The Medical News Report

#123

April, 2022

Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

Subjects for April

1. COVID-19 updates

2. OB/GYN series-Part 2-Chronic pelvic pain

3. Autoimmune Disease—Part 4—Graves disease of the eye and thyroid; Hashimoto’s thyroiditis

4. New recommendations for aspirin use and cardiovascular disease prevention

5. Dry Eyes—update

6. LBGTQ+ updates; Transgender and retransitioning

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.

  As our world is falling apart in many ways, the health of our country is being ignored with open borders, over a million fentanyl overdoses last year, and the general health of citizens is being delayed, denied, and the psychological status of America is suffering more than ever. We may be at war tomorrow, but we must continue to tend to our health needs. Over 60% of the country is not satisfied with the management of all the issues facing us daily.

Thank you, Dr. Sam

1. COVID-19 updates

Opening remarks

  It has been over 2 years since our country found out about the virus that started in the U.S. in Seattle, Washington, and most likely it came from a leak in the labs in Wuhan, China.

  We are getting some answers regarding COVID after over 2 years of pandemic. Studies will continue for years trying to understand how to contain this and other viruses.

  We have had a major shift in our country’s economy to the negative, creating major shortages and slim supplies for medicine, food, major household supplies, and sky high gas prices, thanks in part to our loss of energy independence. It is also has caused major inflation, and will be felt by every American including rate hikes for insurance, medical care, and higher copays and deductibles.

  With the perceived weakness of our country in the eyes of the world, we are facing critical wartime threat. Our entire livelihoods are at stake in the next months and years to come, which will include our healthcare. The younger generations are totally open to a socialized country, not understanding what it will do to the quality of our lives.

  We have lost close to 1 million Americans from COVID-19.  These numbers are highly questioned by some experts, but still a horrible cost for our loved ones.

  With no notice the CDC removed 71,416 cases on March 15 and reduced the number of deaths in children by 24% due to coding errors by hospitals on their website tracker. The first notice in medical journals appeared the last week of March.

  I don’t know why the administration believes all the data from Big Pharma. The vaccine has proven less effective than touted (Omicron cases are occuring with those boostered) and there is still concern for side effects, and they are pushing a second booster.

  The feds are still disregarding natural immunity and have barely acknowledged it. 87% of the country has had at least one dose of vaccine. Why in the world is there a need for mandates? It is called power and control!!

  The pandemic will hopefully become endemic or seasonal, but very likely even less virulent. The new BA-2 Omicron (now accounting for 1 in 3 cases in the U.S.) appears to be no more trouble than Omicron. There is another variant that is a combination of Delta and Omicron variant being watched. We are constantly reminded to not relax too much and “keep our masks close by”, as stated by Dr. Walensky, when she just announced that mask mandates were off unless you lived in the 5% of communities that had surges in hospitalizations.

  The vaccine, however, has still saved countless lives especially for older people with underlying disorders. New vaccines will be more targeted in the near future.

  Obesity is still the greatest risk factor, when our country is more overweight than ever before.

  However, some of the countries like the UK, with their high vaccination rates, are still having surges. The new variants are not as responsive to our current vaccines.

  An experimental vaccine is not only hitting the spike protein but also the nucleocapsid of the viral surface and may be more effective than those currently used. From Reuters reporting from City of Hope National Medical Center, Duarte, California, March 14, 2022

  This pandemic has split our political ideologies more than ever before, but even the liberals are unhappy with the management of most of the crisies currently going on. We are at an impasse in my opinion, and we will find out some future directions in November, including the management of this virus that has killed almost 1 million people in the U.S.

  There is a mini-surge in China (35,000 cases) and they locked down part of the billion population country. That is what happens in communist countries.

  We have been told by the UK that the flu now is more dangerous than Omicron, with more deaths from influenza, although we must not stop doing what we can to protect ourselves since the flu vaccine this year was a flop according to journal articles (why not from the CDC?), missing on the major strain H3N1 swine flu virus. Death rate for flu is 0.04%, and that means COVID is less. Very few healthy people die from COVID.

  We have been told that the numbers of deaths and even cases have been overstated greatly as mentioned above, and now even the CDC stopped emphasizing numbers of cases, rather stating that hospitalizations are the critical numbers to watch, because that can overwhelm certain communities. For over 2 years, the number of cases was frontpage news to instill fear in our country, and it worked.

  We have been told 95% of the population does not need to wear masks, and yet, there are still mask mandates, and vaccine mandates for federal employees including the military when we have over 90% already vaccinated. Private businesses can still make their employees wear masks and be vaccinated, but where is the science at this point? Mayor Adams of New York City has given exemptions to their pro basketball team and other certain special groups such as Broadway entertainers, while still mandating the first responders. 1400 fireman and policemen have been fired over the vaccine mandate in NYC. Pathetic! We are losing military by the thousands when we are facing major wars in our near future, in my opinion.

  So if we have been vaccinated and boosted, the only way to keep from getting a reinfection or the flu is continued diligence in protecting ourselves especially those that are the most vulnerable. Healthy people should not be concerned unless they have vulnerable family members at home. Vaccines are not the only important preventative measure for the vulnerable. Those unvaccinated certainly need to be very cautious.

  And who are we to believe what works? We have been told lockdowns, schools closures, and most masks do not change the statistics for hospitalization and major illness.

  The experts I listen to such as Dr. Marty Makary, from Johns Hopkins Public Health, say depending on people’s health, do what you can to protect yourself. If that means wearing a mask (only N-95 or 3 ply surgical masks), staying away from crowds, gatherings, and younger people (they are the most likely to transmit), please do it.

  If a person wants to live their life in fear, isolating themselves, it is their right. If an individual wants to pretend the virus is over, that is also their right, but always respect other’s personal decisions. The virus is far from over!!

  It is everyone’s individual God given right to do what they think is best, no matter how outrageous some of us think it is. RESPECT, however, for others should never stop.

  The latest information about who has suffered the most from the pandemic may be those with non-COVID illnesses as they continue to have poor access to healthcare, hospitalization, and worsening of their diseases. JAMA Network, March 9, 2022

  Thank you for reading the MEDICAL NEWS REPORT, and enjoy Spring.

                                                                                 Dr. Sam

  There are still some very important issues that have been published in the latest medical journals that still deserve your attention! Please read the information below.

A. Long term symptoms after COVID-19 infection

  I have reported on the significant number of patients that have longer term symptoms after recovery which have created significant quality of life issues, and some permanent ones.

  Pre-existing symptoms may be present before an infection, which likely will be worsened by the infection.

  Many more quality journal articles do find significant symptoms following COVID for 6 months. Time will tell if these symptoms persist.

  A Danish study found at least 1/3 of patients have at least one symptom for 6-12 months after recovery. Smell and taste and fatigue were the commonest in their study. These include a significiant percent of non-hospitalized people.

  These symptoms came from a questionnaire, which has its faults. This data came from those who had documented positive tests for COVID compared to a group who tested negative.

