies among individuals. The important variable
is the body content of water. The greater the body mass - and
especially of muscle mass as distinguished from fat, the greater the
tolerance. Also, be well-hydrated if planning to consume alcohol.
Having food in the stomach increases tolerance by delaying absorption, since alcohol is metabolized in the small intestine.
Alcohol
intake increases appetite and thus increases calorie intake in addition
to the substantial calorie content of the beverage itself.
Alcohol intake adversely affects quality of sleep, The second half of a night's sleep is especially disrupted. This is increasingly true as we age.
80% of drinkers will get a hangover. This effect is mediated by an inflammatory process. A fried meat and vegetable meal, with or without an NSAID, can be helpful.
Alcoholic
beverages vary in problematic components other than the alcohol
content. The darker the beverage, the greater of these components.
Thus, lighter - colored beverages are better, especially vodka.
More recent studies have shown that alcohol in any quantity is a potential carcinogen, involving several different cancers - especially breast cancer.
Most things in life involve a Risk To Benefit analysis. Having the facts helps.
GS - - - - -
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Rapid Response for SATURDAY, December 7,
2019
READ THIS! THE LIVELIHOOD AND LIFE YOU SAVE MAY BE YOUR OWN. The
Health Care delivery system has become a largely Wall Street profit
driven business. There is no "win-win". There is only "win-lose", as
usual with the business types. And the doctors and most other health
care providers have become powerless widgets in the system despite
their best efforts to protect their patients. In fact, in decades-ago
better years those physician efforts to shield their patients from the
progressive pain of revolutionary changes is part of the reason why
we're all here. Physicians, individual and "organized", have never
had power or influence over the business and political types. They
tried to "go along to get along", to have a place "at the table".
Instead, they have been relegated under the table. Only the patient /
public, individual and organized, have had potential massive power. But
they never used it. Now the only way to survive a trip into the
health care system is to be your own advocate or to have a personal
advocate: to question, to demand answers, and to demand personal,
efficient and cost-effective attention - to RATTLE THE CAGE!
Especially if your doctor is an employee of the hospital or other large
health care service, he or she is IMPOTENT to serve, to protect and
defend you in your time of need. And that is the reason for the
galloping "burnout". It's not burnout at all for these people who
survived a crucible of heat and pressure in becoming health care
"providers". The reason is MORAL INJURY. NOW YOU, THE PATIENTS,
HAVE TO HELP THEM - with your voices, with your demands, with your
feet, with your political "representatives". No More "Mr. Nice-Guy". Your personal welfare - and your life - depend on it.
DO YOU WANT TO LIVE TO 100? Then check out Dan Buettner and the "Blue Zone" on google. It rings very true. But first you should want to live to 100.
GS
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FOR THOSE INTERESTED IN "ALTERNATIVE AND COMPLEMENTARY MEDICINE", this article seems reliable and useful. "Aye, and there's the rub". Much information on these subjects falls into the category of "urban legends".
GS
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Rapid Response for FRIDAY, November 29,
2019
HERE IS VALUABLE MEDICAL INFORMATION THAT WE ALL SHOULD BE AWARE OF, AT PRACTICALLY ANY AGE. See: "What Science Tells us About Preventing Dementia", by Anne Tergesen (in WSJ Journal Report - Encore, Mov. 18, 2019,pR1).
GS - - - - -
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Rapid Response for THURSDAY, November 28,
2019
WHILE THE DEMOCRATIC CANDIDATES ARE OFFERING OUT-OF-MIND HEALTH CARE IDEAS, WHAT'S WRONG WITH THIS? NOTHING! FINALLY BRINGING THE CONSUMER BACK INTO THE NEGOTIATION. See: "Trump's Big Health Care Win", by Neeraj Sood (in The National Interest).
GS - - - - -
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- - - - - - - - - WE HAVE BEEN WAITING FOR THIS FOR QUITE A WHILEGS
THIS IS WHAT HAPPENS WHEN "PATIENT SATISFACTION" COMMANDS AN OUTSIZED
PERCENTAGE (EG. 30%) OF THE OVERALL SCORE FOR "HEALTH CARE QUALITY"
RANKINGS - ON WHICH REIMBURSEMENT IS BASED. STUPID!
APART FROM WASHINGTON, HERE IS SOMETHING ELSE INFURIATING. See: "Symposium: Solving America's Drug Pricing Problem" (in The Journal of Legal Medicine, April - June, 2019). No, you won't find a solution there...but you will find some of the elements of causation. Stay Well.
GS
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Rapid Response for SUNDAY,
October 13,
2019
"MORAL INJURY". EXACTLY THE RIGHT TERM FOR WHAT'S AILING PHYSICIANS.
Interesting information, as is much that is written about Bronchial Asthma. But there are three important issues that are being missed by most physicians and most commentators: 1)
the central importance of a carefully taken medical and allergy
history, by a certified Allergist or by a trained and motivated health
care provider. This would most often lead to complete diagnosis and a
treatment program that should include Allergy Immunotherapy for those
allergens that cannot be avoided. 2) the uselessness of the
"diagnosis" of COPD, actually a waste-basket for undiagnosed components
of Obstructive Airway Diseases: Bronchial Asthma, Chronic Bronchitis
and other consequences of personal and occupational life. 3) the
proper and experienced use of oral corticosteroids, both tablet and
inhaled, often used with a "all or nothing at all" approach. 4) the utility of biologics in selected cases - but not nearly as important as the above.
That approach will get our asthmatics better and keep them better.
EDITED
VERSION, although I'm not sure why you want to post it. Most people are
frightened of supplements, and do what their doctor tells them to do.
---------------------------------------------- All
I had to do was read the first two sentences to suspect that Kevin
Campbell, M.D. is a shill for Big Pharma. Or, he is one of the many
medical practitioners who remain safely entrenched in the comfort zone
that conventional medical training continues to place physicians in. I
read further, only to be convinced of this notion. The line in the
second paragraph about FDA-approved drugs being tested until they're
safe was a good belly laugh.
Given the doctor's claim that the
vetting process for supplements is diametrically opposed to that of
pharmaceuticals, I guess we can all let out a giant sigh of relief
considering that not a week goes by that we don't hear about one or
more people being severely injured or killed by an 'FDA-approved',
'painstakingly tested' pharmaceutical. Tell me, would you rather try a
lifestyle/diet change (or experimentation with various natural
supplements) to mitigate your psoriasis, or regularly ingest an
'FDA-approved' pharmaceutical that "solves" the problem of an
overactive immune system by . . . crushing it to the point where
disclaimers of potential cancer and TB are required? Don't go on that
3rd-world vacation with this drug in your system; you may not come back
alive.
Given the rash of morbidly-obese people in the late 1980s
who ingested phen-fen at a rate many times what was recommended
(subsequently experiencing a virtually exploding heart), properly
researched and dispensed supplements are a good hedge on the all-too
human behavior of excess. 'If one pill does X, ten pills will be ten
times better, right?' Wrong. Multiply the effects of this dangerous,
often fatal mindset with pharmaceuticals whose potency can be hundreds
of times that of a supplement.
By the way, just because science
isolates a specifically efficacious compound in nature doesn't mean
that turbo-charging it is necessarily healthy. Ascorbic acid is great
for preventing rickets. However, the half-dozen other bioflavinoids in
citrus fruits are physiologically required for Vitamin C to properly do
its job. And, don't forget that if you megadose on Vitamin C, make sure
to keep up your magnesium intake, which then affects calcium.
Supplements can be misused just as pharmaceuticals can be. But, I'd
rather my kid fool around with a pop gun than a loaded .45.
Simply
put, "scientists" like this physician are often scared (sh)witless of
the effects of the "multi-billion-dollar" business of supplements on
their bottom line and very expensive careers. As the population ages in
the next few decades, Big Pharma is building to be a
multi-trillion-dollar business, pal.
Here's the deal: there are
definitely pharmaceuticals that no supplement can beat or even match.
But that has never been the argument. It has been the intellectually
dishonest argument that seemingly non-partisan professionals like this
guy try to push.
Supplements are most often about prevention as
well as maintenance of wellness. Name one of the many hundreds of
'FDA-approved' pharmaceuticals (in laughably record-time, I might add)
that is about prevention of disease. And, things like statins don't
count because diet, exercise, and/or supplements known as milk thistle
and guggul/gugulipid (in addition to others that a simple Google or
WebMD search will reveal) are just as effective at maintaining healthy
lipid metabolism without the dangerous side effects that 'FDA-approved'
pharmaceuticals note in their boilerplates that often read with the
comic tone of The Onion.
Were I one of the millions who
complains about the cost of healthcare in general and the cost of
prescriptions specifically (while doing little or nothing to live a
healthy lifestyle), I'd also be one of those who swallows every
pharmaceutical the conventional medical community pushes like the
latest street drug.
The point is that supplements (reputable,
pure supplements, not the trash sold at convenience stores) are the
modern equivalent of an apple a day. Consequently, they will continue
to be denigrated by mainstream medical practitioners and Big Pharma
because they are a threat to their biggest cash cow, massive human
ignorance and laziness.
As for the good doctor's final question
to the reader, "I ask you today, would you take a supplement?", my
answer is an emphatic, "With bells on."
- P
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Rapid Response for MONDAY through WEDNESDAY,
July 8 through 10,
2019
PARENTS, THIS IS SERIOUS. There
are too many sedentary, I-Phone addicted, overweight kids. Especially
with a family history of Diabetes, these are their prospects even
before they enter adulthood. Sad. This most be a Call To Action.
FOR THE GENERAL PUBLIC - AND ESPECIALLY FOR PHYSICIANS WHO ARE AT GREATER RISK - this should serve as an important warning about their vulnerable health in these very stressful times. There
are various kinds of stressors for all of us. But the worst is
RESENTMENT, a psychologic acid born of lack of control over one's life
and labors. That is the stressor that will result in cancer and sudden
death. Physicians were not self-selected to become impotent victims
of the world around them. They require significant Control over their
work in order to be effective, in their work and in their lives. Colleagues: If
I am describing you and your situation...get the hell out of there
while you still have your health, your family, your self-image, and
your effectiveness as a care-giver. The First Rule Service is Survival.
"MORALITY". REMEMBER THAT TERM? When
was the last time that you heard or read that concept mentioned in
journalism, in the media or in the tripe flowing out of Hollywood and
Washington like bilge water from a foundering vessel? And yet, there are two areas where we should still expect Morality to be the true compass directing their actions.
One
is Religion, specifically the Catholic Church for Catholics. We now
know the frayed status of that expectation. For an update on that
matter, see two articles recently published in the Washington Post
relating to the further reports of Archbishop Carlo Mario Vigano'.
The
other is the Medical Profession and allied health care professions.
Whereas we can all augment or even supplant the failings of our
religion with our own spirituality and morality, we cannot heal
ourselves from the illnesses that our bodies and minds are subject to.
