Ban on pelvic, rectal exams on unconscious, unknowing patients in Pennsylvania

Dateline: November 16, 2023 

Source: Pennlive

A ban on pelvic, prostate and similar exams on unconscious patients who haven’t given permission needs only the signature of Gov. Josh Shapiro to become law.

An official of the Rape, Abuse and Incest National Network said, “Unauthorized pelvic exams are a gross violation of the privacy and autonomy of patients … The solution is as simple as requiring a patient’s informed consent prior to the examination, which will prioritize the patient’s comfort, safety and autonomy.”

The law will require Pennsylvania health providers to receive verbal and written consent to conduct pelvic, rectal, or prostate exams while a patient is under anesthesia. If not followed, the health care provider would be fined $1,000, and the patient is allowed to seek outside monetary damages.

It ss not just Pennsylvania; more and more states are requiring patients to give consent for med students performing intimate exams.

I have always advocated that medical students should practice on each other (it used to be that way). They owe that respect to the patient, can empathize, and it will give them credibility to a patient. I can't tell you how many times providers have told me (and many others reported the same) that these exams are "no big deal." 

No big deal? Then let me stick my finger in you first. All of a sudden that is a big deal. Patients are told such a response is inappropriate, they (martyr) provider is doing it for the patient, or some other gaslighting response. 

It is all about perspective and empathy. One would think that one must have intelligence and critical thinking skills to become a doctor or a nurse. In fact, these people act like some of the dumbest people. Let me demonstrate perspective in the words of President Ronald Regan: 

"Recession is when your neighbor loses his job. Depression is when you lose yours." 

You lost your job, that is sad. I lost my job, it is the end of (MY) the world. I teach people to say in response to a provider saying in response to a patient's fear, concern, refusal of a procedure/exam something like "you don't have anything I have not seen before" or "we do this all the time (so many times a day)..." The patients response should be:

I feel so much better now. You are so intuitive. Most people accuse me of being selfish, but you see that I am concerned about how YOU (the provider) feel about seeing me naked/giving me a rectal exam/etc. As long as you are OK with it. Thank you for nullifying my feelings, marginalizing me as a patient, and dehumanizing me as a person.

Some other things for patients to protect themselves when they request to keep their underwear on for a procedure, same gender care, refusal of chaperones or other voyeurs, refusal of medical student participation, or ANY request to modify a procedure to make it acceptable to the patient:

Simply saying that under the Americans with Disabilities Act (ADA), I am requesting the accommodation of an all male care team (or whatever), and by federal law you MUST be accommodated. You also do NOT have to disclose what your disability is and you do NOT have to prove that you have a disability. Any reasons that providers give to refuse a patient request are either a policy of their facility or a state law. The ADA is a federal law and trumps all else...

Another reason to grant an accommodation is a religious conviction. What if you were muslim (or some other religion) and had deep held religious beliefs about who sees you naked, you would be accommodated. 

Patients should also share their identity as a protected class (gender, orientation, religion, race, etc.), and simply ask for their accommodation based on that. The protected classes under federal law include: 

• age
• ancestry
• color (of skin)
• disability
• ethnicity, gender
• gender identity or expression
• genetic information
• HIV/AIDS status
• military status
• national origin
• pregnancy
• race
• religion
• sex
• sexual orientation
• veteran status

A good tactic is to find out who the facility/provider has their liability/malpractice insurance with (this should be public record if required by the state to be licensed, check with state department of insurance). Then send a notice (letter) to the carrier of potentially filing a claim, complaint, and/or a lawsuit against the provider and institution. Immediately the carrier creates a claim, assigns an adjuster, and begins charging for handling the (potential) claim. This costs the provider and facility money whether or not you pursue a claim and regardless if it is determined by regulators that a violation occurred. 

Read the facility's annual report to find who sits on the board of directors (and who their employers are) and what organizations are capital investors or donate money (endowments). Many of these organizations have Diversity, Equity, and Inclusion (DEI) and environmental, social and corporate governance (ESG) policies and rules in place. 

