Let’s Live A Normal Life

Posted Posted in Brain Science, Elder Care, Homestudy, Psychology

By Mary, O’Brien, M.D.

There is increasing confusion about mask policies in our country.  This is understandable.  The U.S. is a large country with federal, state, and local governance.  Complexities are bound to develop.  A brief, straightforward review may be helpful.

Clinical experience over the past 18 months has shown that SARS-Cov2 is a virus that will be, in all likelihood, an endemic respiratory virus for years to come, much like the flu.  There will be multiple variants, and vaccines will be adjusted as necessary to reduce morbidity and mortality.

Capricious policies, protocols, and mandates will not protect people or eliminate this problem.  If edicts and executive orders solved problems, we wouldn’t have any problems left.

So what makes sense at this point?  The same things that have always made sense:

  1. Protect the vulnerable.  We know who they are:  the elderly and those with significant underlying conditions.
  2. Offer vaccines appropriately.  The principle of patient autonomy, a crucial component of medical ethics, must not be abandoned.  Forcing any medical procedure on people is a very serious breach of ethics.  Natural immunity after infection is potent and important, and it must be acknowledged.
  3. Expand and facilitate early treatments.  We have failed too often on this one.  Telling infected people to stay home until they can scarcely breathe has been disastrous.  Early use of inhaled steroids and monoclonal antibodies can prevent severe illness and death.  They should not be delayed or restricted for the sake of financial maneuvering, power grabs, or bureaucratic scheming.
  4. Focus on facts, accurate statistics, common sense, and perspective.  A mask-less two-year-old on a commercial jet with a sophisticated HEPA filtration system is not a threat to anyone.  Hysterical neurotic adults are tormenting toddlers to assuage their own paranoia.
  • Consider the current COVID survival statistics from Stanford University:
    • Ages 0-19 years:  99.9973%  survival
    • Ages 20-29 years: 99.986%   survival
    • Ages 30-39 years: 99.96%    survival
    • Ages 40-49 years: 99.18%    survival

5. Stay home if you don’t feel well.  This has always been sound advice.

      So far, medical research has demonstrated that every lockdown, school closing, and mask mandate around the world has failed to stop COVID.  It’s time to face the research, drop the double standards, and get a grip.  It’s time to live a normal life.

Monoclonal Antibodies for Post Exposure Prophylaxis of COVID-19 A Crash Course & Update

Posted Posted in Uncategorized

by Mary O’Brien, M.D.

Perspective:

Monoclonal Antibodies (mAB’s) are a form of immunotherapy, manufactured in vitro to target specific antigens. A wide array of mAB’s are used to treat malignancies such as breast, lung, colon, and renal cell cancer, melanoma, multiple myeloma, lymphomas, and leukemia.

Monoclonal antibodies are also used in the treatment of inflammatory autoimmune disorders such Crohn’s Disease, MS, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. These mAB’s can be directed against such targets as specific B cells, T cells, tumor necrosis factor-alpha (TNF-α) interleukins, cytokines, various proteins, and receptor sites on cells

Commonly used drugs such as Humira (adalimumab) and Remicade (infliximab) are mAB’s.

Update:

Since late 2020, a combination of the mAB’s casirivimab and imdevimab, known as REGEN-COV, has had Emergency Use Authorization (EUA) for patients ≥12 years with mild to moderate COVID and a high risk of progression to severe disease or hospitalization. People in the media and others have referred to this as “Regeneron,” since few people can pronounce or remember the actual mAB combination. “Regeneron” is not a drug, it’s the name of the pharma company that makes the drug.

Last week, the FDA expanded this EUA for use as post-exposure prophylaxis of COVID if:

  • The patient is not fully vaccinated (and at high risk) or
  • The patient is unlikely to have an adequate immune response to full vaccination and has been in close contact with a COVID infected person or is likely to be exposed to COVID in an institutional setting (nursing home, military barracks, prison, etc.)

Protocol:

The protocol for REGEN-COV as post-exposure prophylaxis is:

  • Casirivimab 600 mg plus
  • Imdevimab 600 mg

This can be given as either four consecutive shots (SC injections) at one time or as a single IV infusion Either route of administration is fine. There is no preference.

This combination of monoclonal antibodies has retained effectiveness against all COVID variants, including Delta, as of 8/23/2021.