But the effectiveness of those professions and of their practitioners
is under great and increasing challenge.
'CAVEAT EMPTOR'. The life you save may be your own.
GS - - - - -
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- - - - - - - - - TIME FOR A POTPOURRI OF MEDICAL NEWS OF DIRECT CLINICAL APPLICATION. Most
of these come from the Journal of Allergy and Clinical Immunology: In
Practice, particularly the May-June 2019 edition. These are bottom
lines. Look it up if you want more.
• Several
articles address the problem of aspirin and NSAID sensitivity,
manifesting either as hives or - much more seriously - as acute asthma.
The latter is called Samter Syndrome. The issue is important not only
for the possibility of a severe reaction, but also because successful
desensitization to aspirin would enable use by the patient, thereby
improving the asthma and/or nasal symptoms. Another article notes that
nasal / sinus surgery facilitates the possibility of aspirin
desensitization. • Beef Allergy, the "a-gal syndrome" recently described, can also involve products of porcine origin. •
An article on 275 cases of childhood anaphylaxis points to the severity
of these reactions, the requirement for epinephrine, and the frequent
need for multiple doses of epinephrine.It would appear that children
are usually treated better than adults, for whom the use of epinephrine
is often wrongly omitted. • Biologic Therapy,
building on the long-standing clinical appreciation that much disease
involves the Inflammation component of the Immune system, often a blunt
instrument, and on the extensive research into the many Interlukins (IL
1-50+) involved, has come into wide use. In the fields of Allergy,
Bronchial Asthma and Atopic Dermatitis, IL 4, 5, and13 are prominent
and are now targets of agents like Dupixent, Nucala and Fasenra. The
original Biologic in this area of clinical conditions, the anti-IgE
Xolair, has been in wide use for the last 10 years. All are appreciated
as needed additions to the armaments available to Allergists,
Dermatologists and Pulmonoligists
GS
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- - - - - - - - - CONFESSIONS (NOT MANY) AND CONCERNS (A LOT) OF AN “ANCIENT MARINER” (62+ YEARS). May 19, 2019 - GEORGE A. SPRECACE, M.D., J.D.
In
a large and long-standing medical practice of Allergy and Chest
Diseases, adult and pediatric, including about 70% Bronchial Asthma and
Chronic Bronchitis, a small minority are hyper-eosinophilic and a small
minority are oral steroid dependent. Of the several reasons for
that situation, the evaluation and treatment of allergies – including
allergy immunotherapy – is high on the list.
Why
are allergy evaluations and AI for this group of patients not well
promoted, even by certified Allergists? This is wrong and dumb.
And of course the relationship between Allergists and Pulmonologists
resembles a Kabuki Dance. The discovery of Xolair and its embrace by
Pulmonologists has finally been a boon to their long-suffering
asthmatics and some chronic bronchitics.
I
have long considered the role of Inflammation central in all manner of
disease states. But it is a blunt instrument in the Immune System,
easily capable of over-reacting, injuring or killing the patient before
the disease does. The discoveries of the Interleukins as mechanisms of
specific inflammation, followed by specific Biologics to counter their
action, have been a great boon to the understanding and to the
treatment of many diseases. Nevertheless, the threat of Sepsis must
always be kept in mind – and treated early and aggressively, including
with Steroids.
The
use of LABA medications, providing the body with constant effect of
beta agonists, is controversial. I do not use them, concerned about the
development of tolerance to these valuable medicines when really
needed. We all saw this in the past with the overuse of “rescue
inhalers”.
The
avoidance of serious acute episodes and hospitalizations requires close
follow-up, patient cooperation, aggressive treatment, and Physician
Availability at all times.
Low-dose
constant antibiotics during the Fall – Spring months for some patients
is very helpful. Incidentally: Z-PAC DOES NOT WORK FOR RESPIRATORY
TRACT INFECTIONS!
Notwithstanding
Pulmonologists’ embrace of COPD as a diagnosis, I consider it a failure
of diagnosis until the components of the disease process are defined:
inflammation (smoking, recurrent infections, work exposures, autoimmune
diseases, etc…AND ALLERGIES). All such patients require an allergy
evaluation, in my opinion, since an allergic component – found in up to
30% of such patients when sought – may be the most treatable or the
only reversible part of their disease process.
Coordination
of Care matters. GERD, OSA, Obesity, medically treated hypertension,
all play a role in the diagnosis and treatment of Bronchial Asthma and
Chronic Bronchitis, with or without concurrent Paranasal
Sinusitis. A properly trained and motivated Allergist is in an
ideal position to do this, in view of his training and his frequent
contact with these patients.
Beware schlock and monetized “Science” and the need to “publish”.
In
evaluating a new patient, TAKE THE TIME TO LISTEN TO THE ENTIRE STORY.
In 70% of all medical cases, the patient will give you the diagnosis –
if you LISTEN.
What is it with allergies, asthma and referrals from Pediatricians? Why do they resist?
Atopic
Dermatitis, properly diagnosed, is an ideal condition for treatment by
Allergists. Only one of at least two types of Atopic Dermatitis is
based on allergies. But Careful treatment of that group can produce the
most rewarding results.
Especially
relating to family, and with the uniform understanding that a
physician-patient relationship has thereby been formed - with all of
its mutual obligations - there is no ethical prohibition to a
physician being so available. This is especially true in the current
situation of sometimes unavailable or unhelpful personal physicians.
In my opinion, this availability does not hold true for "friends", except in urgent or emergent situations.
They can rely on their personal physician - until they have completed a medical visit with you, if desired.
EXCELLENT ARTICLE ON THE CURRENT LIFE - AND PLIGHT - OF PHYSICIANS. As for me, in my 62nd year as a practising physician - and counting - I still enjoy it... and I won't let the ignorant Bastards get me down. GS
ON ANAPHYLAXIS, ITS DIAGNOSIS AND TREATMENT. Listen Up, Folks. The life you save may be your own. AND REMEMBER EPINEPHRINE!! That is the proper initial treatment...not the other stuff, which is too often substituted.
What Socialized Medicine Looks Like John C. Goodman
Left-wing
Democrats in Congress have decided on a new version of “Medicare for
All.” Turns out its going to be nothing like the Medicare program
seniors are used to. What they have in mind is what we see in Canada.
Everyone
(except American Indians and veterans) will be in the same system.
Health care will be nominally free. Access to it will be determined by
bureaucratic decision making. Here’s what to expect.
Overproviding
to the Healthy, Underproviding to the Sick. The first thing politicians
learn about health care is this: most people are healthy. In fact, they
are very heathy – spending only a few dollars on medical care in any
given year. By contrast, 50% of the health care dollars will be spent
on only 5% of the population in a typical year.
Politicians
in charge of health care, however, can’t afford to spend half their
budget on only 5% of the voters, including those who may be too sick to
vote at all. So, there is ever-present pressure to divert spending away
from the sick toward the healthy.
In
Canada and in Britain, patients see primary care physicians more often
than Americans do. In fact, the ease with which relatively healthy
people can see doctors is probably what accounts for the popularity of
these system in both countries.
But
once they get to the doctor’s office British and Canadians patients
receive fewer services. For real medical problems, Canadians often go
to hospital emergency rooms – where the average wait in Canada is four
hours. In Britain, one of every ten emergency room patients leave
without ever seeing a doctor.
A study by former Congressional Budget Office director June O’Neill and her husband Dave O’Neill found that:
The proportion of middle-aged Canadian women who have never had a mammogram is twice the U.S. rate.
Three times as many Canadian women have never had a pap smear.
Fewer than 20% of Canadian men have ever been tested for prostate cancer, compared with about 50% of U.S. men.
Only 10% of adult Canadians have ever had a colonoscopy, compared with 30% of US adults.
These
differences in screening may partly explain why the mortality rate in
Canada is 25% higher for breast cancer, 18% higher for prostate cancer,
and 13% higher for colorectal cancer. A study by Brookings Institution scholar Henry Aaron and his colleagues found that:
Britain has only one-fourth as many CT scanners as the U.S. and one-third as many MRI scanners.
The
rate at which the British provide coronary bypass surgery or
angioplasty to heart patients is only one-fourth of the U.S. rate, and
hip replacements are only two-thirds of the U.S. rate.
The
rate for treating kidney failure (dialysis or transplant) is five times
higher in the U.S. for patients age 45 to 84 and nine times higher for
patients 85 years of age or older.
We
can see the political pressure to provide services to the healthy at
the expense of the sick in our own country’s Medicare program. Courtesy
of Obamacare, every senior is entitled to a free wellness exam, which
most doctors regard as virtually worthless. Yet if elderly patients
endure an extended hospital stay, they can face unlimited out-of-pocket
costs.
Rationing
by Waiting. Although Canada has no limits on how frequently a
relatively healthy patient may see a doctor, it imposes strict limits
on the purchase of medical technology and on the availability of
specialists. Hospitals are subject to global budgets – which limit
their spending, regardless of actual health needs.
In
addition to having to wait many hours in emergency rooms, Canadians
have some of the longest waits in the developed world for care that
could cure diseases and save lives. The most recent study by the Fraser
Institute finds that
In
2016, Canadians waited an average of 21.2 weeks between referral from a
general practitioner to receipt of treatment by a specialist – the
longest wait time in over a quarter of a century of such measurements.
Patents waited 4.1 weeks for a CT scan, 10.8 weeks for an MRI scan, and 3.9 weeks for an ultrasound.
Similarly, a survey of hospital administrators in 2003 found that:
21%
of Canadian hospital administrators, but less than 1% of American
administrators, said that it would take over three weeks to do a biopsy
for possible breast cancer on a 50-year-old woman.
50%
of Canadian administrators versus none of their American counterparts
said that it would take over six months for a 65-year-old to undergo a
routine hip replacement surgery.
Jumping
the Queue. Aneurin Bevan, father of the British National Health
Service, declared, “the essence of a satisfactory health service is
that rich and poor are treated alike, that poverty is not a disability
and wealth is not advantaged.” Yet, more than thirty years after the
NHS was founded an official task force (The Black Report) found little
evidence that the creation of the NHS had equalized health care access.
Another study (The Acheson Report), fifty years after the NHS founding,
concluded that access had become more unequal in the years between the
two studies.
In
Canada, studies find that the wealthy and powerful have significantly
greater access to medical specialists than less-well-connected poor.
High-profile patients enjoy more frequent services, shorter waiting
times and greater choice of specialists. Moreover, among the nonelderly
white population, low-income Canadians are 22% more likely to be in
poor health than their U.S. counterparts. These
results should not be surprising. Rationing by waiting is as much an
obstacle to care as rationing by price. It seems that the talents and
skills that allow people to earn high incomes are similar to the
talents and skills that are useful in successfully circumventing
bureaucratic waiting lines.
