Doxycycline: An effective Therapeutic for acute covid

It has been demonstrated in the literature, since May 2021 that Doxycycline is an effective and efficacious therapeutic against the SARS-COV2 virus. The literature demonstrates that physiologically Doxycycline works as an antiviral, and anti-inflammatory in a similar fashion to Ivermectin. Adjunctively, Doxycycline is used to boost the antiviral, and anti-inflammatory properties of Ivermectin.

In the literature Doxycycline is dosed at 100 mg twice a day for 10 days, specifically in the papers out of Uttar Pradesh in India, where the Delta mutant was eradicated with Ivermectin and the aforementioned dosing of Doxycycline.

In my protocol, I dose Doxycycline 100 mg twice a day for 5 days, 7 days or 10 days, depending on age of the patient, and pre-existing medical conditions, such as a history of C.difficile and any gut inflammatory diseases, namely Crohn’s disease and Ulcerative colitis, where the microbiome may not tolerate 10 days duration of Doxycycline. In my protocol, Doxycycline is also used in an infected-no symptoms therapeutic regimen for 5 days or 7 days in addition to Ivermectin.

Additionally, in my protocol the patient must take Vitamin D3 10,000 IU, Zinc gluconate/picolinate 200 mg and Magnesium citrate 800mg/400 mg at least 1 hour prior to consuming Doxycycline or Ivermectin for a minimum of 3 weeks, for the efficacy maximization of these drugs, relative to the aforementioned vitamin and micronutrients being used as cofactors for physiological bio-electrochemical operative/catalytic reactions in the body.

Adjunctively, the gut microbiome must be augmented with probiotics such as Lactobacillus Plantarum PS128 for the innate immunity to work effectively, and to minimize or eliminate gut barrier failure secondary to COVID gastroenteritis. An organic, non-GMO, low gluten/no gluten green Mediterranean diet should also be utilized for the exponential optimization of the gut microbiome healing properties.

The most efficient and lean methodology to prevent Long COVID, and the annihilation of decent minimum healthcare access and delivery, is to deploy Telemedicine to the population in the acute phase of COVID infection or symptoms, utilizing Ivermectin and Doxycycline with recent FDA approved antiviral drugs. There must be therapeutic options, since the side effect profile for the recent drugs can have a deleterious effect on the current population, relative to liver and kidney damage. Most Americans cannot afford healthcare, and liver and kidney damage are not adequately assessed in an extremely overweight/obese population, as well as, an alcoholic epidemic which has worsened secondary to isolation during the ongoing pandemic.

Ivermectin: An effective therapeutic for LONG COVID

Ivermectin as an antiviral is an effective therapeutic for Long COVID. The key is to optimize and augment innate immunity via enhancement of the gut microbiome, as well as, improving the required micronutrient and trace minerals, that are necessary co-factors for the body’s internal wound healing-repair system.

Most of the body’s innate immunity or gatekeeper protection is known to be located in the gut. Additionally, when the gut becomes leaky via loosening of the epithelial tight junctions, this causes a breakdown in the body’s innate immunity. Thus, this is one of the main components of the approach to my long COVID therapeutic protocol. Keep the gut sealed and the gut microbiome happy, and the body with medications such as Ivermectin, can reverse almost any injury or damage over time.

Ivermectin as an anti-viral treats most viruses including Epstein-Barr Virus, Herpes Zoster and HIV. The mechanism for this anti-viral activity has to be further studied at the petri dish level, but it does stop or minimize replicative ability of viruses, including RNA viruses, which are very labile and unpredictable. Hence, no cure for HIV to date. As a Biochemist, after reviewing the structure of Ivermectin, I am sure that one of the main mechanism is the intercalating with the genetic code of the viruses and thus the resulting termination of the replicative process of the virus, with subsequent death of virus and apoptosis of host cell.

My dosing regimen is based on the 1996 FDA approval dosing regimen of Ivermectin. I dose at 0.2mg/kg using ideal body weight based on height. If the actual body weight is less than the ideal body weight based on height, I use the actual body weight. I only dispense 12 mg, 15 mg and 18 mg at 5 days, 7 days or 10 days then twice weekly for 6 weeks then every 7 days thereafter. I normally round up 2nd to overweight and obesity issues in the general population. I only round down when the patient is over 70 years old, since I always take muscle mass into account and decline in liver and kidney function over time. Regarding the consideration of muscle mass, I only dispense 5 and 7 days protocol to women secondary to this reasoning/logic.

Since for me all medications are adjuncts to care, and are not silver bullets or the root source of healing or curing disease; I do a deep dive with the innate immunity focusing on optimizing the gut microbiome and sealing any leaky gut to augment any deficits in innate immunity.

