wathe
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Posts posted by wathe
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It is formally indicated for acute covid illness. Prescribing for prevention of long covid is pretty far off-label, and would be a speculative practice. Also maybe not medicolegally defensible (outside of a clinical trial) if there is a poor outcome.
I'n in a non-US healthcare environment though. We are prescribing a lot less paxlovid here than in the US, I think, with tighter qualifying criteria.
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20 minutes ago, KSera said:
I don't see any reference to the long covid studies in this summary. Those have varied quite widely in how much impact paxlovid has in reducing risk, but many have shown a significant risk reduction. I think for non-elderly folks, it's the long covid risk reduction that is the main reason for taking it. I don't know many otherwise healthy people who are worried about a poor acute outcome from covid, the concern is the long term.
Yes, acute covid.
I think that the long covid data is still very mixed. I haven't seen anything that I would consider convincing. Lots of observational studies, mostly with self-reported data, with both positive and negative outcomes.
To be fair, this will be near-impossible to get great data on -- PCC definition is very broad, and includes many subjective symptoms, with pathophysiology not yet well defined (and I think long covid/PCC term probably covers a number of different things, each not yet well defined, and perhaps with different underlying pathophysiology) -- it's still a bit of a messy basket of who knows what.
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I personally (50's, vaccinated, otherwise healthy) wouldn't take it.
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HHMI has a ton of free educational videos and interactive learning tools. They are meant for use in classrooms, but are available to anyone. " Your Inner Fish", "Your Inner Reptile" and "Your Inner Monkey" are interesting and very good, and not didactic. You can search the videos by topic (evolution, earth science, etc).
Berkeley's Understanding Evolution materials are great
BIg History Project has topics laid out nicely
For a big picture summary, Bill Bryon's A Short History Of Nearly Everything covers history of life and history of the planet in an engaging way (library).
Also, for big picture summaries, there is a surprising amount of good information about geological time on Wikipedia and Britannica
Stephen Jay Gould's popular science essays/books are interesting and not at all didactic - a way to learn without feeling like you are studying . You might enjoy them? Not free, but sure to be at your public library.
BBC In Our Time has done a lot of prehistory episodes.
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4 minutes ago, lovinmyboys said:
Great job to your dd!
So interesting that his wife forgot about his diabetes. A couple of years ago my son collapsed on the baseball field. When I called 911 the operator asked if he had any known medical issues and I said no. She then went on to ask if he had allergies, epilepsy, diabetes. I am ashamed to admit I yelled “I said he has no medical condition quit asking me about medical conditions.” She kind of just ignored me and kept asking questions. I guess it makes sense that people may forget important things in an emergency. (My son was totally fine. It turned out he had gotten hit in the neck with a ball and I guess where it hit him caused his blood pressure to drop and he fainted.)
This happens all the time.
You quickly learn to ask about medical conditions in at least 3 different ways when taking a history, and even then will miss some. People often say "no" when asked if they have any medical conditions, even when they clearly do. Then, when asked about medications, will produce a list of medications as long as my arm, with meds for at least 5 different chronic medical conditions. Which I will then guess at based on the meds, and the patient will then endorse. Or worse, when asked about meds, will say "Oh, yes, quite few," but not have brought them or be able to name them. Or will name medical conditions that they actually don't have (often occurs when pt uses medical vocabulary that means something different than the patient thinks it does - not blaming patients here, medical terminology can be complicated). All.the.time.
Always believe the patient. But also, patients (and families) sometimes say things that are objectively wrong. It's not always easy to find the balance.
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21 minutes ago, Eos said:
That is odd, I can only guess the RN was too focused to clearly ask for it and the flight attendants were having a rough time.
Yes. I would be very, very surprised if there weren't one on board. More likely that they failed to find it, or there was miscommunication.
Resusc in the air by volunteers is seriously stressful, and errors are inevitable. Volunteers don't know what equipment is on board, or where to find it. And are working in a seriously challenging environment, often well outside their usual scope of practice.
