The Medical News Report 

  March, 2023 

#134

  Dr. Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

Subjects for March, 2023:

1. COVID and the 2023 annual vaccine recommendations; treatments failing! Continued analysis of the pandemic management and what to do next time!

2. Myocarditis and other inflammations of the heart; cardiovascular effects from COVID and the vaccines

3. Management of Diabetics and Obesity; weight loss meds, Vitamin D value —Part 2

4. Gender dysphoria and gender affirming therapy—Part A (part 3 of mental disorders of children)

5. Herpes Simplex-oral and genital

6. Socialized medicine in the UK; palliative care in Canadian socialized system substandard

 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. Dr. Sam

1. Updates on COVID; Annual Vaccine schedule, and more

  Before I get into the body of this report, one of the latest journal articles in JAMA has made it pretty clear that when testing for COVID-19, with a home test using the rapid antigen test, it will give better result if both nostrils and the throat are swabbed. I have suggested, more than once and now with this backup, I would suggest you do the same. You can still get free tests from the government by getting on their website until May 11, when the funding stops.  JAMA, Feb. 7, 2023

  FEMA will cease the disaster declaration for COVID on May 11, as the government also stops the emergency authorization act, which will stop payment for vaccines, tests, Paxlovid, and certain in hospital treatments.

  FEMA has provided over $104 billion in COVID funds to states, and all territorial governments, funerals, lost wages support, and crisis counseling. Families who have lost loved ones due to COVID have been eligible for $9,000 for funeral services.

Reuters, Feb.10, 2023

   A. Continued criticism regarding the management of the pandemic—now weak apologies in Newsweek

  Newsweek has written a semi-apology reporting on the management of the pandemic. With the mandates, lockdowns, and isolation requirements put out by this administration, the general public has lost much of their trust in the administration, and it was aided by Big Medicine, and Big Pharma.

  A variety of limited apologies are being made to regain the trust without fixing the underlying issues that led to the disastrous COVID-19 policies that have been forced on the public.

  The mandates created by this administration have backfired on the conventional vaccine industry, with a great deal of skepticism toward all vaccines more than ever, according to a Midwestern private practicing doctor published in Mercola, a health website, that can be far right at times, stated that he is very upset that these totalitarian maneuvers created such angst in the public, making it difficult to practice medicine with the medical academic institutions doing their best to try and tell doctors how to practice, and with their socialized medicine strategy, are supporting Big Government and their management strategies, which have not worked.

  The benefit of the vaccine was highly overstated, while totally ignoring the benefit of natural immunity. The Cleveland Clinic performed a study that found that over time, there was reduced immunity from the vaccines to COVID-19. It starts dropping after 6 months.

  The reporting of the vaccine’s side effects were not properly reported, and increased with each succeeding dose.

  For those who were getting so sick with the virus, it was quite clear that the vaccine was the only tool to fight the infection, even though, often the underlying medical conditions were worsened by the virus, which created the need for hospitalization, and those even more sick died, because there was no treatment known at the time.

  Natural infection was ignored, when all the latest data now has proven that the infection gives the person good immunity over a year as effective as the vaccine.

  There is some evidence that the omicron infections are not providing the same amount of immunity, which continues to provide information to the CDC to get fully vaccinated even if previously infected. There is no study that just one dose of vaccine was equal to a whole series, if previously infected, which has been suspected by many experts. Lancet, Feb. 16, 2023

  Doctors tried many different antiviral agents including HIV meds, early in the treatment of COVID, but most were ineffective.

  Ventilators were used in many cases at high settings, because some of the academic experts felt the only way to treat the infection was similar to a disorder called acute respiratory distress syndrome. Although, some survived, many died, because of the high volumes of oxygen and pressure in the lungs used to keep them alive. Thankfully many doctors found alternative methods that were superior— and changed patient bed position to face down, with high flow oxygen with a mask or CPAP machine, not a ventilator.

  The vaccines have been less effective with the Omicron variant infections. We were led to believe the new bivalent dose would address the issue much better than the previous standard booster, but they were wrong again, as it is now known that the bivalent booster is no better than the original booster. Without trust in the CDC, only 16% have had that bivalent booster.

  The vaccine and boosters all have been valuable in reducing the severity of the disease, but did not prevent the infection, only made it less severe.

  The data still supports those with underlying medical risk factors to have more severe infections, and they should get totally vaccinated, even though we all know just as many vaccinated people are getting infected as those who have not.

Long COVID syndrome

  Now we are dealing with a significant percent of those infected who have prolonged symptoms, usually for months, which is supposedly due to the infection, but some experts are questioning that the vaccine may be playing a role just as the infection raising the immune levels to the point that our own bodies turned against us just as it does in autoimmune disease. It creates months of headache, fatigue, cognitive fog, muscle ache, and are all similar to most autoimmune diseases.

  There is no therapy for these patients, which in most recent studies report 15% of previously infected (out of 15,000 questioned) patients are suffering from long term symptoms, with 46% of them experiencing brain fog or memory impairment, and these findings mirror the experience at the Penn Neuro COVID Clinic making up more than 1 million people who are not able to work, living off unemployment COVID funds. It is estimated that long COVID syndrome will cost the U.S. $170 billion in lost wages.

  Most of these patients are younger.  Previous reports state these symptoms abate in less than a year. I hope they will continue to provide us reports on these patients, as I am concerned about many using this diagnosis to rationalize not going to work. We still are in great need of blue collar workers, as is well known.

 JAMA, Feb. 15, 2023.

COVID case and death statistics

  The handling of the COVID statistics has also been severely criticized, as many other countries have analyzed their cases, and found that the main cause of admission to the hospital and or death was not COVID, only those that had positive COVID tests (since every ER or admission was tested). As many as 50% were mislabeled, because the case did not have to be the cause but merely a part of the diagnosis.  

  We discovered that Big Government was paying the U.S. hospitals 15% more for any case of COVID, whether a death or not.

  The CDC used those numbers to scare Americans to be vaccinated. Earlier this year, it was discovered that tracking the disease with numbers did not reflect the current conditions of the disease nationwide, and stopped reporting numbers (even Johns Hopkins has stopped).   

  Scare tactics were the mantra for 2 years by the government and media to get the vaccination numbers high, which didn’t work after the initial series of vaccines.

  Even though, instead of acknowledging that the government was working without tools, they gave us rule after rule (masks, airlflow, plastic shields in classrooms, offices, and restaurants, surface sterilization, etc.) without sound scientific data to support them, and then changed the rules and guidance time and time again. It was clear that states needed to be in charge of their residents rather than federal rules affecting every state the same.

  Distrust from what was being announced, the feds put a gag order on the CDC and FDA and they were not allowed to talk to the media, using only Dr. Fauci as the mouth piece changing his tune several times as well. Trust is hard to lose, but once it is lost, it will take a long time for it to return to our government, when they can’t even get their stories straight about shooting down balloons over our skies.

Mental Health Disorders Skyrocketing

  We saw the devastation to the mental health and education skills of our children due to the closing of schools as Big Government, Teachers Unions, and school boards made the rules without scientific proof they would work.

  Thousands of teachers refused to teach face to face for fear of infection or were encouraged not to teach. They have tried to leave the parents out of the equation, and it is backfiring now too.

  Bullying, violence against fellow students, and suicide ideation and attempts are escalating. These kids forgot how to treat each other after spending 2 years at home. Adults too!

  The mental health of our country is in crisis, with the mental health industry being overwhelmed, suicides rising, and with fentanyl (300 deaths per day) freely coming across an open border, 110,000 mostly young people have overdosed and died.

  We see that now Big Government is blaming Big Medicine for all the mistakes, and all the time Big Pharma is making $billions (can you imagine the lobbyist dollars going to our politicians).

  This collusion of radical liberal leaning groups are forging ahead in turning our country into a socialist/Marxist country, as I have stated many times, and we are facing deterioration of the quality of healthcare in this country, which will worsen with socialized medicine.

  We have seen $5 trillion dollars spent on the pandemic with a lot of money going to select states and select corporations not necessarily for COVID, with a significant amount not even spent yet, as it created the worst inflation ever, and at the same time, O’Biden stopped the fossil fuel energy in its tracts to further the green new deal, creating a perception of weakness aiding in a economic crisis here with other countries taking advantage of our perceived weakness.

Unintended consequences continue

  Because of the lockdowns, we have seen unintended consequences thanks to the mismanagement of the pandemic with more cancers, strokes, heart attacks, diabetes, etc. Now that doctor’s offices and testing facilities have reopened, patients are finding progression of their cancers, cardiovascular systems worsening, etc. and weight gain  and diabetes have escalated.

  The stoppage of surgeries, chemo and other treatments, and transplants have cost those patients dearly.