  Anders Peter Haviid PhD, epidemiology professor from Denmark State Serum Institute reported 29% responded positively. Mental, cognitive, and physical symptoms including sleep problems occurred in 53% within 6-12 months of infection. A new diagnosis of anxiety and depression were quite common.

  What was not included in the questionnaire were underlying diseases that complicate longer lasting symptoms.

  It is well known that these people plus the unvaccinated are the most commonly afflicted with more severe infection and develop long term symptoms more likely.

MDLinx, March 7, 2022 (not peer reviewed)

  There is some information out that vaccines prevent the long term COVID syndrome, because it is felt that it is an immune response that does not stop, and if a person has been vaccinated, it may block the immune action of the virus that is responsible for longer standing symptoms. I reported in previously that there is microclotting that spreads to vital organs over months and may be part of the cause of prolonged symptoms. More data is necessary, but it does also mean people with natural immunity could get reinfected and their immunity could also prevent long term syndrome.

  A report in the JAMA, assessed patients who had been admitted to the ICU (average stay was 18 days) were questioned 1 year after. 74% reported physical symptoms, 26% mental trouble, and 16% cognitive symptoms. The most common physical symptoms were a “weakened condition”, joint stiffness, muscle weakness and ache.

JAMA, January 27, 2022

  Other reports state that fatigue and shortness of breath was very common up to 3 months in all studies.

  The WHO* estimates 10-20% have these symptoms globally. This is a serious healthcare concern requiring a great deal of care, which will be around for years to some extent.

*World Health Organization

  Long term syndrome is a serious consideration for those hesitant or against getting vaccinated, and should encourage them to reconsider getting vaccinated, especially now that is thought to prevent long term syndrome.

  Side effects from vaccines affect a small percent, which rarely last more than a couple of weeks unless underlying disease complicates the situation. We will never have a clear answer for everyone, but the medical journals make a good case for vaccination. It is pretty clear that getting a serious COVID infection is potentially deadly and could create long term or permanent symptoms.

  If one looks at the consent form test participants had to sign, all those with active illnesses were excluded, all pregnant women, and men who were trying to get their wives pregnant. And yet, there are many articles disputing any increase in pregnancy related vaccine side effects.

  There is more data to implicate COVID infections with autoimmune skin and vascular diseases. Immunologic diseases have been implicated in the cause of rheumatologic diseases. I have been reporting on autoimmune diseases for a few months, which are the same as rheumatologic diseases and have implicated COVID as a possible contributing factor. We will know more about this connection in the near future.

B. Vaccine effectiveness against the Omicron variant; outpatient treatment not very effective

  Vaccine effectivenss was 66% against the Omicron variant, dropping to 8.8% by 25 weeks. After a booster, the effectiveness rose to 73% by 2-4 weeks and dropped to 65% by 5-9 weeks. Boosters still are effective, but does a 4^th dose. Very controversial.

NEJM, March 2, 2022

  The most important issue is keeping people out of the hospital, and boosters are very effective according to the BMJ*, March 2, 2022 article.

BMJ*=British Medical Journal

  Of 11,290 patients admitted to 21 hospitals with 5,720 with COVID-19, 15% (858 patients) were found to have Omicron. Of those admitted, 7% died (60) with Omicron. Those unvaccinated with health issues had the majority of the these serious cases. Omicron was the least most harmful compared to Alpha and Delta, but the vaccine was more effective against the 2 latter variants (85% compared to 65% for Omicron).

  Since this study was published, the BA-2 Omicron variant accounts for 1 in 3 cases.

  Although there have been conflicting reports on the value of the 4^th dose (2^nd booster), the latest data from Israel found that those who had the 4^th dose had a 78% lower mortality rate in a 40 day study after infection. There 92 deaths in those with 2 boosters and 232 deaths in those with just one.

  The effectiveness for most people was not significant regarding getting reinfected or hospitalized. This points to the approval of a 4^th dose by the FDA for Pfizer’s drug for elderly, frail, immunosuppressed, and those with significant underlying risk factors. MDLinx, March 23, 2022

Some outpatient treatment not very effective against Omicron; Others Ok!

  The FDA has pulled support for Regeneron, and the other monoclonal antibodies that require infusion, including sotrovimab, which was the only one that showed hope. Glaxo is asking for approval of a higher dose.

  Fortunately, the oral meds, Paxlovid and Legevrio are still effective. Remdesivir (Veklury) an IV infusion is still FDA approved are effective against BA-1 and BA-2 Omicron for inpatients. Also Lagevrio as well as bebtelovimab is expected to be effective against the BA-2 Omicron subvariant.

  There is new drug Evuseld, by Astra-Zenica that is an antibody drug that is effective against COVID, but only licensed in Europe. It can be used for those 12 years and oleder for only those who have not been exposed to the virus. Clinical trials show 77% of participants were protected from symptoms for at least 6 months. Infections are up in Europe and in great need of outpatient drugs. Reuters in Medscape Surgery, March 25, 2022

Regeneron is still approved.

C. Vaccines and young children; language and reading delay

  Fresh data from Pfizer vaccine found that young children 5-11 stimulate less immune response than teens, because the dose was too low. The vaccine researchers were trying to prevent myocarditis in these young children, but in doing so, with a lower dose, they did not have enough antigen to stimulate the antibody response they expected. A third dose was requested but the FDA has put the decision on pause needing more data.

  Omicron infected more children 6 months-4 years old than Delta increasing the need for vaccination.

  A new study from Texas reported that children have at least 7 months of good protection from natural immunity. The highest immunity continues to be those previously infected who get vaccinated. Pediatrics Journal, March 18, 2022

  The hospitalizations with Omicron increased from 4 per 100,000 children to 14.5 per 100,000 children, but the highest percentage were under 6 months of age. Omicron and croup were found to occur at the same time in this age group. These children are not eligible* for the coronavirus vaccine at those ages, and 63% of the children in this study did not have underlying diseases.

  *The FDA has not approved a vaccine for these ages, only allowing 5 and older.

Information released by the CDC in the Medscape Surgery, March 16, 2022

  Moderna vaccine is requesting FDA approval for a 2 dose vaccine for children 6 months-6 years with only a 43% effectiveness in children 6 months-2 years and only a 37% effectivenss for children 2-5 years. They also have higher myocrditis rates.

  The State of Florida Administration announced that healthy kids need not get the vaccine unless they want to, as the immunity imparted by the vaccine is less effective, based on scientific information about lower immunity, but still the vaccines decrease hospitalizations.

  The case load of children is the lowest since August, 2021, according to Medscape Medical News, March 8, 2022

  Pfizer’s data does prevent severe disease in these younger children 5 years and older, with 73% protected from being hospitalized, which has been effective in reducing the hospital numbers and fewer deaths.

  Only 27% of parents in the U.S. have had their children vaccinated, and 33% are still waiting for more data before making a decision, and 30% are definitely not going to vaccinate their young children. One year of data is not enough for most parents, and that is all the research reports.

  Some teachers are encouraging children to get their parents to change their minds about getting vaccinated, and that is causing more school authority controversy. JAMA Network, January 2021

  Unfortunately, other childhood disease vaccines adminstration are lagging as well with the pandemic delaying pediatric appointments.

