The Medical News Report

#120

January, 2022

 

Dr. Samuel J. LaMonte, M.D., FACS

samlamonte@gmail.com

www.themedicalnewsreport.com

 

Subjects:

1. COVID-19-update; Omicron, Boosters, etc.

2. Hair loss in women

3. Blood clots, emboli, and bleeding disorders

 (including a side effect of J&J vaccine)

4. Autoimmune Diseases-Part 1

5. New innovations in head and neck cancer(oral and throat)

 

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.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit.

  Thank you, Dr. Sam

 

1. COVID-19 Update—Omicron, Vaccines, Boosters, etc.

61% in U.S. have been fully vaccinated! $4.1 trillion dollars spent on COVID healthcare spending in 2020! And we don’t want answers from China??

    

A.  Omicron variant

  Omicron has taken center stage with the delta variant still the dominant variant causing most hospitalizations, however, Omicron now accounts for 56% of the new cases in the unvaccinated, those vaccinated, and in those who have had the booster. That leaves over 40% of Delta still causing more serious illness, creating most of the hospitalizations, but in the face of that, hospitalizations are down 20% and continue to drop. There will always be a lag from case diagnosis and hospitalizations and statistics.

  It appears the Omicron speed of transmission is outcompeting Delta, which could be a good thing if it doesn’t cause many hospitalizations. It is too early to say, but the president’s press conference on Dec. 12, sounded the alarm just in case with some very bold moves, maybe a little late.  MedicineNet.com

  I am not in favor of mandates and more federal control when the president admitted on TV that the feds didn’t have a plan and should leave the heavy lifting to the states. Let’s admit it, the vaccines are not as effective as the CDC touted with the Omicron variant, but it is the best we have plus treatments. We need to admit natural immunity is just just as good, but even they should get boosters or at least one dose of vaccine.

 

Still some good news

  The best news is that Omicron, although very transmissible, is not very virulent (causes severe disease). Vaccines and those with natural immunity are the reason, according to Dr. Fauci. Also the fact that Omicron can’t single out the lungs like Delta, and stays mainly in the upper respiratory tract, creates symptoms of nothing more than “cold”, the surge will not last long.

  Omicron appears to be capable of pushing out the Delta variant with neutralizing antibodies formed that kill Delta, a much more serious infection. This is very positive news after 2 years of this pandemic. Medpage Today, December 20, 2021

  COVID tests do not tell the person what variant they have, ONLY THAT THE TEST IS EITHER NEGATIVE OR POSITIVE.

  Reports from the UK have 60% less hospitalizations with Omicron. And even though there are more hospitalizations for children, it is their underlying disease that prompted their admission not the symptoms of COVID.

Medpage Today, December 29, 2021

  Experts around the world are already stating that the pandemic is on the way out. Even though there is a frenzy of testing showing much higher rates, these people are asymptomatic and not going to the hospital in increasing numbers. In fact, hospitalizations and deaths are continuing to drop. 95% in the hospital with COVID were unvaccinated, and even with the surging case numbers, the rate of moderate to severe illness continues to drop. 95% in the hospital are those with underlying medical illnesses made worse by COVID.

  The real tragedy is shortages, delays of getting medicine, and closing of businesses because of positive tests, lack of desire to work, and a malaise caused by lockdowns, business closures, and the worst inflation in decades.

  We should be at herd immunity with over 200 million with natural immunity, even though we will see more hospitalizations because people still have underlying illnesses that dictate their admissions. This is still good news when a variant is much less serious.

   Staff shortages are closing hospital beds, thanks to mandates with firings and positive COVID tests, plus people are just losing their desire to work with the federal government enabling them with extra money. The winter illnesses are also a factor with flu, and worsening of respiratory illnesses with the colder temperatures, and more children suffering from a variety of viral illnesses.

  If the pandemic is waning, with the speed of transmission of Omicron, and we don’t have another variant right behind it, we will see recovery earlier in 2022. We must recover our economy and any form of mandate or school closures just does not make scientific sense.

  The 2 dose vaccine is 35% effective against Omicron and with a booster raising it to 75%, according to data from South Africa and the UK. It greatly reduces hospitalizations and death, but the variant is much milder than the delta variant. Regardless, vaccination plus booster is highly recommended by the CDC and most experts. CDC website www.cdc.org

 

Days of quarantine now 5 days for some; the difference between quarantine and isolation

READ CAREFULLY

 1- Fully vaccinated and boostered individuals will experience breakthrough infections from Omicron and will probably get a mild infection most likely especially if not too old or have underlying diseases. The CDC has changed the time of QUARANTINE from 10 days to 5 for those with a positive test regardless of vaccination status. If a person has no symptoms or they resolving quickly, they can leave their house, and wear a mask around others for 5 more days.

  The change was motivated by science demonstrating that the majority of COVID transmission occurs 2 days before symptoms and are greatly reduced after 3 more days=5 days.

 2- For those exposed and unvaccinated or more than 6 months since their second dose (or 2 months for J&J vaccine and not yet boosted, the CDC recommends 5 days of QUARANTINE followed by 5 days of wearing a tight fitting reliable mask*. If quarantine is not feasible, they should wear that mask for 10 days after exposure.

 3- If exposed to someone with test positive COVID-19, and the person has been boostered or completed the vaccine within 6 months (2 months for J&J), wear a mask around others for 10 days. No QUARANTINE NECESSARY.

  After 5 days, a COVID test would be recommended FOR ALL.

*reliable mask=surgical masks, KN-95, double masks(3 ply cotton plus a second mask); all others do not work! Also change masks daily if wearing them for hours.

  No person with symptoms should be out in public, and need to quarantine until a negative test confirms symptoms are not attributable to COVID. Wearing a mask will reduce the risk of spreading the virus.

  There is a difference between isolation and quarantine. Isolation relates to behavior after a confirmed infection.

  Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19.  

  www.cdc.org

 

Natural Immunity continues to be ignored

  What is of concern is those previously infected are getting the Omicron variant as well, including some with boosters, and those with natural immunity will likely get their share of infections, therefore, it would be wise to get vaccinated (at least one dose), which has been proven very effective. Consider if you developed COVID and developed a serious disease from it and were one of the 20% who get prolonged COVID syndrome. Vaccines look pretty good!!

  The CDC is recommending boosters, since they will protect you much better. Some very early data suggest the booster will cut down infections much more than the 2 doses of the mRNA vaccines (Pfizer and Moderna).

  Since some scientists believe history has taught us that as pandemics continue, later variants become more aggressively transmissible but less severe in symptomatology, and we are already seeing less sick people not needing the hospital, but this year, patients are much quicker to go to the hospital if they have underlying disease, even if not very sick. And the number of cases will push the number of hospitalizations, therefore, no one can be clueless. Children are being hospitalized more for underlying disease and monitoring their COVID infection which is mild. The media does not say that.

  The cases are milder or asymptomatic than the delta variant cases. One reason is that the Omicron variant tends to thrive better in the nose, throat, and windpipe (bronchi) and less in the lungs. This is similar to the classic upper respiratory viruses causing “colds” with mild cough, nasal congestion, and low grade fever. However, with the massive number of cases, it will be a bigger issue for keeping people at work trying to get tested when the lines are forever. 456,670 cases were diagnosed on Dec. 29 alone with 1,777 deaths (almost all delta).

  Airlines have cancelled over 20,000 flights over the Christmas holidays due to positive tests and exposures in their personnel, healthcare workers are having to stay home creating shortages in healthcare facilities because of a positive test even though most are asymptomatic or have mild disease, and businesses are closing their doors for lack of workers as well. The illness is only one issue, while devastation of our workforce is a strong second. The concern is not just the number of cases, it is the number of hospitalizations and deaths.

  This will not be the last variant, since globally, there have not been enough people vaccinated, and until either most get infected or vaccinated, we will be the recipients of continued variants starting in third world countries where vaccination has been low. This is a global issue.

  Most of the early cases of Omicron are in the younger ages. The WHO (World Health Organization) states the booster is essential to combat the Omicron variant.

  Expect that the definition of being fully vaccinated includes the booster, and some experts feel a 4th dose will be called the booster in the future. If that happens, expect mandates will include the booster. Unfortunately, it also sends the signal that vaccines are not as effective as we would like, and will not enhance those hesitant to get the vaccine. But, it is the best we have. With fear being promoted, I fear more federal rules will be coming, as President Biden admitted the administration does not have  a solution for the pandemic. The states need to manage this pandemic, as Biden stated during a press conference.

  This is a big signal that we need to be better prepared for the next crisis in healthcare. That goes on the shoulders of several presidents who did not follow through with disaster preparedness continuing to depend on other countries for PPEs, medicines, and ingredients of medicines. There is no excuse after MERS and SARS earlier this century.    