  Our healthcare providers are burning out, and many are leaving, retiring, early, and creating a shortage of healthcare. Without adequate manufacturing, lack of transportation, etc., there is now a drug shortage in our country, and the prices of food and goods is skyrocketing.

Who is responsible for the pandemic?

  We have significant evidence that the Wuhan, China lab was responsible for leaking the “gain of function” bat coronovirus (genetically engineered to be a killer of humans, now called COVID-19), and lied to the world about it for a month (including keeping the WHO from announcing we had a pandemic), and later refusing the U.S. from inspecting their labs and paper work.

  We faced sudden deaths in the State of Washington from Chinese citizens who traveled sick and positive with COVID during their major annual holidays.

  Until President Trump stopped air travel from China, the Chinese were traveling to the West Coast, but it was too late to prevent rapid spread.

  We had no preparation, no treatment, and were facing a massive pandemic. Thankfully the emergency authorized vaccine has been fairly successful, and is still a very important method of preventing more serious infections for those vulnerable, even it never prevented the disease.

U.S. involved in gain of function research

  We also have significant proof that the U.S. NIH (Department of Allergies and Infectious diseases, chief Dr. Anthony Fauci) had been providing grant money for the “gain of function” research to strengthen the deadliness of the coronovirus (presumably to develop a weapon against those who might attack us with bacterial warfare), as early as 2003 in the U.S. and collaborated with a non-profit organization (EcoHealth) perform the research, keeping the NIH’s name out of it.

  When the CEO of EcoHealth discovered the virus was so deadly and suggested the research be stopped, the research was stopped in the U.S. but continued in the Virology Wuhan Lab (with our support), and some say in the Ukraine. Wonder why the feds haven’t investigated China? Because we potentially had a hand in it, even though the leakage of the infection from the lab to an outside food market was probably accidental.

  We are still dealing with the virus and will continue to do so just as we will with flu. I consider us very fortunate even with inadequate protective gear, less than great vaccines, and lot of rules that were political instead of scientific-based. As the virus continues to mutate, thankfully, although more infectious, the infections are less severe, and the major immunity acquired in our country and the world are protecting millions with herd immunity. If infected with the Omicron variant, reinfection is very rare, because the immunity is much better.

Most COVID meds not effective

  We are finding most of the drugs used to treat hospitalized patients don’t work except for Remdesivir, an antiviral, and a select Interleukin-6 receptor antagonist (Actemra and Kevzara). The rest of the monoclonal antibodies have proven ineffective and the FDA has removed them from approval.

  The feds spent $5 billion with Pfizer to develop the new variant booster which was no better than the previous one. Spend, spend, spend!! $10 trillion on the pandemic.

Natural Immunity ignored for 2 years

  Fortunately, with natural immunity (which the CDC was told to ignore) from infection being so robust, the pandemic is essentially over, but will continue, and infect those who are vulnerable from underlying diseases. Have we attained herd immunity? Experts vary in their opinion. As the virus continues to mutate, more people will get reinfected, but fewer and fewer are getting sick.

Paxlovid works

  Paxlovid, an antiviral, still works quite well for outpatients but causes rebound in a significant % of patients, because patients probably need to take it for 10 days perhaps to prevent rebound, but can only get 5 days. The reason is shortage of the drug.

  The feds extended the emergency use authorization act to allow Paxlovid to be paid for by the feds, as it will cost over $500 per prescription once the emergency act stops, now planned for May. Just in the last week, Pfizer and Moderna have announced that they will not charge for the drug. We will see!

Possible new treatment for outpatient symptomatic COVID

  Although a drug that normally lowers immunologic response, interferons, a new study found that Interferon Lambda, with one shot has boosted immunity, and has shown significant (greater than 50%) lowering of hospitalization in symptomatic outpatients, if the shot was administered 7 days or earlier when symptoms began.

  This interferon has potent anti-viral activity in patients 18 and older. 75% had high risk issues in this study. Most of these participants were previously vaccinated. This is still experimental, but if commercially made available, I am sure the FDA will see a request for approval.

NEJM, Feb. 9,2023

Annual COVID Booster

  All people must discuss the annual vaccine with their doctors, but doctors are also biased, so each person needs to be an active part of the decision making. Immunity from previous vaccine doses will not be very high after a year, so if healthy and younger, the decision to get the annual dose may be different than for older or vulnerable people.

  The planned annual COVID vaccine will probably be no more successful in getting major numbers to receive it, thanks to all the missteps by Big Government, Big Medicine, and Big Pharma. Once those who get the annual booster are studied, will we know if it is successful.

  Regardless, of all the missteps, power and control measures of our administration, unproven, unscientific methods used to make decisions to curtail this virus, we will survive, and this won’t be the last pandemic we will face.

  Our government needs to address future pandemics  strongly while we are facing potential war and a number of disasters that far outweigh climate issues, which are important but further down the list.

   B. Vaccination annual schedule including COVID

  The American Academy of Pediatrics announced that COVID annual vaccines will be added to the list of recommended vaccines each year for children. These are not mandates, nd should never be. This includes from birth to age 18 with catch up recommendations as well. They include the Pfizer, Moderna, and Novavax vaccines.

  Polio vaccine is emphasized with only for those never vaccinated with a one lifetime dose; For those who didn’t complete the series, it should be; MMR—mumps, measles, and rubella; pneumococcal vaccine for those 65 and older. Polio is included after an outbreak in New York. Hepatitis B vaccine is recommended for all under 60.

  There is a section on recommendations for special vulnerable groups.

  Flu vaccine annually is still recommended annually for everyone 6 months and older, and has been fairly successful this year. They are now recommending a 3 vaccine version for those 65.

  Meningococcal vaccines are included as well, with different schedules depending on the type of vaccine received.

  The CDC website will provide a complete list with special issues, therefore click on www.cdc.gov

  With the loss of trust with the CDC, I am quite concerned that many vaccines may be in jeopardy when it is time for them, and that will create new communicable diseases. We are already experiencing polio cases for the first time since the vaccine was stopped.

JAMA Network News, Feb. 8, 2023

  Vaccine side effects

  More information continues to mount about the side effects of the COVID vaccine, and if you read the medical journals, one would assume little trouble with the vaccine when discussing individual effects. However, journals outside the U.S. have reported more issues, although they continue to be in small numbers. Add them all up and there is still concern.

  Myocarditis is the most talked about, but when all of the neurological, cardiac, pulmonary, and other organ problems that have occurred combined, that is a significant number. Total numbers are not discussed.

  The latest report on a problem with ringing in the ears after the COVID vaccine—according to the National Geographics, 16,000 people developed tinnitus in their ears within hours of receiving the vaccine, while others noticed it weeks after the shot.

  There has been a significant number of people who developed hearing loss with the vaccine, and one of the most common symptoms of hearing loss besides not hearing, is ringing in the ears. These people need to be followed, because tinnitus is very annoying, and needs an audiological evaluation. Medpage Today, Feb.14, 2023

  Representative Nancy Mace, South Carolina House of Representatives, had COVID twice, and being a good steward for her state, she took the vaccine after 2 infections. She developed tremors, fatigue, weakness, and asthma, for the first time in her life. It has been one and half years and she still takes medication (steroid inhalers). Understanding how aggressively vaccines can stimulate the body’s immune system needs some newer understanding with the current vaccines.

  When the body gets stimulated immunologically, no matter whether from a vaccine or infection, it is basically the same. Trying to raise the immune response higher might be harmful in some, and anyone who has had an infection, should discuss the issue of getting a vaccine as well. It is recommended to wait at least 3 months from an infection to receive a vaccine…I would wait 6! We need more data!!!

2. Myocarditis and other inflammations of the heart; COVID and vaccination side effects on the cardiovascular system

   A. COVID infection and vaccine induced side effects of the heart

  It is well known that side effects from COVID and the vaccine both can cause heart inflammation with the autoimmune response not only from the infection, but the immune response of the vaccine. The concern is how many? They say rare!!??

  But people get myocarditis from many causes.

  Early on the COVID infection found its way into the body through the respiratory tract and caused pneumonia in the most severe.

  Cardiac disease can occur from the stress put on the lungs from congestion and infectious pneumonia, inflamming the heart muscle (myocarditis), the covering of the heart (pericarditis) and valves (endocarditis). Those with predisposing heart disease are always hit much worse.

   Perhaps those with pre-existing heart muscle disease are more prone to more inflammation in their hearts from the vaccine, which is well known to occur! Observe the drawings of the inflamed myocardium and pericardium.

The vaccine can inflame the heart muscle, amazingly in younger people (12-24), and highest after the second vaccine dose, however, there were cases in all age groups, and many were not severe enough to be diagnosed or reported. These myocarditis cases also included cases with pericarditis as well, which is inflammation of the lining of the heart cavity (drawing above on right).

