The Medical News Report

#100

May, 2020

Samuel J LaMonte, M.D., FACS

www.themedicalnewsreport.com

Dear Readers,

  Wow!! This is the 100th report with just having celebrated the beginning of my 8^th year of reporting (began Feb, 2012). In those years, I have learned more medicine than I did in medical school. Half of what I learned then has either changed or greatly been updated. Doctors must continually update their knowledge with continuing education, but unless a physician is in a specialty, there is no way to stay up with the fast pace of changes in medicine today. Primary care doctors are the most challenged. Over the years, they have had to rely on specialists more often.

  Medicine and healthcare have become more complex, and with most doctors becoming employees and adjusting to corporate directives, the need for patients to get more information about their own individual health. But there is a lot of misinformation online. You need a trusted site, such as my website, which is always cutting edge. No ads, no cost, and always the latest medical information straight from the best medical journals.

  Telemedicine has had a jump start because of COVID-19 and is here to stay….long overdue. Doctors are, however, struggling to get paid.

  Finally, our prayers go out to those who have lost their lives with this pandemic and to those who have sacrificed their safety to care for the sick and those who have kept us going in this time of crisis. God bless our country, healthcare workers, first responders, and keep us safe and be able to recover soon to some form of normality.

  Thank you for giving me the privilege of providing you with the most up-to-date medical information available, using the top medical journal sites available.

                                                         Dr. Sam

Subjects:

**Medical Report Update on Coronavirus May 6, 2020**

1. Update on the Coronavirus (COVID-19)-where are we now and where are we going? Recovery begins!!

2. Mental Stress and the Pandemic—another crisis arises

3. The Crisis in Emergency Departments—before and after COVID-19

4. Socialism and Healthcare

5. “Sugar Babies”--College girls pay for their school debt in dangerous ways!

6. Raynaud’s disease (Syndrome)-primary vs secondary

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

Thank you,

Dr. Sam

Kuekenhof Gardens outside Amsterdam

Subjects for April, 2020:

1. Update on the Coronavirus (COVID-19) “The sun will come out tomorrow…..”; Recovery effort begins!

DAY 93 OF COVID-19 (APRIL 23,2020)

  I have sent previous updates on the coronavirus, and if you missed my last month’s April report on COVID-19, please review on my website by clicking on: www.themedicalnewsreport #99

  As of April 20, there were 803,000 confirmed cases, 44,575 deaths, and 79,000 have recovered in the U.S. With as many as 50% of people who never had symptoms and would have tested positive (there are probably close to 2 million cases), this creates a much lower death rate, and is better than most countries reporting. 34,000 died of the flu this year, but it took a whole season. We are very close to 100 days of known disease in the U.S.

Use your masks

Physical distancing 6 feet!

A. Opening Remarks

  One of the most frightening aspects about this pandemic is the speed of spread throughout the world. This has impacted all of us as this virus has been very infectious, and yet thankfully, the infection is mild in 80% of patients. This tells us, for most people, we will recover or even have no symptoms. Those with underlying medical disease make up 90% of those who have to be hospitalized, and will need to socially isolate much longer than the rest of the country as America attempts to reopen. If put on a ventilator, 88% die, because these people have little immunity due to chronic disease or immunosuppression from illness or medication. 94% admitted to the hospital had at least one risk factor in one report.

  60% of Americans have increased risks due to age or underlying diseases and will not qualify to return to work or reintegrate into society. Will they cooperate? Do they realize their susceptibility for serious illness? Ask your doctor about your individual risks and how you should adjust to reopening. Trust the governors.

  The government should provide hazardous duty pay to healthcare workers. When I was an Air Force Flight Surgeon, I flew 2 seat jets (with an accompanying pilot) and was paid hazardous duty pay for running the risk of dying in my plane. Doctors and all healthcare professionals should be shown the same courtesy. Healthcare workers love the praise, but show them in their pocketbook. Many doctors have had to close their offices and are suffering too.

  One article in NEJM-Journal Watch cited 44% of transmission of the virus comes from asymptomatic people. This is why we need masks and physical separation. Staying away from sick people is a no-brainer.

  Dr. Deborah Birz, M.D., co-lead consultant for the White House Task Force, states that it is better to think of this viral outbreak as a number of epidemics rather than a pandemic, because the disease expresses itself in very different numbers of people depending on the size and health of each county. That equates to providing varying types of guidance to communities. Cooperation from the public is mandatory for success.  

  Due to misinformation and delays from the World Health Organization (WHO) and China, everyone underestimated this pandemic and have had to accept a fast spreading virus requiring immediate action. It is postulated that if the world had been informed in December, 90% of the illnesses could have been prevented.

  184 countries are infected to some extent, and new information is pointing to a breach in safety measures (or worse) at the chief infectious disease labs in Wuhan, China. Now, Wuhan City alone recently reported over 6000 deaths now that they are being exposed (50% increase). No telling how many Chinese have died in a country of 1.6 billion people. And yet, most of the rest of the country’s big cities are reporting little disease. What are we to believe?

  As the country continues mitigation to control the virus, the curves are finally over the apex with flattening of the curves in the hotspots, and even though we are seeing more deaths, one must remember that they lag behind the infections and sickness by 10 days to 2 weeks.

  Recovery guidelines for states have begun provided by guidance from the White House Task Force, with the  governors deciding  when to reopen their states, but we must not become lackadaisical and start getting sloppy with distancing and personal hygiene. MITIGATION IS WORKING…CONTINUE TO OBEY THE ORDERS! Think physical distancing instead of social distancing.

  This pandemic has taught us some very important lessens about healthcare, our country’s resilience, and the American spirit. Doctors, nurses, all hospital employees, first responders, and even those working in necessary workplaces are risking infection and death, and we all are grateful for their courageous efforts. THANK YOU!  

  The CDC, other branches of the federal government, clinicians, and the private sector have teamed up to address the medical and economic impact to our country with a three phase recovery plan with at least 2 weeks prior to and between phases to be satisfied that more infections don’t occur. 26 million were out of work as of April 22, because the economic crisis is as devastating as the pandemic which will show up over the next year or so.

  One of the best federal waivers arose by allowing CMS* to cover telehealth. It may be here to stay. It could fill the gap in reaching more Americans than ever before, preventing unnecessary face-to-face medical visits and is  providing welcome relief to the overstretched healthcare system working tirelessly on the viral outbreak. People’s ongoing illnesses must be managed. *Center for Medicaid and Medicare Services

  Providing adequate protection for our healthcare workers must be maintained, while 4% of hospital personnel are testing positive.

  America is answering the call to cooperate with authorities for the most part. Lets keep it up!!

  MITIGATION WORKS!! KEEP IT UP! LOOK AT THIS CHART from the WHO and CDC.

This chart demonstrates how bad it would have been without protective measures, i.e. mitigation and how much better it actually is. This is an example of why the public health measures are necessary to project the potential harm from the pandemic.