  The unvaccinated are still the ones most likely to be infected, and 40 million Americans and illegals are not vaccinated. These illegals are still being sent to cities all over our country untested ad unvaccinated. Imagine the effect of the Omicron variant on that group (now over 1.5 million individuals in 2021).

  The administration also continues to ignore the benefit of natural immunity, and are extremely late in providing adequate testing materials.

  500 million tests will supposedly be distributed free of charge (we are paying for it with out tax dollars) by the middle of January, far after the holidays and the spread of Omicron variants. But the White House has not signed the contract authorizing the tests as of the end of December. We need 1 billion tests performed each month, according to several experts. Businesses, schools, and any group need to know who is positive and who is not. 

  The CDC suggested the White House authorize these tests in October, 2021, but they did not agree, continuing to push the vaccine as the sole fix for the pandemic, and now they are scrabbling to catch up…..trying to handle this pandemic from Washington is a mistake. The feds need to be the support group for the state’s needs, as Biden suggested on one of his presentations on TV.

  Those with breakthrough infections after natural immunity or vaccines are 90% less likely to be hospitalized than those with primary infections, according to NEJM, Dec. 23, 2021 (thtat was for Delta).

  23% of those 5-11 have received one dose of the vaccine as of Dec 24. But 2/3 of parents are either unsure or will not have their kids vaccinated.

  95% of those over 60 have been vaccinated and are planning to get the booster. So far, 1 in 4 vaccinated have been given the booster. That will continue to rise rapidly. My booster was on Dec. 22.  Medpage Today, December 3, 2021

 

Omicron hitting the vaccinated!

  Dr. Walensky, chief of the CDC, reviewed 43 cases of Omicron in the U.S. and reported that 60% were younger people, 18-39, and 1/3 had traveled overseas in the prior 2 weeks, and 80% were vaccinated, and 1/3 had boosters, but most had received it less than 14 days before testing positive (vaccines take 14 days to be fully effective). 6 had a previous documented COVID-19 infection. 89% had a cough, 65% had fatigue, and 59% had head congestion with a runny nose. Sounds like a “cold” to me.

  Pfizer says the booster increases the immune levels 25 fold and have the best chance of combating the Omicron variant even if less effective than for the Delta variant, which continue to make up the majority of hospitalizations. No data on Omicron yet.

 

How is the Omicron variant different?

  While all of this information is extremely early, the drug companies are working on Omicron specific vaccines that will cover all other variants in case Omicron turns to be more aggressive. Omicron has been found to be more effective in binding to the spike protein making it more infectious (transmissible). It has been more resistant to monoclonal antibodies which have been given to outpatients to keep them out of the hospital, but are still valuable if you can find them (shortages).

  The binding of the virus is more in the upper respiratory tract rather than the lungs, symptoms are far milder than previous variants. We need more medications that kill the virus, rather than stimulate more of the body’s immunity to fight the virus. Vaccines stimulate the body’s immunity to stop replication, and that is where the resistance from the new variant is having some success. MDlinx, Dec. 23, 2021

Medpage Today, December 10. 2021

Regardless, personal preventive measures continue to be extremely helpful.

  A recent study, however, reminds us what we already know, that single ply cotton and paper masks are not effective. Researchers found a 3-ply cotton mask with an extremely tight fit, added to N-95 or surgical masks is required to get at least 80% protection. This study was performed on humans.

  Washing hands frequently, cutting nails short, and considering nasal saline sniffs to clean out the virus in the nose are still simple methods to do our part. Distancing is questionably effective, but rarely done. In fact, a recent study found that 6 feet was not enough to prevent droplet spread.

  The U.S. and other major countries must start providing more vaccines to needy countries. Only 8% of South Africa is vaccinated. The U.S. has provided millions of doses to a few countries, and perhaps other countries, but this effort has to be much more robust, or we will continue to have tougher variants to deal with, always beginning in low vaccinated countries and spreading around the world. Blocking flights will not do much, with so many other modes of transportation available, and our southern borders seeing illegals cross from more than 100 countries.

  14 states have blocked mandates for healthcare workers (including nursing homes) including Florida. We can’t afford more layoffs when the winter always challenges hospitals with a variety of diseases.

  Pfizer’s oral antiviral pill, Paxlovid, will work on Omicron, according to the company. I will discuss how it works later in this report.

 

   B. Testing and boosters; test strips for fentanyl; who is exempt from mandates?

  Boosters are now recommended for those 18 and older and all Americans healthy and with underlying diseases, when there still is no data proving value for healthy individuals. And yet, the latest information from the UK on the length of immunity from the booster is only 10 weeks.

  After the booster, there was 75% efficacy against the Omicron variant, and by 10 weeks, it dropped to 45%. Bad news, and and speaks of us needing a 4th dose. Even in the face of the shorter immunity, hospitalizations have dropped 80% in South Africa. It would be rare event to have a death from Omicron unless underlying disease was really the reason they died.

Medpage Today, Dec. 28, 2021

  Testing and booster shots have doubled since the Omicron variant became an issue even before its strength or lethal risks are known. And yet testing centers have been closing all over the country until recently, since the CDC did not emphasize how critical testing is, but now we know that was not correct, with the Omicron variant being so easily transmittable. We are now spending a half a day trying to get a test standing in lines.

  There are 8 rapid antigen tests normally available in pharmacies, but the shelves are empty.

  Dr. Robert Redfield, former CDC Director, feels there should be a billion tests a month right now to keep people safe from those who are exposed and need to stay in school or work.

  Workplaces should be home testing weekly. One of the biggest problems to date has been people exposing others for at least 2 days before they are symptomatic, and because rapid tests were not available, and in fact they may not be positive very early. There is no foolproof method.

  There is data stating that home rapid antigen tests and molecular PCR tests will pick up Omicron, but take days to get a result, so even though the rapid antigen tests are not totally sensitive picking up a positive test, they are very good. We need these tests in every home to use, as the UK provided their residents months ago. BUT, no test will tell a person which variant they have. That requires sequencing of the viral proteins in a research lab.

  Omicron has 4 mutations that can be detected in the virus’ N-nucleocapsid protein, which can be picked up by these viral tests. These are not spike protein receptors, allthough Omicron variants have mutations at the spike protein in the virus, but these rapid tests depend on the nucleocapsid protein, according to a published report from the UK Health Security Agency. These tests cost $25 on average in a kit that has 2 tests. Medpage Today, December, 20, 2021

  We are months behind in testing, and now with Omicron, easy access to testing is very difficult. Many of the testing centers will surely reopen, and some already have. We needed these tests in October when the administration was asked if they wanted them and refused.

  The president stated that he was caught off guard by the variants, and yet, the CDC has been warning the public since October that the Delta and the next variants (Omicron) would continue to be more transmissible quickly raising the number of cases, demanding increase in testing.

  There are more airline issues, mandates (boosters?), businesses closing, and fewer healthcare workers and first responders. It is clear there is no guarantee vaccines, isolation, masks, etc. will keep people from getting infected, but we must do the best we can and not listen to the hysteria of the numbers of cases. The hospitalizations are still mostly Delta.

   By the time these home tests will be readily available, we will be past all the holidays, parties, and family get togethers, as 100 million will be traveling somewhere during the holidays. We needed these home tests months ago. It was stated, that individuals had to get on a website and request the tests, delaying again.

  The federal emphasis has been only on the vaccines, but not pushing therapeutics and testing until the end of the December is too late, and will allow the Omicron to do its work infecting more Americans than Delta, creating unrelenting damage to the workforce, not because of severity of diseases, but from positive testing requiring isolation and loss of workers. Shortages, empty shelves, and loss of many businesses because of the lack of an adequate workforce will continue topped by the worst inflation in decades.

  We should be concerned but not fear the new variant, especially since it does not create severe disease except in those vulnerable or unvaccinated.

  There are those who have no business in crowds of unvaccinated families, etc., but our country has had enough and will not listen to the experts to tell those unvaccinated to stay home and not join their family and friends, even though Dr. Fauci recommended uninviting unvaccinated family and friends. It certainly sounds reasonable if there are vulnerable people in the home, but if everyone is healthy in the group, but a few are unvaccinated, I doubt it is beneficial to send them home.

   Get vaccinated or boostered, because the delta variant is still causing the hospitalizations and the vaccines are quite effective against the delta variant.

  Remember, it takes 2 weeks for the body to fully build the immunity from the shot.

  There is no reason why the CDC can’t recommend a dose for those previously infected, rather they continue to be treated as if they had no immunity, when it has been proven that their immunity is as good as those with 2 doses.

   However, if an individual had all the symptoms without a positive test, they can’t assume they had COVID. They have had a positive test to be considered naturally immune. Unfortunately, it is estimated that there are many more who never got tested and just assumed they had COVID, when it was another virus or perhaps COVID, but can’t prove it. In that case, get vaccinated with 2 doses and a booster.

