Thursday, December 17, 2020

Survival Guide from ICU Docs & the "Four D's" of Airborne Transmission

 
"Arguably, most doctors are not like us... we are the last line with the dying and (those with) the most severe illnesses. We are conditioned to work creatively and more aggressively under a major time limit... to reverse life threatening disorders."


Dr. Pierre Kory: Interview with an ICU Critical Care Physician

ON PREVENTION: I'm probably not the best example of maintaining health through Covid because it's pulled me in many different directions that personal health is not a premium. I've been just working, I'm working on fighting and writing and getting involved with trying to help folks treat this disease. I mean, exercise has been definitely on the back burner, but certainly now that things have calmed down a little bit, certainly exercise is a premium for me. 

Ever since the early pandemic, when quite a few healthcare providers got sick, INFECTION CONTROL was really consistent with what you needed in order to operate in a clinical area, whether it's COVID or any other event. The routine mask wearing regular hand-washing and gown donning has gotten us all through. 

 I did five weeks straight in an ICU since May- it was all COVID and none of us got ill.  In fact, when I was at Mt. Sinai/Beth Israel, not one intensivist in that division (pulmonologists) who were seeing patients in all spheres both on and off ventilators contracted the virus.  You have to understand a person on a ventilator is much less risky because you're on a ventilator, it's kind of a closed system. So their exhaled air is not going to expose to providers. There's patients who are not on ventilators, who are breathing very heavy. They're spewing a lot of virus in the hair. And WEARING A MASK CONSISTENTLY throughout the day is really important.  Those three things-  HAND WASHING, MASK WEARING and GOWNS- they will carry you through.  I'm at this now six months and I haven't gotten sick- knock on wood. My wife is pulmonary critical care specialist. She sees as much Covid as I have, but none of us have gotten nailed just by sticking to the basics. 

ON SUPPLEMENTS: Certainly vitamin D vitamin C, Zinc and Quercetin are some of the essentials. Though it's not clear if we're taking enough concentrations to help, but there's some supportive evidence for it. But certainly C and D seems to be key in not only mitigating the development or the acquisition of the attraction, but also the severity and impact.  The other one that I take routinely for years is Melatonin at night and tell him it appears to be very protective against acquiring the infection.  They're cheap, they're easy - taking supplements is really a kind of a no brainer with very little down sides.


ON THE THEORY OF AN AIRBORNE PATHOGEN: I feel very strongly about it. Since early May, we noticed how people got ill and the ways in which they got ill early on, it was clearly airborne. So many people have been debating this for months- something like 275 scientists wrote open letter to the world health organization in July telling them that all the evidence suggests that this is airborne transmission.  There's a multitude of events  which clearly supports this-  that's why it's really important that we all wear a mask, especially indoors. 

The real factors that would lead to airborne transmission is for me is generally occurring indoors- from what I call THE FOUR D's, which is the DURATION that you'll spend in that room, the DIMENSIONS of the room- this reflects on less ambient air flow in a smaller space where there's more of a likelihood that the exhaled virus can  build up to a sufficient concentration for you to inhale it. Next is the DENSITY or the crowd size that raises your probability.  And then there's the presence of a DRAB. There's a number of experiments and publications have shown just having an open window in a room appears to be very protective because it dilutes the concentration of the exhale virus. And so it makes it much less likely you're going to get infected. You have to inhale a significant concentration of a virus- what's called INOCULUM. If you're in someplace with ambient air for short term or a very large room, it's very unlikely that you're going to get infected. And so it's really about small confined, poorly ventilated spaces with a lot of people like ours- and places like bars where everyone's on top of each other or the crowded areas where you might have a high density of people. 

ON MASKS:  Based on just tons of epidemiologic data, which shows that the incidence of infection and transmission plummets when you have a certain percentage of people even wearing standard masks. My opinion on this subject evolved since in the beginning, the way I understood the airborne transmissions that everybody needed an N95 in order to fully protect themselves. But if everybody around you is wearing a mask, (as well as you) the dual mask wearing is as good as if one of you had an N95 to protect themselves. And the reason for that is because those tiny droplets that you can inhale are bursts from larger droplets. And if you're wearing any covering the big spindle or the large droplets that emit when you talk, they all get trapped in those standard masks. They're actually quite protective. So my belief is masks for all!