  The same stats are seen with young mothers, pregnant, or getting ready to get pregnant. Misinformation on the internet in that arena is fierce, with no research to show even the slightest increase in issues such as miscarriages, low birth weight, congenital anomalies, and mother issues, whereas the infection increases risk for all of these issues. And men are not going sterile and have the same rate of impregnantion as those unvaccinated. But these people were excluded from vaccine clinical, which tells me they were concerned side effects would occur.

  In fact, with the slowing of the pandemic, the vaccination rates are dropping. However, that is not good for a vaccine that has only 6 months before it starts to wane, and 3 months for the booster to start losing its potency.

  With such mild disease in younger people that are healthy, it may be time to find another type of vaccine. The FDA Vaccine Committee is meeting on April 6 to discuss this and other issues But convincing parents to vaccinate to prevent the virus from spreading to others is a harder sell. Now you know why vaccines usually take years to be FDA approved.

Medicine.net, March 1, 2022

Myocarditis from the vaccine

  Another recent study on vaccine side effects, from Israel for age 12-15, found that myocarditis occurred 1 case in 12,363 in males, and 1 in 144,439 cases in women. The highest incidence occurs in younger boys and men ages 16-34.

  This data demonstrates that myocarditis occurs more frequently because of the vaccine. These stats were not available for over 2 years, and now that 12-15 year olds are being vaccinated, it gives parents information to use when deciding if their child should be vaccinated.

  If myocarditis occurs in older children, it would still be very helpful to have independent data on 6 months-4 year olds before these very small children are vaccinated. And while Pfizer is requesting approval of it’s 3 doses, the FDA vaccination advisory committee has put a hold on recommending the vaccine for this age group because of the third dose. Moderna has just come out with a 2 dose for this age group but yet to be reviewed by the FDA.

  If we ever find out the actual number of people that had some kind of more serious side effect, combined, they could be very concerning. We must realize that the CDC only counts those side effects reported to their federal website(VAERS*).

VAERS=Voluntary Adverse Event Reporting System

  Deciding any form of treatment requires proper information about the risks and benefits, and with an emergency like the pandemic, information has only come from months, not years, of study from the very companies that made the vaccines.

Language and reading delay in children from mask mandates

  As the children continue to be pawns in the political arena for the use of masks, after the CDC cleared children to no longer use masks on a mandatory basis, the CDC analyzed the delay in language with the sea of consults to speech therapists with trouble, and decided to drop the standards for children with the number of words said correctly.

  The CDC added 2 new developmental milestones for children at 15 and 30 months of age. Currently 50 words should be spoken by age 15 months. The CDC moved that expectation to 30 months to hopefully see if 75% of children can meet that expectation instead of 50%. This was supported by The American Academy of Pediatrics, another board full of academicians rather than practicing pediatricians away from the universities with much more liberal ideologies. Some might say we are dumbing our kids down!

  The expectation for language development increases between 24-36 months of age. There are opinions about this change, one of which is trying to make up for the loss because of mandated masks, which has caused many developmental issues for children in school.

  A study from Washington D.C. children have had a serious delay in reading ability from school closures and mask mandates.

  Recent data found that school scores were 20 points down from before the pandemic.

  Special needs children have suffered the most, with overall social and scholastic deterioration of their development.

  Candace Owens, an activist for children and prevention of delays in childhood development from the pandemic mandates announced the following: Between 2019 and 2020, white children dropped their reading scores from 73% to 70%, Hispanics from 42% to 30%, and Blacks dropped from 44% to 28%.

  Hearing loss with tinnitus has occurred in adults as well as some children from not only COVID infection, but the vaccines. No research on this except observational. Some of the long termers are still experiencing nerve deafness and dizziness from inner ear damage.

  76% of people can’t understand people with a mask on their face in those with moderate hearing loss, and 95% with severe loss. It is the 3^rd most common disability.

  Don’t ignore hearing loss. Get tested and see an ENT doctor. JAMA Network, March 3, 2022

D. Timing of booster after infection still not settled; other intervals questioned as well; underreporting of side effects

2^nd booster (4^th dose) may not be helpful, but FDA approves Pfizer for those over 65, while Moderna is requesting a 4^th dose for everyone eligible

  It has already been reported that the first 2 doses of the vaccine (Pfizer and Moderna) were given too close together (3 and 4 weeks), and now the experts are not sure how long the interval should be before the booster is given to a person has had an infection. It has created doubt that the pharmaceutical companies and even our governmental healthcare organizations are telling the facts using sound scientific evidence or just guessing.

  Some experts state that one dose of vaccine 1-3 months after infection is all that is needed. Why is that not the interval for the unvaccinated? The second dose of vaccine was found to not produce a robust immunological response, because it was given too soon after the first dose.

  This also applies to those who have received monoclonal antibodies to either prevent or treat an outpatient infection. They must wait until the monoclonal antibody levels have dropped considerably for the vaccine to be valuable, usually at least 90 days.

4^th dose worth it??

  Omicron has changed a lot of the thinking about the vaccine, and a recent Israeli study in healthcare workers found that a 4^th dose (second booster) of vaccine was not very helpful for healthy people, only increasing the antibodies from a previous factor of 10 to 11. However, it prevented many deaths.

   There was only 30% prevention in those vaccinated by the Pfizer vaccine and 11% for Moderna. They conclude that healthy people should not expect much help, but are still requesting approval. Thankfully, the FDA only approved it for those 65 and older and medically challenged.

  Those vulnerable should talk to their doctor about getting a 4^th dose. The CDC agrees and only recommends it for immunocompromised people and older people with serious disease.

NEJM, March 16, 2022

  Pfizer has been FDA approved for those 65 and over and Moderna is in the process of requesting FDA approval for that 4^th dose for everyone over 12. The research was performed on only older participants from both companies!

  Another recent Israel research found that the 4^th dose only returned the immune levels to the same as the 3^rd dose (booster). One would think it would increase it.

  Recall the 3^rd dose (booster) only kept the immune levels elevated for 3 months. Why have a vaccine booster that elevates the antibodies for 3 plus months?? We still have no evidence how long the 4^th dose would last.

  The bottomline is talk to your doctor!!

Medscape, March 3, 2022

E. Why was the antibody response to the Omicron variant poorer than against Delta?

A new variant discovered—a combination of Delta and Omicron in addition to the BA-2 Omicron variant

Those with natural immunity and those vaccinated can respond immunologically to Omicron

  When the Omicron variant appeared, there was different data from South Africa and Sweden. After further evaluation of the participants, it became clear that those who had previous infection or vaccination produced a fairly robust neutralization antibody response (Sweden), while those unvaccinated (South Africa) could not mount a good response. Karolinska Institute, March 17, 2022

  Last month, I reported data from South Africa only, and now we know more. That is why you must read my reports each month, as information is rapidly changing.

