COVID Conundrum

https://www.ama-assn.org/delivering-care/public-health/what-tell-patients-about-myocarditis-after-covid-19-vaccination?utm_source=BulletinHealthCare&utm_medium=email&utm_term=071621&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend

Our hot topics and angry controversies about not only COVID infections but now COVID vaccinations reached the boiling point this past week, resulting in protests over COVID vaccination mandates all over the world. Organized medicine (ie, the AMA) has been accused of covering up the origins of the virus and now the side effects of taking the vaccine. To counter these false claims, I would invite you to examine a recent publication from the AMA discussing the side effects of the vaccine and steps to take in order to report unwanted side effects.

As the country continues to push for more people to get vaccinated against COVID-19, some remain concerned over rare cases of heart inflammation—myocarditis and pericarditis—linked to the Pfizer-BioNTech and Moderna mRNA vaccines. While some parents may be thinking twice about teen vaccination, medical experts reassure that the risk of myocarditis and pericarditis are far lower than the risks of serious illness or death from contracting COVID-19.

Since April, there have been more than 1,000 reports to the Vaccine Adverse Event Reporting System (VAERS) of cases of myocarditis and pericarditis occurring after mRNA COVID-19 vaccination in the U.S. with more than 300 cases confirmed. Myocarditis is inflammation of the heart muscle and pericarditis is inflammation of the lining outside the heart. In both cases, according to the Centers for Disease Control and Prevention (CDC), the body’s immune system is causing inflammation in response to an infection or other trigger.

“As physicians, nurses, pharmacists, public health and health care professionals, and, for many of us, parents, we understand the significant interest many Americans have in the safety of the COVID-19 vaccines, especially for younger people,” the nation’s leading doctors, nurses, pharmacists and public health leaders, including the AMA, said in a joint release.

Here is what physicians should share with patients about incidents of myocarditis and pericarditis after Pfizer or Moderna mRNA vaccination.

These are rare cases

Confirmed cases have occurred mostly in male adolescents and young adults aged 16 years or older. But given the hundreds of millions of vaccine doses administered, says the CDC, reports of myocarditis and pericarditis are rare.

“The CDC’s Advisory Committee on Immunization Practices, or ACIP, met to discuss this issue last week,” AMA Chief Health and Science Officer Mira Irons, MD, said during an episode of “AMA COVID-19 Update” on vaccination challenges and masking guidance. “While the CDC did determine the mRNA COVID-19 vaccines can, in rare instances, be linked to myocarditis or pericarditis, the majority of patients have recovered.”

“This is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination,” the joint release says. “Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment.

“In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19,” the release adds, emphasizing that “the risks to the heart from COVID-19 infection can be more severe.”

Symptoms appear after second dose

Severity of myocarditis and pericarditis cases can vary, but “reports have increased since April, mostly in young males 16 and older, several days after vaccination, and more often after the second vaccine dose. Symptoms include chest pain, shortness of breath and palpitations,” Sandra Fryhofer, MD, an Atlanta general internist who serves as the AMA’s liaison to the CDC’s Advisory Committee on Immunization Practices, said during an episode of “AMA COVID-19 Update” about COVID-19 vaccines and variants. Dr. Fryhofer also is a member of ACIP’s COVID-19 Vaccine Work Group.

Sandra Fryhofer, MD

Sandra Fryhofer, MD

While these cases are rare, “ACIP agreed that a warning about the potential risks should be added to the FDA’s official fact sheets on the vaccine so that people would not ignore symptoms,” explained Dr. Irons.

If a parent or their child has any of these symptoms within a week after COVID-19 vaccination, it is important to seek medical care. For instances of myocarditis and pericarditis after mRNA COVID-19 vaccination, most who received medical care have responded well to medications and rest.

Vaccination far outweighs risk

“The benefits of COVID-19 vaccination far outweigh the risks of heart inflammation in young people,” said Dr. Irons, adding that “it’s important to remember that the risk for COVID is far higher.”

“Teens and young adults account for the largest proportion of new cases in the United States,” she said. “And we know that COVID infection itself can affect the heart, so myocarditis after COVID vaccination is still a rare event and the vast majority have recovered.”

https://www.ama-assn.org/delivering-care/public-health/what-tell-patients-about-myocarditis-after-covid-19-vaccination?utm_source=BulletinHealthCare&utm_medium=email&utm_term=071621&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend

COVID-19 vaccines “will help protect you and your family and keep your community safe. We strongly encourage everyone age 12 and older who are eligible to receive the vaccine under Emergency Use Authorization to get vaccinated, as the benefits of vaccination far outweigh any harm,” the joint release said. “Especially with the troubling Delta variant increasingly circulating, and more readily impacting younger people, the risks of being unvaccinated are far greater than any rare side effects from the vaccines.”

Discover what to tell your patients when they ask which COVID-19 vaccine to get.

Related Coverage

Dr. Bailey to Senate: Doctors are nation’s best vaccine ambassadors

Submit cases to VAERS

For physicians who have “a patient with myocarditis … or anything else unusual after COVID vaccination, please send a report to VAERS … so they can check it out,” urged Dr. Fryhofer. “Without this reporting, CDC can’t know the scope of a potential issue, investigate it and provide communication.”

