Newsletter #2 for September 2nd, 2021

In the wake of Ida

Thank you for subscribing!  I’m sending this second newsletter out to everyone on the list, as it starts to grow.  The last 3 days have been pretty intense coming back from vacation, catching up on work, installing a new AC system in our house as we continue to repair it after significant water damage a year and half ago, dealing with the new flooding in Philly where I live, tornado warnings cutting into my evening hours with patients Wednesday, the Supreme Court taking a pass on a Texas law restricting abortions… and not to mention the sudden explosion of spotted lantern flies behind the office.  But I digress.  Here we go!

Three Key News Items

* Hurricane Ida.   I hope your home and neighborhood were not affected.  If they were, the Philadelphia Inquirer has a good list of what to do with your home to help recover, prevent and treat mold, etc.  Keep an eye on any water quality advisories from your local water department, as flood runoff is sure to impact drinking water quality in some locations.  I walked down to the Schuylkill River today and it was shocking… and didn't smell good.  Amid all the devastation we can read about, one positive for health is that the storm really cleared out the atmosphere, and air quality is forecast to be excellent for a change.  Airnow.gov is a great resource, especially for people with medical conditions like COPD, heart disease, and asthma. Otherwise it’s all bad news.

* Texas Law Passes, and stands, severely limiting abortions. I won’t get mired in the debate, especially in just the second newsletter, but I will refer to a history professor’s analysis of the legal implications of this Texas law and how it will be enforced with vigilantism, and the American College of OB/GYN’s standing medical position on abortion.

* J & J Boosters. The J&J coronavirus vaccine that many of our patients chose to receive, some in our office, provides good protection against death and hospitalization from the Delta variant, and boosters after 6 months provide 9 times the antibody levels seen after the first shot.  The J&J vaccine will likely join the Pfizer vaccine as the first shots approved as boosters, likely starting in late September, for people who received their last shot 8 months prior.  More details here at NYT.  Here is a preview of how the rollout might take shape in our region. And finally here is good explanation of the nuance, debate, and regulatory hurdles that booster shots face in general, as well as whether mixing different types of shots will be recommended eventually.  Currently, third shots are only advised for people with significant immunosuppressive conditions.

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Medical Journal Watch

 A quick run down of some highlights:

* The benefits of treating high blood pressure to a target systolic reading in the 120’s is associated with more benefits than harms, and is significantly better in terms of preventing stroke, heart attack, and other cardiovascular events.  This range is compared to more lax goals of 140-150’s.

* A large trial showed that coffee consumption is not associated with fast arrhythmias.  I know that I personally get more extra beats (PVC’s) when drinking coffee, so I doubt this will get me drinking more… but other studies have shown benefits of drinking coffee in terms of reducing risks of certain cancers, diabetes, Parkinson’s disease, and overall mortality.  I’ll review more about this in future letters.

* In addition to receiving monoclonal antibody infusions, certain higher risk people with mild stage COVID might benefit from inhaled corticosteroids like Flovent.  The study was not of great quality given the hectic circumstances, but does support another primary care treatment option that might help recovery of lung function during illness.

* The pandemic is taking a psychological toll on all of us.  It’s been rough for children, too.  Globally, 25% of youths have shown elevated depression symptoms, and 20% have shown elevated anxiety symptoms.

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Towards Better Health

Get your tetanus booster every 10 years, or at the time of a skin wound if it has been 5 years or more since your last booster!  I was on vacation last week, and we took a brief trip up to Lake George in New York.  We stopped at Fort Ticonderoga, and among all the historical education the site presents, it also highlights several medically relevant facts of life for the American Revolutionary Army. 

The first was a painting of a soldier suffering from the severe muscle spasms of a late stage tetanus infection, which was often fatal in those times.  Fortunately, practicing in the age of vaccinations, I have never seen a case.

The second was this historical narrative about General Benedict Arnold, who before he became branded as an ignominious traitor for the rest of posterity, did the right thing by his soldiers in the winter of 1776 as they were succumbing to a lethal epidemic of smallpox.  He instituted mandatory inoculations with smallpox, which helped the army reconstitute enough to be a fighting force again.  Inoculation can be thought of as a proto-vaccination sort of technique, and while very risky, overall reduced suffering and mortality from smallpox.  Benjamin Franklin famously lamented that he had deferred getting his 4 year old son inoculated as he succumbed to the wicked disease. 

Click on photo to enlarge, I think! Still learning this platform.

Until the next letter, I wish you well, and thank you for reading.