No
Exit. The worst features of the U.S. health care system are the way in
which impersonal bureaucracies interfere with the doctor-patient
relationship. Those are also the worst features of Canadian medical
care. In Canada, when patients see a doctor the visit is free. In the
U.S., the visit is almost free – with patients paying only 10 cents out
of pocket for every dollar they spend, on average. In both countries,
people primarily pay for care with time, not with money. The two
systems are far more similar than they are different.
In
Britain, private sector medicine allows patients to obtain care they
are supposed to get for free from government. Middle and upper-middle
income employees frequently have private health insurance, obtained
through an employer. A much larger number of Britons use private
doctors from time to time. The rule seems to be, “If your condition is
serious, go private.” Canada,
by contrast, has basically outlawed private sector medical services
that are theoretically provided by the government. If doctors, patients
and entrepreneurs think of better ways of meeting patient needs they
have no way of acting on those thoughts.
This
is where the U.S. system is so much better—even though, as in the
Canadian system, U.S. Medicare pays doctors the same way it did in the
last century, before there were iPhones and email messages. Many U.S.
employer plans are just as bad.
But
because U.S. employers are free to meet the needs of their employees
rather than live under the dictates of a politically pressured
bureaucracy, one of the fastest growing employee benefits is concierge
care. For as little as $50 a month for a young adult, patients can have
24/7 access to a doctor by phone and email and all the normal services
that primary care physicians provide. Uber-type
house calls, consultations by phone, email and Skype, cellphone apps
that allow people to manage their own care and other innovations in
telemedicine are taking some parts of the private sector by storm.
These are the kinds of innovations that would be outlawed if the congressional Democrats have their way.
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THIS IS A TROUBLING REPORT ABOUT A NEW LETHAL RISK, DECADES OLD, FOR MANY WOMEN.
"The
World Health Organization has ranked vaccine hesitancy - the growing
resistance to widely available lifesaving vaccines - as one of the top
10 health threats in the world." See: "How To Inoculate Against Anti-Vaxxers" (Editorial, NYTimes Jan. 20, 2019, Sunday Review, p10).
Informative
and well-presented, this article only begins to expose the great health
danger posed by this latest mindless fad. And it gives short shrift to
the one main action that needs to be taken: "Get tough". Through
immediate Federal and State legislation, no infant or child (since
"pre-school" is now being offered in infancy!) should be admissible to
school without official evidence of having been properly vaccinated. I can hear the bellowing now. Well: Shut Up! You are endangering our entire society needlessly. Having taken that action, implement the other actions proposed in this useful editorial.
GS
RR#3
SOCIOLOGY: "IT AIN'T WHAT IT USED TO BE". In my college course in 1950, I had to look to the Hopi Indians as a topic for my course Paper. No
more. Sociology has become Behavioral and Abnormal Psychology, with
recent generations flirting with "weird and weirder". Of course, that's
an overstatement - but not by much. One article that caught my attention, given my work, is entitled: "Preparing Your Practice For Tomorrow's Patients",
by James F. Sweeney (in Medical Economics, May 10, 2018). "And at
roughly 80 million strong, the largest generation alive, Gen Z is too
big to ignore for physicians who plan on being in business past the
next 10 years." Not even I plan for that! But it's interesting. I have only one question: And Whose's Preparing Gen Z. For The Real World?
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Rapid Response for MONDAY, January 21,
2019
SORRY: FAT IS FAT, NOT FIT. Although under reconstruction, please visit my other website entitled: www.medidietresources.com. Here is a "Cliff Notes" version: 1) Your choice is to lose, or to gain a lot more. You won't stay where you are. 2) Weigh yourself daily! No surprises. No cowards. 3) The Mediterranean Diet has been declared by many peer-reviewed articles to be the best diet. 4) The Mediterranean Food Pyramid is the American diet on its head. Check it out. 5) The Rule of Half: cut your portion size IN HALF - NOW!. 6) Eat four to six times per day, smaller portions and the right food. 7) Get thee to a Glycemic Index of foods (especially Carbs)...and avoid all foods above an Index of 50. News Flash: Pasta, specifically 100% duram semolina wheat, has a glycemic index of 25! Enjoy. 8) Exercise! Walking is best. 9) This is not a "flash in the pan". This is life-long...and it's DELICIOUS.
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Rapid Response for SUNDAY, January 20,
2019
"DO SECOND OPINIONS TRULY AVERT MISDIAGNOSIS?" I encourage second opinions. They help the patient and myself.
Rapid Response for WEDNESDAY through SATURDAY, January 2 through 5,
2019
"WHEN MEN WERE MEN". When was that? Psychological and physiological research finds that many young men are in a funk. They are confused and intimidated in their dealings with many of the opposite sex. They are depressed, with an increasing incidence of alcohol and drug use and suicides. They are more resistant to attempting lasting relationships and especially marriage. They have lower testosterone and sperm levels. And more. Look it up. And why? Here I offer one diagnosis. "Manhood"
among some of the younger generation has been co-opted by the females.
Not Ladies and not Women, of whom there are still many...but "females"
who have rejected their unique genetic role (among many roles) as
mothers and nurturers of every generation since Adam and Eve. In that context, "men" become the enemy. Everything else follows logically and inevitably. Unless,
that is, "manhood" defines and embraces a new "Status of Forces",
isolates the "females" through total lack of attention, seeks out the
Ladies and the Women as equal partners, and becomes defenders of the
new generations that they help to form, to embrace and to support
through life-long attention from the moment of their conception. Meanwhile,
many men of the younger generations are losing their psychological and
physiological moorings - as men, as males, and as cognitive human
beings. That need not be.
GS
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Rapid Response for TUESDAY, January 1,
2019
HERE'S A NEW YEAR'S RESOLUTION. I'LL BET THAT YOU ARE DEFICIENT IN VITAMIN D. An
easy bet, given the fact that most people are deficient these days.
THAT'S IMPORTANT, as you will read here, not only to avoid some
diseases but also at times to treat some...like recurrent HIVES. So: get your 25 - Hydroxy Vitamin D level taken (blood test). And seek treatment for deficiency with Vitamin D3. Now: Doesn't that feel better?
Rapid Response for WEDNESDAY through SATURDAY,
December 26 through 29,
2018
RR#3 "Five Ways Nixing The ACA Could Upend The Entire Health System",
by Julie Rovner/ Kaiser Health News, (in ctmirror.com Dec. 25, 2018).
THAT WOULD LIKELY BE TRUE, IF THE BUREAUCRATS, THE POLITICIANS, BIG
PHARMA, THE HOSPITAL - INDUSTRIAL COMPLEX AND "ORGANIZED MEDICINE"
CONTINUE TO EMBRACE "A CAMEL: A HORSE DESIGNED BY COMMITTEE". It
doesn't need to be that way. And I have been writing and publishing
about this since the late 1970's. Look it up, throughout my web site.
RR#4
PHYSICIAN, KNOW THYSELF. PATIENT, KNOW THY PHYSICIAN. The life you save may be your own.
THERE ARE FOUR KINDS OF MEDICAL RESEARCH, ALL DEPENDENT UPON VAST AMOUNTS OF FUNDING.
Original Research, beginning de novo;
New Research building upon research results already reported, sometimes many decades ago:
Research essentially re-doing established work of the past, with or without attribution;
Research that totally ignores established work of the past that still supports current mainstays of medical treatment.
It
is the fourth kind of research that I address here: work establishing
Allergy Immunotherapy, first in the clinical laboratory and practices
of pioneers like Dr's Robert Cooke and William Sherman beginning in the
1920's...and then entirely verified in the immunology laboratories of
scientists like Dr's. Larry Lichtenstein and Ichizaka in the 1960's.
That
Allergy Immunotherapy is a bed-rock of desensitization treatment for
serious inhalant allergies - particularly bronchial asthma and combined
asthma / chronic bronchitis.
And It Is Being Studiously
Ignored...by both practising clinicians who never bothered to become
familiar with it, and by researchers who would rather not lose research
grants while giving passing attention to the central role of inhalant
allergy in these fields. This leaves the patient to search out his or
her needs.
See the following extensive article entitled: "Advances In Asthma In 2017:Mechanisms, Biologics, And Genetics.", in J. Allergy Clin Immunology, November 2018. See if I missed anything.
GS - - - - -
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- - - - - - - - - THIS IS MEDICAL INFORMATION...NOT SOCIAL COMMENTARY.
A
few years ago, I reported in this section medical information (and
implicit advice, given the Health implications) regarding possible
defense against Prostate Cancer and Breast Cancer. Both then and
now, medical research found that increase in ejaculations in men over
time reduced the incidence of prostate cancer. (See:
medlinx.com/internal-medicine/article/3218?utm). At that time, I
also reported medical information that increase in breast suckling for
women reduced the incidence of breast cancer. Once again, there is implicit advice here.
Rapid Response for FRIDAY and SATURDAY, December 7 and 8,
2018
NOW HEAR THIS! If an established Asthmatic is not treated with
an accurate and complete diagnosis, with effective environmental
control - especially involving pets, with an effective (and not
excessive) program of anti-allergic and anti-inflammatory medications,
with prompt on-call and effective treatment of superimposed respiratory
tract infections, and WITH ALLERGY IMMUNOTHERAPY FOR UNAVOIDABLE
ALLERGENS, he or she, at whatever age, is BEING POORLY TREATED. And
that is also true - and possibly especially so - for the many patients,
undiagnosed by their Pulmonologists, who continue to miss combined
Bronchial Asthma and Chronic Bronchitis, mis-labled as "COPD", Everybody so affected, whether, parent or patient or primary care physician or pulmonologist: EITHER LEARN, OR GET TO A CERTIFIED ALLERGIST, OR GET OUT OF THE BUSINESS George A. Sprecace., M.D., F.A.C.P, J.D. asthma.drsprecace.com
BRONCHIAL ASTHMA: THE MOST TREATABLE - AND OFTEN THE MOST POORLY TREATED - SERIOUS MEDICAL CONDITION. I
have been writing about and treating Bronchial Asthma for many decades.
That information is available in several sections of this web site, and
is up-dated regularly. Today, I present the latest caution, prompted by the very recent re-approval by the FDA of Primatene Mist as an OTC medication for the treatment of "mild asthma". WRONG, AND POTENTIALLY DANGEROUS. In
this position, I am joined by a Joint Statement just released by the
major medical organizations dealing with such subjects : "Several Asthma, Allergy Groups Express "Deep Concern" Over Primatene Mist Approval" (MPR, November 12, 2018).
The
availability of this agent, racemic Epinephrine, will delay the quest
by asthmatics for proper, comprehensive and very effective medical
care, especially by that group with a high and dangerous tolerance for
asthma and for its hypoxic effects.
The medication is subject to overuse which can produce heart rhythm problems.
Use and overuse can easily result in a rebound worsening of the asthmatic bronchospasm, resulting in crisis situations.