If a facility has violated the rules by mistreating you as a member of a protected class (especially LGBT or minority), they will initiate an investigation if complaints are filed with them about the facility as a recipient of their benefit. The same with the employer of board members.

Some other sources to file complaints with are the Human Rights Campaign (HRC) if one is in the LGBT+ community, ACLU, and state professional licensing boards. Seek out political organizations. Especially if you are a member of the LGBT community or a racial minority. These organizations will hold protests on their front door for discrimination. Another good group are organizations that fight against sexual assault (women's centers). 

Target these organizations with letters, social media post, online reviews (Yelp), etc. Get friends, family, and others to do the same. This creates a pattern which really throws a big red flag that something is wrong at the facility and with the providers.

eBay

 While I fight for patient dignity, I fight for ALL HUMAN DIGNITY. Today I have a guest writer,  deepgroove1. My friend Melissa has a beautiful custom audio system (vacuum tube amplifier, DAC, cables, and speakers) that deepgroove1 created for her. 

These are deepgroove1's own words about her experiences with eBay. I know from personal experience that eBay is no longer seller friendly. eBay has been described as the epitome of corporate greed. eBay sellers have expressed their discontent on eBay communities. 

eBay has canceled some user accounts for too many returns even when the item is not as the seller describes or pictures it. Then there was the debacle where eBay banned some users by mistake.

Corporations taking advantage of people and unfair trade practices ARE human rights issues. Today, the human rights' violations are caused by oligopolies (watch the video for examples). 

To put this into perspective, here are the top 7 auction sites other than eBay

Now, deepgroove1's guest post:

Back in May, I was permanently removed from eBay for being an abusive buyer

I wrote a letter to eBay, what a joke

I first signed up on eBay in November 1998

eBay id, deepgroove1

Over the years I have sold millions of dollars in product, to schools, manufactures etc

In total I have accumulated maybe 10 negatives; I probably had a total of 10-12 returns over all those years

So, after receiving a few supposed eBay warnings, that looked like the usual spoof emails that I get on a regular basis

Abusive buyer, kind of sounds B-D-S-M

Sadly, eBay threw me out, LIKE I DIDN’T EVEN MATTER for less than 10 items with a total value of less than a $700

The items that I returned were 3 different cell phones that wouldn’t work with my carrier

All the phones had preinstalled software for different carriers which wasn’t disclosed and were not unlocked as described

I returned a pair blue tooth headphones that wouldn’t pair with my laptop and my music server in one channel, several clothing items that didn’t fit, it’s my fault their measurements are off?

So after I was removed, I looked at the language for abusive buyer, it is kind of broad, subjective and no mention of combining account returns, dollar amount, how many returns etc

If I get a response to this it, will probably be some broad apology

Apologies are great when you accidentally eat someone’s Halloween Candy

My Friend's Story of Abuse by Healthcare Providers

My friend finally was to write her story of abuse under the guise of healthcare. She was very much on the fence about letting me post this. I told her that she would only get support. This is what she wrote:

*** WARNING: TRIGGERS ***

This narrative is taking me 4+ months to write due to it being triggering. I am also very embarrassed by telling my story because I am strong and fearless in EVERYTHING except medical encounters. Because most people have not experienced what I have, they have no problems with healthcare, do not believe that my fear is real, and just tell me to “get over it.”

Recently I have come to terms with the fact that I am dealing with PTSD symptoms that I trace back to a February, 2018 event. Let me give you some background: 

When I was 5 or 6 years old, I had an accident with an air rifle that I needed stitches for. I grew up in a rural environment. From a young age, I would take off down to the "back 40" or off into the woods for hours. I also played with things you could not imagine giving to a child today (like an air gun). No helicopter parents like today. When I was injured, I was taken to the local hospital ED. (I could just imagine what the the ED staff thought of such a situation.) 

My mind had blocked the memory of the visit to the emergency department and although I do not remember what happened (I do NOT want to know why happened either), I do know the feelings that I experience with anything medical. 

