The Medical News Report

#122

  March, 2022 

 10th Anniversary

Samuel J. LaMonte, M.D. FACS

samlamonte@gmail.com

www.themedicalnewsreport.com

 

Subjects:

Read my comments about 10 years of reports!

1. COVID updates

2. Pregnancy Complications—eclampsia, pre-eclampsia; gestational diabetes; tubal pregnancy

3. Autoimmune diseases-part 3—IBS-irritable bowel syndrome; Crohn’s/Ulcerative Colitis, and Celiac disease

4. Childhood poisoning from gummi bears

5. Less Chemo for elders for cancer

6. Disparities in healthcare (financial, race, gender identity, religion, etc

5th Century Bishop, and Patron Saint of Ireland

March 17 is the date of his death, St. Patrick’s Day

 

10th Anniversary of the Medical News Report

  I would like to thank you for being a loyal reader, some for now the tenth year. I published my first report February, 2012. I have compiled hundreds of subjects with the latest information in the medical literature. Medicine  has greatly changed in 10 years. I have tried to update my knowledge constantly and share it with you free of charge and free of advertisements. This has been my ministry to educate the public and provide truth ful and honest information.

  Healthcare continues to change as our country and is slipping towards socialism with younger Americans supporting socialized federal controlled medicine. They have no idea how mediocre medicine will become. Most socialized countries have other options that cost more, and so there will always be differing qualities of medicine. Free is never free!

  The stresses on healthcare professionals have never been more serious as we find ourselves with shortages of care especially in our rural counties. We are depending on more and more foreign trained doctors. Doctors and nurses are working overtime to try and take up the slack, but are burning out and retiring early.

   Medicine has put much more responsibility on the patient with emphasis on “patient-centered care”, requiring people to acquire much more knowledge about their disease and to participate more in decision making about their care. It is necessary as the time spent with doctor visits drops, and many people don’t even see a primary care doctor, depending on urgent care.

  Many small towns rely on nurse practitioners without the luxury of a physician being present for consultation…welcome to telemedicine.

  These issues make my reports vital to your knowledge in an era of fake medical news throughout the internet and news programs on TV. Please share my reports with your family and friends. Ask to be on my mailing list so you can receive the reports on your private emails. Just let me know at samlamonte@gmail.com

  Thank you for allowing me to share my knowledge with you as I continue into my 11th year. Dr. Sam 

 

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

PRAYERS FOR UKRAINE, THEIR PEOPLE, AND THOSE THAT LOVE THEM. Pray that Putin finds a way to keep from destroying the country and threatening nuclear assaults. Be prepared as always to meet your Maker! Prayers also for our administration to make more meaningful contributions to Ukraine.

 

1. COVID-19 updates

  It is hard to believe how much new information comes out weekly about the ever changing face of the pandemic. I have had to edit this report about every 4-5 days. And now we are finally hearing good news from the CDC, which should have occurred at least a month ago, but remember the public health is mandated to be the most cautious group in healthcare. Regardless of the good news that the pandemic is coming to a close, the information in this report is very important to read.

  Continue personal diligence when around crowds and in close contact with others, get vaccinated and boosted, and be sure you are tested if you come into close contact with a test positive person or develop respiratory symptoms. People that have been infected (proven) or vaccinated do not need to be tested if just exposed according to the CDC on Feb. 28. If unvaccinated or medically dealing with trouble, I would continue to be very cautious, and wear masks when very close to crowds. If healthy, enjoy a return to near normal within the next month, unless a new variant changes things.

  64% of the world’s population have had at least one dose of vaccine and 420 million cases are known with millions unknown, and we are seeing the demise of the pandemic as it goes into an endemic stage, much like the flu. Put away your fears and get back to normal!

  There have been many mistakes made during this pandemic, and politics has blemished the entire pandemic management. I will report on what is in the medical journals, and discuss some controversial issues as well.

 

  1. Natural Immunity is as good as vaccine; new information about our immunity

  Research has finally been performed on those with natural immunity to discover what most of us knew…they have antibody levels close to those with vaccination, and now we find out from data that their quality of immunity is better than those with vaccination, even though the amount of immunity in vaccinated people is higher (quality over quantity). This comes (as usual) from Israel, where probably the best research is being performed and their data is often used by the CDC, since the U.S. has been somewhat delinquent in performing the same research.

 

  a) New information on our immune system

  When vaccinated or infected, two types of blood cells are activated—B cell lymphocytes which produce antibodies, the first line of defense, which attacks the spike proteins of the virus. When the virus begins to replicate, a second type of blood cell is activated—killer T cells (also lymphocytes). The killer cells can recognize an infected cell (not the virus itself) and destroy the infected cells. It is the killer cells that prevent the more severe cases, hospitalizations, and deaths.

  After these cells do their job, they are converted into memory cells, and can recognize when the virus reappears, recognizing the same spike protein and can mount a vigorous response to prevent an infection. These memory B cells are seen when a breakthrough infection tries to occur and when another dose of vaccine is given.

  However, as has happened, the recent variant mutated viral particles (Delta and Omicron), change themselves with more mutations and these memory cells don’t always recognize them. Also we now know that these immune cells tend to wane after 6 months (infection immunity may last longer), creating vulnerability and a need for another dose of vaccine theoretically. Hence the booster was created, but unfortunately even the booster does not last long (3-6 months), developing conversations about a 4th dose. Also the Omicron variant is infecting those who have been boosted.

  That is not to say that many of these memory cells don’t persist, even 1-2 years. The amount is often unknown and is why doing antibody blood tests can’t answer the question…..is my antibody level enough to prevent another infection?

  Long term studies are not known. For now, it is stated that the vaccines are good for 6 months, and then a booster is recommended.

  This information applies to those infected and those vaccinated, but suggest after 6 or more months, those previously infected need a booster, since the latest consensus is that infection is just as successful as vaccines in stimulating immune response.

  According to a study in the JAMA Research Letter, February 3, 2022, about half of people who had symptoms consistent with COVID-19 actually had proven infection (antibody testing).

  If an infected person or one who has had the vaccine has a reinfection, they are called super (hybrid) immune and are probably protected for at least a year. Research right now is using these super immune people to come up with another vaccine that may be more effective. MDLinx, February 25, 2022

  These findings are in stark contrast to a study cited on the CDC website, showing better quality of immunity in the vaccinated at 6 months. This creates controversy and only more studies will give us more information on the latest variant (Omicron and the BA-2 subvariant).