  The antigens, a spike protein product of vaccination, could be causing the inflammation. It is the spike protein that stimulates antibody and T-cell responses. It is thought that the spike protein does not clear the body quickly, having enough time to damage the heart. The author of this commentary favors the spike proteins.   

  The cases occurred within 7 days of the vaccine, which is faster than other types of viral infective myocarditis. Most are milder than other causes.

  The number of vaccine induced cases exceeded the expected number calculated by the vaccine company up to the age of 49 and more common in males. The COVID vaccine cases resolved faster than other causes of myocarditis.

  Other types of myocarditis are usually more severe and 6% require a heart transplant.

  In this study of vaccine induced cases, 854 patients from age 12-20 were reviewed from 23 studies. 24% required admission to the ICU for treatment. No mortality was reported, but many took weeks to recover. 90% were male. Women’s estrogen is thought to be protective.

  Long term outcomes are still not known, but those with  infectious myocarditis have an average recovery time of 6 weeks. Some take months.

  MRIs are not only used for diagnosis but also to monitor the progress during the case. There is no data on boosters and the new bivalent booster regarding their effect on the heart muscle.

B. Myocarditis—all types

  Symptoms of myocarditis, regardless of cause, create chest pain, shortness of breath, pressure and discomfort in the chest, with elevated troponin levels in the blood tests.

  Treatment includes non-steroidal medications, IV immunoglobulins, corticosteroids, vasoactive drugs, and are hospitalized with very few needing intensive care.

JAMA Network, January 25, 2022 

  The theory that younger people are more likely to develop myocarditis is that their immune response to the vaccine was more vigorous.

  Some still feel myocarditis occurs from the release of cytokines (interleukin 6 and 8, tumor necrosis factor (TNF) tha damage the heart muscle.

  The chemokines are released as a result of any inflammatory action in the body.

Medscape, January 10, 2023

  Our bodies respond to any assault normally with the lymphatic cell (T and B cells) that provide immunoglobulins, neutralizing antibodies, and cytokines to kill the offending agent, but that response can get out of control, causing damage to normal tissue, as in myocarditis.

  Imaging and other tests

  EKG, ultrasounds, echocardiogram, X-Rays, and scans can help differentiate these cases based on the findings.

  Treatment may differ depending on the extent of the disease, but any infection that puts stress on the heart, lining, or valves can all cause heart failure*, strokes from emboli, and fluid buildup in the lungs, so the treatment will certainly overlap.

*I just reported on heart failure in the January 2023 report.

  Anyone who develops symptoms mentioned above deserves emergency evaluation and immediate treatment if necessary.  

  Myocarditis(L) may appear similar to pericarditis(R) in symptomatology and presentation. An enlarged heart plus dilation of the lung vessel are present in both X-rays.

  Therefore, the cause of myocarditis must be differentiated with other studies, such as an echocardiogram and ultrasound. Both can cause cardiac arrhythmias.

Common causes of myocarditis

  Viruses (more than bacteria) most commonly can cause this inflammation of the heart muscle including COVID, but medications and vaccines can cause the problem too, as discussed above.   

  Viruses include Herpes simplex, Ebstein Barr virus (mononucleosis), Hepatitis B and C, simple cold viruses (adenovirus, rhinovirus, etc.), and 5^th disease in children.

  Malaria, Chagas disease (parasites), and rarely fungal infections can cause the inflammation.

  Cancer drugs, antibiotics, and seizure medication may be the cause. Autoimmune diseases can cause this disease as well (lupus, Wegener’s, giant cell arteritis, etc.).

  Heart failure, heart attack, stroke, arrhythmias with clots, and sudden death can occur as a result of myocarditis.

Severe cases require devices, transplant

  In severe cases, a ventricular-assist device may be placed to pump the heart.

  An intra-aortic balloon pump may be necessary.

  A device like a dialysis machine may be required to oxygenate the blood.

  Heart transplant is the necessary when the above treatments are failing usally in about 6%.

  Hospitalization for testing is usual, with salt restriction, bed rest, chest pain meds, etc. Those who developed it from the COVID vaccine were usually very healthy young people, and their disease almost always resolves, and quicker than those who develop it from other causes.

Mayo Clinic

C. Endocarditis

  This is an inflammation or infection in one or more of the heart valves and possibly the interior lining of heart muscle.

  Bacteria (strep, staph, enterococci) and fungi (Candida)  can get into the blood stream from an infected area of the body and attach to areas of the heart that have damage (usually not known) in a heart valve, an artificial heart valve, and other congenital heart defects.

  Drug abusers are prone to this (and is increasing greatly), people with bad gum disease (serious source of bacteria), and underlying diseases.

  Symptoms

   Chest pain, shortness of breath, night sweats, flu-like symptoms (body ache, fever, chills, etc.), fatigue, and possibly swelling of the lower legs can all occur. A stethoscope can detect a whoosing sound of the heart (heart murmur), splinter hemorrhages in the nail beds, emboli, etc. Congestive heart failure is the most common complication.

Endocarditis can be acute (sudden) and is an emergency that can cause death in a few days. Subacute or chronic forms are more common developing over weeks or months.

Diagnosis

  Dental exams are critical, evaluation of any yeast infections, the presence of heart murmurs, long term catheter use (vascular or urinary--dialysis, pain pumps, etc.), skin infections, stroke, diabetes, a history of drug abuse, heart failure seen in echocardiogram, blood tests such as ESR (erythrocyte sedimentation rate) and CRP (c-reactive protein). A chest X-ray, CT scan, and EKG are usually performed.

  A high fever in the face of antibiotics is suspicious. Infected clots can embolize either the lungs (right sided heart valve) or the brain (left sided).

  Subacute endocarditis can be autoimmune which can occur from lupus and other diseases that drop the immunocompetence of the body from the disease or treatment of the disease.

Treatment

  For bacterial endocarditis, IV antibiotics (amoxicillin or ceftriaxone- a cephalosporin) are the treatment of choice. If bacteria can be grown out of the blood (blood cultures), amoxicillin plus gentamycin for enterococcus infections are recommended based on sensitivity tests (they use different antibiotics in the lab to see which are best).  

  For fungal endocarditis, IV amphotericin B is the treatment of choice.

Surgical care

  Surgical removal of the infected heart valve (and replacement) may be necessary if the heart valve is damaged sufficiently to cause heart failure, the infected valve does not respond to medical treatment with continued elevation of temperature, blood clots which are occurring, or the bacteria is resistant to antibiotics, have an artificial heart valve, or pus pockets in the heart. Drainage of an abscess anywhere in the body would required removal.

Prevention

  Stopping drug use, treatment of gum disease and other dental issues, treatment of any areas that might get infected, taking antibiotics before dental procedures (especially if a recent joint replacement, or vascular stent, etc.). Corrective heart surgery may be necessary in congenital heart defects to prevent endocarditis. Treating aggressive vascular disease, diabetes, kidney disease, autoimmune disease, yeast infections, aggressive care of indwelling catheters, etc. will reduce the risk of endocarditis.

Mayo Clinic

D. Pericarditis

  This is inflammation of the lining of the heart cavity, the pericardium, which encases the heart muscle. The thin layer is easily inflamed but responds well to therapy.

  When the heart muscle rubs against the pericardium, it cause sharp chest pain, and may be associated with myocarditis. The pain may radiate to left shoulder and neck as in angina, but usually gets better when sitting up or leaning forward (the heart muscle is away from the pericardium with these positions). Other symptoms may be cough, shortness of breath, and tachycardia.

Classes of pericarditis

  1-Acute—3 weeks or less and can be similar to feeling like a heart attack.

  2-Recurrent—occurs after an acute episode usually occurring 4-6 weeks after the first episode.

  3-Incessant pericarditis—lasts 4-6 weeks but less than 3 months.

  4-Chronic constrictive pericarditis—slowly develops and lasts longer than 3 months.

Causes

  Pericarditis may follow a heart attack (Dressler syndrome), myocarditis, or heart surgery. COVID and other viruses can inflame the pericardium. Autoimmune diseases,(i.e. lupus, rheumatoid arthritis, chest injury, or other chronic health conditions including kidney disease and cancers).

Complications

  Fluid buildup or thickening of the heart muscle between the pericardium and myocardium could constrict the pumping of the heart muscle and cause cardiac tamponade, which will drop the blood pressure requiring the insertion of a large needle into the space to drain the fluid.

Prevention

  Vaccination is key in trying to prevent viral disease from inflaming the pericardium. Good dental hygiene, avoiding large crowds where exposure to viruses more likely to contract.

Diagnosis

  The same cardiovascular workup is required in diagnosing pericarditis as myocarditis or endocarditis.

