Hydroxychloroquine...........

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Infection_Ag11
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In reply to dermdoc • 5:55p, 4/1/20
AG
dermdoc said:
With all due respect, the same thing can happen with Tylenol. I have used plaquenil for decades as have rheums I know with out ever hearing of this side effect. And it is interesting we used to have to check a G6pd. Weird.

With all due respect, I kind of throw caution out the door when I am dealing with a pandemic. And I would be pissed if a doc did not start me or my family on the cocktail if the meds were available.


Tylenol toxicity is associated almost exclusively with overdose or in combination with other hepatotoxic drugs though, Plaquenil has known toxicities on standard therapeutic doses.

The bottom line is I simply do not see a reason to subject certain patients with an incredibly low risk of severe disease and death to a drug that could do harm than the disease. I've started Plaquenil on about 80% of the stable floor patients with COVID, but those in their 30s and 40s without hypoxia or underlying conditions? I don't believe the potential benefit outweighs the risk. And I certainly don't see the need to blindly prescribe every outpatient COVID case with a prescription.
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Infection_Ag11
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6:00p, 4/1/20
AG
I have worked aggressively to try and enroll every ICU patient possible into one of the ongoing remdesivir or IL-6 inhibitor trials however, in part because the mechanism is far more clear and the emerging data is far more promising but also because the risk/benefit is dramatically shifted in those patients.
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dermdoc
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In reply to Infection_Ag11 • 6:10p, 4/1/20
AG
Infection_Ag11 said:
I have worked aggressively to try and enroll every ICU patient possible into one of the ongoing remdesivir or IL-6 inhibitor trials however, in part because the mechanism is far more clear and the emerging data is far more promising but also because the risk/benefit is dramatically shifted in those patients.
I am partial to the IL 6 inhibitor. I think there are two separate events, the viral infection and the cytokine storm. I would use the cocktail pre storm and IL 6 inhibitor post.

And if I were you and some 64 y/o dermatologist was posting what I have I would be laughing my ass off.

Thank you for what you do,
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Infection_Ag11
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In reply to dermdoc • 6:29p, 4/1/20
AG
dermdoc said:
Infection_Ag11 said:
I have worked aggressively to try and enroll every ICU patient possible into one of the ongoing remdesivir or IL-6 inhibitor trials however, in part because the mechanism is far more clear and the emerging data is far more promising but also because the risk/benefit is dramatically shifted in those patients.
I am partial to the IL 6 inhibitor. I think there are two separate events, the viral infection and the cytokine storm.


I think the data makes this no longer an opinion, at worst it's a highly educated guess bordering on fact. Everything I've seen personally and what's been reported indicates this is a progression from viral pneumonia with primary pneumocyte destruction to immune mediated alveolar damage and ARDS.

Quote:
And if I were you and some 64 y/o dermatologist was posting what I have I would be laughing my ass off.


Most dermatologists and their 270 STEP 1 scores are way smarter than me.
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Ragoo
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In reply to dermdoc • 6:30p, 4/1/20
AG
dermdoc said:
First of all, I would be happy for Pelayo to be my doc. He and I think alike.

The problem with the use of hydroxychloroquine/azithromycin/zinc(from now on referred to as haz)is that it is being used on folks who already are severe or have ARDS. You want to treat them BEFORE the cytokine storm, not after.

That is why supply of haz is much more important than tests. Anybody with symptoms should be treated with haz. And as early as possible.

I personally would not even wait on a baseline EKG or "test" which can change day to day if I was treating a family member.
the early treatment is exactly what I was suggesting in another thread. Match three symptoms for covid? Here is a HAZ program. Go home and isolate.
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Marcus Aurelius
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In reply to dermdoc • 6:50p, 4/1/20
AG
dermdoc said:
Infection_Ag11 said:
I have worked aggressively to try and enroll every ICU patient possible into one of the ongoing remdesivir or IL-6 inhibitor trials however, in part because the mechanism is far more clear and the emerging data is far more promising but also because the risk/benefit is dramatically shifted in those patients.
I am partial to the IL 6 inhibitor. I think there are two separate events, the viral infection and the cytokine storm. I would use the cocktail pre storm and IL 6 inhibitor post.

And if I were you and some 64 y/o dermatologist was posting what I have I would be laughing my ass off.