  The media, and the spokespeople for the federal government should be honest about what is known, what is assumed, and what is medical guessing. They also often omit information that goes against what is coming out of the White House. Politics has created mismanagement of this pandemic. Most media continues to be complicit.

  Since as many as 30% of those infected may have been asymptomatic or have such minimal symptoms that testing was never done. The CDC chose to not count numbers of cases that have natural immunity. The CDC has finally decided to quit counting numbers of cases, and mmakes decisions only on the basis of number of hospitalizations and percent of hospital beds filled to determine what counties are still high risk (currently 26%).

  There have been significant numbers of patients admitted (and even died) that actually were admitted with a diagnosis of a medical disease but were test positive and therefore called a COVID case wrongly giving the public the actual number of cases admitted because of COVID symptoms. It is well known that Medicare and Medicaid paid the hospital more money for antone with the  diagnosis of COVID, primary or secondary.

 

  b) Percent of immune Americans

  Experts have just reported that 73% of Americans are now immune to the Omicron variant, and by the mid- March, 80% will be immune.

  Some experts suggest approximately 36% of the population has been infected (of 339 million population=122 million), while 69% have been fully vaccinated and 47% have been boostered.

  Dr. Shaun Truelove, epidemiologist at Johns Hopkins University, and a disease modeler, states that by the time the pandemic is over, 3 out of 4 people in the U.S. will have been infected. Add the 214 million fully vaccinated (64.9%) and we have herd immunity even with Omicron.

  This gives our country a nice shield of immunity, whatever you want to call it, according to the University of Virginia’s modeler Bryan Lewis PhD. As high as 81% of our country is immune. Why do we need mandates?????

 

  c) Boosters not as effective against Omicron

  It is clear that the booster is not as effective against the Omicron (67.3% as opposed to 93% against the Delta variant). JAMA, February 14, 2022

  Infected or vaccinated, there has been too much emphasis on vaccinations alone, without urging proper masking (N-95 and tight surgical masks), outpatient treatments, and recognizing natural immunity. However, as of Feb 28, the CDC does not recommend masks inside or out for the majority of the country. I will define the high risk counties later in this report (the only counties that need to continue masking indoors). No one has to wear a mask outside unless in tight quarters, are unvaccinated, or older with medical issues.

  Because of the BA-2 subvariant of Omicron just spurred the FDA to raise the dose of one of the latest outpatient monoclonal antibodies—tixagivamab/cilgagivamab (Evusheld). The length of immunity is not yet known.

Medpage Today, February 25, 2022

 

  Israel studies have found that re-infection can occur in about the same number of previously infected as those who have been vaccinated. The booster, however, in some studies did raise the immune levels and have been much more effective in combating the Omicron variant than those without a booster.

  Recent data found the booster has not been as effective against the Omicron as the Delta variant. If a booster was given to those with waning natural immunity, they too would have been better protected. Too bad the CDC didn’t recommend it.

Medscape Surgery, February 17, 2022

   

  d) Previously infected need only one vaccine!!

  It is now in the medical journal studies have reported that previously infected individuals would have excellent immunity with oone dose, and a second dose did not improve their immunity. The re-infection rate is extremely low in that group in an Israel study. Why won’t the CDC communicate this information to the public? NEJM, Feb. 16, 2022

  The New York Times had harsh words to say about the information the CDC has and has not communicated to the public, because they were afraid they would confuse us. I think they have already done a fine job of that! They don’t give people much credit!

  Only 28% of parents have allowed their children (5-11) to have at least one dose, because of the lack of good data about long term effects (even though it is touted as very safe).  

 

2. Omicron variant and subvariant updates

 

  a)  South Africa says an oral swab is better than a nasal swab for Omicron

  Researchers at University of Cape Town, South Africa announced that an oral swab is better to detect Omicron than nasal swabs.

  Delta variant was better detected with nasal swabs, but things have continued to change based on the variant.

  Collection techniques is critical.  Swabbing the sides of the mouth, under the tongue, the gums, and the hard palate for at least 30 seconds was necessary to attain a good sample.

 

  b) New PCR test can tell which variant is infecting a person

The standard COVID test (molecular test-PCR-polymerase chain reaction), has been refined to tell which variant is the culprit. The molecules in each variant have a different color glow in the fluorescent test, and can identify them as they attach to the DNA or the RNA of the virus. The sequences of their nucleic acids are different and are easily identified one from another. Any lab can perform the test but takes a day or two to get the results. The PCR test is far more valuable that rapid antigen tests, but both do create false positives and negatives.

  Medscape Surgery, February 4, 2022

 

  c)  The Breathalyzer

  A research tool using a “breathalyzer” to test for COVID-19 is a rapid method to test people on the spot and it is such a test that would simplify testing greatly, according to experts in a article in Science Daily Top Health, February 3, 2022.

  The test is hand held and the person breathes into the apparatus for 10 seconds. Specific chemicals created by the virus are analyzed immediately in a spectrometer which was performed in Singapore. The breathalyzer had only a 3.8% false negatives. It is with great hope this will become commercially available and tested by the FDA. Medpage Today, Dec.27, 2021

 

  d)  The subvariant BA-2 Omicron

  There is a subvariant of the Omicron variant called BA-2 Omicron, still less than 5% of the cases in the U.S.

  The University of Copenhagen, Denmark reported that BA-2 is infecting all household residents equally, vaccinated or not, and it is now the predominant variant in Denmark.

  This is in contrast to the original study of the BA-1 Omicron variant which showed a 2x greater chance of infection with those unvaccinated. However, if those vaccinated are getting infected as often those not, it is a pretty good reason to question the value of a vaccine now.  

  The subvariant does not discriminate when infecting those vaccinated or not, and the authors reported that the BA-2 is twice as likely than the BA-1 variant to transmit the virus to the unvaccinated, but in animal studies, the booster reduces infection rates in them versus the unvaccinated.

  Yet, research in hamsters show the BA-2 is more pathogenic than the BA-1 and resists monoclonal antibodies (i.e. Regeneron) dramatically. Of course, these are animal studies but raise concern that a variant would be more virulent, breaking the usual evidence of a pandemic  that as variants continue, they are more transmissible but less serious.