For the fall out of disability and exhausting chronic disease from COVID-19, I highly recommend the deployment of accessible and affordable care, and therefore the achievement of health equity nationally by the espousal of the maximal utilization of Telemedicine/Telehealth technology, and the data mining required for the subsequent elucidation of Long COVID symptoms and COVID-19 disease burden, and downstream clinical sequelae.

The Optimal Opioid Use Disorder Rx: Low Barrier MOUD

Purdue Pharma finally admitted to their guilt to misleading and misinforming physicians and the medical community about the addiction profile of Oxycodone/Oxycontin. The resultant carnage to society, the opioid epidemic, is still rabidly ravaging the country. The COVID pandemic exponentially worsened the opioid epidemic secondary to a lack of access to the only medication, that has been shown to have any efficacy in the treatment of opioid use disorder, which is Buprenorphine.

Thus, there has been a marked increase in overdoses and deaths during the COVID pandemic. Healthcare facilities unfortunately are still working on making Buprenorphine available to patients in the emergency room because of an overdose. More federal funding has to be infused in opioid addiction treatment programs nationally, to make a dent in this accelerating opioid epidemic. There is no need from a jurisprudence point of view, for a DEA waiver to prescribe Buprenorphine for opioid use disorder. These boundaries and hurdles at the federal regulatory level are fueling the deaths of thousands of Americans every year unnecessarily.

A treatment methodology to slow down and halt the opioid epidemic is low barrier medication for opioid use disorder (MOUD). This methodology involves the use of Buprenorphine as soon as one encounters a patient with opioid use disorder, begin treatment immediately after clinical diagnosis. Thus, there would be minimal barriers to initiating treatment for a patient that has overdosed or is repeatedly admitted to the emergency room due to opioid use disorder.

The future of the improved treatment, and the elimination of relapses regarding opioid use disorder, is to leverage Telehealth/Telemedicine for the delivery and facile access to Buprenorphine, as quickly as possible. Do not delay or hold up treatment due to referring patients to specialists, start treatment immediately upon encountering a patient with clinical opioid use disorder.

The Cure for Obesity: The Gut Microbiome

Obesity is now a global disease. In the United States about 40-50% of the population is overweight or obese. This is a twenty-first century problem secondary to the fast food industry. Food has become a drug with exponential addiction potential, and should be considered a component of substance use disorder, like opioids, nicotine and alcohol. Unfortunately, a large part of the food industry involves processed food, which contributes to obesity. In the black, brown and indigineous community, we have food desert, pharmacy desert and healthcare desert, this only exacerbates the obesity epidemic in the United States.

The gut or gastrointestinal tract is the gatekeeper of the human immune system, and the first line treatment landscape for all disease, especially autoimmune disease. The root cause of obesity starts with the gut and involves the gut brain axis ultimately. Sixty to seventy percent of patients/clients with obesity also have a behavioral health issue, and this is why the gut brain axis is a very important portal to control and cure obesity.

Who are the worker bees of the gut? The worker bees of the gut are called the microbiome. It includes bacteria, yeasts, fungi and protozoans. The microbiome keeps us alive, and prevents disease by optimizing our immunity, preventing diabetes, normalizing cholesterol and triglycerides, and ultimately hemodynamically maintaining our metabolism day by day.

The role of the gut microbiome in weight loss, diabetes control, hypertension, dyslipidemia, and behavioral health should be a part of every patient’s/client’s care plan. We should make it categorically clear that the cure for most diseases resides in the worker bees, the microbiome of the gastrointestinal tract.

Urgent Care Telehealth Protocol for Telehealth-Telemedicine Providers

Urgent Care Telehealth Protocol for Beginners: High Quality Documentation: No Representation Without Documentation

Do’s: Verify, don’t TRUST

  • Always document allergies
  • Check HT/WT, if BMI greater than 26, refer to Obesity Medicine, Nutrition and Integrative/Functional Medicine
  • Prescribe Augmentin 875 mg BID for 7 days, Zithromax 500 mg QD for 3 or 5 days, and Nitrofurantoin 100 mg BID for 7 days for Sx UTI. Hydrate with 2,000 ml distilled water/Pedialyte for 10 days or daily.
  • Tamiflu protocol: up to 4 days of symptoms 75 mg BID for 5 days, by 5 days of symptoms Rx patient with Abx (aforementioned)
  • Always inform patient that they must go to ER/urgent care center if Sx persist/worsen/wax-wane in 24-48 hours.
  • UTI protocol: check for CVA tenderness and pink/red urine in toilet/gross hematuria
  • For ICD 10, always additionally code for SIRS/Sepsis when appropriate
  • Sinusitis/Pharyngitis/Otitis Media protocol: Check for anterior/posterior cervical adenopathy/muscle tenderness/pain. Place chin on chest to evaluate for nuchal rigidity/neck suppleness, if positive increased risk for meningitis.
  • Bronchitis/Pneumonia protocol: make sure to check for productive cough and pleuritic chest pain
  • Have a low threshold to send patient to ER/urgent care center

