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  1. #19201
    Join Date
    Dec 2012
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    I smell poutine!!!
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    Quote Originally Posted by I Skied Bandini Mountain View Post
    Kamala Harris V.P.

    Warren Sec of Treasury
    Not a Harris fan. Warren in treasury would be perfect except that I need her on the ticket to feel better about voting for Biden. Unfortunately, Warren in treasury is only partially useful, need Warren clones in Congress and the Oval Office to provide meaningful legislation. And in the courts. Because the bat shit crazy party is stuffing the courts with bat shit crazy.

  2. #19202
    Join Date
    May 2007
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    Sandy, Utah
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    12,077
    Quote Originally Posted by Tri-Ungulate View Post
    Hydroxychloroquine (HCQ) is an old drug, been around longer than most of us. Overall it's relatively safe, and has been used by loads of people for malaria prophylaxis and therapy over the years. I used it for almost a year while I was in malaria endemic areas, although more recent trips to such regions I'd used mefloquine as prophylaxis.

    Arrhythmia (abnormal heart rhythm that can lead to sudden cardiac death) did not originally show up as a red flag (or "black box label") on initial HCQ studies, but that may be because it was approved so long ago (in the 50s). The prevalence is not determined, again because the drug was approved before there was extended clinical trial “vetting”, although there are case reports of it causing heart arrhythmias in the medical literature. I'm guessing the actual incidence is pretty low, prolly <5% more likely <1% or less.

    HCQ has since been observed to be associated with significant heart arrhythmias in SARS CoV 2 patients receiving it in combination with azithromycin (AZR), another antibiotic which is in a class of antibiotics (known as macrolides) that have a track record of causing arrhythmias. Again, since AZR is a relatively old drug, (though much newer than HCQ, from the 80s) the incidence of cardiac side effects is not well established, although again probably on the low side as above.

    The recent Lancet article that's in the news right now, confirms earlier recent reports, and showed that both HCQ and AZR were each independently associated with an increased risk of heart arrhythmia (roughly double) during hospitalization of SARS CoV 2 patients. Also, no clinical benefit was observed, actually lower survival noted, with an increased risk of in-hospital mortality. A weakness of this study is that it is a retrospective analysis (looking back) and less able to adequately control for outcomes. By that, I mean that there is a possibility that sicker patients were the ones that received the drugs, and therefore skewed the results. However, the authors do address this in their analysis, and did their best to control for such variables, so overall I think it’s pretty sound.

    To answer Skidog's question, the best way I can describe it is that in general, we don't think malaria has direct cardiac effects, although it has indirect effects that may contribute to heart failure, and the association is not particularly strong. What little we know about SARS CoV 2 is that the virus itself may have more direct effects on the heart, in terms of inflammation-mediated microclotting events in the heart vessels that can lead to dysfunction. So the side effects of HCQ and AZR, individually and combined, may be more pronounced in SARS CoV2 patients than in malaria patients.
    Much appreciated. Love this place.

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    I wish i could be like SkiFishBum

  3. #19203
    Join Date
    Oct 2003
    Location
    Under the bridge, down by the river
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    4,679
    It took me a while to get around to posting, but I was on service for three weeks during the ‘surge’ in the Boston area.

    Our palliative medicine team was consulted on every covid ICU patient, and about 1/3rd to a 1/2 of the covid general medicine floor patients. Given my line of work, death is a pretty normal thing(I’m typically not seeing you because you are well). This, was decidedly different. Every patient I personally saw for three weeks in the ICU died. During that span the hospital only successfully extubated two patients, both younger with far fewer comorbidities. The tail of the illness is long—the last patient I cared for died about a week ago.

    The waiting period was terrible for families. ICU team would say, ‘they are stable, still on two pressors, sedated, antibiotics.’ Family would hear stable and feel relieved, and then we would have to have additional conversations undoing the (often unintentional) false hope the ICU team would give. Families frequently struggled to make decisions, no doubt made worse by not being able to see the degree of suffering their family was in. Videos only show part of the picture and gravity of it. ICU teams frequently were not realistic—‘well I can’t say they won’t recover’ was a common reason to just wait and wait and wait. If you are 80 or 90+, have physical and cognitive comorbidities, you aren’t vented for two weeks and suddenly back to baseline. Plain and simple.

    Frankly, care looked pretty bad in the hospital those few weeks. It seemed like almost everyone on the floor had delirium. It was upsetting to see 90+ folks with severe dementia be admitted to a hospital, alone and such that family couldn’t visit. PT/OT visits was way down, the physicians weren’t going on to the units any more than necessary. Nurses were amazing, but almost overwhelmed. Some volunteered from research roles and hadn’t cared for a dying patient in 20 years. I can’t imagine what that felt like.

    Visitors could come for ‘actively’ dying patients. Several times I guessed wrong and planned for family to come in the next day, only to have the patient die before hand. That felt terrible. Not having family there almost meant arranging video/phone visits fell to whoever was able, and became a big part of what we did. It was surreal, beautiful, and deeply sad to hold up your phone to FaceTime a patient with their family to say goodbye.