  A recent report stated that the only monoclonal antibody (sotrovimab) is 27X less effective in stimulating neutralizing antibodies against the BA-2 subvariant and more transmissible. The FDA has stopped emergency use approval for this drug. According to Dr. David Ho of Columbia University stated that the 500mg dose of sotrovimab is quite sufficient in combating the BA-2 variant and even more effective if the patient had been boostered. This is another example of conflicting research.

  The FDA has approved the new monoclonal antibody Evusheld, as discussed above, and a second monoclonal antibody has been FDA approved,  blebtelovimab, and is effective even against the BA-2 subvariant, to be delivered to the Feds the end of March.

  Remdesivir, was recently authorized for certain outpatients (previously only for hospitalized patients) and the 2 oral medication (Paxlovid and Molnupravir) are the other approved treatments. Paxlovid is said to be mre effective.

MedPage Today, February 11, 2022

  The bottom line, it is too soon as of this writing (2/28/22), that researchers don’t have enough clinical information to be sure how virulent this subvariant will be in the U.S.

  There is still a lot of unanswered questions about the effectiveness of these vaccines, but certainly anyone with underlying diseases, obesity, those immunocompromised, older than 60, and has a fragile relative living with them, that vaccines save lives.

 

  e)  Safety for pregnant women and/or are breast feeding

  There is probably more misinformation regarding infertility and harm to mother and child than in any other group.

  The fact is the vaccines did not use pregnant and breast feeding women in their clinical trials, but many observational studies have shown no increase safety issues over those who are not vaccinated.

  Sperm studies do not show any motility issues either.

  Pregnancy rates so far have been the same, as they are for miscarriages, premature births, etc., but it is known that these women have increased rates of all these problems if they get infected with COVID.

 

  f)  Omicron not just a “cold”

Omicron may cause just a “cold”, but it still needs to be greatly respected by the vulnerable and the unvaccinated.

  99% of those who die are unvaccinated and 75% of those in the hospital are over 65. Obesity is still the most common risk factor along with heart and kidney disease, diabetes, and those immunocompromised.

  According to Medpage Today, February 1, 2022, Omicron is 23 times more likely to hospitalize those unvaccinated. Those vaccinated without a booster are 2X more likely to be infected and 5X to be hospitalized, as reported by the Los Angeles County Health Department.

  Still, there is good news because in that county those vaccinated with and without a booster had only 0.1% die while those unvaccinated died 0.3% of the time.

  Now that Moderna(Spikevax) and Pfizer(COMIRNATY) are officially FDA approved, there is no reason to not get vaccinated and boosted. This does not mean they will continue to use emergency use vaccines, and we have no information if they are exactly the same.

 

   g)  4th dose for immunocompromised

   A recent study also reminds those who are immunocompromised and don’t know if they can mount adequate antibody levels, need to get the 4th dose, and continue to follow more closely the other protective measures, such as proper masking ( N-95 or 3 ply surgical masks) in crowded areas and groups.

 

   h) The FDA advisory committee admits the first two doses were too close together

  After hearing from experts outside the federal payroll for over a year that the first two doses of vaccine were  offered too close together (3 weeks for Pfizer and 4 weeks for Moderna), the FDA committee responsible for approval of drugs and vaccines, etc., quietly announced on February 4, 2022 what we already knew! They announced that both Moderna and Pfizer should wait 8 weeks between doses, however, the FDA is still deciding whether to follow their advisory group’s decision since longer intervals stimulated higher antibody levels. They stated that the two doses was like getting one dose, and because of that, boosters were recommended!! And there was considerable controversy when the CDC recommended the booster after 5 months.

  Now we know….the first 2 doses did not create the level of immunity if they had waited for a longer interval like the UK and Canada.

  The FDA also recommended that if an individual  developed myocarditis or pericarditis from a vaccine that they should not take it again. Who would be so stupid?

Medpage Today, February 11, 2022

 

  i)  FDA pauses their decision to approve for COVID vaccine for children 6 months to 4 years of age;

  The FDA has put a pause on approving a third dose for children 6 months to 4 years of age, and therefore this age group will not be receiving any COVID vaccine yet! The 2 doses did not stimulate enough immune response, and therefore, recommended a third dose, but little information is known about a third dose, and that is asking  a lot of parents.

  I am sure the vaccine companies are trying to reduce the number of myocarditis cases. It will be a few months before this decision will be readdressed, according to the Vaccines and Related Biological Products Advisory Committee, who is the responsible group to make these approvals.  Medpage Today, February 11, 2022

 

  j)  Medical editors want separation of the administration with the FDA and CDC

  As the editors of Medpage Today stated in their opinion about separation of Washington DC from Atlanta (CDC), they stated that Dr. Fauci is a great spokesman for the White House, explaining questions about the pandemic, but should be left out of the decision making and left to the experts at the CDC and FDA, as stated in their article in MedPage Today, February 9, 2022.

 

  k)  Teachers lost is huge!

  400,000 teachers have been lost because of factors relating to the pandemic. Teacher’s unions have been responsible for most of major decision making, and with lockdowns, virtual learning, loss of teacher’s abilities to interact with their students, COVID illness, frustration with lack of child care, and just plain fatigue with changing regulations in schools, our children are suffering from lack of teachers throughout the country. The lack of concern for the “overall” welfare of children has been lost because politics as usual has created controversy, anger, and dissention in our country.

 

3. Mandates/CDC has new Mask recommendations

  The mandate for vaccination by the administration was too been late. Those vaccinated clearly have a major advantage even though there are people who have had the booster and are now getting infected with the Omicron variant, so why mandates if re-infection occurs after 2 doses of vaccine and a booster??

  If the BA-2 subvariant of Omicron becomes prevalent, it resists the booster even more. Still, it is the best we have to stay protected with no guarantees.

  69% have been fully vaccinated and thousands are continuing to get vaccinated and getting boosters (47%) even without the mandates. Those with natural immunity probably would have benefited from a booster, but are not eligible according to the government.

  If those folks were added to those fully vaccinated, they could add another 20% that could be considered immune. The point is the CDC should consider the number of immune cases rather than the number of infected cases.

 

  a) CDC has new recommendations for masks!!