Updated FDA Criteria for High Risk Conditions for COVID-19 Progression (May 2021)

  • Age 65 or older
  • BMI ≥25 (overweight or obese)
  • Pregnancy
  • Chronic kidney disease
  • Diabetes
  • Cardiovascular disease
  • Hypertension
  • COPD, moderate to severe asthma, or other chronic respiratory disease
  • Current treatment with immunosuppressive therapy
  • Sickle cell disease
  • Congenital or acquired heart disease
  • Neurodevelopmental disorders (such as cerebral palsy or Down syndrome), or other conditions that confer medical complexity
  • A medical-related technological dependence (such as tracheostomy or gastrostomy)
  • Patients 12 years or older with an overweight BMI, pregnancy, cardiovascular disease, hypertension, or chronic respiratory disease are now considered high risk

Vaccination against COVID-19 is prudent for the vast majority of people, But dealing with COVID is far more complex than screaming at everyone to wear masks and “get the jab.” The age, underlying medical conditions, and living, schooling, or working conditions of the individual patient matter.

Stay tuned. It’s not over yet.

A Thin Crust Over A Volcano

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

We are in dangerous territory.  Disrespect for law, order, ethics, life, property, and the rights of others is at an all-time high.  In many of our cities, more people are suffering from violent crime than from COVID.

Shoplifting in California is utterly out of control.  Thugs fill garbage bags full of merchandise, ranging from toiletries to designer handbags and brazenly walk out of stores.  Employees and security guards have been told not to confront the thieves. It’s too dangerous, and no one will be arrested or prosecuted in most cases.  In San Francisco, Walgreens has closed 17 stores as a result of unbridled shoplifting.  The people who suffer the most are the old, the weak, and the poor.

 Violent crime in New York City is skyrocketing. Homicides, assaults, robbery, and rape are the worst they have been in decades. Recently, a 61-year-old disabled lady with a walker was brutally attacked by four people, including a vicious woman who beat the victim repeatedly with a saucepan.  They stole the victim’s purse with $22.00 and even took her walker.  Similar violence has been perpetrated on young mothers, tourists, children, and women walking to church.  The oldest victim was 101 years old.

What is causing this descent into madness?  Several factors are obvious:

  • Criminal behavior is being tolerated by many local authorities.  No-cash bail policies amount to arrest and release.  In many cases, no arrest is made at all. Coddling criminals is neither kind nor compassionate.  It is not wise, prudent, or just.  The first and most important duty of government officials at any level is to keep their citizens safe.  Societies typically experience the behaviors they tolerate.  Tolerate crime and violence, and you’ll get plenty of it.
  • Police presence, numbers, power, and authority have been systematically weakened over the past year.  This is not an accident.  Chaos, confusion, crime, and corruption have been used by malevolent people throughout history.  It is a stepping stone to the subjugation of society.
  • Growing up fatherless is now the norm in many urban areas.  Misguided policies over the past 60 years have done profound damage to the integrity of the American family.  When children and teens have no structure, discipline, or role model at home, they will emulate what they see on the streets.
  • Moral decay and the abandonment of genuine virtue are taking a terrible toll on our culture.  The decline of the American family parallels the removal of any reference to God, faith, prayer, traditional values from public schools, or public life in general. Gang members are not losing sleep over the thought of “Thou shalt not kill.”

   It’s been said that civilization is a thin crust over a volcano.  The thin crust is cracking.  How much more are we willing to tolerate?

Life is Short and Precious

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.
It happened in an instant. Unimaginable horror and tragedy stunned a community and, indeed, the world.  The collapse of a condominium building in Surfside, Florida, at 1:38 A.M. instantly changed the lives and focus of thousands of people in the U.S., Israel, and South America.

Hundreds of people have been working around the clock, under brutal and treacherous conditions, to save a single life.  Rescuers of every race and background are feverishly trying to find even one survivor of any race or background.  Brave, skilled, and dedicated heroes are doing what brave, skilled, and dedicated heroes always do:  They sacrifice their own safety and well-being to help others.  Rescue personnel, regardless of their color or politics, must be pulled off their shift against their will.  Trying to save another human being is their sole focus. They work together selflessly as a unified team to save life.

This is not shocking to anyone who has ever worked in an ER, an OR, or an ICU.  It’s not a mystery to veterans who have served in combat or police officers who have saved countless lived in emergency situations.  However, too many individuals in the realm of politics, the media, academia, and the corporate world remain baffled by genuine courage and devotion in others.  Since the beginning of our species, ill-intended people have tried to sow division and strife.  Pitting people against one another is malicious, but it has always created an opportunity for power-hungry individuals to seize control.  Teaching children and young adults to be suspicious and resentful of others based on race, gender, or any other physical — therefore superficial — characteristic is a form of cultural rot.  It is a poisoning of the mind.