Respirator vs. Surgical Mask - What's the Difference?
Written by: Dr. Robert Bard, MD, PC, DABR, FASLMS  |  Edited by: Cheri Ambrose

Months into the pandemic, we have confirmed that following CDC safety and prevention guidelines of wearing some approved form of face covering in public (or around others) is directly connected to the reduction and control of Covid-19 infection rates.  Time and time again, scientists and medical experts have valid proof that viruses travel through micro-droplets in the form of airborne contaminants. 


Fact: ANY PPE is better than NO PPE!  The science of prevention states that measures toward a reduction in risk can greatly support life-saving others - and yourself.  Meanwhile, discerning the difference between face coverings, specifically MASKS vs RESPIRATORS can be useful in identifying which situation to use which type of mask. There is a significant difference between the two, and wearing one vs. the other provides differing results.

The FDA defines a surgical mask as a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets (NOT MICRO-DROPLETS), splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others. While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.


Meanwhile, an N95 respirator is an "efficient filter and a respiratory protective device designed to PROTECT YOU from airborne particles". Note that the edges of the respirator are designed to form a seal around the nose and mouth. Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s because it is actually rated by NIOSH to keep out or resist an estimated 95% of the harmful particulates in the air. [11]







"GETTING THE SHOT"- A Move Towards Progress  By: Rebecca Nazario
 
Getting the vaccine is a key way that we can protect ourselves, our families, our community and our colleagues. The vaccine is safe and effective. Although its development happened quickly, it went through all the same kinds of testing and rigorous approval that any vaccine does.  I posted my selfie on LinkedIn "getting the shot" because there's so much apprehension out there... especially in our minority communities.  As a Cuban American I know there’s a lot of the mistrust and fear is based on rumors that run rampant through our communities, not the science.  I strongly believe we can lead through example, and a picture is worth a thousand words! My goal is to be a small drop that creates a lot of ripples that ultimately instills more confidence. We need to empower each other to pass that message along, and dispel the rumors in whatever way possible.




IVERMECTIN: A Covid-19 Game-Changer?
On Dec 8, 2020, committee chairman Republican Sen. Ron Johnson called ICU Pulmonary specialist Dr. Pierre Kory of the Aurora St. Luke’s Medical Center (WI) and president of the FLCCC to the US Senate Homeland Security and Governmental Affairs Committee.  The hearing was called “Early Outpatient Treatment: An Essential Part of a COVID-19 Solution, Part II.”  Dr. Kory gave his testimony on behalf of frontline physicians about the current state of care in the Covid pandemic and what his group specifies as the logic-based treatment with scientifically proven data that he pleads the NIH to review.  (
See complete video and Transcript of Dr. Kory's Testimony)



COVID AND STROKE

COVID-19 was rapidly understood as a disease caused by severe and widespread inflammation and “hypercoagulability” (a tendency to spontaneously form clots in the blood vessels. Autopsies have revealed extensive small vessel strokes, with such strokes often occurring despite aggressive blood thinner treatment and regardless of the timing of the disease course, suggesting that it plays a role very early in the disease process. In one autopsy series, there was a widespread presence of small clots with acute stroke observed in over 25%. In a recent review of the incidence of stroke in COVID-19, almost 2% of all hospital patients suffered a stroke, which is 8x higher than in patients with influenza. More worrisome is that this is almost definitely a gross underestimate given the many likely missed strokes in patients who died on ventilators who were too ill to obtain imaging, the general restrictions on and lack of autopsies, and the well-recognized decrease in the number of patients with acute stroke symptoms seeking medical attention in the COVID-19 era.  (go to complete article)



THE KIRBY PROJECT: Re-assessing the "Deadly" Cost of Cancer Meds
According to a report from the NIH, "the cost of cancer care is the most rapidly increasing component of U.S. health care spending and will increase from $125 billion in 2010 to an estimated $158 billion in 2020, a 27% increase. Most experts agree that the current escalation of costs is unsustainable and, if left unchecked, will have a devastating effect on the quality of health care and an increasing negative financial impact on individuals, businesses, and government."  A coalition of patient advocates kickstared by 2x cancer victim Kirby Lewis enacted an initiative to speaks for the countless cancer patients in this country that are drowning from the high cost of cancer meds. "Insurance never covers everything- especially when it comes to drastic cases like cancer. If you're lucky, most insurance covers 50% - or even at the very best, 90% - and a vial of chemo that might be $20,000 you still have to pay a balance or a copay that can easily wipe your family out!" (see complete article)