Through therapy, desensitization, hypnosis, and meditation, I accept SOME things about the experience (that I really do not want to remember); I was forcibly stripped naked and kept that way for the examination and procedure. Some of my abusers were female nurses. 

I wish that I could write more about this event because it is in the top 3 things that have shaped my life. There is a reason that the mind blocked out this event.

My next memory is having to go for my first school physical. I crawled under a library table that we had encyclopedias on, terrified, I grabbed on to the leg for dear life was crying and yelling I did not want to go to the doctor. I was terrified.

After that, a close relative, a physician, took over all my medical care. If I needed a form signed, my parents sent it to him. Infection, he called in an antibiotic. I remember once I needed an immunization and he brought the needle in a cooler when he came to visit. This was all completely normal to my entire family that a child from the age of 6 never went to a doctor for ANYTHING. This lasted into my 40's when he retired. 

This only validated what I believed happened to me. My family never spoke about what happened to me, and I will NEVER ask. I also have somatic feelings in my body whenever I had benign medical encounters (such as a soar throat). 

I am healthy and I also ignored many problems that people would normally go to a doctor for. I have NEVER had a complete physical exam in my whole life (and NEVER will allow one).

My relative diagnosed me with ADHD at age 27. I had to find a doctor to continue my maintenance medication after my relative retired because it was necessary for me to live a somewhat normal life (as much normal as someone with ADHD can have). My first doctor was a very good old school physician. I left him to go with a new, young doctor that was just starting out at a practice of a physician who was an extremely close friend of my father's (a golfing buddy among other things). 

This strategy allowed me more control over this physician due to my father’s relationship with his friend (who also was a board member of the healthcare system). He was promoted to a facility administrator and the patient roster was given to a South Asian physician (who went to medical school in Bangladesh) that the healthcare system brought in. He was horrible; he was good at telling, but not listening. 

There was an issue of English as a second language (ESL). He also did excessive testing and referrals (as if he was paid a commission. He also wanted me to see a psychologist about seeing if I could control the ADHD with therapy alone. I used the visit with the psychologist to get an appointment with a PSYCHIATRIST who concluded that my current regimen (medication) was the best treatment. 

He also diagnosed me wrongly with hypertension (high blood pressure) and prescribed me blood pressure meds (along with all the unnecessary lab work that goes with them). I tried to explain that my BP was in range, that this was just "White Coat Syndrome" caused by my extreme fear of anything medical. He held my ADHD meds (which I needed) over my head to force me to comply with the unneeded BP treatments. 

I had the psychiatrist forward his findings. Six months later, he was pushing me to see the psychologist again (despite what the psychiatrist stated. I realized he did not care about me, just how many referrals that he could generate. He then attempted to cross my boundaries that made me feel safe, so I went back to the old school physician. 

I have always had an intense fear, rising to the level of a phobia with anything medical or dental. I also have an extremely intense fear of needles, so much so that to this day my wife holds my hand for any sticks. I even had a root canal done without novocaine because I feared the needle. I also refuse to undress anything other than my shirt. To undress for anyone for medical purposes feels like a sexual assault to my person. 

I do not ascribe being transgender to this trauma. Being transgender also did NOT precipitate the abuse either. In fact I do not disclose my gender to healthcare providers (NONE OF THEIR DAMN BUSINESS). I present as a cisgender (now) alpha male. (Only my hormone provider and therapist knows my true gender.

 One of my undergrad degrees was a counseling degree. The joke was people become psych majors to work out their own problems first. The two issues that I struggled with in life were my gender and my medical phobia. I was actually fine with my gender, I simply wanted to know what it was called and explore it more. My medical phobia was something that people would say interfered with my life (although I was quite content avoiding ALL medical care. 

My counseling degree has been indispensable in dealing with myself. I eventually found my specific phobias: DSM F40.23 (blood, injection, injury type phobia) and DSM F40.24 (situational type phobia). 

Along with my family normalizing me as a child never going to a doctor, and my feelings of having to undress or anything to do with my genitals (medically) feeling sexual/assaultive, along with my hypersexuality validated my suspicion that I was abused in the ER at age 5.  

