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Message
re: Mrs M is in Lane Hospital struggling with double Covid pneumonia.
Posted on 1/9/22 at 2:10 pm to crazy4lsu
Posted on 1/9/22 at 2:10 pm to crazy4lsu
quote:
As long as there aren't any other contraindications or liver or kidney issues
No doubt
quote:
I don't there are any specific interactions between aspirin and any PDE5 inhibitor.
Since cialis has a daily delivery, I would be interested to see how this plays out in a study (especially when coupled with aspirin).
Lastly, given that these drugs are generally male specific, could this potentially be beneficially in your opinion, for a woman?
This post was edited on 1/9/22 at 2:11 pm
2
Posted on 1/9/22 at 2:15 pm to Hopeful Doc
quote:
Early, we knew nothing. Watched some patients come in and do fairly poorly. Some did ok. Then the idea that plaquenil may work came up. Watched some patients come in and do fairly poorly. Some did ok. I didn’t find it impressive. I read anecdotes about it working wonders. Neither I, my partners, or any of my contacts that take care of hospital patients (mostly ICU and gen hospitalists) saw any defining characteristics like “seems to work Ok in patient with X but not Y.” Remdesivir came months later. I have posted it several times. But I saw a guy who was a few minutes away from dying get intubated (appropriately, that seems to be a whole different discussion in this thread. Intubation isn’t bad. Early in the pandemic, anecdotal data suggested better outcomes with early intubation which proved to be very false very quickly, and it hasn’t really been practiced by anyone I know of since about 4/2020). His liver and renal function were horrible. After about 3 days it improved enough that we were able to give remdesivir. And it was either 12 or 36 hours later that he was extubated. I was excited. I gave it to all my COVID patients that were in the hospital. But none of them made rapid, remarkable turnarounds after the first one. I chalk it up to wanting something to work and coincidence, sadly. My hospital tracks a few therapeutics retrospectively to see their impact. There are tons of flaws with this sort of process, and it is extremely subject to bias. But we were able to tease out that if you were early in the hospital on 2LNC or less, you may have a shorter stay. But otherwise, there wasn’t a big difference. And I don’t mean we had bad confidence intervals or high P values. The numbers were almost the same (attempted case-matched controls. Again. This happens tons of places for internal review and can sort of build a foundation and help to cement anecdotal data as being a bit more than that, but it isn’t worthy of publication on Mom’s refrigerator, much less JAMA/NEJM/the Lancet. But we start to shy away from it. Around that time, we discuss the MATH protocol and generally adopt it. Everyone gets ivermectin before leaving the ER, plaquenil, a couple antibiotics, steroids, all the vitamins before we ran into shortages. From the beginning there, I still didn’t see a big difference in outcomes (and around that time I and several others found that people that got intubated were less likely to recover for some reason. I went through about a 6m stretch where fewer people got intubated, but almost none of them came off once they went on. I only realized it when a CC friend of mine said, “can you remember the last person you got off the vent?” And I, indeed, couldn’t). After about 3-4 months of, again, not seeing a big difference following the protocol, I generally quit using it. There are good parts to it, but I’m certainly not sold on it being as effective as its proponents are suggesting, sadly. Most of us are back to sort of doing our own thing with our own quirks, but none of us really feel like we found any one thing that’s particularly effective (except for giving 12mg of decadron at once instead of splitting it up into BID dosing).
Wow a person with real world experience dropping knowledge
Nice to see on here
Posted on 1/9/22 at 2:24 pm to Damone
quote:
It’s really sad to see casualties resulting from the insane theories and scare tactics used by anti-vaxers
Advocating for therapeutics isn’t anti-vax. A lot of anti-Covid-vaxxers are pro-therapeutics. Just as the pro-vaxxers laypersons are rabidly anti-therapeutic.
Posted on 1/9/22 at 2:28 pm to the808bass
quote:
Advocating for therapeutics isn’t anti-vax.
Posted on 1/9/22 at 2:59 pm to Cosmo
No kidding. And some idiot downvoted it
Posted on 1/9/22 at 3:16 pm to Aubie Spr96
quote:
This is what I'd be demanding.
You can demand all you want but if it’s not part of the hospital’s established protocol then they will probably tell you to pound sand.
Posted on 1/9/22 at 3:22 pm to Hopeful Doc
quote:This is where the monster lives.
I went through about a 6m stretch where fewer people got intubated, but almost none of them came off once they went on. I only realized it when a CC friend of mine said, “can you remember the last person you got off the vent?” And I, indeed, couldn’t
Posted on 1/9/22 at 4:20 pm to LSU28605
Anyone can try but the top guy at FLCCC recently was asked to resign from his professor role at a medical school due to his failed attempts at getting hospitals to accept his “treatments” for Covid.
Posted on 1/9/22 at 4:24 pm to EastDakota
quote:
Anyone can try but the top guy at FLCCC recently was asked to resign from his professor role at a medical school due to his failed attempts at getting hospitals to accept his “treatments” for Covid.
Why do you think that is?
Posted on 1/9/22 at 4:54 pm to jimmy the leg
quote:
Lastly, given that these drugs are generally male specific, could this potentially be beneficially in your opinion, for a woman?
They aren't male specific in the sense that every person has phosphodiesterase enzymes. It will work for women as well. For men it might have the byproduct of causing erections, but I don't think they cause erections without arousal.
Posted on 1/9/22 at 4:59 pm to crazy4lsu
quote:
They aren't male specific in the sense that every person has phosphodiesterase enzymes. It will work for women as well.
