7 Vital Medical Items You Need BEFORE a Pandemic to Prevent Hospitalization for COVID-19

Louis Pasteur (1822-1895), French Microbiologist, Chemist, Pioneer of ‘Germ Theory,’ Inventor of Pasteurization. Quote attributed to Louis Pasteur In the fields of observation chance favors only the prepared mind.’

‘Hi doctor, I was exposed to Coronavirus 19 and now feel fever, chills, cough, and/or difficulty breathing. Do I have COVID-19 & when should I go to the hospital?’

Written by Natan Schleider, M.D. March 25th, 2020 10 PM 3 MINUTE READ

NOTE TO ALL MY PATIENTS: INFORMATION PROVIDED BELOW IS BASED ON CURRENT CDC GUIDELINES LAST REVIEWED MARCH 25TH, 2020 AND THEREFORE LIKELY TO CHANGE GIVEN THE DYNAMIC NATURE OF A PANDEMIC; HOWEVER, SINCE STARTING MEDICAL PRACTICE IN NEW YORK CITY IN 2005, MY GOAL REMAINS KEEPING YOU OUT OF THE HOSPITAL AND LOWERING YOUR RISK OF HOSPITAL-ACQUIRED INFECTION.

TO KEEP YOU SAFE AND THINKING RATIONALLY, REDUCE YOUR RISK OF STRESS, ANXIETY, WORSENING MOOD DISORDER, AND/OR MOOD INSTABILITY, STAY IN CONTACT WITH ME AND MY OFFICE. DO NOT WAIT UNTIL YOUR MEDICINE BOTTLE IS EMPTY BEFORE SCHEDULING A CONSULT. THERE IS NO SHORTAGE OF PRESCRIPTION MEDICINES (ALTHOUGH SOMEMEDICINES NOT NORMALLY MASS PRODUCED LIKE CHLOROQUINE ARE BACK-ORDERED). IT IS NORMAL TO GET ANXIOUS WHEN RUNNING LOW ON MEDICINE SO PREVENT THAT ANXIETY BY SCHEDULING DOCTOR CONSULTS WELL IN ADVANCE.

PLEASE OWN A PULSE OXIMETER AND KNOW HOW TO USE IT. THEY COST AROUND 50 DOLLARS, CAN BE BOUGHT ONLINE, & MAY SAVE YOU A TRIP TO THE EMERGENCY ROOM. IF YOU KNOW HOW TO USE A LARGE PAPER CLIP AND HOW TO INSTALL BATTERIES INTO THE BACK OF A REMOTE CONTROL, YOU KNOW HOW TO USE A PULSE OXIMETER (A MEDICAL DEVICE ABOUT 2 INCHES LONG AND 1 INCH HIGH THAT RUNS ON 2 AAA BATTERIES THAT GIVES AN INSTANT DIGITAL DISPLAY OF YOUR PULSE / HEART RATE AND YOUR BLOOD’S OXYGEN SATURATION)

PLEASE HAVE AN ADVANCED DIRECTIVE OR LIVING WILL PREPARED. THIS IS SOMETHING EVERY RESPONSIBLE GROWN UP ADULT SHOULD HAVE LIKE HEALTH INSURANCE OR CAR INSURANCE. PLUS IT IS FREE. SHOULD YOU VISIT AN EMERGENCY ROOM THE DOCTORS AND NURSES WILL WANT TO KNOW WHO YOUR HEALTH PROXY IS (A HEALTH PROXY IS A PERSON TO CONTACT IF YOU GET SICK NEED, SO SICK OR CONFUSED THAT YOU CANNOT ACCURATELY ANSWER QUESTIONS). YOU DO NOT NEED AN ATTORNEY TO COMPLETE AN ADVANCED DIRECTIVE / LIVING WILL. IN NEW YORK STATE AND THEY CAN BE FOUND FOR FREE ONLINE AND ALL YOU WILL NEED ARE 2 COMPETENT ADULTS WHO ARE NOT YOUR DOCTOR NOR WORK IN THE HEALTHCARE FACILITY YOU MAY OCCUPY: https://ag.ny.gov/sites/default/files/advancedirectives.pdf OR https://livingwillforms.org/wp-content/uploads/new-york-living-will-form.pdf

PLEASE HAVE AT LEAST 3 PAPER COPIES OF THE MEDICINES YOU TAKE AND ONE COPY ON YOUR SMART PHONE. HELPFUL HINT: LINE UP ALL YOUR MEDICINE BOTTLES INCLUDING OVER THE COUNTER MEDICINES AND TAKE A GOOD CRISP PICTURE OF THEM WITH ALL PARTS OF LABELS READABLE.

