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COVID-19 Is Not Over Yet

July 10, 2022 By Deborah

people walking on street during daytime

What we know about SARS-CoV-2, the virus causing COVID, is that it is here to stay. Information is continuing to evolve and research is still on going as new discoveries are being made. What we DO know is that COVID-19  is not over yet. It is still prevalent in many cities, states and countries and the United States remains stuck at an uncomfortable high plateau of pandemic pain and misery while new variants are driving a case surge in Europe.

We used to think that once you were infected and recovered from the virus your odds of dying were very low and both prior infection and immunization showed an even more protective effect against severe disease in certain populations. Age, underlying comorbidities and gender were the main risk factors for illness severity and reinfection. That was based on surveillance information from January 2020 through May 2021. Things have clearly changed.

Last year we thought that reinfections were relatively rare. Now we are seeing people infected 2, 3 or even 4 times after being fully vaccinated and boosted! What gives???

We have to remember that the virus strain that’s circulating now is very different then earlier strains. If we have been infected with COVID-19 or vaccinated, our body creates an immune response and mounts antibodies against future infections. It recognizes the strain that our body was originally in contact with. But as the virus changes as it has with Omicron, it becomes a fuzzier picture for our immune system to recognize the virus and we get re-infected. Omicron by far has been the Hercules of all variants in that it continues to shape-shift into other versions of itself making it more difficult for our antibodies, B cells and T cells to recognize and shut down a growing infection before the next subvariant arrives. What this means is that Omicron infection may have boosted our immunity against earlier variants, but it is less effective against itself and its subvariants (B.1.1.529, BA.4, BA.5, BA.1, BA2, BA.3, BA.2.H78Y). This poor immunogenicity against itself explains the resurgence of reinfections.

The BA.5 and BA.4 subvariants of Omicron account for 70% of all infections in the U.S. “It is the worst version of the virus that we’ve seen” according to Eric Topol, professor of molecular medicine at Scripps Research. He states that it takes “immune escape” to the next level which enhances transmissibility beyond earlier versions of Omicron. Fortunately due to the immunity build up from the winter omicron wave, there has not been a significant increase in hospitalizations or deaths. The BA.5 is different in its biology in that it is able to evade the body’s immune system and go unrecognized by our T-cells.

According to a cohort study in Estonia this year, findings show that an increased risk of death from SARS-CoV-2 is not limited to the acute illness: SARS-CoV-2 infection carries a substantially increased mortality in the following 12 months. This occurs primarily in older people and is driven by a broad array of causes of death. The more times a person gets infected, the higher the risk of long term illnesses effecting the heart and lungs.
Every time our body’s defenses are engaged, it extracts a lot of energy and causes tissue damage. And if our immune system does not have time to heal and repair the damage, then it has less of a chance to help fight the next infection or any other stressor that comes along.  Long-term consequences with repeat infections with the virus can lead to a higher likelihood of long-haul COVID than those who have had it just once.
In the meantime…lets continue the familiar mitigation measures: high quality N95 masks when going out in public, stay home and get tested if you feel ill, better air filtration and ventilation http://Air cleaners and COVID-19, avoid exposure in crowded indoor places. COVID-19 is not over yet.
Currently there is a bivalent or two-component vaccine, with old and new Omicron variants as the target. We hope next generation vaccines are more comprehensive in protection and more durable (longer lasting) that can dampen transmission.

The answers are more than alittle murky. Stay tuned…as we wait for more studies and more clear guidance.

References:  http://Variants Dampen Immune Protection

http://SARS CoV-2 Reinfection

http://Long Term Mortality Following SARS CoV-2 Infection

 

Filed Under: Featured, Health, Wellness

The New Wave of Allergens

April 10, 2022 By Deborah

With more than 60 million Americans affected, allergens are an important health issue. We are seeing a new wave of allergens that are effecting more people. Compared to 1990, pollen season occurs 20 days earlier and stays around on average 8 days longer according to a 2021 study. Not only is the season longer, but the symptoms are more severe. Plants, grasses and trees are spraying 21% more pollen than they did 30 years ago. So what gives?