This started in grade school, shortly after "the event." My childhood playmate introduced me to sex (I suspect that she was a hypersexual). Ironically I could play at a party with multiple partners, but would refuse to allow a rectal exam by a physician because it would feel like a sexual assault.

In the 2000's, I started self-prescribing my regimen for transition with black market hormones and blockers. No blood work (every 3 months), no invasive physical exams, no needless psycho therapy. I had NO PROBLEMS and started an anxiety free transition. This was only further avoidance.

I had my healthcare situation under control until February 2018 when I contracted an infection causing cellulitis in my finger which did not respond oral antibiotics. My old school doc insisted that I go inpatient for IV antibiotics. I did NOT want to go inpatient. I had NEVER spent a single night in a hospital. IV antibiotic infusion could be done at home with a visiting nurse (even every 8 hours). My doc's concern was getting the  antibiotics started as soon as possible, he wanted me to go through the ED to get them started as soon as possible. 

Against my better judgement, I trusted him. I knew in my gut that I should not go. I did NOT listen to myself.

The 2017-18 flu season was the worst season since since the 2009 flu pandemic. It had an extended period of high activity during January and February (2018) nationally, and remained elevated through the end of March. The hospital has never had their ED so full. I sat in the ED for 12 hours. The IV nurse had gone home sick. 

When I got in to a room, there was no IV nurse available, so my assigned nurse (with his license to practice less than 6 months) attempted to insert the IV line. After (at least) 10 minutes, multiple attempts at 3 different locations (with the same cannula), my wife finally stopped him when he was twisting (probing) the cannula at the elbow point. It was a "fight or flight" moment and I chose to "freeze."

I also felt claustrophobic, the staff denied me to take a shower until my doc approved it. I felt trapped. I asked my doctor to prescribe anti anxiety medication for my stay and for one week after. I was only there for 5 days.

To keep my sanity and regain control over my life, i would regularly take walks outside (off the floor). I even went downstairs to visit a relative who happened to be having surgery the same time that I was there. On the last day, one of those "med cart pushers" sees me coming in from the outside, IV connection hanging off my arm and reported me to the head of the floor. 

I was confronted by the floor head (and her clipboard) an my day nurse. I was told I was not allowed to leave the floor, blah, blah, blah. I was taking back control and said that I am requesting an accommodation under the Americans with Disabilities Act (ADA), that I go outside. 

Both of them did NOT know how to deal with the ADA. The clipboard just rolled her eyes, went back in her office, and just left the nurse standing there with a confused look on her face. 

I got out on a Friday. I was a mess. Saturday morning, February 3, I was suffering PTSD, an emotional hangover, and depression. I had to do an emotional reboot. The most dangerous thing that I could come up with was a solo canoe trip down the frozen Susquehanna River.  

My doctor was also started repeatedly, forcefully  pushing colonoscopy despite my refusals. This made me feel threatened.

After getting out, my doctor was ordering blood tests every 6 months, NOT for anything related to my health, because his EMR (electronic medical records) system was was a poorly designed system and he did not know that he prescribed the previous blood work. 

During one of the draws I had a phlebotomy student and the blood draw went horribly bad. Again my wife stopped her and another senior person had to do the draw. 

I had constant anxiety about the upcoming blood draw. Even when I got my blood taken, later that night I was worried about the next blood draw. I was constantly having:

• Intrusive memories, flashbacks, upsetting dreams about the traumatic event, emotional distress to things that reminded me of the event.
• Avoidance, trying to avoid thinking or talking about what happened, and totally avoiding healthcare.
• Negative changes in thinking, anger at the profession of medicine, feeling detached, lack of interest in activities once enjoyed and feeling emotionally numb.
• Arousal symptoms, aways being on guard around anything medical, self-destructive behaviors, trouble sleeping and concentrating (due to intrusive thoughts), guilt and shame.

I have told my doctor all of this, even wrote it out on paper and handed it to him. NEVER any discussion about possible PTSD, it never made it into my medical records, no apologies for what happened to me, and he continued pushing colonoscopy. 