“If you do report a case and CDC asks for medical records, send them ASAP—it’s not a HIPAA violation,” she said, adding that “anyone can submit a report to VAERS—it’s not just limited to health care” professionals.

The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients’ questions, and another to address physicians’ COVID-19 vaccine questions.

Learn more from the CDC about myocarditis and pericarditis following mRNA COVID-19 vaccination.

#covid-vaccines

Capsaicin for Nonallergic Rhinitis

February 5, 2021 by Alan Khadavi

Here’s the full update and thank-you Alan for sharing

Capsaicin nasal spray may be an effective treatment for patients who have nonallergic rhinitis. A significant proportion (25-30%) of patients suffering from rhinitis have nasal symptoms without an infection or allergies, this is referred to nonallergic rhinitis. Up to 50% of these patients have idiopathic #rhinitis after excluding work, elderly, gustatory, hormonal and drug induced rhinitis. Nasal steroid sprays are ineffective for this condition. Astelin, Atrovent are nasal sprays that have also been used for this condition and they have showed some improvement. But for others, these treatment options have failed. Capsaicin is the active ingredient of chili peppers. It is available as an over-the-counter nasal spray (ei, Sinus Buster, Sinus Plumber, others).

Capsaicin is another treatment option available for patients with idiopathic rhinitis. This treatment has limitations though, it can be uncomfortable, time consuming and incompletely understood in terms of its working mechanism. Research for better capsaicin treatment is needed.

A recent study looked at 2 different dosing of #capsaicin nasal sprays to see if it could suppress nasal symptoms. Daily nasal administration of low-dose capsaicin was well tolerated and reduced nasal symptoms. The study also evaluated the levels of Substance P which has been shown to be higher in patients with idiopathic rhinitis.

Symptom reduction was seen between 70-80% of patients with idiopathic rhinitis. Daily administration of low dose capsaicin was well tolerated and reduced nasal symptoms. Levels of Substance P were reduced and there was a positive correlation between Substance P and nasal obstruction, suggesting that rhinitis symptoms result from abnormally increased Substance P levels. As Substance P increases mucus secretion, suppressing it might represent a novel approach.

This study looked at different concentrations of Capsaicin nasal spray. There are various different manufacturers of Capsaicin spray, although the exact concentration isn’t well defined. As always speak to your doctor before beginning any treatment.  Patients who participated in this study were excluded from any allergies or infections prior to beginning treatment.

In conclusion, capsaicin low dose is effective in suppressing nasal symptoms and it may be a good, novel option for patients with non-allergic rhintis.

I have several reasons to write about “non-allergic” rhinitis.

  • Granted, this is the allergy season, but not everything that sneezes is allergy. Patients are always confused when skin testing is negative, yet they have consistent “allergy symptoms”. Heck, I even use the term “allergy” when I’m writing about non-allergic rhinitis.
  • Allergy has to have IgE (that’s the molecule binding to both allergens and subsequently to the mast cell causing histamine release). No IgE, no allergies and unfortunately, no allergy shots will work.
  • As Alan has mentioned, the typical nasal sprays such as Flonase and other nasal steroids don’t work well for this condition. Much of what you see advertised on TV is designed to encourage you to buy intranasal steroids, but many of those conditions are “non-allergic” rhinitis and listening to the TV ads won’t do you a bit of good.
  • I would disagree with the incidence of “non-allergic” rhinitis @ 30%–it’s more like the majority of rhinitis sufferers at ~70% and maybe more during the winter.
  • It is true that treatment of “non-allergic” rhinitis is frustrating because of lack of good nasal sprays, but PLEASE don’t give yourself capsaicin or hot pepper sauce in the nose before getting a prescription to dilute those hot babies down or you’ll be swearing at me all the way to the ER. Pepper spray will reduce that runny nose only if you compound the formula by an experienced pharmacist and deliver it into the nose carefully. Police grade pepper spray will get you into a whole lot of trouble!
  • As a research project, I’m looking into using nasal challenges for patients who have local allergic rhinitis and this may provide some additional use of desensitization even though skin testing and blood work is all negative for IgE. More on that later.
  • Bottom line: Not all that sneezes is allergy and a significant number of patients have runny nose, sneezing and sinus infections without having the opportunity to use allergy shots for desensitization.
  • If this is you, there is hope. See your local allergist for discussion about Astelin, Atrovent (hardly ever used), and if needed, I can work in conjunction with a local compounding pharmacy to get some capscaicin spray to help with that sneezing.

In the meantime, enjoy your tacos!

#if-not-allergy

The Cat’s Out of the Bag!

As the holidays approach, our travel will be limited by #COVID-19, but we still may visit relatives with #cats, and you’re allergic! Researchers from Nestle Purina Research in St Louis MO may have part of the answer. As cats groom (which they do all the time), Fel d 1 is distributed within the hair coat and can then be shed with the #cat hair and dander. Not good news if you suffer from cat allergy. And worse news for your relatives!