Before calling your physician worried with any coronavirus 19 COVID-19 questions, please be ready to answer your doctor’s questions and follow these instructions (because this is what I will ask you):

Doctor Question 1: ‘When did you last check Center of Disease Control (CDC) recommendations about coronavirus COVID-19 Website?’

Intelligent Prepared Patient Answer 1: ‘I visited the CDC website before calling you.’

Doctor Question 2: ‘Have you checked your vital signs including Temperature, Respiratory Rate, Pulse, and Oxygen Level?’

Intelligent Prepared Patient Answer 2: ‘Yes because I own a thermometer and pulse oximeter and know how to use them.’

Doctor Question 3: ‘What is your temperature over the last 12-24 hours and does it go down if you take a fever reducing medication like acetaminophen (Tylenol) or an NSAID like ibuprofen (Advil) or Naproxen (Alleve)?’

Intelligent Prepared Patient Answer 3: ‘My thermometer reads 100.4 degrees Farenheit [38 degrees Celcius] AFTER the maximum recommended dose of acetaminophen (or ibuprofen or naproxen).

Doctor Question 4: ‘What does your pulse oximeter read?’

Intelligent Prepared Patient Answer 4: ‘My pulse oximeter which I put on my fingertip is reading BELOW 95%-98% oxygen saturation. My pulse is reading on average ABOVE 100 beats per minute.’

Doctor Question 5: ‘What is your respiratory rate?’

Intelligent Prepared Patient Answer 5: ‘I counted the number of times I took a breath over 60 seconds at least twice before I called you and the rate was above 20 and yes, I used my inhaler and took an anti anxiety medicine you prescribed’

Doctor Question 6: ‘Do you have a bag packed for a log emergency room or hospital stay as advised?’

Intelligent Prepared Patient Answer 6: ‘Yes including my medicines and my phone charger.’

Doctor Final Question 7: ‘How are you getting to the hospital because all the vital signs you are giving me are approaching the red zone?’

Intelligent Prepared Patient Answer 7: ‘ I am on my way to the hospital already because I knew what you would ask and yes, I am wearing a facemask to protect others from getting infected.’

Coronavirus 19 STILL News March 2020 and 3 Ways to Combat Fear Generated by The Media

BY Natan Schleider, M.D. March 13th, 2020 THREE MINUTE READ

‘POLIO: POINTERS for 1951’ emphasizes washing hands; watching for signs and symptoms of fever; trouble breathing; flu-like symptoms; avoiding contact with the potentially ill

So what do you think of this coronavirus 19 thing? Because I’m scared…’

This is a common question I am getting regularly, especially from patients. Assaulted with news, updates, national guard movement, and political responses I have 3 suggestions:

  1. Educate yourself about Human Coronaviruses (there are a bunch of them) from a reputable source.
  2. Make emergency preparations within your budget and mindset and expect help from the government to come along the timeline and quality of Hurricane Katrina
  3. Study American History of viral epidemics and realize that when neither the ‘government’ nor ‘experts’ know that to advise, hand washing, isolation of the ill, and avoiding / cleaning of fomites ( objects or materials which are likely to carry infection, such as clothes, utensils, and furniture) will be advised.

Knowledge safeguards against fear so before you turn on the news or you smart phone latest feed, learn about the 7 strains of human coronaviruses currently known and ask yourself which of them CURRENTLY scare you?

Seven strains of human coronaviruses are known:

  1. Human coronavirus 229E (HCoV-229E)
  2. Human coronavirus OC43 (HCoV-OC43)
  3. Severe acute respiratory syndrome coronavirus (SARS-CoV)
  4. Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus)
  5. Human coronavirus HKU1
  6. Middle East respiratory syndrome-related coronavirus (MERS-CoV), previously known as novel coronavirus 2012 and HCoV-EMC
  7. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV or “novel coronavirus 2019”

You will learn that after rhinovirus (the most common cause of the cold), coronaviruses are the second most common cause of the common cold (at about 15%).