  Some experts are predicting a 4th dose within a year, and others a yearly booster just as flu. We will find out the answers to these issues in time.

  A report from the Journal of Molecular Diagnostics has developed a breathalyzer test for COVID, known as the Bubbler. Some predict this test will be more effective than the nasal swabs. It is not commercially available, but hopefully soon. MDlinx, Dec. 14, 2021

There is also an oral test for saliva, but these are not FDA approved.

  Test Strips for fentanyl, federal grant for harm reduction programs for addicts

With the pandemic greatly assisted by an open southern border, fentanyl killed over 100,000 Americans in 2020, most of these overdoses are accidental, as the Mexican Cartels are adding it to a variety of street drug as are dealers in our country, not caring that it 100X stronger than morphine and takes a tiny amount of just one pill to kill. Marijuana, hydrocodone, oxycodone, cocaine, and methamphetamine are being contaminated on the street.

  Fentanyl, an opioid 100X stronger than morphine, is manufactured in China, which accentuates other drug’s buz, but dealers have no clue how little it takes to kill. Maybe that is the idea!!

  A $30 million 3 year federal grant will include fentanyl test strips for states that want to open needle exchange programs. It will pay for these programs for 3 years including increase access to naloxone (Narcan), provide sterile needles, which if given early enough can prevent death from the opioid drugs (constantly used by police and healthcare facilities), and distribute test strips to addicts who can check for fentanyl contamination in their drugs.

  The grant will also provide educational models and data collection to get a better handle on the crisis. This is one of the four strategies being developed to combat the drug crisis (others are primary prevention programs, harm reduction strategies, and treatment programs). These test strips will be available to primary care offices, resources to refer to, and begin to  destigmatize drug abuse.

  New York City opened 2 such centers, but one opened in Philadelphia and was blocked by city officials. It will be a long road to developing the understanding necessary to deal with drug recovery. European countries have had needle exchange programs for years and alternate drug options-methadone and buprenorphine. It masy be time for these types of clinics here in the U.S.

Medpage Today, Dec. 8, 2021

 

Who is exempt from the vaccine mandates

  The legislative and judicial branches of our government do not come under the jurisdiction of the executive branch of the government, so they can’t be mandated. Those with medical and religious exemptions are allowed supposedly, illegal immigrants are not mandated, and the Post Office employees are not mandated, or are the pharmaceutical companies Pfizer and Moderna, but can fall in the OSHA regulation for businesses with over 100 employees. Of course all of those businesses fate will be determined by the Supreme Court decision.

  There misleading emails with a longer list that is untrue. The White House staff and all those who have federal contracts have mandates, as does the FDA and CDC.

  The fact that this administration is allowing over 2 million illegals in this country over the past 2 years without tests and vaccine mandates is an absolute travesty and the ost hypocritical decision it has made!

C. Therapeutics for COVID-19; Effective masks

  Dr. Robert Redfield, former CDC Director last year, feels the variants may be more able to reduce the value of therapeutics and maybe even the pills just approved by the FDA, but it is too soon to know. Early data suggests that, and the feds have stopped shipping monoclonal antibodies to healthcare facilities in many cases. The Omicron may be changing the face of the pandemic, but delta is still the one to worry about which, as of Dec. 28, still accounted for 40% of the cases and most of the hospitalizations so far.

  He also feels that these later variants may reduce the length of immunity, and may require a 4th dose after the 3rd dose (the booster). One expert estimates the booster will only raise the immunity for as little as 10+weeks. If that occurs, expect more doses.

  Dr. Redfield also was critical of the administration for not pushing the therapeutics currently available. Nevertheless, oral antiviral pills will still be a most welcome addition and have not been streamlined by this administration, according to Dr. Redfield. Shortages will occur immediately since only 180,000 pills were initially produced, with much more to come. These pills should be reserved only for those with high risk individuals who could develop a more serious infection, and hospital personnel and first responders. Healthy people need not get in the way.

  Combinations of IV infusions are also showing better prevention for early cases of delta variant. (Remdesivir, sotrovimab, Regeneron-casirivimab and imdevimab). Plasma infusions are not as effective, but still valuable in reducing hospitalization, and preventing death. These infusions continue to show more efficacy for earlier cases than severe cases.

  In fact, the FDA is allowing some outpatients to receive convalescent serum (antibodies from people who had the infection previously), because we are encountering shortages of other therapeutics…..what a surprise.

  However, Reuters, Dec 23, 2021, reported that that the U.S. has paused the distribution of Regeneron to clinics and hospitals, because it does not stop the Omicron variant. This will continue until new data proves this early analysis. There are the oral pills and Remdesivir, convalescent plasma, and corticosteroids that can fight the Omicron.  

  Remdesivir (87% kept out of the hospital) and monoclonal antibodies (especially sotrovimab) were found to be effective if given in the very early stages of an infection against delta variant. NEJM, Dec. 22, 2021

  Monoclonal antibodies are made by cloning a unique lymphocyte (B cell) thereby allowing specific ones to target the disease or infectious cell. There are many different monoclonal antibodies used in cancer and autoimmune diseases.

   Here is the mechanism of action--monoclonal antibodies are used to reduce the severity of symptoms and progression of illness by attaching to the spike protein of the virus, and when the virus tries to enter the cell, it is blocked, because the spike protein is coated with the monoclonal antibody not allowing it to get into the cell to reproduce. 

 

Correct Masks

  

The CDC and administration are pushing the vaccines (appropriately), but should have included treating patients early with effective drugs, and even preventing symptoms with proper masks (only KN95, surgical masks, and 3-ply cloth tightly formed around and above the nose with a 2nd mask underneath) instead of accepting any mask, and keeping people out of the hospital.

  Since Omicron can infect those with 2 or 3 doses of vaccine, it should be clear treatment should be on the top of the list for combating Omicron besides vaccines. The administration needs to get these pharmaceutical companies to allow other companies to manufacture it, especially if Regeneron and the other monoclonal antibody that requires infusion are not readily available.

  These medications (Remdesivir, etc.) have been very successful where emphasized such as Florida, but they require 3 days of IV infusions, but are keeping people out of the hospital (70-90%). Regeneron and other monoclonal antibodies are also an important part of treatment.

 

Finally oral medication to fight COVID-19

  Now 2 oral antiviral pills have been developed and are showing extremely effective results, similar to Remdesivir. The FDA has just approved ritonavir/nirmatrelvir (Paxlovid)-Pfizer and Merck’s drug, molnupiravir, to be taken for 5 days (3 pills twice a day) and will be free to patients, paid for by our tax dollars ($530 and $750 for these drugs), but still requires a prescription. They have stated they will be effective against the Omicron variant. Reuters Dec. 23, 2021

 

Mechanism of action

  Paxlovid contains nirmatrelvir and ritovir, both protease inhibitors. When COVID enters the body it tries to reproduce itself as fast as possible, and tells our body’s cells to make a large protein, that is necessary for the virus to reproduce. For the virus to utilize this protein, it needs our body to split it into smaller proteins, which occurs with proteases, which are enzymes that split the protein. If the body has proteases inhibitors present the protein can’t split and the virus can’t reproduce, thus dying. That is how Paxlovid works.

  Paxlovid can stop severe COVID illness 89% of the time. Data also reports that it is effective against all variants including Omicron. Molnupiravir is only effective in 30% of the time.

  Paxlovid can be taken by anyone 12 years and older and at least 88 lbs. (molnupiravir above 18) who are at high risk for progressive disease. These pills are not authorized for those exposed to prevent disease. There will be a shortage quickly, as they have only produced 800,000 pills so far, but the U.S. has agreed to purchase 10 million courses. Only those at high risk should be considered for the prescription if we are already in short supply.

  Paxlovid can interact with other medications (i.e. statins, colchicines, Latuda, Coumadin, Pacerone, St. John’s wort, etc.) and those with liver and kidney disease should be very cautious.

  The FDA had mixed feelings about molnupiravir, favoring Paxlovid, as it is 3x more effective, but still authorized both of them. Also, molnupiravir must not be taken if planning on being pregnant and women must be on birth control pills to prevent pregnancy if in that age group. Men will have to use birth control for 3 months after they have taken this medication. Birth defects are of concern. It should not be taken for those 18 and under because it could affect bone growth.

    The best way to contend with the pandemic is still the vaccine, but at least Paxlovid will be very welcome in keeping individuals out of the hospital and must be started within 5 days of symptom onset, but since testing is hard to come by and you have to have a positive test, some may pass the window of opportunity.

Medpage Today, Dec. 22, 2021

  The public private sector cooperation in these kind of issues is critical, so call your congressmen and ask them to get to work on it. We need more pills manufactured.

GoodRx.com

  An antidepressant, fluvoxamine, has been found to provide considerable help as well. This is not FDA approved for COVID, but Canada lists it as a treatment. It is an SSRI antidepressant as most antidepressants are, and fluvoxamine binds certain receptors that reduce the body’d production of cytokines, an inflammatory substance well known to cause progression of COVID-19.