B. COVID-19 is a systemic disease

  As physicians and other healthcare workers treat thousands of very sick patients, it is becoming clear that, even though the lung seems to be a primary target, all organs are being injured.

  This disease is a blood disease (viral sepsis), causing thickening of the blood (requiring blood thinners), injury to multiple organs (heart, lung, liver, gut, and kidney disease), requiring intensive care for the disease but also the underlying illnesses that complicate this viral infection.

  As many as a third of patients may have neurological deficits (headache, dizziness, nerve pain or numbness, and muscle inflammation). Severely infected patients are more likely to have strokes, unconsciousness, seizures, etc. JAMA Neurology, April 10, 2020

  Gastrointestinal symptoms (abdominal pain and diarrhea) were found in half the test positive patients, and half of them had no cough or obvious respiratory symptoms. Stool samples had persistent virus present in 70% of them long after virus was absent in the respiratory tract in one study. This is of great concern for perpetuation of spread of the virus.

  10% of patients are admitted to the hospital, and about 10% of them required immediate mechanical ventilation with another 15% within 2 days, according to physicians at Stony Brook Hospital, New York.

  The ventilators, although necessary to prevent hypoxia,  over time can cause serious abnormalities of the lung by applying the standard high pressure normally recommended in other lung conditions. (The higher pressure is normally needed to raise the oxygen levels in the blood).

  Doctors are finding that adjustments in ventilators are still able to provide adequate oxygen levels to the body, using lower pressures on the ventilator. When pneumonia replaces lung volume, oxygenation becomes more critical, and in many of the cases, that requires a ventilator necessitating the patient to be paralyzed with medications to tolerate the endotracheal tube down the throat into the lungs and allowing mechanical ventilation with maximal oxygenation.

  This systemic disease is hitting those with aging and underlying diseases (comorbidities) the hardest, but it still can kill healthy people at any age. Age, obesity, and heart disease are the top reasons people have a more severe case.

  The black and Hispanic communities are disproportunately affected. Their higher rate of underlying diseases are one of the main reasons for higher numbers—these populations are burdened with a 40% higher rate of hypertension, 20% higher heart disease rates, and 60% higher diabetes rate. Obesity is epidemic in these populations, and one of the main factors for these racial disparities.

  Genetics and social issues play a role as well. Being black and poor plays a major role. Overcrowding in many poor homes also plays a role in disseminating infectious disease.

  Many patients have to take corticosteroids to manage their disorders, including asthma, COPD, inflammatory bowel disease, arthritis, lupus, sarcoid, some cancers, and other disorders. When people take corticosteroids, the adrenal gland quits making cortisone. When the body is stressed, it can’t respond with added adrenal secretions of steroid necessary to combat such challenges as the cytokine storm*, which occurs in seriously ill COVID-19 patients. Also taking steroids lowers the immune response, which is why these patients are at higher risk.

*cytokine storm=inflammatory markers flood the body creating organ failure and collapse of the vascular system.

  Several blood chemistry levels are often elevated including liver enzymes, kidney function studies, lactic dehydrogenase, troponin, brain peptides, d-dimer, inflammatory markers (cytokines, etc.). Kidney failure often occurs with those on ventilators, now stressing the supply of dialysis machines.

  Looking at the most serious cases, acute respiratory distress syndrome (ARDS) was present in 100%, sepsis 100%-bacteria in the blood, acute cardiac injury 77%, heart failure 49%, kidney failure 25%, encephalopathy 20%. Long term effects on those who survive will be serious.

  When COVID-19 attacks the body, the blood pressure goes up dramatically in response the inflammation of the organs, and if the blood pressure is already high, this will increase the chance for heart attack, stroke, and other disease failure.

  Obesity (waist line >34 inches in women, >37 inches in men) doubles the risk of hospitalization. 40% of our immune system is in the gut, and obese people have too much fat in their abdominal organs, which causes inflammation and diminishes immunity.

  Now that we are at home, there should be no excuse not to exercise. Get off the couch and walk, do yoga, stretch, do jumping jacks, burn some calories, etc. If a person is emotionally eating more, exercise is a must to counter those extra calories.

  84 million Americans (1 in 3 people) are either pre-diabetic or type diabetic. These people are 7X more likely to die of COVID-19, due to the chronic inflammatory state diabetes creates, according to Dr. Mark Hyman, M.D., author of Food Fix, strongly recommends a plant based diet to keep spikes in blood sugar plus pre-biotic and pro-biotic foods. Stabilizing the blood sugar lowers craving.    

C. Comparing patients who died versus recovered:

  The latest death rate in the U.S. is 44,500 as of April 20  far below the projected models put out by the CDC. 0.2% of people will contract the virus and 98% will recover. Those who recover usually are younger and have fewer underlying diseases. Those over 80 are the most likely to succumb to the infection. Interestingly, asthma, thought to increase the risk of serious disease has not proven to be as true. There will be an enormous amount of data published after this virus subsides.

D. Differences in age groups, gender, and race

  A study reported considerable difference in blood studies from the infection and gives doctors an idea of how the body is fighting the illness.

Compare patients at age 68 vs. 51:

a) The older group is more likely to be male (73% vs 55).

b) The white blood cell count (neutrophils) count much higher in older (50% vs. 4%). Higher neutrophil counts correlate with severity of illness.

c) A low lymphocyte white cell count is lower in the older group (91% vs 47%)—an indication of a more severe infection overwhelming the white cells responsible for immune response.

d) Clotting problems are a serious issue for both groups but more for the older group, and correlates with older patients having more heart and lung disease to complicate the illness. Blood thinners are used to prevent clots to vital organs.

e) Liver and kidney functions can fail, increasing the likelihood of death. Many may have ongoing organ failure long term, including the need for kidney dialysis, which has created another shortage of machines.

f) Men have higher infection rates than women, even more at earlier age. That discrepancy starts to narrow after menopause. That tells us that estrogen has an impact on immunity.

g) Testing positive by age group:

     25 or younger-11% positive,

     25-45—17%,

     45-65—21%

     65-85--24%  

     25-50% test positive are asymptomatic, but currently are not being tested, according to the CDC.

  The problem with relying on tests is this--if the test is negative, the person could get exposed the next day, and test positive within a few days.   

h) Smoking and vaping are more common in men more than women, men are more careless about personal hygiene with exhibit more reckless behavior overall.

i) Men also do not respond as well to vaccines as women (for most vaccinations). Women have two X chromosomes and men only one (XY). X-chromosome have more protective genes against infection than the Y chromosome.

E. Treatment innovations; unproven drugs and dietary supplements; blood pressure medicine and the virus

  While there is more hype about hydroxychlorquine/Z-pak, Remdesivir, convalescent plasma (antibody transfusions) from previously infected patients, and other antiviral agents are being tested and some uncontrolled studies are showing some improvements in treating patients in serious condition.