Emergency preparation, especially in an urban environment, is extremely nuanced and from a medical perspective, is changing very quickly. If a patient with metastatic cancer on hospice is in a quarantine zone, will they be provided a large supply of opiod pain killers in the setting of an opiod epidemic AND viral pandemic?

For example, the following New York State Department of Health has new guidance which seems only applicable to Medicaid and remains active only until the ‘Declared Disaster Emergency in the State of New York COVID-19 has ended’ https://mcms.org/resources/Documents/Practice%20Manager%20Resources/Medicaid%20Pharmacy%20Guidance%20Disaster%20Emergency%20in%20the%20State%20of%20New%20York.pdf

This allows for early refills of controlled and non-controlled substances for Medicaid members due to quarantine or outbreak. Does this mean physicians can prescribe larger quantities of pain killers to the cancer patients on hospice in quarantine zones? I asked the New York DEA this past in January 16th, 2020 and they replied promptly and politely referring my to the state medical board. The New York State Bureau of Narcotic Enforcement has not yet replied to my questions.

A Review of American Response to Infectious Pandemics is quite interesting with hygiene and quarantine staple go to initiatives by the CDC or historic equivalents.

Soap advertisement for fighting Polio circa mid 1900s [with later data showing soad does NOT kill Polio virus, chlorine does]

As a result of Polio in the early to mid 1900s, soap sales went way up (like hand sanitizer is currently) despite later evidence showing that soap did not kill Polio virus, rather chlorine did.

Hope the above provided a bit of insight, knowledge and comfort.

sincerely,

Natan Schleider, M.D.

Coronavirus COVID 19 remains in the News causing ‘Turmoil’ and ‘Panic’ March 6th 2020: ‘When It Bleeds it Reads’

By Natan Schleider, M.D. March 6th, 2020 9:20 am

Information and news regarding coronavirus 19 changes as quickly as the name of the virus (1st called ‘2019 novel coronavirus’, then ‘2019 nCoV’ and now Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This leads to a misinformed public and more confusion AND MORE CLICKS AND USE OF MEDIA NEWS WHICH IS OBVIOUSLY A STRONG FINANCIAL MOTIVE.

Example: February 12th, 2020, Article by Healthcare Purchasing News Title reads WHO renames novel coronavirus Covid-19 BUT writes in very 1st paragraph The World Health Organization (WHO) head, Tedros Adhanom Ghebreyesus, said the group has come up with an official name, Covid-19, for the disease caused by the new coronavirus. If media editors and journalists cannot accurately report simple definitions like a name change, how can we trust ANY information they provide moving forward. These semantics are important. Maybe it is done on purpose (making it disinformation)

Information about SARS-CoV-2, again aka COVID19 aka coronavirus 19 causes changes, misinforms, and misleads. Moreover, by the time I finish typing half of what is written may be dated BUT media use of words crisis, turmoil, panic I can guarantee will remain in use for a long time as they have in the past.

Cultivating more anxiety creates more: readership, followers, and newspaper sales. ‘When it Bleeds It Reads’ remains tried and true.

Simply saying the truth about coronavirus 19 like We Don’t Know Much about What We Don’t Know probably would not sound good for the CDC, WHO, politicians MIGHT leave them more street credibility?

News information / updates from this morning rea something like: coronavirus 19 causes 3000 people dead worldwide and 87,000 infected.

Let me rephrase: a strain of coronavirus has caused no symptoms or cold symptoms in 96.6% of people tested with the remaining 3.3% (many with underlying serious health conditions) hospitalized or killed by either the coronavirus OR a bacterial pneumonia that easily set in when the patient’s immune system was weak.

I have to head to work so please contact me with any specific questions and I can tell you whatever crappy data and information is or is not available.

BY THE WAY, 7,000 AMERICANS DIED LAST WEEK FROM ATHEROSCLEROSIS, A DISEASE LARGELY PREVENTABLE AND HAVE BEEN DYING AT A RATE OF ABOUT 1000 DAILY IN THE USA FOR SOME TIME. THAT IS 4000 DEAD IN 1 WEEK IN 1 COUNTRY THAN CORONAVIRUS HAS KILLED WORLDWIDE. WHY IS THAT NOT NEWSWORTH?

Thanks for reading,

Natan Schleider, M.D.

How can I protect myself from the coronavirus COVID-19? 4 Coronavirus Prevention and Treatment Tips:

By Natan Schleider, M.D. February 26th 2020 2 MINUTE READ

Does this image scare you? It should if the common cold scares you. This is the coronavirus, one of the most common causes of the common cold.