The tragic collapse of a condominium complex in Surfside, Florida, shows how misguided our priorities can be.  Life is short and precious.  There is never a good reason to promote hatred.  There is more than enough heartache in life without deliberate nastiness. We should never permit ourselves to be focused on race.  We have every reason to keep our focus on grace.

Einstein Was Right!

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Uncategorized

By Mary O’Brien, M.D.

“Everything should be made as simple as possible, but not simpler.”  Albert Einstein said that many years ago.  He was referring to physics, but his wisdom could easily apply to any situation, including COVID-19 vaccines.

Increasing numbers of people in business, politics, education and, of course, the media, are trying to force COVID-19 vaccines on everyone.  “Vaccination or termination” has become the new threat to employees and students.  Most people, regardless of their lofty achievements in other areas, are not well-versed in the fine points of immunology.  Sadly, however, some of them are convinced that they know what’s best for everyone.

Nearly everything in medicine carries potential risk and reward.  Both possibilities must always be considered.  Every prescription we write and every procedure we do has some potential to cause harm.  Every patient is unique.  Every individual has a combination of genetic factors, past illnesses, medications, and allergies.  Also each patient has metabolic, endocrine, hematologic, rheumatologic, neurologic, and cardio-pulmonary conditions that may need to be considered.  For example, patients with rheumatoid arthritis, psoriatic arthritis, Crohn’s disease, and other autoimmune disorders produce antibodies that attack their own tissues, hence the need to suppress — with potent drugs such as TNF (tumor necrosis factor) inhibitors — certain parameters of immune function.  Giving such a patient a vaccine, which stimulates the immune system to produce antibodies, can be unwise.  This is usually most problematic with live virus vaccines such as those for varicella, measles, and mumps, and rubella.  The COVID-19 vaccines are messenger RNA-based.  They do not contain live virus.

Pregnant women with COVID-19 illness are at increased risk for serious disease and mortality.  According to the Food and Drug Administration, data on the COVID-19 vaccines are “insufficient to inform vaccine-associated risk in pregnancy”.  Translation:  we don’t know enough yet to be dogmatic about these decisions.

All of COVID-19 vaccines available in the United States (Pfizer, BioNTech, Moderna, and Johnson & Johnson) are safe, effective, and appropriate for the vast majority of people.  But good medical practice is not about the vast majority of people.  Medical decisions are based on the conditions, needs, and details of the individual patient.  Politicians, corporate chief executives, school board members, and media types have no business making (or forcing) medical decisions on other people.

Einstein was right.  Oversimplifying anything is a bad idea.  So is judging others without knowing all the details.

Correct Answers

Posted Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Quick.  Looking back on your life, who was your favorite teacher or coach?  Was it the one who let you get away with anything?  Was it the one who set standards so low you tripped over them?  Was it the person who gave you a gold star for repetitive breathing?  The answer to all of those questions is a resounding “no.”  Most of us would agree that our favorite teacher or coach was the one who inspired us to give our best and achieve more than we thought we could.

Recently, many of us were stunned when state education officials in Virginia proposed eliminating any advanced or accelerated math classes prior to the 11th grade.  They opined that such classes were “unfair” or “intimidating” to less gifted students.  Somehow they reasoned that slowing down the smarter students would make sense.  We already went through this in the 1970s.  Educational giants back then introduced the “New Math” and declared that spelling and grammar didn’t “count.”  Creativity was king.  More recently, the “woke” crowd has informed us that correct answers don’t even matter when it comes to math.  “Process” matters.  In order for our future generation to compete at the highest level, both precision and creativity matter; we need both to succeed. 

We need advanced math to send astronauts to the moon and to the international space station.  We need math to calculate a safe antibiotic dose for critically-ill patients with deteriorating renal function.  Correct answers matter.

Perspective, Humanity and Common Sense

Posted Posted in Brain Science, Elder Care, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s been a year now.  Several hundred thousand frail, elderly people have died in hospitals and nursing homes alone, confused — and no doubt — feeling abandoned.  Tens of thousands of people have lost their businesses and livelihoods.  Children and teens deprived of normal schooling, sports, and other activities are suffering from anxiety, depression, insecurity, and loneliness.  Poor and disadvantaged children and those with learning disabilities are falling behind rapidly.  Online absenteeism is staggering, and grades are sinking.  The frustration and loneliness are excruciating for millions of innocents.

