The Medical News Report

#125

June, 2022

Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

Subjects:

1. COVID 19—updates; Baby Formula info

2. Alzheimer’s update—how sleep affects the brain

3. Autoimmune Diseases-Part 5-- Alopecia Areata, Scleroderma, Guillain Barre’ Syndrome

4. Roe Vs Wade

5. New FDA Drug for insomnia--Viviviq

   Relaxium---more TV ad marketing!

IMPORTANT REMINDER!!!! PLEASE READ!!!

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

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

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

Thank you, Dr. Sam

1) COVID-19 update; Baby formula shortage

  The economy has struggled with multiple moves by our administration especially blocking energy production in our country and the massive outlay and stimulus spending that occurred because of the pandemic, creating the inflation. The inflation rate was 1.4% when Biden started his presidency and is now 8.4%, which has created a massive problem in the buying power of Americans and has created crises everywhere, while our government says they are doing a fine job. Only 36% agree with them.

  Poorer people can’t afford medicine and are not going to the doctor for routine care.

  Thanks to the baby formula shortage and the hoarding, many children are going without the proper formula, especially those who have a special type.

  The fentanyl crisis on our southern border is getting worse by the day as thousands of illegals cross our border daily, thanks to Cartels who are untouched by our leaders. The healthcare cost for these people is massive, as sex and human trafficking, and drug and alcohol deaths skyrocket (107,000 in the last year).

  And if the State Of New York could not do anything more controversial, their health department put out posters and posts on how to safely use illicit drugs. Nice try, but even though well intended, only says one thing……here is how to more safely do drugs, not STOP doing drugs.

There are still 11 million jobs open in this country, while thousands of people just are not working and have learned to live with less, hoping for governmental assistance. When they can’t afford $6.00 loaves of bread and $8.00 a gallon of gas, that may change their mind.

  Our schools are a mess with children suffering greatly, and teaching is in a crisis with radical left ideologies being inserted.

  The recent school shootings in Uvalde, Texas, point to lack of regulations, mental health assistance lacking, and parenting becoming a real issue as the schools would rather help a child transition than teach them math. Not for my child!!

  Our country is more divided than ever. We must have a change in strategy or our country will go exactly where the radical left wants us to go….SOCIALISM AND WORSE. Who wants to live in Cuba, North Korea, China, or Venezuela?

  The pandemic is not over and we must continue to be careful although the number of hospitalizations and deaths continue to drop in most states, thanks to a virus that continues to cause less illness except in the immunocompromised and those with underlying diseases. We have thousands of illegals helping the rising number of cases in certain areas. However, as stated by the CDC, the number of cases is not the issue, it is the number of hospitalizations and deaths, but the media just can’t stop stirring fear. Re-infections in those vaccinated and treated with antivirals has become apparent.

 Most Americans see little value in a 4^th dose of vaccine, and parents are not getting their children vaccinated in great numbers, even though the data supports their use. 4^th doses are certainly smart for the high risk.

 The antiviral pill, Paxlovid, is making a difference which can be obtained in pharmacies if an individual has a positive antigen test there in the pharmacy (test and treat). However, fewer people are taking advantage of this free test and treat option. And now there is a report that even after taking Paxlovid, reinfection can happen. There are just no guarantees.

 How interesting the timing for the Supreme Court to consider reviewing  Roe vs Wade, which has rallied many women (on both sides) to get out and demonstrate and vote. In the middle of May, the Democratic Congress voted to legalize abortion for all 9 months of pregnancy, which is highly controversial, and created extra concern.

  The U.S. economic crisis leads the many other crises including  shortages, crime escalation, border over run with Cartel sex and human trafficking, abuse, spread of Omicron and other diseases from the border, limited infant formula, out of control mental illness, death from guns and drugs, delay in healthcare, and the highest gas prices in history.    

Baby Formula Shortage

While the FDA and CDC continue to show their incapability to stay up with pressing matters, the current FDA Commisioner, Robert Califf, M.D., took some harsh criticism from a congressional committes on May 26-27 for the FDA’s lack of speed in re-inspecting and enhancing the reopening of the baby formula factories at Abbott Labs.

  The pharmaceutical company closed its factory on February 17 following the concern of bacterial contamination of baby formula, when there were reports of 4 children becoming ill with 2 dying who drank their formula. There is no proof the formula was actually contaminated. It was a precautionary move.

  The factory was found to be unsanitary in several ways, with leaky roofs, poor employee hygiene, bacteria growing on surfaces, etc. with an FDA inspection in January.

  The FDA was criticized by U.S. Senators for their lack of acting on the shortage issue fast enough. Between this lack of action and the closing of the facility, we have seen a huge shortage of formula, so much so, that the administration invoked a Defense Production Act to speed up formula production in other facilities and authorized formula to be flown in from overseas.

  The FDA did not come to an agreement with Abbott to solve the problem until May 16. The facility said it would take 2 weeks to be ready to open and produce formula. It has been 3 months since they closed!!

  A whistleblower contacted the FDA in 2021 regarding violations of multiple rules in the formula plant, but the FDA did not interview the person for months and did not inspect the plant until January 31, 2022. This is inexcusable, and Dr. Califf admitted it was too slow.

  The fact that there would be an acute shortage with so few U.S. comapnies producing formula in this country, sounds like the same excuses made about the shortages for proper viral testing, PPEs, etc. for COVID-19, especially since most of these items are not even manufactured in the U.S.