Blood test can predict severity of COVID

  A new report found that a blood test can predict how severe the illness might be. Because the virus stimulates inflammatory proteins produced by white cells, called cytokines and chemokines, and these substances creates a severe reaction in the body, called cytokine storm, by stimulating an overwhelming immune response in the body usually requiring hospitalization and likely ICU treatment. Research in the U. S. and U.K. is underway to combat these inflammatory proteins developing targeted treatments.

MDlinx, December 22, 2021 from a Science journal publication

  Another positive note comes for those who have had a breakthrough infection, as they are demonstrating extremely high immunity and should keep Omicron away, however, no data yet on the preventative capability. Mdlinx, Dec. 17,2021

    D. School closings

  Many Ivy League colleges are already having virtual classes, locking their doors. Princeton will not allow their students to leave the county. Where is the science??

  Some elementary schools are closing their doors requiring virtual learning knowing the severe consequences of their decision. The harm outweighs the good. It has been proven. Our country is disarray.

  And yet the CDC has stated that schools need to stay open. Who is running the health issues of the schools…administrators and school unions and boards or the CDC, who is supposedly the health authority.

The hospital rate for children is up 5 fold over last December. They are all unvaccinated, and now children 5 and older can be vaccinated, with only 23% having been vaccinated to date, according to the CDC. However, hospitalizations this time of year (winter) rise for all childhood medical issues. Still strong consideration for vaccination is highly recommended by the CDC.

  But with the milder Omicron variant, children will usually just have “cold” symptoms, but certainly is more dangerous for kids with underlying diseases. Vaccines are very well tolerated by children.

Medicine.net, December 28, 2021

   E. More and new vaccine development to combat resistance of new variants

  The vaccines so far have been more capable of preventing COVID-19, and even though there is a small difference between Pfizer and Moderna, both are extremely efficient. Now the FDA is not recommending the J&J vaccine for younger people because new research has disclosed that 1 in 6000 are contracting myocarditis, and 8 cases came in 5-11 year olds. And Pfizer is revising some research on the dose for 5-11 year olds, because the 3mg. dose may not be creating enough immunity, and they are considering a third dose. This stinks!! It only reveals how little these companies know about their vaccines, and it has made me question just what we know and what we don’t know. Who do we believe??

  A non-peer reviewed article from Medrxiv.org (BMJ-Yale) found even higher incidences of myocarditis in Pfizer and Moderna in those under 40 years of age and male, although all ages and both sexes are at risk. The report states that the risk doubles for each dose, up to 113 events per million doses. This is higher than the incidence of myocarditis from a COVID infection.

  Is the pandemic about health, politics, or revenue? Even with little to no data, these “experts” and the media are scaring people with a virus that is admittedly more transmissible, but extremely mild. Vaccines with boosters are still the best prevention we have.

   F. Vaccines for immunocompromised people

  Vaccinations have been proven to be safe for those with autoimmune diseases who are taking some medication that reduces the immune system (immunmodulatory medications).

  A recent study of 325 patients with rheumatoid or musculoskeletal diseases had no higher side effects (usually fatigue) than healthy individuals. They, of course, may not provide as effective immune response because of these medications, and some of these patients are being recommended to have extra doses of vaccine. This is a decision from their rheumatologist, dermatologist, etc.

  These vaccinations are supported by the American Rheumatological Association and the National Psoriasis Foundation, but the decision may vary with the disease, so please contact your doctor. Medpage, December 15, 2021

  The main focus on prevention and treatment continues to be on the spike protein of the virus, but there are additional surface areas on the spike that may be more vulnerable to newer mutations.

  The best patients to study variants are those immunocompromised who hold on to these viral loads the longest, allowing the virus time to mutate. That is why 4 vaccines are recommended for them (2 initial doses followed by an additional dose 2 weeks later and then a booster 2 months later).

  Mutations and evolution are part of the natural history of viruses. Every time the virus encounter defenses from antibodies stimulated by vaccines and natural immunity, the virus tries to form a genetic copy that is different enough to evade the body’s immune defense. The longer the virus stays in a cell, the better chance of surviving and continuing to replicate. It is thought the first Omicron patient in South Africa (immunocomporomised) was infected with Delta but could not fight the virus and with time, the Omicron mutations developed. These mutations are called escape mutations. This is happening in the Omicron variant with 15 escape mutations compared to the Delta variant that had only 2. Fortunately, the number of mutations does not necessarily equate to more lethalness of a virus, but can increase transmission capability, which appears to be true with the Omicron variant. Most of the cases so far are very mild but easy to catch. That doesn’t mean Omicron can’t kill in vulnerable unvaccinated people.

  Clearly, we are facing more vaccines with different components, not something anyone wants to hear. The pharmaceutical companies are licking their lips. So plan on seeing more vaccines and don’t expect Omicron to be the last new variant.

  Mdlinx.com, December 3, 2021

 

 FDA authorizes Astra Zenica’s cocktail for immunocompromised patients to prevent COVID-19 and those with severe side effects from the vaccine

  The FDA has a new cocktail they approved to prevent illness in those immunocompromised from drugs or disease and also those with immunologic side effects from the COVID vaccine. The person (adults and adolescents) must not be infected to be eligible for the combination drug called Evusheld (texagevimab and cilgavimab-monoclonal antibodies). This company’s vaccine is still not approved in the U.S., agreeing to provide the U.S. with 700,000 doses. Trials reported a 77% lowering of these patients developing symptoms. The cocktail will last several months to a year. Get on with it FDA!!

  There are immunocompromised patients that can’t take the vaccine or those who had a serious reaction to a vaccine need an alternative, and this may be a good choice..

  The FDA stated this therapy is not a substitute for the vaccine. Monoclonal antibodies are also available for these patients and those with underlying diseases who are exposed or are early in their illness.  

   G. Getting a booster when infected unknowingly

  People should not get a vaccination or booster if they have any respiratory symptoms, as the virus may be in the process of infecting them. If they get a booster and then have more symptoms than usual from the shot (more than 72 hours), get tested and be sure it is not positive.

  If infected, once recovered, check with your doctor to get an antibody test and be sure the antibody levels are falling before getting a dose of vaccine. If a person is infected and gets a booster, there should be no harm, according to Dr, Adalja of Johns Hopkins. Also keep in mind an individual does not have protection from the shot for at least 2 weeks.

  The CDC just changed their guidelines for these patients to recommend that an infected person be out of quarantine and completely recovered before getting a dose of vaccine.

  If your doctor gives any type of cortisone shot or a prescription for it, wait 30 days from the last dose to be vaccinated.

  Once again, experts state that natural immunity from an infection provides robust immunity, but additional vaccinations give even more immunity (called hybrid immunity). Does a person need “extra” immunity? There is no science on that question, just antibody levels, which have never been defined as adequate levels. They just state the higher the better.

  Also experts don’t know yet whether natural immunity will fend off an Omicron variant infection. No one even knows if the additional booster in those vaccinated will fend off the Omicron yet, since South Africa and Israel had boostered patients who contracted Omicron.

  Most are saying the 2 dose vaccine is not enough to fight the Omicron variant, but then even getting the booster still may not do the job. That is why Big Pharma is already underway creating an Omicron vaccine for clinical trials.

Medpage Today, December 17, 2021

 

   H. Moderna COVID/Flu shot not as effective for seniors; ?effectiveness of the flu shot this year

Moderna/Flu vaccine

  The combination COVID and influenza vaccine does not induce the same level of immunity that a standard senior high dose Fluzone flu shot gives against 4 seasonal strains of influenza A and B especially in older people.

  Other companies are experimenting on a variety of annual COVID/seasonal respiratory viruses as well.

  However, the CDC recommends it is perfectly ok to receive the vaccine and in the other arm the flu shot.

  The high dose vaccine (Fluzone) is recommended for people 65 and older, because their immune system does not stimulate as high an immune response as younger people, and thus the higher dose will make up for that potential difference.

  If a person can’t receive the mRNA vaccines, special counseling is recommended if the J&J vaccine (an adenovirus source) is chosen regarding the possibility of blood clots. If a person received the J&J vaccine, and had no problems for the first couple of weeks, they should be safe and considered fully vaccinated.

Reuters Health Medical News, Dec. 10, 2021

The 2021-2022 flu vaccine not stopping H3N2

  The latest information is that the current flu vaccine is not as effective against a strain of H3N2 influenza A virus, according to the CDC. This virus is known as the swine flu which has been around since 2010. However, young children and those vulnerable just like those for COVID, should get the flu shot. Children are extremely vulnerable to the flu viruses. Most people that have been vaccinated with the flu shot usually have a milder illness if they do get infected which saves hospitalization and deaths.