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It’s a scam to our patients

Much of my medical office day is explaining to patients what they DON’T have rather than treating #allergy. Allergy has become the explanation for all medical disease. For instance, it’s rare for allergy to cause lack of attention, abdominal cramping (because of food allergy), or even constipation, but patients want allergy testing nonetheless. What are some “non-allergy” conditions that you’re likely to spend money you don’t need because of excessive testing?

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#allergy-shots-2, #food-allergy, #myths, #sinus-infections

Where Do You Get Your Medical Information?

I recently found an article on the accuracy of #medical information on #Facebook–it was 85% (wrong that is).  With this much misinformation at our fingertips, no wonder medical advances seem to be muted…obesity, cost of medical care, gun violence, heart disease. If you’re relying on the internet for your medical information, perhaps this link on how to counteract medical-misinformation might be helpful.

Take a survey for me at the end of the article: I want to know your thoughts.

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I lie and so do you

I was in my doctor’s office today (yes, I go to the doctor as well) and she asked me if I was taking my #medications.  Of course, I said “yes, the ones that are in my chart”, not really having that photogenic list in my head.  As we talked, I realized my confession of what my doctor wanted to hear got the priority over what I was really doing. Busted for lying, but not intentional.

I wish it wasn’t so difficult to take care of our bodies.  I always overestimate how much I #exercise and how little I eat.  Scales don’t lie, so I just don’t weigh myself.  Isn’t it a good thing I only see my dentist every 6 months? I only have to lie about flossing twice a year!

We all do this everyday--just kidding!

We all do this everyday–just kidding!

#Asthma, however, is no laughing matter. Your asthma control and cost of keeping you out of the hospital depends on how often you take the medications prescribed to CONTROL your asthma not just treat it. The solution is simple, yet very difficult to actually perform correctly.  Here’s the issue with asthma–which inhaler do I use when it’s prescribed by my asthma doctor?  I’ll bet you confuse the use of controller medications with reliever medications and now that more new inhalers are on the market it’s even more difficult to do the right thing.

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#american-academy-of-allergy-asthma-and-immunology, #american-college-of-allergy-asthma-immunology, #respiratory-disorders

Drug Reps Will Give You Asthma

I know you’ve been there before….waiting in the doctor’s office for your appointment and some smartly dressed man or woman barely has to say hello to the receptionist and walks right by your seat, straight to the doctor’s office. “Hey, that’s not fair,” you say to yourself as you dig your nose into that outdated magazine trying to mask the irritation.  “My time is just as valuable as theirs is, put me to the front of the line!”  As a patient, my frustration with the #health care system only percolates at the injustice.  Isn’t the cost of #medication so high in America because of all the drug companies?  If there were no drug reps, wouldn’t my doctor have a better and certainly more unbiased selection of medications?  Granted, the goal of any #pharmaceutical company (employer of drug reps) is to make profit, but they can’t do that unless a product (medication) works well and is taken as directed.  In the end, drug companies want you to be adherent to medications prescribed so they’ll work, you get better, all of which is good for the bottom line.  Almost sounds too good to be true when everybody wins, but hang on and I’ll show you how this is possible. Continue reading

#allergies, #asthma, #immunoglobulin-e, #wheeze

Tulsa is the Allergy Capital of the Nation

Tulsa is the #allergy capital of the nation.  You wouldn’t believe how many times in a day I hear that!  and it makes sense…countless numbers of patients return to Tulsa and find their #allergies are now out of control. But is this really true?  Does anyone even keep track of which city in America has the highest pollen counts and can thus claim to be the most miserable #pollen city in America? Continue reading

#asthma, #pollen-counts, #respiratory-disorders, #runny-nose, #sneezing

What Else About Allergy is Out There?

It’s difficult to find good material on the internet related to the practice of #allergy. Here is one such blog site: http://blogs.medscape.com/garystadtmauer.  This blog originates from New York and the practice website is www.cityallergy.com.  I will periodically post comments & articles from Dr. Stadtmauer’s blog and I’ve included one below about the coexistence of systemic allergy (that’s a positive skin or blood test) and LOCAL allergic rhinitis which has all the signs & symptoms of allergy, but guess what–skin & blood testing is all negative.  Very frustrating for #patients to experience allergy symptoms, but go in to their local allergist and find nothing. I wish treatment would be more satisfactory, but as you can imagine, it’s unknown what allergens to mix up for your allergy recipe if all testing is negative.  Continue reading

#allergy-blogs, #allergy-shots-2, #medscape

It’s allergy season and what can I do?

The following YouTube video describes a process called “Rush Immunotherapy” conducted in Ohio.  It’s now a more common way to deliver #allergy shots and reduces the total number of shots required to achieve clinical relief from your #allergies.  Some caveats about #RUSH Immunotherapy need to be included and your bullet list is below the video.

I would make the following corrections to this video:

1.  Unfortunately, you can’t answer all questions about immunotherapy (allergy shots) in a 3 minute news clip.

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#allergen-immunotherapy, #allergy, #american-academy-of-allergy-asthma-and-immunology, #american-college-of-allergy-asthma-immunology, #oklahoma, #tulsa-oklahoma