  But randomized clinical trials are pending and no medication is approved by the FDA to treat COVID-19, even though they have been fast tracked to be allowed in certain hospitals.

  There are some preliminary studies that show harm with the use of this combination especially if used late in the disease. These drugs need to given as early as possible before a patient is overwhelmed with infection to show much value.

  Remdesivir, an antiviral, have had mixed reviews, but is still promising. The clinical trials are not complete. How early can it be used? That is the key.

  Convalescent plasma is also showing significant therapy.

  While we have gone from over-scaring people (because people won’t obey the rules unless they are scared) to being able to consider economic reintegration, there are a lot of unproven treatments on the internet, TV, and word of mouth. BEWARE!

  Most of the herbal and supplement industry is promoting these products to prevent or lessen the illness from COVID-19. The attitude of the public is “I might as well try it, and if it works or does not work, no big deal”. People need hope and control, and purchasing “hopeful” substances is one way people feel more in control, but it is false hope.

  High doses of Vitamin B, C, and D have never been proven to help prevent viruses. All they do is send most of out in the urine untouched by our liver, since the liver can store only so much of these vitamins. These substances can’t just circulate around the blood and be more effective.

  Recently zinc lozenges has been promoted as a preventative, because there is some weak evidence it may help get people over “colds” more rapidly. This is a classic example of assuming if it may help one illness, it likely will help another. Studies have never shown much improvement with using zinc lozenges at current recommended doses.

  20mg is the recommended daily dietary dose of zinc (easily obtained in our diet), but ICU doctors are using it intravenously (220mg) added to hydroxychloroquine and the Z-pack. Published results are still pending. When multiple therapies are combined, it is impossible to know what is working with randomized trials.

  The bottom line is….don’t jump and consume large oral doses of zinc or any supplement out of fear and without a doctor’s approval.

  Side effects of zinc (loss of taste, gastrointestinal upset, etc.) can certainly occur and drug interactions can happen too. And COVID-19 can interfere with the smell and taste as it is, as the entire respiratory tract is inflamed.

The virus and blood pressure medicine controversy

There are certain blood pressure medicines that share the same sites on the cell wall as the coronavirus. Angiotensin converting enzyme (ACE inhibitors) is a central component of the rennin-angiotensin system (RAS) converting angiotensin I to angiotensin II, the active blood vessel constrictor. People with hypertension are prone to more severe illness from the virus (almost twice). Is it because of these antihypertensives?

  Both ACE inhibitors and ARBs** (angiotensin receptor blocker) are very common blood pressure medicines, and because of the news and social media, people are concerned about staying on these medications. The concern is that these medications will increase the expression of the virus in the heart, brain, and kidneys (all 3 organs involved in COVID-19).

  The Council on Hypertension and the American College of Cardiology strongly recommends that those taking these anti-hypertensives continue these antihypertensives, because to date, there is no clinical or scientific evidence that these meds should be stopped.

  Please discuss this with the treating doctor and DO NOT STOP THESE MEDS WITHOUT CONSULTATION. Perhaps, alternatives can be prescribed, but it is up to the doctor. Unchecked blood pressure is much more hazardous than this virus.  JAMA Network, March 24, 2020

** common ACE inhibitors (Lotensin, Captopril, Prinivil, etc.) and ARBs (Cozaar, Avopro, Benicar, Edarb, etc.)

F. Who can get tested now? Infection tests, Antibody and saliva tests; Reinfection?

a) Rolling out tests

  According to Dr. Deborah Birz, M.D., co-coordinator for the White House COVID-19 Task Force stated that due to a very aggressive mobilization of the private sector and the CDC, the number of diagnostic tests has improved from 300,000 tests per week to 3 million in just 3 weeks to 150,000 per day with the need for perhaps 300,000 per day. Harvard Researchers say we need 500-750,000 tests daily to safely return to work. These tests are not widely available outside the hospital. This will create controversy about reopening the states for those that insist these tests must be available before that decision. How long can our country stay locked down and survive? We are about to find out.

b) It was announced that there is an FDA approved home test kit (using a swab just around the inside rim of the nostrils) which will soon be made available with a doctor’s prescription, an exciting advance. Any home test (blood or swab) will always be less sensitive due to collector’s errors.

c) It is important to understand that testing is not the only method to determine when America can get back to work. It is a state-federal partnership that will accomplish this goal using the number of cases, deaths, and bending of the curves. Ultimately, the governors will decide and don’t expect uniformity.

d) Negative test people might show a positive test again but experts say it is very unlikely to get the infection again shortly after being infected the first time. Forget the hype of the media. The antibodies from the infection would prevent that unless, in certain cases, the immune response was poor.

e) A new infection in the fall is still to be determined, but experts state that the infection would be much less severe because over because a percentage of the country will have some type of immunity and self-isolation will occur much faster.

  Dr. Birz stated that the country will be much better prepared to deal with the next round of infection should it occur. Most of the country needs reassurance, not worse case scenarios for the media to exploit.

  We will still need to practice physical distancing for months. Time will tell when we can return to casual close contact with people.

  If some governors are too dependent on testing alone to decide reopening, their states will lag economically, but only time will tell. Balancing harm vs economic relief is quite a challenge.

f) Those with any symptoms of COVID-19 are allowed to get drive-through testing now without a doctor’s order, (do not go to a healthcare facility), but antibody tests (see below) are not available yet. It is still important to contact the primary care doctor about steps to take if symptomatic. Also those who have been exposed to a positive tested person are allowed to get tested (in your family for instance).

g) Asymptomatic people who might be positive can’t get tested yet. Also many of those people will test negative for the virus as soon as they “recover” since these tests have are not always reliable (up to 40% could have a false negative test).  

h) A saliva test is being evaluated instead of nasal and throat swabs to diagnose COVID-19. Hopefully, it will prove just as effective as nasal swabs.

i) The antibody-based serology test using a finger stick is being evaluated and used now, but mostly in the hospitals to determine what healthcare workers are safe to work. Results are available in 10-15 minutes.

  As of April 21, there have been 4 FDA approved antibody tests. How this will be used and compared in its value will be evaluated as they are distributed.

  Preliminary reports from the WHO have not confirmed that a significant percent of those who have been infected have shown adequate antibody titers in the blood, so it remains to be seen whether antibody tests will solve the government’s problem of reopening.

j) The antibodies come from 2 immunoglobulins can be checked for immune response: (IgM) for active infection and IgG for level of immunity.  This test could be used to survey a population for infection and adequate immunity to safely go back to work with little fear of contracting or transmitting the virus. It remains to be proven.  Nursing homes are in great need of these tests as would be schools and places where people could congregate.

k) At home swabs for testing are not FDA approved yet, but being evaluated.

l) Process for finger stick antibody test when available

  Through telemedicine, one could contact a doctor and request the test and the qualified doctor could decide if the person qualifies. A test kit would be sent to the home or picked up at a pharmacy. The sample is a finger prick.  Medpage Today

This test measures the amount of immunoglobulins (IGM, IgG, IgA) in the blood, and if high enough, can provide life saving plasma to 4 other patients. Nursing home people and hospitals will need this antibody test immediately.