The cause is our ever changing climate. As temperatures go up and the CO2 in the environment increases, plants produce more pollen. The severity depends on where you live and the plant species that proliferate there according to William Anderegg, associate professor of biology at the University of Utah and the lead author of that 2021 study. His study found that Texas and the Midwest have taken the brunt of these increasing pollen hot spots. This new wave of allergens is nothing to sneeze about (sorry.. I had to say it!) Climate change is not in the future…but is here with every breath you take.

If the current trends continue, ragweed and grass pollen concentrations will significantly rise over the next 40 years, says research analyst Hannah Jaffee of the Asthma and Allergy Foundation of America (AAFA). One spokesperson from the AAFA, Neeta Ogden MD, states that allergy symptoms usually improve as we get older because our immune systems become less reactive with age. But climate change is robbing us of this natural protection. Unfortunately, some older adults are actually developing allergies for the first time in their lives. While others are suffering longer and more intense seasons. In many areas, high pollen counts can start in early March and go through late October (even through Halloween!). Microparticles of pollen can continue to linger into the winter season. Treating allergens can also keep you healthier when it comes to warding off viruses. That’s because if you have allergies, your airways are more reactive to viral illnesses. So suppressing flare-ups may improve your overall immunity keeping your defenses up to fight off colds and flu.

Here are some things you can do to help reduce your sneezing, coughing congested symptoms.

  • Start treatment early: It’s easier to prevent your immune system from getting overwhelmed and overly aroused than it is to calm it down. So for the fall ragweed season, start treatment in August. The dates differ depending on what part of the country you live in. Consider starting with a nasal steroid spray. Over-the-counter nasal sprays include fluticasone (Flonase), triamcinolone (Nasacort) or budesonide (Rhinocort). These nasal sprays reduce nasal swelling and mucous production but can take a week to work so start early. Which one to choose? Some people find Flonase irritating because it contains alcohol so you can start with Nasacort. Anti-histamine nasal sprays are also available that treat itchy, runny nose symptoms and sneezing. These include prescription azelastine (Astelin, Astepro) and olopatadine (Patanase).
  • Oral antihistamines are also effective. Most over-the-counter medications work well. They include loratadine (Claritin), fexofenadine (Allegra) which are both non-drowsy formulas. Cetirizine (Zyrtec) or levocetirizine (Xyzal) are sedating so they should be taken at night. Natural products that have antihistamine effects include Quercetin, Stinging Nettles and Vitamin C. Still suffering? Consider allergy shots or immunotherapy.
  • Mask up if you are outdoors on high allergen days. Check the pollen counts daily on apps such as pollen.com, weatherbug.com and weather.com. These resources show counts and ratings for the day. If high, then try to shift outdoor activities indoors. Or you can avoid outside activities when pollen release is at its peak especially on windy and warm days. Those are 5-10AM and after 4 PM to dusk.
  • Avoid indoor allergens too. The sheer load of allergens can make symptoms worse. Common indoor allergens include pollen, dust mites, dander and mold. Zip up box springs and mattresses with dust mite covers. Vacuum carpets frequently, and keep windows closed while setting up a HEPA air purifier if you are allergic to your pet. Make sure to get roof leaks fixed and keep the indoor humidity to 40% to reduce mold in your home.

Being aware of your allergens is the first step toward taking preventative measures. Speak to your practitioner or see an allergist for testing if you are unsure.

References: Migala, J. Allergies: The next wave. AARP Bulletin April 2022.

Extreme Allergies and Climate Change. Asthma and Allergy Foundation of America. aafa.org

 

Filed Under: Allergies, Featured, Health

Overuse of Proton Pump Inhibitors

March 20, 2022 By Deborah

The use and availability of proton pump inhibitors (PPI) have become very convenient. The common over-the-counter names of these drugs are esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec). They are used to treat heartburn and recommended to be used for no more than 14 days. But there seems to be an overuse of proton pump inhibitors.  Unfortunately 1/4 of patients end up taking these drugs for over 1 year, and the majority of the time, these drugs are over-used (2/3 of patients) with no indication for treatment.

When you overuse proton pump inhibitors for the long term, you have an overproduction of acid producing parietal cells, and when these drugs are discontinued, you have a hyperacid environment and the symptoms return which is why people stay on them. There are some indications for staying on these acid blockers. They include: High grade erosive gastritis, Barrett’s esophagus, esophageal strictures from gastroesophageal reflux (GERD), gastroprotection of those at high risk for GI bleed, protection from idiopathic pulmonary fibrosis, eosinophilic esophagitis and Zollinger-Ellison syndrome. So it’s between you and your practitioner on whether long-term treatment is necessary and whether the benefits outweigh the risks. And yes…there are risks.