  Chest X-ray, EKG, cardiac scan, echocardiogram, MRI and the same blood tests (CRP, ESR, blood count).

Treatment

  NSAIDs including Aleve, Colchicine, and corticosteroids are the main stay to treat pain and the inflammatory process. Other associated infections and diseases need to be looked for, including recurrence of pericarditis.

Mayo Clinic

3. Management of Diabetes and Obesity—Weight loss treatments, BMI—Part 2

I reported on the anti-diabetic meds last month, that have been prescribed for diabetics, and because the success of some of these medications, physicians are being pressured to prescribe them off-label for non-diabetics with obesity. This is causing some shortages of these medications, while the drug companies see the revenue flowing in, and are in the process of building new facilities to manufacture them.

  I also want to report on the best way to manage diabetes, and that is insulin. However, with weight loss, it will be hoped that many of the insulin dependent diabetics will be able to switch to oral or injectible medications. Weight greatly correlates with diabetes, and here are the stats.

A- Statistics regarding weight and diabetes 

36% of adults (18 and older) in the U.S. are obese,

69% are overweight or obese,

13% of the world’s population is obese,

10.5% of adults (34 million) in the U.S. are diabetic,

96 million U.S. adults are prediabetic,

70% of prediabetics will become diabetic,

80% of diabetics are overweight or obese,

283,000 diabetics are under age 20,

American Indians/Alaskans--14.5% diabetic,

Blacks--12.1% diabetic,

Hispanics--11.8% diabetic

Whites 7.4% diabetic.

  Blood sugar determines whether a person is prediabetic or diabetic. Look at the chart below.

Normal—99mg/dl or less;

Prediabetic—100-125mg/dl;

Diabetic—126md/dl or greater.

Note the A1-C test is determine how the blood sugar has been managed over a period of time, usually 3 months.  The target for most diabetics is less than 7%.

B. Continuous Glucose Monitoring (CGM)

  Patients get tired of sticking their finger every day, and with some of the new devices to prevent that, continous monitoring has become more popular.

  Hopefully, now that the cost of insulin has been curtailed by the government, it is hoped that affordability will not be as big a problem. Medicare is expanding their eligibility for this device, because, long term, it is thought that costs for the disease will be reduced.

  Doctors need to get up to speed on this CGM device, and with a 2 hour online educational hub, from the American Academy of Family Physicians, which teaches the doctors on educating the patients on the use of this device.

  Eligibility for Medicare coverage includes a diagnosis of diabetes, 3 or more daily administrations of insulin, or continuous infusion vi a pump, frequent adjustment to insulin treatment based on glucose readings, and presentation for diabetes in the last 6 months. A prescription must written, with certificate of medical necessity, and a supplier must be named.

  The American Diabetic Association has webinars, articles, and webinars.

Medscape, Feb. 22, 2023

C. Diet, Life Style, Vitamin D and prediabetes; obesity and Vitamin D levels

  It is not the goal of this report to rediscuss diets, exercise programs, behavior modification regarding attitude toward eating, when, where, and how much, but these are crucial parts of managing diabetes. Without these important factors being embraced, success will be minimized. Even dietary supplements seem to be an issue.

  There are several reports that Vitamin D supplements have been found to reduce the risk of prediabetes by 15%.

  It has been discovered that Vitamin D can reduce blood sugar levels, according to the Annals of Internal Medicine, Feb.7, 2023, they found that there was a reduction of the glucose levels with 20,000 units of cholecalceferol compared to those who took placebo, giving the study a 30% chance of returning the blood sugar to normal levels.

  These were subjects with prediabetic levels, not diabetic blood levels, and did not reduce blood sugar levels in diabetics, according to this study.

  Although, this benefit is small, even a 15% drop in blood glucose is helping to reverse prediabetes considering there are 374 million adult prediabetics, which it could mean that 10 million may delay or help prevent the development of diabetes taking supplements of Vitamin D3.

  The recommended dose was 20,000 units weekly in this study, and normal patients should not take more than 4,000 units (100 mcg) daily to prevent side effects, as recommended by the NIH and FDA.

RDA recommended doses of Vitamin D for healthy people

  The recommended dose for adults is 600 units (15mcg) for people ages 1-70, and 800 (20mcg) units for those over 70. The best form of Vitamin is D3. These doses described above far exceed the RDA recommendations for normal healthy people.

  The primary action for Vitamin D3 is for the gut to absorb magnesium, calcium, and phosphate, and provide healthy bone growth. In certain patients, they do not absorb normal amounts of Vitamin D. One group includes some with autoimmune diseases, specifically multiple sclerosis.

Obesity and Vitamin D

  There are studies also that those considerably overweight with significant amount of body fat in their tissues will sequester Vitamin D in it, creating low circulating levels of blood Vitamin D. Those who are obese might want to discuss with their doctors regarding taking higher than normal amounts of Vitamin D3 (cholecalciferol), a fat soluble vitamin.  

  Sun increases the synthesis of Vitamin D in the skin. Only a few dairy products and cereals that have Vitamin D added provide some supplementation. Those who live in the north usually have lower blood levels than those in the sunbelt.

D.  Metformin

  The most common oral medication is Metformin, and it can lower the A1-C% by 1%, by itself, but exercise and diabetic diets are a must. The blood sugar should be 140mg/dl or less for most diabetics.

  Metformin reduces the liver glucose levels and has an difficult to explain effect on the gut, perhaps changing the normal bacterial flora in the intestine. It can cause gastrointestinal issues, and there are some medications that may interact with Metformin.

E. SGLT-2 inhibitors (Sodium GLucose co-Transporter)

  There is a significant list of oral medications if Metformin does not achieve target levels of fasting blood glucose and A1-C.

Avandia, Nesina, Tanzeum, Jardiance, Invokana, Steglatro, Farxiga. Some of these medications can be added to Metformin (Janumet=Januvia+Metformin), and even insulin. But, they are expensive.

  The newer diabetic drugs (approved in 2014) are SGLT-2 inhibitors (Invokana, Farxiga, Jardiance, and Steglatro).

  SGLT-2 inhibitors are proteins that affect the kidney, and when an inhibitor is used, the kidney releases more glucose concentrating in the urine, and prevents it from being reabsorbed into the blood stream. These inhibitor drugs also decrease the risk of cardiovascular disease in diabetics, a great concern. Kidney function studies should be monitored, as any diabetic would have performed.

  If these medications are used in addition to insulin, hypoglycemia can occur more easily.

  An alternative therapy for pregnant women should be entertained because of the potential for fetal risks.

F. GLP-1 Agonists* (Glucagon-Like Peptide)

*agonist=acts like

The newest diabetic drugs approved were in 2020. These medications have been successful in maintaining blood sugars and A1-C levels, but are injectibles and are very expensive. They are also the group creating the greatest weight loss.

  GLP-l agonists mimic the function of glucagon, a hormone which is secreted by the pancreas, and stimulates insulin by the pancreas, but also activates stomach peptides.

  They include Trulicity (weekly), Exenatide extended release (Bydureon-weekly), and Byetta-twice daily, Wegovy, Ozempic-weekly, Victoza and Saxenda-daily, Adlyxin-daily, now an oral form of Ozempic-Rybelsus-daily, and Mounjaro.

  These drugs are peptides, in a class of incretin hormones, similar to the gut hormones that are stimulated after eating, which stimulates the pancreas to secrete insulin to lower blood sugar.

  Mounjaro (not Ozempic) also activates another gastric peptide which makes it 5x more active. This increases satiety (feeling full)(a brain function), slows gastric emptying, stimulate insulin secretion, decreases glucagon, and lowers blood sugar. They also reduce triglycerides and raises the good HDL cholesterol, therefore this class of drugs is winner in everyway.

  When some of the new injectible drugs for type 2 diabetes became popular, it incidentally caused weight loss, and it didn’t take long for the word to get out, especially now that Ozempic, Wegovy, and Mounjaro have been available.

  The weight loss has been quite impressive. 15% of body weight loss has been quoted, but these medications must be continued to keep the weight off, which means permanently, otherwise the weight can return.

  These medications are FDA approved for diabetics 12 years and older. Insurance may or may not pay, and certainly won’t if not diabetic.

  Some reports have said the results over time could be equivalent to bariatric surgery. Obviously, each individual will respond differently, as motivation, staying on a diabetic diet, and exercising are critical.  

  Of course, prescribing these diabetic drugs for non-diabetics is off-label prescribing, and if the FDA follows through with the power they were just given by a small insert in the latest $1.7 trillion Omnibus bill, they may have the ability to keep doctors from prescribing off-label use. I suspect, if that occurs, suddenly, the FDA will approve these drugs for weight loss, diabetic or not, because BigPharma has great influence over the FDA. For now, only diabetics should be prescribed these drugs to prevent further shortages.