Don’ts: must send to urgent care center/ER

  • Rx chest pain, send for cardiac enzymes/PA-lateral CXR
  • Rx failure of Abx Rx
  • Rx tooth abscess, send to dentist or above, need X-ray
  • Rx arrhythmia, evaluated by wearable or if blood pressure cuff says it can’t read the rhythm
  • Rx abdominal pain, only if absolutely sure that it is gastroenteritis and inform about visiting ER/urgent care center in 24-48 hours
  • Rx possible Fx, send for X-rays
  • Rx digit/hand or foot/toe infection that cover several joints with inability to flex or extend. Again, if need X-ray sent to urgent care/ER.
  • Refills only give 15-30 days supply, insist they see PCP/PMD
  • Don’t Rx chronic Dz, send to PMD/PCP and appropriate specialist (neurology, endocrinology, cardiology, pulmonology, allergy-immunology, gyn-urology, endometriosis specialist-reproductive endocrinology, and rheumatology), document clearly in chart

Endometriosis: The Great Chameleon

Endometriosis is an inflammatory autoimmune disease that affects 1 in 10 women globally and affects women mainly during their reproductive years. Secondary to the ability of these inflamed tissues or inflammatory mediators possibly spreading to anywhere in the body, endometriosis is woefully underdiagnosed and misdiagnosed. Unfortunately, it can take an average of up to 15 years before a woman is diagnosed with endometriosis. Those intervening years of non-treatment, and constantly being exposed to the cognitive bias of psych-out bias, most women suffer excruciating pain, devastating disabilities, as well as, untreated fertility issues.

Alas, endometriosis can cause migraines with subsequent seizures. Many women with lung and heart issues are not asked about the occurrence of these symptoms with their menses, which should be a routine part of the history of reproductive-age women. Additionally, lung lesions are normally only realized when the patient’s lung collapses, and the patient undergoes emergency surgery.

Another issue with the prolonged misdiagnoses of endometriosis is the lack of understanding that Stage 0 endometriosis has no macroscopic or critical mass findings. Thus, endometriosis is a clinical diagnosis and not a pathological diagnosis. Unfortunately, there may not be enough tissue specimens to even send to pathology. A patient who has to go to the emergency room almost every month when having her menses due to excruciating pain, has endometriosis, even if there is no evidence of pathological disease upon diagnostic laparoscopy. However, if an endometrioma is found during laparoscopy, it is now recommended to ultimately perform an oophorectomy emergently for increased risk of ovarian cancer over time. In the face of pulmonary endometriosis, removal of the endometrioma normally results in the lung symptoms being resolved.

There is no cure for endometriosis at the moment, even if one removes both ovaries and uterus during surgery. The adrenal glands and the patient’s adipocytes, especially if overweight or obese will produce estrogen analogs/imitators, and can cause symptoms wherever there are endometriosis lesions or inflammatory mediators in the body.

The severity of the systemic endometriosis symptoms should be decreasing as one approaches menopause. However, there is postmenopausal endometriosis, although it is rare. With the advent of Telemedicine, psych-out bias and posterior probability bias should be greatly diminished relative to improved continuity of care. Thus, endometriosis with more education, awareness, and academic studies should be easier to diagnose over time. There is a blood test developed in England, but the sensitivity is only 90%, meaning the test can miss 10% of positive cases.

Treatment for Low Sexual Desire in Women

Hyposexual desire disorder (HSDD) or low sexual desire in women affects about 1 in 10 women globally. The causes of low sexual desire in women are varied and many. The main causes I have seen in my practice are due to oral contraceptives, intrauterine devices, implantable hormonal devices, occupational/life stress, anxiety/depression, and psychiatric medications.

Unfortunately, obesity also plays a huge role in low sexual desire in women. Obesity is a chronic inflammatory state and can cause hypertensionheart disease, kidney damage, and diabetes. One of the main side effects of medications used to treat the aforementioned diseases is low sexual desire. So it is absolutely important to maintain a body mass index of 25, and a waist circumference of 35 inches in women. Additionally, obesity can be responsible for polycystic ovary disease (PCOS) and infertility.

