Any respiratory virus has the potential to become a pandemic. We have had influenza pandemics in the past, and we are always worrying about an influenza pandemic, but this is the first pandemic since 1918. The 2018-2019 influenza season was really bad with hospitals packed to capacity, but it did not reach pandemic level proportions. There were 35.5 million cases of influenza worldwide with 490,600 hospitalizations and 34,200 deaths. That’s a 1.4% hospitalization rate and a 0.1% death rate.
Compare that to COVID-19, which has 92.3 million cases worldwide with 1.98 million deaths. The death rate is 2%. That’s 20 times the death rate of influenza. The COVID-19 hospitalization rate is 40% for those with one underlying health condition (this includes BMI > 25) with an ICU rate of 13%. The hospitalization rate for those who are completely healthy with BMI < 25 is 9% with a 2% ICU rate. That’s at least 10 times the normal hospitalization/ICU rate during cold and flu season, and we literally don’t have room in our hospitals and ICUs, we don’t have enough ventilators for those who need them, we don’t have enough doctors and nurses to care for COVID-19 patients. Even if you are young and healthy and not worried about COVID-19, you should worry that if you get appendicitis or get into a serious car accident, you may die because there’s no room in the hospital, there’s no available ventilator for your emergency surgery.
Interestingly, viruses with a very high death rate are unlikely to reach pandemic proportions. MERS is another corona virus which had a 35% death rate. Severe symptoms requiring hospitalization usually began within 4 days. The infected were too sick to go to parties and spread the virus. Viruses with a very short incubation period are less likely to cause a pandemic for a similar reason. Influenza causes symptoms within two days of exposure, so the infected don’t have much time to spread the virus. COVID-19 has all the markers of a pandemic virus: a very long incubation period (up to 14 days), no symptoms or very mild symptoms in the majority of infected people, and a low-to-moderate rate of hospitalization and death. All of these factors allow for maximal spread of the virus and a very large number of hospitalizations and deaths even though the majority of the infected recover.
I am extremely excited about the Moderna and Pfizer mRNA vaccines which are both over 90% effective at providing immunity against COVID-19 with miniscule risk. Essentially, the only risk is a slightly higher risk of anaphylaxis (11 out of 1 million) as compared to other vaccines. Anaphylaxis is serious but very easy to treat, so as long as you are monitored by a nurse for 15 minutes following administration of the vaccine, there is nothing to worry about. This vaccine does not change your DNA, and there are no long-term side effects. Since the mRNA codes for the spike protein, which is the way that the virus enters our cells, I am not concerned about mutations decreasing effectiveness of these vaccines. Basically, if a viral mutation changes or eliminates the spike protein, this virus would not be able to cause infection. The scientific trials were done perfectly and were not rushed. The only reason that this process was faster than usual is that all of the bureaucratic red tape was eliminated and funding was guaranteed. Basically, we have these amazing vaccines not because of the government but because the government stepped out of the way.
The government response to this pandemic has been abysmal. Mandatory shutdowns and school closures have resulted in economic devastation and predictable worsening of mental health, addiction, suicide, spousal and child abuse as well as educational delays which are especially harmful to low-income children whose parents cannot afford to support their family with a single income or to pay for private schools, childcare centers, tutors, or nannies. Widespread vaccination is the best way to keep our businesses and schools open and get back to normal, but I do not believe mandatory vaccination will be necessary. I believe that enough Americans want this vaccine and that once we vaccinate everyone who wants it, we will achieve herd immunity or at least decrease the spread enough that our hospitals will be able to handle COVID-19 cases. I am encouraging my patients to get the vaccine not for the greater good but for their individual protection. I respect everyone’s right to decide whether or not to get the vaccine, but I hope that they make that decision using objective data rather than falling prey to conspiracy theories.
Is “manopause” real, and do the benefits of testosterone replacement outweigh the risks? Testosterone levels decrease by 1-3% per year starting at age 30 in men. When testosterone falls, men experience fatigue, loss of bone and muscle mass with an increase in fat, inflammation, joint pain, depression, irritability and loss of libido (interest in sex). Low testosterone levels are also associated with an increased risk of heart attack, stroke, prostate cancer, and death. Normalization of testosterone levels through testosterone replacement decreases the risk of heart attack and prostate cancer, but there are still concerns about testosterone injections and associated risks involving the liver, heart and prostate. These risks are eliminated with topical testosterone or with testosterone pellets, but 45% of men do not absorb topical testosterone. Topical testosterone is messy and can be transferred to family members and pets. Testosterone injections often make men feel like they are riding a roller coaster as symptoms return every week or two before the next injection is due. The absolute best delivery system for testosterone is pellets. They last for up to six months with consistent release of testosterone, and they decrease the risk of heart disease and prostate cancer.
