This question arises from the way the virus enters the cells of the body. It uses the ACE2 receptor on cells to access the inside and get the RNA into the cells to replicate. In patient taking ACE inhibitors and Angiotensin Receptor Blockers, these receptors may be increased.
So the first thing to realize is that every blood pressure medication is not called into question. Only medications that end in pril and medications that end in sartan, and possibly spironolactone, are the medications that are being discussed. The second thing to realize is that this discussion at this time is purely theoretical. So……
Currently, the answer to this question is yes. We do not have enough information to tell our patients to stop taking medications that we know are beneficial to them. There are thousands of doctors having these conversations daily, and we keep coming to the consensus that our average, healthy patients should stay on these medications. In more critically ill patients, that’s a different decision, that should be made on a case by case basis, by each individual physician. But please, if you’re healthy, don’t call your doctor demanding to be taken off these medications…at least not yet. We just DON’T have enough information, and strokes, heart attacks, renal failure–they’re still a threat, guys.
What was thought to be a very promising combination of therapies turned out not to have a huge benefit when studied in a large combination. This was recently published in New England Journal of Medicine, and is quite disappointing.
Chloroquine/Hydroxychloroquine +/- Azithromycin
Currently, these medications show the most promise. However,
they are only being studied in the critically ill, AND they haven’t been “studied”
in the traditional sense. That means, we don’t quite understand benefit and
risk profile in patients who aren’t critically ill. In addition, using these
medications in mild cases means that patients who need the medication for their
chronic illness (i.e. Lupus) aren’t being able to access the medication. This
is a harm to these patients. Please do not ask your physician for this
medication if you are only mildly ill. We are weighing risk and benefit of these
new therapies and having to take the greater good into account. Right now, the benefit
DOES NOT outweigh the risk in mild cases, despite Donald Trump’s lay opinion.
There is a company that is targeting the cytokine storm that causes the severe outcomes of this illness. Again, very early—not much out there.
Trial
The WHO is launching a more scientific trial, described here.
The Vaccine
They have started human trial in a hurry. And as quickly as
they are trying to get there, in order to safely do this, they have to monitor
people for at least 14 months before they can say that this is safe to inject
into the general population (so for all the anti-vax people out there—understand,
we do not take this lightly, and this is happening much faster than typically
makes people comfortable, but a vaccine, and herd immunity, is our best defense
against any illness).
You remember when I told you may favorite things to take to strengthen your immune system? Turns out, this illness, when severe results can result in cytokine storm, and this is one of the things thought to contribute to the mortality of this infection. Turns out, this is part of the way elderberry strengthens the immune system, and many are cautioning that it SHOULD NOT be used in this illness. Remember, my blog is not to be taken as medical advice—particularly in this extremely fluid situation. I’m not even sure what to do here myself! Because there is so little understood, I am currently still taking my elderberry, but at this point, I would stop it if I were to become ill. What would I say as a physician to my patient? If my license were behind it, given the risk, I would recommend against it. When it’s not a personal choice, but a professional one, I don’t take risk lightly AT ALL. Hopefully this sheds some light on how little we understand—talk to YOUR physician. Ask their opinion. Again, when it’s my license, I’m extremely risk averse.
NSAIDS may worsen the course of the illness, but there is inconclusive data. The WHO officially recommended against taking the medication (then took it back), but the article that reports this even notes that we aren’t sure, and the general consensus I’ve seen among physicians is that if it’s beneficial for our patients and they aren’t severely ill, they should continue their anti-inflammatory regimens unless they are particularly ill. Remember, ALWAYS CONSULT YOUR PERSONAL PRIMARY CARE PHYSICIAN PRIOR TO A CHANGE IN YOUR MEDICATION.