The most important systems to be optimized are endocrine such as thyroid/parathyroid levels, a circulatory system such as hemoglobin level, and vitamin B/D levels. Optimization means that levels should be above the 50th percentile, sometimes even closer to the 100th percentile. The level should be titrated to how the patient feels relative to the improvement in symptoms.

The main treatment for low sexual desire is dietary/lifestyle change. The diet that is normally recommended for low sexual desire in women is the Mediterranean diet. It is important to make sure that this diet has organic components since regular food has a lot of hormones/steroids, antibiotics, and fertilizers/dioxins.

Medications that are available to treat low sexual desire in women are few. The drug that works really well after any underlying medical conditions are stabilized or resolved, and the aforementioned optimization of systems achieved is Addyi. Addyi can take up to 8 to 12 weeks to start working, the shortest time frame I have seen in my practice is 2 to 3 weeks, and I advised the patient to discontinue her oral contraceptive prior to starting Addyi. Once underlying medical conditions are stabilized, Addyi can be effective 70 percent to 90 percent of the time, otherwise, it is only 10-20 percent effective.

Telemedicine/Telehealth is a methodology for facilitating the delivery of women’s health and should be utilized frequently to improve the care of women globally. Low sexual desire in women is easily eradicated with Telehealth/Telemedicine as a modality for the delivery of women’s healthcare.

COVID-19: An endovascular systemic disease

Even though COVID-19 disease is caused by the SARS-COV 2 virus entering the human body mainly through the respiratory system, it is not a respiratory disease. The virus also proliferates in the sinuses, and thus enters our neurological system, causing a lot of damage. Any system in the body with a rich capillary network for blood supply is heavily prone to clotting, and thus ischemia, and ultimately the death of tissues/cells in that ischemic penumbra/area.

Systems in the body that are detrimentally damaged by this microvascular clotting are mainly; the neurological/psychological system resulting in central nervous system injury with subsequent peripheral nerve damage, the respiratory system with extensive lung scarring, the cardiac system with resultant arrhythmias, the renal system with chronic renal failure and the gastrointestinal system. These systemic sequela thus can morph into chronic or long haul COVID-19, which can effect 50-75% of COVID-19 disease survivors.

Long haul/chronic COVID-19 disease

Chronic COVID-19 disease is very debilitating and is normally multi-systemic. The bone crushing fatigue alone leads to such functional impairment, that there will a population of seriously disabled patients applying for disability and early retirement in the next 6-12 months. Treatment for chronic COVID-19 disease is currently supportive. I recommend optimization of thyroid/parathyroid function, meaning levels above the 50th percentile, which includes hemoglobin level, and Vitamin D/B12 levels. I also recommend high doses of Vitamin C with rose hips/bioflavonoids, dose of 2,000-3,000 mg daily, as well as, Magnesium Citrate 800 mg to 1,200 mg daily. All doses should be adjusted if renal failure is present.

Prevention of microvascular clotting

If the patient is not on Lovenox subcutaneously after discharge from the hospital or was never hospitalized, then keep the blood thin with herbs such as Red Panax Ginseng and Gingko Biloba should be adequate. Avoid Vitamin K in vitamins/supplements, and foods rich in Vitamin K.

No cure for COVID-19

Currently there is no cure for COVID-19 disease. The cure is actually in the prevention of the disease or being an unavailable host, by wearing masks in public areas, physical distancing and excellent hand hygiene with 20 seconds hand washing. Remdesivir shows promise as a therapeutic agent and convalescent plasma is also helpful. Hydroxychloroquine treatment remains controversial, more robust academic studies need to be performed for the role of Hydroxychloroquine as a therapeutic agent.

Endometriosis: A systemic disease

Endometriosis is a progressive chronic autoimmune inflammatory disease that affect 1 in 10 women of reproductive age, which can sometimes start at 9-11 years old. It is an extremely debilitating disease which is often misdiagnosed and under diagnosed. There are two types invisible/microscopic disease (Stage 0) and macroscopic disease (endometriomas/pulmonary with catamenial pneumothorax). It mainly affects the reproductive system with severe menstrual cramps, however, most women have some aspect of systemic endometriosis since it also simultaneously affects the psychological system with PMS/PMDD, respiratory system with restrictive lung disease/pneumothorax, the neurological system with migraines, the musculoskeletal system with diffuse myalgia, endocrine system with severe fatigue, and gastrointestinal (GI) system with constipation/diarrhea and nausea/vomiting.