BA-2 Omicron variant

  About 33% of the cases now in the U.S. are BA-2 Omicron variants, taking over the BA-1 Omicron variant. So far, it is about the same in infectiousness, virulence, and resistance to treatments. It has been estimated that 30-40% of the population has been infected with the BA-1 Omicron variant, therefore the newer variant will find it harder to infect, with all these vaccinated and previously infected people with natural immunity. Medpage Today, March 17, 2022

  Another concern continues to be waning immunity from vaccinations, and it is becoming more clear that those with natural immunity have immunity longer than those with vaccines including children.

  The latest thinking is that those with Omicron infection are considered infectious for 6 days, and therefore must isolate at least 6 days, be free of symptoms for 48 hours and no fever, and feel on the road to recovery.

A new variant--Hybrid versions of Omicron combined with Delta

  Hybrid versions of Delta and Omicron have been discovered in both the U.S. and Europe, according to the lead author from Marseille, France’s Mediterranean Infectious Disease Institute. It is possible while both viruses were making their rounds in the world, that they created a version of a combination of the virus with these 2 variants.

  It is still not known the exact transmissibility or virulence of this hybrid variant. Only 17 patients have shown this variant after performing genetic sequencing, which is done constantly to keep an eye on newer variants. Reuters

  This is different from the BA-2 variant which has been repsonsible for 33% of U.S. cases to date, and reports from Africa found they are not any more transmissible or virulent than the Omicron variant.

F. Testing with immediate free prescriptions for patients (“Test to Treat” Program)

  Reliable testing easily accessed with immediate treatment is being planned by the administration to provide free rapid antigen testing with immediate free prescriptions for oral Paxlovid right at the pharmacy, certain healthcare facilities, and other areas, one of the oral anti-viral treatments now available. There is another oral antiviral malnupiravir by Merck, but not as effective. Both still have a good chance of furthering infection if taken within 5 days of symptoms.

  Physicians including the AMA and even the Countrywide Pharmaceutical Associations have been very critical of the administration allowing pharmacists to be able to prescribe this medication. This controversy has been going on for years regarding prescription writing. I would talk to my doctor before taking thes meds, as there are side effects and some should not take it.

MDLinx, March 2, 2022; Medscape Medical News, March 11,2022

G. New vaccine combats newer variants better—here is why!

  A new vaccine has been developed that does more than cover the spike proteins of the coronavirus. It also attaches to the nucleocapsid protein. The current vaccines approved by the FDA only targets the spike protein. It is in Phase 2 of clinical trials especially for immunocompromised people, who do not create a good antibody response from all the vaccines and boosters. It is COH04S1, the experimental name, developed by City of Hope, licensed by Geovax Inc.

  This vaccine provides a robust creation of neutralizing antibodies and the T-cell immune response, published by the Journal, Lancet Microbe. This vaccine covers the newer variants as well as the old.

  The neutralizing antibodies interact the ACE-receptor on the spike proteins on the virus that allows entrance into the cell, while the T-cell antibodies fight the nucleocapsid protein, the other route into the cell, which the approved vaccines do not affect.

  The T-cell response is especially important in immunocompromised patients with cancer, and should combat future variants. There was a four-fold increase in antibodies by each participant who received the experimental vaccine booster, which can be given at this point only to healthy people 18 and older who were vaccinated with either the Pfizer or J&J vaccine.

  It will soon be approved for the final phase 3 clinical trials and hopefully assuming the response stays 4 fold and the safety is excellent, we will be hearing about this and perhaps other new vaccines, coined super vaccines, yet to surface.

MedLinx,March 10,2022

H. Nasal spray as an adjunct to vaccination

  As an Ear, Nose, and Throat-Facial Plastic Surgeon, I have mentioned the importance of saline nasal sniffs and gargles to keep the very site clear of viruses that multiply before spreading. I also mentioned there is no reason why researchers couldn’t develop a vaccine to be placed in the nose. Children have one for polio and flu now. Could it be so easy to apply, but Big Pharma and public health could not control its distribution and provide the surveillance the CDC is known for? So far there is no such FDA approved nasal vaccine for COVID-19.

  It is known that povidine (betadine) gargle and mist in the nose will kill bacteria and viruses including COVID, however it can be dangerous. There is no commercial product for the nose or throat, so do not use it in the nose ot throat without discussing with your doctor. Why didn’t we have proper research for a safe solution and its efficacy?

  Continued use over a week causes abnormalities in thyroid function, so it can’t be used routinely in the study published in JAMA Otolarygology and Head and Neck Surgery, February 4,2021

  A recent research report on mice found that a nasal spray “booster” could prevent COVID-19.

  At Howard Hughes Medical Institute at Yale University may have provided the answer experimentally. This nasal spray could have been ready to use as a booster instead of needing an injection, but after 2½ years of pandemic, we are just hearing about an animal study that would have been so simple.

  Flumist, a nasal spray to treat early flu, is only eligible to those ages 2-49, because it is an attenuated live virus and not suitable for those with compromised immune systems.

  Dr. Iwasaki’s at Yale University states that the nasal spray is only a protein that attacks the spike protein of COVID-19 and not a live virus. The spray was given 2 weeks after the Pfizer vaccine with no deaths when exposed to COVID-19, while 80% of the placebo group died.

  This research is 2 years past due. This booster could have been given to those unvaccinated if they refused the vaccine, but would not have had near the benefit, but better than getting the infection.

MDLinx, February 9, 2022

I.  Fentanyl keeps coming over the border, death rates rising

  Daily, illegal drugs are coming cross our border, and our government has not said a word.

  To date (Jan. 12), 2022 lbs. of fentanyl has crossed our border. 2022 lbs will kill a major portion of our country. We are going to suffer for years from the deaths, accidental overdoses and suicides in our younger people. Thousands of Cartels are making $billion of dollars per month carrying illegals over the border while they bring those drugs as well.

  838,240 deaths from fentanyl to date this year. 

  This abuse of our healthcare system continues to cost the tax payer $billion of dollars. The pandemic has cost us over $8 trillion, and not a word about the origin and who needs to be reprimanded.

  There have been over 120,000 apprehensions at the border so far this year, and the health consequences of unvaccinated and untested people, not to mention the criminals that will cross our countries are overwhelming. The cost of and responsibility of travel for them plus contaminating our emergency facilities, filling our hospitals with COVID, destroying property, and other transmitting diseases, is unspeakable. Is this collateral damage our country must tolerate for open borders as future voters acceptable to most Americans??        

2. OB-GYN series-Part 2, Chronic pelvic pain

  26% of the world’s population of women suffer from chronic pain in the lower abdomen, many of which occur during the menstrual period, but many are not limited to it.

  40% of laparoscopies are performed because of this chronic pelvic pain (CPP). 12% of hysterectomies occur because of CPP, but 80% are not from gynecologic causes.

  A wonderful review article appeared in the JAMA, June, 2021, which will make up most of the content of this report.

  Dysmenorrhea is defined as pain originating in the pelvic area for at least 6 months, often associated with a multitude of psychophysiological-social issues including cognitive, behavioral, sexual, and emotional difficulties. The strict definition is painful menstrual periods but these authors choose to use the term for chronic pelvic pain to include painful periods.