  The overall disease flu burden 2019-2020 estimated 35 million cases, 16 million medical visits, 380,000 hospitalizations, and 20,000 deaths. Flu can be as bad as a bad COVID case according to data from cdc.gov

 

   I. CDC and FDA do not recommend the J&J vaccine because of clotting side effects

  J&J causes more clotting problems than Pfizer and Moderna, and the CDC recommends against that shot. It also occurs with the Astra Zenica vaccine, not available in the U.S. These are not mRNA vaccines, rather than are derived from adenoviruses.

  J&J reported it occurred 1 in 100,000 doses and 15% are fatal. Most were in younger people, but the CDC reported on 54 cases with an average age of 45, and more than half had cerebral venous thrombosis. Average time was 9 days after the shot of J&J with 9 deaths that occurred in the first week of symptoms (headache, dizzy, blurred vision, etc.).

  The shot is still available even though not recommended by the CDC or FDA, for exceptional cases such as those allergic to the mRNA vaccines (Pfizer and Moderna).

  The risk comes from thrombosis with low platelets causing clots and potentially bleeding in mostly the brain. I discuss this syndrome (thrombosis/thrombocytopenia syndrome) in the clots and emboli article which is the #3 article in this report. This is a serious side effect and can occur with other drugs such as heparin, an anticoagulant.

  Be sure you do not receive the J&J vaccine without special counseling. Medpage Today, Dec. 16,17, 2021

 

   J. Mandates and lockdowns don’t work!

  Mandates were based on the fact that vaccinated people had an 80% chance of not getting COVID, however, that was against previous variants, and experts already know that Omicron has dropped a vaccine to 20%, and with the booster higher. With this information, mandates to get vaccines are outdated based on the science for Omicron. Today, people vaccinated are close to being at the same risk of getting the Omicron infection as those unvaccinated. Will the administration drop the mandate? I doubt it, as they are more interested in telling the U.S. what to do (federal power).

  BTW, where is the mandate for the southern border illegals???

  34,000 hospital workers in New York have had to quit their jobs because of the mandate. Sad as we continue to experience the pandemic with hospitalizations needing more personnel. With the mandate going to the Supreme Court, we will have their decision. In the meantime, businesses with 100 or more employees can demand vaccination or be fired. If they have to be tested twice a week, where will they get the tests? The military is already losing hundreds of service people and the recruiting is at a very low level. 90% have been vaccinated.

  How long will it be before the administration makes the booster a mandate? 62% of seniors have had the booster and the numbers are rising rapidly.

  There are still mask mandates in 8 states to be worn inside (not Florida or Georgia)), whether vaccinated or not.

  Australia has been locked down for months, and with no positive effect, therefore their minister has lifted it. Lockdowns did not work here last year, and as the president said on his press conference, we must lean on the responsibility of individuals and states to be in charge rather than the feds. So many mixed messages have created extreme confusion, distrust, and frustration from the White House, the CDC, and the FDA.

  Even the president stated schools need to stay open and now only if a student is symptomatic, they are tested and sent home. The other students are then tested and if negative, can stay in school rather than what happened in 2020.

  We still have no vaccines for children under 5. Pfizer has performed tests in kids younger than 5 and found that they will need 3 not 2 shots, because they do not develop enough immunity with the dose that is safe.   

 

 

   K. More on the origin of COVID-19; U.S. involved

  The internet site Judicial Watch has received 221 pages of information from the Department of Human and Health Services including the 2018 grant from the NIH on funding in part the “gain of function” research on the SARS-Cov-2 virus (COVID-19) in the Wuhan lab to genetically manipulate the full length bat virus (SARSr-CoV W1V1) strain molecular clone.

  Through lawsuits, they were able to obtain records of communication, agreements, and contracts with the Wuhan Lab. The Judicial Watch also have proof of the shunting of NIH grant money to Ecohealth, a non-profit organization and Peter Daszak, one of the biggest players in the development of this research. Funds also went to the University of North Carolina, Chapel Hill (Dr. Ralph Baric), and also to East China Normal University and Duke-NUS Medical School in Singapore.

  Dr. Danzik writes, in these documents, the 20 year funding from the NIH on various projects including the above. Dr. Barics biographical information is included in these grant applications for “ gain of function” research and his participation in 2 Chinese-U.S. workshops and participation of a 2014 workshop on GAIN OF FUNCTION REASEACH RISKS AND BENEFITS. In July, 2020, Ecohealth wrote a letter expressing concern of biosafety of this research, stating they were concerned about safety measures in the Wuhan lab. They suspended all activities on July 8, 2020.

  The grant applicants stated that the new sequenced COVID-19 virus could enter human cells via the well known ACE2 receptor.

  Dr. Yangi Wang of the Wuhan lab was interested in using this research to implement measures in combating epidemic outbreaks.

  Records also include letters to Dr. Anthony Fauci regarding the concerns and also reported to the Gates Foundation.

  In March, Judicial Watch publically released emails and other records of Dr. Fauci and Dr.H. Clifford Lane from HHS approving the release of this information. All this demonstrates our involvement in the development of the gain of function mutated COVID-19.

Judical Watch Weekly Update with Tom Fitton, 2021

  With 800,000 deaths in the U.S. from COVID, this would be grounds for a declaration of war in other circumstances, and not one word has been said to the leader of the Chinese Communist Party.  

 

   L. Additional health crises making the pandemic worse; The Southern Border Crisis and fentanyl overdoses

  As the pandemic continues exceeding any previous viral illness, we are facing a disaster created by open southern borders, and our administration won’t even deal with the over 600,000 got- aways at the border with over 2 million mostly untested and unvaccinated.

  The Mexican Cartels are tearing our country apart making $1 million a day from those they are carrying across the borders with no answer. The additional COVID cases, the lawlessness coming with it, and the crime across our country has lasted long enough. And the Hispanic vote is starting to come to the conservative side, as votes are the real reason our border is wide open.

  I am sad politics is taking advantage of every American, as 100,000 Americans are dead from fentanyl drug related accidental overdoses, as the cartel is lacing many of the drugs sold on the street with fentanyl, 100X stronger than morphine. Even marijuana, hydrocodone, and other street drugs including cocaine, and methamphetamine.

  Thousands of pounds of fentanyl have recently been confiscated trying to get over our open borders, and they are even using drones to deliver this lethal drug into the U.S. It was calculated that fentanyl has been calculated to kill 200 million Americans. All fentanyl is manufactured in China. Is this one more way China is trying to overtake us? Why has our government not addressed this issue with China? Who is in bed with whom?

 

My opinion!!

  For those wishing politics were not discussed in this report, if anyone thinks it has not become a major factor in healthcare, you must be reading different newspapers and watching different news channels than me.

  As CRT and other teaching models are confusing our children in school, they have made segregation a new issue to further separate the races, which as most know, is a major goal of socialism, a subject I will address in a future report, discussing the pros and cons on this future changing way of life and especially how it will change our healthcare system


 

2. Hair loss in women

 

  Women shed 50-100 hairs per day and is a normal process. When it accelerates gradually or somewhat suddenly, hair loss can be very disturbing. This is called alopecia.

3 phases of the Hair Cycle

1. The Anagen growing phase can last 2-8 years, referring to 80-90% of the hairs.

2. The Catagen transition phase occurs when the hair follicles shrink and takes 2-3 weeks.

3. The Telogen resting phase takes 2-4 months after which the hair falls out.

 Hairs other than the head have a much shorter life span; the anagen phase is much shorter, about 1 month. Scalp hair can last up to 6 years or longer.

 

3 types of hair loss and most common causes

1. Anagen effluvium—medication causes toxicity to the hair follicle, such as chemotherapy, radiation, and other meds

2. Telogen effluvium—this occurs when significant numbers of hair follicles reach the telogen or resting phase, when the hair falls out. Physical or emotional  stress or shock to the body, losing a lot of weight, blood pressure meds, gout medication, high doses of vitamin A, or changes in hormone levels all can cause this type of hair loss.

3. Androgenic alopecia—the most common type with loss of hair on top and the sides. Genes, aging, and menopause.

  Up to 50% of women experience noticeable hair loss. By far, female pattern hair loss (similar to male pattern hair loss) is the most common (1/3 of all cases) accounting for 30 million cases in the U.S.

Those most likely to develop hair loss are: 1) women over 40, 2) post-partum,  3) women who have had chemotherapy or other medications (meds for hypertension, arthritis, depression, heart issues), 4) women who wear their hair in tight styles or use harsh chemicals, 5) menopausal women.