It is a new Coronavirus that originated in a bat in Wuhan, China. It causes the illness COVID-19. It has mutated at least 2 times and is now causing a pandemic. It is believed to have a mortality of between 1-3%, but this could be lower, because we aren’t testing enough mild cases. Either way, it is causing lots and lots of people to die and will cause a lot more people to die if we don’t do our parts to slow the spread. At this point, it’s inevitable that the virus will be everywhere—at least that’s what epidemiologists much smarter than me are saying. The important thing is that it not be everywhere all at once, so that doctors and nurses have time to help people, and people who don’t have to die, don’t die simply due to lack of resources. This is what is meant by flattening the curve, and this is why we are asking people to socially isolate. This article explains why this is important. This article gives us a state by state breakdown of the estimated last possible moment we can prevent overloading our hospitals.
At the risk of sounding alarmist, I want to reinforce how dangerous this can be for everyone. We still have so many people going about their lives as if this is business as usual. I saw it explained this way:
“You know how everyone rushed to the stores at the same time and bought everything out at once instead of staggering their visits?
Now imagine the same thing in the hospital, but instead of TP, it’s ICU beds and ventilators that are out. This is why everything is cancelled.”
We really don’t want patients and physicians to die when they don’t have to. Even if you would be okay, your parents, your grandparents, and the healthcare professionals caring for them may not be so lucky. Please, think of the greater good. STAY HOME.
So many unknowns…
There are so many unknowns about this virus. Please click below for brief discussions and links to topics that are still evolving regarding SARS-COV-2.
I continue to maintain that panic is not helpful. This is a scary situation, but in the vein of my page, this is a good time to tap into our mental and spiritual strength for support. We control what we can control, and we focus on what we have to be grateful for. Being physically away from others in today’s time doesn’t have to mean true isolation and it may mean we can slow down and focus more on what is truly important in the first place.
What we now know about COVID-19 is that it has many different faces, much like the other illnesses caused by coronaviruses. This is why it is extremely important to stay home if you feel ill at all, and to move around as if you have the illness regardless. We have tested people who seemed relatively asymptomatic (meaning without symptoms) and found them to be positive. However symptoms include:
Unfortunately, testing in Texas, and Houston, has really lagged behind what we would have liked to have seen happen. We are 49th in the nation. However, we do have quite a few testing options available in Houston that are summarized and updated at the link in the heading. Most of the private hospitals now have means of running their own tests, and the public locations are testing anyone who wants to be tested.
What do I do with these Kids?
When they’re not doing their work, which I’ve read really should comprise a very small part of their day (remember, they have lots of breaks and ancillary time when they’re young), see the below for some ideas.
I am an internist, so hypertension is one of my “bread and
butter” medical problems. Contrary to what many people believe, I do not like
to prescribe medications. My favorite thing is when I get to STOP a medication
because someone actually did the things I preach on a regular basis: LIFESTYLE
MODIFICATION. But we must treat hypertension, or high blood pressure that is
high enough that the medical community considers it a disease process. So let’s
discuss why that is.
I like to break down to my patients what constitutes disease
in the first place. Generally, when we look at pathology, that is, something
that is not normal, we have to pick a place where we are going to say that this
pathologic process is now a disease. With blood pressure, there are studies that
show varying data that could argue that the lower the blood pressure, the
better, until you have problems with getting blood flow to the kidneys and brain.
The higher your blood pressure, the more likely you are to have bad changes to
your heart and kidneys and the blood vessels in your brain, and pretty much
everywhere else. We know that a value of less than 120 over less than 80 is
ideal. But where do we say that you have an actual problem?
For a long time, the cut off was when you hit a systolic of
140 or a diastolic pressure of 90. However, in 2017, the guidelines changed,
and we decided that numbers that had previously been defined as
pre-hypertension should be defined as hypertension. The new cut off became a
systolic of 130. When we define disease, we consider complications, and so, for
now, the thought is that we will prevent more complications if we take a
systolic of 130 more seriously. The recommendation for a systolic of 130s:
first, lifestyle modification.
So what lifestyle modifications affect hypertension the
most?