Rampant misdiagnosis

Since endometriosis is a systemic disease it is often misdiagnosed, for example as irritable bowel syndrome (IBS), chronic medication induced migraine, and fibromyalgia. I call the disease the great Chameleon. It is important to note that women understand that endometriosis is initially a clinical diagnosis, there may not be any macroscopic findings (Stage 0), and laparoscopy may be initially negative for macroscopic disease, this does not negate the fact that there are endometrial ectopic foci that are invisible.

Diagnosis and Treatment

As previously mentioned endometriosis is very difficult to diagnose especially for Stage 0/invisible systemic disease. There is a blood test that was developed, but it is only 90% sensitive. Thus, there is a 10% chance that the patient is positive for disease but the test says that the patient is negative. Otherwise, it is a clinical diagnosis until there is macroscopic disease seen on laparoscopy, which can take up to 20-25 years to manifest.

Treatment is mainly hormonal with utilization of birth control therapy, such as oral contraceptives, Mirena IUD, Climara Pro patch or combinations of the aforementioned hormonal therapy. GnRH agonist/antagonists such as Leupron or Orilissa are also used. The side effects of these therapies can be devastating, but Orilissa works really well if the side effects can be tolerated for at least 6 months. Surgical options include a hysterectomy or hysterectomy with ovary removal. The ovaries when removed prior to menopause can be very detrimental to women’s health even with hormone replacement therapy.

Traditional Chinese Medicine with locoregional treatment such as acupuncture with moxibustion, reflexology and cupping, is also extremely helpful. Energy medicine techniques such as Krieger-Kunz Therapeutic Touch and Tai Chi are also invaluable tools in the armamentarium for treatment of endometriosis. Herbs such as Pau D’ Arco, Astralagus, Red Panax Ginseng, Gingko Biloba, Nopal, Graviola and Reishi Mushroom are also critical to controlling systemic endometriosis. Memorial Sloan-Kettering’s complimentary medicine herbal website is an excellent source for informational education about these herbs relative to academic research.

Adjunctively, counseling is very highly recommended secondary to the debilitating effects of excruciating pain, symptoms being disregarded, and being told that symptoms are psychological, can be very damaging to a women’s global health and daily routine care.

COVID 19 Rx Protocol relative to Hydroxychloroquine and Zithromax

First and foremost be very clear with your patients/clients that your goal is to slow down replication/reproduction of SARS-COV2 virus and not to cure or prevent COVID 19. Also, delineate the risk for QT prolongation with Hydroxychloroquine and Zithromax, since both drugs causes QT prolongation. Additionally, in the face of cardiac comorbidities, obesity, diabetes and hypertension, as well as, autoimmune disease, there will be an increase susceptibility for QT prolongation. The aforemnetioned chronic diseases also portend to electrolyte abnormalities that exacerbate QT prolongation such as hypocalcemia, hypomagnessemia and Vitamin D deficiency.

Prevention of QT prolongation

In medicine you are mainly restricted by the patient’s innate presenting comorbidities, innate immunity, genetic polymorphisms, epigenetic polymorphisms and pharmacogenetic polymorphisms. As a physician who includes Genomic Medicine in my practice, I am acutely aware of these determinants in the outcome of the patients COVID 19 disease course, and disease sequelae. Consequently, in my COVID 19 protocol I request that the patient consume Zinc, Vitamin D and Magnesium, 30 minutes to an hour before taking Hydroxychloroquine. I request that Zithromax be taken 2 hours after Hydroxychloroquine to minimize any drug-drug interaction relative to synergy or multiplicative QT prolongation side effects. I also address metabolic syndrome issues secondary to obesity, such as persistent chronic absorptivity issues, hypocalcemia, hypovitaminosis D and B12, as well as, the chronic inflammatory state due to obesity, which also affects myocardium and nerve/neural global conductivities.

The role of Telemedicine/Telehealth in the eradication of COVID 19

Telemedicine/Telehealth has the potential to eliminate health inequity and health disparities. In the COVID 19 era, I have seen where all the limitations and restrictions in the delivery, compensation/parity, and access to Telehealth/Telemedicine, basically evaporate or “gone with the wind”. I started practicing Telemedicine in 2016, and I thought it was the “Wild, Wild, Wild, Wild” West relative to the startup arm of the marketplace. I have even dappled in Telehealth consulting and was sometimes told I was too negative. Those companies of course eventually collapsed. We must understand in medicine that health care servants (MD, DO, PA, NP and DNP) are the Orcas in the food chain of the Trifecta that is medicine. The Trifecta is revenue cycle management, financial management and last but not least, medicine, the art and the science, which drives the whole space ship of reimbursement, the USS Enterprise.

Relative to Public Health, the validity and necessity for Telehealth/Telemedicine is indispensable in scope and reach, regarding the potential to eliminate health inequity, health disparity and underserved areas/population.