Thanks for the info. Perhaps in addition to addressing concerns with “long Covid“ (micro-clotting), this could be used as part of an ambulatory care package...provided there aren’t issues concerning interactions with other drugs.
I don’t understand taking things off of the table that would seem to be beneficial. I don’t get it.
Posted on 1/9/22 at 6:13 pm to jimmy the leg
quote:
What are your thoughts on implementing this as part of a treatment protocol, and, for the OP, can this “treatment” be used for women?
An oversimplification of what it does is dilate the pulmonary vessels. Blood pressure is both different and no different than water pressure (our conduit is just alive and can change size, block up, and heal itself in some cases and build hundreds of microscopic vessels to bypass blocked ones when needed)
Vasoconstriction leads to an increase in pressure and a subsequent decrease in flow (no different than changing a 1/2" pipe and putting in 1/4" in its place).
Sildenafil (viagra), in the simplest terms, dilates the vessels in the lungs to decrease pressure and increase blood flow through the lungs. It is a common treatment (Revatio, basically 1/5 the standard "boner dose" of the "little blue pill." I wrote it off label in place of viagra up until the 100mg tablets went generic about a year or two ago. You could get 30 tabs of 20mg (usually needed to take 3-5 to do "the trick") for about $30. The 100mg tabs were probably still $30/tab or more. Point is- it's the same medicine) for pulmonary hypertension. Buddy of mine's son has a congenital heart defect and has been on sildenafil since infancy.. From my experience, you get more pulmonary vessel efficacy at lower doses, and more dilated of penile vessels as the dose increases (or at least don't tend to see it at the lower dose).
Would lowering the pulmonary pressures lead to better outcomes? I doubt it, unless the patient had pulmonary hypertension as a result of a PE or several small PE. And even then, it's not been the standard for that type of pulmonary hypertension.
"increasing blood flow to the lung" sounds like it may be impressive given the virus attacks the lung and there are oxygenation issues, but it doesn't work quite like that. They tend to ventilate (get rid of CO2) fine. They just can't transmit oxygen. Increasing the volume of flow, in theory, shouldn't really fix that. It shouldn't really make it worse.
I don't see it becoming a part of standard treatment without a lot better results or a specific subset of patients (IE- those with PE) that have clots.
Posted on 1/9/22 at 6:24 pm to Hopeful Doc
quote:
I don't see it becoming a part of standard treatment without a lot better results or a specific subset of patients (IE- those with PE) that have clots.
I guess that is why I brought it up. Im going on recollection, as I don’t remember the thread, but I thought that someone posted that they saw improvement by patients (or linked an article stating as much) by those on viagara.
My question to you is, do you know which patients are on the daily dose of cialis? It would be interesting to get info from your personal experience (albeit...limited in scope).
I have yet to see ANY info addressing what you brought up:
quote:
results or a specific subset of patients (IE- those with PE) that have clots.
Without knowing for sure, it is just speculation, and we have seen how well that has ( or rather...hasn’t) worked out in the past.
This post was edited on 1/9/22 at 6:28 pm
Posted on 1/9/22 at 6:33 pm to Rick9Plus
quote:
It’s so random, who gets hit hard and who doesn’t. Even the “experts” disagree. I’m saying a prayer for Mrs. M.
Thank you for your kind words and thoughts. I’ll bounce an update off of your post. Her care at Lane is implemented by Lane ICU staff. Her care is directed by OLOL pulmonologist and others who monitor her remotely and with OLOL physicians on staff at Lane as “Hospitalers” in effect.
She had to be intubated this afternoon. That decision was driven almost solely by her arterial blood gasses this morning. All of our sons and our daughter and her husband who drove in overnight from KC participated in the discussion. It’s the hardest most difficult and heart breaking decision I will ever make.
Our priest came up last night and was able to administer Holy Communion to us. Her’s was a field expedient version allowed by our Prayer Book and encouraged by our Bishop.
I want to say again in the strongest possible terms that I read every response and post submitted and am forever in y’all’s debt for such depth of tender kindness and support to me and my precious bride of 43 years.
Honestly from my heart.
Mr. M
Posted on 1/9/22 at 6:35 pm to Mr. Misanthrope
I’m so sorry. Peace be unto you during these difficult times.
Posted on 1/9/22 at 6:43 pm to Mr. Misanthrope
Sorry to hear this. We're still rooting for you and your family.
Posted on 1/9/22 at 6:49 pm to jimmy the leg
quote:
My question to you is, do you know which patients are on the daily dose of cialis? It would be interesting to get info from your personal experience (albeit...limited in scope).
Too limited to be useful. I have very few patients on daily cialis in the first place, and I can't recall any of them specifically having a poor outcome. But I don't think that's the reason as I could say the same for about 50 other drugs that I have small subsets of patients on.
Posted on 1/9/22 at 6:52 pm to Mr. Misanthrope
I’m glad your kids are with you
Prayers for better news soon
Prayers for better news soon
Posted on 1/9/22 at 6:54 pm to Mr. Misanthrope
quote:
Mr. M
God bless, brother. I hope the good news comes in a couple of days.
Posted on 1/9/22 at 6:54 pm to Mr. Misanthrope
quote:
She had to be intubated this afternoon.
Do not give up because of this. We have been having much more success on getting people off vents than we were at the start.
It's a long, slow process but I've seen it first hand.
Prayers sent.
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