wathe
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Posts posted by wathe
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The state of evidence for paxlovid is poor.
There are only 2 RTCs to date that I am aware of. The first, EPIC-HR, done in unvaccinated covid-naive high-risk patients showed benefit, but there were some quite serious limitations (esp disease-specific mortality/hospitalization rather than all-cause) and was pharma-funded, pharma-designed, and pharma-run, and has not been replicated. Also, unvaccinated covid-naive high-risk is a population that likely doesn't exist anymore (or is very small). The second, EPIC-SR, also pharma-funded/designed/run, was done in mixed population including both vaccinated plus at least one at risk condition patients, and unvaccinated without at-risk condition patients, did not show benefit and halted for futility, and was not published (result available by press release only).
All other pax studies, for both acute and long-covid outcomes, are observational and must be interpreted with caution.
In non-pandemic/emergency circumstances, this drug would likely not have been approved; the state of the evidence is too poor.
I think it probably doesn't work, at least not clinically meaningful benefit.
The trade-off is multiple potential serious drug reactions, necessitating altering dosing or stopping other necessary meds for co-morbidities (why all-cause mortality/hospitalization outcome is so important! - if, say, anticoagulant was stopped and pt then died/hospitalized for a stroke as a direct result of stopping anticoagulant in order to rx pax, this outcome would have been missed in the above studies with covid disease-specific outcome measures)
I, personally, would not recommend it for my own vaccinated elderly parents.
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I was there for a few weeks in the summer with Canadian youth and adults as part of the World Scouts Jamboree. Not study abroad, but we did stay in 4 different university dorms in Seoul and Suwon for a total of 8 nights.
Things that we were advised to be aware of:
Legal:
- Minors will be tried as a adult starting at age 14, and there is no bail. Legal system is relatively harsh.
- Age of consent for sexual activity is 20. Apparently penalties for underage SA can be harsh.
- There are cameras everywhere. Expect to be on camera while in public.
Cultural:
- Strict separation of the sexes in dorms
- They did not know what to do with our transgendered youth in dorms -- see above. It was a big issue.
- Some of our LGBTQ2S youth struggled. The culture is conservative wrt gender roles, and while not illegal, LGBTQ2S culture/lifestyle is not publicly embraced.
- Food allergies and intolerances do not seem to be a recognized thing. There is no awareness, and accommodation of dietary needs was very difficult.
- There are very few public garbage cans. One is expected to take ones trash home (ie take-out containers etc) and dispose of it there. Which everyone does; the streets were very clean.
- Toilet paper is only sometimes available
- Toilet paper often goes into the garbage (rather than flushed). Public bathrooms and dorm bathroom we visited all had signage one way or the other.
- There is very little street crime (see legal above). We saw people just leave their phones on tables in crowded food courts while they went to an out-of-sight counter to order, and one couple left their toddler at a table we were sharing while they went out-of-sight to the kiosk to order -- this last at a very, very crowded amusement park.
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26 minutes ago, cjzimmer1 said:
No, the "open" toys like the licky mats and the three tray spinner I linked we freeze (kibble with cottage cheese, applesauce, bone broth etc) so even if she flips them nothing comes out. She either has to lick/chew the food out or wait till it melts (aint happening). The other toys have small openings so only a few pieces fall at a time. Doesn't matter how much she shakes them, she can't empty them in one go. But when I'm picking puzzle toys, I make sure to select ones that are hard to open them all at once (or I freeze them).
Our dog very quickly learned that dropping those down the stairs was a very effective strategy 🙂
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29 minutes ago, Corraleno said:
The online order portal on the Panera website does list 219 mg, but that's not what the in-store signage says. The figure of 389 or 390 mg caffeine for 30 oz is stated in the lawsuit and it's what's listed on the actual Mango Yuzu Citrus lemonade dispenser as well as the warning about it not being suitable for children and pregnant women (see below).
