Post by the Scribe on Apr 14, 2020 10:44:53 GMT
Health
Emergency room doctor, near death with coronavirus, saved with experimental treatment
Richard Read
LA TimesApril 13, 2020, 10:48 PM MST
Dr. Ryan Padgett, a Seattle emergency room physician, contracted COVID-19 and was saved by doctors who used an experimental treatment. (Karen Ducey / Los Angeles Times)
As critically ill, elderly patients streamed into his emergency room outside Seattle, Dr. Ryan Padgett quickly came to understand how deadly COVID-19 could be.
www.latimes.com/world-nation/story/2020-03-15/nursing-home-visitors-coronavirus-life-care-center-kirkland-washington
Of the first two dozen or so he saw, not a single one survived.
It took longer for Padgett and his colleagues at EvergreenHealth Medical Center — the first hospital in the country to treat multiple coronavirus patients — to learn how easily the disease could spread.
www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak
At first, the medical workers wore only surgical masks and gloves. Later, they were told to wear respirators and other gear, but the equipment was unfamiliar and Padgett couldn't be certain he put it on and took it off correctly each time.
A 6-foot-3, 250-pound former football star who played for Northwestern in the 1996 Rose Bowl, he wasn't fazed by much.
“To worry about myself, as a 44-year-old healthy man, didn’t even cross my mind,” he said in an interview Monday.
But on March 12, with his wedding day two months away, Padgett became the patient.
Soon after being admitted to his own hospital with a fever, cough and difficulty breathing, he was placed on a ventilator. Five days after that, his lungs and kidneys were failing, his heart was in trouble, and doctors figured he had a day or so to live.
He owes his survival to an elite team of doctors who tried an experimental treatment pioneered in China and used on the sickest of all COVID-19 patients.
Lessons from his dramatic recovery could help doctors worldwide treat other extremely ill COVID-19 patients.
"This is a movie-like save, it doesn't happen in the real world often," Padgett said. "I was just a fortunate recipient of people who said, 'We are not done. We are going to go into an experimental realm to try and save your life.'"
Once his colleagues at EvergreenHealth realized they had run out of options, they called Swedish Medical Center, one of two Seattle hospitals that has a machine known as an ECMO, which replaces the functions of the heart and lungs.
But even after the hospital admitted him, doctors there had to figure out why he was so profoundly sick.
Based on the astronomical level of inflammation in his body and reports written by Chinese and Italian physicians who had treated the sickest COVID-19 patients, the doctors came to believe that it was not the disease itself killing him but his own immune system.
It had gone haywire and began to attack itself — a syndrome known as a "cytokine storm."
The immune system normally uses proteins called cytokines as weapons in fighting a disease. For unknown reasons in some COVID-19 patients, the immune system first fails to respond quickly enough and then floods the body with cytokines, destroying blood vessels and filling the lungs with fluid.
The doctors tried a drug called Actemra, which was designed to treat rheumatoid arthritis but also approved in 2017 to treat cytokine storms in cancer patients.
"Our role was to quiet the storm," said Dr. Samuel Youssef, a cardiac surgeon. "Dr. Padgett was able to clear the virus" once his immune system was back in balance.
Dr. Matt Hartman, a cardiologist, said that after four days on the immunosuppressive drug, supplemented by high-dose vitamin C and other therapies, the level of oxygen in Padgett's blood improved dramatically. On March 23, doctors were able to take him off life support.
Four days later, they removed his breathing tube. He slowly came out of his sedated coma, at first imagining that he was in the top floor of the Space Needle converted to a COVID ward.
He soon became more conscious of his surroundings and had a FaceTime conversation with family members, who hadn't been able to visit because of the hospital's coronavirus lockdown.
"It's an incredible thing to survive a brush with death and not be able to see and be with your most loved people," Padgett said. "And when everyone on staff who comes to see you has to be in a spacesuit, you just feel like this pariah. The isolation was pretty devastating at times."
On March 31, balloons, gifts and letters came in the door. It was his 45th birthday. "My birthday cake was an ice chip," he said, recalling how grateful he was for his first sustenance by mouth.
As Padgett got to know Youssef, Hartman and other team members, they told him about a 33-year-old woman — a mother of three — who was in the hospital as well, also having experienced a cytokine storm. He saw the team's excitement when they tried the approach on her, and she too recovered.
Padgett went home on April 5. He said Monday that he faced a long, slow recovery, physically and cognitively. He expects to be a better doctor, reminded how devastating an illness can be to a patient and a family.