  The usual excuse from federal agencies, when they get criticized, is that they are underfunded. The government never has enough money!! The real problem is expecting a federal government to be in charge of everything, like they would do in a socialistic society. This is one of many issues which should make it eminently apparent of how ineffective our government is.    

Note!!  The medical journal articles have dried up with new medical information, and therefore this will be the last extensive report on COVID-19, except for very important new information, which I will continue to publish monthly. Yes, I am sick of it as much as you are!

 Secondary infections in Omicron variants

  People, no matter whether they have been vaccinated  fully, or had a reinfection or not, We are still at risk to become infected again, mostly with only mild symptoms.

  Even if you took antivirals in the hospital or were prescribed Paxlovid at the pharmacy (test and treat plan), you can still get infected again. There have been recurrences of virus after the 5 day oral medicine, therefore, check with your doctor if respiratory symptoms recur, especially those with higher risk.

  This is after the media reassured the country the vaccine would stop the virus. Of course, that is not true. But it may be true for the immunosuppressed and those with underlying diseases, as has been stated multiple times. They have been very successful in preventing serious illness.

  If you have respiratory symptoms suggestive of COVID, please get tested, out of respect for the people around you. These recurrent illnesses, thankfully, are usually mild.

  This is also why the CDC won’t say we are in herd immunity, and as is also known, herd immunity does not stop the virus totally either……NOTHING DOES; IT WILL REMAIN AROUND JUST LIKE THE FLU.

Medicinenet, May 25, 2022

  A study performed in Norway with a 90% vaccination rate found that 25% of family households had a positive PCR test, since Omicron took over. There were fewer cases if Delta variant (19%).

85% of the cases in Norway are now Omicron.

JAMA Network, March 22, 2022

  A new subvariant of BA-2 Omicron (BA-2.12.1) has started on the East Coast and is going to spread across the country, but is not more deadly than the other Omicron variants, but may be more infectious.

  There is no information on the effectiveness of the current vaccines against Omicron, but are probably in the  60% range as was BA-2 Omicron.

  Currently most of the cases are being picked up incidentally, because most are asymptomatic transmitters and those getting infrected are asymptomatic or have very mild disease.

  Of course, the CDC will show over-concern as they have throughout the pandemic, but that is public health’s job.

  It is too soon to know the important information about this new subvaraint, also as usual, we will probably have to depend on Israeli studies.

Medicinenet.com May 5, 2022  

Remdesivir has been approved for COVID-19 for children; FDA approves booster for children 5 and older

  The FDA has approved the use of the injectable Remdesivir available for children 28 days and older in the hospital for COVID-19, who are at high risk for severe disease. Medscape General Surgery, April 25, 2022

  This antiviral has been successful in reducing the severity of the viral illness.

  Also the FDA approved a booster now for children 5 years and older. The rate of vaccination for small children has not been very high, because mothers want more longer term data for this emergency use vaccine for children.

Countries have been over-testing—cost and value less than desirable

  The country of Norway stated that they spent too much money testing everyone in their country. Denmark had the same number of cases, etc. with much less testing.

  The costs for the pandemic have been in the $trillions and now with herd immunity creating fewer symptomatic cases, hospitalizations, and deaths, smart countries have decided to stop mass testing, instead doing sample testing, and performing more strategic analysis of areas with more cases.

  Of course, our administration has no plans for trying to become more strategic and becoming much more cost-cautous. It was hypothesized a year ago, that mass testing would stop the pandemic and it did not. Neither did vaccination, but certainly helpful in those in high risk categories of people. Getting the infection has been the biggest reason the virus is getting weaker, as it is estimated that 95% of the population has been infected.

  Of course the public health officials, worry about a much more dangerous variant, and that has not happened. 

  As in any epidemic or pandemic, as the variants continue to mutate, they are having a harder time finding vulnerable hosts, as the unvaccinated people have all been infected.

Medscape, May 11, 2022

  The NEJM just pointed out that at least 75% of children have had COVID-19!!!! This has occurred because of high transmissiblility of Omicron variants. 1/3 of the cases have occurred because of Omicron.

NEJM Journal Watch, May 12, 2022

Booster after COVID infection of little value against Omicron

  If a person has had a COVID infection, there is scientific proof that one vaccine dose is probably enough to be as immune as possible. However, no studies have been performed for 2 doses after an infection.

  A study mentioned on Reuters about a third dose (booster) was found to be of little value to those with natural immunity from an infection.

  An author from Connecticut stated that 2 doses were necessary, but the data was unclear and it was published in a questionable internet journal, MedRxiv.

  I think most would be happy seeing those with natural immunity get at least one dose of a vaccine about 6 months after the infection. Then there would be no reason for any mandate.

  Unfortunately, with mandates for federal employees, universities, certain businesses, etc. required them to get 2 doses, and those who did not were considered unvaccinated. Shame…..and the CDC still does not recognize natural immunity except to advise them to get fully vaccinated, which now is considered to be 3 doses. Trust me, if the CDC was independent, you would be hearing much different information.  

Negative home antigen tests

  A comparison between the home antigen test and PCR test found that if a person became symptomatic with the virus, and used an antigen nasal swab test for COVID-19 testing, and was negative, that people should wait 2 days and retest.  Many who have a first negative home test had a positive PCR test in 2 more days. Unfortunately, the PCR test takes 24 hours to get the results.

JAMA Network, April 29, 2022

Research on home tests

  The latest research from Harvard found that Binax, Carestart, Genbody, and Lumira DX tests all were quite sensitive to Omicron variants, however, GenBody was less sensitive for Delta variants by 20%.