Thank you for what you do,



Agree 100%. HCQ I predict will be shown to have similar effects like Tamiflu dosed early. HCQ has no effect at day 7+. As Ive posted. IMO. IL-6 inhibitors the most intriguing for these folks. Cytokine storm syndrome is a nightmare. Also maybe antivirals such as remdisivir given early.
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SMM48
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In reply to Infection_Ag11 • 7:07p, 4/1/20
AG
Amen.

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SMM48
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In reply to dermdoc • 7:09p, 4/1/20
AG
You get your liver checked....you know you do. Your doc ain't dumb.
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Bonfire1996
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In reply to Infection_Ag11 • 7:10p, 4/1/20
AG
Infection_Ag11 said:
barnyard1996 said:
Thank you Mr President for putting it on a pedestal so the average american will know about the drug and push the conversation. I know it will make many doctors and scientists uncomfortable that you broke their protocols, but they will get over it. Or, maybe they won't.



But rest assured, we'll still get blamed when that patient has an adverse reaction to the drug. Especially in a patient who had a very low probability of developing severe disease from COVID.
Us aggies are world champs at tunnel vision. Undefeated.
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dermdoc
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In reply to SMM48 • 7:12p, 4/1/20
AG
SteveMedina said:
You get your liver checked....you know you do. Your doc ain't dumb.
My doc is a drinking buddy of mine. He would never check my liver functions.
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SMM48
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In reply to dermdoc • 7:16p, 4/1/20
AG
Haha
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dermdoc
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In reply to Infection_Ag11 • 7:30p, 4/1/20
AG
Yes you will get crucified if some one has an adverse reaction and maybe sued.

I have been sued once and won. And it still haunts me sometimes. But I know it is better to do what is right. And trust God to protect you.
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Marcus Aurelius
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In reply to dermdoc • 7:34p, 4/1/20
AG
Man. One would hope that during this nightmare pandemic disaster with a deadly virus that no one understands well, that the med mal would be forgiven. Battling this **** makes me kinda feel really like a doctor like we should all the time. IDK.
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Exsurge Domine
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In reply to dermdoc • 7:35p, 4/1/20
dermdoc said:
Yes you will get crucified if some one has an adverse reaction and maybe sued.

I have been sued once and won. And it still haunts me sometimes. But I know it is better to do what is right. And trust Hod to protect you.


[url=https://ibb.co/vq7SyF1][/url]

Weird reference doc, but whatever helps
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dermdoc
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In reply to Exsurge Domine • 7:40p, 4/1/20
AG
I corrected it, sorry.
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Pelayo
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In reply to dermdoc • 8:50p, 4/1/20
AG
dermdoc said:
Yes you will get crucified if some one has an adverse reaction and maybe sued.

I have been sued once and won. And it still haunts me sometimes. But I know it is better to do what is right. And trust God to protect you.
Yep
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74Ag1
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9:52p, 4/1/20
AG
https://www.independentsentinel.com/hydroxychloroquine-keeps-people-alive-at-the-smith-center/
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DTP02
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In reply to 74Ag1 • 8:15a, 4/2/20
AG
74Ag1 said:
https://www.independentsentinel.com/hydroxychloroquine-keeps-people-alive-at-the-smith-center/


[NOTE: they have now changed the link. My summary below linked and summarized the original video. You may just have to take my word for it because I'm not going to try to hunt down the original link]

I was just coming to post this. Here's a direct link to the show, with the interview starting a little after the 12 min mark:



It's an interesting interview on several fronts, although it's a bit disjointed.

A quick and dirty recap:

- ID Clinic in NY has 70+ COVID patients. The majority are diabetic, pre-diabetic, and/or obese, so lots of high risk folks. Mentions some study from Seattle that zeroes in on the high incidence of diabetes and obesity among serious COVID patients and that this probably isn't getting enough attention

- He's giving hydroxychloroquine and Zithromax to all of his patients and has not lost any yet.

- here's the big point: none if the patients that had been on the protocol for even 3 days needed to be intubated

- of the ~20 patients who needed to be intubated they all came to the clinic fairly late in the infection and had been on the protocol for 2 days or less. He agrees that the protocol is a game-changer.