We need to remember that we need stomach acids for absorption of many nutrients, primarily proteins and minerals. Deficiencies include Vitamin B12, iron, calcium, magnesium, zinc, and folic acid. Other dangers associated with long-term use of PPI’s include osteoporosis, kidney disease, pneumonia, stroke and contracting Clostridium difficile (C.diff) bacterium.

The real concern of the progression to adenocarcinoma with Barrett’s esophagus would make the decision of staying on PPI’s quite easy, except for the fact that studies have found no protective effect.

The same goes for eosinophilic esophagitis which is an allergic condition that occurs in the esophagus. The esophagus becomes inflamed and has difficulty contracting properly, getting more narrow and developing rings or abscesses. Although acid suppression helps manage the symptoms of eosinophilic esophagitis, it should only be used after eliminating foods that are triggering an allergic reaction. Eliminating the triggered foods cures the problem in about 50% of patients. There is also some concern that staying on PPI’s may continue to promote the condition. Acid activates proteolytic enzymes to help break down food to make it more digestible. When acid is not available to stimulate digestion, then exposure to undigested foods can trigger eosinophilic inflammation along the gut’s immune system.

So how can we de-prescribe these medications?

  1. Identify foods that trigger your symptoms. Tomato based foods, caffeine and alcohol are common triggers I see clinically. I recommend a food list to my patients that can be found on line. Foods that cause GERD.
  2. I treat my patients naturally for a condition known as Helicobacter Pylori (H. Pylori), a bacteria that lives in the digestive tract which can cause similar symptoms as acid reflux and can lead to ulcers in the lining of the stomach. I use a combination product that has mastic gum, bismuth and zinc called “Pyloracil”. Mastic gum is a resin, or sap-like substance that comes from the mastic tree grown in the Mediterranean. It helps reduce stomach acid and protects the stomach and intestinal lining. Studies have shown it also fights bacteria including H. Pylori.  I recommend using it for 3 weeks while reducing their PPI from twice daily to once a day or if once a day use, to 1 every other day.
  3. If patients develop heartburn when reducing their PPI dose, I recommend “D-Limonene”, which is an orange peel extract on the days they are off of their medication. This can neutralize gastric acid and supports normal peristalsis. It has been used for the relief of heartburn and GERD.
  4. Deglycyrrhizinated licorice works well by soothing the stomach lining. You can find this over the counter in chewable tablets.
  5. Melatonin can help symptoms if they primarily occur at night. This sleep hormone increases the tone of the lower esophageal sphincter. Start with 1-3 mg before bed.
  6. Acupuncture can also be helpful.
  7. Stop the use of non steroidal anti-inflammatory medications (NSAID’s), which includes Naproxen, Ibuprofen and Diclofenac to name a few.

If a person has recurring symptoms that last over 3 weeks after stopping their PPI then they should contact their practitioner for possible referral to a GI specialist for an endoscopy. Make sure you discuss all your over-the-counter meds and supplements with your practitioner.

References: Rakel, D. Clinical Practice Update on De-Prescribing PPI’s. Primary Care. March 17, 2022.

Sun, J. D-Limonene: Safety and Clinical Applications. PubMed.ncbi.nlm.nih.gov. Altern Med Rev. 2007 Sept.

Filed Under: Featured, Health, Wellness

Aquatic Therapy for Chronic Back Pain

March 1, 2022 By Deborah

floating woman on body of water

Back pain is no stranger to most of us. About 84% of adults have back pain sometime in their lives. For many people back pain is self-limiting. But it can become more of a problem if it continues more than 3 months which is considered chronic. So what about aquatic therapy for low back pain? A study based out of China randomized supervised aquatic exercise versus traditional physical therapy in 113 adults, ages 18-65 with moderate to severe low back pain (LBP). The study went on for 13 months, and participants were randomized to either supervised aquatic therapy or traditional physical therapy in twice weekly sessions for 12 weeks.