  Since Omicron variants are most of the cases today and have been for over 2 months, the tests are working pretty well, but the Harvard authors strongly suggested the manufacturers need to re-evaluate these tests for future variants. MDLinx.com

Dog sniffing COVID successful in airports

  A new study published in the British Medical Journal Global Health found that dogs were able to sniff people with positive COVID-19 virus. This test was over 90% successful. There have been other small reports that were as effective. Too bad we didn’t get these studies performed about 2 years ago.

  It is still has not been utilized in airports yet.

BMJ Global Health, May 17,2022

Results of Israel 4^th dose of vaccine

  Once again we lean on the results of research in Israel and find that the 4^th dose only gives 4 weeks of protection above the immunity of the 3^rd dose, and by 8 weeks, the immunity provided by the 4^th dose is gone. That seems like a very short time to ask the public to get another dose of vaccine.

  During that time there was 2/3^rd better protection over the 3^rd dose for severe disease.

  This would be important for those who would want maximum protection such as those with medical problems which would complicate an infection and 70% reductions in hospitalization with worth it even if for only between 7 and 30 days after the 4^th dose. This makes no sense for others.

  Big Pharma is winning! But there is a clear choice for those older and with medical issues…..get the maximum doses recommended.

NEJM, April 28, 2022

The CDC notes hospitalizations doubled in unvaxxed kids ages 5-11 from Omicron

  The CDC announced that in Dallas and Atlanta, unvaccinated kids ages 5-11 had double the numbers of hospitalizations with 9.1/100,000 vaccinated kids vs 19.2/100,000 in unvaccinated kids.

  These children were authorized by the FDA to receive 2 doses of Pfizer vaccine. 44% were Black compared to 22% white.

  Expect the same data from the new and upcoming subvariant of Omicron BA-2.12.1.

  As seen with all demographics, more Blacks (34%) are unvaccinated than whites (31%) or Hispanics (19%) for fear of the side effects of the vaccine and lack of trust from the medical profession.

  These numbers are quite low compared to older kids and adults, and most of the children who get infected have mild disease, and even those who have severe disease and are hospitalized, do not require higher levels of oxygen therapy.

  A limitation of this research was the study did not separate children who were unvaccinated or vaccinated and healthy vs those with underlying diseases. This is a majot flaw.

   It was clear that diabetic children had a higher admission rate, but those with asthma and immunocomprosing conditions were actually lower. However, the study did report that 30% of admissions to the hospital had no pre-existing conditions.

  Obesity and diabetes continue to be the risky conditions to have regarding COVID-19. The author of this CDC report encouraged minorities to receive a booster when recommended.

MedPage Today, April 19,2022

More fentanyl….more deaths, and more Cartels in our country;  Alcohol deaths up during the pandemic

  The Cartels are sweeping the southern border and are now making $200 million a week (double from 3 months ago) just on human trafficking, as Title 42 near being dropped (although there is a temporary delay). Once this regulation is dropped regarding preventing anyone entering our country must not have active diseases. The numbers expected to rise from 8,000 to 18,000 illegals crossing our southern border per day. This is a disaster and no person who cares about our country could support this travesty.

  The Secretary of Homeland Security Mayorkas says the border is closed (yea,right!!). How stupid does he and the administration think we are?? I guess pretty stupid! Tell him how you feel in November.

  The abuse of opioids during the pandemic set up the rise in buying street drugs that unknowingly have been laced with fentanyl (40% of all street drugs), and not only killed 105,000 people last year, but have filled our emergency departments with overdoses, including alcohol deaths (increased from 79,000 in 2019 to 107,000 in 2021), withdrawals, and accidents created by being drunk, stoned, etc. The largest group affected are those 25-44 years of age, but alcohol abuse in the elderly population has risen as well.

  Fentanyl accentuates the “high” of the drugs laced, and is so cheap, it saves the drug dealers money by lacing these street drugs with fentanyl.

Deaths in which alcohol contributed to drug overdoses increased by 60% since the pandemic began, and alcohol deaths increased by 25% with the pandemic.

JAMA Network, March 18, 2022

   Have you heard one word about this from our administration??

   Why hasn’t the press asked the obvious questions about the Cartels, the sex and human trafficking, murders, abuse, and substance abuse cases and deaths?

  What is our government doing about it?? NOTHNG! Allowing illegals to flood our border just for future votes is just not acceptable, and we have leaders that don’t care about the consequences of their actions. I hope you do!!

  The trial regarding abuse by Walgreen’s has settled with the State of Florida for $620 million over 10 years for flooding the market with opioids. The lawyers’ fee was $63 million (Papantonio, etc. in the Levin firm). 

As stated, the number of valuable research publications has dwindled after the journals flooded the internet with less than brilliant studies, however, I have chosen the best, but next month, there will be far less new information to pass along. However, be rest assured, you will receive reports on any pertinent new information.

                                                                          Dr. Sam

2) Alzheimer’s Disease—sleep and its effect on the brain

 An addition to the list of dementias

 Dementia is a scary disease, and research has not found us a way of preventing or stopping it yet, but we continue to get closer to answers.

  Dementia has many causes, with Alzheimer’s disease as the number one cause, while vascular dementia is second, Lewy body disease with Parkinson’s like symptoms is third, and frontotemporal dementia is 4^th. There are close to 6 million with this diagnosis in the U.S., with 55 million globally. It is increasing because the U.S. is aging.

