Unifying theory as of September 2020
September 21st, 2020
Warning - very technical piece. I am attempting to put together a coherent hypothesis as to the pathophysiology of this fascinating disease. However, it explains a lot about risk and lifestyle choices mechanistically. We are learning a lot rapidly. There is no time to waste to reduce your risk and be a part of the 99%.
What do we know or better yet, what do we THINK that we know. This reminds me of the Donald Rumsfeld comment on the known knowns and the known unknowns and so on.
Chemicals are back in the news! Reboot
July 28th, 2020
Are Your Sperm in Trouble? The 2017 NYTimes article reports on human sperm damage from chemical exposure in our environment. What is the story and what chemicals are the trouble makers?
Endocrine disruptors are chemicals that may interfere with the body's endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans and wildlife. EDC's are unfortunately heavily involved in hormonal regulation and metabolism throughout the body.
Sperm Counts Are Dropping
July 28, 2020
Should we be worried that our collective male sperm counts are plummeting? The simple answer is yes. Dropping sperm counts are going to cause lower fertility and less population growth for those that would want to have a family. This is not a United States centric issue as it is pervading western society. According to a Scientific American article from 2017, they write: "Sperm counts in men from America, Europe, Australia and New Zealand have dropped by more than 50 percent in less than 40 years, researchers said on Tuesday. They also said the rate of decline is not slowing.
SPA Covid 19
SPA Covid Plans
July 27th, 2020
Salisbury Pediatric Associates continues to study the data and we are working very hard to provide every patient with the care that they need in the safest possible environment. We remain open and are performing many in office and telemedicine visits to care for children.
Great resources for COVID
July 27th, 2020
First: My good friend Dr. Kathi Kemper has just published a lovely article on the HealthyChildren.org site about Mood boosting for children during the pandemic. Link
Second: Scientific American has done it again. An absolutely amazing pictorial experience regarding the many facets of SARS2 activity in humans. This website is a must visit for all of you. I am really serious. Awesome. Link
Coronavirus Update 15 Quick Hits Data, Data and More Data No Spin
Mother nature's equivalent to coronavirus!
Volume 10, Letter 32.5
July 25, 2020
Latest numbers show that on balance COVID19 incidence is rising rapidly in certain parts of the nation while declining to minimal counts in formerly hard hit areas. The death rate is not tracking as fast as the average age at infection has dropped by over 10 years from the previous months data. The death rate is also likely lower because of effective quarantining of at risk individuals in nursing homes and at home. Urban centers remain the areas with greatest mortality and infectious risk.
July 20th, 2020
Why do we have all this stuff?
Does it fill an emotional need or are we just blind consumers?
May 2018's Scientific American has a fascinating psychological expose answering the question of why we keep stuff or certain objects for a prolonged time. The simple answer distilled by author Francine Russo is that we are trying to fill attachment voids that developed in our childhood years. She discusses a lot of data throughout the course of the article which is beyond the scope of this piece. I encourage you to read the article in its entirety.
This is an OPINION piece - plain and simple.
July 20th, 2020
Obesity and the antecedent nutritional triggers of COVID risk are finally in the literature despite not being covered by the media at large if at all over the past 4 months. I have petitioned friends at media outlets including NPR in Charlotte to take a deep look at why certain subgroups of Americans are dying at higher rates. The response, maddeningly, is that they are too busy to look into it based on current events. As if dying from a 120 nanometer silent killer is not worth learning how to prevent. Everyone sees that media outlets have no problem publishing static risk data about metabolic disease. Why then can we not discuss the WHY? That is a mystery that I cannot solve while I do have my beliefs.
Compounding this reality, I am often mystified that even my colleagues in medicine cynically respond that patients are not going to change so why bother discussing nutrition, sleep, alcohol and other lifestyle mitigating factors as it relates to COVID or anything for that matter.
School and Teachers So, they are going back!
July 20, 2020
Following up on the last two week's articles on schools and COVID, I thought that it would be useful to discuss teachers and risk moving forward. In an effort to not repeat the findings from last week, I will reference last weeks prevention plan for the elderly which mirrors all at risk adults here for those that missed it.
Teachers are about to place themselves into situations where contracting SARS2 becomes increasingly possible although still low risk based on most studies to date with the exception of one cautionary tale, Israel.
July 14th, 2020
Melanoma is the most dangerous form of skin cancer, but it is by far not the most common. It can be found on any part of your body including places that never see the sun. This makes the sun a strange cause for this type of skin cancer as opposed to the other types which mainly occur on sun exposed places and increase in incidence with sun exposure volume and frequency. However, melanoma incidence, epidemiologically, increases with UV radiation exposure, yet also has other etiologies that are still being elucidated. (Arise et. al. 2018)
School If and when they go back?
July 14, 2020
Following up on last week's article on schools and COVID, I thought that it would be useful to discuss risk moving forward. Dr. Koontz and I had a lengthy discussion about the large number of older and elderly who may be placed into harms way as schools return to in class activities. There are many individuals over the age of 65 years who have comorbid conditions and are the primary caregivers for children that will return to school this fall.