    Thankfully, volume is way down for COVID cases. We had a subsequent spike of non covid consults afterwards, but things almost seem ‘back to normal’, apart from everyone wearing masks and face shields all the time.

    The aftermath for me has been the rage I feel towards folks who don’t wear masks, get too close in public, flaunt their lack of compassion for others under the guise of ‘freedom’. It’s tiring, and I wish they could have had one day of the experience I did, hoping they would see things differently.

  4. #19204
    Join Date
    Sep 2001
    Location
    The Cone of Uncertainty
    Posts
    49,550
    Quote Originally Posted by skiballs View Post
    @flyover, i wish you iceman immortality.
    Ha. While I've demonstrated a somewhat notable ability to almost die and then rally and then actually be pretty much fine again, I have no intention of fucking with the covidzz if at all possible. Keeping my head down and my mask on.

    Cant, thank you for your efforts, I honestly can't imagine, it must have been like a literal battlefield. Get some rest man.

  5. #19205
    Join Date
    Sep 2009
    Location
    PNW
    Posts
    5,397
    Quote Originally Posted by CantDog View Post
    It took me a while to get around to posting, but I was on service for three weeks during the ‘surge’ in the Boston area.

    Our palliative medicine team was consulted on every covid ICU patient, and about 1/3rd to a 1/2 of the covid general medicine floor patients. Given my line of work, death is a pretty normal thing(I’m typically not seeing you because you are well). This, was decidedly different. Every patient I personally saw for three weeks in the ICU died. During that span the hospital only successfully extubated two patients, both younger with far fewer comorbidities. The tail of the illness is long—the last patient I cared for died about a week ago.

    The waiting period was terrible for families. ICU team would say, ‘they are stable, still on two pressors, sedated, antibiotics.’ Family would hear stable and feel relieved, and then we would have to have additional conversations undoing the (often unintentional) false hope the ICU team would give. Families frequently struggled to make decisions, no doubt made worse by not being able to see the degree of suffering their family was in. Videos only show part of the picture and gravity of it. ICU teams frequently were not realistic—‘well I can’t say they won’t recover’ was a common reason to just wait and wait and wait. If you are 80 or 90+, have physical and cognitive comorbidities, you aren’t vented for two weeks and suddenly back to baseline. Plain and simple.

    Frankly, care looked pretty bad in the hospital those few weeks. It seemed like almost everyone on the floor had delirium. It was upsetting to see 90+ folks with severe dementia be admitted to a hospital, alone and such that family couldn’t visit. PT/OT visits was way down, the physicians weren’t going on to the units any more than necessary. Nurses were amazing, but almost overwhelmed. Some volunteered from research roles and hadn’t cared for a dying patient in 20 years. I can’t imagine what that felt like.

    Visitors could come for ‘actively’ dying patients. Several times I guessed wrong and planned for family to come in the next day, only to have the patient die before hand. That felt terrible. Not having family there almost meant arranging video/phone visits fell to whoever was able, and became a big part of what we did. It was surreal, beautiful, and deeply sad to hold up your phone to FaceTime a patient with their family to say goodbye.

    Thankfully, volume is way down for COVID cases. We had a subsequent spike of non covid consults afterwards, but things almost seem ‘back to normal’, apart from everyone wearing masks and face shields all the time.

    The aftermath for me has been the rage I feel towards folks who don’t wear masks, get too close in public, flaunt their lack of compassion for others under the guise of ‘freedom’. It’s tiring, and I wish they could have had one day of the experience I did, hoping they would see things differently.
    Thank you for sharing your experience. Brutal.
    life ain't guaranteed, love your people while you can

  6. #19206
    Join Date
    Oct 2003
    Location
    ?
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    6,178
    Quote Originally Posted by CantDog View Post
    The aftermath for me has been the rage I feel towards folks who don’t wear masks, get too close in public, flaunt their lack of compassion for others under the guise of ‘freedom’. It’s tiring, and I wish they could have had one day of the experience I did, hoping they would see things differently.
    Seems worth quoting.

    ETA: Thank you for your hard work and for sharing that.
    I remember a bottomless freedom...

  7. #19207
    Join Date
    Sep 2009
    Location
    PNW
    Posts
    5,397
    Indeed.
    life ain't guaranteed, love your people while you can

  8. #19208
    Join Date
    Dec 2012
    Location
    I smell poutine!!!
    Posts
    10,923
    Quote Originally Posted by iceman View Post
    Keeping my head down and my mask on.
    My glasses fog if I look down while wearing a mask. So I have to hold my head up high. And SIP.

  9. #19209
    Join Date
    Feb 2008
    Location
    here and there
    Posts
    16,849
    Always a refreshing sameness to the TGR groupthink.

    Dontneedaweatherman#
    watch out for snakes

  10. #19210
    Join Date
    Sep 2001
    Location
    The Cone of Uncertainty
    Posts
    49,550
    You rugged individualist you. No groupthink in West-By-God at all, is there?

