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re: Facts about Ivermectin from an ICU Nurse
Posted on 8/15/21 at 12:09 am to Hopeful Doc
Posted on 8/15/21 at 12:09 am to Hopeful Doc
quote:
Partner is my big bro and wife is in private practice a few towns away (yeah, way to save on overhead, honey. But in reality she wanted to be at a bigger center to practice the way she wanted) that’s at this point starting to be established. I know you’re joking, but I also know you know how cool it is to practice with/near family.
I knew you had a good set up. Didn't realize that good.
My wife has a pharmacy in the parking lot. Neither daughter going into medicine...yet. Oldest going to law school. Youngest just had my first grandchild. A boy. My dad got to see him. Got to be a great grandpa for 4 months. Hardest thing I've had to do was go through his things and found the buddy seat he ordered for them to fish together. Had already gotten him his first rod and reel. First gun. He was going to retire and spend the time with him that he missed with me and my younger brother. I'll admit. It's hard continuing to practice in the same building where he'd been at for 34 years. I've lost much of my love of medicine. Seems like it's coming back though, but after him passing of COVID, I realized the system don't give a single shite about us. They see us as disposable. He said from day one if he got COVID, it would kill him. Yet, he still worked and saw pt's. It was in his blood more than mine. I do enjoy teaching and they are bringing the residency program back here. I've been asked to be the director, but I'd rather not. Clinical only or I may just precept at my office. Don't know. It's just not the same. Night guys. 
0
Posted on 8/15/21 at 12:10 am to SquatchDawg
quote:
Facing a pandemic, if you have even anecdotal evidence that a drug that has been widely used for decades with no harmful effects may save lives…why the frick don’t you use it? If it doesn’t work…what harm have you caused ? This shite…and HCQ have been given to people for years.
If I get a bad case of COVID… I want HCQ, Ivermectin, fricking ginseng root, zinc, vitamin C and whatever the hell else might help. Trying to block access or poo poo these drugs because we haven’t had a double blind peer reviewed clinic study is just stupid as shite.
I don't really care if people take HCQ or ivermectin. I only care in as much it creates a false sense of security in many and gives them an excuse to not do the one thing we know beyond all doubt prevents severe disease and death with stunning efficacy, vaccination.
That being said, at this point the volume of data is there to state with a reasonable degree of certainty that HCQ doesnt work. The verdict is technically still out on ivermectin, and there are some incredibly well powered trials coming down the pipe there, but nobody absent wishful thinking is optimistic in our field on that topic. The mechanism by which its supposed to work isnt viable in vivo, and much of the data showing efficacy are trials designed specifically to generate a given result.
So take then if you want, but people need to stop getting up in arms when it is dispassionately stated they dont (or probably dont) work. My job is to provide patients accurate information. As for why I don't prescribe them, I don't prescribe any med for any condition that I can't show the patient meaningful evidence for efficacy. That's a disservice to them.
Posted on 8/15/21 at 12:13 am to Roger Klarvin
quote:
My job is to provide patients accurate information
How donthebvaccines compare to natural immunity for a healthy person?
Posted on 8/15/21 at 12:14 am to Hopeful Doc
quote:
Local urgent care basically gave up about 3 months ago and basically tests and then tells the patient to call us to ask what to do.
I wish it were just isolated to urgent care. I still have to battle with the ER and hospitalist groups at our hospitals to keep every COVID patient from getting ceftriaxone, azithromycin and enough vitamin C to fill a bathtub with diarrhea.
I've seen more COVID patients get C. diff colitis from unnecessary antibiotics than I have such patients with concurrent bacterial pneumonia at the time of presentation.
Posted on 8/15/21 at 12:15 am to Roger Klarvin
Our ID group here is so lame they don’t even fight. They just let everyone get rocephin, azithro and zinc.
Pro cal undetectable and segments WNL :|
Pro cal undetectable and segments WNL :|
Posted on 8/15/21 at 12:20 am to David_DJS
quote:
How donthebvaccines compare to natural immunity for a healthy person?
Clinically, both dramatically reduce your chances of getting severely ill or dying if you get infected at a late date. The vaccine appears to be superior to asymptomatic or very mild infection, whereas moderate to severe illness is perhaps a little better than vaccination Wit regards to the delta variant, and this data is very early, but it appears previous natural infection is a little better at preventing infection entirely but both prevent severe disease/death at >95%.
We could get into the nitty gritty regarding antibody response and specificity, but the point is clinically both are EXTREMELY effective at keeping any individual from getting severely ill or dying from COVID in the future even amongst the highest risk populations. The difference obviously is that vaccination spares you from the risk of COVID during that initial infection, as the rates of morbidity from COVID are varying orders of magnitude greater for every age group than from vaccination. That is still true for children, though the risk to children is SO low as to make vaccinating them effectively like running 11 miles a day instead of 10.
Posted on 8/15/21 at 12:26 am to Roger Klarvin
Why do you think public health and the med industry are pushing Vaccines on Americans with natural immunity?
Posted on 8/15/21 at 12:26 am to Tiguar
I have a good enough relationship with them that it works pretty well and they rarely get upset, but I still usually have to be the one to discontinue them. I still let them check RVPs on all these people even though its completely useless clinically. I'm still waiting for one of them to tell me exactly what they plan to do when they catch that coinfection with rhinovirus 
I don't even care that much about procal (its really meant to be used as a means of determining when antibiotics are working and can be discontinued as opposed to when you should start antibiotics) but I've learned to use it as a tool to point to in COVID patients to make non-ID docs more comfortable stopping antibiotics.