My guess is that the online menu is fudging the numbers by assuming someone would fill the cup with ice and only actually get 17 oz of drink in a 30 oz cup. But that is disingenuous since comparisons to drinks like Monster or Red Bull, or even Coke or coffee, are comparing ounces of the actual product, not including a vague ice-displacement-fudge-factor that assumes people will only drink half the can of Monster.
Yup, as served with ice.. Canadian online ordering menu states this "Charged Sips, as served with ice, contain 150-237mg of CAFFEINE. Consume in moderation. NOT RECOMMENDED FOR children, people sensitive to caffeine, pregnant or nursing women." Bolding mine.
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Mine is very similar to PP's. Works great.
We use amazon basics laminating pouches. Cost less than brand name and can't tell the difference.
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To keep liquids hot for 10 hours you need a proper vacuum bottle with a thick screw-cap. I don't think that there exists a travel mug/tumbler that will keep a beverage really hot for 10 hours - by definition, they all have a thin spot in the lid to accomodate the drinking mechanism, and that's where the heat leaks out.
Contigo mug is only good for a few hours (thin lid), but it spill-proof. Thermos King mug keeps heat in longer (thicker lid), but you have to remember to shut the drink port after each sip or it will leak heat (and spill if tipped). It won't keep a drink really hot for 10 hours though.
THermos King vacuum bottle keeps my tea steaming hot for >24h.
For long shifts I use a 3 vessel strategy: Large vacuum bottle to hold my tea for the duration of the shift, and pour out from that into a contigo mug to drink from. I add milk to the contigo mug as I go - I have access to a fridge (so I guess it's really a 3 vessel strategy) or , if I won't have access to a fridge, I preheat the milk and then add it to the main vacuum bottle at home before I leave. Adding cold milk to a hot bev pre-cools it too much, and it won't stay hot for as long as otherwise.
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2 hours ago, Mrs Tiggywinkle Again said:
I ordered the free government ones last week; they arrived but sat out in the cold for over a day.
Quick search finds this study: Tests that were frozen for up to 2 weeks still worked.
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As an aside, the hospital I work at lets us work with covid, so long as symptoms have been improving over 24h and fever-free. Staff with covid are required to mask and take breaks in special zones, but otherwise go about their jobs as usual. This includes staff providing direct patient care.
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Is this your only testing option? Can you test through work (my hospital hands out RAT tests to employees if they ask, and also supports PCR testing), or buy a fresh test from a pharmacy? It sounds like you really need to know.
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Just now, kbutton said:
I wish the local hospitals would start masking again. Staffing shortages are becoming a problem. What a surprise! /s
Where I am, hospital staff have been required to mask while providing care, and masks for everyone in select higher-risk departments (emerg, dialysis, oncology etc) here since about mid-September. Thank goodness -- otherwise we would be much worse off, I think.
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Regional wastewater report is somewhat eye-popping this week:
Shaded area with dashed line is incomplete data to be interpreted with caution, but tracks with the giant uptick in covid admissions we've seen in the hospital over the past 3 weeks or so. I think provisional data will prove true.
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4 hours ago, kbutton said:
A vent…you cannot safely donate blood in my area because the blood bank insists you remove your mask not only for vitals (which they also do on a crowded bus and won’t step outside for) but for the actual donation because “you need extra oxygen while you donate.”
I tried to donate today at my son’s school. I was unlikely to be successful (historically I clot and can’t finish), but I have a relatively recent change in meds that might me less likely to clot. I’m so disgusted; the major blood donors in my family are now ineligible, and my son has received blood, so I would like to do my bit.
I told the blood bank bus that we already have ERs going on divert because they can’t manage illness, and they just looked at me like I have three heads.
That is very strange.
I think I might ask to see a copy of the written policy. (Dollars-to-donuts it doesn't actually exist, or doesn't actually say what the staff think it says). If there really is a policy that prohibits mask use during donation, I might follow-up with a letter or email to the medical director, because that doesn't make any medical sense.