  Urinary, sexual, bowel, myofascial, and gynecologic conditions must be considered. The pain may be related to the menstrual cycle, from intercourse, stress, work related or family issues.

  Painful periods (dysmenorrhea) are included in this symptom complex, and not often also associated with other systemic conditions such as central sensitivity syndrome (formerly chronic myalgia, fatigue syndrome). It can be associated with pressure, bloating, and nausea, constipation, diarrhea, alteration in bowel habits, can be associated with urinary symptoms (urgency, frequency, or retention), cramps, sometimes cyclic pain. Menstrual periods can be heavy or irregular. Pain on intercourse is not uncommon.

  There are several associated conditions that must be taken into consideration. For instance, interstitial cystitis or bladder pain syndrome patients have endometriosis 48% of the time and 30-75% have irritable bowel syndrome (IBS).

  These associations are explained by neuro-endocrine-sensory overlap, adverse childhood experiences abuse, and trauma plus psychological stress, psychiatric disorders, and dysfunctional reactions to stress.

  This used to be explained under the umbrella term of psychosomatic medicine, but as usual medicine has to come up with more complicated and all encompassing terms difficult for most to understand.

  The experts felt the term psychosomatic somehow implied this syndrome was not real and only in the minds of the individuals, which lead many physicians to not believe these syndromes were real and tried to treat it with psychotherapeutics or discharged them from their care, because the patients weren’t getting better and felt their doctors did not believe them.

  Central sensitivity syndrome explains dysmenorrhea fairly well, which is now the new term for chronic fatigue syndrome and chronic fibromyalgia so commonly seen in women with many of these disorders with joint and muscular muscular pain, headaches. This is just an extension of this syndrome with the name of the organ to organ cross sensitization and how one organ can adversely affect another organ.

  That is true with muscular-organ cross sensitization. The pain fibers are called nocioceptive neural fibers connecting various parts of the body. It comes from overstimulation of these fibers, which leads to less stimuli needed to cause increasingly over reaction of these pain fibers.

  I suggest you read my report on central sensitivity syndrome due to the overlap of these reports and more indepth discussion of the neurosensory mechanisms.

www.themedicalnewsreport.com/84

  There are centers for these difficult syndromes with Mayo Clinic leading the way.

  Centers who treat these patients feel they had their origin of pain centered in musculoskeletal structures.

  The coexistence of these pain syndromes includes thousands if not millions of women looking for help and finding little available. Delayed diagnosis, multiple symptomatic treatment failures, and great stress which creates a viscious cycle of anxiety, depression, physical symptoms, and often leading to unnecessary surgeries.

  Having finally made sense to this overarching syndrome, clinical guidelines propose a change in clinical practice, and the authors recommend certain screening considerations be routine.

1. Identify central sensitization symptoms (generalized pain, multiple pain syndromes, hypersensitivity, sleep disturbance, mood disorders) and social or environmental stressors.

2. Identify myalgias and neuralgias including chronic low back pain and fibromyalgia.

3. Consider gynecologic causes (dysmenorrhea, endometriosis, vulvodynia-pain in female genitals, pelvic masses, chronic infections, and non-gynecologic causes (IBS, bladder pain syndrome, and interstitial cystitis).

4. Longer doctor visits are needed including surveys and educational materials and counseling are all valuable in these cases. Support groups if available would be helpful.

5. Chronic pain management is needed. Understanding the triggers for this complex syndrome of dysmenorrhea is critical.

6. Providing physician reassurance that the patient is believed and that the doctor will follow up with return visits for validation and further evaluations as critical.

7. Confidence from the patient that the physician understands the syndrome and will try and meet the .patient’s needs. This will allow the patient to divulge quite sensitive issues that may be the actual stressor(s) and will more likely keep subsequent visits. Social histories are critical knowing the family dynamics and work related stressors.

8. Follow pain ratings and scales which are standard for any pain disorder.

9. These pain syndromes are often intimately related to prior history of abuse, mental illness, and social stressors. Consultations with proper mental health professionals is necessary.

10. A complete exam must include a thorough gyneolgic exam including a digital exam asking the patient to perform a squeezing motion to see if pain occurs or spasm without relaxation occurs. This maneuver requires trust between patient and examiner. A speculum exam can then be attempted to perform standard exams.

   Also palpation of the pelvic floor muscles felt transvaginal is a must. Palpation over muscular areas of the lower back, pelvis, and sacroiliac area may elicit hypersensive areas. These maneuvers will elicit 70-80% of women’s origin of their pain focus which spread to other areas of pain, according to these authors. Touching surgical scars very lightly may elicit hypersensitive areas with a cotton tip applicator.

11. Vulvar pain (vulvodynia) is common in these patients in 15-20% lasting longer than 3 months. Pelvic rim exam for sights of hypersensitivity is also very valuable.

12. Tests include a pregnancy test if of reproductive age, testing for vaginitis causes, and STDs (sexually transmitted diseases), urinalysis for urinary symptoms, an endometrial biopsy (uterine) for any abnormal bleeding especially if the patient is 45 or over.

13. Transvaginal pelvic sonography looking for pelvic abnormalities.

Transvaginal ultrasound

14. Laparoscopy found 20% in their study to have clinical endometriosis. There is controversy for this more aggressive test, but should be considered.

Treatment

  Symptomatic therapy whether medical or psychological must be tailored to the individual. The most important aspect of therapy is these patients need to feel they are not “crazy”, and that the doctor believes their symptoms and tries various forms of treatment.

  Appropriate counseling and referral to a chronic pelvic pain center are suggested, especially if the physician is not motivated to spend the time and effort in dealing with the challenges of these patients.

  Depending on the specific subcategory of diagnosis (IBS, interstitial cystitis, endometriosis, or dysmenorrhea) there are specific medications that should be tried.

  Hormonal therapy (estrogen, progesterone, gonadotropin hormones) is often helpful including anti-inflammatory medications (NSAIDs-ibuprofen, Aleve, etc.).

  For central sensitivity syndrome (chronic fatigue and fibromyalgia) medications such as Cymbalta, Neurontin, and Savella are listed (antidepressants and anticonvulsants). 

  Nucynta prescribed for nerve pain should be carefully prescribed because of its potentially addictive narcotic nature.

In Conclusion

  I have emphasized the complex difficult syndrome of chronic pelvic pain, which includes a multitude of subtypes and is being place in the grouping under central sensitivity syndrome based on the origin of many of these diagnoses which will be suggested.

  It is critical that the physician is highly motivated to work with these patients, encourage them that they are believed, and spend significiant time and effort to try and get to the bottom of the patient’s cause of their pain.

  Counseling, pain management specialists, gynecologists, and special referral to centers for chronic pelvic pain may be considered. Mayo Clinic is one of these centers.

  There is no quick fix for these patients and the patient must be as motivated as the doctor to work as a team in improving their symptoms, as there is usually not a cure, but control with various forms of therapy.