My doctor is actually a very good doctor. He is old school. He is very good with physical ailments and injuries. I TRUST his therapy recommendations and I TRUST him. (I just need to decide what is best for me.) Like all other providers, he believes that acceptable healthcare practices can NEVER be traumatic as long as one wears a magic stethoscope or magic white coat.

Prior to 2018, I was doing cognitive behavior therapy (CBT) to desensitize my self to everything medical and deal with my phobia. I was shamed and bullied by everybody (but especially by those who worked in healthcare) because THEY had no problem going to the doctor, so they could NOT understand how I could have problems.

The events of 2018 undid any advances that I made with CBT therapy. Even worse, the inpatient IV infusion VALIDATED the fears and beliefs that my phobia sparked. It was no longer an irrational fear; it has been validated and rationalized. 

I took control of my life back. 

After the 2018 events, I started flushing my BP meds. I told my doc that and gave him a journal of my daily BP taken by my wife showing a normal BP and proving White Coat Syndrome. Since I was no longer on BP meds, blood work was no longer required. 

In 2019, I took my "doctor's orders" for blood work and threw it away. The next visit, he asked about the blood work and was going to order it again. I put my foot down and told him about the anxiety I had surrounding it, so I was no longer doing blood work. I also told him that also due to the anxiety, I was no longer doing ANY preventative care. The only thing required for my ADHD meds was to monitor BP. 

In 2019, my best friend (and my medical hero because she is not afraid of ANYTHING medical) began encouraging and supporting me to take better care of my health by doing preventative care. Most recently she has been trying to get me to do regular blood work and a colonoscopy. 

I agreed to do these things for her. Within one month, she went through two of my ultimate nightmare medical procedures. I do need to be in the right state of mind. Right now, I am fragile, and if one of these goes bad, I will walk away from ALL healthcare forever. 

I can die with dignity, but I can NOT live without it.

In my 20's, I did something stupid and was facing sure death. I went through all the stages of grief. I finally accepted the inevitable. I closed my eyes resolved that I would never open them again. Shortly after, a knock on the window. I was saved. When you accept your death, it changes your thinking FOREVER. I no longer FEAR death. (Note: I do not want to die and do NOT "idealize" suicide.) (Emotional) threats of dying from fear of colon cancer have no effect on my decision making.

2020 was the worst year of my life. The pandemic hit and the psychological harms with isolation came with it. My 28 year old friend (and sub) was found dead in a motel room in New Jersey. (As of writing this, the corner has not released a cause of death.) She was board because we could no longer go clubbing in NJ and NYC. She fell in with the wrong crowd who continued to "party."

 I also came out to my family. My parents took it the hardest. They were emotionally abusive and threatened financial abuse. (I am going to enjoy the day that I put them in a home.) We have since began to reconcile. My tech company that I built from scratch in 2010 died. Due to regulatory issues (on the part of my biggest client), my contract was not being renewed. I had to spin up the staffing company that I started in 2019. Being in this industry over 20 years, I know that a deal lasts ONLY 2-5 years. 

I started doing a support group in order to begin dealing with the anxiety. During one of the support group sessions, the psychologist who moderated the group bluntly said to me, "You are exhibiting symptoms of PTSD, have you thought about doing therapy (specifically) for PTSD?" I knew that he was right. A month later I emailed him and asked, how do we start?

I use to deal with my problems by avoidance and crushing the feelings and memories down to a little pea and throwing the pea in that closed in the back of my head. All the stressors that I had to deal with in 2020 was like the cartoon where the character is trying to plug the leaking dike. Eventually all his fingers, nose, and toes are plugging holes and new holes continue to appear.

Up until 2020, my strategy to deal with my anxiety and PTSD was working fine. I had too much stuff to deal with and the symptoms of PTSD began to show. Even worse, what was (I was being convinced was) an IRRATIONAL FEAR was VALIDATED. Treatments for phobias will no longer work. 