  Up to 50% of asymptomatic people are infected and will show varying levels of these antibodies. Those who have low levels might get re-infected. Those with high levels can donate their plasma to others (convalescent plasma) and have shown significant improvement in many patients. Developing these antibodies occurs at different times depending on the severity of the infections.

m) Pregnant women

  15% of pregnant women coming in for delivery in one hospital setting tested positive, and 88% of that group were asymptomatic. This is another example of how often asymptomatic people have been exposed to the virus. Previous studies have shown that these viruses do not transfer to the baby via the placenta. Further studies in time will prove or disprove that these babies will have no adverse disorders as they grow.

n) Convalescent Plasma—antibodies (IgG) from those recovered can be donated at a blood bank. These patients can qualify as donors after 2 weeks of complete recovery.

o) Use of hyperimmune serum gamma globulin shots have been used for decades for those low on gamma globulins and are being used in some COVID-19 patiens. Results of studies are ongoing.

p) CAUTION!  Don’t fall for online viral and antibody testing scams that state they are FDA approved, as they are not FDA approved and likely will have large false positive and negative results. 90 different companies have applied for approval, and it is very different to be in the process of approval and being approved.

q) Testing everyone is not practical and will not occur in the near future if ever. Spot testing of groups, facilities, especially healthcare facilities and nursing homes will be used for months and perhaps years. China has an app to provide individuals proof of their test results and status. This may work for us.

Summary--- Point of testing results is the goal for any test. Do not confuse the PCR diagnostic test to diagnose the illness and the antibody test which tests a person’s immunity against the virus.  

G. Clinical course of patients recovering from COVID-19; When are they not contagious? Seasonal variation?

a) There are many varying stories of recovery, but depending on the severity of the disease, recovery could take weeks to months especially those who were hospitalized. The 80% who develop minimal to mild diseases will recover in a matter of days but may still be contagious. These people are not getting tested.

  Depending on co-morbidities, the underlying disease may determine how fast a patient recovers depending on whether that organ or organs is involved in the disease process. Return to a normal life may take months and may not even be attained. Lab results will need to be followed for months.

b) People with type A blood may be more susceptible to this virus. There is no reason known, but evidence collected on people with the virus. People with type A blood (or type AB) are the most needed to donate blood if they have recovered, because those with type A blood compose the greatest number of patients in the hospital.

I donated blood today (April 23), how ‘bout you?

c) Contagion index of COVID-19

  R0 is the designation of how infectious a virus can be. R0 for COVID-19 is thought to be R5.7 (flu has an RO of 1.1), and means that one person could infect 5.7 other people, and as that infection spreads to even others, the total number infected could be potentially 1280 people.

  It is clear this virus is one of the most contagious viruses to ever hit the U.S. This is the reason social isolation of infected people must occur, but it still leaves up to 50% who might be infected who have no symptoms and don’t know they have infected.

d) Contact tracing

  This concept is a classic public health method, by investigating those people that may have been in contact with an infected person. It is a massive undertaking, but is helpful in concluding that specific areas of the country can reopen.

  Thousands of phone calls and digital interventions will accomplish this effort with speedy reports to public health officials. Understanding where the disease exists in specific states is critical.

e) When are patients non-contagious?

  Patients are probably not contagious from the time of the last symptom and no fever (for at least 3 days) after 14 days regardless of the severity of symptoms according to the CDC.

What about seasonal variation?

  No one knows yet, but Australia, already in late fall is not showing a resurgence, since their seasons are reversed south of the equator. The Director of the CDC, Robert Redfield, stated that it is very possible, since most viruses do not spread well in warm weather. Certainly the number of cases in Florida are not high as projected by the CDC.

Will a vaccine be ready in time before a possible outbreak occurs next fall or winter?

  No one knows yet, but most novel viruses that have a vaccine create immunity for an extended period of time. But, clearance for a national vaccine may take the FDA several months to a year or so before the safety and efficacy can be proven. There are dozens of vaccines being developed, and which one becomes the standard remains to be seen. If an outbreak occurs in the fall, that would be a perfect place to perform a clinical trial with a potentially good vaccine.  

  Since COVID-19 has never appeared before, time will tell if those who were infected will have lasting immunity. Once a significant number of people have had immunity (antibody) testing, it will become clearer how strong the defense is, since some may not react immunologically as strong as others depending on the viral load. We must know this information.

  One thing for sure, every person able to get the vaccine next year should. Those anti-vaccine people may want to reconsider their position with this preventative.

I. What about our animals?

  Veterinarians have stated that animals can acquire coronaviruses and can pass them along to other animals. Cats seem to be more vulnerable to develop symptoms from these viruses, and 2 tigers in a zoo did test positive as developed a cough but were not ill.

  There is no research to prove that they can infect humans. There is a concern of the fur of animals being petted by others and be a transmitting surface to humans. Therefore, it is recommended not to let people pet your animals. Wash your hands after petting your animal (that would be 100X a day for me). Give your pets baths often and brush their fur. If they develop respiratory symptoms, please call the veterinarian.

J. White House Task Force-- first steps to reintegrate our workforce to society and recover our economy: the gating criteria

  Our healthcare workers are the most crucial workforce to treat this virus and need to stay at work. They need protective equipment and time off to keep from burning out.  

  The CDC guidance for essential workers including healthcare workers and other groups are: 1) Take temperature before going to work 2) Wear a mask at all times while at work 3) Strict adherence to social distancing 4) If any illness begins, immediately go home. It sounds a lot like common sense for anyone returning to any job.

  The White House Task Force’s guidelines for reopening the country can be viewed by clicking on: www.whitehouse.gov/openingamerica   

  There must be a staggered return to work based on each state and city’s disease burden, and how fast the number of cases is dropping. Governors who decide when to return to work and lift restrictions in consultation with the federal task force. Pray this can begin in May or June.

  3 metrics (Gating Criteria) will guide the way to start the 3 phases of recovery: (this is already happening)

1) rate of new cases decreasing

2) rate and number of hospitalizations decreasing

3) new admissions to the ICU dropping

CMS* guidance for beginning healthcare services

  Testing capability must play a significant role. Elective surgeries will start in certain state based on facility capability and necessity of procedures based on medical need. High complexity chronic disease management can begin with non-COVID zones with strict surveillance of all personnel and patients for fever, symptoms, etc. Areas of low viral incidence should begin initially.

*CMS=Centers for Medicare and Medicaid Services

  Those decisions may be very different for governors in less crowded states and lower populations. We can expect certain areas to jump the gun and cause mini outbreaks.