JAMA, June 12, 2021 

3. Autoimmune Diseases-part 4—A)Graves Disease of the eye and thyroid; B)Hashimoto’s thyroiditis

A) Graves Disease

  Grave’s disease is an autoimmune disorder that results from hyperactivity of the thyroid, producing too much thyroid hormone. Although hyperthyroidism can occur without Grave’s disease, this disorder also involves other organs especially the eyes, most often occurring in women under 40.

Common signs and symptoms of hyperfunctioning of the thyroid include anxiety, a fine tremor of the hands, heat sensitivity and easy sweating, a lump in the lower neck in midline, weight loss, menstrual changes, erectile dysfunction or reduced libido, frequent bowel movements, bulging eyes (30%), thick red skin over the shins or tops of the feet, rapid heart rate, and sleep disturbances.

  Grave’s disease of the eye causes bulging of the eyes, a gritty sensation (exposure keratitis) when the eyelids can’t close easily, puffy or retracted eyelids, reddened or inflamed eyes, light sensitivity, vision loss, or double vision. Protection of the bulging eyes is a necessity. At least 50% of the patients have at least some mild bulging.

  As in all autoimmune disorders, the body senses certain tissues as foreign, and antibodies are stimulated abnormally for unknown reasons and the antibody attacks the thyroid initially, stimulating the thyroid to enlarge with a form of inflammation, and in as many as 50% of patients have eye enlargement due to antibody effects. This is the same immune system that defends our body from infectious diseases, foreign objects, and inflammation.

The thyroid gland is one of the endocrine glands that produce hormones that are involved with metabolism and growth rates. In Grave’s disease, it produces a specific type of antibody, thyrotropin receptor antibody (TSHR), which overrides the normal thyroid stimulating hormone produced by the pituitary gland, a tiny gland at the base of the brain stimulated by the hypothalamus of the brain (these stimulating hormones govern the other endocrine glands such as ovaries, testes, adrenal glands, thyroid, and other glands). There are 2 other antibodies involved in TED (thyroid eye disease)that will be explained under treatment.

  The thyrotropin receptor antibody (TSHR) overrides the normal stimulating hormone stimulating growth of the thyroid, called a goiter, but a toxic adenoma (nodule) can cause this disease, usually benign.

  The cause of this antibody development is unknown, but it is in a large category (over 100) diseases that have the same pathophysiology from stimulated antibodies causing the disorder. Other autoimmune diseases also may occur in the same person, therefore anyone with these diseases need a thorough evaluation in all organ systems.

  Grave’s disease of the eyes (TED=thyroid eye disease) causes enlargement of the eye muscles and tissues of the eyeball from buildup of certain carbohydrates (glycosaminoglycans). 3 antibodies enlarge the eye by stimulating growth of fat and other tissues in the eyeball. This is explained under treatment below.

  This is created from the same antibody that stimulates the thyroid. It occurs in 20-50% of Graves disease with or without hyperthyroid function.

  The enlargement of the eyes can occur long before hyperthyroidism occurs or long after hyperthyroidism begins. It can also occur without hyperthyroidism.

  Risk factors include being hereditary, being female, under 40, other autoimmune diseases, emotional or physical stress may bring it on, pregnancy or recent birth, and smoking. Men can have this disease.

  Complications of Grave’s disease

a) during pregnancy can increase miscarriages, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure or pre-eclampsia which causes hypertension and other issues.

b) heart failure and or arrhythmias.

c) thyroid storm is unusual but can be severe with accelerated hyper function of the thyroid, which causes all of the above problems created by sudden high hormone levels. This is an emergency.

d) osteoporosis from too much thyroid hormone which interferes with the bones being able to encorporate calcium

e) Skin redness of the skin with various bumps, thickening of the skin and nails (clubbing).

Diagnosis   

a) thyroid hormone levels—TSH is the stimulating hormone secreted by the pituitary, and when the thyroid levels are high, it turns off that stimulating hormone, therefore, the levels will be lower than normal. The T3 and T4 hormones are high as expected. It is also possible to measure the antibody levels (TRAb).

b) Radioactive iodine studies--the patient is given radioactive iodine and the amount is measured in the thyroid using a scanning camera.

  Below on the left, this scan demonstrates a normal thyroid (A), an enlarged gland (goiter) (B), toxic multinodules (C), and a solitary nodule (D). On the right demonstrates a classic enlargement of the left side of the thyroid from a nodule.

c) Ultrasound—it can measure the size of the thyroid gland and discover nodules (single or multiple) frequently not felt on exam.

d) MRI or CT scan—rarely is used if the diagnosis is in question to rule our other causes.

e) Elisa test—this is most common blood test to evaluate for antithyroid antibodies (anti-TPO antibody). The thyroid stimulating antibody test will usually be elevated as well. These tests, however, may be positive in normal individuals.

Treatment

 a) Radioactive iodine can shrink the gland. The thyroid depends on iodine to function, and as the radioactive iodine is taken up into the thyroid cells, it destroys the tissue. It can complicate the eye disease and may not be recommended. Of course, it can’t be used in a pregnant woman, and the person must strictly avoid being around those who are or are considering it.

b) Anti-thyroid medication—methimazole (Tapazole) and propothyouracil (Propocil) are usually prescribed for 4-6 weeks and then reduced to prevent the thyroid hormone levels dropping too low. Liver disease may prevent its use, and propolthiouracil is preferred in pregnant women, while Tapazole is the preferred medication otherwise.

  Nightly occlusive dressings for Graves skin disorders are recommended with a potent corticosteroid cream. However, the skin changes may not resolve with treatment of Graves.

  Iodine therapy--A saturated solution of potassium iodide may be used in severe cases to block the conversion of T-4 to T-3 thyroid hormone.

c) Beta blockers—do not block the thyroid hormone, but can prevent some of the cardiovascular complications created by the disorder. Inderal, Tenormin, Lopressor, and Corgard are examples.

d) Immunotherapy-monoclonal antibodies—

  In January, 2020, the human derived Teprotumumab was FDA approved, another one of the monoclonal antibody, effectively blocking the inflammatory response of IGF1-R on orbital fibroblasts and TSHR (thyroid stimulating hormone receptor).

  IGF1-R is another antibody stimulated in TED (thyroid eye disease), and it is a insulin like growth factor-1 receptor (IGF1-R). These antibodies stimulate fat production and production of extracellular matrix proteins called glycosaminoglycans, that make the eyeball enlarge.

  Another antibody, CD40, can stimulate T and B-cells to enhancing the inflammation.

  It takes a monoclonal antibody to block the function of these antibody receptors.

  Corticosteroids were the only anti-inflammatory drugs used before the new monoclonal antibodies were FDA approved.

  In the drug company’s clinical trials, 69% of patients with TED responded to Teprotumumab, and has become a game changer according to Dr. Andrew R. Harrison M.D., Director of Oculoplastic Surgery at the University of Minnesota.

  The orbital enlargement takes months to respond.

www.pro.endocrineweb.com

e) Surgery on thyroid and eye

  Thyroid surgery—there are cases that do not respond to more conservative measures requiring removal of the entire gland. There are as many as 20% unwilling to take radioactive iodine, those who develop thyroid storm (18%), have a thyroid nodule (16%), and cancer of the thyroid. Needle biopsy may or may not be positive and surgical resection may need to be performed.