From the American Red Cross: "The Red Cross follows a high standard of safety and infection control and will continue to socially distance wherever possible at our blood drives, donation centers and facilities. While donors are no longer required to wear a face mask, individuals may choose to continue to wear a mask for any reason. The Red Cross will also adhere to more stringent face mask requirements per state and/or local guidance, or at the request of our blood drive sponsors." bolding mine.
For what it's worth, Canadian Blood Services has this to say about masks and donation: "Although no longer required, masks are known to help curb the spread of COVID- 19 and are welcome in our environments and available to anyone who chooses to wear them," and "Masks, including N95s, are available to staff, volunteers, donors and visitors," and "Yes, you can wear your own mask. Surgical face and N95 masks provided by Canadian Blood Services are also available."
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12 hours ago, KungFuPanda said:
Ok, call me fussy, but I don’t want mashed eggs in my egg salad so much as I want them very finely chopped. Yes, I do realize the difference is negligible. 😬
45 minutes ago, bibiche said:Easiest and fastest way to have non-mashed eggs for egg salad is to push the cooked eggs through a gridded cake rack
Two or three quick smashes with the potato masher = beautifully cubed whites and smooth yolks. It's a magic tool 🙂
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Just now, KungFuPanda said:
I use my pastry blender for mashing eggs 😁
Potato masher is WAY better for eggs. Very efficient smashing 🤣
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14 minutes ago, KungFuPanda said:
I own an actual ricer. It’s in my basement and never use it. This is the style masher I have that I use for all potato-mashing applications.
I used that style for smashing eggs to make egg salad. It's the best!
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“There is nothing – absolutely nothing – half so much worth doing as simply messing about in boats”
--Ratty
The Wind in the Willows
My canoes are named "Ratty" and "Mole"
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4 hours ago, Happy2BaMom said:
Hmmmm, the HCWs pictured are in full-on hazmat gear.
I'm sure (or hoping) that's because there are unknowns with the appearance of this new virus (& it's infectiousness), but given China's history of being less-than-forthcoming with information in general, as well as the previous pandemic, it's a little unsettling to be told "it appears like pneumonia" while all HCWs are running around in hazmats.
The images in the Telegraph article (which is the one I think you are referencing?) are old ones from the height of covid. I did a reverse image search and found the same images in countless other older covid articles. Here it is in a Business Insider article from 2020.
Media like to stick stock images in news articles, and aren't often very transparent about the practice. Our national news uses another image ( of a nurse in PPE at the bedside in the ICU) over and over and over for various health care stories.
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1 hour ago, mommyoffive said:
Thanks for your thoughts. My older ones usually do not have breaks to eat in that 4 to 6 hours. And if they do they cannot really eat much because than it makes them sick to their stomach to do all the jumping and spinning. Same with show days. They are so tight with shows back to back that it is hard to have a break to eat something, let it digest enough that it will not make them sick.
I personally would be motivated to find a digestible real food solution, rather than bottled commercial sports drinks (one of mine likes chicken noodle soup in a thermos at tournaments). But, I find commercial sports drink culture/marketing personally irritating -- I am aware of my bias on this issue!
(I would also be unhappy with a youth athletic activity that did not prioritize basic needs such as nutrition during training and performance. Kids need time to eat. That's a completely separate issue though)
Sorry @popmom. I'm well off topic. I will stop!
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17 minutes ago, popmom said:
I’ve got my diluted Gatorade Zero, tea, and bone broth. COVID test and coconut water are on the way. My orange Gatorade may be junk food, but it’s comforting when I’m a sickling.
re bolded: And that's what matters!
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Thanks everyone. We went with the TC5 Classic wash. Mostly because it's most similar to what I"m already used to.
I'm glad to hear that everyone is happy with their models. I think that either one would have suited us just fine - that's what made the decision difficult 🙂
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1 hour ago, mommyoffive said:
Do you recommend sports drinks for athletes? My kids are dancers and train 4-6 hours a day. More on show days. I am wondering if water alone is not the best at keeping them fueled up.