Returning to the ER won't be easy, he said. "But that's my home, that's what I do," he said. "I enjoy that everyone-in-the-foxhole mentality."
And one day before then, Padgett and his fiancee, Connie Kinsley, plan to have a small wedding ceremony with a few friends on their boat moored on a Seattle lake.
Black Diamond2 hours ago
He's not out of the woods. Immunosuppressive drugs often cause cancer. My sister was pressured to take one by her doctor even though she wasn't in an imminent life or death condition. She took it briefly and shortly thereafter she developed breast cancer and had to get a mastectomy. The drug was called CellCept. Her ex-husband tried to get her to sue but in order for her to take it she had to sign a waiver accepting the risk of getting cancer. I guess if you're going to die otherwise, it makes sense to take a known carcinogen. I'm just trying to let anyone thinking of taking an immunosuppressive as a standard treatment or as a precaution that it is definitely without risk. Keep social distancing and hope you never have to make the choice.
BruceB4 hours ago
Fresh chopped garlic has a super potent antiviral enzyme called alliinase that only lasts 2 hours after the garlic is chopped. chop up one big clove of garlic and take it on a full stomach with honey or water and 500mg of vitamin c 2 x a day as soon as you feel a cold or flu (and hopefully corona virus) coming on. For me, it shortens the lifespan of the flu/cold by 2/3.
Emergency room doctor, near death with coronavirus, saved with experimental treatment
Richard Read
LA TimesApril 13, 2020, 10:48 PM MST
Dr. Ryan Padgett, a Seattle emergency room physician, contracted COVID-19 and was saved by doctors who used an experimental treatment. (Karen Ducey / Los Angeles Times)
As critically ill, elderly patients streamed into his emergency room outside Seattle, Dr. Ryan Padgett quickly came to understand how deadly COVID-19 could be.
www.latimes.com/world-nation/story/2020-03-15/nursing-home-visitors-coronavirus-life-care-center-kirkland-washington
Of the first two dozen or so he saw, not a single one survived.
It took longer for Padgett and his colleagues at EvergreenHealth Medical Center — the first hospital in the country to treat multiple coronavirus patients — to learn how easily the disease could spread.
www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak
At first, the medical workers wore only surgical masks and gloves. Later, they were told to wear respirators and other gear, but the equipment was unfamiliar and Padgett couldn't be certain he put it on and took it off correctly each time.
A 6-foot-3, 250-pound former football star who played for Northwestern in the 1996 Rose Bowl, he wasn't fazed by much.
“To worry about myself, as a 44-year-old healthy man, didn’t even cross my mind,” he said in an interview Monday.
But on March 12, with his wedding day two months away, Padgett became the patient.
Soon after being admitted to his own hospital with a fever, cough and difficulty breathing, he was placed on a ventilator. Five days after that, his lungs and kidneys were failing, his heart was in trouble, and doctors figured he had a day or so to live.
He owes his survival to an elite team of doctors who tried an experimental treatment pioneered in China and used on the sickest of all COVID-19 patients.
Lessons from his dramatic recovery could help doctors worldwide treat other extremely ill COVID-19 patients.
"This is a movie-like save, it doesn't happen in the real world often," Padgett said. "I was just a fortunate recipient of people who said, 'We are not done. We are going to go into an experimental realm to try and save your life.'"
Once his colleagues at EvergreenHealth realized they had run out of options, they called Swedish Medical Center, one of two Seattle hospitals that has a machine known as an ECMO, which replaces the functions of the heart and lungs.
But even after the hospital admitted him, doctors there had to figure out why he was so profoundly sick.
Based on the astronomical level of inflammation in his body and reports written by Chinese and Italian physicians who had treated the sickest COVID-19 patients, the doctors came to believe that it was not the disease itself killing him but his own immune system.
It had gone haywire and began to attack itself — a syndrome known as a "cytokine storm."
The immune system normally uses proteins called cytokines as weapons in fighting a disease. For unknown reasons in some COVID-19 patients, the immune system first fails to respond quickly enough and then floods the body with cytokines, destroying blood vessels and filling the lungs with fluid.
The doctors tried a drug called Actemra, which was designed to treat rheumatoid arthritis but also approved in 2017 to treat cytokine storms in cancer patients.
"Our role was to quiet the storm," said Dr. Samuel Youssef, a cardiac surgeon. "Dr. Padgett was able to clear the virus" once his immune system was back in balance.
Dr. Matt Hartman, a cardiologist, said that after four days on the immunosuppressive drug, supplemented by high-dose vitamin C and other therapies, the level of oxygen in Padgett's blood improved dramatically. On March 23, doctors were able to take him off life support.