I really do think that airlines need a better plan than relying on volunteers. I would love to see an airline medic type role, staffed on commercial flights - someone medically trained who can lay medical eyes on the medically distressed person, get a set of vitals, start an IV, do chest compressions, manage an airway, administer meds, and expertly communicate with base MD on the ground (both of whom know what resources are available equipment-wise and medication-wise, and are familiar with all the aviation angles - both practical and policy.procedural). Particularly on large overseas flights where diversion may not be possible. That would be so much better than hoping there is a medical professional on board with the right skills willing to step up (and then the flight staff having to trust to that -- that the person who steps up actually knows what they are doing. People who are pushed out-of-scope in emergencies sometimes do very dumb things, and bystanders will defer to their authority). There are probably a million legal and jurisdictional and financial reasons why this will never happen, and airlines will just continue to lean on the goodwill of volunteers instead.
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26 minutes ago, Eos said:
It was Air Canada and they didn't have an ambu bag, just a tank and mask. The RN was doing super fast compressions with no puffs, just mask oxygen, which seems to prove the modern protocol of slipping in rescue breaths but focusing on compressions. That, plus probably lots of prayers...
I am surprised that there wasn't an Ambubag or other BVM on-board. It's usually stored with the AED (NOT in the medical kit)
Video of Air Canada medical kit. BVM is mentioned at the very end.
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@Eos I'm glad that your daughter stepped up to help, and I'm glad that there was a good outcome.
I hope she is OK. Resuscitation can be traumatic for responders (both professional and lay-responders alike) and witnesses.
Peel Regions's Lay-Responder and Bystander Resource Guide is excellent.
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13 minutes ago, KSera said:
Wow, that is amazing. Good thinking on your dd’s part. And immense effort on the part of the RN giving chest compressions for half an hour (do planes not always have an AED?).
I've volunteered to assist in on-board medical emergencies, and I know a bit about Canadian standards (apparently very similar if not identical to US), and no, and AED is not required. But most airlines carry one, as well as a lot of other medical equipment that's not required.
Canadian standards require a Canadian standard emergency medical kit (section 725.91, copy-pasted at end of post) for flights with greater than 100 passengers. This is in addition to first-aid kits, which contain very basic supplies, required for all flights no matter how many passengers.
Air Canada and West Jet have great kits (with both AED and glucometer). CMAJ ran a great article few years ago, with photo and table listing contents of the actual kits carried by these airlines. Which I happened to have read a few weeks before an international flight that had a medical emergency happen mid-flight over the Pacific.
This is actually a thorny issue in the medical community. We have an ethical obligation to assist (but, interestingly, not a legal obligation in most jurisdictions). Airlines lean on our goodwill as part of their business model. Some believe it's exploitative. Their medical kits are loaded with drugs and equipment that can only be used by medical professionals (flight attendants cannot use), --- utilization depends entirely on chance and goodwill. Legal protection for volunteer responders is murky, especially on international flights.
They do generally have a air-to-ground medical consulting service with and MD advising from the ground to advise and direct airline staff, which is better than nothing.
725.91 Emergency Medical Kit
For aeroplanes with more than one hundred (100) passenger seats, an emergency medical kit must be carried and shall contain as a minimum, the following:
ItemsQuantity
a) Sphygmomanometer1
b) Stethoscope1
c) Syringes (sizes necessary to administer required drugs)4
d) Needles (sizes necessary to administer required drugs) and one safe disposal unit
(amended 2005/06/01)6e) 50% dextrose injection, 50cc1
f) Epinephrine/Adrenalin 1:1000, single dose ampoule or equivalent
(amended 2005/06/01)4
(amended 2005/06/01)g) Diphenhydramine HCl injection, single dose ampoule or equivalent2
h) Nitroglycerin
(amended 2000/12/01)10 tablets or equivalent
(amended 2000/12/01)i) Protective non-permeable latex gloves or equivalent, disposable
(amended 2005/06/01)2 pairs
(amended 2005/06/01)j) Bronchodilator inhaler (metered dose or equivalent)
(amended 2005/06/01)1
(amended 2005/06/01)k) Acetylsalicylic acid (ASA)
(amended 2005/06/01)4
(amended 2005/06/01)l) (i) CPR mask with an oxygen port and
(ii) valves
(amended 2005/06/01)1
2
(amended 2005/06/01)m) Intravenous (IV) administration kit (incl. Alcohol sponges, tape, bandage scissors and tourniquet)
(amended 2005/06/01)1
(amended 2005/06/01)n) appropriate intravenous (IV) solution (e.g. normal saline 0.9%(500cc)
(amended 2005/06/01)1
(amended 2005/06/01)o) (i) Airways, oropharyngeal (3 sizes) or
(ii) Ambu bag
(amended 2005/06/01)1 set
1
(amended 2005/06/01)p) Atropine (0.4-0.6 mg per ml, single dose ampoule or equiv.)