After 1 year, mean scores on a 24-point disability scale improved by about 4 points more among participants in the aquatic exercise group then among those in the traditional physical therapy group, which is a meaningful difference. The aquatic exercise group also had improvement on the pain scale vs the traditional exercise group. Significant improvements in other measures of functioning and sleep also favored the aquatic participants.

Aquatic Therapy, or hydrotherapy as it is otherwise known has been used as an alternative therapy for those with chronic pain, or recovering from an injury or surgery. The natural buoyancy of water helps to reduce weight and eases stress on joints, even those in the spine. It does offer some resistance which can increase strength without muscle fatigue. It can reduce muscular and neurological pain and improve flexibility and range of motion. Plus it can be soothing and comfortable when done in a rehab setting by a physical therapist trained in hydrotherapy.

A study in 2019 sited in Physical Therapy stated that “aquatic exercise produced sufficient muscle activation, intensity and exertion.” It also noted reduction of pain vs land exercises. Several other studies have praised its benefits, including its positive effects in those with spinal stenosis, which is a neurological condition affecting the lower back and neck.

Speak to your practitioner and physical therapist about whether this treatment is right for you. This may be an effective option for managing this very common and difficult to treat condition.

References: Thomm, M. Get in the Water: Hydrotherapy for Pain and Movement. Practical Pain Management 11/11/2021.

Peng M-S et al. Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain; A randomized clinical trial. JAMA Netw Open 2022 Jan 7; 5:e2142069.

Filed Under: Featured, Health, Wellness

Long-Haul COVID-19 Will Be With Us For The Long-Haul

January 16, 2022 By Deborah

woman sitting on floor near window

 

Viruses have a tremendous capacity to drive chronic disease and illness. COVID-19 is no exception. We now have several terms for the condition that causes lingering symptoms after recovering from SARS-CoV-2 or COVID-19 infection. You may know it as “long-term COVID”, “post-COVID syndrome” or “long-haulers”. The NIH (National Institutes of Health) refers to these symptoms as PASC, which stands for “post-acute sequelae of SARS-CoV-2”. This syndrome is getting more and more press, but I still don’t believe it’s getting enough attention. The amount of people that continue to get COVID-19 infections is staggering and is currently driven by the Omicron variant. The CDC’s summary as of January 16, 2022 reports over 800,000 new cases per day, more than doubling the January 2021 peak! The more cases…the more long-haul symptoms. And long-term COVID can occur with mild symptoms and at any age, gender or with no prior illness or health problems. What we know is that long-haul COVID-19 will be with us for the long-haul.

The reason I am harping on this matter is because I believe Long-Haul COVID will be the main health challenge for health care workers, families, our economy and the work force in decades to come. Post-COVID is a multi-system disease that includes physical, mental and emotional symptoms. There are some health care facilities that are addressing these symptoms as real and looking for causes to help treat patients. But others are brushing the symptoms off as being all in their head and “hysterical” reactions to the stress of the pandemic. After going though tens of thousands of dollars of tests, some people are just going home with an inhaler and being told the symptoms will probably “go away” and to give it some time. How frustrating is that?!!!

In a recent meta-analysis, researchers identified nearly 2000 studies that addressed persistent post-COVID symptoms. The 45 studies appropriate for analysis reviewed about 10,000 patients and 84 discrete symptoms. Nearly 3/4 of the patients reported at least 1 symptom that persisted for an average of 2-4 months and some symptoms as long as 6-8 months. The most common symptoms were fatigue (40%), shortness of breath (36%), anosmia or loss of sense of smell (24%), anxiety (22%), persistent cough (17%), ageusia or loss of sense of taste (16%), and depression (15%). So the facts are there, but without much guidance on specific treatments. And yes…you can develop post-COVID symptoms even if you have been fully vaccinated and received a booster!

Integrative medicine is the best solution to recognizing and treating post-COVID syndrome as we are seeing a significant response in improving symptoms and shortening the course of the illness. Integrative medicine prides itself in treating and helping patients when conventional medical therapies have failed. The NIH (National institute of Health) has recognized that integrative medicine can support recovery from post-COVID disease. Restoring homeostasis plays a key role in integrative medicine even when diseases have no clear treatment.