I think it depends on intensity and duration of exercise. If it's not possible to keep up with salt loss and fuel needs by eating, then that's what sports drinks are for. A pretty rare scenario in youth sports, I think.
My kids are also athletes training similar amounts (4-6 hours per day, with much longer tournament days). They drink water; I don't offer them sports drinks. Their training and tournament schedules allow for meals and snacks, which contain plenty of salt and carbohydrate. Most youth athletes would be similar, I think.
Something like marathon running in the heat of summer would be different story, or elite endurance athletes. Or sustained intense exercising for so many hours that meals are missed and eating/snacking isn't possible. IME, these are relatively rare youth sports scenarios though. Youth at this level are often supported by sports medicine/trainers/sports nutrition teams.
Sports drinks are a big money industry and a bit of a cultural fad that's more about marketing and psychology than science. We all want to believe that our own kids are great or exceptional athletes who are training so hard that they must need special nutritional support during exercise. That last bit usually isn't objectively true for most of us.
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30 minutes ago, gardenmom5 said:
fun fact on coconut water.
during WWII, in the south pacific medics would use it in place of saline in IVs to rehydrate patients.
I've heard this, and there are reports of IV coconut water in the medical literature. It would be a very last-ditch choice though. Not enough sodium.
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I think that the big advantage of coconut water for oral hydration in the developing world is that, fresh from the coconut, it's relatively sterile and less likely to be contaminated than any drink made using the local water.
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36 minutes ago, regentrude said:
Unless you're vomiting, have diarrhea, or are sweating profusely, you don’t have to worry about electrolytes. The minerals you consume with your normal food will be sufficient, and you can just drink tea or whatever liquid to up your hydration.
Agree. Unless you have copious GI losses, then eating food and drinking water (or other drink you like), as guided by thirst, is fine.
There is nothing magic about gatorade or other electrolyte drinks. You don't have to take in salt and water in a precise ratio -- your healthy kidneys will manage your salt/water balance for you, just as they do every day. If you are worried about salt intake and your appetite is off, try something salty and bland, like crackers, or drink some broth. If you are worried about hydration, then drink whatever tastes good to you when you are sick. (Gatorade is junk food with an excellent marketing department).
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If you want oral rehydration solution, there are all kinds of published recipes. Alberta Health has a leaflet with a bunch of them. Though, if you are so dry that you are actually needing these, then you probably also need medical attention.
As an aside, oral rehydration solutions meant to replace GI losses in illness are different than sports electolyte drinks. Sports drinks are meant to both replace salt and water lost by sweating, and provide fuel for intense endurance exercise -- they contain relatively more sugars for this reason. Sick people with GI losses need relatively more salt and less sugar than endurance athletes.
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8 minutes ago, cjzimmer1 said:
Mine is from 2016 so I haven't kept up with the models but based on what wathe says here, I would get the classic. I much prefer the dial controls over and electronic panel for the simple fact that electronic panels are more likely to break and more expensive to fix/repair than dial controls.
Thanks. Yes, we are looking at only dial control models for that reason.
Both the classic (TC) and perfect wash (TR) come in dial control versions. .I'm still waffling; but also reassured that owners of both TR and TC models are happy with their machines. 🙂
Paxlovid--recent experience/info?
in The Chat Board
Posted
I see it differently. The drug itself has risks, besides drug-drug interactions. dysgeusia and diarrhea being the most common, followed by headache hypertension, malaise, vomiting. Then more rare but serious risks: hepatotoxicity, hypersensitivity reactions and anaphylaxis, stevens johnson syndrome, toxic epidermal necrolysis, pancreatitis, bradycardia. These may be rare, and any one individual's risk is small. But, on a population level, we are absolutely causing harm with this drug, with very poor evidence for benefit. Negative RTC done a population that best matches the patients prescribe to (vax'd with risk factors).
(as an aside, Pfizer's failure to publish EPIC-SR trial will have downstream legal consequenses, I think. It's tantamount to purposely hiding data that would harm their profits, and has caused harm)