  Temporary suspension of immigration and selective airline suspension is another attempt to protect Americans from the virus and their ability to get jobs when allowed. This does not affect those seeking a work permit….only those seeking permanent residency (green card). With the economic crisis which will last for years, money is going to needed to take care of our own. We are a caring and loving country, but to remain strong, we must get Americans back on their feet first.    

  Look at this mask after a cough in this healthcare worker.

K. The WHO and China must be held accountable!!

  The World Health Organization and China must be held accountable. The world needs a global health agency that is unbiased and not dominated by countries like China. We are paying more than any country to the WHO (much more than China). It is known that Chinese whistleblowers were shutdown rather quickly by their government under great duress trying to suppress information on the magnitude of the pandemic, that it was passing from human to human. They shut down travel from Wuhan to the rest of China but allowed all travel out of their country, which contaminated the world in a matter of weeks.

  A female Chinese researchist, Xing Lou Yang, has published articles as far back as 2013 that the SARS-like viruses (COVID-19) can infect humans with the probable source of bats. She published in the journal, Nature, on Feb. 3, 2020, that the pneumonias seen in Wuhan were coronavirus and probably of bat origin.

  She also defined the genome sequence of the coronavirus. The theory of a lab origin remains to be proven. You are familiar with the death of a whistleblower (neurosurgeon and Chief of Staff of a hospital) in Wuhan. He supposedly died of COVID-19. There are accusations of bio-safety issues in their equivalent facility to our CDC in Wuhan, China. Gordon Chang, well-known Asian consultant, was interviewed on Epoch Times.

  Right or wrong the NIH* of the U.S. has been funding such research in China for sometime, according to Senator Ted Cruz. *NIH=National Institutes of Health

L. What positive things have happened with this pandemic?

  We must always keep infections and other health hazards in perspective. While social isolation has been going on and successful, it also prevents asymptomatic spread, which is how herd immunity can happen.

  Crime has dropped significantly in our country. Traffic accidents and many other causes of injury and death are exceedingly low. Collateral damage to our country and Americans will far outweigh the disease. So is the cure worse than the disease? That will be debated for months, even years. 

  The #1 painful benefit (if we see it that way) has been a brutal lesson that the U.S. needs to become independent of other countries for our medical and disaster preparedness needs. Proper funding by our congress for public health and research is also part of the equation for the future.  

  Less traffic is equating to fewer accidents and deaths. Social isolation provides for fewer emergencies outside the home. Families are relying on each other for a change and not other people outside the home. Injuries are down, less high risk activity computes to less human harm.

  As social isolation began, there was little flu diagnosed, because people were not touching each other…a lesson learned. We can really reduce flu cases in the future with more careful hygiene and even less human contact.

  Although seemingly a negative, experiencing this pandemic has awakened the need for much better disaster preparedness from a state and federal standpoint. The speed of the response has been incredible to mobilize our federal and state agencies. Yes….the political pendants will fight to death on how late and poor the response was, but has anyone said how they would have done it better? .

  As vaccines become available, it is stated by some experts that these preventative vaccines will be much more effective than flu vaccines, since COVID-19 does not appear to mutate as readily as flu.

M. The Other Negatives from the Pandemic

  We are facing a landslide of preventable illness, because people have been told by the government that non-essential procedures and screening techniques need to be put off, but now that reopening is being considered, Thousands (even millions) won’t have to put off near emergent issues, however, and some won’t go because they fear getting the virus.

  Hospitals are seeing people who waited too long to seek care and need more intensive treatment. There are delays in disease diagnosis and treatment. Americans must call their doctor and discuss options for care and if in trouble, please call 911.

  Patients with COVID-19 are totally isolated from the rest of the hospital population, therefore patients should feel comfortable going to outpatient facilities for elective and preventative procedures.

  Our hospitals are partially empty (except the ICU and emergency rooms) and desperately need the revenue to stay open and not furlough more staff. We are already seeing rural hospitals close across the country, and I am concerned many more will close, leaving rural America without a hospital or clinic. Even starting up elective procedures will still take weeks to months to be fully implemented.

  States are letting certain prisoners out of jail because of the fear of the virus spreading inside the prison and some are already being arrested for crimes. There was a murder reported the middle of April just 2 weeks after this prisoner was released because of the pandemic. Scary!!

  The legal profession will create a psunami of lawsuits over this pandemic making a terrible situation worse, I fear. 

  Behavior modification regarding personal hygiene and physical separation will need to occur for the foreseeable future. We must all work together…we can!

  One final point! When it is time to get the flu shot in the fall, for God’s sake, get it, so we don’t have a horrible flu season should we have a resurgence of COVID-19. Vaccines are not going to be ready in the fall.

   Mental health and the pandemic follows in the next article below!

2. Mental Health--Stress and the Pandemic—another pandemic arises

  Stress can lead to disease without question….not only physical but mental—the mind-body connection. Each age group will experience different ways of expressing their stress. Family units must understand this and deal with crisis somewhat differently. We must all have hope and faith that this pandemic will be over, but for now, we must expect different expressions of fear, anxiety, anger, and depression. The important issue is to limit the long term effects of this crisis.

  Anger is rising as people are fed up with staying home. America needs to get back to work, school, and play not only for economic reasons but true physical and mental illness prevention. Large scale testing is not practical anytime soon, and it may be more important to protect the vulnerable rather the healthy. 90% of cases in the hospital are from the vulnerable population (older, chronic disease, disability, nursng home, etc.).

A. Healthcare workers and first responders hard hit

  The country has had to adapt to an enormous crisis on many different levels. Some of our healthcare workers are going to come out of this with PTSD, substance abuse, depression, and burnout; it is reported that 50% of China’s doctors and nurses are suffering from depression.  

  People who have serious underlying disease have been scared to death they will be infected, families have had to be cooped up with each other for weeks creating increased domestic and substance abuse, and those with ongoing mental health issues are suffering even more.

  A published study from China regarding healthcare professionals analyzed 1257 workers and found that 50% had depression, 45% anxiety, 34% insomnia, and 72% had significant feelings of distress and fatigue. It was highest in women, nurses, and those who were directly caring for COVID-19 patients. JAMA Network, March 23, 2020

B. Effect on Generation Z and millennials and their parents

  Those age 23 and younger are having a very hard time with social isolation. It was recently stated that for the young people, this is their 9-11, according to Jason Dorsey, president of the Generational Kinetics that focuses on Gen-Z and millennials.

  Long term effects of the virus for children and young people are putting a huge amount of pressure on parents. Allowing everyone to express their feelings is the best way to work through this virus. Physical activity and communication will help greatly as outlets for stress. Talk to children about their feelings, fears, and concerns.

  April was child abuse prevention month, and domestic abuse including children is already on the rise with stay at home rules and schools closed. Please report child abuse!!