4 Coronavirus COVID-19 Prevention and Treatment Tips:

  1. Keep following the Center of Disease Control recommendations daily. To date they continue to emphasize the USA is low risk. And for good reason: the coronavirus is far less deadly than the influenza virus and many other viruses that cause cold or flu-like symptoms. WANT SOME PERSPECTIVE: ‘So far, 16,000 people have died and 280,000 people have been hospitalized during the 2019-2020 flu season, according to preliminary estimates from the CDC released several days ago.’ If we use (sloppy, not quite technically accurate math) we see the death rate from influenza in the USA is about 5.7%. COVID-19 mortality rates are approximately half that in mainland China (probably lower if we include people that had no symptoms but were in fact infected)
  2. Read my blog: The 7 Effective Treatments for the Common Cold: https://www.doctorinthefamily.com/blog/the-7-effective-treatments-for-common-cold-symptoms-in-adults/ Here is a cheat sheet for those too lazy to click and sorry, chicken soup and Vitamin C are NOT on the list: Acetaminophen (aka Tylenol); Combination anthistamine plus decongestant (IE Zyrtec-D); Intransal ipratropium bromide (aka Atrovent) – particularly helpful for reducing the lingering cough after the infection which can last weeks; Intranasal oxymetazotine aka Afrin – not to exceed 10 days; Lactobacillus casei 22 grams per day in dairy products for 3 months; NSAIDs – ie Advil or Alleve; Zinc acetate or zinc gluconate – 80 to 92 mg per day within 3 days of symptom onset and continue until symptoms resolve
  3. Get an N95 Respirator Mask — not the flimsy masks we see surgeons wearing will not prevent airborne disease transmission very wello.
  4. Make sure you have the flu vaccine and get yourself some Tamiflu aka oseltamavir (and some antibacterial antibiotics) as the coronavirus may weaken your immune system allowing harmful viruses and bacteria to grow.

Thanks for reading

3 Reasons Why The Most Common Cause of the Common Cold – Coronavirus – Is Making So Much News?

Written by Natan Schleider, M.D. on January 29th, 2020

Disposable Paper Advertisement for Treating Common Cold
Vinatage Disposable Paper Advertisement circa 1950s

A common virus called the coronavirus (yes, like the beer) is making news. This virus is the most common cause of the common cold (along with rhinovirus and parainfluenza virus). This virus has NEVER killed remotely as many people as influenza virus or opiods or car crashes.

According to The New York Times ‘ 132 people had died from the virus’ to date.

For reference about 1,000 (that is one thousand) people died yesterday in the United States of America from atherosclerotic disease (artery clogging) like coronary artery disease. And 1000 people the day before…a total of ‘360,000 people will die from [atherosclerosis] each year’ according to WebMD.

So 5 Reasons Why The Common Cold causing Coronavirus is Making News:

  1. This new coronavirus may be as lethal as the Corona SARS virus which killed a total of 774 people in 29 countries according to the World Health Organization. in 2003-2004. More people died yesterday from heart attacks in the USA alone.
  2. This new coronavirus may be worse that the MERS Coronavirus which has killed a total of 858 people since 2012 in 27 countries. More people died yesterday from heart attacks in the USA alone.
  3. Anything new is fundamentally scary to humans which gets the media excited.

I am following the Center of Disease Control website actively and see no evidence that coronavirus poses a threat even close to influenza but I am no virologist, just a regular fully licensed board certified medical doctor / general practitioner.

5 Reasons to Consider the Human Papilloma Virus (HPV) Vaccine in 2020: Prevention of Warts and Cervical Cancer in Adults.

By Natan Schleider, M.D. Written January 14th, 2020 3 MINUTE READ

Vintage Medicine Container for Treatment of Warts. Circa Early 1900s.

Basic Facts About Human Papilloma Virus (HPV) and Disease in the USA as of 2020:

Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the United States infecting 1 in 4 Americans (79 million of the infected based on USA population of 330 million in 2020). This virus likes grows in skin cells where sexual contact has occurred and condoms do not prevent it. While causing a bunch of different cancers like Cervical Cancer, Anal Cancer, and Mouth (Oropharyngeal), it far more commonly causes little painless fleshy bumps called warts.