Four days later, they removed his breathing tube. He slowly came out of his sedated coma, at first imagining that he was in the top floor of the Space Needle converted to a COVID ward.
He soon became more conscious of his surroundings and had a FaceTime conversation with family members, who hadn't been able to visit because of the hospital's coronavirus lockdown.
"It's an incredible thing to survive a brush with death and not be able to see and be with your most loved people," Padgett said. "And when everyone on staff who comes to see you has to be in a spacesuit, you just feel like this pariah. The isolation was pretty devastating at times."
On March 31, balloons, gifts and letters came in the door. It was his 45th birthday. "My birthday cake was an ice chip," he said, recalling how grateful he was for his first sustenance by mouth.
As Padgett got to know Youssef, Hartman and other team members, they told him about a 33-year-old woman — a mother of three — who was in the hospital as well, also having experienced a cytokine storm. He saw the team's excitement when they tried the approach on her, and she too recovered.
Padgett went home on April 5. He said Monday that he faced a long, slow recovery, physically and cognitively. He expects to be a better doctor, reminded how devastating an illness can be to a patient and a family.
Returning to the ER won't be easy, he said. "But that's my home, that's what I do," he said. "I enjoy that everyone-in-the-foxhole mentality."
And one day before then, Padgett and his fiancee, Connie Kinsley, plan to have a small wedding ceremony with a few friends on their boat moored on a Seattle lake.
Black Diamond2 hours ago
He's not out of the woods. Immunosuppressive drugs often cause cancer. My sister was pressured to take one by her doctor even though she wasn't in an imminent life or death condition. She took it briefly and shortly thereafter she developed breast cancer and had to get a mastectomy. The drug was called CellCept. Her ex-husband tried to get her to sue but in order for her to take it she had to sign a waiver accepting the risk of getting cancer. I guess if you're going to die otherwise, it makes sense to take a known carcinogen. I'm just trying to let anyone thinking of taking an immunosuppressive as a standard treatment or as a precaution that it is definitely without risk. Keep social distancing and hope you never have to make the choice.
Monkeymantoday4 hours ago
I don't believe it. It appears that this drug is the last one you would give a patient who was dying of pneumonia cause by corona.
ACTEMRA can cause serious side effects
Serious Infections
ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.
I don't believe it. It appears that this drug is the last one you would give a patient who was dying of pneumonia cause by corona.
ACTEMRA can cause serious side effects
Serious Infections
ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.
Satele 4 minutes ago
Credit to original poster: Possible adjunctive therapy:Probably more than SARS 1, SARS 2/ COVID 19 seems to supress fevers more than usual. A lot of people have the virus, don't know they have it and have no fever at all. This may be the reason the virus is able to replicate and spread. (calm before the storm) So if we can increase the core body temperature unsing whatever techniques are available like contrast showers, hydro thermal therapy, hot bath then cold, this might actually help speed up recovery and not spread the virus.
Patients coming in with COVID-19 have elevated liver function tests. Non steroidal medications inhibit the production of prostaglandins, which are directly responsible for antibody production. That is the adaptive immune response but no the innate immune system. The impact of COVID-19 isn't just on lungs. It attacks the entire body including the heart, kidneys, liver, the collagulation system, neuroligical system.
Thermal stress produces heat shock proteins which are immune modulators. They essentially jumstarts the immune response whereas this virus tries to downregulate the innate immune system. This treatment has to be complimented with current medical care. If you are relatively fit the same can be accomplished with exercise to increase core temperature then cooling off with a cold shower.
In terms of anyone who might be immunocompromised, many companies are looking at the natural killer cells to help with immunity in other diseases and repurposed to look at COVID-19. They are taking it and infusing it on people coming in to the hospital. Imagine that you can do this in much less invasive ways much earlier in the process with hydro thermal therapy.
Warning to anyone with asthma as steam hot showers can precipitate an astma attacks. Hot/Cold therapy treatment can potentially boost immunity with coronavirus. He cites 4 studies below indicate affects the part of the SARS COV2 natural cells and monocytes. Keep in mind there is no studies on this with COVID-19 but he is using the next best scenario studies if you follow. Hot and cold temperature regulation affects part of the innate immune system that helps with targeting viral infections. Hyperthermia and then cooling off actually improved surrogates for the immune system monocytes and their stimulation/ response to foreign invaders.