  The CDC has revised, once again, their recommendations for the use of masks. According to the CDC, only 28% of the country lives in a high risk county, and does not need to wear masks inside or out.

  Their metrics were based on the numbers of hospitalizations, emergency visits, and the reduced numbers of cases in the counties (40% and higher).

  Masking in schools was only recommended in those 28% of high risk counties. Children’s illnesses have been very mild. We will see how well school boards and unions follow their recommendations.

  The new mask recommendations do not apply to public transportation.

  Those who are suffering from medical diseases, are frail, very old (you decide), immunocompromised, and anyone who just feels better protected should wear a proper mask if desired. That goes for people who have been vaccinated, boostered, infected, and certainly those with any active symptoms of any disease, as they need testing as do their household members.

 

  b) Speech, social, and psychological delay in kids

  A recent study cites that there is a 300% increase in referrals to speech therapists for language delay and social improvement because of masks and virtual teaching, since children are losing out on using facial expression to enhance their socialization and maturing, their personalities and communication skills. Add this to other developmental delays especially math.

  The CDC still encourages masks in areas of high transmission, while some states are making their own decisions and even some blue states are now dropping mask mandates (did you see many masks at the Super Bowl?) JAMA Network, February 3, 2022  The red states have not required indoor masks for some time.

  Unfortunately all federal employees are still required by mandate to be vaccinated and masked. This includes the military, and those with federal contracts. The booster has yet to be mandated.

  The White House is still against dropping mask mandates, but the states have the power, thankfully. And now the CDC is changing their recommendations. New York, Nevada, California, Connecticut, Delaware, New Jersey, and Oregon are ending their mask mandates by March.

  We are literally close to an endemic and the administration is still forcing its power and control on our citizens.

  The CDC lifted some of restrictions on cruise lines and allow voluntary programs. They still require a negative COVID test prior to embarking. Because there are various status protocols, be sure passengers are quite familiar with their requirements, since they may be different for different ships.

 

  c) N-95 masks are the appropriate masks to wear

  Most of the N-95 masks have been made in China, and there are significant fakes online. The mask to be optimally effective, must be fitted by someone who is aware of the factors necessary to prevent transmission and well as breathing in droplets or aersol viral particles. They also come in different sizes, so one size does not fit all.

  Alcohol cleaning of N-95 masks drop their effectiveness greatly.

  Surgical masks are not all 3 ply, and if not, they are quite ineffective. Those wearing double masks must not use cloth masks, but double up on the above masks.

  New research points to aerosol transmission much more than droplet, and the aerosol can go through any fabric just like ciagarette smoke, according to experts. That is why these specific masks are critical if one wants to prevent aerosol transmission or breathing in the virus.

    The Medpage article stated that the principles of vaccinology that the priming dose antibody levels last at least 6 months. Most other vaccines have never been given so close together.

  The UK and Canada waited 12 and 16 weeks to provide the 2nd dose. The FDA has not yet endorsed the longer interval. How did they decide on 8 weeks, by the way. The CDC, FDA, and the administration have a lot of explaining to do. Will they even change the interval??

  For now, 26% of the country needs to be careful as they have not been infected.

Medscape Surgery, February 17, 2022; WebMD

 

4. Johns Hopkins University, Denmark, and Sweden study claims that lockdown only improved the death rate by 0.2%--controversy created

  A study published in the Journal of Applied Economics with authors from Johns Hopkins University, Denmark, and Sweden found after reviewing 34 different studies that lockdowns do little to reduce the death rate (only by 0.2%) from COVID-19. However, this publication has not been peer reviewed and some governmental experts are questioning the validity of the study, since they locked us down.

  I hope the findings and the validity will be resolved, but regardless, none of those providing opinions in some medical journals have totally excluded the enormous disaster those lockdowns created to our economy, jobsd, businesses, the mental deterioration of our country, drug overdoses and suicides, and delay in diagnosing cancer, heart disease, stroke, and many other issues including the devastating effect on our school children’s socio-psychological and learning ability.

  One of the main criticisms comes from the definition of lockdown, but most of us know what it means. Lockdowns in most parts of the world have not been effective, and I hope we are not faced with another one.

  I certainly will follow up on this paper when appropriate. I try to stay neutral as much as I can, but our government has taken over the decision making for the CDC and possibly the FDA. As I have stated before, these agencies need to be independent bodies of experts.

Medpage Today, February 8, 2022

 

2. Pregnancy Complications-pre-eclampsia, eclampsia, gestatinal diabetes, and ectopic pregnancies

  I reported in the September, 2021 Medical News Report, some pregnancy issues affecting the mother early and late from recent medical journal articles. This report will include some potential obstetric complications for women to be aware of.  

 

  A. Pre-Eclampsia prevention

  Eclampsia and pre-eclampsia are degrees of hypertension resulting from a series of issues leading up to the diagnosis. Weight gain, fluid retention, liver and kidney disease, hypertension.

  Pre-eclampsia usually starts about 20 weeks of pregnancy. If left untreated, complications can result in mother and child death.

  Although rare, pre-eclampsia can occur after delivery.

  High blood pressure, protein spilling in the urine, visual, and gastrointestinal symptoms, a drop in blood platelets causing bleeding, severe headaches, and as fluid builds up in the lungs, shortness of breath. Stroke can occur from blood clotting as well. 

  3 million women a year suffer from this disease. The high blood pressure reduces the blood flow through the placenta and fetus.

  Risk factors are first child, between 20-40, history of hypertension or previous pre-eclampsia, placenta previa (disruption of the placenta from the uttering lining), overweight, those with autoimmune disease (lupus, rheumatoid arthritis, etc.), kidney disease, expecting multiple births, had in vitro fertilization to become pregnant, and is more common in black women.

  Eclampsia occurs when these patients develop seizures, or coma.

  Treatment before birth includes blood pressure medication, close monitoring of lung, kidney, and liver studies, with plans for early admission in complicated cases. Vaginal deleviery or c-section can be performed.

  IV magnesium is used to prevent seizures, and careful past partum monitoring.

  Pre-eclampsia usually dissipates after delivery, although the blood pressure treatment may be required for a few weeks.

Cleveland Clinic

 

 B. Gestational Diabetes (GD)

  Women are prone to developing elevated blood sugars during their pregnancy usually in the middle trimester. OB doctors routinely test blood sugar during the 24-28 weeks.