  Pre-diabetics would also be a good group to expand the use of these medications (Ozempic, Wegovy, and Mounjaro advertize the most and cost $1500-1800 a months), to help them to lose weight and possibly reduce the 80% risk of becoming diabetic. Control of diabetes and the total body benefits will tell the tale.

  For the 69% of those overweight or obese in the U.S., the marketing of these drugs will create a tremendous demand. And if the drugs work as well as they say, the overall effect on the cost and mortality for diabetes and obesity will be epic!

  Getting insurance to cover these drugs will be critical, but difficult.

G. Insulin use

  If a patient requires insulin, it is critical to attend a diabetic clinic or have frequent assistance in a doctor’s office until a person is comfortable using insulin.

  The insulins are many, some short acting, and some long acting. Using them correctly may take some time, and patience is important.

  Types of insulin---Onset---Peak---Duration

Ultra-long-acting (once a day)—onset 6 hours—doesn’t peak—lasts 36 hours or longer.

Long Acting (also called basal-once daily—onset 2 hours—doesn’t peak—lasts up to 24 hours

Intermediate Acting (before bedtime)—2-4 hours—peaks 4-12 hours—lasts 12-18 hours

Short Acting (also called bolus; use within 30 minutes of eating)—peaks in 2-3 hours—lasts 3-6 hours

Injectable Rapid Acting (also called bolus, used before or after meals)—peaks 1 hour after injection—lasts 2-4 hours

Inhaled Rapid Acting (used just before meals)--onset 10-15 minutes—peaks in 30 minutes after injection—lasts 3 hours

CDC/Diabetes

H. The price of insulin has been curtailed

  Insulin has been prescribed since 1922, and the price has skyrocketed because the pharmaceutical companies could charge whatever they wanted to. Recently, there has been a congressional effort to cap insulin co-pay at $35 a month (The Affordable Insulin Now Act), as the average cost has exceeded $1000 a month. It is now a reality! It also opens the financial door for some diabetics to get the new device to monitor glucose continuously, and have more options for treatment.

I. Diabesity

  The Cleveland Clinic has coined the term diabesity! As a person gains more weight, there is more pressure for the pancreas to make more insulin to manage the blood sugar, and at some time, the insulin becomes resistant to lowering the blood sugar (insulin resistance).

  The liver stores excess blood glucose, and as it increases, fat is deposited into the liver outcompeting glucose. When fat fills the spaces in the liver, glucose stays in the bloodstream, and the liver becomes a fatty liver disease, which can progress to cirrhosis.

  The pancreas keeps making more insulin to drive the glucose into the liver and the cells of the body, but the fat prevents it from happening.

  Insulin resistance is the underlying problem in obesity and developing type 2 diabetes. The higher the blood glucose goes, the greater strain on insulin to do its job, and the harder glucose has to enter the cells in the body thus leaving more and more in the bloodstream. 

  Diabetics with high cholesterol and triglycerides tend to be the most likely to develop insulin resistance. I have reported on the “metabolic syndrome”, and these factors along hypertension, and even gout, commonly make up that syndrome and are common in diabetics, which raises the risk of cardiovascular and stroke disease.

  Not all people with obesity develop type 2 diabetes, because heredity, diet, exercise, stress, and gut health all play a role.

  Some continue to point the finger more at the makeup of the gut bacteria as a significant factor, as is the case in many medical conditions.

Cleveland Clinic

J. Being overweight or obese--consequences

   Being overweight is not OK!! It is a serious health care issue and is costing the U.S. $173 billion in extra healthcare costs every year.

  The health risks of type 2 diabetes are great, and the list continues to lengthen, and is somewhat dependent on the extent of weight, age, heredity, and other medical conditions.

Diseases caused or made woese by type 2 dabetes and obesity

  Asymptomatic heart, kidney, and liver disease caused or aggravated by diabetes can occur for years before there is any clinical evidence, but discovering an elevated blood glucose brings many medical issues to light that can even begin with prediabetes or early and mild diabetes:

-- neuropathy, eye diseases, kidney damage, cardiovascular and stroke diseases, orthopedic disasters, and cancers (endometrial, breast, colo-rectal, esophagus, liver, gall bladder, pancreas, kidney, and prostate), gastric reflux, gall bladder disease, fatty liver progressing to cirrhosis, obstructive sleep apnea, and increased severity of every illness including COVID, influenza, etc. including much higher death rate.

-- depression, disability, shame and guilt, social isolation, being bullied, and lower work achievement all take their toll. Quality of life obviously, is challenging. And even knowing all of this does not motivate many people to lose weight. Mayo Clinic 

K. When are we overweight? BMI, waist size

  When the BMI (Body mass index) was instituted to address weight, it was an attempt to standardize who was overweight. Unfortunately, it had some limitations, and now that children, especially, have gained so much weight, there has been some changes in their standardization BMI and what is considered overweight and obese.

The internet has several sites to calculate your weight! It was hoped that when a person was over the limit by these calculations, people would lose weight. Physicians often do not have the time to address the elevated BMI satisfactorily, and weight issues have become a struggle for both patient and doctor.

  There are those with significant musculature, etc., that do not calculate well, but waist size does not lie. Men with a waist of 40 inches or more is considered obese. For women it is 35 inches. Measure the waist around the middle of the abdomen just above the hip bones. Measure after breathing out!

Waist size is another marker just like weight, height, blood pressure, pulse, and respirations and should be included in a routine annual doctor’s office visit.

  These calculations and measurements without an analysis of the overall health of the body is a disservice.

  Counseling about diet, exercise, and behavioral modifications is a must for anyone considering trying to lose weight, not depending on a drug to do the work for them.

National Institutes of Health. Measuring overweight and obesity in adults, 2013, page 501  

L. Renaming obesity?

  Academic medicine has called the word obesity a “bad word” and are asking doctors to use overweight in their practice. The politically correct are at it again. They feel it is shaming people.

  All physicians understand the difference between being overweight and obese. The industry tried to define obesity with the BMI, but it does not always define the issue well.

  The media and marketing efforts for clothing have tried to normalize being overweight. That may work for them, but obesity is a health issue which is “growing” by the month with over half of the population over weight.

  TV programs with significantly overweight people also are common on cable TV, and again, I realize with the number of overweight people, they deserve equal time.  The media is trying to subconsciously make being overweight perfectly normal, and that is not true and unhealthy.

  Obesity should not be a stigma, and no one should be bullied or harassed in any way if they are fighting their weight, because no one wants to be overweight. Black people also consider size differently in some cases, and they often accept being heavier.

  Physicians are not meeting the goal of assisting most of these patients, and those overweight, who have tried so many times to lose weight, have become discouraged and somewhat accepted their weight issue.

M. Weight issues are rapidly rising in children

  The obesity in children has become part of this epidemic in that 17% of the kids ages 10-17 now are considered overweight, and the numbers are rising.

  Pediatricians have had to drop the concept of telling a parent their overweight kids will “grow out of it”, because THEY ARE NOT GOING TO, in most cases.

  The child and parents need to be told the truth that they are going to have to deal with their children’s weight issue ASAP, because a high percent of these children will continue to gain weight as they hit adulthood, and will face all of the medical conditions brought on by being overweight. Many of these kids also have overweight parents, which complicates the home environment greatly.

  Heredity plays a significant role, but the “environment of excess” is just as potent a factor. Obesity is not a disease, but sure causes diseases!!

Medscape, December 14, 2023

  With the food industry, especially fast food, schools without exercise periods, providing cheaper, high caloric meals to their kids, children spending their life playing electronic games and on their cellphones, and parents not providing proper guidance, and spending time with their kids, the road to more obesity is assured.

  Being overweight has tripled in children and adults over the past 3 decades according to the CDC.

  How do you control the weight of a child when you as a parent are overweight??

  The weight loss drugs will soon be prescribed for certain children, but there is no data for kids.

  For any weight loss program, drug, surgery, etc. to be successful long term,  behavioral modification will always be a major factor. Without it, success will be short-lived.

N. CDC revises BMI limits for children

  The CDC has had to revise their charts on BMI for adults to include children. Medical organizations are now extending the definition of who is overweight—raising BMI numbers.

  Pediatricians have revised growth charts for the young, since so many kids and teens were over a BMI limit of 37, that they had to extend it to 60 to reflect the increasing severity of obesity in that group, which included 4.5 million kids in 2018 in the category of severe obesity.  

  The American Academy of Pediatrics has provided aggressive guidelines for the first time including using anti-obesity drugs for kids 12 and older.

JAMA Network, January 18, 2023

  Teens are offended being called “fat” and are bullied by their peers, become depressed, cut themselves, turn to drugs, and consider suicide. Teens are in a crisis.

