Monday, April 12, 2021

Family Medicine: Preventing and Treating COVID-19 with I-MASK+ Protocol

Yes, my practice, Neighborly Family Medicine in Beavercreek and the Free clinic where I'm Founding Medical Director, Open Arms Health Clinic (OAHC) both use the I-MASK+ Protocol to prevent and treat COVID-19.  Outpatient COVID Prevention and Treatment

The COVID-19 virus is a huge challenge and an important opportunity for physicians and others to help people and fix many elements of our health care system.  COVID-19 can be mild, moderate, deadly and/or confusing.  Especially the Long COVID-19 syndrome or Longhauler Syndrome as many call it.

The Front Line COVID-19 Critical Care Alliance (FLCC) worked together since March 2020 to identify re-purposed, existing medications that could prevent and treat SARS-CoV2.  They also developed an inpatient protocol called MATH+ Hospital Protocol for COVID-19

Most physicians seem to be, unfortunately, unaware of these protocols.  The FLCCC site  (FLCCC web site ) includes the protocols, Information to share with your doctor,  Information about Ivermectin for COVID-19Prevention and Treatment Protocols, and more.

Here is a list of Doctors who prescribe Ivermectin, most of whom use the whole I-MASK+ Protocol (with personalized variations):  Doctors who Prescribe Ivermectin,  including Dr Jonas under Ohio (A. Patrick Jonas, MD in Beavercreek, OH.  Physicians are allowed to treat patients via video visits, which we do almost daily, only for patients in our own state).  We have a more flexible schedule than most physicians, enabling Dr. Jonas to provide the COVID-19 support service.  Our practice is one of a growing number of Direct Primary Care practices in the US which don''t accept insurance as payment for services.  We have zero contracts with insurance companies.

Since the start of the Pandemic, patients recorded in our EHR at Neighborly Family Medicine with a diagnosis of "At risk for COVID-19 exposure", "COVID-19 exposure", "COVID-19" and "COVID-19 Longhauler" include more than 30, 44, 72, and 12 people respectively.  Most of these are after June, 2020.  Many other friends and family members of these patients  had similar diagnoses, but didn't seek care from my practice.  The patients with COVID-19 or Longhaulers that I've treated with the I-MASK+ Protocol (57+ patients) included persons with CHF, CAD, Diabetes, AFib, Renal Failure, Asthma, Allergic Rhinitis, Prostate Cancer, Chronic Lymphocytic Leukemia, Obesity, Chronic Anticoagulation, Depression, Anxiety, Bipolar, Ehlers Danlos Syndrome, Hypertension, Stroke History, Rheumatoid Arthritis, High Cholesterol, Migraine Headache, Irritable Bowel Syndrome, and others.  They included persons from age 24 to 94 (6 persons in their 80's).  After starting the protocol, everyone got better except 2 of the Longhaulers (who are improving) and no one was hospitalized or died.  The Longhauler treatment is based on the I-MASK+ protocol with personalized variations for the chronic inflammation and evolving literature about the Long COVID-19 Syndrome.

I've been pleased with the effects of the protocol on my patients so far.  Together, we actively go after prevention or treatment of COVID-19 and the Long COVID-19 Syndrome.

We're finding that many persons also want to prevent COVID-19 until they get their COVID-19 shot(s) or until an important event.  Many ask about using the protocol after they are vaccinated, if they ever get infected with a variant and/or find out that they are one of the 5% who didn't get full immunity from the vaccine.  Some are waiting for the oral vaccine (at least one is in development)  while others only want to get one shot and many are vaccine hesitant because of new shot technology and so forth.  

I'll be broadcasting about this post on my Blog Talk Radio Show during the next week to further clarify.

More later

 

Saturday, November 7, 2020

Family Medicine: Straddling COVID-19, Influenza and Life

 What can we and our patients do as the cold and flu season nears and COVID-19 lingers?

First is to check what Dr. Google says about these infections, all of which are viruses.  What do we know about viruses?

Physicians have read a lot recently about SARS-CoV-2 also called COVID-19, coronavirus, Rona and other nick names.  Formally SARS-CoV-2 is the name, but COVID-19 is widely accepted and used, so I'll refer to it as COVID-19.  In spite of our reading and a wide variety of ongoing research, there are many mysteries about COVID-19.  With over 200,000 deaths in the United States attributed to COVID-19, it has generated a myriad of responses and expense from our whole society and its leaders. Most recently, schools have reopened with variations on the learning models including a lot of online and home learning.  

There is at least one dashboard for school data about the models of learning and COVID-19 impact.  School COVID-19 related data

How will physicians adjust the COVID-19 oriented systems we've organized for the Pandemic to respond to cold and flu season?