  State agencies are reporting fewer abuse cases, perhaps because mothers and children are trapped at home and cannot get away to report the abuse. They are suffering in silence!!

 National Child Abuse Hotline 1-800-4-A-CHILD

  Young people are losing their grandparents, parents, and even friends from COVID-19 and other illnesses. Facing mortality will have a greater impact on these generations the longest and may create changes in behavior…good and bad. And families can’t even see their sick loved ones and go to a funeral.

  By the same token, parents are burning out having their children at home, but when schools do open and people can go back to work, daycare needs to support that workforce.

  Young people in isolation are not used to being away from their friends. Social media may be their only means of communication, and it is well known that kids can be very mean online. Bullying is just one of the stresses they endure.    

  Technology (social media) has affected these young people greater than any other generation and now is consuming even more of their time than pre-COVID-19.

   Disappointments such as cancelling graduations, taking trips with friends, and seeking summer employment is all being greatly affected. Wages tend to be lower during recessions as well.  

  Isolation and fear will certainly make pre-existing psychiatric disorders worse. This group tends to be in the service industry, most hit by this pandemic.

  It is suggested that this pandemic will lead to even more ties with a very progressive ideology toward the government for safety and protection including universal basic income and Medicare for all healthcare.

  Unintended pregnancy during this crisis will be an inevitability. A study on women who experienced intimate partner violence were less likely to take their contraceptives. It is believed to occur because these women are depressed and don’t care for themselves properly including using contraception. OB-GYN, March 10,2020

C. There has been little normal life for weeks and our patience is being tested

  Our friends and family are getting sick and thousands are dying (including first responders and healthcare providers). Visitation is not being allowed, and closure with funerals are being delayed.  

  The loss of human touch is causing difficulty for intimacy and how we approach and greet people will be changed for a long time. When will solitude be a choice instead of an order? We are developing a form of chronic fatigue syndrome.

  Human nature requires predictability some experts say, and not knowing the outcome of this crisis is going to scar us. PTSD could be widespread, depending on how it is defined.

  Those losing a job (22 million Americans as of April 16), not being able to pay bills, not having enough food and basic necessities is keeping us extremely anxious and desperate.

  But, the recovery of our country was outlined on April 16 by Dr. Deborah Burz, M.D., of the White House Pandemic Task Force. It will take many weeks to work through the 3 phases of recovery, and the timetable will be very different in every corner of the country.

  29 states are on the verge of taking steps to begin Phase 1. This is enormously hopeful news for those who are out of a job, have medical needs that need meeting, and bills that need paying. This will prevent enormous healthcare issues if the return is a success, but it is not up to our leaders…..it is up to the American people to follow the guidelines.

  The hallmark of maintaining a good grasp on reality and not getting depressed requires good sleep (at least 7-8 hours), exercise, and getting away from 24 hour coverage of the media stuffed down our throats with glamorization of the worst case scenarios. Add an election year, and the increased nastiness on TV, and we have a perfect storm for anger, depression, worry, sleeplessness, and a drop in our immune system, which is the absolute last thing we need when trying to prevent infection. Turn off the news and watch a movie!!

  Exercise is the best medicine--yoga, stretching, taking long walks, bicycling, or any other non-participating sport to relieve tension until we can resume gym participation (soon) and group sports.

  We must be concerned that our healthcare workers will weather this enormous storm they have shouldered and be ready to care for our routine medical needs when this virus is gone. I am confident they will, because we are trained to. The medical profession has done us proud!!

  There will be great temptation to violate the rules of social distancng especially for those who have pre-existing conditions. Those who had subclinical anxiety and depression will find it to be more of a problem needing counseling. Thanks to telemedicine, thousands will be able to be assisted online.

  Germaphobes will find it especially difficult to reintegrate to normality, as this pandemic has strengthened their fears of catching disease through contact. A certain amount of caution is welcome, but will they be able to continue human to human contact?

  It is not enough to tell people it is normal to be depressed, worry, but in fact, any crisis demands better toleration of difficult circumstances.

  We must be positive with hope for an end to this crisis and our leaders are already starting to give us a path back to a new normal….and WE WILL DO IT. I pray politics regarding this issue can take a back seat, but….you know it won’t, and with social distancing, people’s political ideology may separate us further, if that is possible.

  We need to be praying to our higher powers for strength and perseverance. Pray America!! We need back in our places of worship (GROUPS OF 50 IS ACCEPTABLE WITH APPROPIATE SOCIAL DISTANCING).  

  The hope of return to some kind of normality and a vaccine that will prevent this disease in the future will go a long way to be the psychosocial medicine needed to recover from from a mental health standpoint. Mental Health and the COVID-19 Pandemic, NEJM, April 13, 2020

Effect on the opioid crisis

  It will take time for the impact to be determined, but plan on seeing an uptick in opioid abuse in a time when social isolation is occurring and also every other legal and illegal substance that affects the brain.   

3. The crisis in the emergency room-before and during the Pandemic

  I have spent a lifetime in emergency rooms (now called departments). I moonlighted in ERs when there were no specialists in emergency medicine. As a resident, I spent hours and hours in the ER or took the more serious patients to surgery. For 30 years, I was on call as often as every 4^th night, repairing facial injuries and other emergencies. Never did I feel like care was deferred or delayed because of inadequate staffing. That is not the case today. A emergency department nurse resigned and here are some of her reasons:

  Her ability to perform acceptable care for her patients reached a crisis when her shifts were staffed with one triage nurse from 7-11 for an entire department, and no nurses available for medical screening to make decisions about the urgency of being seen and treated. The volume has increased exponentially in the past 20-30 years because so many people continue to abuse what an ER is meant for. These people have no insurance, often don’t speak English, and bring their whole family in creating chaos in the waiting rooms.

  She stated only 2 trauma nurse were on duty for this large public hospital. She stated the technical support (lab, X-ray, cleaning, transportation, space for EMTs, police, etc.) was lacking.

  Keeping up with electronic medical records, billing, etc. was also lacking in adequate staffing. She stated she had to perform non-nurse duties out of necessity.

  The bottom line is this is a responsibility of the hospital, and in many emergency departments throughout this great land, this is the same song.

  Most doctors have called the ER the “knife and gun club” for as long as I have been a physician (51 years). When I was teaching at LSU medical school residency program in New Orleans, the emergency department at Charity Hospital was the classic crisis ER, with people lying on the floors up and down the halls waiting for care.

  This nurse stated that only 2 nurses were responsible for nine critical care units in the ER. This is just one of her great concerns for the nursing staff having to endure such stress but the patients who were receiving less than adequate care.

  Nurse Jardino stated it well, “I am leaving a job and a department I love because the hospital continues to ignore the call for reform and change, choosing to ignore patient safety concerns and employee well-being. I am leaving because my personal and professional morals are regularly colliding with misdirected values of the system being put in place”.