  Now a dementia very similar to Alzheimer’s disease (AD) has been named-LATE=TDP-4 encephalopathy, estimated to cause 15-20% of dementias. The reason, the disease has not been discussed before is that it can’t be diagnosed except at autopsy. It is often confused with AD. The same drugs that help Alzheimer’s may help with LATE

Published in Medical Express Breaking News, but not a research paper, May 5, 2022 in MDLinx.com

8 risk Factors raise the risk of AD

  The CDC Behavioral Risk surveillance committee has found that 8 factors (and certainly those with multiple factors) will raise their risk of AD by 40%:

1. midlife obesity 2. Midlife hypertension 3. Physical inactivity 4. Depression 5. Smoking 6. Diabetes 7.Low education and 8. Hearing loss.

  These factors are even more risky for Black, Hispanic, Alaskans, Indians, and males of all groups.

  The most modifiable factor is midlife obesity, which continues to rise in the U.S.

  Unfortunately, in this partially woke country, obesity is now considered a non-subject since it is so wide spread and those people with this radical leftist ideology have influenced weight loss advertisement, the size of models, and because obesity is far more serious in Blacks and Hispanics, and is politically incorrect, when it is killing so many Americans, even children.

JAMA Neurolgy, May 9, 2022

New information about how the brain rids itself of waste and how it applies to Alzheimer’s disease

The body must rid itself of toxic waste to remain healthy. That system for the body is the lymphatic system, which includes the lymph nodes and other lymph tissues, liver, spleen, and lymph vessels. If you are interested, I reported on this system in detail, and you can review the system, by logging into: www.themedicalnewsreport.com/61

  Below is a comparison of a normal brain and Alzheimer’s with a special type of PET scan. Also note the amyloid and neurofibrillary tangles seen in brains with AD. Also below left there is shrinkage of the cerebral cortex and enlargement of the ventricles, responsible for production of cerebrospinal fluid.

Pathophysiology of brain removing toxic waste through the lymphatic system

  The lymphatic system is responsible for providing an immune response and ridding the body of waste, from cellular death and turnover of bodily fluids and tissue growth. This includes waste substances such as amyloid and tau proteins, known to be increased in AD.

  Below is a drawing that demonstrates the tissues that make up the lymphatic system.

Note that the brain is absent in this lymphatic system. NOT ANYMORE! New research has proven in animal models that the lining of the brain (meninges) does have a sophisticated lymph system, called the glymphatic system.

The Glymphatic system

Not until recently, a lymphatic system has been discovered that surround the blood vessels in the lining of the brain, specifically in the arachnoid mater layer. It is called the glymphatic system (the “g” implies it is a glial cell system).

  The lining of the brain is called the meninges, with 3 distinct layers—dura mater, arachnoid mater, and the pia mater above the subarachnoid space, which contains the choroid plexus that makes the cerebrospinal fluid on the left, with the blood vessels between the pia and arachnoid layers.

  The glymphatic system is a drainage system that circulates fresh cerebrospinal fluid with waste product rich brain interstitial fluid and flushes the fluid and waste products out of the brain into the systemic lymph circulation. The brain fluids surround the tiny arteries (see drawing right above) traversing the subarachnoid space with water channels that act like pores in our skin.

  Several of the body’s forces affect this system mostly the blood pressure and respirations. As fresh CSF (cerebrospinal fluid) is made and the waste products are mixed with it, the water channels allow the filtering of these fluids out of the brain. These waste products include the two proteins known to accumulate in Alzheimer’s disease—tau and amyloid. Removal of these proteins allows the brain not to accumulate these toxic substances. However, in Alzheimer’s we know that these proteins accumulate in specific areas of the brain.

Sleep and the glymphatic system

  This system is most active during sleep, particularly during non REM (dream) sleep.

  It is now known that several factors influence the flow of this glymphatic system including aging, which diminishes the water channels for filtration in this system. It is occurs  with shift work, those who are sedentary, have brain injury in conditions with elevated spinal fluid, patients with sleep apnea, obesity, hypertension, type 2 diabetes, brain atherosclerosis, ischemic stroke, brain hemorrhage, sleep disruption and deprivation.

 Chronic sleep loss is associated with many neurological and psychological disorders, including Alzheimer’s disease.

  It is critical that these risk factors are addressed to prevent decreasing filtration of the waste products of the brain.

Blood test may detect early Alzheimer’s

  A simple blood test (p-tau217), developed by Lilly Pharmaceuticals, may one day detect early AD, and in some cases detect it decades before symptoms. Research published in JAMA.

  It can detect a certain protein that serves as an indicator for amyloid plaques and tau tangles, key findings in AD. This test can differentiate AD from other types of dementia 89-98% of the time. That precision is similar to PET scans of the brain and cerebrospinal fluid analysis, very expensive tests.

  There is a gene with high levels of p-tau217 that is present in some patients with AD.

  This blood test hopefully will be available soon, since the research was published in 2020, according to Dr. Oskarr Hanson, from Sweden Lund University.

  Currently, a series of memory tests is necessary to diagnose AD, along with brain scans affecting 5 million people in the U.S. and at least 50 million worldwide.

  60% of people with dementia are never adequately worked up and diagnosed.

JAMA, July 28, 2020

  Progress on treating Alzheimer’s disease (Aduhelm—a new drug)

amyloid and tau tangles in neurons

New medication (Aduhelm)

  With 50 million people worldwide suffering from AD, one might think that the progress in treating this disease would be more fruitful, and yet, there is no drug to prevent the disease or even stop the progression. The only progress has come from a few medications that might slow the disease process in some early stages, not later.