  There are several risk factors for developing GD: including obesity, lack of exercise, prediabetes, diagnosis with previous pregnancies, polycystic ovaries, family history of diabetes, hypertension, elevated lipids, being overweight, over 25 and delivering heavy babies previously (9lbs. or more).

  Controlling the risk is obvious with diet, exercise, losing weight or not gaining more than the acceptable weight during pregnancy.

  If a woman has GD, monitoring the blood sugar at home and blood pressure, and maintaining a healthy diet with regular exercise is critically important.

  It is important to get tested 6-8 weeks after delivery to rule out prediabetes which can lead to type diabetes (prediabetes=HgA1c over 5.7%; blood sugar 100-125mg). It is important to have this diagnosis in the medical chart for the primary care doctors to follow as well.

  Gestational diabetes goes away after delivery, and taking medication (oral or insulin) to prevent the complications of GD, can be stopped as well usually, but it is the doctor’s decision. If the blood sugars stay elevated, referral for further management is critical.

  The complications of GD include very large babies, often necessitating a C-section, pre-eclampsia (hypertension) causing fluid retention, which could increase the risk of premature births, seizures and strokes (from blood clots) in the mother, and low blood sugar secondary to diabetic meds. CDC, American Diabetes Association

  Complications besides running the risk of developing type 2 diabetes (23%) is cardiovascular disease including heart attack, failure, arrhythmias (atrial fib most likely), valvular disease, stroke, and peripheral vascular disease.

Medpage Today, February 4,2022

 

 C. Ectopic pregnancy

Pregnancy begins with fertilization of the ovum by sperm, which usually attaches to the uterine wall, whereas in an ectopic pregnancy the implantation occurs in the fallopian tube. This is a tubsl pregnancy. Rarely, the implantation can occur in the ovary, the abdominal cavity, or at the cervix.

  An ectopic pregnancy can’t survive normally, and it usually bleeds causing acute abdominal symptoms, and can occur even before a woman knows she is pregnant.

  The woman has most likely missed a period, and if tested for a pregnancy, it will be positive.

  Early signs include light vaginal bleeding with some lower abdominal pain. When blood spreads to other areas of the abdomen, the signs would be similar to any number of other causes. If the pregnancy ruptures, acute bleeding will cause acute symptoms requiring urgent evaluation.

  Bleeding can be severe causing shock, fainting, and even shoulder pain from referred pain lower in the abdomen.

  Risk factors include a previous ectopic pregnancy, a history of STDs (causing scarring from sexual transmission infection), fertility treatments, previous fallopian tube surgery, using an IUD (rare but if it occurs more likely), tubal ligation, and smoking cigarettes.

  Diagnosis includes a transvaginal ultrasound will demonstrate the position of the pregnancy. An abdominal ultrasound may also be recommended.

  Treatment

  A laparoscopic or abdominal surgery will be required to stop the bleeding and terminate the pregnancy with the fallopian tube (salpingectomy). Rarely, the tubal pregnancy can be removed and the tube repaired (salpingostomy).

  If the ectopic pregnancy is diagnosed a cancer drug, methotrexate, will be given by injection to stop the growth and the pregnancy and allow the cells to dissolve. HCG tests can be performed to be sure the tissue dissolves and the need for another injection.

Mayo Clinic  

 

 

3. Autoimmune diseases-part 3IBS-irritable bowel syndrome, Crohn’s disease/Ulcerative Colitis, and Celiac disease

 

  A. Irritable Bowel Syndrome (IBS)-is it Autoimmune?

Although IBS is not always classified as an autoimmune disease (it is considered a functional disorder), there is a lot of crossover with this syndrome and other autoimmune diseases, as has been stated before. There are many individuals that suffer from several autoimmune disorders.

  Because the immune system senses abnormalities or foreign substances in the body, antibodies can be stimulated causing any number of diseases, and the bowel is no exception.

  The immune response creates inflammation at times, and the bowel can be the target. There are more than 100 autoimmune diseases, therefore, when there are unexplained symptoms, the immune system must be evaluated.

  Symptoms are constipation intermittent with diarrhea, and bloating, and belly cramps. This can be caused by a myriad of factors indcluding infectious, medications, change in daily routines, foods (gluten, dairy, , and chronic stress.

  Most of the common autoimmune diseases from rheumatoid arthritis, lupus, ankylosing spondylitis, scleroderma, Sjogren’s syndrome, Bechet’s disease, psoriasis, asthma, food and animal  allergies, gluten, etc.), and treatments for these autoimmune diseases are often associated with symptoms that fit IBS.

Alimentary, Pharmacology, and Therapeutics, January 27, 2019

Diagnosis

 Although there is no specific test to diagnose IBS, many of the typical autoimmune tests can be positive such as RA, ANA, sed rate, etc. Traditionally, if these symptoms persist for at least 6 months, the diagnosis of IBS can be made.

  Seeking other diseases (such as the above), and allergens must be explored. Since many of these diseases can come and go, the physician must follow the patient for extended periods of time after endoscopy of the upper and lower gastrointestinal tract has been performed including cultures for bacteria, slide diagnosis of parasites, biopsies of the bowel, radiographic studies, etc., immunologic studies, allergy testing, family history discussion, may need to be included.

  A psychological evaluation is often necessary to manage stress and other psychological issues (depression, bipolar, marriage and job, other physical ailments causing stress, etc.). Allergy consultation with testing, including food and environmental elimination.

www.healthline.com/health/ibs

 

 Supplements

  A recent report on Vitamin D and Omega 3 fatty acids may be helpful in preventing autoimmune diseases.

  Vitamin D alone prevented 22% of cases, and combined with Omega 3 prevented 30% of cases.

  Vitamin D 2000IU and Omega 3 1000mg daily were used.

  The test subjects were all over 50 and took the drugs or placebos for 5 years.

  It is known that there people with genetic tendencies not to absorb Vitamin D well. Vitamin D is also known that it does regulate the genes that are involved in immunity and immune modulation.

Dr. Joann Manson, Dept of Medicine , Harvard Medical School and Brigham and Women’s Hospital

Medscape Surgery, February 16, 2022

 

 

  B. Crohn’s disease/Ulcerative colitis

Crohn’s disease usually begins in the 20s and 30s. As many as 28% of patients have a relative with Crohn’s, more commonly found in Caucasians.