  Obesity, drug use, and mental disorders has impacted the ability to recruit an adequate number into the military to mention one serious consequence.

  The military is already spending $103 million dollars on military personnel because 658,000 days of lost workdays due to obesity related issues. Will they allow these drugs for weight loss in the general population? Not yet.

  For years, there has been a stigma for diabetes, a medical disease, and some academic organizations have chosen to call obesity, a disease. It is a hereditary behavioral disorder which must be addressed as early as childhood, regardless of what it is called.

   Type 2 diabetes does not just happen in overweight patients, but it is 3-7X more likely to develop it, as weight increases.   

  When a patient is placed on one of these diabetic drugs to lose weight, their blood pressure, cholesterol, triglyceride, and heart status must be monitored, as there will be benefits in these areas, and that is the most exciting part of the use for many of these patients. Being overweight creates so many medical issues, and all of these issues should improve with weight loss. If they are not, that requires more evaluation.

Medpage Today, December 1, 2022

  27% of adult Americans gained an average of 12 pounds just during the pandemic, but 35% lost weight because they had more time to exercise, so not all bad news.

  The bottom line still is….calories in…calories out. If you want to increase the metabolic rate by burning more calories, exercise is the answer.

4. Gender dysphoria and gender affirming treatment—part A (Also Part 3 of mental disorders in children)

A. Comments on gender issues

  I report on medical issues that impact our country, regardless of its controversy, and this subject certainly has become a point of contention.

  It is not my place to criticize the children that find themselves questioning their gender or the parents dealing with this extreme situation, but to only report how much suffering it causes, and some of the clinics that are now providing services for them, especially the gender affirming therapies. I am concerned what schools are doing to overemphasize the issue to vulnerable children.

  It is every person’s right to be happy, regardless of whether it fits into other people’s religious, moral, or even political viewpoint.

  The interest shown about this issue has been high, regardless of approval. I am here to report what the medical journals are focusing on, even though they are very biased. It is very interesting the amount of space this subject has occupied in these very liberal journals. Big Medicine is just as aggressive in trying to influence clinicians.

  What a challenge for any parent when faced with this issue (including any LBGTQ issue) in their child or relative.

  Education is always the best tool to use when hundreds and now thousands of kids are being directly exposed to this issue at a very tender age in school classrooms, the media, and friends. Like it or not, it is here to stay, so at least understand the pros and cons of this issue.

B. Gender Diversity terms

  Transgender refers to a person who does not identify with their biologically assigned sex. Transsexual refers to a person who has undergone sexual surgical  reassignment. A transvestite implies wearing the clothes a person identifies with, and not classically cross-dressing. It also does not necessarily relate to an individual’s sexual preference or orientation. Drag queens are different as it is a man who dresses as a woman for purposes of entertainment. Cisgender implies people who biologically identities as that sex, and would be considered “normal” by most people. Queer used to imply someone gay or lesbian, but today, it is defined as a gender identity that does not correspond to established ideas of sexuality or gender. The “Q” in LBGTQ refers also to questioning their sexuality. Nonbinary is essentially the same as queer or questioning. There are others, but these are most commonly used. Gender dysphoria will be defined below.

  I have previously reported on gender dysphoria and sex change operations now called gender affirming surgery. I recommend you click on my reports for in depth information. www.themedicalnewsreport/45/46

C. Gender dysphoria

  This is defined as a state of severe stress or unhappiness caused by feeling that one’s gender identity does not match one’s biologic sex, as registered at birth, and is usually worsened with puberty with breasts, genitalia growth, masculine or feminine hair distribution, depth of voice, masculine or feminine facial features, Adam’s Apple, etc.).

  In a study of children questioning their gender, 75% reported gender dysphoria for the first time at age 7 and 96% by age 13. Most reported that these feelings were some of their first memories. These feelings can disappear, so it is better to accept that these children have confusion, uncertainty, and need time to work them out without being rejected or pushed in anyway by schools.

  Questioning their attraction for the same, opposite, or both sexes can be normal, and it takes time to work out how the child will decide where they fit in.

  This study did state that if gender identity begins in childhood and worsens with the start of puberty, the dysphoria does not usually resolve.

D. The medical criteria for a diagnosis of being transgender:

1) symptoms for at least 6 months,

2) consistently say they declare they are the opposite sex, 3) strongly prefer friends of the sex with which they identify,

4) reject clothing, toys, or games typical for their sex,

5) refuse to urinate standing or sitting depending on their sexual preference,

6) want to get rid of their sex organs and or have their genitals altered (not all),

7) even if they look male or female, they state they intend to grow up the opposite sex,

8) extreme distress about body changes during puberty,

9) as a teen, they feel their true gender is not aligned with their body appearance,

10) show disgust for their genitals,

11) avoid showering, changing clothes, or having sex in order to avoid seeing or touching their genitals.

  Parents who are not able to cope with these issues need counseling with and without their child to prevent home related disruption, which is quite common. The children experience enormous amounts of distress in their lives, and as many as 70% of these children have been diagnosed with anxiety, depression, guilt, sleep difficulty, eating disorders, cutting and other physical harms, including suicidal ideation and attempts. They often don’t want to discuss it, so parents and clinicians must be on the alert when these psychological disorders appear.

  Rejection by siblings and or parents is a significant problem. Abuse both mental and physical from family and school kids is often a problem. Bullying, shaming, and actual physical abuse occurs often.

  These children need love and understanding by the whole family as it requires tremendous adjustment, adaptation, and support, when the child has found themselves in this predicament.

  Many of these kids run away from home, become homeless, prostitutes to make a living, abuse drugs, commit suicide, and really pay a high price for being a transgender individual. It is no surprise, these kids will turn to this growing community of LBGTQ+, who will accept them easily.  

  The latest medical journals state that 1.8% of high school students identify as transgender with an increasing number of children and adolescents who are seeking gender identity specific healthcare, according to JAMA Network-Pediatrics in the Nov. 22, 2022 issue.

  As difficult as it is, parents must try and carefully open a conversation if they suspect the issue exists, and trust that their child is serious about difficulties questioning their biological gender. There are still tom-boys and boys who want to play with both genders, so parents need to be aware, many of these kids will “grow” out of these trends.

  It is foreign to most parents, but with a cool head, counseling, and accepting what a child wants (and may change their minds more than once), the child needs to know that there is an environment of acceptance, love, and if they want to proceed, they are supported.

  Parental pressure may change the child’s mind for a time, but if they cannot change the way they feel, the issue will return, and family unrest will rise.

E. School propaganda and Mental Disorders

  Some teacher’s unions, a percentage of teachers, the CRT promoters, and even some of the major medical organizations, especially the American Academy of Pediatrics, AMA, and others all are supporting this gender identity education even if they say it is not being taught. It is school indoctrination, not education. Proper education in the right setting is never wrong, but the way it is being taught has stirred much emotion and controversy. It is clearly a poltical recruitment tool, and it is working!

  Sex education has always been included in most schools, but now the transgender identity has been added without permission from many angered parents, although, many approve it.

  Schools and certain activists groups are trying to exclude the parents with how and what is being taught in school, and even trying to legally take away the rights of parents regarding their children.

  The reason the subject is so controversial is that there is little reliable medical data to determine the value (risks and harms) of such education. There are few studies that have been published to determine the psychological value of implementing gender affirming therapies and have been positive. But they are not long term studies.

  There is the thought that gender dysphoria can be learned or mimicked from exposure to other gender dysphoric individuals (so called social contagion), according to Dr. William Wilkoff, M.D., primary pediatrician from Maine, in an article he wrote for Medscape General Surgery, September, 2022.

  There are concerned parents that their child may decide it would be “cool to experiment” with the concept since those with the dysphoria are becoming more open about their gender concerns.

  As children approach puberty and their bodies begin to change, it is natural to have questions about the entire field of sexuality, however, the way it has been handled in schools is getting pretty controversial.

  Until there are better quality larger studies regarding the risks and benefits of this type of education, it opens the door for fear, concern, and anger in parents and those who are actually anti-trans.

  The key to success in dealing with this issue is the parent-child relationship with love, understanding, openness, and support if their child is questioning their gender identity.

  Because of the high rate of mental disorders in this group (70%), it is clearly a grave public health concern and these children, who through no fault of their own, find themselves unhappy with their biological gender. Half of kids in school today are dealing with some mental anguish, and the greater number are not able to rid these issues without intervention.

  As gender clinics are opening up in major university centers to provide medical puberty blockers and provide education and support for those with gender dysphoria for those who desire to become a transgender child, this has started a nationwide movement, because as long as insurance is paying the clinics, there is money to be made, even though the universities would deny that is a major reason. Trust me….medicine is a business to make money, just like any business.