This question and many more pop up as we start to think about coughing, aching, febrile miserable patients who want to see their physician.  Will video visits suffice  for the coming viral onslaught this winter?  Will patients want to enter an office where coughing people have been?  Will we further develop the parking lot approach to patients with a drive through, service in your car approach?  Or a drive through or walk through tent in the parking lot for privacy during the physical exam?  Will we still do the ENT- ears, nose, throat - part of the exam or the lung exam which includes "take a deep breath in and out through your mouth" for each lung area? 

Many questions and many options arise as we ponder our response to the waves of mucous, droplets and mists of microbes that will greet us from our patients.   

One aspect of the viral mucous challenge is a major concern for physicians- the being unavailable for 14 days of practice.  Many patients will have needs for care during those 2 weeks of quarantine.  What will they do?  Will the physician have enough energy and focus to offer phone or video visits during the 14 days?  Will revenue generated or not generated during the time away from practice combined with losses during the first two months of the Pandemic lead to closing or selling the practice?  

Lots of family physicians went out of business already during the Pandemic.  There is very little in financial reserves for many who made it through the first half of 2020.  What's next?

Flu shots.  

Monday, August 17, 2020

Corona Sports: Buckeye Football, Buckeye Fans, and Buckeye Hearts

How do we understand the various football conferences "Postponing" their competition to spring?  As a Buckeye fan, I felt a vacuum suck out my gut when I heard the news.  As a Family Physician, graduate of The Ohio State University College of Medicine, former faculty in the Department of Family Medicine 1990-94 (when we, humbly, were honored as one of the top five primary care medical schools in America by US News and World Report twice), and a patient who had a 5.2 CM kidney stone removed at OSU Medical Center, I'm disappointed.

I love Ohio State.


OK, some people worship the Buckeyes, a concept I recognized by recognizing it with a song I wrote called:

"Jesus or the Buckeyes"

Jesus or the Buckeyes, Which one is your Lord?

Which one gives you hope Through the shouting of their word?

Do you need a touchdown To know that you’re alive,

Or prayer and praise and worship To learn how you should strive?


Jesus or the Buckeyes What can ease your stress?

Will script Ohio save your life And let you find your rest?

Will Urban Meyer call a play To save you from your boss?  

Will Jesus come and “dot your I” Just when all seems lost?


Jesus or the Buckeyes Which one makes you whole?

Which one gives you hope  For the healing of your soul? 

Will cheers and banners fill your heart With hope for victory?

Or heartfelt prayer and Jesus love At home upon your knees.

Chorus:

Jesus or the Buckeyes? Which one “dots your I?”

Which one gives you comfort When you’re about to die?

O-H, I -O may not set you free 

The I that you need dotted Is in B-I-B-L-E.


OK, I'm reminded that some priorities are above Buckeye football.  BUT... the decision to not play this fall seemed to be heavily weighted with a consideration/intense fear about athletes getting COVID-19 induced myocarditis and then, sudden death.  There are TWO examples of athletes having that problem, without the sudden death, in the news articles about the decision.  In hospitalized patients with COVID-19, many have a transient myocarditis.  BUT, the athletic and university leaders expect to have competition in the spring, when the corona virus will still be around and some may get the myocarditis, and it will get diagnosed and treated since they are in a good medical system with good team physicians. 

In the meantime, thousands of college athletes won't be playing sports, but they will be catching the virus.  They may not do as well fighting the virus, since well conditioned people fight viruses better than deconditioned people.  Some will get the myocarditis.  Will they be feeling good enough to play?  Will it be diagnosed and treated as well as it would be in the OSU healthcare system (for example, considering our athletes)?  Will some of our student-athletes get more exposure to the virus in the less controlled setting of the campus or their hometown?

The athletes in the SEC and ACC and my alma mater team, The Army Black Knights of West Point are going to play.  Navy and Air Force are also intending to play.  Air Force conference has cancelled fall sports, but agrees to let them play, at least the other service academies.  Are their health risks any different than the Buckeyes?   Is their healthcare from sports physicians and their campus healthcare systems better than the Buckeyes? 

AND, in the rest of America, those with COVID-19 in the under 50 age groups usuallydon't even get examined by physicians if they get COVID-19.  They might call their doctor with symptoms and get sent to the drive through testing site.  In 2-7 days of self quarantine, they may call their doctor again to clarify how they're doing.  At the appropriate time after fever and some other symptoms have resolved, they go back to work, following CDC website guidelines.  Do they have to get an EKG, Echocardiogram, Troponin blood test and see a cardiologist?  NO.  The NBA does since they are perceived to have extra risks of myocarditis and, therefore, increased risk of sudden death.  Fed EX workers don't have to get cleared by a cardiologist, even though they may be lifting a lot and chased by dogs sometimes, even after having COVID-19.