  The 3 most common drugs prescribed for AD is Aricept, Razadyne, and Exelon to help slow down the symptoms in early and mild AD

  The latest medication comes from the first monoclonal antibody to treat AD, aducanumab (Aduhelm), that can reduce the amount of amyloid deposits in the brain verified by PET brain scans.

  To date, there is no absolute proof that amyloid and tau cause the disease, but these protein deposits do result in loss of neurons and their connections creating difficulty with memory and and thinking.

Aducanumab (Aduhelm) in a controlled double blind study of 3500 participants showed a dose and time dependent reduction in amyloid beta plaque, while the controls showed no improvement.

  This FDA approval, first since 2003, was not unanimous going through the accelerated approval pathway, stating that further studies by Biogen, the pharmaceutical company, are needed to prove lasting results for final FDA approval and to find out long term side effects..

  The drug cost $56,000 a year.

  NEJM, May 6, 2021

  Alzheimer’s vaccine—good news, bad news

  An experimental vaccine appears to safely clear tau protein from the brain, but it is not clear it can improve brain function.

  Stage 2 clinical trials demonstrated high levels of antibody development that targets the free floating tau protein before it can create the tangles that clog neurons and damage brain function.

  While amyloid seems to accelerate progression of the disease, the tau tangles actually create brain atrophy and cognitive loss.

  Those actually diagnosed with AD responded better to the vaccine. Those patients who had proven tau biological markers, slowed loss of brain function in about 30% of patients. However, this study included many with suspected AD, and they did not respond as well even though they developed high antibody response.

   For those who responded to the vaccine, they were able to reduce, by 58%, the accumulation of a neurofilament light chain protein in the blood, an important biomarker for neurodegenerative diseases.

Good nutrition may help

  It has been proven that a Mediterranean diet does prevent deposition of amyloid and tau with diminished mediotemporal brain pathology.  This diet is high in fish, vegetables, and fruits.

  Just how long it would take for visible improvement has yet to be analyzed. These studies occur over at least 5 years and some as long as 9 years. It would only make sense for anyone in the early stages of AD to prevent any progression with this diet.

  There is no evidence of reversal of memory loss and other cognitive functions.

   Research has not pinnned down the cause of AD as of this date, and that amyloid and tau depositions have proven to be the actual neurological effects of the disease or the cause. 

  Neurology, June 15, 2021; Aging Journal, June 14, 2022

3. Autoimmune disease Series-Part 6

Alopecia areata, Scleroderma, Guillain Barre’ Syndrome

A. Alopecia Areata

The most common form of baldness is hereditary in both women and men. I have previously discussed all forms of baldness in a previous report    www.themedicalnewsreport.com #94

  Alopecia areata became better known because of the fiasco at the Oscars, when Will Smith hit Chris Rock on stage, creating an incident over  an innocent joke about his actress wife, Jada Pinkett Smith. He was not aware that Jada was having an episode of alopecia and shaved her head, which most patients do when they experience round patches of hair falling out. Facial hair also may be lost, including eye lashes and brows. Rarely, body hair can be lost rarely.

Alopecia areata is autoimmune in cause, but as usual I these diseases, there is no known actual cause why the immune system suddenly sees hair follicles as foreign, and the body’s immune cells attack them. This statement holds, to date, for most autoimmune diseases. Viral etiologies have long been suspected as a cause, but not proven.

  There are genetic factors and a family history which  is not uncommon. Pitting or ridges of the nails is not uncommon.

Triggers include stress or an infection to bring on an episode.

  3 types of alopecia are seen: 1) Patchy alopecia  2) alopecia totalis-almost all the hair 3) and alopecia universalis-rarest-hair throughout the body is lost similar to chemotherapy loss of hair. The episodes can last months and rarely years.

  Pathology-- Lymphocytes* around the hair follicle are seen on microscopic examination in these patients.

*Lymphocytes are white blood cells and the T- and B- cells which produce antibodies that interfere with the growth of the hair follicle, thankfully do not create permanent hair loss. 

  Pigmented hair may be more vulnerable to loss than graying hair, and regrowing hair will usually return without color, gray or white, but color can return over time. There is no cure, but treatments can help return the hair back quicker.

  These patients may begin losing areas of hair in childhood, regrow the hair, only to lose it again. The most common age is 35-50. It can last for several years or a lifetime.

  Short broken hairs around the forehead may be the earliest sign. Small patches of hair loss are the most common.

  Patients are prone to other autoimmune diseases such as  hay fever, asthma, eczema, vitiligo, immune thyroiditis (Hashimoto’s disease), myasthenia gravis, and type 1 diabetes mellitus, just as I have reported on most diseases in this large category.

  A scalp skin biopsy confirms the diagnosis. Also the hair pull test is diagnostic for most of these types of hair loss. Looking at a hair shaft under a microscope will demonstrate various abnormalities.

Normal hair follicle

Alopecia affects over 2% of the population! 

Treatment may include injectable corticosteroids into the affected areas of the scalp to combat the immune reaction (every 3 weeks). Topical steroids are much less effective but preferred in children to prevent growth issues. Anthralin cream can also be used.

  Rogaine 5% topical can be used by both children and adults. Some sources suggest 2% concentration for women but 5% is available too.

  Anthralin (a tar-like treatment) is applied to the scalp 30-60 minutes and then rinsed off.

  Diphencyprone is a preparation that causes an allergic reaction on the scalp site, which tricks the immune system, and after about 3 months, hair will regrow. It may require 2 treatments.