  Burnout for physicians and nurses is at an all time high thanks to larger medical centers and hospital administrators pushing their staff to the limit. With this pandemic, it has been magnified many times over. Board room investors are looking for a return on their investments and that has gotten in the way of good healthcare.

  The avalanche of immigrants (legal and illegal), the federal regulations and insurance carrier’s rules for reimbursement have driven a stake in the heart of health care providers. The thought of the government taking over healthcare saddens me greatly.

  Times are tough for hospitals, but if they are to function as a quality facilty, they must make enough money to keep the doors open, but doing it at the expense of their medical and nursing staff is outrageous.

  The feds have made it just as hard on hospitals to make money as it has on doctors and their staff with monster regulations. Now they pay them on the basis of quality of care, by fining them as much as 5% of their Medicaid and Medicare revenue if they don’t comply.

  Keep in mind, most hospitals only make 4% above cost, and must depend on private insurance to keep their head above water to sustain that 4%, since Medicare only provides 80% of the hospital’s overhead costs for caring for Medicaid and Medicare patients.

4. Socialism and healthcare

  I have discussed Bernie Sanders’ socialistic health plan in his platform in the past. Bernie might have bowed out, but he has not gone away, as former VP Biden needs Bernie’s socialist supporters and seems to have been moved further to the left to be able to compete with President Trump.

  Much is at stake for our country, and there are a great number of Americans (especially young people) who think they want our country to go socialistic without really having a clue about the true definition of socialism and what it entails. For those who understand exactly what socialism will do to our country and still support that ideology, that is your right in a free country.

  It is clear the divisiveness in our politics is slowing down progress on many of the country’s most important issues while we struggle to begin with recovering from the pandemic with the 3 phases outlined by the White House Task Force.

  Many people especially young people do not understand socialism. Socialism supports fundamentally changing the entire political structure taking individual responsibility and giving it to the government.

  Offering free education, forgiving student loans, free healthcare, destroying a capitalistic society, as you know. As we struggle to recover from a pandemic, how does socialism tell entire industries to go away?

  How will this country recover financially from this pandemic while burdening the taxpayer with the essentially the other half of the population including illegal immigrants and opening our borders to more dependent people to support a socialistic society?

  Socialism supports collective control of the economy, the energy and health industry, the productivity of the country, political revolution, and expecting tax payers to carry the burden of nearly half of the country who pay little or no taxes. The pandemic will already burden the next two generations.

  The final step of socialism is to eliminate the middle class leaving only the poor and the rich. With a price tag of $60 trillion over 10 years for Medicare for all, who will pay? How will that compute with the $trillions of dollars that this pandemic is costing the taxpayer and every American on top of that price tag for socialism?

Socialism and Single Payer healthcare

  How does a federal single payer system play into a socialized country?

“Equality for all in healthcare is a myth, because no matter how medical care is provided, there will always be inequality in access, disease intervention, responsibility of patients, and results from treatment.The only thing socialism has ever created is equality in misery and poverty”. Want to read more from the author of these comments ? Check out Thomas DiLorenzo-The Problem with Socialism—see below:

Saul Alinsky is often linked to creating steps to a socialistic society, which includes a single payer federal healthcare program. This original community organizer was the author of 1971 book “Rules for Radicals”. 

  He went to undergraduate and did postgraduate work at the University of Chicago. I am sure Dr. Bill Ayers found his work fascinating. Hillary Clinton did her master’s thesis on Saul Alinsky. Most forget that President Barack Obama (originally) proposed a single payer system but had to settle for Obamacare.

  32 of the 33 civilized countries have some form of universal healthcare. Can America accept it?

  Although Snopes states that the rules for the creation of a socialistic society came from the “Communist Rules for Revolution”, not Saul Alinsky, it really does not matter who created them, but it is important to see what is said. There is a lot of misinformation out there about these principles, but it is for the reader to decide if they agree with the ideology or not.

www.snopes.com/saul-alinsky-dedicated-rules-for-radicals-to-lucifer/

Below are the 8 rules for creating a socialistic state, no matter who wrote them, but they follow Alinsky’s Rules for Radicals written in his last year of life.

1. Healthcare—control healthcare, and you can control the people.

2. Poverty—Have as much poverty as possible. Poor people are much easier to control.

3. Debt—Raise the debt as high as possible. Increase taxes as high as possible. That way people stay poor.

4. Gun Control—take away the guns, and you control the people and can create a police state.

5. Welfare State—another way to control the people with the amount of food, housing, and income can have.

6. Education—take control of what people can read and learn, and listen to on social media and television.

7. Religion—remove religion and create secularism.

8. Class warfare—divide the people into the wealthy and poor, and destroy the middle class. Tax the rich and give to the poor, which cause greater discontent.

  When Senator Bernie Sanders first got into the race, I reported on the pros and cons of a single payer healthcare system. Please click on my website for review:

www.themedicalnewsreport.com #62  and  #63

  Since Senator Sanders has bowed out of the presidential race, but not giving up his state delegates, it is clear he will try every move to pull former VP-Biden to the left. He will remain on the ballots because they have already been printed. We will see how bad Biden wants to court the far left. BTW, he is already pretty much there, so to solidify the Democratic vote, he will have to support single payer healthcare.

 Take a look at some differences in the Canadian socialized healthcare system and ours: (these stats were before the pandemic)

  Wait time for a first time primary care doctor appointment in Canada is 10 weeks on average (U.S. 24  days), elective surgery appointments with a specialist in Canada 20 weeks (U.S. 30 days).

  3% of Canadians were on a waiting list for operations averaging 182 days for hip and knee replacement. 63,000 Canadians went abroad for for care in 2016. 143,000 English people sought healthcare outside the UK.

  Imaging—CT scans in Canada-4.3 weeks; MRI-10.6 weeks; ultrasound-3.9 weeks   The Foundation for Economic Education

  Canada has 11-12 ICU beds per 100,000 people (U.S. 34.2 beds).

  Death rates after being discharged from the hospital after having a stroke—Canada-76% higher than U.S.

  As happy as many recipients are with Medicare, the VA, and Medicaid, each has major ongoing problems, and if a single payer (Medicare for all—really Medicaid for all) will triple the number of recipients under governmental responsibility. Rationing is the only method of containing costs, considering medical staff shortages and the lack of individual responsibility by people for maintaining their own health. Right now, those who would be taxed (30 plus trillion dollars over a 10 year period) will be far less since this pandemic and will destroy an already very stressed American economy.  

5. Sugar Babies--College girls paying for their school debt in dangerous ways

There is over a $trillion dollars in school debt out there, and having an after school job is one of the ways to reduce that debt. However, there is an increasing trend for college girls to cut into that debt and live quite well at the same time by finding a “sugar daddy”. This “soft prostitution” means of paying for school has become very popular from coast to coast.