Politicians and bureaucrats are not lonely, however.  Their lives have not been destroyed.  If they want to dine out, work, socialize, or travel they do.  After all, they’re special.  They are enlightened elites.  We have heard the elites preach “science” to us for over a year.  The question is which science?

Medicine involves many sciences — chemistry, biology, mathematics, physics, statistics, genetics, physiology, pathology, epidemiology, and microbiology.  And that’s only a partial list.  Medicine, however, is also an art.  Sadly, over the past year, too many people have forgotten that.  Individual nurses, doctors, and other professionals have worked heroically to save lives and to be kind — under impossible circumstances — to patients.  But bureaucrats and politicians, with rare exceptions, cannot fathom the art of caring for seriously ill or dying patients — deprived of even a loved one — to hold their hand.  Once they taste control over others, they will not relinquish it willingly.

Human beings are social creatures.  We need contact, communication, and — perish the thought — touch.  Throughout human history exile, isolation, or solitary confinement has been considered painfully harsh punishment.  Yet this is precisely what has been inflicted on young children, the frail elderly, and millions of people in-between — all in the name of “science.”

The point of medicine is to relieve pain and suffering, it is not to control behavior.  Elderly people giving up hope and dying alone, and young people committing suicide were entirely predictable.  Some of us warned about an epidemic of anxiety, depression, addiction, abuse, and suicide a year ago.  These concerns were largely dismissed.  Histrionic media types and “officials” had millions of people convinced that COVID was a veritable death sentence for everyone. 

In reality, 99.7 percent of people who test positive for COVID survive.  Children are not vectors for this illness.  This virus attaches to human cells via angiotensin, converting enzyme receptors in the nasal mucosa and respiratory passages.  Children have very low levels of these receptors.  This is not difficult “science.”

Across the country we are seeing dramatic declines in case numbers, hospitalizations, and deaths.  In all likelihood, millions more people have antibodies to COVID than we realize.  They were simply never sick enough to be tested.  Millions more have been and are being vaccinated.  When 80 percent or so of the population has antibodies (either from infection or vaccination), we will have herd immunity.  There is no need to compromise the physical, social, psychological, and academic well-being of children and teens for one more day.  There is no need to refuse grandparents a hug.  We are rapidly losing any sense of perspective, humanity, or common sense.  We have developed a penchant for panic.  But panic is not policy.  Paranoia is not policy.  We must never again permit the self-serving notions of so few to dictate the misery and destruction of so many.

On Leadership, Science, and Happiness

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

It’s safe to say we’ll all be happy to see this year come to an end.  Fifty years from now people will still be studying the pandemic of 2020, catastrophic hurricanes, tornadoes, wildfires, riots, a controversial election, and the Nashville bombing.  We have reasons to be exhausted.

Despite all these dreadful events, or perhaps because of them, there is much to be learned.  It could easily fill a book, but for now, a few thoughts will suffice:

On Leadership

  • The people who are trying to frighten you are trying to control you.  Ignore them. Good leaders inspire confidence and optimism, not despair.
  • There is never a place for panic in leadership. There is never a place for panic in public policy.
  • Good leaders actually do what they ask others to do. They do not exempt themselves from difficult, inconvenient, or unpleasant tasks.
  • True leaders respect others.  They do not harbor disdain for others.
  • Tyrants (false leaders) often succeed because cowardice is so common.  Show some spine when bullies arise, and remember, no politician or bureaucrat has missed a paycheck in 2020.
  • When in the course of human events, it becomes clear that what you’re doing isn’t working, it’s time to change what you’re doing — especially in a crisis.

On Science

  • Genuine science requires brutal honesty, discipline, openness, acceptance of uncertainty, and humility.  Real science always has been and always will be a work in progress.  When people scream, “Follow the science,” all too often they mean, “Do as I say.”
  • The main point of science is to help us overcome problems and adapt to difficult circumstances. Creative people in every domain have learned to adapt to massive challenges over the years. The Year 2020 was no exception.  In a crisis people need practical advice and suggestions, not domination and suppression.

On Happiness

  • Most of us still have much for which to be grateful, and there is no happiness without gratitude. Take nothing for granted. Many of us now miss things as simple as family, friends, hugs, and handshakes.
  • There are plenty of unkind people in the world. Don’t be one of them.  Kindness and happiness go hand in hand.
  • Don’t believe anyone who insists our darkest days lie ahead.  Such people do not understand the wonders of the human spirit.  It is never time to give up, despair, or cower in a corner.