Immunosupressant drugs are the most affective treatment; topicals, pills, or injectables are available. The topical can return the hair in about 6 months in 40%, according to the National Association of Alopecia areata.

  There is good information about a specific type of immunosuppressant, baricitinib (Olumiant), which can prevent hair loss as well reversing the loss of hair once it begins. Ruxolitinib (Opzelura) and tofacitinib (RinVoQ) are also used. These immunosuppressants must be continued indefinitely and side effects can occur, plus putting them in a category of high risk for COVID-19.

  The psychological trauma for these patients must not be underestimated, and depression is common. Seek help for this.

NIH, NEJM, May 5, 2022, Healthline

B. Scleroderma

  Another serious autoimmune disease that affects the skin primarily is scleroderma.

The collagen in skin degenerates as this is a classic connective tissue autoimmune disease and tightens the entire hand, allowing calcium to deposit after the injury to the tissues of the hand or any extremity, often causing ulcers  because of loss of blood supply from the disease or chronic Raynaud’s phenomenon with painful blanching of the fingers (lower right photo), a vasoconstrictive event.

  About 200,000 Americans are diagnosed annually, and the symptoms usually appear 30-50 yrs. of age. Women are more common to develop scleroderma and more often occur in Blacks.

  Not only is the skin involved, blood vessels, and the gastrointestinal tract and cardiopulmonary system can be affected as well.

  Swelling of the hands with tightening of the skin is the most common symptom, including Raynaud’s phenomenon, with any part of the gut involved. The esophagus when involved may cause reflux and difficulty swallowing from thickening of the lining causing loss of motility, while the intestines can cause bloating, diarrhea, or constipation.

  With cardiopulmonary disease, scarring can occur in the lungs and heart, causing shortness of breath, pulmonary hypertension, and arrhythmias.

  There are two types of scleroderma:

1) Localized to the skin—in patches or linear streaks

2) Systemic sclerosis affecting most organs of the body especially blood vessels, heart, lungs, and kidneys.

Treatment targets vascular damage, fibrosis, and regulation of the inflammatory process

  NSAIDS (ie. Ibuprofen, Aleve, etc.)

  Skin lotions and moisturizers

  Physical therapy of the hands

  Treatment based on organ involved and symptoms

  Target immunosuppressives, chemotherapy, and corticosteroids (colchicines, pencillamine, corticosteroids, the immunosuppressant agents mentioned in alopecia, and other autoimmune drugs are successful.

  This disease can be progressive and requires continuous monitoring and treatment. 10 year survival rates can occur for 90%, but if systemic sclerosis is present, there will be earlier deaths.

NIH, Mayo Clinic, Johns Hopkins Medical Center

C.  Guillian Barre’ Syndrome (GBS)

  When one reads about this syndrome that can occur as a side effect of many vaccines (J&J COVID vaccine), some respiratory and gastrointestinal viruses, and often is unknown, but it can be severe and very scary when a child or adult develops paralysis.

  This is not classified as an autoimmune disease, but the same pathology causes it.

  When polio was a serious infection in the 40s and 50s, this disease was confused with it. However, most of the people with this syndrome did not require ventilator (iron lung in those days) assistance as polio almost always did.

  This may not be a classic autoimmune disease, but I have included it because the pathology occurs just as it does in these diseases. However, the autoimmune diseases are chronic and can’t be cured but may have remissions and exacerbations, whereas, thankfully GBS does usually recover from paralysis.

  It is often described as an inflammatory immune disease, but stimulates the same T and B cell lymphocytes pouring out inflammatory markers (cytokines, etc) that seek out the peripheral nerve myelin sheaths that nourish the nerves, and cause temporary damage to their functions, usually the motor neurons.

  The drawing below shows a normal nerve and a nerve covering damaged by the immune response of this disease, and is very similar to what occurs in multiple sclerosis, although they have very different clinical courses.

The syndrome can progress rapidly and can cause complete paralysis of the arms and legs often beginning with tingling and weakness in the lower extremities.

  It can also paralyze the face, even cause double vision from weakness of the extra ocular muscles, some have severe pain and cramps in the legs, loss of bladder and or bowel control, tachycardia, low blood pressure, and difficulty breathing.

  Although once thought to be a singular disease, there are now 3 types of GBS:

1) Acute inflammatory polyradiculopathy—this is the most common type with weakness beginning in the lower extremities and progressing upward.

2) Miller Fisher Syndrome—starts with double vision associated with dizziness. It is more common in Asia.

3) Acute motor or sensor axonal neuropathy—this could present with weakness of the extremities or numbess and tingling, again more common in Asia and Mexico.

  This condition requires immediate hospitalization, and a workup for any neurological disease causing these type of symptoms including meningitis, encephalitis, brain tumor, etc.

  The most common bacteria that can cause GBS is camphylobacter, found in undercooked poultry, influenza, mycoplasma pneumonitis, Hepatitis, Hodgkins Lymphoma, HIV, Ebstein Barr virus occurring in infectious mononucleosis, COVID-19, and a history of J&J COVID vaccine.

  Protocol for paralyzed patients is the same regardless of the cause, and there are no drugs to treat the nerve weakness, or numbness.

   Supportive therapy is required depending on the system(s) involved. Although very rare, 2-5% of patients can have a relapse according to the Mayo Clinic Proceedings. Blood clots may occur and anticoagulants may be given.

Diagnosis

   Tests include a spinal tap for cerebrospinal fluid, electromyography to test the amount of weakness present, and nerve conduction studies to determine the extent of nerve damage.