I was Head Team Physician for Denison University (Woody Hayes alma mater, by the way) for over a decade and remember the intensity and commitment of the athletes.  They love the competition.  They generally know and follow the in season training rules.  They all signed the consent forms acknowledging the dangers of their respective sports ("even death", was on the forms they signed).  Their conference, The NCAC won't have fall sports due to issues related to COVID-19.

The athletic systems haven't supported their arguments by producing the estimated numbers of actual at risk players who might die because they played after COVID-19.  They could have said instead that they are so afraid of COVID in athletes that any athlete who caught it would be banned from playing.  That would eliminate the risk of sudden death at practice or in a game, if that's their ultimate concern.  They didn't even have to do that.  Each athlete and/ or their parents signs a document acknowledging that they could be seriously injured or even killed playing their sport.  Parents even have to sign a similar form for little league players.  The authorities have only to add a clause about possible exposure to infectious diseases such as COVID-19 and, not surprisingly, almost every athlete and/or their parents would sign it.  They want to play.  I believe they should have the right to make that decision, since they are the reason given by the Big 10 Conference and others for the decision to cancel the seasons.

"I would say we have seen enough to develop a safe plan.  They have not," Dr. Catherine O'Neal said as an infectious disease specialist at LSU in the SEC, referring to the Big 10 and Pac 12 decisions not to play.  The (so-called) "Medical Facts" are the same for all the physicians, they just interpret them differently.

That's my opinion..What's yours?


Jesus or the Buckeyes,Which one is your Lord?Which one gives you hopeThrough the shouting of their word?Do you need a touchdownTo know that you’re alive,Or prayer and praise and worshipTo learn how you should strive?Jesus or the BuckeyesWhat canease your stress?Will script Ohio save your lifeAnd let you find your rest?Will Urban Meyer call a playTo save you from your boss?Will Jesus come and dot your I”Just when all seems lost?Jesus or the BuckeyesWhich one makes you whole?Which one gives you hope For the healing of your soul?Will cheers and bannersfill your heartWith hope for victoryOr heartfelt prayer and Jesus loveAt home upon your knees.
Chorus:Jesus or the Buckeyes?Which one dots your I?Which one gives you comfortWhen youre about to die?O-H,I -Omaynot set you freeThe I that you need dottedIs in B-I-B-L-E.
Jesus or The Buckeyes by Pat JonasJesus or the Buckeyes,Which one is your Lord?Which one gives you hopeThrough the shouting of their word?Do you need a touchdownTo know that you’re alive,Or prayer and praise and worshipTo learn how you should strive?Jesus or the BuckeyesWhat canease your stress?Will script Ohio save your lifeAnd let you find your rest?Will Urban Meyer call a playTo save you from your boss?Will Jesus come and dot your I”Just when all seems lost?Jesus or the BuckeyesWhich one makes you whole?Which one gives you hope For the healing of your soul?Will cheers and bannersfill your heartWith hope for victoryOr heartfelt prayer and Jesus loveAt home upon your knees.
Chorus:Jesus or the Buckeyes?Which one dots your I?Which one gives you comfortWhen youre about to die?O-H,I -Omaynot set you freeThe I that you need dottChorus:
Jesus or the Buckeyes?Which one dots your I?Which one gives you comfortWhen youre about to die?O-H,I -Omaynot set you freeThe I that you need dottedIs in B-I-B-L-E.

Sunday, August 16, 2020

50th Anniversary Vietnam Service Post 3

  I followed orders and flew to Cam Ranh Bay, reporting to the 18th Engineer Brigade, which sent me to their aviation unit.  I was instructed to meet with someone the next day to get my specific assignment.  In the mean time, they had a cookout and a volleyball game which was a pleasant way to meet some other pilots who flew for the Engineers.  

The next morning, I got the word from a captain in their aviation unit that my assigned unit would be the 45th Engineer Group headquarters, which had an aviation section.  The captain pointed on the map of Vietnam to the location of the Group in Phu Bai (which I was later told meant the "land of the dead ").  "What are those red pins on the map?" I asked.  "Oh, that's where the 45th Engineer Group Aviation Section had been taking fire from the enemy."  I already noticed that there were no such pins in the area around Cam Ranh Bay.  My assignment might be more "engaging" in I Corps where I was headed.  The area of operations of the 45th Engineer Group was I Corps which was the northernmost area of military operations in South Vietnam, extending north to the Demilitarized Zone - DMZ (there was a II, III, and a IV Corps).  

I flew from Cam Ranh Bay to Phu Bai that day and reported to Headquarters of the 45th Engineer Group.  Personnel assigned me to the Aviation section and a hooch - Vietnam War slang for a thatched hut or improvised living space- my plywood home for the next several months.


