Preventing Severe Complications of COVID19

The virus which causes COVID19 can produce severe inflammation called a cytokine storm, which can then set off a chain reaction which results in thrombosis (tiny blood clots), which can damage all of the organs in the body.  This process is known as DIC (disseminated intravascular coagulation).  As we age, we become more prone to thrombosis, which is why heart attacks and strokes are more common among the elderly.  Men are more prone to thrombosis than women.  Certain medical conditions put you at higher risk of thrombosis, including high blood pressure, high cholesterol, and diabetes.  Smoking and eating processed foods increases the risk of thrombosis as well.

These are the reasons why COVID19 poses a higher risk for the elderly, for men, and for those with certain chronic medical conditions.  If you have one of these conditions, the best thing you can do is to keep that condition under good control by taking your medication, eating healthy foods, exercising, avoiding smoking, and getting plenty of sleep and water.

For these same reasons, medications which lower your risk of heart attack and stroke seem to prevent COVID19 complications, such as statins like lipitor, ACE-inhibitors like lisinopril, and anti-coagulants such as aspirin and Plavix.  N-acetyl cysteine and Vitamin C also help to decrease inflammation within blood vessels and prevent thrombosis.  On the other hand, medications which increase your risk of heart attack and stroke, such as ibuprofen and other NSAIDs, also increase your risk of COVID19 complications.  If you have cold or flu symptoms, you should avoid taking NSAIDs for fever and body aches and stick to Tylenol.

Antihistamines like Claritin decrease inflammation, and Claritin seems to help with COVID19 prevention.  Vitamin D helps to suppress inflammation as well.  In fact, Vitamin D and antihistamines decrease inflammation by the same molecular pathway as chloroquine.  Zinc prevents viruses from replicating, so it is helpful in preventing COVID19.  One of my colleagues works at one of the leading infectious disease centers in the US, and they are recommending the following regimen to all of their medical students and residents: Claritin 10 mg once daily and a multivitamin three times daily, in order to get adequate Zinc, Vitamin C and Vitamin D.  Although I do not typically recommend daily multivitamins, during this pandemic, I am taking and recommending this regimen.  Although the benefits have not been proven, the potential benefits outweigh the minimal risk of taking these supplements.

Treating COVID19 with Hydroxychloroquine and Azithromycin

I have received many questions about azithromycin and hydroxychloroquine.  These medications have been on the news, and some politicians and reporters are touting them as miracle cures.  At this time, these medications are being used experimentally for treating COVID19, mostly on hospitalized patients with severe disease.  The studies which have been done are small with mixed results.  Hydroxychloroquine and chloroquine are currently being investigated in randomized controlled trials, but at this time, we cannot say with any certainty whether these treatments work.

Azithromycin, chloroquine, and hydroxychloroquine all have anti-inflammatory properties.  Azithromycin is an antibiotic, which means that it is used to treat bacterial infections and has no effect on viruses, including corona viruses.  However, azithromycin is given to patients with certain inflammatory lung conditions to clear up the inflammation.  Hydroxychloroquine and chloroquine are used for treating and preventing malaria, a parasite which attacks red blood cells.  Hydroxychloroquine is also used in treating autoimmune inflammatory conditions such as rheumatoid arthritis and lupus.  Hydroxychloroquine may actually help to prevent the COVID19 virus from entering our cells.

The majority of patients with COVID19 have mild cold symptoms and do not require any special treatment, but certain high-risk individuals develop severe inflammation which affects lung function, sometimes requiring a ventilator.  Azithromycin and hydroxychloroquine have been used together to treat severe cases of COVID19.  Both medications can cause very serious side effects, including a fatal heart arrhythmia.  This particular risk increases when the two medications are taken together; however, hospitalized patients have continuous heart monitoring.  A local hospital was previously treating all COVID19 patients with both azithromycin and hydroxychloroquine and is now only using hydroxychloroquine.  It is unclear whether this change was made due to the complications of taking these medications together or because azithromycin was shown to be ineffective.

At this point, I feel that the risks of taking these medications for prevention or for treating mild cases of COVID19 outweigh any benefits.

Ahhh Choooo! Is it Allergies?

Hampton Roads, Virginia is one of the top two regions of the country for Allergic Rhinitis.  Tucked between the ocean and the mountains with a temperate climate, allergens swirl through the area all year long.  Many people experience a flare of their allergy symptoms during one or more seasons, but some people have symptoms year-round.

