Swerd

Swerd

Audioholic Spartan
I saw a rheumatologist last year. Do you recall what blood test or other test was able to diagnose you with AS? Do you have difficulty bending your spine? Are you HLA-B27 positive?
The major symptom I have is auto-immune inflammation of my eye, my left eye only, go figure. It is said by a British (?) study of AS, that 30% of AS patients had no other symptoms.

My blood tests for RF and HLA-B27 were both negative. That same British study said 90% of those AS patients had the B27 haplotype. I do not.

I am not aware of any major difficulty bending my spine, or of major lower back pain, but a series of x-rays of my lower spine and pelvis joints showed enough signs of inflammation to diagnose me with AS. That was enough for the rheumatologist to make the call. I did not suffer from any of this until my 60s, clearly not juvenile onset AS.
 
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Swerd

Swerd

Audioholic Spartan
I know there is also a problem with most studies as they don't take into account the lifestyles of the people being tested. What is their diet, do they smoke, do they excessively consume alcohol, exercise etc. There are so many factors to consider.
It's not only their diet and lifestyle, it's their genetic background, where they live, their age, and general health, as well. Lab scientists would much rather study these things in strains of in-bred mice, where all the mice are genetically identical, they all eat the same food, and live in the same place. That way we don't have to rely so much on statistics to explain away sampling errors.
We don't have in-bred humans… outside of West Virginia :rolleyes:.
 
Swerd

Swerd

Audioholic Spartan
I have to say that I'm distressed as to how this discussion has degenerated into inconsequential drivel.
Not surprising considering how many of us are essentially locked in, riding out the self-imposed shutdown.

I know I've read far too much news lately, most of it bad news or just plain infuriating. So we vent about it here on the Steam Vent.
 
Swerd

Swerd

Audioholic Spartan
@Verdinut – I admit, I did come down harshly on the paper you linked about Vitamin D supplements. Please don't take that personally. I sometimes did serve as a referee for a scientific journal, so I know the language to use when rejecting a paper. It can sound harsh. I also tend to see RED when I run into opposition to vaccinations against infectious diseases.

Your particular argument against the yearly flu vaccine isn't entirely wrong. Some years, the vaccine isn't very effective at all. So why not take both the yearly flu vaccine and Vitamin D supplements?

I do hope for one good thing to come out this Covid-19 nightmare. It's that the irrational opposition to vaccinations dies a well-deserved death.
 
mtrycrafts

mtrycrafts

Audioholic Slumlord
Hot off the press.
Businesses controlled by the president, vice president, members of Congress and heads of federal agencies are not eligible for loans.

Does this include family members? He can say he doesn't control anything, his kids are in charge.
Or, how about direct aid without a loan?
 
D

Danzilla31

Audioholic Samurai
I have to say that I'm distressed as to how this discussion has degenerated into inconsequential drivel.

Let me say right now that this pandemic is actually turning out to far worse than anything I imagined.

The death rates in Italy and Spain have now both surpassed China and both have much smaller populations.

The mortality in France and the UK are going up smartly. The UK is under lock down.

New York is a disaster with other areas like New Orleans following. According to Dr Birx at the news briefing today the mortality in New York is running at 3.1% which is very high. The bodies are stacking up.

JAMA this evening has just sent a paper from China now showing this miserable virus is cardiopathic. They show that 20% of their more serious cases have cardiac damage. If this is confirmed this has enormous implications going forward.

The UK and others are reporting more serious illness in the young including babies now. The UK has a very seriously sick 6 month old with no underlying disease. They have lost a previously healthy and athletic 21 year old. In the US a 17 your old athlete has died of the disease. The UK are noting serious illness in pregnant women

The mortality in New York is going to rise astronomically as they need 30,000 more ventilators according to the governor and can only obtain 400. They are now considering ventilating 2 patients with one ventilator. This is very suboptimal care.

In Minnesota we are going under lock down for at least 2 weeks with compulsory shelter in place orders for all but essential services.

There are now plans being drawn up to convert the huge US bank stadium into a huge temporary hospital.

London that is reeling from this. The UK is now under a shelter in place order. The UK has taken a leaf out of China's play book, and built a new 4000 bed hospital in the old East End docklands on the North bank of the Thames just down River from Canary Wharf. They hope to have this on line Monday or Tuesday and it can't come soon enough.

I have a horrible feeling this nightmare will now go on until we have an effective vaccine unless immunity proves to be very long term and we can get to 70% herd immunity at least. However we will still need a vaccine.

Any Trump speak of easing restrictions prematurely is totally amoral. It is now fatuous to compare this outbreak to any influenza out break. This is far, far more serious. Dr Tedros Adhanom Ghebreyesus leader of the WHO told Trump off good and proper today without naming names, but everyone know who he was talking about!