Treatment

  Plasma exchange (plasmaphoresis) to hopefully rid the antibodies in the blood created by the disease. The blood cells are returned to the patient. Special fluids can replace the plasma and the red blood cells can also produce plasma.

  Immunoglobulin therapy is also given, usually gamma globulin, to block the antibodies in the blood. Other monoclonal antibodies may be tried if other treatments are unsuccessful.

Recovery

  Usually symptoms worsen for 2-3 weeks, and after 4 weeks, symptoms plateau. Recovery usually begins after 6-12 months, but could persist for years.

  For adults, according to the Mayo Clinic, 80% can walk independently within 6 months, 60% will fully recover motor strength within 1 year, and 5-10 have either delayed or incomplete recovery. Support groups for patients and family are very helpful.

  Children almost always fully recover, thankfully rare in kids. When I was in my pediatric rotation in training, my primary patient to care for was a child with GBS. It was devastating to the parents as one would expect. He recovered.

Mayo clinic; NIH, Medpage

4. Roe vs Wade

  The U.S. Supreme Court offices have been stained by a leak from someone in one of the justices’ office, the first time this has occurred. There is nothing sacred anymore.

  The respect of our Supreme Court has been maligned by a bunch of political hacks who can’t respect the highest court’s decisions and want to replace them or stack the court. The administration and the Department of Justice is not even respecting the law breakers protesting at the justices’ private residence. Breaking federal law has become a common occurrence the last 2 years.

  The protests will only increase the justices’ resolve to make their decisions regardless of the illegal attempts to sway their votes, even with death threats, and demonstrations.

  The protestors are using the abortion rights constitutional decision to rally their forces against a weak chance of holding the House and Senate, when the country’s current multiple disasters are stacking up against the White House and are just as important as a women’s rights.

  Like Rahm Emanuel, former advisor to President Obama, classically said, “Never let a crisis go to waste…..”.

  How women and men feel about abortion should not be a political decision. It has been one of the most deep seated and inflammatory issues in our country for decades. It is bout a woman’s decision about her own body, but in the face of potentially taking a life. 

   Roe Vs Wade made abortion a national constitutional right in 1973, not a law, as only the Congress can make it such.

  1 out of 4 women in America under 40 have had an abortion. Over 60 million abortions have been performed since the landmark decision.

  In a majority opinion delivered by Justice Blackman in 1973, the court argued that making abortions broadly illegal was unconstitutional, violating the 14th Amendment, ensuring the right to privacy.

  It states that “no state has the right to allow any person of life, liberty, or property, without due process of law” ensuring that states must respect the rights due to every American (women in this case). In the document regarding Roe vs Wade, a person’s bodily autonomy is part of the right of privacy.

  It is not a federal law, only a constitutional precedent, as previously stated. It is the responsibility of the legislative branch of the government to enact it as a law, and it has never done has done that.

  With a split in the House and Senator Manchin (D-West Virginia) not willing to codify it as a law, it is unlikely that it would become law. Why wasn’t it put into law when Obama was president?

  The court held that in the 1st trimester (1 to the end of the 12^th week), abortion may not be regulated by anyone except the woman and their doctor.

  In the 2nd trimester (from the 13th week to 26 weeks) , the state may regulate abortion if the the health of the mother is in question.

  In the 3^rd trimester (from 27 weeks to the end of pregnancy), once a fetus is “viable” (can survive outside the womb), states may regulate or prohibit abortion, except in cases where the act is medically necessary to save a life.

  If Roe vs Wade is overturned by the Supreme Court, the question of legality would be left up entirely up to the states, and it is pretty clear how the states will deal with it.

  Currently, abortion is legal in every state, however, certain states have created restrictions. If the case is overturned, abortion could become entirely illegal in many states, mostly conservative.

  Even though preventing abortion in the first trimester is unconstitutional, certain states have enacted bans anyway. Others have allowed abortion right up to the time of delivery.

  A fetal heartbeat can be heard by a standard ultrasound (without a vaginal probe) by 12-14 weeks of gestation, although the heartbeat becomes audible with special equipment by the 5^th week. This is commonly an epical moment in many minds when there is a human being present, although for some religious groups, it begins at conception.

  There are many factors to decide on viability that is non-religious.

  In Arkansas and Georgia, doctors are required to tell expectant mothers that the fetus could feel pain when an abortion is performed, and are required to offer anesthesia during the procedure.

  Congress may soon vote on The Unborn Child and Awareness Act, tht requires doctors to state that by 20 weeks has the physical structure necessary to experience pain.

  In JAMA (summer of 2021), reported that fetuses are not capable of feeling pain until the 28^th week, when the nerves that carry pain to the brain have developed, and stated routine abortions should not require anesthesia. There is, however, lack of consensus on this topic, and there are many experts that disagree with the article.

  Most people feel strongly regardless of where they stand, but there are 3 groups of thinking generally—1-no abortions, 2- limitations in certain situations, and 3- abortions are the decision of the mother regardless of timing, with no rights given to the child.

  Many people are stuck between the religious rights of the child and the concept of “my body, my decision”. Doctors are caught in between if they are professionally taking care of the mother.

  The Bible does not specifically talk about abortion, but in Genesis 9:6 and Psalm 36:9 provide God’s view of the unborn, in that life is a gift from God including the life of a fetus in the womb. Jeremiah 1:5 states, “ Before I formed you in the womb, I knew you. I have appointed you a prophet of the nations”, God talking about Jesus. There are many indirect references to abortion in the Bible and the internet can guide the reader to them.