(amended 2005/06/01)1
(amended 2005/06/01)q) Basic instructions for use of the drugs in the kit.
(amended 2005/06/01)1
(amended 2005/06/01)-
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18 minutes ago, KSera said:
Cuts off partway through for web readers unfortunately. I was wondering if she describes how the actual teaching of this occurs. It’s hard for me to fathom girls actually being formally trained in what their voice is supposed to sound like. I have no idea what that looks like.
I expect it's like conditioning for any other cultural behavioural norm. Part imitation and part parental correction.
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Since we are discussing books on vaccination in general, I will put in a plug for my very favourite vaccine book:
It's superb.
Also pre-covid. I really wish there were a more up-to-date edition (most recent edition is 2015)
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8 minutes ago, kbutton said:
I recently saw this book (broadly) recommended about vaccines (written pre-Covid), and I wondered if anyone knows anything about it. The person that recommended it is generally sane.
Science Based Medicine has posted a detailed unfavourable review.
Anonymous author also gives me pause.
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It worked for me. This is standard first line treatment for NVP in Canada (Dilectin).
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33 minutes ago, Kalmia said:
I am so glad you woke up and that everyone got out of the house in time. We care about our WTMers and I couldn't help crying when I read your story to my young adult, which I did that he would have a story (with a happy ending) embedded in his mind regarding the dangers of carbon monoxide.
I think all my "smoke detectors" are dual purpose for fire and carbon monoxide (more expensive, but more of them as I have one in each bedroom, one in each hall, and one in the entry near the kitchen so if one stopped working, hopefully the others would still be on the job). I am going to check them to make sure, today. I also had been thinking about getting an explosive gas detector as we have a propane stove. We got one for my MIL once she was unable to smell the propane. I think I should get one right away.
We have a CO story with a happy ending. About 10 years ago our CO detector alarmed. I, foolishly, assumed it was a false alarm and re-set it. It alarmed again. I called the fire dept. They came and measured CO with their fancy detector. It was indeed elevated. Fire dept cleared the house, and called their gas guy, who condemned the furnace. This is when I learned that CO detectors (and smoke detectors) expire -- and that every single on in our house was beyond expiry. Fire department took all our expired ones and set us up with fresh loaners until we could get ours replaced. We were lucky that the CO detector still worked. Now we have 4 dual CO and smoke detectors, plus a wall plug in CO detector, and I check the expiry dates.
The only one of us with any symptoms was me; I had a tiny bit of nausea. Enough to prompt me to take a pregnancy test, but not enough to otherwise get my attention. In retrospect, it was a symptom of mild CO poisoning.
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4 hours ago, Harriet Vane said:
Yep.
I have Covid.
So far mild. So far dh and foster teen are not sick.
I have berberine and NAC. I bought them last year before traveling because I had read some things suggesting they might help. But I am worried that my super-vague research of last year might have turned up snake oil and pixie dust.
Whaddya think? Are those good anti-covid measures? Or not?No quite snake oil, for NAC at least -- it's a drug with legitimate non-covid indications.
Based on my quick search, the evidence to support NAC and berberine efficacy for covid seems very poor, and seems to gloss over risk.
I, personally, wouldn't bother with them. I am an EBM person though; I am generally skeptical of supplements and alt-med.
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2 hours ago, Drama Llama said:
My allergic kid is on a second gen antihistimine (and other stuff) 365 days a year, so when his system gets overwhelmed, we add Benadryl at night or he's too itchy to sleep. This makes me wonder if we should try something else instead.
I also have a tendency to get dramatic welts in response to bee stings and bug bites. It hadn't occurred to me to use Zyrtec in that kind of rescue situation. Maybe I should? Or maybe it's OK since I am very far from pediatric.CSACI position statement applies to both adults and paeds.