There
may be usefulness for Primatene Mist, only by prescription and under a
doctor's emergency advice, in case of acute laryngospasm...and then
FOLLOWED IMMEDIATELY by transfer to an Emergency Room - in view of the
medication's propensity to produce worse rebound. BEWARE: The life you save may be your own.
GS
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Rapid Response for SUNDAY,
October 21,
2018
AKA "RED MEAT ALLERGY", ALSO CAUSED BY BITE OF "LONE STAR TICK".
THIS IS AN IMPORTANT HEALTH ADVISORY. A majority of people are deficient in Vitamin D.
In recent decades, Vitamin D has been found to be vital for many body functions besides bone health.
Now comes the reproduced article.
Please
get your 25-OH Vitamin D blood level drawn. If the level is below 30,
contact your physician to prescribe Vitamin D3, 1000 or 2000 units per
day, with repeat blood levels every four months. You're Welcome.
Rapid Response for THURSDAY through SATURDAY,
September 20 through 22,
2018
"THE DECLINE OF THE DIAGNOSIS" = THE DECLINE OF MEDICINE. Here
is an article, written by Joel B. Levine, M.D. and appearing in the
September 2018 edition of Connecticut Medicine, which crystallizes the
decline of Clinical Medicine...that is, the medical care that directly
impacts every patient. Apart from the 50% of a clinician's time that
must be spent "documenting" on an increasingly redundant "electronic
health record". Apart from the rapidly increasing loss of private
practitioners to the role of hospital employees tied to the "15 minute
office visit", no matter what. Apart from the decades-long theft of
services identified as "adjustments", wherein a physician's reasonable
and customary fee is discounted by 40-50% by insurance payors on a
"take it or leave it" basis. Apart from the sometimes idiotic regulations under which physicians are forced to practice...if they want to get paid at all. This
article describes how some physicians allow themselves to make a snap
"diagnosis" without time to develop a "differential diagnosis" list
upon which to explore and act. The National Quality Forum, formerly the
Institute of Medicine "acknowledges
that the EMR (electronic medical record) is inherently incapable of
such a clinical synthesis. The EMR demand for a billable action at the
end of every encounter creates an ongoing need for a conclusion when
one may not, as yet, have emerged." Resulting wrong diagnoses produce many adverse events and deaths. Master clinicians are master diagnosticians. "By being smart, a masterful physician was invariably quicker to the right answer and cheaper." "Sadly,
we are being persuaded that medicine is not nearly as difficult as we
thought it to be. All you need to do is keep the electricity bill paid."
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Rapid Response for SUNDAY,
September 16,
2018
"LIFE AND DEATH IN THE GREAT 1918 INFLUENZA PANDEMIC" At this, the 100th anniversary of the "SPANISH INFLUENZA", John Ruddy and The Day perform another very useful public service:
to
remind their readers that things are not always as they seem...and that
contact with one's physician early on in an illness is much better than
playing catch-up - or not catching up at all.
The following is a
brief over-view, including my opinion of the lessons to be drawn from
the 1918 devastating experience - and applicable to a future similar
experience.
That Influenza was extremely lethal. A future episode may be no less lethal if we rely only on vaccines and antibiotics.
In that pandemic, it was the young, healthy and immuno-competent who were mainly affected. WHY?
One
theory relates to the variable availability of immune resistance, among
young and old, from exposure to prior epidemics of the 1890's and of
1909, and to genetic mutations. Possible, but not sufficient for
explanation, in my opinion.
The pathologic findings in the
lungs (the main cause of death being an overwhelming pneumonia and
suffocation): bacteria were very hard to culture, and the lung tissue
resembled the effects of toxic / inflammatory destruction.
It
is well-known that the Inflammatory System, a basic part of our Immune
System, is a Blunt Instrument - not a scalpel - easily capable of doing
more harm to the host than the invader might do...even killing the host
itself, as in "Septic Shock".
Most of the Influenza victims had robust Immune Systems.
It
is highly likely that the inflammatory response to the initial viral
invasion killed the patients, through Sepsis and the implementing
"Cytokine Storm".
WHAT TO DO?
a) Seek the advice of your physician early-on, certainly within hours of developing significant symptoms and/or signs.
b)
Be aware of the increasing capability of viruses, even in non-asthmatic
and non-bronchitic patients, of producing substantial bronchospasm
requiring aggressive anti-asthmatic treatment.
c) Patient and
physician should have a high index of suspicion for the early signs of
Sepsis...and should intervene with hospitalization and aggressive
treatment immediately.
d) In the event of the above
developments, the use of high-dose Steroids should be added promptly -
not just "considered" - to counter the otherwise devastating effects of
an Inflammatory System run amok.
THIS IS NOT OVER-REACTION. This may well save your life.
And
- in the increasingly inattentive, hurried and even impersonal domains
of today's medical care areas - you must have an effective ADVOCATE to
present and if necessary to argue your case.
A Google Search under "Spanish Influenza, 1918" and under
"Sepsis and Steroids" will produce many relevant references.
Just don't get bogged down in the favorite ploy of some academicians, as distinguished from clinicians : "On the one hand; on the other hand".
PLUS, WHAT WE LEARNED IN MEDICAL SCHOOL: from the patient's point of view, the THREE MOST IMPORTANT QUALITIES OF A PHYSICIAN; Ability, Affability, and AVAILABILITY...IN REVERSE ORDER!
Patients under my care for Allergy and
Chest Diseases receive all of these services...in addition to
"coordination of care"...at no extra cost. That's the way I've been
practicing for six decades - and counting.
ENJOY "HOOKING UP" INDISCRIMINATELY AS PART OF THE SOCIAL SCENE? YOU DUMMIES! Read the Linked article: "STDs Reach Record Levels in CT, Early Data Show", by Jake Kara and MacKenzie Rigg, in ctmirror.org, August 30, 2018. Then "Google" Gonorrhea, Chlamydia and Syphilis. Read about Herpes for "extra credit". Then see if you "enjoy".
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Rapid Response for SUNDAY, August 5,
2018
BINGO! This is THE TRUTH, THE WHOLE TRUTH, AND NOTHING BUT THE TRUTH... about physicians, the Medical Profession and the patients they find it increasingly difficult to care for properly. This could only have been written by a Good Doctor. THANK YOU.
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- - - - - - - - - PS: MOST PEOPLE ARE DEFICIENT IN VITAMIN D (less than 30 of 25 OH Vitamin D). All
patients should be tested. If deficient, they should receive Vitamin
D3, 1,000 or 2,000 units daily. They should be re-tested every few
months to avoid toxic levels (ie. above 70).
Rapid Response for WEDNESDAY and THURSDAY, August 1 and 2,
2018
PAYING FOR HEALTH CARE DELIVERY: THE MACRO AND THE MICRO. Let's start with the MACRO...and with the obvious.
"Yes,
the government should help those in need; but there is no fundamental
reason that your and my health care and insurance must be so screwed up
to achieve that goal". So ends a recent article by John H. Cochrane entitled: "The Tax-And-Spend Health-Care Solution
(WSJ July 30, 2018, Opinion, pA17. The author compares the current
Health Care payment experience nation-wide with our experience with
national telephone service and with national air service before and
after finally producing a rational solution. Of course, why these vital
and massive services were "so screwed up" was because businesses with
great political clout wanted great profit - without competition. And
our fearless leaders obliged. The same is true now - and for decades -
with the Health Care Industry.
And now onto the MICRO. See: "The GOP's Clean Bills Of Health Savings"
(in the same edition of WSJ, Editorial, pA16). As I have been writing
for decades on this web-site and in the lay press, Health Savings
Accounts have been a logical solution for decades...and have been
thwarted for decades by the same organizations with great clout and by
their wholly-owned subsidiary, the Government. And we are all,
providers as well as consumers of health care, getting screwed!
"SEVERAL NOTABLE
MEDICAL SOCIETIES HAVE ISSUED ETHICAL STATEMENTS DISCOURAGING
PHYSICIANS FROM TREATING FAMILY MEMBERS AND FRIENDS." This statement
is too sweeping and is generally wrong, especially in today's health
care delivery climate...where every patient needs a diligent advocate. Furthermore, all of my patients are my friends, as are my family members. In
the informative discussions presented in this article, Dr. Gold is more
doctrinaire than informed; Dr. Prager is too anxious; and Dr. Abbate
presents the best of the arguments. In the final analysis, "it takes two to tango". Doctor and Patient should make the decision for themselves.
THE HEALTH INDUSTRY AND ITS PARTICIPANTS: PART II.
GS
I
remember when the Health Care Industry represented 8% of GDP. So, they
went along just doing the same old things, like employer and employee
tax deductability for health care expenditures, like suppressing health
savings accounts that would bring patients back to caring about what
they seek in health care, like making no effort to address the 50% of
health care costs (ie. sickening life styles), like letting insurance
companies run amok, like treating health care providers (the only ones
who can really affect health care demands and costs) like the enemy,
like Legislating a Prohibition against the Government being able to
negotiate drug costs, like treating potential patients (ie. all of us)
just as votes ("a chicken in every pot, a car in every garage").
So now, Health Care costs represent 17+% of GDP. What was that that Einstein said?
GS - - - - -
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Rapid Response for FRIDAY,
June 22,
2018
THE HEALTH CARE INDUSTRY AND ITS PARTICIPANTS: the patient- public, health care professionals, payors, government... This industry is approaching 20% of the GNP, a vital part of us. Three
recent articles in the WSJ will provide a detailed primer to the facts.
And they augment several decades of personal writings on the subject. (See the relevant sections of asthma.drsprecace.com) • "A Health Fix For Mom And Pop Shops", by Alexander Acosta, June 19, 2018. • "Exit From ObamaCare", Editorial, June 20, 2018. • "Health Savings Accounts for Everyone", by Scott W. Atlas, June 20, 2018. The physical, mental and financial health you save may be your own.
GS - - - - -
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Rapid Response for FRIDAY, May 18,
2018
RETARDING ADVANCED PRACTICE REGISTERED NURSES. and efforts by some in their professional organizations to allow unsupervised practice. My
interactions with APRN's has been uniformly favorable. They are humane,
highly motivated, fairly well educated and trained...and effective in
what they do. BUT THEY DON'T KNOW WHAT THEY DON'T KNOW! That is the worst and most dangerous kind of ignorance. It's
not their fault, not even their responsibility. Their career path just
does not provide for the comprehensive education, training and
experience vital for the ultimate responsibility of a physician for the
care of a patient entrusted to his or her care. That is the one reason to work against free-standing APRN practice. It's not about turf or professional insecurity. Therefore, please support efforts to retain APRN medical practice within the supervision of a licensed and practicing physician.
