Michael Loren MD

Recovery from Covid infection 3-4 months after is a reasonable time to begin Covid vaccination. Antibody titres can be checked through major labs like quest or labcor. Despite having been infected with Covid , a second infection can occur. This use of antibody titres should be viewed as a tool that is new and needs refinement. I think it’s useful in individual situations. Second vaccination doses improve the success of the vaccine and in about 20% of patients the second dose may have more side effects. Side effects that are short lived and not nearly as dangerous compared to a Covid infection. Older patients usually have milder reactions.

Jack had Covid infection in September and recently got his first Covid vaccine. He had a terrible headache, fever and fatigue for 48 hours. He was worried about getting the second dose of the vaccine. We measured his antibody titre to Covid. His level was very high. We advised him to not get the second dose. There was a recent small study finding that in patients who had the Covid infection and later vaccinated that a second dose did not change the antibody titres. Checking antibody titres over time May give us more information on protection from vaccination and insight about when to revaccinate. .

Over the last six months I have been practicing nasal and diaphragmatic breathing. What difference is there with nasal or mouth breathing? When we breath though our nose we produce a gas nitrous oxide that helps dilate lung airways, improves the oxygen uptake of red cells, and helps the immune system in killing viruses and bacteria in the sinuses and lungs. All these advantages are lost when breathing through the mouth. Of all the mammals in the world man seems to be the o...nly one breathing through both the nose and mouth. All other mammals are nasal breathers. Even babies when born are obligate nasal breathers. Patients with allergies and asthma may commonly breath more by mouth and often use their upper chest accessory muscles breathing. This may lead to hyperventilation and or dysfunctional breathing. Diaphragmatic breathing may be helpful practicing when sitting, walking, laying down and exercising. Enclosed is a handout from the Cleveland Clinic. See more

Last week I meet with friends, all of us vaccinated. We had been meeting for a year on Zoom. We Met in a coffee shop where the rules are wear a mask until you sit down. I said , No more zoom. This is how we are meeting. It felt so good to be together. It felt safe. Unfortunately there are Many who are afraid to get vaccine. Excuses might be COVID deaths are only 1%. Aborted babies are used To make the vaccine. ... The problem now is complicated by COVID variants that are more contagious. The best plans are get more people vaccinated. And this seems more difficult despite the abundance of available vaccine. Currently over 130 million in American have had at least one vaccine. (41% of population). If you meet family or friends that haven’t Been vaccinated, encourage them it’s safer getting vaccinated compared to getting COVID infectiion.

It looks like Covid19 is not going away. Duh. I am making changes in the office regarding air ventilation and How I am seeing patients. The issue with Covid is close physical contact and time. Shorter time: less exposure to viral particles. ... Until we have a rapid quick test, we don’t really know who is safe. We are all suspects. I check my temperature every day. Outside is safe because of massive continual air movements. In our office we are increasing the ventilationWith exhaust fans that change ordinary rooms into negative pressure rooms. These are rooms are usually found only in hospitals. The use of HEPA filters are very good at remove particles in the air. Currently most patient visits are by teleconference. There are a Few patients we are seeing in the office who may be more complicated. Joke warning: people are complicated, there are a lot of moving parts. Be smart, be safe.

I just saw this today, on Covid-19 and asthma risk. Asthma Seems Not to Be Linked to COVID-19 Hospitalization Jun 24, 2020 TUESDAY, June 22, 2020 (HealthDay News) Asthma seems not to be associated with COVID-19 hospitalization, according to a study published online June 9 in the Journal of Allergy and Clinical Immunology.... Krishan D. Chhiba, M.D., Ph.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined the prevalence of asthma among COVID-19 patients. The clinical characteristics and comorbidities in patients with COVID-19 with and without asthma were assessed by searching medical records. In addition, the risk for hospitalization associated with asthma and/or inhaled corticosteroid use was determined. The researchers found that 14 percent of the 1,526 patients with COVID-19 were classified as having asthma. After adjustment for age, sex, gender, and comorbidities, asthma was not associated with an increased risk for hospitalization (relative risk, 0.96; 95 percent confidence interval, 0.77 to 1.19). In a similar adjusted model, the ongoing use of inhaled corticosteroids was not associated with an increased risk for hospitalization (relative risk, 1.39; 95 percent confidence interval, 0.90 to 2.15). Interestingly, asthma did not increase the risk of hospitalization after adjusting for covariates, the authors write. This is notable as it has been anticipated that underlying chronic lung disease such as asthma, which are typically triggered by a viral illness, would place these patients at increased risk of severe exacerbations.