  Unfortunately, there will be typical misinformation on the internet, providing fake news for those who want to protest.

  The White House appointed a “disinformation czar”. Sounds like Twitter’s new owner has stirred up the liberals pretty well. For now, the idiot appointed has resigned, and the Dysinformation Governance board has been put on hold. What a disservice to all Americans to have a small number of biased people deciding what it actually factual.

  When a woman’s life is at stake, this becomes a medical issue, but the parents still have a say, so there are many isses that make the subject of abortion extremely complex.

  It is not my place to pontificate about this issue or express my opinion. What is important is that we quit acting like a “third world country” when people don’t like a decision from the highest court in the land, especially when the justices have just begun discussing this issue. What happended to respect for our laws??

  Between now and November, I am very concerned that our country’s activists and some well known communistic groups will take advantage of our cities, and create even more destruction of property, bodily injury, and mayhem in the name of a cause, a federal crime. We should be better than this………..but some of us are not.

5. New Drug for Insomnia (Viviviq); other wannabees-Relaxium

Viviviq

  The FDA has approved a new insomnia drug, Viviviq. It was found to improve wake quality after sleeping, total sleep time, and improving persistent sleep. Most exciting was the improvement of day functioning, according to the Research Department at Henry Ford Hospital in Detroit.

  25 and 50mg tablets will soon be available.

  Chronic sleep deprivation is a serious medical issue including poor functioning in the daytime at work and social activities, difficulty with concentration, fatigue, irritability, anxiety, and depression, and family discourse.

  Daridorexant (Viviviq) is an dual orexin receptor antagonist, as are other sleep drugs, which binds the receptors of orexin found in the hypothalamus of the brain to block the activity, but only temporarily. This inhibition of these receptors, decreases the downstream action of the neurotransmitters that are overactive in insomnia patients.

  Similar drugs already on the market is Suvorexant and Dayvigo. Restoril, Halcion, Sonata, and Ambien products are also by prescription, but are only recommended for short periods of time. Of course, there is considerable abuse.

Relaxium

  The TV is flooded with non-FDA approved supplements and chemicals that are touted by celebrities that they can give anyone a great sleep every night.

  The contents of Relaxium, often marketed on cable news channels, contains melatonin, tryptophan, an amino acid, GABA-gamma amino butyric acid, an inhibitory neurotransmitter in the central nervous system to reduce neuronal excitability in the brain, magnesium, and various herbal extracts that include  ashwagandha—which contains chamomile and valerium root.

  These are all touted to relax people, and adding so many products together gives any scientist concern for cross reactivity and question whether the combo is worth the cost.

  Ashwagandha is an herb often used in Ayurvedic (Indian) medicine to relieve anxiety.

  There are many products with this herb on the market.

  Relaxium is a garbage can full of different ingredients that have been touted to help people to sleep. Most are more effective in getting to sleep rather than keeping people asleep.

  Melatonin is produced by the pineal gland in the brain stimulated by dark hours after light hours. 5mg is the safest amount to take, but the FDA is not happy seeing millions of people overusing the chemical, and the purity is questioned with many potentially harmful ingredients in some of the products. Gummy products have become extremely dangerous for children, thinking they are candy.

  Melatonin and some of the other ingredients may allow an individual to get to sleep better, but none are touted to keep people asleep, or if a person wakes up during the night, there is less likelihood that it will help a person  getting back to sleep.

Buyer Beware

  Relaxium offers a 30 day supply online, but if you agree to an auto-ship subscription, you will have a very difficult time cancelling it, like most of the over the counter offers do.

Research by the Company?

  Reviewing the tiny clinical trial by the company that is the basis for its value, I found there were only 33 participants that completed the questionnaire with a diary for 2 weeks taking the drug each night.

  This is an inadequate number to draw any conclusions, although this was a double blind study with half of these people taking placebo capsules and half Relaxium. That means only half of the 33 actually took the real Relaxium. Totally unacceptable numbers.

  The only information that I found that has some basis for use concerned the degree of daytime concentration and it was better in the Relaxium group (38% compared to 21% for placebo). The fact that the Relaxium group had better sleep was clear.

  $59.95 is the cost for 60 pills, often marketed (sadly) by former Arkansas Governor Mike Huckabee.

  If you agree to the two week  free offer, it will cost $7.95, and if you decide to accept this free offer, you will be agreeing to a 2 month supply, and if you do not call them within 17 days of ordering your free bottle, the Relaxium company will charge your credit card $119.90. This charge will continue automatically every 55 days until you try to cancel.

  I have 2 friends that spent weeks of work trying to cancel the order. You will be required to enter your credit card, phone number, and email address before you can even find out the cost. Your phone number and email address will be sold to companies(Spam) to infiltrate your texts and email (read the fine print).

  If you want to try this sleep aid, do not deal with the company or buy it online or by phone, rather go to WalMart, Walgreens, or CVS and buy a bottle with no strings attached.  www.relaxium.com

This completes the June, 2022 report.

The July report will include:

1. COVID-19 updates

2. Ob/Gyn Series—Part 4-Endometriosis updates

3. Autoimmune diseases—Part 6—glaucoma, ankylosing spondylitis, psoriasis/psoriatic arthritis

4. Social Security is not so secure!; Medical insurance denials rise!

5. Breast feeding needs to be more utilized

Thank you for reading my reports, and pray this country, Ukraine, and others can recover.

Prayers and understanding of the massacre of 19 school children and 2 teachers in Uvalde, Texas.

 Stay healthy and well, my friends, Dr. Sam