Exercise: Both cardiovascular exercise and weight training have been shown to be of benefit, Aim for 150 minutes of moderate intensity cardiovascular exercise or 75 minutes of vigorous exercise weekly.
Decrease sodium intake: Some people are particularly sodium responsive
Monitor your caffeine intake: Generally the equivalent of 1-2 cups of coffee is safe, but different people tolerate different amounts. Some people do better to avoid caffeine alltogether
Avoid red meats: Beef and pork: the more we learn about the gut microbiome the more we find. I had a patient tell me that every time she ate “meat”, meaning these meats, her blood pressure went up. At the time, I had no idea why. Now we have science for it. You will do much better if you begin to give up, or significantly reduce these meats in your diet.
Consider a plant-based diet: Going even further than giving up red meats is giving up all meats and dairy. A plant-based diet is extremely evidence based for not just hypertension, but heart health in general.
Weight loss: it’s last because it gives you the least bang for your buck, and I generally only bring it up as a side effect of the other healthy things you’ve already done. You need to lose quite a bit if you have significantly high blood pressure, but if you’re in the lower ranges of hypertension, losing 22lbs or so will drop your blood pressure roughly 10 points systolic. I generally like for people to focus more on the healthy lifestyle habits, and see the weight loss just as something that happens as a nice side effect, but it’s nice to know that if you lose weight, there’s additional benefit!
Sometimes you’ve done all these things, and you still need medications. And you know what? That’s okay. That’s why they exist. And be thankful they do. Because they help prevent morbidity (problems) and mortality (death) from uncontrolled hypertension over the long haul. But making these changes definitely means you will need less of those medications if you need the medications at all. And if you REALLY don’t want to be on medications, REALLY consider plant-based. I tell my patients all the time, it’s a give and take. Some of us don’t have the genes that let us eat certain things AND not be on medications. Sometimes you have to make a choice. And it’s okay–whatever choice you make! I, and your doctor, are here to support you in that, as long as it’s a healthy one.
I didn’t want to let the month end without a good post encouraging you to focus on your heart health—after all, I am an internist—who focuses on preventative care. This is what I live for. It’s been a busy month, and I haven’t really had a lot of time to sit down to do this, but if you take a look around the site after reading through this, you’ll see why I couldn’t let this one slide…
I was very animated, and had a lot more hair…lol!
So—last year, I gave a talk where I told a bunch of ladies in order to protect their heart they should focus more on their HEART:
Healthy Diet
Exercise
Address your stress
Regular health care appointments
TAKE RESPONSIBILITY!
Healthy Diet
A diet high in whole grains, vegetables, omega 3, 6 sources (seafood) and low in animal fat, saturated fat, simple carbohydrates—white and sugars, sodium is what you want to focus on. The most evidence is on a plant-based diet, but everyone isn’t always ready for this lifestyle commitment. I teach my patients about the healthy plate, one where you have ½ plate of veggies and fruits, ¼ of a lean protein source, and ¼ of a carbohydrate, preferably whole grain. In addition, ways of eating like, intermittent fasting, are showing additional promise.
Our sedentary lifestyle is killing us. We spend times in
commute, in front of computers at work, in front of screens to unwind. The
amount of television one watches can be correlated with how unhealthy you will
expect them to be—why? Because generally, you aren’t moving while you’re doing
it.
For a healthy lifestyle, it is recommended 150 min of
moderate (walking) or 75min of vigorous (Zumba) cardiovascular exercise weekly;
2 days weekly of strength training. This can be over 5 days or 2 days—just get
it in!!
Address your Stress
It is well known that stress is correlated with uncontrolled
hypertension and diabetes, which are risk factors for heart disease.
Mindfulness, meditation, counseling, exercise—and, yes, sometimes
medication are important ways to make sure you are addressing this important aspect
of your health.