Whatever we do now the worlds economy is going to be left shattered. Life form here on out will be different for all of us in ways we can not imagine now.

I spoke with a very good friend of mine who was one of our general surgeons. We arrived in Grand Forks on the same day and worked very closely together for 40 years.

He has been in touch with some of our former residents. According to him he thinks the skills of retired ICU physicians will be required before this is over.

I'm high risk for this virus and I have intended to stay in total isolation until this pandemic is in the rear view mirror even if it takes over 12 months. However may be my plans will have to change.

After this is over biology must take precedence over economics. Actually a lot of us are not surprised by this catastrophe. The Corona family of viruses have shown a very worrying tendency to be able to jump species over the last 20 years. Historically viruses have been highly species specific. We now have a very worrying trend. The worry is in infectious disease circles that we may "have seen nothing yet!"

One last point. Be cautious about ordering from Amazon now. There are early indicators the virus is probably rampant in the Amazon system.

This virus survives 24 hours on cardboard and paper and 3 days on plastic.

My wife and I were worried about this before today's reports. If the package is non urgent we handle it with gloves and put it into the garage for the appropriate time handling it with gloves. All packages are also disinfected.
I know I don't know you very well and anything you chose is greatly respected but I feel compelled to say please be careful if you decide to jump back in the front lines.

As you stated your at high risk if you catch this and I know your family probably needs you now as well as others. It won't help at all to have you rush down there and get put in intensive care when many here and your family And friends could benefit greatly from your knowledge and help in your community

You've put yourself on the front lines your whole career it sounds like man just because I don't know you that well doesn't mean I don't care.

I know your heart as a doctor is going out to all the suffering right now and your proffesional colleagues but please weigh the options carefully before you'd go off and do this

I hope I'm not out of line for expressing this
 
Verdinut

Verdinut

Audioholic Samurai
@Verdinut – I admit, I did come down harshly on the paper you linked about Vitamin D supplements. Please don't take that personally. I sometimes did serve as a referee for a scientific journal, so I know the language to use when rejecting a paper. It can sound harsh. I also tend to see RED when I run into opposition to vaccinations against infectious diseases.

Your particular argument against the yearly flu vaccine isn't entirely wrong. Some years, the vaccine isn't very effective at all. So why not take both the yearly flu vaccine and Vitamin D supplements?

I do hope for one good thing to come out this Covid-19 nightmare. It's that the irrational opposition to vaccinations dies a well-deserved death.
@Swerd,

I've heard of some people having taken the vaccine becoming sick with flu. Also, on TV tonight, someone in the medical circles was mentioning that the flu vaccine was not as effective for older people. I beg to disagree but that adds to my arguments against it. I have been taking other vitamin and mineral supplements for over 35 years and I haven't had the flu for at least 25 years.
 
D

Danzilla31

Audioholic Samurai
The situation we are going through reminds me off my proffesion in mental health

For years and years budget cuts and bad decisions have stripped our resources to where quiet frankly The system is broken and we are left dealing with the problem at the acute level only

Meaning we stabilize them through intensive in patient and then after they regain functionality and there quality of life as a human being there are very few resources set in place anymore for long term care aftercare support followup treatment preventative maintenance

As a result they revolve in and out in and out and you watch the light and spirit slowly leave there eyes as they suffer vicious decompensation and relapse into the illness again and again.

Then the day comes where we find out through the news that one of them was found frozen to death homeless under a bridge or shot or commited suicide or die in other tragic ways so many don't make it that could

Basically we have accepted long ago that many of our patients are not going to make it due to the resources at hand and we do the best we can with what we have

Basically we've had to accept that we are in a triage care situation and we have to allocate our resources as best we can and try to make impacts and reverse outcomes as best we can providing at least as good as quality of life as we can for so many that keep slipping through the cracks

And that gentleman is what I'm afraid our medical community is probably going to end up being forced into with this situation

Your in the same boat psychiatric care has been in for awhile

Some tough decisions are going to have to be made both on the front lines medically and in the economy if we indeed enter into a state of triage care

My prayers And heart go out to everybody going through this right now
 
GO-NAD!

GO-NAD!

Audioholic Ninja
@Swerd,

I've heard of some people having taken the vaccine becoming sick with flu. Also, on TV tonight, someone in the medical circles was mentioning that the flu vaccine was not as effective for older people. I beg to disagree but that adds to my arguments against it. I have been taking other vitamin and mineral supplements for over 35 years and I haven't had the flu for at least 25 years.
 
highfigh

highfigh

Audioholic Overlord
Tremendously.
22K deaths, so far- I don't think it qualifies as 'tremendously', yet.

"The Small Arms Survey report, published on Thursday, estimated that 385,000 people were killed in homicides across the world in 2016, an increase of 8,000 on the previous year."