 

Medical disorders affecting hair loss

  1-Alopecia areata—an autoimmune disease that causes patchy hair loss

     

2- Thyroid issues—either low or high

3- Pituitary deficiency

4- Lupus

5- Addison’s disease (adrenal gland deficiency)

6- Celiac disease (gluten deficiency)

7- Lichen planus (skin disease)

8- Mental issue (trichotilla mania)-disorder makes the individual pull their hair out

 

Prevention of hair loss

  Be kind to the hair, with no traction or pulling of hair, hot blow dryer or other styling tools, stop hair straigtheners, perms, and other chemicals including hair color, manage stress, counseling, antidepressants, mild shampoo, balanced diet with good protein and iron. Unless extremely oily hair, wash hair only every other day.

  Hair loss can often be temporary, but seeing a dermatologist is a good start. Skin diseases, nutritional and vitamin deficiencies, hormonal issues and endocrine abnormalities, medication causes, and genetics all must be discussed and labs drawn.  

 

Common myths

  Hair loss occurs from shampooing too often, having dandruff, wearing hats and wigs, only occurs in intelligent women, or under stress (temporay can occur). Shaving the head will make hair grow back thicker, standing on the head will increase circulation and help hair loss, and brushing the hair 100X will make the hair more healthy.

 

Treatment

  Minoxidil not only helps male but female pattern hair loss, however, must be continued indefinitely, as stopping the medication will return the hair loss. This med is a antihypertensive.

  Oral cortisone will treat autoimmune causes and reduce inflammation.

  Oral contraceptives may help. Hormone replacement at menopause may help.

  Hair transplants and scalp reductions may be considered.

  Wigs are a godsend for those with chemotherapy induced hair loss. Coolng caps during chemotherapy do help.

  Spironolactone (a diuretic) is an antiandrogen, and may be of value.

  WebMD, Healthline.com, Cleveland Clinic

 

3. Blood clots, emboli, and bleeding disorders

 

Defects in the body that create them

  To understand the body’s ability to prevent bleeding and clotting, requires an understanding of how the body uses the clotting factors to prevent bleeding. There are many defects in the hematologic system that increase the risk of bleeding. I have discussed the blood system in previous reports www.themedicalnewsreport.com #67  and #68

These reports discussed how the blood is produced, and the diseases that occur with aberrations in the red and white blood cells.

  This report includes the actual clotting factors that must be present in order for normal clotting to occur. When these factors are deficient from genetic diseases primarily, there is a risk of bleeding, spontaneously or excessively when trauma occurs.

  

    A. Clotting factors

  The clotting factors produced by the blood system are responsible for maintaining hemostasis (the balance between clotting and keeping the blood flowing). When a cut occurs or any form of trauma that creates bleeding, the body mobilizes clotting factors with the addition of platelets, another blood product created in the bone marrow. Otherwise, these clotting factors are not mobilized to allow natural blood flow.

There are 13 blood clotting factors (created by liver cells), and most of my readers don’t need to see the list, but there are certain factors that are the common ones that create potential bleeding or clotting.

  It is a very sophisticated system that requires a cascade of promoting these factors through pathways that combine these factors that creates a normal clotting system stimulated by bleeding. If there are deficiencies in certain factors, bleeding is more likely.

  Genetic mutations can occur causing an overproduction of factor V (Leiden), causing potential hereditary blood clotting in siblings who carry the Leiden gene mutation.

 

   B. Bleeding disorders

  Hemophilia A is by far the most common severe bleeding disorder, caused by a partial deficiency of factor VIII. This is a serious bleeding disorder requiring administration of regular transfusion of Factor VIII which can be extracted from donated blood. Approximately 1000 new cases per year are diagnosed in the U.S.

  Hemophilia B (Christmas disease), named after a 5 year old boy diagnosed with the disorder, is caused by a deficiency of Factor IX (9). Most hemophilia is genetic, but deficiency of these factors can occur in acquired conditions such as pregnancy, autoimmune diseases, cancer, multiple sclerosis, and drug reactions.

  Small cuts are not usually an issue, rather, nose bleeds, and bleeding into joints, and internal organs are major risks.

  A minor head injury could cause brain bleeding. Blood in the urine or stool, unexplained bleeding after minor surgery, and easy bruising are signs that there is need to check the blood clotting factors with a few tests.

  The genetic mutation occurs on the X-sex chromosome, and the X chromosome in males, but must come from the mother, who is the carrier. Therefore the disease almost always occurs in males passed on by their mothers. Anyone who has hemophilia should have their male family members checked for the disorder.

  In addition to factor VIII transfusions, there are 2 medications that can be used: Desmopressin can stimulate factor VIII in the liver, and Hemliba that can help prevent bleeding. Doctors can apply certain products on a bleeding wound to stop or reduce bleeding.

  Von Willebrand disease is by far the most common and mildest genetic bleeding disorder and can go undiagnosed for years. It also can be associated with a mild deficiency of factor VIII. VW disease can occur in both sexes.

  85% have Type 1 (caused by a low level of Von Willebrand Factor). Type 2 have normal amounts of this factor but it doesn’t work well. Type 3, the least common, is the most severe. These patients would be at higher risk for surgery especially on mucous membranes (mouth, tonsils, throat, nose, sinuses, GI tract, bladder, prostate.

  Treatments for Von Willebrand disease include Desmoplastin injection or nasal spray, factor replacement therapy (Vonvendi, etc.). Antifibrinolytic agents can be used and birth control pills can increase this factor.

 

   C. Excess blood clotting disorder

 

     1- Factor V Leiden hereditary clotting disorder

  Leiden disease is caused by too much Factor V, and is hereditary, and most family members have a mild tendency to clot more easily.

  This is an issue for women who have other factors that increase clotting, such as birth control pills, estrogen replacement, lower leg venous disease. This disorder would potentially be a risk factor for COVID-19, since clotting does occur with this viral illness.

  Most families affected are from European descent. If one parent has the gene, the children will have very mild issues, while if both parents would have the gene, the clotting potential would be more significant. Blood tests can determine this disorder.

 

     2- Most clotting disorders

  Most individuals who develop blood clots do not have a hereditary predisposition, rather it is a group of underlying diseases that increase the risk for stasis of blood usually in the lower extremity veins. However, the number 1 cause is atherosclerosis (hardening of the arteries), since blood vessel in heart, brain, or anywhere and can clot off after they have been narrowed by plaques of a combination of fatty products, platelets, and clotting factors. Here is a list:

1. Atherosclerosis

2. Deep vein thrombosis, thrombophlebitis, varicose veins

3. Heart arrhythmias

4. Obesity

5. Sitting for prolonged periods

6. heart attacks, stroke, and heart failure

7. Pregnancy

8. Smoking

9. Postsurgical risks

10. Phospholipid syndrome

11. Polycythemia (too much blood)

  When blood clots form, they can cause blockage at the sight of clotting or by breaking off and embolizing to right side of the heartlungs if on the venous side or right heart, and the brain or lower extremities if from the left side of the heart.

Mayo Clinic

 

  Enoxaparin (Lovenox) and other non-heparin anticoagulants are the treatment of choice for blood clots in patients with both venous and arterial blood clots. These treatments interact with other drugs and supplements that thin the blood including aspirin and other NSAIDs, fish oil, ginseng, gingko blioba, garlic, and ginger.

Below is a blood clot with red cells, little white fragments (platelets), and blood clotting factors.

Prevention techniques for the lower legs

  1. Do not sit for longer than 1 hour, 2. When driving, get out of the car hourly, 3. Be aware of any change in calf size, tenderness, redness, or swelling of one ankle, 4. Because leg vein clots embolize to the lungs, be aware of any shortness of breath, coughing bloody sputum, 5. Chest tightness or pain

 

Prevention of heart emboli includes treatment of heart arrthythmias, heart valve difficulties, and anticoagulants.

  For emboli that come out of the heart usually from left atrial fibrillation, usually go to the brain, therefore, any sudden headache, stroke symptoms, or vision changes, seek help immediately. If the right atrium is involved (less likely), the blood clot would travel into the lungs, with shortness of breath, chest pain, and lightheadedness.

 

Clots and emboli

   Clots with low blood platelets (Thrombosis/thrombocytopenia Syndrome) caused by the J&J COVID vaccine

    The CDC and FDA just recommended the J&J COVID vaccine not be used because it is a side effect, causing clotting problems. This is much more common in J&J than the mRNA vaccines (Pfizer and Moderna).

  The J&J vaccine is made from an adenovirus. It is normally a very rare type of clotting issue, but the J&J vaccine is causing the side effect in 1 out 6000 doses. It called thrombosis/thrombocytopenia syndrome).

    Low platelets usually do not cause blood clots, but since J&J has created the situation (which can occur from other drug side effects too, especially heparin, it has received notoriety.

  Heparin (1-2% of cases) can cause an antibody response in certain patients that drops the platelet count but not before these small blood platelets can collect in vessels blocking them off. It is rare but can be devastating, these can lodge in extremities or other organs causing loss of the lower limb or severe damage to an organ. Most of the clots that occurred with J&J vaccinated patients were cerebral venous thrombosis (pulmonary emboli, cerebral hemorrhages, and other types were less common). This is in contrast with blood clots from lower leg and heart emboli not associated with low platelets. These photos show emboli in where the arrows point.