There is clear evidence (and thousands of studies) for selected integrative medicine approaches that can be used to combat inflammation, repair lung injury or dysfunction, replete nutritional deficiencies, reset autoimmune exacerbated conditions, reduce chronic stress and mitigate fatigue. A comprehensive approach combining oriental medicine, functional medicine, homeopathy, intravenous nutrient therapy, nutritional medicine and herbal medicine are introduced in providing healing support and effective treatment in recovering from COVID-19 infection. Individualizing care is essential as each persons symptoms are unique in their own way as well as their course of recovery.

Theories as to how COVID-19 causes long haul symptoms include:

  1. Persistent intermittent viremia causing inflammation resulting in lung, heart, pancreas, and liver end organ damage. Symptoms come and go of having recurring fever, chills, myalgia, fatigue and brain fog.
  2. Severe inflammation occurring outside the brain (in the lungs and elsewhere) signals through the blood-brain barrier that activates the brains immune system. SARS-CoV-2 can directly modulate human gene expression and the patterns seen in COVID-19 patients are similar to patterns seen in patients with neurodegenerative diseases (dementias and schizophrenia). Synaptic signaling are impaired in the excitatory neurons that are important in cognition. This can generate symptoms such as poor cognition, mood disorders, hallucinations and delusions.
  3. Triggers autoimmune reactions to various organs- more likely those who already have autoimmunity or undiagnosed gluten intolerance. It can attack the central nervous system and can re-activate (wake up) latent viruses such as herpes virus or Epstein Bar virus, leading to extreme fatigue.
  4. Wide spread microvascular damage causes micro-clots or endothelial dysfunction. This leads to ischemia, oxidative stress, and inflammation in the brain through the olfactory nerve (nose) where the virus can burrow into nerves and hide genetic material. These reservoirs or “anatomical sanctuaries” become the source of neuro-inflammation.
  5. The body fails to completely clear the virus which continues to cause an immune reaction where the immune system attacks healthy tissue, increasing allergies, mast cell activation, muscle and joint pain and re-activates other viruses.
  6. Neuropathic mechanisms such as autonomic denervation can cause failure of the vasculature of the lower extremities to maintain resistance while in an upright position leading to blood pooling in the lower extremities and causing unstable blood pressure and tachycardia (high heart rate). This is known as POTS (Postural orthostatic tachycardia syndrome).  This condition is thought to have an autoimmune component.
  7. Nutrient depletion occurs, especially those nutrients necessary for mitochondrial function such as glutathione, alpha lipoid acid, CoQ10 and L-carnitine.
  8. Hormonal disruption can occur due to the stress of illness which leads to increased cortisol (stress hormone), adrenal and hormone imbalance. Symptoms can be lack of sleep, and difficulty coping and adapting to stress. Pre-existing conditions start to surface such as gluten intolerance, sleep apnea, pyroluria and nutritional deficiencies.

What we know is that post-COVID will be with us for some time. The sooner we address its significance and initiate treatment, the sooner we can get people back to feeling healthy, more resilient and back to work. Integrative medicine has given us the assurance that the body’s healing system is capable of restoring wellness. It may take longer for some depending on the severity of the illness but we need to trust in the wisdom of the body and its healing power. Colorado Covid Care has experienced clinicians that focus on outpatient treatment of people recovering from acute and long-Covid infections. 

Helpful resources are: Colorado Covid Care and Survivor Corp

 

Reference: Alschuler, L, Chiasson, M petal. Integrative medicine considerations for convalescence from mild-to-moderate COVID-19 disease. www.ncbi.nlm.nih.gov.

Yang AC et al. Dysregulation of brain and choroid plexus cell types in severe COVID-19. Nature 2021 July; 595:565.

Marshall, M. COVID and the brain: Researchers zero in on how damage occurs. Nature 2021 July; 595:484.

Cline, H, Einhardt, A. Postural orthostatic tachycardia syndrome: A conundrum for patients and healthcare providers. The Nurse Practitioner.  Jan 2022: 13-19

Nasserie T et al. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: A systematic review. JAMA Netw Open 2021 May 26; 4:e2111417

 

Filed Under: Featured, Health, Wellness

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A Little About Me

Debbie is a board certified family nurse practitioner with an emphasis on women's health. During the past 22 years she has worked in women's health and family practice with a focus on the integration of conventional and alternative therapies.

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