GS
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Rapid Response for SUNDAY, May 13,
2018
REGARDING DRUG PRICING: See the article published in The Day (May 12, 2018) entitled: "Few Teeth In Trump's Prescription To Reduce Drug Prices". "But
it does not include his campaign pledge to use the massive buying power
of the government's Medicare program to directly negotiate lower prices
for seniors." "Drugmakers
generally can charge as much as the market will bear because the U.S.
government doesn't regulate medicine prices, unlike most other
developed countries."
AND DO YOU KNOW WHY? Because
your Senators and House Representatives in Congress, in passing the
Medicare Modernization and Prescription Drug Act of 2002, specifically prohibited the Government from negotiating prices with the drug cartel. Why
did they do this? Because they did not want to lose the many millions
of dollars of contributions to themselves from the drug companies. And
to hell with their constituents. That's why.
President Trump
cannot unilaterally reverse that. Only Congress can repeal or pass
Laws. Indeed, there is now a Bill in Congress which would address that
issue: "The Medicare Drug Price Negotiation Act of 2017.
It is
going nowhere. Why not? Reread the above. And don't swallow the
cyinical and divisive blame game being constantly dumped on the
President. THE SWAMP HAS PROVEN TO BE MUCH DEEPER THAN ANY OF US
IMAGINED. But give him time. He has accomplished a great deal of good,
despite all manner of obstruction, in a short time.
THIS IS GOOD ADVICE ABOUT TICKS. Also: 1) Take a shower right after any walk in a wooded area; 2)
Remember that Lyme Disease is much more likely to occur in a person who
has already had one or more bouts of Lyme Disease than in a person who
by this time in this region has never had the disease; 3) A rash, or
"the target rash" does not occur in all cases. Any "flu-like symptoms"
especially between Spring and Fall are suspect and should be tested for
Lyme Disease and the other diseases related to tick bites. As always, a diagnosis is most likely made by thinking about it as a possibility.
Rapid Response for TUESDAY and WEDNESDAY, April 17 and 18,
2018
MORE ON THE COMING DEMISE OF MEDICAL CARE - AND OF THE MEDICAL PROFESSION ITSELF- IN AMERICA. THIS IS OBSCENE! A
personal note. I have been a practicing physician for 61 years...and
counting. I have never closed my practice to new patients. I have
always taken all patients, regardless of the accompanying payment
schemes, some miserable and all subjecting me and my medical colleagues
to theft of services of about 40% of my income for the last 30 years. "No Brag. Just Fact".
But
I have refused to get sucked into the vortex described below:
electronic health records for clinical care; performing work 10 points
below my pay grade; sitting on hold - or allowing my staff to sit on
hold, etc. I and my staff work WITH patients, not FOR patients. we
require that they do their part. Meanwhile, many tens of thousands
of good physicians have given up private practice - or medical practice
entirely, even choosing suicide! Not Me. But you, the patient, are
right now at great and increasing risk. You are receiving less and less
effective and timely care. And only you can unite to reverse this
lethal trend - because the regulators and the legislators don't give a
damn for the health care personnel that they are trampling with
abandon. Rise and Fight; or Sit and Die a slow death. I kid you not.
1) The brain has many endo- and exo- cannabinoid receptors, ready to engage as part of the brain's endorphin systems. 2)
There are many type of cannabinoid chemicals, natural and synthetic,
that can be manipulated by manufacturers for specific effects. 3) A person's response is dependent on dose, frequency, route, types and ratios of chemicals. 4) When smoked, peak effect is in 15-20 minutes; duration is about one hour, then promoting further desire. 5)
"Spice" is a synthetic cannabinoid, easily subject to overdose...and
can be sprayed on other related drugs. It is not detectable in urine,
but requires more extensive and expensive tests for detection.
Withdrawal symptoms begin within 2-4 hours of withdrawal. 6)
Cognitive effects: acute for 1-6 hours; residual for 7 hours to 20
days; long-term effects for 3+weeks; chronic effects possibly
persistent. These effects include academic performance, driving and
psychiatric illnesses. 7) Addictive in 10% or more of users.
Withdrawal effects, including gastrointestinal, sleep and irritability
effects, can last 10-14 days. 8) Age at onset of use is critical.
Much worse in children and adolescents, including permanent reduction
of IQ. There is evidence that use is now extending down to Middle
School children!
MEDICAL MARIJUANA HAS MUCH MORE TO RECOMMEND IT, in a "risk-to-benefit" analysis, and evidence-based.
Therefore: MEDICAL MARIJUANA, YES. RECREATIONAL POT, NO.
JUST SO YOU KNOW: TWO THINGS ABOUT VITAMIN D. 1)
In the last couple of decades, Vitamin D has been found to be important
in many body functions besides bone health. This article points to
another likely connection. 2) Probably a majority of people have
Vitamin D levels below the minimum considered adequate (30-100).
Certainly that is true of my patients.
Therefore, all should
have their blood 25-OH Vitamin D level drawn and reviewed with their
physician with the above in mind. In addition, it is now recognized
that replacement should be with Vitamin D3 rather than with Vitamin D2.
READ IT AND WEEP: ABOUT HEALTH CARE DELIVERY TODAY. Completing
my 60th year in private medical practice, I don't work for patients; I
work with patients, who have their own responsibilities for their
health. And as far as "concierge medicine" is concerned, I offer that daily, 24-7, without extra cost. "No brag. Just fact".
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- - - - - - - - - MIGRAINE HEADACHES...NOT JUST A BAD PAIN. First, get a clear diagnosis, preferably with a Neurologist, ruling out other possible causes. Then
get the best treatment you can find, both for the acute episodes and
for maintenance treatment to reduce or avoid the episodes. And also
consider acupuncture with a qualified practitioner for treatment. Protect your blood vessels, all of your blood vessels.
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- - - - - - - - - IS THIS CLEAR TO YOU? THAT MAKES ONE OF US. The important message is to use the safest medication...but NOT TO TOLERATE GERD / HEARTBURN.
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FROM PARTICIPATION IN COLLISION SPORTS MAY TURN OUT TO BE ONE OF THE
MOST PERVASIVE AND SERIOUS MEDICAL CONDITIONS OF THIS GENERATION,
AFFECTING OUR CHILDREN MOST OF ALL. "Is anybody there? Does anybody care?"
AND YOU WONDER WHY "DEFENSIVE MEDICINE" IS ALIVE AND WELL...AND IS RESPONSIBLE FOR 25-30% OF ALL HEALTH CARE COSTS? WHAT A WASTE! The
only "Medical Malpractice Reform" that will work is the establishment
of Health Care Courts, analogous to Patent and Bankruptcy Courts. The
only impediment to that is the Trial Bar.
REGARDING THE CURRENT FLU EPIDEMIC. 1)
Immunizations of all kinds are the most effective and cheapest form of
medical care. To refrain from or to neglect getting immunized is
STUPID; and for any parents and their children is IRRESPONSIBLE.
Regarding the annual Flu vaccines, "egg allergy" is no longer
considered an impediment to getting the shot. And you can still get the
2017-2018 Flu shot now.
2) The characteristics of this year's
Flu epidemic resemble those of the Pandemic of 1918: the young and
healthy are more likely to get seriously ill and to die. That is
probably because the Inflammatory part of our Immune System is a BLUNT
INSTRUMENT, prone to over-reacting to an invader, thus at times being
itself the cause of death rather than the infection. The obvious
example is SEPSIS. Therefore, make sure your physician considers
high-dose Steroids in case of serious or grave illness.
3) Any
"cold" is not "just a cold". It is a viremia, involving the entire body
and capable of causing serious illness besides the well-known problems.
Thus, treat a "cold" aggressively from the outset. My patients are
given a "Cold Regimen" and are urged to use it. If you wish a copy of
that Regimen, without thereby establishing a physician-patient
relationship, send me a stamped, self-addressed envelope with your
request. Meanwhile, an important note: "Z-PAK" DOES NOT WORK FOR
RESPIRATORY TRACT ILLNESSES.
"PHYSICIAN, HEAL THYSELF." That is my intent, as I complete my 85th year today. For that, I thank God, my parents and my great family. My inspiration is my mother, who lived well to age 95. Other inspirations are noted in this direct quote from the Mayo Clinic Health Letter for December, 2017:
"Astronaut John Glenn returned to space at age 77. Frank Lloyd Wright was still working at age 91. Ronald Reagan was elected to his second term at age 73. Dr. William Worrall Mayo founded Mayo Clinic at age 70. Recently,
Robert Merchand set a new world record for his age group by bicycling
nearly 17 miles in one hour. Mr. Merchand is 102 years old. What makes the difference among such people? Why do some stay young and vibrant despite their 'true age'? Most people who live long, healthy lives are just regular folks who refuse to equate age with illness and inactivity."
As
I approach my 61st year as a physician, continuing an active medical
practice of 40 hours per week (half/time for me), I intend to continue
with this privilege as long as I am competent. That's my plan.
THIS IS GOOD NEWS FOR PATIENTS WITH SLEEP ISSUES. Sleep Specialists are swamped with evaluations, resulting delays in attention. Attentive non-sleep specialists who take a little time can make the diagnosis as well, then leading to specific treatment. I
have diagnosed scores of patients with Obstructive Sleep Apnea,
actually an epidemic in recent years, by using three tests: a careful
History, a Sleep Questionaire, and an Overnight O2 Saturation Test
performed in the home.
Remember: good quality and quantity of Sleep is vital to good health. OSA
untreated can result in refractory high blood pressure,
gastro-esophageal reflux, obesity, diabetes, heart attack and stroke.
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- - - - - - - - - Laughing Is Key to Good Health By Mehmet Oz, M.D., and Michael Roizen, M.D.
From 1995 to 2014, comedies took in $38.6 billion at the box office — more than action, adventure and horror movies. And that's not even counting romantic comedies, which grossed $9.1 billion. While
you might think that comedies are simply a great way to start off an
evening with your significant other or spend an afternoon with the
kids, they offer even more to all of you (that's moviegoers
everywhere): They bring laughter, a great medicine.
Laughter
Lets You Go With the Flow. A University of Maryland study found that
laughter helps your blood vessels relax, promoting healthy blood flow,
and good blood pressure. (Dramas — especially bad TV ones — make them
stiff and reduce blood flow!) Suggestion: "This Is Spinal Tap"
Laughter
Makes You a Flu-Fighter. Several studies indicate that laughter boosts
levels of antibodies that help the body fight off upper-respiratory
infections. Suggestion: "Splash"
Laughter
Helps You Lose Weight and De-Stress. When you laugh, even if it's not
spontaneous, you lower cortisol and epinephrine levels that are
implicated in weight gain, blood vessel damage, and depression. So the
next time you are inclined to reach for a sweet treat, tell yourself a
joke and walk away smiling! Suggestion: "Anchorman: The Legend of Ron
Burgundy"
Laughter Keeps Glucose Levels
Steady. Want your post-meal blood sugar spikes to be slower and lower?