  The internet has become quite handy in creating websites to help these young women find one or more men to “lighten” their financial burden.

  According to Zerohedge website, there are 1304 “sugar babies” at Georgia State University signed up to be provide “company” for usally older men. Websites such as “Seekingarrangement” is quite busy. According to this report, this arrangement accounts for 1 in 10 girls at the college enrolled in 2019--15,277.

  For example, signed up on various “dating arrangement” sites at U. Alabama are 968, Florida State-873, University of Central Florida-1068, and University of Florida-501.

  The Seeking Arrangment website has 20 million members worldwide (4.5 million students). Even if that is half true, the morals of our country (and the world) have decayed considerably along with a wicked world.  

  This is no joke and our young women have to get a grip. When some people want free college, do you think this trend is going to change? Add sex trafficking to these naïve girls, and the world is in sad shape.

  The author states that today many women do not want a traditional monogamous relationship, rather they are seeking a “modern” relationship that matches her drives and ambitions without placing unreasonable limitations on personal growth. They want help paying tuition, books, housing, and even “more benefits”, gaining access to opportunities and the right network.

  Note that only 30% of their “revenue” goes toward school tuition and expenses. These entrepreneurs have raised their standard of living while lowering their moral and ethical standards, greatly increasing STDs including HPV virus, well known to cause genital, rectal, and oropharyngeal cancers. Of course, unwanted pregnancy, unnecessary abortions, and ruined reputations are on the list too.

  Do they think these “gentlemen” are not going to take advantage of these young women in one way or the other including rape and physical injuries even death. Rough sex can land people in the emergency department with major genital and rectal injuries or kidnapped and sold in the sex trafficking industry.   

  Just what do these parents think, when they find out their “little girl” is a prostitute?

  Pornography, the internet, videos, birth control, Viagra, loosened morals, decreasing religious affiliation, secularism, and lack of parenting with no father figure in the home, etc. have all played a role in the increasing rise of the “oldest profession”. Even the pressure on girls to attend college has an effect.

Gender equity has its price

  Think about the concept of equality and that women have the right to decide what they want to do with their bodies including abortion, and using their body for financial gain. My body…my decision!! Long gone is the concept that prostitution is a form of slavery, and yet sex trafficking is at an all time high.

  On the other side, many men (and perhaps women) decide to “hire” a sugar baby, stopping by the college campus for a quickie, and when the wife or husband finds out, the marriage is in real trouble. And where is the law enforcement of a crime of prostitution?

  What has happened to our society? Where are we going with so much loss of responsibility, entitlements, free stuff, and the high cost of education (which needs to be reformed).

  Here is what sugar babies spend on their income:  

The world of wanting to get ahead has taken a quantum leap, when women are willing to sell their bodies to have nicer things, etc., live above their means, and yet, everyone strives for improvement in their life in every way, but prostitution is no less worse than theft.

  With the pandemic, this issue will worsen.

  Once a woman decides to settle down and leave this lifestyle behind them, think of the guilt and shame they will carry….at least some of them. How do they adjust to normal relationships, marriage, children, etc.?

  Below is a list of paths of schooling and other professions and the occupations these people seek. The average age of the women is 26-41.

The list is below:

6. Raynaud’s disease (Syndrome)-primary vs secondary

This disease can be a symptom of other diseases or a phenomenon with no known cause. It can be mild or severe.

  It is characterized by vasoconstriction (blood vessels shrink in size) causing blanching of the fingers and or toes appearing white and then blue, creating significant numbness and a feeling of extreme cold, and pain at times. This vasospasm causes diminished blood supply to tissues with the development of these symptoms. Women are more likely to experience this syndrome. It occurs in colder climates.

  Once the vasospasm abates or the extremities are warmed, the fingers and toes will appear purple or very red and begin to tingle with pain. This occurs when the blood rushes back into the area. Over time with repeated episodes, the vessels can thicken and further reduce blood flow.

Primary vs Secondary Raynaud’s Disease

 A.  Raynaud’s disease (primary Raynaud’s) is usually mild to moderate and rarely needs treatment. There is no underlying disease. It can occur in other family members.

 B.  Raynaud’s phenomenon (secondary Raynaud’s) is caused by an underlying disease. Symptoms usually start around the age of 40. These causes must be explored to help these patients.

Causes of secondary Raynaud’s phenomenon include:

   a) Connective tissue diseases such as lupus, rheumatoid arthritis, scleroderma, or Sjogren’s disease   b) Diseases of the blood vessels including atherosclerosis(hardening of the arteries), Buerger’s disease (inflammation of the arteries in the hands and feet is vasculitis), or a form of high blood pressure in the lungs(pulmonary hypertension). When the spasm in the vessels is prolonged, there will be loss of soft tissue with blistering, ulcerations, and loss of the tip of the fingers and or toes just like is seen in frostbite. This is especially a concern in Buerger’s disease.

   c) Carpal tunnel syndrome

   d) Repetative movements of the hands such as playing the piano, using power tools, etc.

   e) Smoking causes vasoconstriction of all blood vessels and may be the cause or a contributing factor.

   f) Injuries to the hands and feet, frostbite, surgery on the hands, etc.

   g) Medications including beta blockers (metoprolol, etc.) to treat high blood pressure (an ACE inhibitor), migraine medications containing ergotamine, certain ADHD medications, and certain chemotherapy agents and certain decongestants that can raise blood pressure.

Prevention is the key!

  Once the vasoconstriction and blanching of the fingers and or the toes begin, it is difficult to stop it. Wearing gloves (and socks) and warming the hands in heated water or wearing microwaved gloves or socks will increase circulation to the fingers (and toes) before being exposed to the cold.

Triggers

  Cold car wheels, door knobs, faucets, exposed metal, etc. must not be touched without protection. Even air conditioning needs to be kept on the warm side as it can be a trigger.

Pathophysiology of Raynaud’s phenomenon

  The reflex constriction of the blood vessels is an over-reaction to a stimulus such as cold either for no known cause or from inflamed or traumatized tissues such as the hands where small vessels are close to the surface of the skin and blood supply is the farthest from the heart.

Treatment

  Treatment for Buerger’s includes anti-inflammatory medications like NSAIDs (Aleve, ibuprofen, etc.) to relieve inflammation and pain. There really is no treatment for primary Raynaud’s disease.

  If it becomes more burdensome, patients must seek help from a vasculitis center, usually available in large centers in a rheumatologist’s or cardiovascular center.

This completes the May, 2020 report!

The June 2020 report will include:

1. Suicide; Resistant Depression

2. Pancreatic cancer updates

3. The health benefits of quitting smoking

4. Weight gain and antidepressants

5. “It is all in your head”- when patients can’t be diagnosed

6. Diagnosing lung disease—the difference between restrictive and obstructive disease

Stay healthy and well, my friends, and practice good personal hygiene and physical separation when necessary,  Dr. Sam