While ‘painless’ in that warts do not hurt physically, the look at you (former) new partner’s face running out the door after seeing your wart hurts. Getting the wart removed by the doctor also hurts and they can be stubborn and grow back.

HOW TO KNOW IF YOU OR YOUR PARTNER HAVE HPV:

HPV infection may not be obvious to the naked eye (nor obvious to the infected patient which is why doctor do PAP smears and HPV DNA tests during women’s health exams) sitting dormant for months to years until causing a wart or cancer, it is difficult to know whether your partner carries HPV. By the way, there is no test to confirm skin infection of HPV in men, at least nothing done routinely. We do not swab or scrape a man’s genital region to look for HPV infection, If anyone reading this wants to know why, contact me.

While the HPV vaccine better known as Gardasil has been recommended since 2006 for ages 11-26, now all men and women should consider it so….

Five Reason to Consider the HPV Gardasil Vaccine If You Have Never Been Vaccinated:

  1. You are sexually active and your partner is infected with HPV.
  2. You want to reduce your risk of getting HPV infection and are open to vaccination
  3. While considered about the risks of safety of any vaccine, 8-10 years of data not only in adults (more in children) show no evidence of any long term disease or risks of the vaccine.
  4. You do not like cancer.
  5. You have not figured out a clever, cool way to ask prospective or current sexual partners about HPV infection–if there is one?

Given this new information, I will be contacting my doctor for the Gardasil vaccine and will keep you posted. Thanks for reading.

Citation

Oshman LD, Davis AM. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). JAMA. Published online January 13, 2020. doi:10.1001/jama.2019.18411

Four Ways to Treat Chronic Pain WITHOUT Medications

Written By Natan Schleider M.D. on January 13th, 2020

3 MINUTE READ

Dr. Gustav Zander, a Swedish physician known for inventing mechanotherapy, which was defined in 1890 as “the employment of mechanical means for the cure of disease.” Zander exhibited his exercise machines at the 1876 Centennial Exhibition in Philadelphia where they won a gold medal. By 1906 Zander had established his first gyms with these machines in 146 countries.

In my arsenal of pain management treatments are plenty of evidence based treatments that do not require you to swallow a pill.

If you suffer from chronic pain, your doctor may walk into the cold exam room you’ve been waiting in with your paper gown and say something like: “Here at A1 Pain Management Center, an integrative, multi-modal, team delivers interdisciplinary care. Before initiating analgesics, my staff will give you some resources. Follow up one week.” Was that English?

Below are definitions and explanations of 5 ways to manage chronic pain you are likely to hear about so let’s sort through the jargon.

  1. Mind Body Therapy incorporates a blend of light exercises and meditation along a continuum. Examples include meditation, mindfulness, mindful based stress reduction (MBSR), yoga, and Tai Chi. Evidence supports that Mind Body Therapy causes SMALL improvement in chronic pain with moderate improvement range of motion, depression and anxiety.
  2. Exercise Therapy is most effective for patients with orthopedic or musculo-skeletal pain like chronic back, shoulder, hip, or knee pain. Examples included graded, resistance, aerobic, and pilates exercise. Medical evidence, while not strong, does suggest that exercise therapy causes SMALL to MODERATE reduction in chronic pain with improved quality of life.
  3. Manual Therapy involves another trained professional helping your movements and include Rehabilitation, Manipulation (IE chiropractic movement, osteopathic manipulative movement, passive movements done with physical therapist), Acupuncture, and Massage. While massage therapy has data to support short term improvement, manipulation and acupuncture can provide chronic pain relief for short to intermediate amounts of time (days to weeks).
  4. Psychological Therapy, namely cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) can improve chronic pain. These will be helpful for those patients who are interested in cause, effect, and prevention of pain triggers; however, if you are thinking ‘I don’t see how sitting around and talking about crap is going to help my back pain’ then exercise or manual therapy may be more for you.

So what did the doctor mean with all that jargon before?

Essentially the doctor is saying that there are resources other than pills, surgery, and injections that can help chronic pain. It is up to the patient and doctor to chose which work and which do not. That said, unlike a pill, all above therapies will involve the patient be willing to put in time and effort.