  It is very important that the training of these healthcare professionals are top notch and provide the best care for these youngsters, with parental permission, and should all have ongoing research to prove the risks and harms of such a center. They should have counselors present that provide alternative support as well.

  There are some states that have forbidden these centers from opening and have laws preventing treating any child under 18 with gender affirming therapy, including Florida. Georgia’s Medicaid program allows this care, after the ACLU sued the state when they banned it.

F. Observational study published by NEJM

  One study in the NEJM studied 315 transgender and non-binary youth 12-20 (averge age 16) who were beginning gender affrirming therapy at 1 of 4 pediatric gender clinics.

  Altough purely observational, the clinic found the medication greatly reduced symptoms of anxiety and depression. This research cannot be controlled for many factors that can influence the findings and limit the value of any study, especially when they only followed for a few years.

  The study also found the kids approved of the changes in their body from the hormones, and improved their quality of life.

  However, there is definitely a down-side. In the face of their treatment, 11 patients had suicidal ideation, and 2 committed suicide. This points out the potential harm, and a deep dive on these negative effects is a must.

  Puberty is a normal maturation process, but now there is the media and LBGTQ+ communities popping up throughout the country and openly expressing their sexuality and preferences, which is their right, but it has created chaos in many homes throughout our country.

  Prepubertal 5 or 6 year old children can become engulfed in propaganda about questioning gender and deciding if their emotions are “off” because they are not the cutest kid in the class, gaining too much weight, getting pimples, aren’t athletic enough, aren’t popular enough with the opposite sex, and may even be getting attention from the same sex, all creating confusion.

G. Study of trans kids in the UK

  Violence, self harm, at least one suicide attempt (41%) in a study of 16 year olds was published in a UK study. 19% had HIV in transgender women and long term use of estrogen increased their mortality with an increase in the risk of heart attacks. This study reported between 34-75% increased risk of mortality from disease, suicide, homicide (mostly in women), and drug overdose. There is no increased risk in cancer.

JAMA Network, January 30, 2023       

H. Preventing natural puberty

  Because of the intense pressure children face, preventing puberty has become the focal point of not only treatment but extreme controversy.  

  Detransition is more common in the earlier stages of transgender concerns, particularly before surgeries. The actual number in unknown, but estimates range from 1-8% decide to detransition. The NIH (National Institutes of Health) reports that the families often have a lot to do with detransitioning and stigma issues. As many as 15% fluctuated with their feelings of proceeding with transitioning.

  Prepubertal children often change their mind before accepting hormones to stop puberty. If they continue with gender dysphoria past puberty,the children will likely continue with their dsire to become trans.

JAMA Network Pediatrics Nov.1, 2022 

  Next month, part B on gender identity, (also part 4 of mental disorders in children), I will report on the actual medications (puberty blockers) being used, and transgender surgical procedures being performed, including the most common cosmetic procedures requested including before and after photos.

5. Herpes Simplex—oral, ocular, and genital

  Like other viruses, there is no cure, but with diagnosis, treatment, and preventive measures, it can be lessened and often controlled. Stress is a common denominator in breakouts.

  There are two strains of Herpes simplex, HSV-1 and 2 (not to be confused with herpes papilloma virus—HPV), which also occur in the mouth and genital areas. I have reported on HPV when discussing genital and oropharyngeal cancer and will be updated in the next few months, as I just gave a lecture for the Oral Cancer Foundation in Clearwater, Florida.

  HSV-1 is more common in oral infections and HSV-2 for genital, but both strains can affect either region. About 2 in 3 people worldwide contract HSV-1, while HSV-2 occurs in about 15% of those 15-49.

  Herpes Simplex virus does not cause cancer (HPV causes cervical, genital, and anal cancers, and very likely most of the oropharyngeal cancers).

  HSV is a problem, especially because, once a person acquires this virus, it is for life, and it will recur requiring treatment if a person wants those blisters to recede quickly or even prevent from happening.

  Herpes labialis, the proper name for those nasty “fever” blisters on the lip and gum, can be treated with topical antiviral meds successfully, and if more pronounced in some individuals may require oral antiviral medication.

  Most humans are exposed by age 1-5 years of age. Half of youngsters 14-49 have been exposed to the HSV-1, and 12% have infections. The body stores that virus for life as the virus travels up sensory nerves to the ganglion, near the spinal cord, until it is mobilized from some type of stress, only to travel back down that nerve and then erupts on the skin, similar in cases of shingles.

  Before eruption, the area becomes itchy or more sensitive than normal, and may have a burning sensation with tingling, all symptoms implying irritation of the nerve supplying sensation to the particular area of skin.

  A. Oral

  Common “cold sores” on the lip and gums, also called fever blisters and are very common, and create pain, blisters on the lip, and usually occur when the body’s systems are upset, physically or mentally.

Regardless of where the blisters occur (lips or in the mouth), they will infect others, and prevention of oral or sexual contact is necessary to prevent spread. Unfortunately, the skin where it erupts, can shed the virus before and after the blisters disappear, which makes it a concern for couples, families, etc.

  Swollen glands in the neck may occur, with a sore throat, and painful swallowing if further in the mouth and can occur in the throat.

  Besides some type of stress, sun exposure, menstruation, and fever from any cause are common causes. For people who are immunocompromised for any reason, are particularly vulnerable and the blisters can spread more easily. These patients and those with frequent outbreaks need a ready supply of prescription antivirals to take as soon one suspects an outbreak.

  Most are obvious what the cause is, however, viral culture, viral DNA test, or the Tzanck test can be ordered to prove HSV.

  HSV-1 can be transmitted on razors, toothbrushes, towels, dishes, and other shared items. Kissing, sharing lip balm, utensils, razors, etc. can also spread the virus. Someone with a fever blister on the lips who performs oral sex can transmits it to the genitals. Parents can easily transmit the virus to their children. Children ages 1-5 are most common.

  Prior to breakout, as the virus travels to the lip nerves, the lips may tingle or feel more sensitive, and that is the best time to start treatment to try and prevent a breakout.

  Medications will be discussed after reporting on genital herpes, as they are the same chemicals.  HSV-1 can be associated with Bell’s Palsy, a facial paralysis, which is serious, and will be discussed in the near future. HPV virus also can be associated with facial paralysis with breakout on the sife of the face and eye, and is called Ramsey-Hunt Syndrome, also caused by the chicken pox virus (shingles).

  B. Genital

  Genital herpes can be caused by both strains of virus, and they can be symptomatic or asymptomatic, but much more commonly HSV-2.

  It is interesting that if a person has HSV-1 oral infections, it may protect against or lower the incidence of HSV-2  genital infections. The symptoms of genital herpes tend to be more severe in women, as are complications.

  The incubation period is 3-7 days, however can last 1 day to 3 weeks. Constitutional symptoms can occur with fever, headache, malaise, muscle ache, and pain running into the buttocks or groin, before breakout.

  If the ulcers occur in the vagina or labia, there will be pain, discharge, pain on urination, vaginal discharge. Tenderness in the groin from swollen glands (lymph nodes) may occur with active infection.

Vulva patch of ulcers

Shaft of penis

Ulcers all over vulva and labia

Genital ulcers are extremely tender. In women, 70-90% have involvement of the cervix and demonstrate ulcerations, but don’t cause cancer as the HPV virus clearly does. The urethra may be involved as well.

  In men, the glans penis, shaft, the foreskin or its remnant are most common, but can occur on the scrotum, the perianal area, and the buttocks.

  Herpetic urethritis occurs in 30-40% of men with severe pain and discharge from the penis.

  Anal sex can spread this infection into the rectum, and are very common in the LBGTQ+community, however there are no groups that are immune.

  These lesions start as a small group of blisters, which can spread, and ulcerate at different times. Having sex will rupture the blisters, spreading the virus actively. These ulcers last on average about 12 days.

  By age 50, approximately 90% in the U.S., will have antibodies to HSV-1, and many who do, will deny ever having these lesions, whether being honest or not.

  Ulcers from syphilis are not painful, and are quite a distinguishing factor from herpes simplex ulcers, however, a VDRL blood test is recommended.   

C. Treatment and prevention of Herpes Simplex outbreaks

Prevention for those with frequent episodes of Herpes simplex 

  The suppressive treatment for genital herpes simplex is valacyclovir (Valtrex) 500mg orally once a day, however for those who have frequent outbreaks, the dose may need to increase to 1 gm daily. This daily therapy greatly reduces (70-80%) the risk of transmission.

  Acyclovir 400mg orally twice day may be recommended. Famciclovir 250mg twice a day is another option.

  Topical preparations of penciclovir is available for oral herpes.