"Mexico recorded 9,916 murders in the first five months of 2017, roughly a 30% increase over the same period last year."

 
highfigh

highfigh

Audioholic Overlord
This virus survives 24 hours on cardboard and paper and 3 days on plastic.

My wife and I were worried about this before today's reports. If the package is non urgent we handle it with gloves and put it into the garage for the appropriate time handling it with gloves. All packages are also disinfected.
Yeah, about that 24 hours-

 
highfigh

highfigh

Audioholic Overlord
It's not only their diet and lifestyle, it's their genetic background, where they live, their age, and general health, as well. Lab scientists would much rather study these things in strains of in-bred mice, where all the mice are genetically identical, they all eat the same food, and live in the same place. That way we don't have to rely so much on statistics to explain away sampling errors.
We don't have in-bred humans… outside of West Virginia :rolleyes:.
Never been to Arkansas, eh? :)

The video I watched referred to sunlight exposure as being very important in how people raised their Vitamin D levels.
 
TLS Guy

TLS Guy

Audioholic Slumlord
It seems we need a quick primer on Vitamin D.

There are two sources of vitamin D. The major source is skin synthesis from sunlight, however there are huge racial differences. The other source is in our food. It is fat and not water soluble and is itself an oil.

Now somewhat paradoxically Caucasians synthesize vitamin D from sun light in much greater quantities than black skinned people of African origin and other dark skinned races in general.

Now Caucasians who tan synthesize vitamin D at the highest rate of all from sunlight.

Now Vitamin D is not readily excreted in large quantities. So I suspect that these racial differences in synthesis are related to hours and intensity of sunlight at the area of the globe of origin. As you go to the poles there is less sunlight than at the equator.

Now as I think you know I set up and lead the nutrition support team at our hospital for 30 years, mainly to support very sick patients through prolonged critical illness.

Our population was heavily northern European Caucasian. I pretty much never saw Vitamin D deficiency , but I did see toxicity.

You should only supplement vitamin D in the winter and then never at over 1000 units per day. Taking more than that is dangerous. If you are a Caucasian that tans I would not supplement vitamin D at all.

My recent case was interesting. I am a Caucasian that tans easily. Now over the years I had two slightly elevated blood calcium levels. I never really paid much attention. However when my left hip prosthesis started to loosen 18 months or more ago, I started to wonder if I had hyperparathyroidism. So I pushed my local quack into doing blood tests I requested. Despite my calcium being normal I had unequivocal evidence of hyperparathyroidism. This was confirmed at Mayo clinic and I had the offending tumor removed a year ago. Now this disease leeches calcium from the bones which was why my hip was loosening. So the endocrinologist had me take 1000 units of vitamin D a day. My calcium went up and I quickly showed vitamin D toxicity! So that was fast demonstration of having to be careful with vitamin D in Caucasians who tan! I'm glad to report that my hip showed good prompt new bone growth at the stem without vitamin D and calcium supplements.

The bottom line is that there is a load of dangerous and bogus information about vitamin D and it is spilling into this thread.
 
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GO-NAD!

GO-NAD!

Audioholic Ninja
Yeah, about that 24 hours-

They found traces of genetic material after 17 days, not live virus.
 
Dan

Dan

Senior Audioholic
TLS,

I'm not sure when you retired. If you do go back you have even greater respect from me than I already have because I know how difficult it would be to be a rusty doctor, just as if they called me back to the wards after 30 plus years.

Aside from the obvious cautions, much may have changed since you retired. If you were used to writing notes and orders by hand you will be in for a big shock. Beginning with Obamacare which mandated electronic records every hospital has gone to fully computerized charting. There are relatively few vendors and the products are basically horrible. Designed by software engineers with little or no input from practicing doctors in hospitals.They seem mostly designed for hospital administrators to keep track of supply usage and ordering patterns rather than smooth user interfaces. The system I use takes me ten times longer than writing by hand in part because I don't use it much. It is also much harder to find results.

One example on the product my system uses. Based upon the stated admitting diagnosis, the computer would recommend imaging tests. The were not based upon consulting with a radiologist or using the publicly available American College of Radiology Appropriateness Criteria which were carefully derived by experts in the field based upon exhaustive literature review (I have colleagues who have written several and told me how hard it was). Instead these software idiots did an iterative search of the internet and found articles to support recommendations. The result was that for a diagnosis of urinary tract infection they suggested contrast enhanced ultrasound as the first test based upon one article from Europe with a small set of patients. At the time ultrasound contrast agents were NOT FDA approved in this country.

If you do have to go back, good luck!
 
3db

3db

Audioholic Overlord
They found traces of genetic material after 17 days, not live virus.
Can you imagine if this was SARS ....SARS was more difficult to catch but its mortalilty rate was far higher on a percentage scale then COVID.
 

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