Source: Using Non-Pharmacologic Treatment Modalities: Practical Guidance for Pain Management by American Medical Association December 12th, 2018

Three Keys to Ensuring a Lifetime of Healthy Bones: Vitamin D Supplementation Effective for Bone Health but ONLY with Calcium supplementation

By Natan Schleider, M.D. Written January 8th, 2020

Young child with Rickets, a disease common in the USA until the early 1900s resulting from inadeuqte intake of Vitamin D and or Calcium and or Sunlight. Image circa 1900.

If your doctor told you your Vitamin D levels are low and you live in the United States, join the club. In my practice here in New York City, at least 50% of my patients labs (along with my own labs) show low levels of Vitamin D (below 32 ng/mL is considered deificient with 10-20 mg pg/mL or lower considered severely deficient).

‘So should I be taking a Vitamin D supplement? Get a prescription supplement from your doctor? Isn’t sunlight enough to increase my Vitamin D levels which will probably increase when summer returns?’

These are all common questions and reasonable ones!

A little basic science: Vitamin D is a fat soluble vitamin (like Vitamins A, K, and E) which is why it is packaged in a light brownish clear round or oval capsule at the pharmacy and found in good quantities in fatty fish (and in edible mushrooms exposed to ultraviolet light). When the USA began fortifying cow’s milk with Vitamin D (breast milk does not have as much as we would like), cases of rickets dropped significantly by the mid 1920 to 1930s. Vitamin D increases absorption of magnesium, calcium, and phosphate in the intestine. Since our bones like a good steady supply of calcium, we need Vitamin D to get it absorbed or risk osteoporosis (severe thinning of bone to the point patient is high risk for bone fracture, especially of the hip or vertebrae of spine). That frail looking older person that looks like they have a hump (called Dowager’s Hump almost always due to broken weak vertebrae in the neck or upper back) on their back you see walking around might walking with normal posture had they followed the advice below when they were younger and taken Vitamin D with calcium daily.

There are different types of Vitamin D (five actually but I will just mention the important kinds that will confuse us as they are named on labs or at the pharmacy):

  1. Cholecalciferol is the name for Vitamin D3 which is available over the counter at the pharmacy (usually at doses of 1000 to 4000 International Units, take 1 capsule daily). Vitamin D3 is the ACTIVE form of Vitamin D but it only becomes active if we ingest enough Vitamin D2 or ergocalciferol.
  2. Ergocalciferol is the name of Vitamin D2 which is found in foods and or in supplements. Ergocalciferol is INACTIVE when swallowed but our intestines turn it into Vitamin D3 as does sun exposure.
  3. SINCE I ALWAYS TRY TO WEAR SUNBLOCK AND SUN PROTECTIVE CLOTHING REGARDLESS OF SEASON TO KEEP MY SKIN FROM GETTING WRINKLED AND SPOTTY, I DO NOT RECOMMEND SUN EXPOSURE FOR MY VITAMIN D DEFICIENT PATIENTS; HOWEVER, AS I DO NOT LIKE TO FORCE ANY PATIENTS TO TAKE A PILL WHEN THEY DO NOT WANT TO, SO ABOUT 15 MINUTES OF NATURAL SUNLIGHT A DAY AND NO MORE COULD ALSO WORK PRESUMING YOU HAVE ENOUGH VITAMIN D IN YOUR DIET. SINCE I DO NOT LIKE HAVING BLOOD TESTS DONE EVERY FEW MONTHS TO SEE IF I NEED VITAMIN D SEASONALLY OR ALL YEAR ROUND I ADVISE AND TAKE IT ALL YEAR.

If you are found to be Vitamin D deficient on your labs, many doctors (including me) will recommend Vitamin D supplementation BUT they often forget to mention the following: you MUST add calcium supplements with Vitamin D supplements or the extra Vitamin D you are taking will likely not have enough calcium for our bones. THIS IS WHAT WAS CONCLUDED IN A LARGE STUDY IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION DECEMBER 2019. Calcium needs to be taken twice daily minimum for best absorption, I usually recommend and take 600 mg in the morning and 600 mg in the evening. You can also use some antacids like TUMS for calcium supplementation and take care of mild heartburn and bones all at once.

While on the subject of Vitamin D, other studies show that taking Vitamin D reduces risk of falls in elderly patients and reduces stress fractures in high impact athletes.

While my smart patients know that Vitamin D3 is the better form of Vitamin D to supplement, many patients prefer prescription strength Vitamin D2 ergocaciferol 50,000 International Units once a week which can be easier to remember, just don’t forget the daily calcium!