  Although any part of the bowel can be involved, the small intestine (ileum) is the most commonly involved. When the disease affects mainly is affected, it is called ulcerative colitis. Ileocolitis can also occur.

  Depending on the area most involved will determine the major symptoms whether nausea, vomiting, stomach pain, bloating, constipation, and or diarrhea.

  Treatment centers around the symptoms. All of the above symptoms are treated constitutionally. More severe symptoms may require antibiotics, anti-inflammatory agents, and antibody medications.

  Specific treatments include 5-salicylic acid (5ASA), Purixan, Methotrexate, specific diets, biologics (Humira, Stelara, Cimzia, Tysabri, and Remicade are a few).

  Surgical resection of the involved bowel is necessary when medications do not keep the patient in remission or feeling close to normal. In ulcerative colitis, there is a chance of cancer of the colon, and an acute emergency called megacolon, requiring a colectomy.

  These diseases are not curable but can be controlled.

Mayo Clinic, The Crohn’s and Ulcerative Colitis Foundation

 

   C. Celiac disease  

 

The above drawing demonstrates a normal surface of the small intestine with little “fingers” called villi that provide absorption of nutrients from the bowel.

  When inflammation of the lining of the small bowel occurs over time, the villi are attacked by an immune response to gluten, a protein which is a component in wheat, grains, barley, and rye.

  This “allergic” reaction which causes inflammation and destruction of the lining villi, preventing absorption of nutrients and creating diarrhea, cramping, gas, bloating, and anemia (iron deficiency due to lack of absorption) when gluten hits the gut.

  Other symptoms such as headache, fatigue, joint pain, brain “fog”. Skin disease can occur “dermatitis herpetiformis” and mouth (aphthous) ulcers can occur. Since these antibodies can affect any organ, even liver disease may occur and numbness and tingling in the legs can occur from lack of absorption of calcium and vitamin D. This is an example of the nutritional deficiencies causing symptoms and doctors must ask individuals that have these disorders if they have gastrointestinal issues.

  Over time, nutritional deficiency occurs and must be addressed with supplements (vitamins, minerals, and antioxidants). Removing gluten from the diet will put this disease into remission.

Overlap and combination of autoimmune diseases

  As in other autoimmune diseases, patients with Celiac disease also suffer from Type 1 Diabetes, thyroiditis, lupus, rheumatoid arthritis, and Sjogren’s syndrome.

  Certain genetic markers are present in these patients can confirm the diagnosis. The diagnosis is confirmed with a biopsy using an endoscope that demonstrates what the above drawing shows.

  Because this disease is common, most grocery stores now have gluten-free products in a specific area, and many products have labels stating they are gluten free. There, however, can be cross contamination in restaurants, so be on the alert. Read the labels carefully, and be sure waiters and food service people know what they are talking about.

Celiac Disease Foundation, Cleveland Clinic

 

4. Childhood poisonings-gummi bears laced with medicine a rising hazard

300 cases of poisonings from age 0-19 are treated in emergency departments daily in the U.S. according to the CDC.

Poison Control Center-- 1-800-222-1222

  The list below includes some of the common poisons and what they look like to children in the list below. Parents, babysitters, and grandparents should be aware of these issues when children come to visit. Poison proofing homes is a critical issue to prevent these ingestions and severe consequences.

  Because gummi bears concentrated with numerous over the counter medications from vitamins to melatonin to marijuana have become a serious potential source of poisonings. Cannabis gummis are very popular where marijuana products are legal and sold in stores.

  Pets are at risk as well especially if the gummi contains a sweetener, xylitol, which is toxic to dogs.

The poison control center of the U.S. reports over 3 million cases annually. 76% are oral ingestions and 93% occurred in the home.

  Ipecac and other gastric decontamination (charcoal and gastric lavage) products are no longer recommended unless symptoms are severe. 51% were under the age of 6.

  There can be respiratory, circulatory, and neurological symptoms depending on the substance ingested.

  Anti-diabetic drugs can cause severe hypoglycemia, and cause a clammy, pale, sweating child with an altered mental status. Dextrose or Glucagon can be given to reverse low blood sugar.

  Opioid poisoning can cause respiratory depression, unconsciousness, and calls for naloxone (Narcan) to be given immediately.

  Cosmetics and personal care products account for 13.4%, cleaning products (10%), pain killers (7.9%), topicals (7.4%), foreign objects (7.3%), cough and cold meds (5.4%), plants (4.4%), pesticides (4.2%), and vitamins (3.9%)

American Family Physician, Mar. 1, 2009

CDC Poison Prevention

 

5. Less Chemo for senior’s cancers

Chemotherapy and radiation therapy is a enormously difficult to endure. I have been there myself. The short and long term side effects are real, and can be devastating, but when an individual is facing cancer, that is the last thing on their minds. All they want to be cured, but the price is far from small.

  Many have to stay on some form of biologic treatments as well. Women have to take tamoxifen (or raloxifene) for 5 years after an estrogen positive breast cancer. Men with somewhat advanced prostate cancer may take a similar drug to suppress testosterone long term as tamoxifen suppresses estrogen.

  The treatment for cancers in general have been treated with a  “one size fits all” based on body weight, etc.

  It is already known that certain cancers with advanced techniques may have less radiation sessions especially with the addition of chemotherapy.

  A study has suggested that for elderly people with locally advanced or metastatic gastrointestinal cancers may be able to take less chemo. Two groups of patients were treated with an 80% dose or a 60% dose vs a full dose of chemotherapy (oxaliplatin and capecitibine). The survival was not statistically significant between these 3 groups. The toxicity of the treatment was greatly reduced with the lower percentages of chemotherapy. 

  Frail or elderly patients often cannot continue the treatments because of  side effects. This study shines hope that chemo doses can be reduced in selected patients without reducing the survival of these patients.

  Clearly, each oncologist must determine tolerance of treatment vs side effects that further debilitate the patient. It is certainly something that needs to be discussed with each individual’s doctors.

  Change can come hard for doctors, so be prepared to be met with some skepticism since older studies determined a certain dose was needed to attain the highest cure or control rate of the cancer. This is patient centered care time, and no decision should be made without total understanding by patient and family.