What causes PTSD is the loss of control that people experience during traumatic events. This "soft" trauma (not remembering exactly what happened to me at age 5) caused my phobia. If you look at the symptoms and causes of phobias and PTSD, they are almost IDENTICAL. The real difference between the two is the intensity (of the trauma and the response to the trauma). 

In ALL other aspects of my life I am fearless, actually a thrill seeker. When it comes to anything medical, I fall apart and become a real mess. I have compartmentalized my PTSD only to anything dealing with healthcare or medical related. My wife and best friend know me as a strong person (physically, emotionally, and mentally). They feel safe when I am around, and this is the person they got to know and love. (I am sure that many others feel the same about me.)

My best friend convinced to have a real provider involved with my hormone regimen. I agreed. I invoked the Americans with Disabilities Act (ADA), requesting the accommodation that I do not do bloodwork. All the centers and practices that I contacted did NOT even bother to respond back, except one. 

She went with me to my first appointment (and will go to subsequent appointments) with me. A nurse came in and thought he was going to do a blood draw (standard operating procedure). He was aggressive, TELLING me what he was going to do and kept pushing it despite my refusals.

I felt threatened, was frightened, but then I chose to FIGHT. With clenched fists, stood up and YELLED ant him my refusal. The nurse practitioner came in and did the usual listening to heart and lungs, BP, and we talked (history). The only requirement for the prescribing was her to palpate (feel) my liver to make sure that it was not enlarged. 

At this point, for the "exam," I broke down and was a mess. My best friend saw the mess in the lead up to the appointment. She did not recognize me as the person that she knows. She could not believe the fear and anxiety. She does NOT like that weak person. 

So many people don't understand how I can be afraid of doctors when THEY (themselves) have no problems with doctors. I was CONDITIONED at age 5 to fear the profession of medicine. What happened to me at the age of 5 was the equivalent to a gang rape. The worst part was that it was (and to some extent still is) an acceptable medical practice. 

Let me demonstrate another acceptable medical practice, read this:

WHY DOES THIS HAPPEN STILL IN 2021?

Look at the responses nurses give to a similar situation:

When I first started in the ICU, I was pretty bad at IVs so common advice I got from other nurses was to try on sedated, vented patients LOL. So I can see why the nurse asked you guys to try.

This is exactly the attitudes that allowed me to be abused (twice by doctors and nurses.

In 2013 I met Archie Banterings, a patient advocate from Philadelphia. He taught me how to advocate for myself in healthcare. He showed me how to use the ADA to get the healthcare that I want and deserve. 

I hate that when I say that I am not doing preventative care and that I avoid healthcare that all I get is shaming and bullying. Some people are more understanding when I say that I am an abuse survivor. All that does is REVICTIMIZE  and RETRAUMATIZE me. 

Why do I have to disclose this? Is it NOT my body and do I NOT have the right to live my life my way? Am I not the customer when I consume healthcare and do I NOT have the right to choose the healthcare that I want?

Many people refuse to disclose that they are survivors to avoid revictimazation. As I have dealt with the other "holes in my dike" I am seriously considering quitting therapy and going back to crushing trauma down to a pea, TOTALLY avoiding healthcare, and lying that I am receiving healthcare. 

I wore as a badge of honor the fact that I never stayed in a hospital overnight and I never had psychotherapy. My doctor talked me into it and I trusted him. I feel like the girl talked into giving up her virginity to a guy that says "trust me," "I love you," "I want to be with you," etc.; and he "dumps" her shortly after. 

It is not outright rape, but I feel that I was cheated, not listened to, and just hurt. Adding insult to injury, NO ONE ever apologized for what happened to me. Something was taken away from me and nobody in the (so called) compassionate, altruistic profession of medicine even cares.

The pain was so bad that I gave in to the recommendation of doing therapy. I feel weak, like a failure, guilt, pain, and shame over doing therapy. I worry that I am receiving care in place of someone who really needs it. Again, this was taken away from me. 

I want a female to hold me while for a whole night while I just cry and get these bad feelings out of my system. 