Regular Health Care Appointments
Get screened for important risk factors to heart disease and
listen to your doctor when they tell you what they are seeing. I can’t tell you
how many times I hear, “But Doc, I’ve never had X.” Insert whatever disease
they haven’t had until this day and don’t want to have. Guys, you don’ have it
until you do. And sometimes, you don’t have, it, and I’m trying to prevent you
from having it. Listen to your doctor when they are telling you that they are
seeing the signs of disease or the early signs that one may be developing.
Specifically, diabetes, hypertension, and obesity are large contributors. And I realize, no one wants to hear about their weight, and no one wants to be on medications. There’s a way to have the discussion, and I’m totally here for lifestyle modification (see the hyperlink)!! But you can’t fight what you don’t acknowledge.
Which leads to…
TAKE RESPONSIBILITY
You should ask questions in your appointments. If your doctor isn’t telling you about your risk of heart disease, ask to make sure it’s being addressed. Know your numbers, and where they fall in relation to what normal values are, and what that means for your overall health. And ultimately, your doctor, and health care professionals provide the education, but you make the change. MAKE THE CHANGE!! 😊
In light of the new Coronavirus, Sars-Cov-2 the virus that causes COVID-19, I felt a new post was in order.
This is the thing…coronaviruses are the types of viruses that cause illnesses that are similar to the common cold. So we are literally trying to contain something that can be as mild as the common cold in presentation, but be deadly. For this reason, I have a few words of wisdom:
Understand that social isolation is not a vacation. You need to cancel play dates, not go to the museum or brunch or the mall. You need to limit your contact with everyone not in your immediate family. Looking for things to do? The Met is streaming operas for free. There are also these virtual field trips you can take with your kids.
Wondering about church? Well, I am very religious and spiritual, as you’ll know if you visit the rest of my site. But this exposure at church is a risk everyone is taking by continuing to attend worship services. I maintain that it is not my place spiritually to say whether in person service should continue, but I strongly believe that leadership should consider that it is no longer expedient given our ability to reach the masses virtually, and should be offering these options, particularly to our populations most at risk.
****Resume Original Post
Do not obsess over this. You will drive yourself crazy trying to control the uncontrollable. There are many variables we will not be able to control. Rest well knowing that many people who will become infected will not die of the illness. Hopefully, the same strategies that help shorten a viral illness will work to help decrease the severity of this one.
Do not buy face masks. Not only does it take away from the supply that could be needed for the front line staff caring for sick individuals, but it could put you at greater risk for infection. Only wear a mask if you are already sick and have the potential to expose others around you.
You know the serenity prayer—employ those principles. There are things you can’t do, and there are things you can. Below are things you can do from this article (note: I addended one of the bullet points with my recommendation)
Wash your hands often with soap and water for at least 20 seconds (the time it takes to sing the “Happy Birthday” song twice). If soap and water are not available, use an alcohol-based hand sanitizer. Avoid touching your eyes, nose, and mouth with unwashed hands. (Further notes on hand washing—you can truly prevent the spread of so many viruses and bacteria through proper hand washing! See this article!)
Avoid close contact with people who are sick and their immediate environment.
Stay home when you are sick and try to avoid close contact with other household members.
Cover your cough or sneeze with a tissue (or your elbow if no tissues are available), then throw the tissue in the trash. Immediately wash your hands.
Again, stay home if you are infected to help prevent spreading the virus to others. If you must leave home, wear a face mask (surgical or N95) covering your mouth and nose. (I changed this bullet point)
Stay informed of the progress of the outbreak by accessing the news and the CDC “Situation Summary.”
Clean and disinfect frequently touched surfaces. The WHO recommends using a diluted bleach solution made of 1 part chlorine bleach to 99 parts water
Please find below some helpful resources on COVID-19
When
I first started this blog, I knew I would eventually be writing something about
margin. And here we are. And I know I won’t be doing it justice here, but it
came up this week, so even though this migraine thing was definitely meant to
teach me a great deal about this concept, I must not be learning the lesson.
I’m a slow study.