Disclaimer & Copyright Notice: The materials provided on this website/web-based article are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

Wednesday, December 2, 2020

MICHAEL'S CHOICE: A DIFFERENT END-OF-LIFE PLAN

By: Lorraine S. Davi (San Francisco, CA)- edited by: Graciella Davi & Carmen R. Dewitt  / NY Cancer Resource Alliance

INTRODUCTION:
I dedicated my career in Cancer Awareness and Recurrence Prevention not just to fight cancer, but to promote the public commitment to staying proactive with their health ("GET CHECKED NOW!" mission).  My own experience of having lost someone who DID NOT WANT TO UNDERGO ANY CANCER TREATMENT was a challenge that shaped all this.  It took a long time for me to put my feelings aside and honor his wish to "live all the remaining final days to the fullest"- instead of undergoing the many pains and challenges of treatment.  

Since Michael, I found more and more victims choosing this decision.  Some are convinced that cancer treatment is a temporary band-aid and that cancer will always come back anyway (so why bother).  Another deciding factor was MONEY- where the cancer victim chose the path of not bankrupting his/her family with what many consider to be a "deadlier" bill than the cancer itself. Others choose to exist a post-diagnosed life without STRESS, that which adds to the malignancy.  In the case of Michael's story, the thought of a pre-determined or pre-destined cancer from known heredity became a self-fulfilled program.  Either way, I chose to finally share my story hoping to keep everyone in the fight... IF they choose to. 

This is my story.


In April of 2008, my (then) fiancĂ©e Michael received his colonoscopy report showing scans of a golf ball-sized tumor in his colon.  Michael was always a bit closed about his family, but it was then that I learned about his parents' history of hereditary cancers and the rare genetic disorder that ran through his father's side called Lynch Syndrome.  

As shocking as the diagnosis was, we were even more stunned to receive Michael's reaction-- what seemed like a pre-written plan to something that he seemed to expect was going to happen.  "My whole family is a ticking time-bomb and I guess now is my turn", he said, with an icy calm. "Since I was a kid, I've been thinking about how to handle this if and when it was going to come. I made a simple plan to live out the rest of my life the best way I can-- not putting ANY attention to (this) cancer.  This means NO treatments or spend a second fighting the inevitable".

At first, I found his view to be boldly selfish. "How could he do this to his loved ones?" But the more I thought about it, maybe WE were the selfish ones to make him undergo all those horrible chemotherapies and radiation at the hopes of keeping him around indefinitely.  Either way, this was unlike any other reaction I have ever heard of when someone gets diagnosed.

Just so happens, I spent years as a volunteer fundraiser to a handful of cancer organizations and knew then that there was no shortage in cancer research programs for ANY kind of cancer.  I have read and reported about so many treatment protocols, clinical trials and diagnostic innovations where the race for a cure is definitely at the highest point ever.  By this, there is always HOPE for an eventual CURE.  But regardless of generations of advancements at our grasp, Michael's decision was firm.  He always believed that his limited TIME and MONEY should be best spent living each moment, and not "gamble on hope."


By the fall of 2009, Michael passed away, but not without fulfilling his so called "set of final Hurrahs"- or what most call a 'bucket list'.  The crescendo of his final days ended in a stark silent emptiness in the hearts of many.  But to some of us, supporting the fight for a cure was fanned with new energy and conviction. I may not be an oncologist or a genetic specialist or a cancer immunologist (or even a patient advocate), but Michael's story helped shape my crusade toward anyone else from CHECKING OUT this way.  I became a data fiend, tracking cataloguing all available resources for cancer patients.  From personal grants to treatment alternatives to  housing help to the smallest wish and possible need - literally everything is available and accessible! But in addition, if we can show (and prove to) our loved ones that the fight to extend life was worth it, and we can introduce a new program by bringing confidence in the current global cancer initiative - maybe that's what TRUE PREVENTION really means.


VIEWPOINTS

ROBERTA KLINE, MD (genomicmedicineworks.com)
This story brings out complex issues with our healthcare system, including power imbalance. In my experience, people who refuse treatments have one thing in common: feeling disempowered. Whether it expresses as fear, rejection, rebellion or self-sacrifice, in the end the person is taking back their power from a system that, at its core, strips their locus of control. Honoring each person’s spiritual journey, and their health challenges within that, is imperative. But our system fails patients all along the way. How we research, convey information, make diagnoses and prognoses, and approach treatment including the cost of it. Especially with inherited genetic diseases, too often a “death sentence” is given without any understanding of how to empower people with the right knowledge and resources to make critical decisions. Innovations like Genomic Medicine are changing that. With a holistic approach to DNA-based care, people feel empowered to create a health strategy that works for them. 