Try watching a funny movie before or during your meal. Researchers find
that laughter's effect on the immune system and gene expression helps
control your blood glucose level. Suggestion: "The Pink Panther Strikes
Again"
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Rapid Response for SUNDAY,
January 28,
2018
REGARDING ADEQUATE SLEEP, IN QUANTITY AND QUALITY... Now hear this: adequate sleep is the single most important controllable factor for GOOD HEALTH. It
is also the most abused and overlooked, other than the other miserable
"life style habits" - which are responsible for over 50% of all
illnesses and health care costs. Sleep disturbances are Diagnosable and Treatable. TALK
TO YOUR DOCTOR. And if he or she isn't thinking straight because of
sleep deprivation also, Run, Don't Walk to the nearest Sleep Specialist! The life and quality of life you save Will be your own, for decades to come.
WHAT? A VOICE OF REASON CRYING IN THE WILDERNESS? And something is definitely wrong when there is an ICD - 10 code, among over 60,000 other codes, for "Had argument with in -laws." I kid you not.
REGARDING THE IMPORTANCE OF ACCESS IN HEALTH CARE... We were
taught in Medical School that the three most important attributes of a
physician to a patient are Ability, Affability and Availability - IN
REVERSE ORDER! I took that message to heart. During almost all of my
60 years in the practice of Medicine...and counting...I have been
available to all of my patients all of the time: 24/7, directly through
my three phone numbers. I don't call it "Botique" or "Consierge"
Medicine. I don't charge extra for it. I just do it as part of good
Medicine, Specialty Care and with Coordination of Care among my
patients' other physicians. For this, I require only one thing: that
patients do their part in dealing with their own care. I don't do
things For patients. I do them With patients...or I don't do them at
all. And for that I have been called "a living and breathing
anachronism". Well, "No Brag. Just Fact".
HERE IS ANOTHER REASON, A VERY IMPORTANT ONE, WHY I DO NOT USE LABA INHALERS. The
continuing original reason is that the 24 hour effect on the body of
such medications tolerizes the body against their effectiveness when
needed in a "rescue inhaler".
ON IMMUNIZATIONS (VACCINATIONS): Folks, immunizations are the cheapest and most effective form of health care available. If
you fail to take them, you are negligent. If you intentionally refuse,
you are reckless, especially with regard to your children.
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- - - - - - - - - THE ARTICLE PROVIDED HERE DISCUSSES GENDER IDENTITY. This has become a complex, confused and politicized subject.
Indeed, numerous other scientific questions have also become polluted by the injection of social / political demands.
In this case, the author offers strong reasoning for one position.
Please
search also questions like the following for a more comprehensive
review: Gender Identity and Intrauterine environment: Nature and
Nurture. My personal position is to urge great caution and expert
medical advice in dealing with children with sexual identification
issues. As always: "Primum Non Nocere / First Do No Harm".
Please see also the several articles in National Geographic, January 2017, entitled: "Gender Revolution".
THESE PSYCHIATRISTS SHOULD HAVE THEIR HEADS EXAMINED. No personal professional examination? And then divulge a "professional" opinion? That's medical malpractice. What
psychiatrists should be allowed - and required - to do in all cases
where they have reason to believe that a third party is at imminent
risk, is to divulge that information to the proper authorities in order
to protect the third party. That's what "the world needs now". Not schlock.
Rapid Response for SATURDAY and SUNDAY,
November 25 and 26,
2017
FINALLY: SOMEBODY IS STARTING TO LISTEN, IF ONLY BECAUSE IT'S COSTING MONEY. The
government regulators and the ivory tower researchers, in their
hell-bent quest for "data", are in the process of destroying Health
Care and its "providers". What's going on is obscene. STOP!!
ABOUT ELECTRONIC HEALTH RECORDS IN CLINICAL MEDICINE: "True, True, and Related", an excellent exposition. And may I add: I Told You So, about 8 years ago. I
do not use EHR'S in my clinical practice. And I am penalized 2-4% of my
Medicare payments per year for that decision. My patients are just fine.
FINALLY,
THE WORD FROM THE MEDICAL "ON HIGH" AGREES WITH THOSE OF US WHO HAVE
BEEN TREATING HYPERTENSION AGGRESSIVELY FOR MANY DECADES.
And
we even had to go through the period about three years ago when some
cost-conscious "gurus" proposed 160 mm Hg. as a good BP for the
elderly. Crazy.
Essential Hypertension is the most important,
most prevalent and most easily treated of the many chronic diseases
that beset us, most often at a relatively early age. This is especially
true if there is a family history of hypertension. The alternatives to
good BP control are stroke, heart disease, dementia and a shortened and
uncomfortable life span. "CAN YOU HEAR ME NOW?"
THIS IS WHAT I HAVE BEEN SAYING FOR DECADES ABOUT INFLAMMATION.
The
inflammatory process, part of our Immune System, is a very blunt
instrument that can at times hurt or kill you. Learn about it, both the
internal mechanisms and external agents.
AS
I HAVE BEEN SAYING FOR DECADES, THE INFLAMATION ARM OF THE IMMUNE
SYSTEM - THAT VERY BLUNT INSTRUMENT - IS AT THE HEART OF MANY IF NOT
MOST DISEASES. It is often as likely to kill as to cure.
Our
families are products of the free market system. Nobody gave us
anything. Nor did we expect it. In that system, there were always
winners and losers. Then that was allowed, even expected - like the
tides. Given the last two or three generations, losing is not allowed.
Everyone must be a "winner", with "participation awards", with diluted
grades at both levels of the spectrum, and above all with ENTITLEMENTS.
The word itself indicates the mind - set: we don't have to earn or be
responsible...we are Entitled. The concept has now altered the genetics
of hundreds of millions of voters and potential voters and illegal
voters. The Democratic and Republican and Republicrat politicians have
done their job well. Thus, whether we are dealing with what the
author N.N.Taleb has coined "IYY" ("Intellectual yet idiot") or just
with run of the mill hypocracy / cynicism, THERE MUST BE NO LOSERS, as
is inevitable in a free market system. And there is another
problem. The "Free Market System" (aka. Wall Street in many minds) is
simply not to be trusted. Washington is considered not the only
"swamp". I think you will agree that some of this has been earned. So, what to do? For
that, you need to read or re-read my many commentaries regarding HEALTH
CARE REFORM" which populate my web site. They are all designed to
re-inject Personal Responsibility into the Health Care System. They are
all doable, given the legislative will. And they will all be attacked:
"YOU CAN'T TELL ME WHAT TO DO, JUST GIVE ME MY ENTITLEMENT". The end-game of that unsustainable scenario: with or without "medical care", prepare to suffer and die. "In a democracy, the people always get what they deserve".
GS
Although
there are of course bad actors in the free market, they are held
accountable for their actions. Bad actors in government are much more
dangerous because they have the ability to use force over others (that
is the essence of government) and the government just throws more money
at problem programs and departments while private companies are
decimated by the market, the SEC, and the DOJ when the do something
fraudulent (as they should be).
IMPORTANT: HEALTH CARE COVERAGE, "PRE-EXISTING CONDITIONS", AND GENETIC TESTING. A
genetic pre-disposition is Not a "pre-existing condition". I argued
that years ago, including on this web site. But I then cautioned
patients and the public not to undertake genetic testing unless and
until iron-clad safeguards for their equal insurability were in place.
Those safe-guards eventually came in the form of a Federal Law: GINA. See the article published in ctmirror.org July 2, 2017: "Safe Under ACA, Patients With Pre-Existing Conditions Now Afraid", by Charlotte Huff / Kaiser Health News. Of course, when dealing with lawyers and paid-off legislators, "it depends on what the meaning of the word 'is' is". Any
new Health Care legislation MUST safeguard the equal insurability of
persons who might seek information about genetic pre-dispositions
before any "manifest disease" is diagnosed. The alternate - no
protection or weasel-word "protection" would effectively eliminate this
important method of avoiding "manifest disease" in time.
GS
MORE, EVER MORE, ON HEALTH CARE. This report has it exactly right.
IMPORTANT HEALTH INFORMATION FOR US OUTDOOR TYPES... especially
the part about possible transmission of this severe tick-borne disease
within 30 minutes of a bite - and no treatment. BEWARE.
See also the article entitled: "Leaked ObamaCare Bill Fires Up Debate", in doximity.com, Health Affairs, Feb. 25, 2017.
Between
the politics involved for House members already preparing for their
2018 elections, and the massive cost of Health Care in general, the
answer may be yes.
But there is another way if enough of them
are true patriots and heroes: REDUCE HEALTH CARE COSTS BY ADDRESSING
THE FOLLOWING PROBLEMS:
Half of all health care costs are
due to unhealthy health habits, "life-style related". I recently heard
one politician say that "personal responsibility cannot be legislated".
The Hell It Can't! Has he ever heard of motivation, of legal coercion
if necessary?
Drug costs are much too high and are artificially
propped up by Government action. Remember the specific provision placed
in the Medicare Act of 2002 by recipients of Big Pharma graft (aka
"donations")...the one that PROHIBITS THE GOVERNMENT FROM NEGOTIATING
DRUG PRICES?
Employer provided Health Care benefits to
employees, tax deductible to both, have for decades shielded both from
the results of their health choices and treatments. Marvelous. Health
Savings Accounts, properly structured, can restore patient
consideration and decision-making into those choices.
Half of
all Health Care costs are generated in the last 6 months of a person's
life. Given mechanisms for meaningful choice (ie. Advanced Directives
actually completed by the patient and actually followed by physicians
and families), a vast amount of these costs would disappear...without
any reference to "assistance in dying:".
Now we go to the
doctor and "take a chance on the National Lottery", ie, Medical
Malpractice suits. Wasteful, unjust to all and simply a money machine
for the Trial Bar, this situation generates about 25% of Health Care
costs that are called "Defensive Medicine" ordered by health care
professionals to protect themselves. Health Care Courts, akin to
Bankruptcy and Patent Courts with their special expertise, would
generate more Justice at much less cost than the current "system"
provides - and would obviate the need for "Defensive Medicine".
Physicians
and related health care workers, by virtue of their position at the
entrance to Health Care, are responsible for ordering over 20% of all
such costs. Pay them adequately (not now the case) and remove the
unnecessary encumbrances on their professional expertise, and they will
do a better job of triage, care, coordination and education. This is
not happening now.
SO YOU SEE, YOU DO HAVE CHOICES. ANY PATRIOTS, ANY HEROES OUT THERE?
GS
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Rapid Response for SATURDAY,
January 28,
2017
ATTENZIONE!
In
recent months, several useful clinical topics - apart from the
ever-present "urban legends" - have been reliably reported and deserve
inclusion in standard medical practice, in my opinion.
1)
Regarding Proton Pump Inhibitors (eg. Nexium, Protonix, etc), the
plethora of recent warnings have been found by GI specialists to be
overblown. The most important goal is controlling GERD totally.