Source #1 www.ncbi.nlm.nih.gov/pmc/articles/PMC4786079/pdf/nihms755275.pdf
Source #2 www.tandfonline.com/doi/abs/10.3109/07853899009148930
Source #3 www.ncbi.nlm.nih.gov/pubmed/12060966
Source #4 journals.physiology.org/doi/pdf/10.1152/jappl.1999.87.2.699
Consider taking contrast showers 4-6 minutes warm/hot water, clean yourself, then rinse with 1-3 minutes cold water. Every day. Takes 1-2 weeks to get used to it, but it's well worth it. Or hot bath/then cold shower. Consult with your doctor first but here is a instructional video on contrast showers vimeo.com/165013134/346f3ef87a
If you have pneumonia, sleep on your stomach. This alone reduces mortality rates by 30-40% because in the prone position, lung compression is decreased, secretions drain better, and collapsed alveoli reopen. Source 1: journals.lww.com/nursingcriticalcare/Fulltext/2009/05000/Prone_positioning__Improving_oxygenation_in.10.aspx
Source 2:
digitalcommons.ric.edu/cgi/viewcontent.cgi?article=1272&context=etd
If you go out in public practice social distancing and wear a mask or face covering of some kind. They make a whole room UV light sanitizer on uvsterilizex.com/ they make for surfaces/rooms. UV light is highly effective at killing viruses. The three main types of UV rays are UVA, UVB, and UVC. Because UVC rays have the shortest wavelength, and therefore highest energy, they are capable of killing bacteria and viruses, also called pathogens.
Regarding prescriptions if they run out another doctor, Dr. Nicole Apelian has recently come up with alternative herbal remedies along with natural plants to use. She has some great coronavirus tips but please don't discount her as she has a PHD and is a herbalist because an unexpected diagnosis of multiple sclerosis in 2000 led Nicole to apply her research skills towards her own personal wellness.She was selected on history channel back in 2015 on a survival show called Alone. Her guide is on lostremedies.pg-blog.com/
Here are some additional proactive tips coming from several doctors on coronavirus. If you have a compromised immune system or just want to boost it against this virus here are some proactive measures that can help according to pulmonologist Dr. Seheult. & John Campbell. Make sure you are not Zinc deficient and start a daily dose 10-50 micrograms (400-2000 IU). of Vitamin D, get some daily sun in. Getting more than 50 micrograms reduces the positive effect. Taking this amount reduces respiratory infection by 50%.
Credit to original poster: Possible adjunctive therapy:Probably more than SARS 1, SARS 2/ COVID 19 seems to supress fevers more than usual. A lot of people have the virus, don't know they have it and have no fever at all. This may be the reason the virus is able to replicate and spread. (calm before the storm) So if we can increase the core body temperature unsing whatever techniques are available like contrast showers, hydro thermal therapy, hot bath then cold, this might actually help speed up recovery and not spread the virus.
Patients coming in with COVID-19 have elevated liver function tests. Non steroidal medications inhibit the production of prostaglandins, which are directly responsible for antibody production. That is the adaptive immune response but no the innate immune system. The impact of COVID-19 isn't just on lungs. It attacks the entire body including the heart, kidneys, liver, the collagulation system, neuroligical system.
Thermal stress produces heat shock proteins which are immune modulators. They essentially jumstarts the immune response whereas this virus tries to downregulate the innate immune system. This treatment has to be complimented with current medical care. If you are relatively fit the same can be accomplished with exercise to increase core temperature then cooling off with a cold shower.
In terms of anyone who might be immunocompromised, many companies are looking at the natural killer cells to help with immunity in other diseases and repurposed to look at COVID-19. They are taking it and infusing it on people coming in to the hospital. Imagine that you can do this in much less invasive ways much earlier in the process with hydro thermal therapy.
Warning to anyone with asthma as steam hot showers can precipitate an astma attacks. Hot/Cold therapy treatment can potentially boost immunity with coronavirus. He cites 4 studies below indicate affects the part of the SARS COV2 natural cells and monocytes. Keep in mind there is no studies on this with COVID-19 but he is using the next best scenario studies if you follow. Hot and cold temperature regulation affects part of the innate immune system that helps with targeting viral infections. Hyperthermia and then cooling off actually improved surrogates for the immune system monocytes and their stimulation/ response to foreign invaders.