ELIZABETH BANCHITTA, Technical Contributor / EMT
The article Michael’s Choice paints a realistic picture of the painful realities facing patients with an aggressive illness and the options, advances and need for continued perseverance toward cure and the insistence upon hope. It also reminds us of why we are driven and persistent in what we do; fighting so hard for a cure. It is my belief that the best way to prevent illness and injury is to remain disciplined and diligent in one’s efforts including "getting checked" by one’s health care team. I completely understand why Michael made the choice to forego cancer treatment as he was prepared with a mindset and a plan as he anticipated the outcome of his inherited genetic disorder and chose what was comfortable for him. The truth is that cancer, with all its complexities and uncertainties, is scary for everyone involved. Perhaps Michael would have changed his mind if fear of a  heavy financial burden of treatment could have been offset. The best way to determine your options is to stay educated. Cancer treatments and protocols are changing by the day. The diagnoses, written only as “Ca”, and once considered a "death sentence" when my mother was a new nurse in 1981, these cancers are now detected earlier and are more easily treated with various options for comfort and cure. Education in many areas may be one of the most powerful tools for successful healing answers for a patient and their family.

CHERI AMBROSE (President, Male Breast Cancer Coalition
I found Michael's Choice to sadly be the voice of many.  That feeling of fear that grips so tightly when hearing a cancer diagnosis can often time cause us to shut down. Though Michael had options, he knew that prolonging the inevitable would only make him feel less power over his own life and choices.  I feel the medical community as a whole can and should do better to engage each patient. To treat the whole person and not just the disease. In doing so, patients would experience a better quality of life and be more apt to opt into treatments. 


SYLVIE BELJANSKI (Author: "Winning The War On Cancer") 
Michael’s story is about how painful it might be to be respectful, and to accept our loved ones’ decisions regarding their choice of treatment. Whether they choose to go with conventional, integrative or alternative medicine, or no treatment at all, this ultimate decision remains theirs. We can only hope they reach their decision in the most educated way. And there is so much out there! There is definitively no bad time to start educating yourself about health and wellness, but doing it under the pressure of a diagnosis is not the way to go, because the information is just too overwhelming. 





11/28/2020- According to a report from the NIH, "the cost of cancer care is the most rapidly increasing component of U.S. health care spending and will increase from $125 billion in 2010 to an estimated $158 billion in 2020, a 27% increase. Most experts agree that the current escalation of costs is unsustainable and, if left unchecked, will have a devastating effect on the quality of health care and an increasing negative financial impact on individuals, businesses, and government."   A sensible first base was to connect with all the community groups and cancer foundation leaders or anyone in a leadership role who recognizes this economic dilemma and "the real price of cancer". (see complete article)



CANCER RECURRENCE: Viewpoints and Strategies (See Video)
11/8/2020- When cancer comes back after treatment, doctors call it a recurrence-  or recurrent cancer. Finding out that cancer has come back can cause feelings of shock, anger, sadness, and fear. But you have something now that you didn’t have before—experience. You’ve lived through cancer already and you know what to expect. Also, remember that treatments may have improved since you were first diagnosed. New drugs or methods may help with your treatment or in managing side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can manage for many years. (see complete article)



5/5/2020- Cancer is a genetic disease—that is, cancer is caused by certain changes to genes that control the way our cells function, especially how they grow and divide. Genes carry the instructions to make proteins, which do much of the work in our cells. Certain gene changes can cause cells to evade normal growth controls and become cancer. For example, some cancer-causing gene changes increase production of a protein that makes cells grow. Others result in the production of a misshapen, and therefore nonfunctional, form of a protein that normally repairs cellular damage.   Inherited genetic mutations play a major role in about 5 to 10 percent of all cancers. Researchers have associated mutations in specific genes with more than 50 hereditary cancer syndromes, which are disorders that may predispose individuals to developing certain cancers. Genetic tests for hereditary cancer syndromes can tell whether a person from a family that shows signs of such a syndrome has one of these mutations. These tests can also show whether family members without obvious disease have inherited the same mutation as a family member who carries a cancer-associated mutation. (See complete article)





Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/ IntermediaWorx inc. It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.