  Since the longevity of our country continues to rise (except during COVID times), it is consideration.

  It is a life and death situation, but living with cancer treatment’s long term side effects can greatly affect quality of life, as it has in my case. When I had radiation treatments the dose was higher than today, and the techniques were far inferior than  today’s improvements in therapy, but very few undergo cancer treatment without carrying future potential problems for the price of cure.

JAMA Oncology, June 1, 2021

 

6. Disparities in healthcare (financial, race, religion, gender identity, etc.)

I was not confronted with a lot of the disparity issues facing our country and our healthcare professionals when I was in practice. By and large, patients either had insurance or not. My clinic took on about 10% of the patients that were indigent for one reason or another, but made payments over time, as my clinic was extremely liberal with this issue.

  I never changed my practice methods because of race, color, creed, or financial reasons.

  Our clinic supported a free clinic for the entire city of Pensacola, Florida. Doctors volunteered their time and when a specialist was needed, we agreed to care for them pro bono. I taught at LSU Medical School for 12 years probono! (3 days a month).

  Today, diversity issues are in the media 24/7. The medical literature is now replete with articles about the diversity of care issue, and I want to pass along some of this information. It is a serious issue. It also continues to be an issue with medical school training.

  Trying to tackle such a huge subject is challenging.

 

A- Financial disparity

  The difference in care because having and not having insurance has been known for decades. Access to care, reluctance to ask to be seen in a doctor’s office, and necessity to use the emergency facilities has all been reasons for the difference in healthcare, quality of life, and mortality rates in most diseases. Uninisured people wait til a disorder is far advanced, causing pooere outcomes.

  Would single payer healthcare solve this? Thoeretically yes! But socialized medicine creates differentials in healthcare just like in our capitalistic society. It would help some that are reluctant to seek care because of lack of insurance, but there ae still a significant number of people who live in denial and wait til a disease is more severe.

  There is a large slice of patient responsibility because there are many studies to show lack of improvement in healthcare status, because a majority of patients with chronic disease do not follow doctor’s orders, take their medicine (they may be negligent or can’t afford the meds), and don’t follow up. The younger generation does not even have a primary care doctor they see and depend on urgent care for their needs.

  The point is that even if healthcare is given to everyone (at no direct expense), the poor American diet, obesity, lack of regular exercise, domestic factors, environmental exposures, smoking, drug abuse, genetics, self neglect, and other factors will continue to prevent our healthcare system from improving much regardless of the system of healthcare we have in this country. The cost is also astronomical, and the added layers of unnecessary paperwork, surveillance, and costs rising regardless of financial methods.

  Politicians use this issue often to expand medical services, propose socialized medicine, and a host of other handouts but when it comes down to it, our country is lazy, spoiled, and not very responsible. How can we change? I wish I had the answer.

 

B. Race

  The issue of racial disparity has long been a problem not only in this country but throughout the world. It started with the American Indians and was exaggerated in Blacks who were brought to this country as slaves.

  It took into the 1950s for our country to start to wake up. Segregation created another gap in healthcare, education, and opportunity. But handing free stuff to people who need proper education will not solve the problem. It will make more them dependent and not motivate them to enhance their own status, and foster a better life including taking more personal responsibility for an individual’s own healthcare.

  Genetics is a huge factor in people of color, creating an obesity epidemic, which has created a cascade of medical issues. 

  People of color often do not seek care until the disease is more serious. There are many taboos that make people of color from seeking. Trust is a big issue as well. That is why mortality rates are higher for most diseases in this group.

  Progress has been made but still there is a gap, partially because of opportunities, wages, traditions, superstitions, bias, and many other factors. I do not have the answer to the problem, but certainly pitting one race against another will not solve anything but divide our country even more. Besides, it is right out of the socialist’s playbook, unless that is where our country wants to go.

  Critical race theory is causing so much anger and splitting our races apart, which will create more pain and sorrow. It is the absolute wrong way to address the racial disparities.

  I do know from medical experience, people of color are very reluctant to seek out routine care, preventative screenings, and often do not follow medical advise and do not always take their medicine as prescribed or even fill prescriptions, partly because of cost but often because of fear from taking medicine and having side effects.

  These factors are magnified by the lack of better patient education by physicians to people who do not understand medical diseases and the need for prevention.

  Seeing white doctors is an issue for some races. We need so many more people of color in the medical field especially physicians, nurse practitioners, and P.A.s (physicians assistants).

  22 out of 25 medical schools is teaching critical race theory and will create more dissention among healthcare professionals, not less. Parents deserve the right to agree what their children learn in school. Today, kids come home and cause major family issues thanks to teachings of certain staff. It is becoming a major political issue and will be one of the top issues in the November elections.

  Even given free medical care, which is often available, some do not follow up properly when it is crucial to maintain a near normal blood level of blood sugar, for instance. Understanding the dynamics of disease is critical for people to follow medical advice.

  It is also the responsibility of the individual, the parent(s), and many times other family members to teach right from wrong, not teachers.

  Getting the COVID vaccine is a good example.  People of color do not believe vaccines is safe and are the lowest group to be vaccinated. They respond to fear more than non-Hispanic whites. They also tend to have more people in the home which spread the virus faster.

  Crime, illegal drugs, ghettos, traditions that are anti-healthcare, and so much more must be better addressed to get our country on a more even playing field in healthcare.

  Politicians who are only in it for power are sending the wrong message to those less fortunate. We must quit dividing our people or our country will fail regardless of who is in charge. We must respect all races! Actions speak louder than words!  

 

C- Religion   

  Religion has been attacked by a variety of groups as we struggle to cope with the continued diversification of our country. There are those that still believe this country was founded on Christian principles and secularism is trying to overtake religious practices. The number of people attending church has dropped to 50% of the population (77% in 1999).

  Muslims women are very reluctant to be seen by American doctors (I had the experience volunteering in a medical clinic for Muslims). Their traditions keep a woman  from seeing male doctors allowing for examination.

  Regardless of religion, as long as their practices do not profess to destroy other religions, we must accept the diversity, but with the Iraeli/Palestinian issue and many Arabic sects having been fighting among themselves for centuries, it is unlikely anything will improve.

  Our constitution protects freedom of speech (at least it is used to), freedom of religion, amony other rights. It is being tested every day!!!