The only reasons I can see to use benadryl for allergic rhinitis or urticaria are 1) financial barrier precludes 2nd gen AH --benadryl is dirt cheap-- or, 2) you actually want the side-effects of drowsiness, tachycardia, dry mouth, constipation etc -- there are some specific circumstances where the side effects themselves are therapeutic.
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17 minutes ago, horsellian said:
This isn't true as this kind of testing is part of what I do for a living! But expiry dates are often much shorter than effectiveness because most studies run only 3 years, and expiry dates are calculated from date of manufacture. It's not in any drug company's financial interest to run a 10 year stability study. And no-one would fund one on generic medicines - again, no commercial benefit.
I also know from stability testing them that some vitamin tablets have very short shelf lives. Off the top of my head, vitamin C and folic acid are two that will be well below dosage after the expiry date, particularly if you live in a hot humid climate.
This is the role of government funded science: doing important scientific work that has no commercial benefit. Also driving important social change that has no commercial benefit, for the benefit of all citizens.
We live in a world where we produce colossal amounts of waste because "commercial benefit" to corporations is more important than anything else (more important even that having a habitable planet). Litigiousness of American society is also a factor.
Drug waste is a huge issue. As are drug shortages. Extending expiration dates to match actual stability of products would constitute wise use of resources on a population level. It would require government intervention and regulatory change. I don't know if that would be possible in the current American political landscape.
IME, a stable, affordable, and socially responsible drug supply should be a public good.
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14 hours ago, Drama Llama said:
What are they using for sudden allergic reactions in kids that need relief but aren't serious enough for an epipen? Benadryl is still my go to for those things.
Second gen antihistamines as per CSACI position statement for allergic rhinitis and hives
I personally like cetirizine: available both oral and IV.
Systemic allergic reactions get epinephrine. Threshold for epi is low.
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I think of drug expiry dates as like warranty periods. Guaranteed potency until dates specified, but useful life generally extends beyond warranty period.
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53 minutes ago, KSera said:
Yes. SARS-CoV-2 is still the official name for the virus that causes Covid-19 (similar to how varicella zoster is the name of the virus that causes chicken pox).
Yes.
2019-nCOV was the provisional name for the virus, also called Novel Coronavirus, for a short while. Then the scientific community settled on SARS-CoV-2 for the virus and COVID-19 for the syndrome.
Varicella-Zoster Virus (VZV) causes two different clinical syndromes: Varicella (chicken pox) and Herpes Zoster (shingles). In this case, the syndrome names existed long before science figured out the common causal virus - hence the hyphenated name.
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Covid terminology did change really fast.
Early on, we were calling it 2019-nCOV. I still have grand rounds notes from Feb 11, 2020, and that's the term that was in use on that date. By March, the terminology had shifted to COVID-19.
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Talk to your doctor.
In general, first gen antihistamines are not recommended for kids at all anymore (have been removed from formulary from my local paeds hospital), and definitely not recommended for sedation.
Paradoxical excitation is a concern.
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11 minutes ago, Harriet Vane said:
And now I'm doomed.
Infuriating!
But not necessarily doomed. Masks and ventilation really do work. You very well may be able to mitigate your way through.
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1 hour ago, Ottakee said:
I am not sure if it would work on the water issues there or not but we backpack with a sawyer squeeze which is very small and portable and could be used to filter water as needed.
Sawyer Squeeze and other water filters will remove bacteria and protozoa, but not viruses (like Hep A). Fine for backwoods water treatment in North America.
A water purifier, like the Grayl, or MSR Guardian, will remove bacteria, protozoa and viruses like Hep A, norovirus, rotavirus. A better choice for travel to parts of the world where these are a concern.
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Paxlovid--recent experience/info?
in The Chat Board
Posted
Is anyone aware of any prospective randomized trials of paxlovid for long covid/PCC?
One of the problems with all the observational cohort studies that I'm seeing is that the selection bias is huge. People who seek paxlovid treatment may do better than those who don't, but that may have nothing to do with the paxlovid itself -- those who seek paxlovid were likely to have better outcomes regardless.
Paxlovid seekers tend to be health-aware, and have the resources to get a test, see a provider, and fill a script, all within a 5 day window. Those seem like small things, but are indicators of social determinants of health that are tied to good outcomes, which is huge.