- he is concerned about side-effects of the protocol, especially given most of his patients have other risk factors, so they've been monitoring EKGs. Only two EKGs showed any concerning readings after starting the protocol.
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Player To Be Named Later
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In reply to DTP02 • 8:51a, 4/2/20
AG
Just more proof that we need to square away our testing speeds and get high risk folks on this early.
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DTP02
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In reply to Player To Be Named Later • 8:57a, 4/2/20
AG
Yes, I'm hoping that the big study in NY will enroll enough patients who were identified early in the infection to assess the efficacy at that stage. My concern is that the fact that NY is being overwhelmed is more likely to lead to the vast majority of patients getting the protocol late in the infection, when it seems like the efficacy is more doubtful.
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Reveille
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In reply to Pelayo • 8:59a, 4/2/20
AG
Pelayo said:
dermdoc said:
Yes you will get crucified if some one has an adverse reaction and maybe sued.

I agree completely! I believe you do what's right!

I have been sued once and won. And it still haunts me sometimes. But I know it is better to do what is right. And trust God to protect you.
Yep


I agree completely!
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Reveille
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In reply to DTP02 • 9:05a, 4/2/20
AG
DTP02 said:
74Ag1 said:
https://www.independentsentinel.com/hydroxychloroquine-keeps-people-alive-at-the-smith-center/


[NOTE: they have now changed the link. My summary below linked and summarized the original video. You may just have to take my word for it because I'm not going to try to hunt down the original link]

I was just coming to post this. Here's a direct link to the show, with the interview starting a little after the 12 min mark:



It's an interesting interview on several fronts, although it's a bit disjointed.

A quick and dirty recap:

- ID Clinic in NY has 70+ COVID patients. The majority are diabetic, pre-diabetic, and/or obese, so lots of high risk folks. Mentions some study from Seattle that zeroes in on the high incidence of diabetes and obesity among serious COVID patients and that this probably isn't getting enough attention

- He's giving hydroxychloroquine and Zithromax to all of his patients and has not lost any yet.

- here's the big point: none if the patients that had been on the protocol for even 3 days needed to be intubated

- of the ~20 patients who needed to be intubated they all came to the clinic fairly late in the infection and had been on the protocol for 2 days or less. He agrees that the protocol is a game-changer.

- he is concerned about side-effects of the protocol, especially given most of his patients have other risk factors, so they've been monitoring EKGs. Only two EKGs showed any concerning readings after starting the protocol.


I watched this night also! Was very interesting and looks very promising. He stated being an infectious disease doctor he hasn't read EKG's in over 20 years so had them read by an electrophysiologist and they found two with slightly widening QT Intervals. He did say that they were also on other medications that prolong QT Interval.

I think it also reiterated what we have been thinking and that diseases that cause weakening of the immune system like diabetes put you at high risk is serious disease!
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Tabasco
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10:30a, 4/2/20
AG
Haven't seen this posted yet, but I know a lot of the psychiatrics are a no-no if someone has a propensity towards long-QT, namely antidepressants and antipsychotics. Do these come into play here, or is that only for those with some sort of long-QT predisposition?
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KidDoc
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In reply to Tabasco • 11:15a, 4/2/20
AG
Tabasco said:
Haven't seen this posted yet, but I know a lot of the psychiatrics are a no-no if someone has a propensity towards long-QT, namely antidepressants and antipsychotics. Do these come into play here, or is that only for those with some sort of long-QT predisposition?
My understanding is that any drug that has a chance to prolong QT interval synergizes with other agents. Being on an SSRI + HCQ + ZMAX is concerning and needs to be monitored IMO. I am not a cardiologist though so this is just my understanding, it is not something I have to worry about in Pediatrics very often.

Add in ondansetron for vomiting and you have real potential problems.
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In reply to Reveille • 11:23a, 4/2/20
GE
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In reply to SUag • 11:24a, 4/2/20
AG
SUag said:
He wouldn't say anything other than that until there are randomized controlled trials completed, documented, and reviewed. And he isn't wrong.
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BusterAg
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In reply to Exsurge Domine • 11:51a, 4/2/20
AG
Exsurge Domine said:
This is even bigger

[url=https://ibb.co/XS6NPVD][/url]

https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf

HCQ plus Azithromyacin, 100% effective at 6 days
Promising.