The body’s immune system inappropriately responds to things in the environment like dust and pollen as if they were parasites, which is why it can be difficult to tell if you have a cold or allergies.  You may experience increased sinus congestion with runny nose, post-nasal drainage with sore throat and cough, headache, pressure in your ears, and even muffled hearing and dizziness due to trapped fluid behind your ear drums.  For these symptoms, an over-the-counter nasal steroid spray can help to decrease your sinus congestion and pressure.  You may experience symptoms of high histamine levels like itchy watery eyes, itchy ears, itchy nose, sneezing, and hives.  Over-the-counter antihistamines can help with these symptoms.

Prescription medication is available to suppress the part of the immune system responsible for causing allergic rhinitis, which can also help with related conditions like asthma and eczema.  There are also herbal supplements, such as stinging nettle, quercetin, and bromelain have been shown to decrease allergy symptoms by promoting a healthy immune system and decreasing inflammation.  Finally, immunotherapy can slowly decrease your response to certain allergens through controlled exposure.  You can get allergy shots or drops under your tongue.  You may even benefit from a natural form of immunotherapy by consuming local honey, since it contains local allergens.

If you’re suffering from allergy symptoms and want to explore your treatment options, I can help you!

Monkey Mind

This morning, my six-year-old son hopped into bed with me, and I asked him how he had slept.  “Not good,” he replied, “I was trying to sleep, but my brain was like ‘Oh, I want to talk to you! Oh, I want to talk to you!’”  Amused, I asked, “What did your brain want to talk to you about?”

“I don’t know,” he replied, “I didn’t say yes.”

Wow.  Is this my child or a tiny little Buddhist monk?  He intuitively knows that he is separate from the constant chattering in his brain AND that he has to give his consent to allow it in.  It was only a few years ago that I came across the idea that we are not our thoughts.  Meditation is a great way to practice letting go of all the thoughts that are buzzing through your brain, often causing feelings of overwhelm, worry or frustration.  The goal is to be able to take control of your own mind when you feel yourself losing your temper, losing your focus, or lying awake listening to your brain chatter on.

Meditation is done by focusing on the sensations in your body without any judgement, the sounds and smells, the weight of your body, the air entering and leaving your lungs.  Thoughts will inevitably appear, but the goal is to allow them to drift away as you bring your focus back to your body.  You may be able to keep this focus by silently counting your breaths or repeating a word or sound.  This is far more challenging than you might imagine.  Despite all of your best efforts, your monkey mind will surely grab ahold of you and go swinging through the trees.  You may not even notice that you’re lost in your thoughts until several minutes have passed.  Similar to physical exercise, this exercise of the brain may be unpleasant at the time, but the benefits will last all day.  Over time, your monkey mind will learn to behave.  You will sleep better.  You will find it easier to focus at work.  You will be more present with those you care about.  You will experience less day-to-day frustration.  Just remember, next time your brain wants to talk to you, you don’t have to say yes.

Should I Go To Urgent Care?

In a typical insurance-based primary care office, patients are scheduled months in advance, and there are no appointments available if you get sick or injured.  When patients call for an appointment, they are told to visit an urgent care, where they often wait for hours in a waiting room filled with patients with highly infectious illnesses, like influenza and strep.  A trip to urgent care for an injury this week may lead to a second urgent care visit for the flu next week.  These visits are necessary if you have a fracture, need stitches, need an abscess drained, or have a fish hook embedded in your skin.  It’s also important to be seen urgently for strep, for an ear infection, for a UTI, for pneumonia or bronchitis.  Patients with chronic conditions like asthma, COPD or congestive heart failure can experience sudden worsening of their symptoms which can be addressed in urgent care to prevent further worsening and need for hospitalization.  All of these issues are best addressed by your own primary care physician, but if this is not possible, urgent care is the next best option.

If you have symptoms of a serious medical condition like a heart attack or stroke, you need to go straight to the Emergency Room.  The same is true if you are having severe abdominal pain, which could be appendicitis or another serious condition.  On the other hand, if you’re having mild abdominal cramps with vomiting and diarrhea, this is a viral illness, for which there is no treatment.  Staying home and drinking Gatorade is your best bet.  If you have a cold or sinus infection, this is typically viral; it’s best to stay home and take over-the-counter cold medications for your symptoms.

If you’re a Direct Primary Care patient, you have the perfect solution right at your fingertips.  You can easily call or text your personal physician to get instant medical advice on cold and flu symptoms, injuries, pain, UTI and rashes.  Many conditions can be diagnosed and treated remotely.  Telemedicine works best when it’s provided by a doctor who already knows you and your medical history.  The best part about being a DPC patient, is that if you do need to be seen in person, your doctor can usually see you right away.