Source #1 www.ncbi.nlm.nih.gov/pmc/articles/PMC4786079/pdf/nihms755275.pdf
Source #2 www.tandfonline.com/doi/abs/10.3109/07853899009148930
Source #3 www.ncbi.nlm.nih.gov/pubmed/12060966
Source #4 journals.physiology.org/doi/pdf/10.1152/jappl.1999.87.2.699
Consider taking contrast showers 4-6 minutes warm/hot water, clean yourself, then rinse with 1-3 minutes cold water. Every day. Takes 1-2 weeks to get used to it, but it's well worth it. Or hot bath/then cold shower. Consult with your doctor first but here is a instructional video on contrast showers vimeo.com/165013134/346f3ef87a
If you have pneumonia, sleep on your stomach. This alone reduces mortality rates by 30-40% because in the prone position, lung compression is decreased, secretions drain better, and collapsed alveoli reopen. Source 1: journals.lww.com/nursingcriticalcare/Fulltext/2009/05000/Prone_positioning__Improving_oxygenation_in.10.aspx
Source 2:
digitalcommons.ric.edu/cgi/viewcontent.cgi?article=1272&context=etd
If you go out in public practice social distancing and wear a mask or face covering of some kind. They make a whole room UV light sanitizer on uvsterilizex.com/ they make for surfaces/rooms. UV light is highly effective at killing viruses. The three main types of UV rays are UVA, UVB, and UVC. Because UVC rays have the shortest wavelength, and therefore highest energy, they are capable of killing bacteria and viruses, also called pathogens.
Regarding prescriptions if they run out another doctor, Dr. Nicole Apelian has recently come up with alternative herbal remedies along with natural plants to use. She has some great coronavirus tips but please don't discount her as she has a PHD and is a herbalist because an unexpected diagnosis of multiple sclerosis in 2000 led Nicole to apply her research skills towards her own personal wellness.She was selected on history channel back in 2015 on a survival show called Alone. Her guide is on lostremedies.pg-blog.com/
Here are some additional proactive tips coming from several doctors on coronavirus. If you have a compromised immune system or just want to boost it against this virus here are some proactive measures that can help according to pulmonologist Dr. Seheult. & John Campbell. Make sure you are not Zinc deficient and start a daily dose 10-50 micrograms (400-2000 IU). of Vitamin D, get some daily sun in. Getting more than 50 micrograms reduces the positive effect. Taking this amount reduces respiratory infection by 50%.
Aleksandar4 hours ago
I don't understand why every single patient isn't treated before they get to the point of needing a ventilator. I obviously am not a doctor, but I have read several doctors saying that it's not the virus that's killing people, it's the immune system response. The cytokine storm as mentioned. I'm pretty sure that all doctors know this is the case, so when you have a patient who checks into the hospital with dropping oxygen levels why not give an immunosuppressive drug? This Actemra sounds promising because it suppresses this response. Hydroxychloroquine is another drug that's had luck. Going on a ventilator where the survival rate is roughly 20%-30%, and then those who do survive have lung damage, that doesn't seem to be a better option than some of these drugs. Sure there are possible side effects, and obviously some people won't be able to take them due to pre-existing conditions. The good thing is these drugs are known, they have been used already so the possible side effects are known. They can't be worse than these drugs advertised on tv all the time. In most people though, probably 99% it should be given. Otherwise you're just giving someone oxygen, watching them deteriorate, and hoping for an outcome of low probability on a ventilator. It's better to go on the offensive if this starts getting bad.
I don't understand why every single patient isn't treated before they get to the point of needing a ventilator. I obviously am not a doctor, but I have read several doctors saying that it's not the virus that's killing people, it's the immune system response. The cytokine storm as mentioned. I'm pretty sure that all doctors know this is the case, so when you have a patient who checks into the hospital with dropping oxygen levels why not give an immunosuppressive drug? This Actemra sounds promising because it suppresses this response. Hydroxychloroquine is another drug that's had luck. Going on a ventilator where the survival rate is roughly 20%-30%, and then those who do survive have lung damage, that doesn't seem to be a better option than some of these drugs. Sure there are possible side effects, and obviously some people won't be able to take them due to pre-existing conditions. The good thing is these drugs are known, they have been used already so the possible side effects are known. They can't be worse than these drugs advertised on tv all the time. In most people though, probably 99% it should be given. Otherwise you're just giving someone oxygen, watching them deteriorate, and hoping for an outcome of low probability on a ventilator. It's better to go on the offensive if this starts getting bad.
BruceB4 hours ago
Fresh chopped garlic has a super potent antiviral enzyme called alliinase that only lasts 2 hours after the garlic is chopped. chop up one big clove of garlic and take it on a full stomach with honey or water and 500mg of vitamin c 2 x a day as soon as you feel a cold or flu (and hopefully corona virus) coming on. For me, it shortens the lifespan of the flu/cold by 2/3.