Testosterone pellets are the only safe and effective way of treating women with testosterone deficiency. Women make ten times more testosterone than estrogen over a lifetime, and both hormones fall with the approach of menopause. When women have low testosterone, they experience many of the same symptoms as men, including fatigue, weight gain with loss of bone and muscle mass, inflammation, joint pain, depression, and loss of libido. Women also experience anxiety, insomnia, night sweats, memory loss, mental fog, and headaches. Testosterone pellets last for up to four months in women, and they help to prevent dementia, osteoporosis and heart disease.
If you think you may have low testosterone and are interested in an anti-aging, disease-preventing, health-promoting treatment, please reach out. I am offering hormone-replacement therapy, including testosterone and estrogen pellets, to both members and non-members.
Many women (and their doctors) are afraid of hormone replacement therapy. The Women’s Health Initiative (WHI) study followed over 160,000 postmenopausal women taking premarin (horse estrogen) and medroxyprogesterone (synthetic progestin) for fifteen years, and this combination resulted in a slight increase in the rates of heart disease and breast cancer. Premarin alone showed a decrease in heart disease and breast cancer, and the combination showed decreased rates of osteoporosis, cancer and death. Premarin and medroxyprogesterone are not bioidentical hormones because horse estrogens are different than human estrogens, and medroxyprogesterone is synthetic. Synthetic progestins increase the breast cancer risk while bioidentical micronized progesterone decreases the risk of breast cancer. Progesterone also decreases the risks of uterine cancer, osteoporosis, and heart disease. Progesterone can additionally improve mood and sleep.
Oral estrogen and testosterone increase the risks of blood clots, heart attacks and strokes, but when estrogen is delivered by pellet or patch, it actually decreases these risks. Estrogen lowers cholesterol and blood sugars and lowers the risk of diabetes, fatty liver disease, colon cancer, and cardiovascular disease. Estrogen increases blood flow to the brain, decreases inflammation, improves mental functioning and mood, and decreases the risk of Alzhiemer’s dementia. Estrogen builds bones and can prevent and treat osteoporosis. Estrogen restores young, healthy vaginal tissue for optimal sexual functioning and prevention of urinary incontinence and urinary tract infections. Estrogen replacement can reduce wrinkles, joint pain, headaches, hot flashes, and night sweats. As long as you are taking the right hormones the right way, you can improve your health with very little risk.
It’s allergy season again (does allergy season ever end in Hampton Roads?) If you suffer from allergies, you may be miserable with itchy watery eyes, runny nose, sneezing, sore throat, cough, sinus headaches, earaches, dizziness, and fatigue. You may also get frequent colds, ear infections, and sinus infections. If you have asthma, allergies can cause frequent flares and even trips to the emergency room. Allergies can make eczema worse and cause other allergic rashes, like hives. If you have food allergies, they may worsen during allergy season.
You may have considered allergy shots or even tried them. Allergy shots are a form of immunotherapy: giving yourself tiny doses of the things that you’re allergic to on a regular basis for several years until your allergies resolve. Allergy shots are extremely expensive, around $10,000 per year. Allergy shots are inconvenient because you have to visit your doctor once or twice a week to get a shot. Allergy shots have a low success rate, probably because it’s so challenging to keep hundreds of doctor’s appointments and get hundreds of shots.
There is another form of immunotherapy which is much more effective, convenient and affordable: sublingual immunotherapy. These are drops which you place under your tongue several times per day. It’s pain-free and easy and does not require any trips to the doctor. 70% of those who complete sublingual immunotherapy cure their seasonal allergies, pet allergies and even mild food allergies. My patients can obtain allergy testing and treatment for less than $800 per year! There’s no need to continue suffering. Contact me today to get started.
I know that many people do not get an annual flu shot. Some people hate to get it because they feel sick afterwards. Others are just frustrated that even after getting a flu shot, they still get the flu. Let me share some information about the flu shot and why I get one every year myself and make sure that my husband and children get one as well.
The flu shot contains proteins from several strains of the influenza virus. Since the vaccine does not contain the virus itself, you cannot get the flu from the flu shot. You may experience some flu-like symptoms after getting the flu shot, which is a sign that your immune system is making antibodies against the flu.
Every year, an educated guess is made about which strains will be the most common, and the flu shot will be more or less effective depending on the strains chosen. If you develop antibodies against a particular strain of influenza and encounter that strain, you will not get sick. If you encounter a different strain of influenza, you may still have partial immunity based on the antibodies that you do have. Although you may get the flu, you will experience milder symptoms and will not be at risk of severe complications and death. If a COVID-19 vaccine is made available, it will have the same issues as the influenza vaccine due to multiple strains of SARS-CoV-2.
So, I get the flu shot for myself and my family to protect against hospitalization and death. I also hope, as a bonus, that we won’t get the flu at all. Last year, my entire family got the flu despite the flu shot, but our illnesses were brief and mild. I had fully recovered within two days.
Last flu season was a terrible one with an estimated 56 million cases of influenza in the US with 740,000 hospitalized and 62,000 deaths. In January 2020, there were so many patients hospitalized with influenza in Hampton Roads, that none of the hospitals had available beds. I fear that next flu season will be even worse due to high numbers of both influenza and COVID-19 patients requiring hospitalization.