While the need to go back to school is clearly of paramount importance for many reasons, there is a potential recipe for trouble for those with risk as COVID19
Coronavirus Update 14 Quick Hits Coronavirus Lose Lose
July 12, 2020
Latest numbers show that on balance COVID19 incidence is rising rapidly in certain parts of the nation while declining to minimal counts in formerly hard hit areas. The death rate is not tracking as fast as the average age at infection has dropped by over 10 years from the previous months data. The death rate is also likely lower because of effective quarantining of at risk individuals in nursing homes and at home. Urban centers remain the areas with greatest mortality and infectious risk. As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.
July 6th, 2020
We should wear masks as the data is good enough to warrant this intervention as the virus rages on.
However, what are the unintended consequences of wearing masks? In a nice piece by Olga Perski in Fast Company, we find four such effects.
1) People are more likely to perceive that they are safe and take on more risky behaviors like an elderly person going to the grocery store and standing within six feet of a person for a prolonged conversation. Assuming that the mask is even donned appropriately the time of exposure to an ill person is a major risk modifier.
School, should they go back?
July 6, 2020
The American Academy of Pediatrics, AAP, has taken the stance that children should return to school this fall. We wholeheartedly agree for the children that we see in clinic and all of the 22 million young Americans that need nourishment of the mind and body. As stated in previous newsletters, COVID19 is a lose lose scenario. There is no winner in a pandemic. Thus, we have to make the best of this net negative experience. The CDC has pegged the infection fatality rate at 0.26% for all Americans and It is highly likely that COVID19 will be with us for years if not forever moving forward. The preponderance of belief is that this virus is a new norm for us as a society.
June 29th, 2020
Here is a great book for parents looking to educate their young children about fear, worry and resolution.
The author Dawn Huebner states in the final chapter:
How to beat the worries?
1) Use LOGIC against worries - this is beyond true.
2) Lock worries up in a strong box in your mind
3) Make worries wait for worry time
4) Tell worries to get lost
5) Move your body to rest your system
6) Relax with a favorite memory
7) Stay strong with your body and mind
This is stage one of a comprehensive plan for a worrier to face one's fears as they grow older and stronger.
Celiac and Chemical Exposure
June 29th, 2020
Celiac disease is a common autoimmune reaction to the ingested proteins in the plant based foods made from wheat, rye and barley. The immune based inflammatory response to the proteins causes disruption of the intestinal lining leading to permeability and malabsorption of nutrients. It is also associated with cancers and other autoimmune conditions over time if not controlled by a gluten free diet. It affects roughly 1% of all Americans.
In a study by Gaylord and colleagues this year, we see a pilot analysis looking at the exposure of children to persistent organic pollutants, POP's, and the risk of developing celiac disease. They found a 2 fold increase in celiac disease incidence when the children had high levels of POP's in their bloodstream.
July 28th, 2020
As more and more schools unfortunately change course towards complete online learning let us not forget the downstream risks likely to occur based on this decision. The AAP, CDC and Dr. Fauci have not recommended in person schooling by accident. The AAP and the CDC have come down hard on being in school. Why? School is the life blood of children's social, emotional and for many nutritional growth. The disparities that currently exist between the well to do and the poor are set to dramatically widen based on this online decision and this sets up a cascade of negativity for these children for their entire lives.
Non Alcoholic Fatty Liver Disease, NAFLD Non Alcoholic Steatohepatitis, NASH
August 3, 2020
2 COMPLETELY AVOIDABLE DISEASES OF CHILDHOOD
When I was in medical school in the early 90's, the primary cause of fatty liver disease in adults was alcohol abuse. Over the last 20 years, the obesity epidemic and associated fatty liver disease, NAFLD, has taken over first place. Unfortunately, this is no longer an adult only phenomena. Akin to type II diabetes mellitus, children are now suffering increasing rates of NASH and then NAFLD. It is now the most common liver disorder in children.
School food - Where did it all go wrong and can we right the ship?
September 14, 2020
We all remember the days of yesteryear when we cued up for the lunch line waiting for our gruel to be served to provide us with some sort of sustenance over the ensuing hours of school and sports or arts. We ate one meal a day at school, lunch. It was a starch, a protein and multiple vegetables and fruits. We ate and we lived. Obesity was rare. Picky eaters seemed rarer. I do not remember a single friend avoiding eating school food or a home packed lunch. We ate breakfast at home and rode the bus to school in our local community. We were not waking up at 4 or 5 am to catch the bus. We were not starving when we entered school after a long bus ride that began too early. What changed? When did school become primarily a source of calories and less about nourishment?
Coronavirus Update 18 A must read article in Medium from Thomas Smith called A supercomputer analyzed COVID 19.
September 6, 2020
Latest numbers show that we have seen massive drop-offs in deaths and cases in all of the formerly hard hit areas. The previously untouched midwest is seeing increased case volume. North Carolina peaked on July 23rd. More than 80% of deaths are skewed toward the over 55 age group and 94% of all deaths occurred in a person with a comorbid chronic health disease. As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.
NC death cases