  11. #19211
    Join Date
    Oct 2003
    Location
    Big in Japan
    Posts
    41,867
    Quote Originally Posted by KQ View Post
    Yeah... been feeling demoralized everytime I see HIM on the news and hear the crap coming out of his mouth.

    I did however save a baby bunny from my cat tonight.
    Yeah, but, can you save the bunnies from the bunny virus that's taking them down?

    https://www.cbsnews.com/news/deadly-...it-population/

    Let's do some livin'
    After, we die

  12. #19212
    Join Date
    Oct 2009
    Location
    Maine Coast
    Posts
    2,938
    About two thirds wearing masks at Lowes today despite governors orders that they be worn. There was a greeter counting in and out. I asked why so many without masks and he said we can only suggest. I responded you can not let them in the store.

  13. #19213
    Join Date
    Dec 2003
    Location
    Nhampshire
    Posts
    5,793
    My heart goes out to you Z, hope the bike rides I've seen pics of are helping. Thanks for all you've been able to do

  14. #19214
    Join Date
    Oct 2003
    Location
    Big in Japan
    Posts
    41,867
    Quote Originally Posted by cat in january View Post
    About two thirds wearing masks at Lowes today despite governors orders that they be worn. There was a greeter counting in and out. I asked why so many without masks and he said we can only suggest. I responded you can not let them in the store.
    Minimum wage and discounts on power tools isn't worth getting shot by some yahoo.

    Let's do some livin'
    After, we die

  15. #19215
    Join Date
    Mar 2008
    Location
    the ham
    Posts
    7,710
    Quote Originally Posted by glademaster View Post
    Seems worth quoting.

    ETA: Thank you for your hard work and for sharing that.
    Absolutely.

    Thanks CD.

  16. #19216
    Join Date
    Feb 2015
    Location
    Boston
    Posts
    3,403
    Quote Originally Posted by schuss View Post
    My heart goes out to you Z, hope the bike rides I've seen pics of are helping. Thanks for all you've been able to do
    X2, thanks man.

  17. #19217
    Join Date
    Mar 2008
    Location
    the ham
    Posts
    7,710
    Quote Originally Posted by KQ View Post
    I did however save a baby bunny from my cat tonight.
    Cute little guy. I've had to save a few bunnies and possums from one of my dogs as well. Put it in the win column.

  18. #19218
    Join Date
    Oct 2007
    Posts
    8,910
    Re bunnies, if they get eaten, don't worry. They'll make more

  19. #19219
    Join Date
    Nov 2002
    Location
    EWA
    Posts
    16,969
    Quote Originally Posted by Benny Profane View Post
    Yeah, but, can you save the bunnies from the bunny virus that's taking them down?

    https://www.cbsnews.com/news/deadly-...it-population/
    Saw that the other day. Have not seen any sign of it yet here in our state. Hoping it stays away.

    Thought I had a muley with blue tongue. Haven't seen it for a while. Probably died.
    Kindness is a bridge between all people

    Dunkin’ Donuts Worker Dances With Customer Who Has Autism

  20. #19220
    Join Date
    Nov 2002
    Location
    EWA
    Posts
    16,969
    Quote Originally Posted by cat in january View Post
    About two thirds wearing masks at Lowes today despite governors orders that they be worn. There was a greeter counting in and out. I asked why so many without masks and he said we can only suggest. I responded you can not let them in the store.
    Again for the 100th time: How is requiring a mask any different than requiring shirt and shoes?

    Or no smoking?

    Or no food or drink?

    Or no pets?

    I just don't get it.
    Kindness is a bridge between all people

    Dunkin’ Donuts Worker Dances With Customer Who Has Autism

  21. #19221
    Join Date
    Nov 2003
    Location
    Portland
    Posts
    13,837
    Quote Originally Posted by Benny Profane View Post
    Minimum wage and discounts on power tools isn't worth getting shot by some yahoo.
    Exactly. The home Depot I visited yesterday had maybe 25% of people wearing masks. Lots of disgusted looks my way for wearing a mask, lots of people not respecting personal space, etc. Overall a depressing situation. Most of the staff there weren't wearing masks. Pretty lame

  22. #19222
    Join Date
    May 2009
    Location
    inpdx
    Posts
    13,170

    Fear and Loathing, a Rat Flu Odyssey


  23. #19223
    Join Date
    Oct 2007
    Posts
    8,910
    An alternative version:

  24. #19224
    Join Date
    Oct 2003
    Location
    Under the bridge, down by the river
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    4,679
    Quote Originally Posted by Self Jupiter View Post
    X2, thanks man.
    Thanks guys. Despite it being hard it was also deeply meaningful to help the patients I saw and their families. Definitely one of the most impactful experiences of my career. And the biking has been amazing the last few weeks.

    The outpatients I see remotely are still holed up, many I suspect will never leave their house for the remainder of their lives. It has been startling to see how the pandemic has factored into people’s medical decision making.

    I do another few weeks on service in the hospital in June, and hopefully things will still be getting better.

  25. #19225
    Join Date
    Jan 2017
    Location
    on the banks of Fish Creek
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    2,610
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