  There are times when religious groups are fearful of accepting healthcare practices (the obvious one is accepting vaccines). A group of Orthodox Jewish people who live in NY have had major outbreaks of measles and COVID-19 rejecting vaccines.

  COVID shutdown our churches and prevented those members from having an important method of coping with the pandemic.

  Anti-semitism continues and it has been increased since the pandemic. Anti-Muslim actions are also serious.

  China is trying to destroy the Chines Uyghurs, many who are Muslim. Sterilizations, medical experimentation,  severe abuse, killings, and devastation against humanity is being tolerated by a world that has turned their head and even supported the recent Olympics, while these people suffer night and day by the thousands, just because of their faith.

  Genital mutilation in children is legal in many countries and has been brought to this country, which is totally illegal in the U.S.

  For those who believe in a higher power, this is a very important method of managing healthcare issues, severe illness, and even death (i.e. no funerals was devastating for thousands considering over 600,000 deaths have occurred from COVID-19 as of June, 2021

  Prayer has always been and always will be a tremendous value in stimulating hope, no matter what religion.

  Zooming services was a great help but for most does not replace the face to face benefits in church, mosques, and synagogues.

  Our government has become very secular and has discriminated against religious opportunities. Closing church services caused a tremendous harm.

 

D- Gender identity (LGBTQ+)*

*Lesbian, gay, bisexual, transgender, queer-or sometimes questioning, and the (+) means other sexual identities

  The press, the current administration, and now the medical journals have become replete with opinion articles about an array of racial and gender identity issues. It is my responsibility to report what is contained in them. 

  I previously reported on trans-gender dysphoria, body dysmorphia, surgical sex reassignment procedures, and the issues prepubertal children face when questioning their sexuality and the process to transition: www.themedicalnewsreport.com/45/46

  The LBGTQ+ community has become so diverse it has become difficult the define the gender identity names of these individuals. I refer the reader to the internet for many references regarding all the names this community includes.

  There are schools holding sessions with young children about choosing gender. I would not want my child exposed to this, as I feel it is the family’s responsibility to discuss such issues.

  Gender identitiy is not synonymous with “sexual orientation”, as it refers to the person they are sexually attracted to. Likewise, transgenders do not imply a sexual orientation, and still can identitfy as gay, lesbian, or both, or straight based on their attractions. I refer the reader to www.thegenderbook.com  which defines all these different terms and illustrations.

  Biological determination and gender identity has interfered with women’s sports, and I hope it will be resolved. The NCAA, however, deferred the decision to each individual sport. Fairness has been lost in allowing transgenders to outcompete women especially in track and swimming. The bathroom issue has become a big issue that has split society.

  There are a multitude of studies to report the discrimination these individuals suffer with their decisions—much higher rates of parental and friend rejection, homelessness, foster care, extremely high STDs (sexually transmitted disease), prostitution, drug and alcohol abuse, psychiatric disorders, especially eating disorders, suicide attempts (as high as 56%), and other forms of abuse.

  It is known that HIV individuals are often relunctant to seek treatment because of homophobia.

  Discrimination must not be tolerated if a person chooses to change gender. It is a right they should have, even though it creates horrible socio-psychological-physical issues.

  It is stated in Pediatrics publication, “that being transgender or transgender variant implies no impairment in judgement, stability, reliablitiy, or general or social vocational capabilities. Discrimination does foster mental health difficulties”. It is not a mental disorder. Why individuals develop LBGTQ+ behavior and orientation is still not known based on neuroscience. Bullying, rejection, and discrimination is cause enough!

  This is the price they pay for being different through no fault of their own and discrimination continues at a high level. If someone understands what they are facing for making such an enormous decision, we should respect it.

  Currently, certain people don’t recognize themselves as male or female, and some businesses are required to ask when they meet someone for the first time, to ask them what pronoun they would like to be addressed. If non-gender, these individuals prefer “they and them”.

  The term, cisgender, is defined by a person who identifies and expresses a gender consistent with their birth identity based on external genitalia. Transgender may be only psychological with hormonal administration with or without trans-sexual surgery.

  The bathroom issue continues today in the courts and certainly on the minds of many Americans. In Muslim countries, if a person declares they are gay or is caught in a gay or lesbian act, they are executed. Thes people began the field of transgender surgery, as Muslims allow transgenders, but not gays.

  Gender identity people report that 1 in 5 doctors have refused to care for them. When I became a doctor, it was my firm responsibility to care for any and all in need, and that is the way I practiced my surgical practice for 30 years. Times have become more challenging with the liberalization of our world.

  There is a gap in medical training and understanding and caring for gender identity individuals. Diversity training now for all physicians is required to maintain a medical license as is HIV training, domestic abuse, etc.

  Allowing hormonal manipulation at pre-puberty is another issue of controversy but is now an accepted practice, and it has been proven to diminish psychologic stress in these transgender youth.

  Clearly there is no room for abuse, ridicule, bullying, or rejection based on sexual preference. These individuals carry their own load of guilt, feelings of rejection, and a host of psychiatric issues, including family discourse leading to being kicked out of their home, leading to living on the streets and turning to deviant behavior to survive.

  Straight individuals often have strong feelings regarding these issues, however, everyone needs to respect others as much as possible.

  At the end of the day, everyone deserves to be treated on the “basis of the content of their character, not the color of their skin” or different gender identities.

  The American Medical Association and the American Academy of Pediatrics have policy statements regarding protective and management strategies for gender identity issues in individuals.

  The American Academy of Pediatrics recommends

1) those individuals who are transgender should seek comprehensive gender-affirming and developmentally appropriate care.

2) Family based therapy is recommended

3) Insurance should cover these issues

4) Pediatricians should advocate for these individuals

5) Continued research be carried out exploring all possible avenues to assist and understand these individuals.

Reference—Official statement from the American Academy of Pediatrics, October, 2018

 

 This completes the March, 2022 report.

Next month, the April report will include

1. COVID-19 updates

2. Auotimmune Diseases-Part 4-Graves disease, Hashimoto’s disease of the thyroid

3. OB/Gyn issues—Part 2; Chronic pelvic pain

4. New recommendation for aspirin to reduce cardiovascular disease

5. More on Dry Eyes

 

Enjoy your family, and stay healthy and safe. Dr. Sam