SOURCE: Yao P, Bennett D, Mafham M, et al. Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(12):e1917789. doi: https://doi.org/10.1001/jamanetworkopen.2019.17789

The 7 Effective Treatments for Common Cold Symptoms in Adults

September 8th, 2019

By Natan Schleider, M.D.

Department of Health Advertisement on Cold and Flu Prevention (Circa Early 1900s)

‘We can put a man on the mood but can’t cure the common cold.” My grandmother would shake her head. saying this repeatedly, making me chug grape flavored Dimetapp and prune juice. This was her cold remedy cocktail and my have the cold remedy cocktail options grown. Walk through a large pharmacy’s Cold and Flu section without the Physician Desk Reference and you’re lost.

So while no cure exists for the common cold, also called a viral upper respiratory tract infection or URI, studies have been done revisiting whether common remedies used were, in fact, helpful or not. Some are even harmful.

The following seven remedies have good data to support their efficacy in relieving cold symptoms:

  1. Acetaminophen (aka Tylenol)
  2. Combination anthistamine plus decongestant (IE Zyrtec-D)
  3. Intransal ipratropium bromide (aka Atrovent) – particularly helpful for reducing the lingering cough after the infection which can last weeks
  4. Intranasal oxymetazotine aka Afrin – not to exceed 10 days
  5. Lactobacillus casei 22 grams per day in dairy products for 3 months
  6. NSAIDs – ie Advil or Alleve
  7. Zinc acetate or zinc gluconate – 80 to 92 mg per day within 3 days of symptom onset and continue until symptoms resolve

And now the list of remedies historically thought to have worked but proven no better than placebo for cold symptoms like cough: acetylcysteine, antibacterial antibiotics, antihistamines taken alone (that is, without a decongestant bundled in), antitussives and expectorants, codeine, echinacea, intranasal corticosteroids, African geranium, steam, garlic, Vitamin C. Vitamin D, and Vitamin E which actually worsened cold symptoms at doses of 200 mg or more.

So use the above list to help shop for cold symptom remedies and feel free to comment.

SOURCE: AMERICAN FAMILY PHYSICIAN V. 100 No.2, 9.1.2019

Thanks for reading,

Natan Schleider, M.D.

HEART / ARTERY HEALTH, & ATHEROSCLEROSIS FOR DUMMIES PART II: SIGNS OF ARTERY CLOGGING (AKA ATHEROSCLEROSIS)

Vintage American Heart Association Poster Circa 1970s

July 20th, 2019

By Natan Schleider, M.D.

As our arteries clog with cholesterol and get occluded by thick unhealthy walls for high blood pressure, smoking, and other risk factors, most of us feel nothing. Then things hit a tipping point–that is, the arteries which bring oxygen rich blood to our organs and muscles become so narrow that the following examples can happen often quite suddenly:

  • A stroke occurs in our brain resulting in paralysis or weakness or difficulty speaking or seeing (depends on which artery of the brain has stopped feeding the part of the brain responsible for our movements, thoughts, vision, etc)
  • Our hearts suffer damage which patients describe as chest pain/pressure OR can loose so much blood flow so quickly it stops pumping and the patient dies in what is called Sudden Cardiac Death
  • The arteries that feed our kidneys (an organ that requires almost as much oxygen-rich blood as the brain and heart’) clog and the patient suffers leg swelling, electrolyte problems, and ultimately kidney failure
  • The arteries in our legs get clogged resulting in pain or fatigue in the legs with exertion, often relieved by rest

What I want to emphasize is that while atherosclerotic disease can kill quickly and suddenly, it can also leave the patient severely disabled and in pain so if your attitude is: ‘Well, I’ll just enjoy my greasy cheeseburgers ’cause I gotta live and then I’ll keel over and die painlessly,’ you may want to think again.

An excellent example of this is one major risk factor for artery clogging caused hypertension or high blood pressure, know as the “Silent Killer.’ Most of the time people do NOT feel their high blood pressure and it only causes death or serious non-reversible damage. How? High blood pressure causes artery walls to become thick and really stiff. As the walls thicken, less blood flow occurs until, you got it, the lumen of the artery is too small to provide oxygenated blood.

So there are some basic (rather over-simplified) warning signs on atherosclerotic disease.

In Part III we will looks at more specific risk factors for artery clogging.

Thanks for reading!

Natan Schleider, M.D.