      

The above left drawing demonstrates the veins that drain the brain’s blood, and on the right a clot (arrow) in the posterior saggital sinus on CT scan with contrast.

  Splanchnic vein thrombosis also can occur (these vessels are in the gut), presenting with severe abdominal pain.

  Platelets are formed in the bone marrow and other organs that can form blood products such as the spleen. Platelets release blood factors and stimulate the release of other clotting factors creating a clot. Their life span is 10-12 days and are readily replaced by the body.

  AstraZenica has reported 209 cases as of April 30, but now J&J reported many more. Both vaccines have been administered to at least 7 million people. If you received the J&J vaccine, it would be advisable to get the Pfizer or Moderna booster.

  Among the antibody abnormalities were anti-PF-4 antibodies (PF=platelet factor) which drops the platelet count, causing bleeding and secondary thrombosis. This is similar to the adverse effect heparin has on platelets in 1-2% of patients and is a serious side effect.

  A neurosurgeon in my medical group had this occur from heparin after undergoing coronary bypass surgery, and blocked off his lower leg, creating massive pain and ultimately loss of his lower leg.

 

 Pathophysiology of clotting in the face of low platelets

  There are two processes of blood clots in the face of a low platelet count, according to experts at Emory University in Atlanta.

  The platelets are destroyed by vaccine-induced antibodies in extremely rare cases. The second process occurs by rapid consumption of the platelets, which stimulates more platelets that can aggregate forming a clot, most commonly in these cases in the veins that drain the brain.

  The vaccines apparently accelerate the destruction of platelets and create a low platelet count. Platelet counts drop to 10-20,000 per cubic millimeter (normal range is 150,000-450,000). This process is similar to heparin induced autoimmune thrombotic thrombocytopenia.

  Both the vaccine related issue and adverse effect from heparin present with severely low platelet counts (thrombocytopenia), aggressive clotting, and disseminated intravascular coagulation.

  The J&J cases have been declared within the norm considering the millions of doses administered. J&J is still available in the U.S., while Astra Zenica has yet to be approved in the U.S. and is on hold in many European countries considering that 209 cases have occurred.

  These cases occur 5-24 days after the vaccine, and are mostly in women age 18-34. Although there is a caution about the rare instance of clotting issues with vaccines, it is one more reason that younger women are hesitant to get vaccinated, even when the risk is so small.

  The ELISA blood test can detect the platelet factor 4 abnormality.

  These cases need to be treated with IV immunoglobulins, use of non-heparin anticoagulants, and avoidance of platelet transfusions. High dose glucocorticoids and immunoglobulins can elevate the platelet count in a few days. 

Medpage Today, April 23, 2021

NEJM Cardiology, April 16, 2021

 

4. Autoimmune diseases-Part 1

 

Incidence

  I have reported on autoimmune diseases in 2012 (my first year of this report), but with new testing and treatments, it is appropriate to update that information.

  There are over 100 diseases that are considered autoimmune in origin, according to The American Autoimmune Association reporting as many as 50 million Americans that suffer from these disorders with half that number with specific named autoimmune diseases. For that list, click on www.aarda.org/diseaselist/

This website has information on all of these diseases. I will only report on the most common.

  8% of the U.S. population is affected by autoimmune diseases but 78% are women according to the CDC. There is circumstantial evidence that prior infections play a role in women. Female hormones seem to play a role in these diseases considering the major difference between sexes.

  Another factor is known that women respond to diseases with a more robust antibody response. But why specific parts of the body are seen as foreign by the body is still unknown with the body’s own immune response attacking what appears to be normal tissues.

  There may be genetic markers and other inflammatory markers that create this attraction by the T- and B-cell lymphocyte response.

  These diseases rank only behind heart disease and cancer in numbers. Autoimmune diseases occur only in susceptible individuals.

 

Immune response in normal and autoimmune diseases

  The immune system is found throughout our bodies as pointed out in the drawing below. These tissues contain lymphoid tissue, such as lymph nodes, tonsils, the spleen, bone marrow, and other tissues.

  A close genetic relationship exists between these diseases, which explains cluster of these diseases in families and a common pathway for disease.

  To be healthy, we must have a good functioning immune system. We also know that there are many diseases that have a basis in creating inflammation that is seen as foreign.

  COVID-19 massively stimulated our immune T- and B-cell blood lymphocytes to cause severe damage in our bodies wherever it saw inflammation (cytokines). Our bodies had never seen that specific virus and had no natural immunity to it.

  Injury of any type to our body calls on our cells to fight back whether it is infection, cancer, or other types of bodily insults.

  It is normal to create an inflammatory response to stimulate the right cells to flood an area that is injured or inflamed and begin the process of healing. That does not work so well in these autoimmune diseases.

  Our immune response is the only reason we survive, but in these diseases the response from our body causes injury (inflammation) the tissues instead of healing them. Our body is bombarded by insults constantly without us even knowing it. The wonders of our body keeps us out of trouble…MOST OF THE TIME!

  Although the immune system is the culprit, environmental exposures combined with genetic factors are the key to the disorder. And the CDC points to past infections inciting the immune system predisposing an individual to these diseases.

  There is considerable overlap between these autoimmune diseases. Chronic fibromyalgia is one of the most common overlapping illnesses. It has been renamed Central Sensitivity Syndrome, and there is a detailed report available by logging on:  www.themedicalnewsreport.com #84 

Risk factors

  According to the NIH*, the following exposures influence some of these disease—*National Institutes of Health

a) Sun exposure with lupus

b) Childhood poverty with rheumatoid arthritis

c) Agricultural pesticides with rheumatoid arthritis in males

d) Mercury exposure in food and drink influences the development of inflammatory bowel disease (Crohn’s and Celiac), lupus, and rheumatoid arthritis

e) Genetic factors in Caucasian populations in Europe and the U.S.

f) Smoking tobacco is linked with rheumatoid arthritis

g) Vitamin D deficiency and poor nutrition may influence multiple sclerosis and lupus.

Carrie Ann Anaba, judge for Dancing with the Stars, who suffers from multiple autoimmune diseases including Sjogren’s disease, rheumatoid arthritis, lupus, fibromyalgia, and markers for antiphospholipid syndrome, and has had to take a leave of absence from the TV show to attend to her disorders.

  The most common parts of the body affected are the joints, skin, and thyroid, although all organs are at risk.

A. The most common autoimmune diseases

The top 10 according to the autoimmune registry are:

1-Rheumatoid arthritis,

2-Type 1 Diabetes,

3-Systemic Lupus Erythematosis,

4- Inflammatory bowel disease (Celiac disease, ulcerative colitis and Crohn’s disease) (not to be confused with IBS-irritable bowel syndrome most likely stress induced)

5-Skin symtoms and diseases-vitiligo-white spots, blisters, rashes

6-Rheumatic fever

7-Thyroid diseases-Hashimoto’s thyroiditis and Graves disease

8-Pernicious anemia

9-Alopecia areata

10-Autoimmune thrombocytopenic purpura

. There are many more you have heard about (Multiple sclerosis, Dermatomyositis, Scleroderma, Psoriasis, Lyme disease, Wegener’s Granulomatosis, Juvenile Arthritis, Meniere’s disease, Sarcoidosis to name a few). Because some include Fibromyalgia in this category, I will report on it as well.

There is a definite differences between the most common diseases in men and women.

 

Women have 78% of autoimmune diseases

  Women suffer from over 2/3 of the cases, therefore, female hormone must play a role. Those in the childbearing age, family history, enviornmental exposures, and certain ethnic groups (Black and Hispanic, although type 1 diabetes more common in whites) The top 4 diseases suffered by women are:

1-Lupus

2-Multiple sclerosis

 3-Thyroid diseases (Hashimoto’s thyroiditis and Graves disease)

4) Rheumatoid arthritis

 

Common symptoms from any inflammatory disease could include fatigue, weakness, muscle ache, dizziness, weight loss, etc. and occur intermittently as does the severity, which makes the diagnosis difficult.

I will report on the more common autoimmune diseases and briefly discuss less common ones with a reference to investigate those who might have a special personal interest in them. 

Medpage, May 4, 2021

 

1. Systemic lupus erythematosis (SLE)

Butterfly Lupus rash

Discoid lupus rash

Systemic lupus erythematosis (SLE) is the most common type of lupus. It is 3X more common in women of color-black, brown, and yellow). Family history is not uncommon. It causes widespread inflammation in various tissues including the skin, joints, brain, lungs, blood vessels, and kidneys.

  Discoid lupus affects only the skin. The rash occurs as  discs of inflammation any where on the skin (most commonly hands, feet, face, arms, scalp, and neck) ultimately with scarring and hyperpigmentation. It must be differentiated from systemic lupus with a workup, but must be followed since about 5% can develop systemic disease.  