  Cancer is found in nodules at the time of surgery without a positive diagnosis prior to surgery in 17% of  according to study in Australia.

  About 6-8% of patients with Graves disease have cancer in their thyroid, while thyroid nodules can be found in up to 25% of cases. Papillary carcinoma is much more common than follicular carcinoma. If cancer is found, strong consideration for postop radiation will be made, because of the liklihood of neck nodal metastases.

  Patients will need to take replacement thyroid hormone, and if hypoparathyroidism occurs at the time of surgery, calcium may need to be supplemented.

  Orbital decompression  

  There are cases that need the bone surrounding the eye (orbit and sinuses) to allow the eye to sit deeper in the eye socket so that the eyelids can be closed easily.

  Below a radiograph demonstrates the orbital bone and ethmoid and maxillary sinuses that may need some bone removal to give the eye enough room to rest easily in the eye socket, protect the eye, and allow the eye muscles to move normally. Ophthalmologists and Ear, Nose, and Throat surgeons (like me) may work together to perform the decompression.

  The X rays below demonstrate the bone that may have to be addressed in these cases needing decompression. Obviously most of the bone is conserved to prevent complications of the eye muscles and the eye falling to low into the maxillary sinus.  

Prognosis

  It may take years for the eyes to return to near normal or normal. The thyroid can be managed in most cases, but most will need replacement therapy if the thyroid hormone levels are too low.

  About one third may have to live with a mildly high level of thyroid hormone levels. This disease will need years of surveillance, and testing is critical to be sure the thyroid levels don’t elevate, or develop more nodules.

Emedicine/Medscape.com; Mayo Clinic; NIH

B)Hashimoto’s thyroiditis

The other autoimmune disease affecting the thyroid is an inflammatory reaction in the gland from antibodies that sense the gland as foreign. The blood cells, lymphocytes, invade the gland causing inflammation, swelling, and tenderness and destroy the gland’s ability to form thyroid hormone.

  It is more common in middle age women, and can cause fatigue and weight gain. It occur in 5 out of 100 people in the U.S.

Symptoms of hypothyroidism

  Symptoms arise from a low thyroid hormone level (as opposed to Graves) include hoarseness from swelling of the vocal cords, puffines of the skin and eyelids (myxedema), cognitive dysfunction with difficulty thinking and concentrating, menstrual abnormality, sexual dysfunction, hair loss, and constipation all from a slow metabolism.

  It can be hereditary, and these patients are more likely to develop other autoimmune diseases such as liver conditions, vitamin B12 deficiency, gluten sensitivity (Celiac disease), joint pain from rheumatoid arthritis, type 1 diabetes, lupus, and Addison’s disease (discussed next month).

Diagnosis

  As in Graves disease, the thyroid hormone levels (free T4), and stimulating hormone from the pituitary gland (TSH) are involved, however, in the opposite direction. The TSH is elevated since the actual thyroid hormones are low. When low, the thyroid sends signals to the pituitary to raise the amount of TSH.

  An ultrasound can demonstrate any abnormalities (nodules, enlargement).

  The immune antibodies are elevated in both Hashimoto’s and Graves, since that is one of the antibodies causing the symptoms in both diseases (antithyroid antibody test--anti-TPO) 95% of Hashimoto’s cases and 75% in Graves disease).

  10-20% of anti-TPO are elevated in thyroid nodules and cancer. 10-15% of normal people have elevated levels.

  There are three antibody tests that may be ordered—thyroid peroxidase (TPO), thyroglobulin antibodies, and TSH-R thought to be produced by the blood cell the B-cell lymphocytes. The third is the TSH-receptor test is commonly elevated in Graves disease but can be elevated in Hashimoto’s.

  A patient can have Hashimoto’s thyroiditis even if these tests are normal and this disease process progresses much slower. Thyroidpharmacy.com

  There 5 stages of Hashimoto’s starting with no symptoms and normal thyroid hormone levels, to overt Hashimoto’s leading to other autoimmune diseases.

Treatment

  All patients don’t need treatment, but for those with near normal thyroid hormone levels, they can be monitored. For those with hypothyroidism, levothyroxine (Euthyrox) is recommended.

  Patients need to be monitored for other autoimmune diseases, heart disease caused by hypothyroidism, and any other symptoms known to occur with low thyroid. Ver careful monitoring of thyroid levels in pregnancy are necessary to prevent complications from low thyroid in the fetus.

  Most people with hypothyroidism do not have Hashimoto’s disease, and it is with the tests that make the differentiation. The symptoms will be the same regardless of cause of hypothyroidism.

Cleveland Clinic

4. New recommendations for aspirin for primary prevention of cardiovascular events

The USPSTF*has revised its recommendations for the prophylactic use of aspirin to prevent cardiovascular events in peole without known heart disease.

  Low dose aspirin is still being recommended for all those who have diagnosed heart disease to prevent future cardiovascular events which would include hypertension, heart disease, peripheral vacular disease, history of lower leg venous disease (thrombosis), or stroke.

  Additionally, for those 40-59, aspirin may be recommended, who have a higher risk of cardiovascular disease from a family history, underlying diseases such as diabetes, kidney disease, and any disease that increases the 10 year risk of death, as judged by an individual’s physician.

  However, individuals 60 and over should not take low dose aspirin (81mg baby aspirin) without higher risks of a future diagnosed cardiovascular disease, because of the higher risk of complications such as bleeding, heart burn, etc.

  Previously, those at higher risk for colon cancer were included in the 2016 recommendations, but were not included in the new guidelines, so they may still be recommended.  

  Keep in mind these are not rules, just guidelines, so always consult your doctor regading the use of low dose aspirin for primary prevention of cardiovascular events.

NEJM, October 20,2021

5. Dry eyes-more treatment

  Dry eyes affect millions of Americans and the causes are many. I have reported on this issue of keratoconjunctivitis sicca, an autoimmune eye disease affecting the lacrimal glands, but there are many causes including diabetes, Graves disease (from thyroid disease) with bulging eyes, aging, many medications, excessive dry air, laser (LASIK) eye surgery, reduced blinking, looking at the computer excessively, hormonal changes in women, and use of contact lens.

  Testing of the eyes include testing the amount of tears, the content of tears (mucus vs water content), test to look for markers in tears such as metalloproteinase or lactoferrin by an ophthalmologist or optometrist.

  Mild dry eyes can easily be treated with over the counter artificial tears. There are also lubricating eye drops that soothe the eye but can blur the vision temporarily.

