As more of our patients test positive for COVID19, it’s a good time to look at treatment options.
Caduceus is actively managing a case load of over 50 cases, all accumulated over the last three weeks. There will be more by the time you read this; we take on additional cases every day. Most are diagnosed through our own testing program, and we also accept referrals from patients unable to find doctors to treat them. Our cases stretch from LA to Riverside.
We have developed a treatment protocol based on available research and old fashioned “trial and error.” By spreading the word, we hope current and future COVID-19 positive patients may find it useful.
STEP 1---It seems obvious, yet we insist on COMPLETE AND TOTAL BED REST. Multiple studies over the years show the beneficial effect on our immune system to minimize stress on your body while fighting infections. That means bed, couch, or recliner. Patients can get up to use the bathroom and shower and eat at the dinner table. Alone.
The idea of exercising the virus away or keeping the body in shape will certainly prolong the symptoms. You feel fatigued with the virus for a reason- your body is asking for rest. Listen to it.
STEP 2--- Have a Covid cocktail. NO, not that kind. (We named it, but feel free to steal it.) Sudafed, Promethazine DM, and an albuterol inhaler. A twist is optional.
The idea is simple; we need to keep the mucus and fluids out of your lungs. That is where the serious cases have problems.
The Sudafed shrinks the blood vessels in the nasal passages, reducing congestion. The Promethazine Dm (by prescription only) helps with the cough, thins the mucus, helps keep the lungs clear and helps you rest.
The inhaler (also a prescription) opens up the airways. It’s like removing the cones from a two lane highway, making it a four lane highway. We want a path for the fluids to get out of your lungs.
Not everyone needs all three. We grade all of our cases as asymptomatic, mild, moderate or severe. The exact ingredients of the cocktail and the frequency varies on severity of the case.
Results? Unquestionable improvement.
STEP 3---Finding a medication that fights the virus. We have been putting all symptomatic cases on the "Double Z’s"- a Zpack and Zinc. For the Zpack, it is more than just preventing a secondary bacterial infection. Azithromycin appears to have activity over "atypical" bacteria, which have some elements of a virus. It was used in Asia with fair success.
Zinc makes sense. We know there is activity using Zinc versus the common cold. It’s safe, cheap, and readily available.
Unfortunately, neither has been especially impressive.
Hydroxychloroquine -aka Plaquenil - has been our go to for moderate to severe cases. The results so far ARE impressive. Despite media reports that millions of doses are flooding the pharmacies, it is still a challenge to find it. The pharmacies want to see proof of a positive result. Most deny having it.
So far we have been able to find it for every patient we feel has needed it. But it takes a lot of calling around. We have had to send patients out of the OC to get it. Our advice- if you are positive and are sick, let us find it for you. Our goal is to keep you out of the hospital.
Both Proteus inhibitors (used for HIV) and Ivermectin (used for scabies) have promising reports- we will advise those in certain cases if Plaquenil is not available or fails.
That's about it. No other meds appear to be worth using at this time. (Convalescent serum is being developed, but will be reserved for inpatient usage)
STEP 4--As a medical student in the ‘70's at the VA Hospital, I would need to get up at 3 AM to perform an order for "Pulmonary Toilet.” In the 21st Century, political correctness renamed the process “Pulmonary Hygiene.” Either way, it’s getting the yucky mucus out of the lungs.
The premise is simple- put a glass of water on your front porch. In a few days, it turns brown, and has little things swimming around in it. But a garden hose trickling for days stays clear. Stagnant fluid in the lungs turns badly infected, and needs to be removed. Here are the three processes we teach--they should be done 3-4 times a day.
TURN, COUGH, AND DEEP BREATHE- Lie in bed on your right side, cough hard, take a deep breath, and turn to your left side and repeat. Do this for 5 minutes. Imagine trying to get honey from the bottom of a jar to the sides. Same idea.
INCENTIVE SPIROMETRY- If you have one of those gadgets with balls that rise as you take a deep breath; perfect. Otherwise, improvise by exhaling totally, take as deep a breath as deeply as possible, hold it for 5-10 seconds, exhale, and repeat the process for 5 minutes. We need the airways open, and this accomplishes that.
PERCUSSION AND DRAINAGE- Again we improvise for home use. You'll need a partner wearing PPE (protective personal equipment). They cup each hand and begin playing the bongos on your back as you lie over a table with your shirt off. They should pound fairly hard. After about a minute, they should leave the room as you cough deeply to remove as much fluid as possible. Repeat the process for five minutes or more. (As a medical student I would sing “BABA LOU” as I played bongos on my patient’s back- it kept me awake and sometimes they'd even sing along.)
As part of the protocol, we schedule video visits every one to five days depending on the severity. Per CDC criteria, this protocol is complete once the patient is without fever or symptoms for three days, and at least one week after the original diagnosis (although we advise two weeks in most cases).
At this point we can do a test. A nasal PCR will tell us if the virus is still there. An ACCURATE antibody test will tell us if your immune and recovered. To date there is no test to see if you are an asymptomatic carrier other than repeated PCR swabs. We currently advise a PCR nasal swab done at our curbside locations. By the time your home we will have an answer. Keep in mind both the antibody tests and nasal swabs are still in short supply.
50 cases are hardly sufficient for a statistical analysis. What our records show is two patients that tested positive needed hospitalization -4% compared to a 12% national rate.
Of course we began testing earlier than most of the country and were able to start treating with milder cases. No deaths of our patients have occurred, compared to a 3% national mortality rate. As we head to 100 cases under our protocol, we must brace ourselves for that possibility.
The three most effective treatments?
- Total bedrest.
- Aggressive Pulmonary Toilet- I mean Hygiene.
We share this with you hoping you will share this with others. If you know someone with COVID19 and is not doing well, perhaps this data will assist. If you are a medical professional, please feel free to critique and/or use the info here. If you have successful treatments we didn't mention, please let us know. It will be awhile before the peer reviewed journals can give us strong data. By then it may be too late for some victims.
Gregg DeNicola MD, Chief Medical Officer
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