Fear not.  We’ve learned a great deal in 2020, and we will build on that knowledge.  Be focused.  Be engaged.  Stay informed (not indoctrinated).  No matter what happens in 2021, do not relinquish your right to engage in independent thought and speech.  The future depends on it.

Happy New Year to All.

Exactly What We Need

Posted Posted in Brain Science, Continuing Education, Homestudy, Nutrition, Psychology

By Mary O’Brien, M.D.

The holidays have gotten off to an odd start.  Thanksgiving was different, to say the least.  Most family gatherings were small and lots of people were alone.  Now the focus has shifted to shopping and decorating. At least it’s a pleasant distraction.

Hanukkah begins on December 10th and Advent started this week.  Who knows what will happen by Christmas.  Given the depressing and stressful nature of this entire year, it might be uplifting to embrace some time-tested traditions of a spiritual nature. For centuries the Christmas tradition of Advent was a time of fasting, prayer, and alms giving.  Many of us were taught to “give up” something like candy or soda as a spiritual discipline in preparation for Christmas.  Nothing wrong with that, especially since many of us have gained a few pounds during the pandemic.  But giving up candy doesn’t help someone feel better.  And right now, nearly everyone needs a little something to feel better.  So here’s an old idea that might help us all feel uplifted.

Cut 25 strips of paper and write an activity for the day on each one.  Fold the strips of paper and place them in a jar or bowl.  Each morning, pick one, and commit to performing the activity.  By Christmas, you will be a better person (and a happier one) for the ripple effect you will have set in motion.

Here are some examples:

  • Send a Christmas card with a personal note of gratitude and encouragement to an active service member or veteran.
  • Leave a little treat (not homemade this year) on the doorstep of a neighbor you haven’t met.
  • Stop by your church or synagogue for a few minutes of quiet prayer or reflection.
  • Give up fancy coffee drinks or alcohol for a month and donate the money you save to a shelter.
  • Offer to do a grocery store run for an elderly neighbor.
  • Say something pleasant or kind to someone you don’t like, perhaps a grumpy patient.
  • Send a small floral arrangement anonymously to someone in a nursing home.
  • Order take out or delivery and give an unexpectedly generous tip.
  • Apologize to someone you may have hurt or offended. It may be more difficult than giving up candy.
  • Place a treat in the mailbox for your mail carrier just because.
  • Try to get through the entire day without criticizing anyone.  There’s some spiritual discipline!

You can make up your own list. It’s well worth the effort.  The next four weeks will pass regardless of our actions.  This year the true spirit of Advent could be exactly what we need.

homestudy

The Greatest Enemies of Freedom

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Election Day.  Veteran’s Day.  Pearl Harbor Day.  Do these days have anything in common?  They do — more than most of us might think.  The catastrophic attack on Pearl Harbor on December 7, 1941, shocked the nation into unprecedented action.  Millions of people who had ignored the war in Europe and Asia could no longer remain unaware or uninvolved.  Massive numbers of people rushed to enlist or pitch in on the home front to defend freedom itself.  People willingly sacrificed everything from gasoline, to meat and sugar, to fabrics and metals for the sake of the war effort.  Discipline and sacrifice were a given.

Veteran’s Day (originally called Armistice Day) honors the end of World War I. Few of us can even begin to fathom the anguish, misery, and suffering endured by the troops in Europe.  The horrors of trench warfare, malnutrition, hideous infectious disease, nerve gas, and deprivation of every sort took a terrible toll.  Nearly half of U.S. troops who died succumbed to complications of the Spanish Flu.  A hundred years ago, there were no antiviral drugs and no antibiotics to treat secondary bacterial pneumonia or meningitis.  Curiously, President Wilson never even gave a speech about the flu pandemic.

In World War I and World War II, the hardships of sacrifices endured by so many millions of people were intense.  But how does that relate to Election Day 2020?  It’s not that strange or complex.  The two greatest enemies of freedom are apathy and cowardice.  It’s been that way for thousands of years.  We are in a time of great conflict and uncertainty.  Angry, jealous, controlling people are everywhere.  Remember, if someone is trying to frighten you, he or she is trying to control you.  Don’t be intimidated.  Don’t be demoralized.  Observe, think, and vote.  Apathy and cowardice have dreadful consequences.