  Topical steroids, injections into stubborn lesions, and even oral steroids are used along with other anti-inflammatory medications such hydroxychloroquine (an antimalarial). More severe cases may require immunosuppressant medications.

  Smoking, sun exposure,  antibiotics, diuretics, and other medications can flare the skin in discoid lupus just as it does in SLE, with only 5% later developing SLE.  

  The severity of SLE can range from mild to life threatening. The disease usually occurs in women with rashes, fevers, joint pain, swelling, and stiffness, fatigue, usually in episodes intermittently which can be weeks, months, or years apart.

   Sun sensitivity is common cause of the facial rash, which occurs across the cheeks and over the nose giving the appearance of a wolf, which gives the Latin name of the disease (lupus means wolf). Oral ulcers, dry eyes, arthritis, lung, kidney, and heart problems, stroke, seizures, psychosis, blood cell (anemia) and immunologic abnormalities can all occur. These multiple systems involved require an investigation of various tests.

  Triggers to flares include stress, sun exposure, lack of rest, infection, injury, and certain types of medications. Symptoms worsen as a flare comes on.

  Fatigue is very common problem limiting quality of life, and as the disease progresses, any number of organs can begin to fail. The key is prevent progression with proper treatment.

  Laboratory tests include a positive ANA (antinuclear antibody test), abnormal blood count, white count, and other abnormal tests such as rheumatoid factor (RF), sedimentation rate (indicating inflammation), possible skin biopsy if rash is present, and kidney biopsy if there is evidence of kidney disease. Kidney functions studies and urine evaluation is part of the workup. Antiphospholipid studies may need to be tested.  

  Treatment includes prevention of triggers, NSAIDs (Aleve, ibuprofen, etc.) corticosteroids, antimalarials (hydroxychloroquine), immune inhibitors (monoclonal antibodies—belimumab—Benlysta) to limit the abnormal B cells in the blood, and immunosuppressive medications and chemotherapy (Imuran, Celicept, cyclosporines, methotrexate (Rheumatrex), cytoxan, and leukeran).

  A rheumatologist should be consulted to decide the correct course of action. 80-90% of patients should be able to live a near normal life with prevention of major complications.

CDC, Lupus Foundation

 

2. Dermatomyositis

These photos are consistent with classic skin signs of dermatomyositis. These hyperpigmented areas with little violet or red bumps (papules) with dilated blood vessels in the nails, with patches and plaques (similar to psoriasis) on the body (even with calcium deposits in the skin).

  This is associated with muscular weakness of the extremities from arthritic changes in the shoulders and hips strongly suggests dermatomyositis.

  However, there can be involvement of the esophagus causing swallowing difficulty (mirroring scleroderma, another autoimmune disease). Breathing difficulties can occur from weakness of the chest muscles. 

  This uncommon autoimmune disease begins in the 40s-60s and incurable. As all these diseases, the cause is unknown.

  Associated conditions can include Raynaud’s phenomenon (blanching of the fingers and toes from cold exposure), other autoimmune diseases such as scleroderma, rheumatoid arthritis, and Sjogren’s disease, myocarditis, lung disease, and cancer (particularly ovarian cancer in women).

  Blood tests for autoantibodies, skin and muscle biopsies will confirm the diagnosis. Although control is possible, it is incurable.

  Treatment is similar to other autoimmune diseases (corticosteroids, Rituxin-monoclonal antibody, hydroxychloroquine, and sunscreens.

  Mayo Clinic, NEJM, June 24, 2021 

 

3. Scleroderma

  Another autoimmune disease with someaht classic skin signs is scleroderma, and the name implies scarring of the collagen and tightening of the skin of the hands and feet.

 Another collagen vascular disease, it can affect the same organs as other autoimmune diseases including the kidneys and erectile dysfunction.

  Note the tightness of the skin (L), Raynauds (R), which blanches the arteries to the fingers turning them white.

    

Raynaud’s can be very painful, and can lead to loss of fingers and toes.

The treatment again is similar to the other autoimmune diseases. Depending on the clinical and organ involvement, these diseases will require organ specific medications too.

 

4. Type 1 Diabetes

  As opposed to type 2 diabetes, type 1 is an autoimmune reaction to the pancreas destroying the cells that secrete insulin (Islets of Langerhan). This is an insulin dependent disease to control metabolic symptoms and prevent ketoacidosis. It is often called juvenile diabetes, starting at 4-7 and 10-14 years of age.  

This disease starts in childhood and affects about 1 in 500 people. Blurred vision, fatigue, weight loss, thirst, and increased urination. It can be genetic. Diet and life style do not cause type 1 diabetes as it does in type 2. It can take months or years for the immune system to destroy the pancreatic insulin cells.

  The same complications of type 2 occur in type 1 (neurologic, cardiovascular, and kidney). Heart disease, kidney failure, foot problems with loss of toes, etc., cataracts, glaucoma, and diabetic retinopathy, skin infections, pregnancy complications, and ketoacidosis (a metabolic disease that can be fatal).

  Life span can be shortened if the complications of type 1 diabetes are not prevented with proper maintenance of the blood sugar with insulin, proper caloric intake, foot care, regular checkups for complications, eye care, and prevention of injury from neuropathy.

  Insulin pumps have become a helpful way to monitor and treat variations of blood sugar. Research to produce insulin cells resistant to the antibodies is encouraging.

 

  Next month, I will report on more autoimmune diseases in Part 2.

 

5. New innovations in the treatment of head and neck cancer

  One of the most difficult cancers to tolerate in terms of treatment is the pain and disability it causes. Most oral and throat cancers including laryngeal cancers require surgical removal, chemotherapy and radiotherapy if cancers have spread to the neck lymph nodes. Chemotherapy is also necessary when using non-surgical attempts to cure these cancers or early cancers that will respond without surgery.

  I spent 30 years performing this kind of surgery with major reconstruction of jaws, tongues, voice boxes, etc.

  2 innovations were reported in the medical literature.

1. New research has been published in the British Medical Journal that shows promise in diagnosing early cancers in the mouth, throat, and larynx….a breath test.

  They took breath samples by having the suspected cancer patient breathe into a sealed bag and analyzed volatile organic compounds using the mass spectrometer.

  66% of the participants had early stage primary tumors and 58% had nodal metastases. The sensitivity of this test was 80%, meaning this test can pick up the early cancer 80% of the time, and a specificity of 86%, which means it will have only 14% who will show a positive or negative test erroneously.

  Patients chosen did not have obvious cancers present on ENT exam. Anything to diagnose these patients earlier will perhaps save this patient’s life and prevent more extensive therapy.

2. The second is the use of proton radiotherapy including the use of gabapentin prior to RT, which is diminishing several symptoms of radiation which occurs in IMRT, the standard therapy. The majority of these patients underwent transoral surgical removal of their primary cancers obviating the necessity for radiation to that area, and allowing more focus on the neck lymph nodes, where these cancers are likely to spread first.

  Proton radiation can reduce the scatter of radiation to the surrounding areas, causing many of the symptoms that can be long term or even permanent.

  Most of the oroparyngeal (throat) cancers are HPV (human papilloma virus) positive and respond to reduced amount of radiation and even chemotherapy. Most of these patients are in their 40s and 50s, and have many years ahead of them. Preserving quality of life issues and functions of the mouth and throat is critical to that quality of life.

  Swallowing, breathing, speech require efficient pliable tissue to function well. This innovative therapy seems to accomplish this to some degree. Unfortunately, losing saliva is a problem with any form of radiotherapy, and proton radiation was no better in that respect.

  Less toxicity means better and faster recovery.

  Additionally, instituting gabapentin, a neurological pain med known as Neurontin, a same week radiation was begun, and prevented the need for opioids 60% of patients. Radiation is required once a day for 7 weeks, 5 days a week.

  By week 7, only 9% of patients required morphine compared to the control group. Both these groups had about the same amount of complications from RT (mucositis, dermatitis, fatigue, pharyngeal inflammation).

  It is hypothesized that the pain from radiation irritates  the nerves of the throat and neck tissues causing pain. Thus a neuropathy type of medication makes sense that it is of value.

  The doses of gabapentin far exceeded the current recommendation of no more than 2700 mg per day.

American Society of Radiation Therapy

 

Thank for reading my first report of 2022. It also completes 10 years of reports. February will begin my 11th year of providing the latest information on a host of medical and healthcare issues. Lets hope 2022 brings this country some more common sense and a better healthier year.

 

  Next month, the February 2022 report will include:

1. More on the pandemic

2. Autoimmune diseases-part 2

3. Degenerative shoulder difficulties

4. Stress incontinence

5. Disparities in healthcare

 

Stay healthy and well, my friends, Dr. Sam