Some of my patients have problems breathing with face masks. Consider using a face shield. Faceshields can be easily cleaned and reused. Prices $5-10./ shield. The shields may Be more protective than the cloth masks.

There is a lot of stress with COVID-19. I saw this pic that Looked helpful.

There is an argument that wearing face shields are safer than masks. When we start back to seeing patients in the office we will be using face shields and a mask. It has been suggested that face shields may be helpful in the classroom. https://www.nytimes.com//he/coronavirus-face-shields.html

This is an interesting article on the science of spreading Covid19. A must read on risk and lowering risk. https://www.erinbromage.com//the-risks-know-them-avoid-the

I just learned this from my daughter, micro meditation. Use it to destress. How? Yoga breathing. Take a deep Breath in through your nose and slowly breath out your mouth. Count Each breath and stop at breath 10. Do it before sleep. Do it driving. Do it walking, sitting, laying down. it’s a fantastic simple idea to calm down and relax your mind. Try it tonight!

In the last few days I have been teleconferencing with patients instead of seeing them in the office. This keeps it safer for us in the office and for the patients. Patient's with rashes have sent pictures to: [email protected]. ... We are doing drive in allergy shots.. Patients sign in at the office and then we can give patient's their shot while they are in the car. So far these temporary changes seem to be working out.

Background/objectives: Community-based elderly studies concerning microbiology of acute respiratory infections are scarce. Data on subclinical infections are even totally absent, although asymptomatic persons might act as a source of respiratory infections. Methods: In a 1-year community-based study, we prospectively investigated the possible virologic cause of acute respiratory infections in 107 symptomatic case episodes and 91 symptom-free control periods. Participants, per...sons >/=60 years, reported daily the presence of respiratory symptoms in a diary. Virologic assessment was performed by polymerase chain reaction (PCR) and serology. Results: In 58% of the case episodes a pathogen was demonstrated, the most common being rhinoviruses (32%), coronaviruses (17%), and influenzaviruses (7%). The odds ratio for demonstrating a virus in cases with symptoms vs. controls without symptoms was 30.0 (95% confidence interval 10.2-87.6). In 4% of the symptom-free control periods a virus was detected. Conclusions: This study supports the importance of rhinovirus infections in community-dwelling elderly persons, whereas asymptomatic elderly persons can also harbor pathogens as detected by PCR, and thus might be a source of infection for their environment. This study was from Holland in 2003. Notice elderly can be infected and have no symptoms and Coronavirus was found, obviously a different strain. MLL

During the winter it is hard to move outside because of the bitter cold, or ice and snow. Frequently I will discuss exercise with patients. Let me clarify I’m not thinking of going to a gym. For the vast majority of us it consists of walking, joint mobility exercises or flexibility activities and simple calisthenics. A major benefit of moving is it stimulates or strengthens our Immune System. This may prevent infections. Think of short walks or activity throughout the day. Walking inside the house, office, or walking in a mall, or grocery store is valid. Keep moving!

I learned an interesting idea from my sister. Problems and hard times seem to have a sticky effect on our brain.. They stick like Velcro. Good ideas and Happy thoughts stick like Teflon. It seems hard getting problems or sad ideas out of our head. One suggestion is to do a form of meditation, thinking about a stream that is slowly moving and leaves are floating on the stream. Any idea you get, good or bad, happy or sad, stick it on a leaf and watch it float away. You can do this sitting, walking, laying down with your eyes open or closed. Over time sticky ideas become less sticky, less worrisome. Give it a try.