15
minutes to be still. It’s a homework assignment. I almost laughed because
around this time last year I was asking God to show me the importance of rest
and it took me down some studies on a Sabbath heart and margin in our lives
that truly prepared me for the sabbatical that was my migraine catastrophe. Had
it not been for those studies, I wouldn’t have been ready for the spiritual
growth I accomplished during that time. But I knew that with returning to work,
I was in danger. I told myself that if I didn’t have time to write, I was doing
too much. But I’ve been increasingly unfocused and overwhelmed. And you know
what I was told—“you’ll hear God’s voice when you’re still.” Duh!! I know this.
Why do I have to keep hearing this? Why do I need to keep being reminded.
So I’m here, with this very cursory introduction to margin.
Remember, that the Lord rested, not because he needed to, but because he thought it important to set the example.
And Moses, in Numbers 9:8, instructed them to wait, so that he could hear the Lord’s command. He was in no hurry, he was still.
And in Isaiah 30:15, “For thus said the Lord God, the Holy One of Israel, ‘In returning and rest you shall be saved, in quietness and in trust shall be your strength.’ But you were unwilling.”
I
realized the moment I got my homework that even typing the blog wasn’t
protecting my margin. So God sent it a different way. And boy, am I looking
forward to it!
Soulful Sundays: Once a week I will have an installment that speaks to my spirituality, because, as I’ve said, to me, spiritual wellness, is essential to complete wellness. Because I am Christian, my spirituality is heavily based on my relationship with the Trinity and the Christian Bible. If reading about God, Jesus, or the Spirit will offend your sensibilities, these posts aren’t for you–be advised
“But if we hope for that which we see not, then do we with patience wait for it.”
Romans 8:25 ASV
A
recurring theme for me this week has been patience—my need to cultivate it.
First
of all, when speaking of general wellness, it serves as a great reminder that
we must practice patience:
Patience in our hardships. Someone described this in a
non-spiritual way, and I love how science and spiritual agree: trouble
will only last so long because there is always regression to the mean, and
so nothing can stay horrible forever. She said this to me while
rationalizing her own patience through a particularly horrible time in her
life. Things can stay bad for a very long time, but as I told my son today,
everything, good and bad, ends eventually.
Patience with ourselves: we aren’t perfect. We can only
continue to try our best. When we really mess things up, all we can do is pick
ourselves up, and try again given the chance, while giving thanks for the
chance. I let myself enter a major migraine episode, mainly because I
wasn’t sure when the right time to take my medicine was…I don’t like
medicating when I don’t have to, but I waited too long. I was kicking
myself, and someone reminded me I’m still in a learning stage. Patience.
Patience with those around us: we aren’t perfect, and
neither are they.
There
are so many other places to practice patience. I could type all evening. What
I’m saying is we’d be a little more mentally well, and our relationships would
be a little healthier with a bit more patience.
“Yea, and for this very cause adding to your part all diligence, in your faith supply virtue, an din your virtue, knowledge; and in your knowledge self-control; and in your self-control patience; and in your patience godliness; and in your godliness brotherly kindness; and in your brotherly kindness love.”
2 Peter 1:5-7 ASV
Well,
spiritually, like never before in my life, I am seeing, not academically, but
with my whole spirit, the fundamental connection between trust and patience.
I’ve been really praying on a situation, and telling myself that I was trusting
God to handle it. Well, this week, I almost worsened the situation because I
became impatient and wanted to move quickly. Interestingly, prior to the
events, a friend posted and interesting twist in the fruits of the spirit, so
that when I was praying on the decision, patience was very much what I was
receiving back. And the self control I exercised then led me down a path of
exercising…you guessed it…MORE PATIENCE. What I was ready to steam roll in
weeks may take months. But it’s likely for the best.
If
I’m trusting God to handle my situations, I’m also trusting his timing. So let
me sit down, again.
“Count it all joy, my brethren, when ye fall into manifold temptations; knowing that the proving of your faith worketh patience. And let patience have its perfect work, that ye may be perfect and entire, lacking nothing.”