If medications like Ranitidine (H2 antihistamines with dual effect) and
Sucralfate work, fine. If they don't, continue the use of PPI's.
2)
Low Vitamin D has been found to be both nearly epidemic in the general
population and important in many more areas of Health than just
regarding bone health. Thus, Vitamin D levels should be obtained
on all patients (25 Hydroxy Vitamin D), and levels below 30 should be
treated aggressively with Vitamin D replacement. 3) Sleep
Deprivation is clearly an epidemic in today's society. There are many
causes, including addiction to phones and gizmos used to and through
bedtime, and the inordinate and inhuman demands of some employers to
have employees "on call" at all times. But an easily diagnosable
and treatable cause is Obstructive Sleep Apnea, also present in
epidemic form if looked for. I use a Sleep Questionnaire and a
Nocturnal O2 Saturation Test (performed at home) as screening devices.
If either or both of these and the patient's initial history are
suggestive, I order an Overnight Sleep Study, preferably performed in a
formal Sleep Lab. If that test is positive for OSA, the patient
is placed on CPAP and/or on O2 during all hours of sleep. Untreated
OSA contributes to or causes obesity, GERD, high blood pressure,
diabetes...and sudden death during sleep!
4) The following is an "oldie but a goodie": THE PROPER EVALUATION AND TREATMENT OF BRONCHIAL ASTHMA. Notwithstanding
the resistance and temerity of too many Pulmonary physicians to
acknowledge this decades-long established fact, Bronchial Asthma - and
also Chronic Bronchitis (aka "COPD") cannot be properly evaluated or
treated without an Allergy Evaluation. In fact, COPD is a waste-basket
diagnosis without that, a point at long last acknowledged by the
admission of combined COPD - Bronchial Asthma syndrome. The patient, at
least, should recognize this...and should self-refer if necessary.
5)
Mental Health in today's world is much more than the absence of
established psychiatric disease...and much more than taking
handfuls of psychotropic medications. See the section on this web-site
entitled "Physician - Patient Spirituality" for some valuable insights.
6)
Most patients these days have 3,4,or 5 different physicians. And too
often, they don't talk to each other about the patient's multiple and
often intertwined conditions and needs. Seek out a physician who
adds "coordination of care" to his or her offerings in your behalf.
7)
We learned in Medical School (for me having graduated 60 years ago)
that "the three most important attributes of a physician from the
viewpoint of a patient are: Ability, Affability, and Availability... in REVERSE ORDER." Make sure that your physician is AVAILABLE to you when you need him.
The 20 best journal summaries in Internal Medicine in 2016.
Dietary water intake and bladder cancer risk: An Italian case-control study
Meta-analysis of potassium intake and the risk of stroke
Association between vitamin D deficiency and antinuclear antibodies in middle-aged and older U.S. adults
Coffee and caffeine intake and risk of urinary incontinence: A meta-analysis of observational studies
Chocolate intake and incidence of heart failure: Findings from the cohort of Swedish men
How statins aid the immune system
The Centers for Disease Control and Prevention opioid guidelines: Potential for unintended consequences and will they be abused?
Coffee and green tea consumption in relation to brain tumor risk in a Japanese population
Coffee intake and the incident risk of cognitive disorders: A dose-response meta-analysis of nine prospective cohort studies
Sugar addiction: The state of the science
Egg consumption and cardiovascular disease according to diabetic status: The PREDIMED study
Statin myopathy: Over-rated and under-treated
Coffee consumption is positively associated with longer leukocyte telomere length in the Nurses’ Health Study
Discontinuation of statins: What are the risks?
Infusing pleasure: Mood effects of the consumption of a single cup of tea
Effect of vitamin D3 supplementation on blood pressure in adults: an updated meta-analysis
Multivitamin use and the risk of cardiovascular disease in men
Coffee consumption and risk of cardiovascular events in hypertensive patients: Results from the HARVEST
Association of breakfast intake with incident stroke and coronary heart disease
Add-on effects of a low-dose aripiprazole in resolving hyperprolactinemia induced by risperidone or paliperidone
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Rapid Response forTUESDAY
and WEDNESDAY, December 13 and 14,
2016
THE STATE OF OUR HEALTH
CARE SYSTEM
By George A. Sprecace., M.D., J.D.
A Recent Interview with Adam Sprecace, PE,
On the Lee Elci Radio Show, December 13, 2016
Q&A
Note: You can also hear the
segment broadcast on December 30, 2015...
1) A BRIEF SUMMARY OF HEALTH CARE IN AMERICA?
Quality: excellent at the top; modest on average, and decreasing. Access: sporadic. Cost: excessive and wasteful. IN GREAT NEED OF EFFECTIVE REFORM.
2) WHAT HAS LIFE BEEN LIKE, WORKING IN THE TIME OF OBAMACARE?
(eg. patient workload, reimbursement rates and dependability, electronic record-keeping, etc.) Workload
increasing; compensation decreasing; EMR’s poor for the private
practicing physician and patient, necessary for hospitals but
generating increasing cost and workload and decreasing quality as
measured by productive provider – patient interaction.
3) HOW HAS OBAMACARE AFFECTED PHYSICIANS?
Much more stress and strain, with less physician and patient satisfaction. Physician burn-out and declining physician health. Pressure
to practice UNETHICALLY: eg. ACO’s, BUNDLING, etc., which for first
time would force the physician’s self-interest to work at variance with
that of his or her patient, with whom he has a Fiduciary Responsibility.
4) IS OBAMACARE GETTING BETTER OR WORSE?
Increased premiums, reduced coverage…. Obamacare
was and is a Christmas Tree of Wants, with no attention given to needed
Health Care Reforms. The Goals are reduced costs at any cost, and
increased Regulations by many who have no knowledge of what they are
doing. Example: THE 30 DAY READMSSION RULE, which substantially
penalizes hospitals for readmitting an inpatient within 30 days of
discharge…EVEN FOR AN UNRELATED READMISSION DIAGNOSIS!
5) WHAT ABOUT THE PENALTIES FOR REFUSING TO BUY MEDICAL CARE COVERAGE UNDER OBAMACARE?
20 million subject to penalty. 8 million paid penalty. 12 million exempt. Thus, more subject to penalty than were covered.
6) WHAT’S BEEN HAPPENING WITH RELIGIOUS HOSPITALS THAT REFUSE TO FOLLOW OBAMACARE MANDATES?
Endless
Litigation, including the USSC. Coercion: loss of Freedom of Religion,
reduced quality and availability due to intimidation and decisions in a
System (ie. Catholic Hospitals) that is nearly the largest in the
nation.
7) WHAT WOULD YOU CHANGE ABOUT OBAMACARE?
Repeal
and Replace, with a two year transition period. a) increase insurance
policy competition across State lines; b) reduce and rationalize
Regulations; c) make all patients financially at stake at every
encounter (HSA’a, co-pays, defined contribution instead of defined
benefit plans, etc; d) retain coverage for pre-existing conditions
while imposing penalties for continued bad life-styles, which account
for about 50% of all health care costs; e) as “Defensive Medicine”
accounts for 20-30% of health care orders – costs, REFORM MEDICAL
MALPRACTICE LAW – eg. Health Law Courts; f) promote and enforce End Of
Life Decisions – 50% of Medecare costs occur in the last 6 months of a
recipients life!;g) make electronic medical records OPTIONAL for
private physicians; h) re-think and revise EMTALA LAW – currently a
poor and wasteful use of ER’s; i) prohibit UNETHICAL medical practice
and payment programs; j) pay physicians fairly – they are now bearing
the brunt of this Christmas Tree. ETC.
8) DO PHYSICIANS AND HOSPITALS GENERALLY AGREE WITH YOUR POSITIONS ON OBAMACARE?
Most
physicians, yes. Hospitals are ambivalent: gaming the system where
they can; merging and selling out; trying to “go along” so as to “be at
the table” when government decisions are made – not working; acting
like trained businessmen when dealing with professionals: “win-lose”
instead of “win-win”, treating professionals like widgets…. A bad plan.
WHAT IS YOUR PROGNOSIS?
Short-Term, GUARDED. Much damage has been done. Long-Term, FAIR, now that competents have retaken the ASYLUM.
NB:
GEORGE A. SPRECACE, M.D., J.D. has been writing and speaking on this
subject since the late 1970’s, a practicing physician for 60 years…and
counting. These Commentaries are found on www.asthma.drsprecace.com
"VALUE-BASED
MEDICAL CARE".
Sounds like a no-brainer, right?
Not when your Government defines and implements it!
In
fact, although our Health Care Regulators are doing as much as possible
to make it sound like "motherhood and apple pie", THE DRIVER FOR THIS
PLAN IS REDUCTION IN HEALTH CARE COSTS, at any cost.
And the
vehicle for this trip is inherently UNETHICAL: rewarding physicians for
providing less health care, and punishing them for providing more
health care...perverse incentives that for the first time place the
interests of physicians in opposition to the interests and needs of
their patients.
It is RATIONING ON STEROIDS, couched in such
reasonable terms as "evidence-based medicine", "efficient health care
delivery" and "patient satisfaction".
NOW HEAR THIS: That's
exactly how I have always practiced Medicine in my 59 years as a
physician. But that will not shield me from being crippled with yet
more demands for "documentation" beginning in 2017; and it will not
prevent me from being penalized 4% of my receivables beginning in 2019
unless I want a 4% increase by cheating my patients of the care they
need. That's what we're talking about, without the sugar-coating.
THE
ABOVE IS DIRECTED MAINLY TO THE PATIENT / PUBLIC. For the
Regulators
don't give a damn about what physicians and other health care providers
care or say. They do care about what the voters say.
So: "DON'T JUST STAND THERE. DO SOMETHING", for a change.
Now comes the latest victim of Political Correctness run amok.
The prime responsibility of our government is to protect its people
from threats near and far. It's responsibility is not to
rehabilitate a continent ravaged by the excesses of former colonial
powers and by the corruption of its own leaders. But that is
exactly what our reckless "leaders" are touting to justify their
refusal to quarantine America from a potential pandemic...an action
successfully taken by some of the African nations themselves.
This is not "panic". It is common sense and basic protocol
for
the management of infectious diseases of all kinds.
Then you have a litany of negligent actions and inactions taken by our
own politicized "professionals": on - the - job training and making it
up as they go along, all the while looking over their shoulders for the
approval of their political masters.
"WHERE IS IT WRITTEN..." that
"the
virus cannot be transmitted airborne?" Viruses are notorious for
mutating to develop new capabilities. Indeed, the more hosts
the
virus infects, the more opportunities it has to mutate. And
it is
acknowledged by the independent scientific community that a mutation to
airborne capability would be catastrophic indeed.
"an
infected person is not contagious until he or she begins to demonstrate
symptoms". You hope that is true, even if the person involved divulges
having symptoms.
"after
21 days, all is clear". Perhaps, so far, hopefully!