Our Aviation section shortly after my arrival in Phu Bai: Cpt Sherk, Cpt Holland, Cpt. Jonas, Lt Marsh, CW2 Leo Childress, ?, SSG Cooper (L to R standing) Sitting Sp4 L. Kawai, ?, Sp4 Washington, ?, ?, Sp4 M. Metro. 2nd row includes Sgt. Jones, Sp4 Steele, May, (Sorry I don't remember everyont)


Some facts about the 45th Engineer Group:

45th Engineer Group (Construction)

Arrived Vietnam: 8 June 1966
Departed Vietnam: 30 January 1972
Previous Station: Fort Bragg
Authorized Strength
HHC
1966 - 98
1968 - 111
1970 - 111

The 45th Engineer Group was under the 18th Engineer Brigade throughout its service in Vietnam, planning a coordinating the activities of its assigned and attached units. These consisted of construction or other units engaged in the field construction, rehabilitation, or maintenance of facilities in support of the U.S. Army or Air Force operations. The group arrived at Cam Rahn Bay and moved to Dong Ba Thin on 15 July 1966. It relocated to Tuy Hoa on 15 October 1966, moving to Qui Nhon that December. It moved north to the Phu Bai area in February 1968, where it assumed general construction support missions for the I Corps Tactical Zone. The group then remained in the Da Nang area until departing Vietnam. The following engineer battalions served the group one time or another;

14th Engineer Battalion       39th Engineer Battalion
19th Engineer Battalion       84th Engineer Battalion
20th Engineer Battalion      299th Engineer Battalion
27th Engineer Battalion      577th Engineer Battalion
35th Engineer Battalion      589th Engineer Battalion
More later

50 years of Vietnam Memories: Arriving in July 1970

 

50 years of Vietnam Memories: Arriving in July 1970

OK, off to Vietnam in July 1970.  That was 50 years ago and I've processed lots of thoughts about the Vietnam Conflict/ War in the interim.  I'm pleased to have served in Vietnam. 
 
My reflections are through a lens of awareness that 58,318 names, including twenty of my West Point classmates, representing those who died as a result of their service in Vietnam, are engraved on the Vietnam Veterans Memorial ("The Wall").  I have an array of books about Vietnam to try to better understand it from multiple perspectives.  Some are enlightening.  Some are troubling.  Some, such as Visions of War, Dreams of Peace -Writings of Women in the Vietnam War, edited by Lynda Van Devanter and Joan A. Furey (poetry) can be gut wrenching.  Here is an excerpt from Mellow on Morphine by Dana Shuster in 1967:
                                  "...Mellow on morphine, he smiles and floats
                                    above the stretcher over which i hover
                                    I snip an annular ligament
                                    and his foot plops unnoticed into the pail,
                                    ....His day was just starting when his hootch disappeared
                                    along with the foot and at least one friend...
                                                                                                                                      
 
In another book In Retrospect, the late Robert McNamaraSecretary of Defense in the Kennedy and Johnson administrations, laments, "This is the book I planned never to write.... I want to put Vietnam in context.          
    We of the Kennedy and Johnson  administrations who participated in the decisions on Vietnam acted according to what we thought were the principles and traditions of this nation.  We made our decisions in light of those values.
    Yet we were wrong, terribly wrong.  We owe it to future generations to explain why."

We arrived in Saigon after a very long flight, the last leg starting in Japan.  As we descended, I noticed what looked like a large section of countryside pockmarked with small bomb craters, which actually were graves in  a huge cemetery, I noticed as the lower altitude afforded a better focus.  Several buses transported the 200 or so Army men who had shared the flight from the landing strip around or across a part of Saigon via a rubber tree plantation to Long Binh where we would get our unit assignments at the Replacement Depot (or something like that- excuse the 50 year old fog).

I remember filing out some forms asking about assignment preferences that would accompany my personnel file and official orders for service in Vietnam to be reviewed as my unit assignment was decided.  I expressed a preference for assignment in an aviation role with an Engineer unit, since I was an officer in the Corps of Engineers.  I then waited in a bar with many other members of my flight school class for the listing of names and assignments as they were posted on a bulletin board.  Several of my fellow pilots were assigned to the !st Cav and we drank a toast to the Cav.  After a short while of wondering, my name showed up on a list as the only one assigned to the 18th Engineer Brigade in Cam Ranh Bay.  I laughed and drank another Budweiser, assuming that I would spend the year with the Engineers based at Cam Ranh Bay, which probably had some level of creature comfort.
  Some US Army pics at Cam Ranh Bay 1970-71
Here are the first pictures I took in Vietnam.  Just getting adjusted.