I don't even care that much about procal (its really meant to be used as a means of determining when antibiotics are working and can be discontinued as opposed to when you should start antibiotics) but I've learned to use it as a tool to point to in COVID patients to make non-ID docs more comfortable stopping antibiotics.
Posted on 8/15/21 at 12:28 am to Roger Klarvin
Yes. I’ve successfully argued for abx discontinuation with lack of wbc shift and negative procal.
Now if I can get them to stop picking random steroid doses, I’ll be cooking with gas
Now if I can get them to stop picking random steroid doses, I’ll be cooking with gas
Posted on 8/15/21 at 12:31 am to David_DJS
quote:
Why do you think public health and the med industry are pushing Vaccines on Americans with natural immunity?
Public health officials don't deal in nuance as a general rule. Their job is to make policy for large populations, and to be frank they regard the average American as a moron who can't understand nuanced instruction. They think "everyone should be vaccinated" is a better message.
Now that being said, there are groups who clearly benefit from vaccination even after primary infection. Very elederly patients, the severely immunocompromised (chronic high dose steroid use, chemotherapy, etc.) and probably advanced kidey/liver disease patients on average mount much lesser responses to natural infection.
But for the average American adult from 18-80 or so, natural infection is fairly reliable.
Posted on 8/15/21 at 12:31 am to Tiguar
quote:
stop picking random steroid doses
There was a 3ish month period that our ER was giving something like 125mg of solumedrol four times daily.
That said, they still give 60q6 or 80q8 for plain old COPD, so I’ve pretty much given up on them doing anything right and try to see people as soon as possible after being told of the admit.
Posted on 8/15/21 at 12:34 am to Hopeful Doc
I die on the inside when they order steroids on floor copd exacerbations. ER docs love humping solumedrol for just about everything and it kills me
Posted on 8/15/21 at 12:36 am to Tiguar
I've actually been fairly impressed with the data our critical care docs have shown with respect to higher dose steroids in patients circling the drain about to get tubed. They do seem to do better than standard floor patient dosing.
For more severely ill patients dex 10 mg BID, toci x1 400-800 mg and letting them ride on HFNC at any saturation above 80% or so if they arent working too hard to breath has really worked well for us. I'll given remdesivir if its within 7-10 days of symptom onset but TBH I dont feel strongly that its helping much. Overall much better outcomes than paients intubated and maintained at higher O2 sats, and better than BiPAP patients as well. COVID patients just dont do well at all with higher positive airway pressures required to keep their sats higher.
For more severely ill patients dex 10 mg BID, toci x1 400-800 mg and letting them ride on HFNC at any saturation above 80% or so if they arent working too hard to breath has really worked well for us. I'll given remdesivir if its within 7-10 days of symptom onset but TBH I dont feel strongly that its helping much. Overall much better outcomes than paients intubated and maintained at higher O2 sats, and better than BiPAP patients as well. COVID patients just dont do well at all with higher positive airway pressures required to keep their sats higher.
Posted on 8/15/21 at 12:37 am to Roger Klarvin
I’m of the opinion remdesivir is a very expensive placebo.
Posted on 8/15/21 at 12:38 am to Hopeful Doc
quote:
There was a 3ish month period that our ER was giving something like 125mg of solumedrol four times daily.
For regular old 2 L NC COVID?
That's like temporal arteritis with vision loss dosing, and even then its probably excessive.
Posted on 8/15/21 at 12:40 am to Roger Klarvin
Dude there’s two docs here that will give 125mg q6h for copd and CAP.
They’re night docs and when they work days I walk over to them every single time and tell them this isn’t third shift and that shite won’t fly with me here
They’re night docs and when they work days I walk over to them every single time and tell them this isn’t third shift and that shite won’t fly with me here
Posted on 8/15/21 at 12:41 am to Tiguar
My biggest issue with steroids is the LONG arse TAPERS some people use in these patients. Patients slow to wean from the vent or high flow will get 3-4 WEEKS sometimes.
You think severe COVID is bad, sprinkle a little post-COVID aspergillosis on top of ARDS fibrosis and then tell me how your day goes
You think severe COVID is bad, sprinkle a little post-COVID aspergillosis on top of ARDS fibrosis and then tell me how your day goes
Posted on 8/15/21 at 12:42 am to Roger Klarvin
quote:
I don't really care if people take HCQ or ivermectin. I only care in as much it creates a false sense of security in many and gives them an excuse to not do the one thing we know beyond all doubt prevents severe disease and death with stunning efficacy, vaccination.
That being said, at this point the volume of data is there to state with a reasonable degree of certainty that HCQ doesnt work. The verdict is technically still out on ivermectin, and there are some incredibly well powered trials coming down the pipe there, but nobody absent wishful thinking is optimistic in our field on that topic. The mechanism by which its supposed to work isnt viable in vivo, and much of the data showing efficacy are trials designed specifically to generate a given result.
Wow, you talk like you know what you are talking about but you don't.
Posted on 8/15/21 at 12:42 am to Roger Klarvin
quote:
For regular old 2 L NC COVID?
Yes. Without concurrent optic neuritis (about the only other thing I can think of warranting a gram a day of the stuff)
Posted on 8/15/21 at 12:42 am to Roger Klarvin
We’ve had a disconcerting run of aspergillosis and steno malto here the last few months.
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