Meanwhile,
the Governors of several States are to be lauded for their initiatives
in defense of their own citizens. Or can we expect Attorney
General Holder to initiate legal process prohibiting such action "in
order to protect Liberia..."
We can't "...stop the world". And we can't "get
off". But
we can object. We can demand. We can Vote!
"Is anybody there? Does
anybody care?"
GS
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Rapid Response for FRIDAY,
September 18,
2014
FEE FOR SERVICE: GETTING
A BAD RAP FROM THE BEAN COUNTERS. BUT ONCE AGAIN THEY ARE
WRONG.
READ THIS.
GS
I
thought you would like to read the attached
article: Friday Feedback: Docs Defend Fee-for-Service Click http://www.medpagetoday.com/PracticeManagement/Reimbursement/47748
for the full story: Sign up at http://www.medpagetoday.com/updateProfile.cfm?action=register
for your FREE, once-daily, Medical News Daily Headlines Email. MedPage
Today(R)
provides physicians and 'expert patients'
real-time
coverage of
breaking medical news and the top stories in health and medicine.
Physicians,
PAs, Nurses, and Pharmacists may also receive CME/CE credit as part of
our news
coverage. Our content is reviewed and accredited by the University of
Pennsylvania School of Medicine, Office of Continuing Medical Education
(OCME).
OCME is accredited by the Accreditation Council for Continuing Medical
Education (ACCME) to provide CME for physicians. There is no cost to
use the
service. Visit MedPage Today www.medpagetoday.com
now. At MedPage Today, we are Putting Breaking Medical News into
Practice(R).
The following is a summary of the most recent foray into
achieving this goal.It
is based upon a
TV interview on the Today Show (February 11, 2012) between Lester Holt
and a
Professor of Geriatrics from California.And it says a lot.
To
enhance short and long-term
memory: Focus on the topic; Snap
a mental picture of
the subject matter; Connect it to something else
of interest
to you.
Add to
your regular diet foods
abundant in anti-oxidants (see lists readily available, mainly
vegetables, fresh and dried fruits), omega 3 oils (fish, nuts), and
whole grains (especially oat and corn).
Obesity
promotes dementia.Regain
and maintain a proper weight.
Anxiety
promotes dementia.Don’t
be “Outcome Oriented”…”What if…”
this or that.Be
“Process Oriented”:
control what you can control; and then observe how the issue plays out.“A little sugar…” in the
form of rest and
relaxation will help this “medicine go down”.
Exercise,
both physical and mental,
is vital.A daily
brisk walk is all it
takes.And studying
a new language or a
musical instrument are potent exercises.
Humor…and
a good laugh…help
everything.See the
section on my web-site
(www.asthma-drsprecace.com)
entitled “A Bit of Whimsey”.
Make and
keep friends, in every
sense of that word.And
if you are lucky
enough to be married, work on making that person your Pal.
Heredity
is not destiny.More
relevant to destiny is what you do with
your body, your mind and your time.
YOU
CAN DO THIS.If not, at least buy Long-Term Nursing Home
Insurance…because
you may
well be headed there.
GS
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KEEPING
DEMENTIA AND ALZHEIMER’S DISEASE AT BAY
The following is a summary
of the most recent
foray into
achieving this goal.It
is based upon a
TV interview on the Today Show (February 11, 2012) between Lester Holt
and a
Professor of Geriatrics from California.And it says a lot.
To
enhance short and long-term
memory: Focus on the topic; Snap
a mental picture of
the subject matter; Connect it to something else
of interest
to you.
Add to
your regular diet foods
abundant in anti-oxidants (see lists readily available, mainly
vegetables, fresh and dried fruits), omega 3 oils (fish, nuts), and
whole grains (especially oat and corn).
Obesity
promotes dementia.Regain
and maintain a proper weight.
Anxiety
promotes dementia.Don’t
be “Outcome Oriented”…”What if…”
this or that.Be
“Process Oriented”:
control what you can control; and then observe how the issue plays out.“A little sugar…” in the
form of rest and
relaxation will help this “medicine go down”.
Exercise,
both physical and mental,
is vital.A daily
brisk walk is all it
takes.And studying
a new language or a
musical instrument are potent exercises.
Humor…and
a good laugh…help
everything.See the
section on my web-site
(www.asthma-drsprecace.com)
entitled “A Bit of Whimsey”.
Make and
keep friends, in every
sense of that word.And
if you are lucky
enough to be married, work on making that person your Pal.
Heredity
is not destiny.More
relevant to destiny is what you do with
your body, your mind and your time.
YOU
CAN DO THIS.If not, at least buy Long-Term Nursing Home
Insurance…because
you may
well be headed there.
Offerings by George A.
Sprecace M.D.,
J.D.:
(Scroll down or click here for
More Relevant
Offerings)
"TRUE,
TRUE...AND RELATED". Good advice, especially about the
Obstructive
Sleep Apnea, of which there is an epidemic, most often
undiagnosed. GS
Mayo
Clinic - Aspirin not a joke!
Dr.
Virend Somers, a cardiologist from the Mayo Clinic who is lead author
of the report in the July 29, 2008 issue of the Journal of the
American College of Cardiology
Most
heart attacks occur in the day, generally between 6 A.M. and noon,
Somers said. Having one during the night, when the heart should
be most at rest, means that something unusual happened. Somers and his
colleagues have been working for a decade to show that sleep apnea is
to blame.
1.
If you take an aspirin or a baby aspirin once a day, take it at night.
The reason: aspirin has a 24-hour "half-life" therefore, if most heart
attacks happen in the wee hours of the morning, the aspirin would be
strongest in your system.
2.
FYI, aspirin lasts a really long time in your medicine chest for years,
(when it gets old, it smells like vinegar). Please read on.
Something
that we can do to help ourselves - nice to know. Bayer
is making crystal aspirin to dissolve instantly on the tongue. They
work much faster than the tablets.
Why
keep aspirin by your bedside? It's about Heart Attacks: There are other
symptoms of an heart attack besides the pain on the left arm. One must
also be aware of an intense pain on the chin, as well as
nausea
and lots of sweating, however these symptoms may also occur
less
frequently. Note: There may be NO pain in the chest during a
heart attack.
The
majority of people (about 60%) who had a heart attack during their
sleep, did not wake up. However, if it occurs, the chest
pain may wake you up from your deep sleep.
If
that happens, immediately dissolve two aspirins in your mouth and
swallow them with a bit of water.
Afterwards:
-
call 911 -
phone a neighbor or a family member who lives very close by -
say "heart attack!" -
say that you have taken 2 aspirins. -
take a seat on a chair or sofa near the front door,
and
wait for their arrival and... - do NOT lie down.
Until this year, "the Flu" was a viral disease of Fall and
Winter, with occasional extension into early Spring. Thus, a
"flu-like illness" occurring in late Spring or Summer produced a search
for tick-borne diseases like Lyme Disease, Babesiosis, and /or
Anaplasmosis (formerly known as Ehrlichiosis).
This Summer season there is
another bad actor
out there: Swine Flu, otherwise known as H1N1 Influenza. It
can
be tested for by ordering an Influenza A test which, if positive, is
further tested for Swine Flu virus. But now that is not
enough. Tick-borne diseases must also be sought (requiring
specific testing) when the patient presents with a "flu-like
illness". Please do not dismiss such symptoms and "tough it
out". Consult your physician; and share this information with
him
or her. All of these illnesses are more or less
treatable.
And all of them can produce serious consequences if not diagnosed and
specifically treated in timely fashion.
Here is a report with which I agree: "Doctors See
Benefit From
Net-searching
Patients", by Tyler Chin (American Medical News - www.amednews.com
- Aug. 15, 2005, p1). "As more people go online for health
information,
physicians are finding that research can deepen levels of conversation
during visits". So, please surf the rest of this web site, in
addition
to the Mediterranean Diet site: This is a public service gift...that
keeps
on giving.
But there are risks to patients' direct access to
frequently
raw
medical data, not yet peer reviewed, and to pharmaceutical information
which is often "mere puffery", not filtered by a "learned
intermediary".
The recent and continuing problem with COX-2 Inhibitors, and currently
the Vioxx case, are examples...with serious risks affecting both
producers
and consumers. SO, "ASK YOUR DOCTOR".
The Patient Safety and Quality Improvement Act of
2005,
recently
signed into law andalso discussed on the same page of the above
reference,
sounds good - but stay tuned. It may be too good to be
true...and
still to risky for health care providers to buy into. More to
come
on this.
And to finish this offering on another medical note, this
year
"just
a cold" may not be the right attitude...considering the past
and
possibly
continuing difficulties with getting the flu vaccine, and with the
possible
arrival here of Bird Flu - God forbid. Everyone, and
especially
people
with other illnesses, should check with their physician for anything
but
mild symptoms. Don't try to "tough it out" this time around.
GS
One of the most common dangers encountered by all of us who,
especially
in the summertime, stray to the shore, or the hills, or just to the
golf
course is the possibility of being struck by lightning. One
can
survive,
but dying is often not the worst of it. A very informative
article
on the subject appears in this month's issue of Field and Stream"
entitled
"Thunderstruck", by Keith McCafferty (p32). Unless I'm wrong,
you
don't know all that you should know in order to protect yourself and
your
family from this threat from the skies, even from the blue skies.
GS
Physicians and their patients are in tough times
partly
because,
in a mis-guided and paternalistic effort to shield their patients from
the turmoil, physicians in the 1980's and early 1990's did not keep
their
patients informed and did not seek their political help. They
also
had this quaint idea that politicians and legislators gave a damn about
their points of view and input. We all learned
otherwise.
So,
in addition to all the warnings I have been sharing since the late
1970's
(see other relevant categories on this web-site), here are
some
more
that may make a real difference to the most altruistic of your
physicians.
"Pay for Performance" is one of the
latest brainstorms
being
tested.
If not structured properly, physicians' income, already discounted over
30% from what they legitimately earn, will be based - not on
proper
procedures - but on successful outcomes. So now your
physician
would
be held responsible for your adherence to instructions, for your taking
your medications, and for all the other stupid life-style things that
you
might do...in addition to having chosen the wrong genetic stream at
conception.
"Cultural Competency Training".
Physicians
may
be required
to handle not only the medical problems of that patient from Haiti, but
also to discuss her problem in her mother tongue and with sensitivity
to
her beliefs in voodoo.
There is planned a further decrease in the already
borderline
reimbursment
for treatment of Medicare patients, stretching
several years
down
the road.
Some States are considering taxing physicians 1%
of their
gross
income
for the permission to take care of Medicaid patients.
Their
care, in which most of us participate, is often the most time-consuming
and always the very least reimbursed.
Patients take note: even the most caring and committed physicians may
decide
that they have been insulted, denigrated and marginalized once too
often.
These smart and energetic people have always had other
options.
This is not a threat. Rather, it is a call for help.