  An underlying disease must be looked for by the eye doctor:

 a) Blepahritis--eyelid inflammation from the lid margin with inflamed meibomian (oil) glands that lubricate the surface of the eyeball-conjunctiva and cornea.

b) Multiple diseases--decreased tearing occurs in aging, certain autoimmune diseases such as Sjogren’s syndrome, rheumatoid arthritis, lupus, scleroderma, sarcoid, thyroid disease, graves disease of the thyroid, and vitamin A deficiency. Not only eye medication but actual treatment of any underlying disease is necessary.

c) Keratoconjunctivitis sicca--immune inflammation of the cornea which is treated with cyclosporine (Restasis). This is well covered in www.themedicalnewsreport/77

d) Certain medications-- including antihistamines, decongestants, hormone replacement medications, antidepressants, high blood pressure meds, acne meds, birth control meds, and Parkinson’s meds can cause dry eyes.

e) Eyelid problems-- such as ectropion (relaxed lower  eyelids turning out), entropion (turned in), from aging, eyelid surgery, and trauma.

f) Eye allergies-- are very common causing itching and excess tearing which can lead to the tear glands being depleted of tears.

g) Preservatives in eye drops--most bottles of artificial tears have preservatives, which can cause irritation and dryness. Individual one time use artificial tears do not have preservatives and need to used (over the counter), which are unfortunately expensive.

h) Wind, smoke, and pollutants in the air--as well as dry air all can cause dry eyes. Wrap around sunglasses are a must.

i) Contact lens-- are commonly a problem. 

Treatment

  There are new eye inserts (called Lacrisert), a cellulose little wafer the size of a clear grain of rice, that are placed between the lower eyelid and eyeball that dissolves slowly releasing a substance like tears to lubricate the eye. This is reserved for moderate to severe dry eyes.

  Common sense maneuvers include avoiding dry air (humidifier by bedside or chair, keeping the level of the computer below eye level. Avoid and or stop smoking, wear wraparound glasses, and use artificial tears (without preservatives) often.

  The two major medications to address inflammation in the lacrimal gland are Restasis and Xiidra. They are very expensive ($600-700), so check with Good Rx and Simple Care for their prices, if you don’t have insurance, but compare your co-pay and deductible, as GoodRx may be even less expensive.

  Xiidra supposedly works quicker than Restasis, but depend on your eye doctor to decide what medication is best. They can be used long term without problems.   

Mayo Clinic

6. Updates on LBGQ+, Transgender issues; Detransitioning

Definition of LBGTQ+

L-Lesbian (females)

B-Bisexual (attracted to both sexes)

G-Gay (men)

Q-Queer or questioning (implies being somewhere between male and female, actually not acknowledging either male or female; it also implies they may be very fluid in where they identify

Cisgender- (identifies as the sex they were assigned to at birth), heterosexual

Gender binary- (social system that sees only 2 genders requiring the raising of a child as the sex assigned at birth), therefore non-binary signifies all of the designations in this list

Pansexual (not limited in sexual choice with regard to biological sex, gender, or gender identity)

+ sign signifies a number of other identities, and there is a long list

  In 2015, I reported on the gay, lesbian, transgender dysphoria, transgender surgery issues which are extremely complicated, therefore I would invite you read what is in those 2 editions of my previous reports as they are the very important basics: www.themedicalnewsreport.com/45/46

  There has been much written about these individuals, but their mental, physical, and sexually transmitted disease complications remain the same, and they are covered in those reports above.

  The psychologic trauma dealing with this identity crisis for most is very difficult creating anxiety, depression, exaggeration of underlying psychologic disorders, being ridiculed by family and friends, bullied, and disowned. Thankfully the tides have turned more recently with increasing left leaning younger people especially.

  42% of LBGTQ+ reported that they attempted suicide. 43% of Hispanics, 42% Blacks and multiracial, and 39% of Whites have reported attempted suicide. Almost half of transgenders have attempted suicide. This is a very important subject to bring up to these people, as they ae unlikely to admit to ideations about suicide, and need help immediately.

  Homelessness is a big problem especially for the transgender, and turning to street drugs and prostitution is not uncommon. More parents are accepting their children’s decisions today. Gay and lesbians are accepted by most people, even though they may not agree with marriage, etc., primarily from the religious.

  Florida has passed a “Don’t Say Gay” bill forbidding classrooms from teaching sexual orientation and gender identity. Here is the bill:

  Florida HB 1557 Parental Rights in Education include:

1) Notify parents of changes to health or well being 2) Don’t encourage from holding info from parents 3) Allow parents to access student records 4) Let parents refuse school healthcare serices 5) Get parental permission for health screening 6) No discussion in kindergarten through 3^rd grade on sexual orientation or gender identity, or in a manner that is not age appropriate or developmentally appropriate.

  7% of American adults are in the LBGTQ+ community, according to a Gallop poll (11% of Hispanics, 6.6 % of Blacks, and 6.2% of Whites). 10% of millenials (GenZ born from 1997-2012) are in this group and youth is closely tied with this identity. This implies these percentages will continue to grow. Acceptance continues to improve as well.

  Couples are much more common living in the same household in the past few years. There were 980,000 same sex couples in 2019, 58% were married and 42% unmarried, according to the U.S. Census.

  These marriages were not legalized in the U.S. until 2015. There are slightly more female couples than male. 15% of these couples had at least one child. The highest number of same sex couples live in Washington D.C. 16% of couples are interracial. NBC News app

  Since 2015, grade schools are spending time talking about gender choice and have confused many a young child, even without their parent’s permission to discuss this subject, along with other controversial issues on racism.

  Liberal teachers have created significant parental concerns that have activated thousands of parents to become more active in school curriculum with school boards and unions fighting them all the way.

  Insurance covering transgender surgery and medical treatment is not uncommon, and is covered in the military.

  Regardless of where a person stands on the whole issue, transitioning and detransitioning have progressed greatly. Young people are looking for acceptance as they decide on their gender desigination.

  Currently 1.2 million adults identify as transgender, double in the last decade while 7% are in the LBGTQ+ community. California, Georgia, New Mexico, and Florida have the highest percentages. The largest age group in this community are 18-24 year olds. Adults who are Latino or Black are more likely to identity more than White-non Hispanic. While 0.06% of the population is transgender, 0.08% of blacks and 0.05% of whites are transgender.

  Hormonal (estrogen/testosterone) manipulation is necessary to transform the body to a more female or male body shape, but only 25% attempt trans-sexual surgery (breast implants or mastectomy, genital change using sophisticated plastic surgery) and it is not always successful, often requiring multiple surgeries. Providing normal sensation is very difficult and often not successful, but it is more about appearance than function.

  As many as half of those who choose to transition change their minds (de-transitioning), usually before having transsexual surgery.

  The sad part is there are not enough doctors willing to help either group. The uninisured are often those who have identified in this group. Discrimination is still an issue even in medicine.

  The majority of transvestites identity as heterosexuals.

  The National Center for Transgender Equity in 2015 surveyed over 27,000 LBGTQ+ and found 21% identitfied as queer, 18% pansexual, 16% gay or lesbian, 15% straight, 14% bisexual, and 10% asexual.

Medscape, November 4, 2021

This completes the April Medical News report!!

Next month, The May, 2022 report will include:

1. COVID updates

2. Autoimmune Diseases-Part 4-Sjogren’s disease, Myasthenia gravis, Addison’s disease

3. Stress incontinence

4. Skin resurfacing of aging skin-options

5. Progress in cancer 1971-2022