Sample size is 22 patients, so we need further testing, but, if this holds, amazing news.
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BusterAg
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In reply to dermdoc • 11:56a, 4/2/20
AG
dermdoc said:
Yes you will get crucified if some one has an adverse reaction and maybe sued.

I have been sued once and won. And it still haunts me sometimes. But I know it is better to do what is right. And trust God to protect you.
Keep doing what you do. Do right, based on your best judgement. If I'm in trouble, I want an educated man trying to make a positive difference more than anything else.
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PJYoung
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12:19p, 4/2/20
AG
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culdeus
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In reply to PJYoung • 12:25p, 4/2/20
AG
PJYoung said:


This guy still gives me the vibes of some chain email my grandmother would send me.
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dermdoc
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12:26p, 4/2/20
AG
I have peripherally worked with Dr. Fauci and heard him speak several times. He is a genius but he is primarily an epidemiologist and not a clinician. Because of that he does not treat patients and is only interested in controlled studies, etc.

Front line clinicians are a totally different animal.
I guarantee you clinicians are not waiting on studies and are discovering how to use HAZ. It needs to be used BEFORE the cytokines storm to really be effective.
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BadMoonRisin
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In reply to Reveille • 12:42p, 4/2/20
AG
Reveille said:
DTP02 said:
74Ag1 said:
https://www.independentsentinel.com/hydroxychloroquine-keeps-people-alive-at-the-smith-center/


[NOTE: they have now changed the link. My summary below linked and summarized the original video. You may just have to take my word for it because I'm not going to try to hunt down the original link]

I was just coming to post this. Here's a direct link to the show, with the interview starting a little after the 12 min mark:



It's an interesting interview on several fronts, although it's a bit disjointed.

A quick and dirty recap:

- ID Clinic in NY has 70+ COVID patients. The majority are diabetic, pre-diabetic, and/or obese, so lots of high risk folks. Mentions some study from Seattle that zeroes in on the high incidence of diabetes and obesity among serious COVID patients and that this probably isn't getting enough attention

- He's giving hydroxychloroquine and Zithromax to all of his patients and has not lost any yet.

- here's the big point: none if the patients that had been on the protocol for even 3 days needed to be intubated

- of the ~20 patients who needed to be intubated they all came to the clinic fairly late in the infection and had been on the protocol for 2 days or less. He agrees that the protocol is a game-changer.

- he is concerned about side-effects of the protocol, especially given most of his patients have other risk factors, so they've been monitoring EKGs. Only two EKGs showed any concerning readings after starting the protocol.


I watched this night also! Was very interesting and looks very promising. He stated being an infectious disease doctor he hasn't read EKG's in over 20 years so had them read by an electrophysiologist and they found two with slightly widening QT Intervals. He did say that they were also on other medications that prolong QT Interval.

I think it also reiterated what we have been thinking and that diseases that cause weakening of the immune system like diabetes put you at high risk is serious disease!
Does the potential prolonged QT interval that is a side effect of this medication last only while the patient is on the medication, or is there a risk that it would prolong it permanently?
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1:02p, 4/2/20
AG
Was just thinking about this and the testing situation. How on earth are we going to start getting to people with symptoms but before it is no longer too useful?

Even if our tests get to running 1 to 2 days out on results, aren't we still dealing with fairly high false negative test results?

Seems awful to me that we likely have a good early treatment but looking like a long time away from getting it to people.

Do people like Gov Abbott not take the high false negatives into account before banning these drugs prior to a positive test?

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Cant Think of a Name
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1:02p, 4/2/20
AG
Hey, the guy above me copied me!

The Texas Medical Board (or whomever makes these decisions) wont authorize this drug treatment without a confirmed test. The tests are taking 5-7 days to get results, and are highly inaccurate. This treatment works best if administered in the first 7 days.

Anyone else see a problem here?
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fig96
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In reply to Cant Think of a Name • 1:11p, 4/2/20
AG
Cant Think of a Name said:
Hey, the guy above me copied me!

The Texas Medical Board (or whomever makes these decisions) wont authorize this drug treatment without a confirmed test. The tests are taking 5-7 days to get results, and are highly inaccurate. This treatment works best if administered in the first 7 days.

Anyone else see a problem here?
I posted something very similar to someone questioning why testing was important on another thread.
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