  Research is under way with a new antiviral, Pritelivir, for resistant cases of genital herpes.

Treatment of an acute infection

  For the first infection if diagnosed, Acyclovir 400mg 3 times day for 7-10 days, or famiciclovir 250mg 3x a day for 7-10 days, or valcyclovir 1 gm orally for 7-10 days.

  NSAIDs (Aleve, ibuprofen, etc.), ice compresses, Orajel or Abreva, over the counter ointments help. 1-2% topical lidocaine may help if the pain is severe.

  Treatment should be extended if healing is not complete after 10 days. As soon as any suspected symptoms begin, therapy is strongly encouraged. Waitng until the blsters form may reduce the number of days before healing, and in many cases, if taken early enough, may prevent blisters.

D. Ocular HSV

On ophthalmic split lamp exam, the ulcers tend to be in a linear fashion (dendritic)—herpetic keratitis. Above on the left photo, is a blister on the conjunctiva, and the right photo shows an ulcer, which is green from fluoroscein dye.

  50,000 cases a year occur in the U.S., according to the Academy of Ophthalmology. It can involve the eyelid and surface the eyeball (cornea).

   The cornea is prone to be involved in a smaller number of patients, and can be severe with pain, photophobia, blurred vision, tearing, and redness. It occurs in 0.15% of American adults. 20,000 cases are diagnosed in the U.S. annually and a common cause of blindness in the U.S. requiring corneal transplants.

  Scrapings of these ulcers will demonstrate multinucleated giant cells, and a viral culture will grow the virus.

  Most cases resolve spontaneously in 3 weeks. The rationale for treatment is to prevent permanent damage to the cornea, eventually needing a corneal transplant.

  Topical eye drops, ointment, and oral antiviral therapy is available.

E.  Pregnancy Concerns

  Herpes simplex can be a very serious infection in a newborn and can cause severe blistering, involving the skin, mouth, and eyes, and if untreated, death will occur in 85% when it invades the brain and other organs. If they survive, neurological problems usually persist. They can be treated with the same antiviral. Newborns usually don’t show symptoms between the first and third week of life, but may not appear until the 4^th week.

  Pregnant women who have frequent outbreaks must discuss this with their obstetrician. Taking daily acyclovir may be recommended, but certainly consideration for a C-section will be discussed, as genital herpes can infect the newborn as the child is delivered vaginally. If active infection is present near delivery time, treatment with acyclovir is required.

  Testing for HSV prior to delivery may be performed with cultures and a PCR test (similar to the COVID test). Even asymptomatic women without blistering can transmit the infection sexually and to the newborn.

Merck Manual; NIH/NCI

  Hepatitis is a rare concern of disseminated herpes simplex infection, often reported by pregnant women who acquire the infection during their pregnancy. It can be associated with severe hepatitis and liver failure with a 25% death rate, according to the CDC. 

F. Condom use

  Although condom use is highly recommended, it can be somewhat effective although with no guarantees because the virus may be on the skin beyond the genitals.

6. Socialized medicine in UK—not working ( a look at our future potentially); Canadian palliative care socialized system substandard

  Here are some sad stats in the UK! There is a 12 hour wait in ER for an admission; over 90 minutes to get someone to the hospital with a heart attack or stroke. Since the pandemic, death rates are 20% higher than the previous 5 year average.

  Strikes by ambulance drivers and nurses over pay and working conditions have had a direct effect on the quality of care.

  Many emergency departments report a 4 hour wait to be seen.

  In the face of rising salaries, taxes are rising higher and higher to cover UK medicine.

  Other European countries are suffering with their socialized government paid healthcare. Doctors are striking in Spain and France (also socialized medicine countries), because of poor working conditions, and inadequate pay.

  One of the biggest problem healthcare is having is providing care for the ever-aging societies. Lack of federal funding is hitting the over 65 group the hardest because they need the most care.

  Inflation throughout the world, especially in the U.S. is higher than in decades.

  During the pandemic 7 million were in a waiting list to get in the hospital. Medical practices were put on hold. Millions of operations were delayed or cancelled. Cancer screenings were delayed. All medical care was also delayed or missed.

  NHS (National Health Service) in the UK is now not seeing as many patients UK because of less staff.

  The average federal medical cost per person in the UK is $3715 annually….. 18% lower than all the other EU countries.

  Over the past 30 years the number of beds in UK has halved from 299,000 to 141,000, while the leaders bragged that they could cut costs because of better efficiency.

  Home care is in a crisis, and has left patients in the hospital for weeks waiting for home care and being safely discharged. Social (home care) is paid for by NHS.  There are 166,000 vacancies in the home and nursing care workforce.

  Morale, stress, burnout, as the lines in the corridors are being filled with patients waiting to be seen.

  Doctors and nurses are leaving the country particularly to  Australia.

  Negotiations with the unionized doctors and nurses is unresolved.

CNN News, January 23, 2023

  The publically funded UK program costs over $200 billion a year, and will continue to cost more as the UK is being challenged by the ever aging population, obesity, more healthcare conditions per patient, a growing population, and closure of many decentralized centers, making access poor. Look at their costs!

  More patients are going to their emergency departments, overloading them, and making the waiting period longer. The UK is spending less and less on eldercare, social care (home and nursing care), and the seniors are suffering the most in their socialized medicine model.

  You can plainly see, everyone of these issues are already affecting us in the U.S., even without socialized medicine, but when the UK spends more than 30% of the dollar, this crisis will do nothing but worsen, with poorer quality of care, and less of it, with the seniors feeling the brunt of the crisis. Taxes can carry these programs just so far. Is this what the American public wants?? And over 1 million illegals have already crossed our southern border in the U.S. with complete acceptance by the Democrats. The effect on healthcare is obvious, not to mention all the other issues creating multiple crises in our country. Chaos is part of the mantra to switch to a socialist/Marxist country.

  Private insurance companies have increased in numbers in the UK exponentially, creating a 2 tier healthcare medical system, only utilized by the well to do (supplemental insurance at the additional cost to the individual is having to pay for what their socialized system won’t or nedding faster care). Add that cost to an already skyrocketing need for tax increases, and one can see there will be fewer people getting healthcare in a timely manner.

  Seniors will be denied elective treatments, and urgent care will take center stage, while chronic diseases and aging issues suffer raising the cost ultimately of healthcare.

BBC.Com

 Canadian palliative care system substandard

  Another example of where socialized medical system falls far short is care of those needing palliative care in Canada, as ailing seniors do not receive this type of care.

  The reports in the Medscape medical news state that these patients are left vulnerable to pain, dementia needs, psychological distress, and inadequate care for end of life care, according to Justin Sanders, MD, director of Palliative Care in the Montreal University Health center Quebec.

  This came after the description of care at St. Mary’s Hospital, which was described as shameful, by the patient’s family, a relative of a former premier of Quebec, the implementor of socialized health care system in Quebec. He called it a broken system, a system that was ranked 22 out of 81 countries with socialized healthcare systems.

  One of the complaints noted that children and non-cancer patients were the most underserved. Rural areas are left with little care, and even in some larger centers, the care is very patchy.

  Training of enough staff is one of the greatest weaknesses in the system, a common concern in many countries. Often mandatory palliative training does not exist. Recognizing what patients need when patients are in great need, is another criticism. Earlier care is a very common concern, and waiting until hospice is called is what happens, and too late. Hospice is not Palliative care.

  Pain management, shortness of breath, appetite management, fatigue, etc. are common areas that are neglected.

  These criticisms are common for all palliative programs, even in the U.S., and as we approach a system where prioritization of care will be mandated, those old who are going to die soon are likely to be the most neglected.

  As any healthcare system continues to take on millions of immigrants annually with open borders, the healthcare dollar will inevitably shrink per capita. The mental health crisis is also making most other health issues harder to treat.

Medscape, Feb. 9, 2023

  One of the biggest problems already happening in the U.S. is emergency departments are losing their staffs in record numbers.

  The hospitals are depending on staff hired by hiring companies to fill empty slots. Many times, doctors are being replaced by nurse practitioners and P.A.s, especially in smaller communities. Imagine what will happen as the number of people in the country continue to rise from illegals coming across the borders, and we inch closer to a socialized system!!!

This ends the March, 2023 report!!

April, 2023 will include:

1. OB-Gyn Series—Part 9—Opioid abuse in pregnancy; treating withdrawal in infants and mothers

2. New targets for blood pressure; New Class of anti-hypertensive medication

3. Gender affirming therapy--medical and surgical care-part B  (also Part 4 of the mental disorders of children series)

4. Colonoscopy vs new blood tests to diagnose cancer

5. The Drug Crisis in the U.S.-- an epidemic

Stay healthy and well, my friends, and pray our country stays safe. Dr. Sam

St. Patrick

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