The women closest to me that would support me in this, I cannot ask ask them because they know me as nothing but strong. I hold them when they cry. I would be a complete stranger to them. They also do not tolerate poor-me, whiney people and I am afraid that they will see me that way. 

I have asked my best friend NOT to read this. I am ashamed that I feel this way.

Having worked with people who have been severely abused, I feel that I have not been "abused enough" to have PTSD. This is probably from being gaslighted by so many people.

I got through most of what happened to me and where I am at. I got through this finally. It has triggered me, but it is done.

I have an extremely high tolerance for pain. (Try having your nipples pierced.) It is not about the pain, it is about the control that was taken away from me. Sure I can do blood draws, even if painful. That is not the point, it is that as long as the profession of medicine pushes these, I will REFUSE. I am in control of my life and body (again). This is about survival for me.

Update 2021-04-26: I have also made advances in my therapy for my medical PTSD and medical phobias. I am logically ready to do blood work, but the hurt, fear, and anger are holding me back. They make me afraid to heal and be strong again. (Ironic...) 

Thank you for reading. 

 

 

My COVID Cocktail

 DISCLAIMER: While my circle of friends take this cocktail (or a form of it), I am not recommending it for anyone. I am simply stating what I am taking with supporting material (some anecdotal) of why I believe it is effective. (See additional disclaimer below.)

My assertions are based on my personal research and that of intellectual, trusted individuals known to me and where I have witnessed the effects of their therapeutics that I describe here. I attempt to validate all of them, but there are a couple that I am unable to do for obvious reasons. The most prevalent is the use of nicotine (something that I have never done). 

What I assert will offend many people, but that is the purpose of science and debate. There was a time that it was believed that the Earth was flat and to assert anything else was heresy punishable by death (in some cases). 

This blog acts as a record of my research. As the political climate changes because people are sick and tired of the lies, coverups, denial, endless lockdowns, vaccine mandates, and the rest of the bulls**t, the truth will come out. 

This attitude is further spurred on by the current administration destroying every aspect of American life. Most Americans have completely lost trust in many institutions, including the pharmaceutical industry, government, public health, healthcare, and justice. 

The good that I see is that as those in power now being voted out of that power, the new legislators will enact laws that leash the pharmaceutical industry, public health, and the healthcare industry to protect patients' human rights and bodily autonomy, and put patients back in control.

Update: 2021-08-12 

In my mind, COVID-19 is over. I do not know how many more updates that I will do. All my assertions made over the last 2 years are now being proven true. 

The group includes experts: a nurse working the front lines of NY Presbyterian in Queens, a nurse working in long term care facilities near Baltimore, a virologist at a major academic research institution in Philadelphia, and a safety specialist (industrial, healthcare, laboratory, etc.), along with myself. There have been other minor contributors as well. (Update 2022-07-29) An engineer in senior management of one of the largest healthcare systems (based in the greater Philadelphia area) has began contributing. 

Please note that the contributors are NOT suppose to disclose information because of employment, codes of conduct, nondisclosure agreements, etc. They have the courage to contribute to (hopefully) help others.   

This is my complete cocktail for SARS-CoV-2 prophylaxis:

• hydroxychloroquine (or quinine)
• zinc sulfate
• vitamin C
• vitamin D
• quercetin
• antiandrogens (testosterone blockers) spironolactone, cyproterone acetate
• estrogen
• progesterone
• Lion's Mane mushroom (hericium erinaceus)
• nicotine (I have not tried & not sure if this should be part of the cocktail) 

Reference: https://www.medpagetoday.com/casestudies/infectiousdisease/87976

Reference: https://consultqd.clevelandclinic.org/covid-19-and-supplements-what-we-know-now/

Reference: https://clinicaltrials.gov/ct2/show/NCT04335084

There is a lot of politicizing of HCQ, friends working the front lines of NY Presbyterian in Queens swear by it. The physicians there say Fauci is wrong. Here are some additional info:

https://pubmed.ncbi.nlm.nih.gov/21221847/

https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwaa093/5847586

Since I can't get HCQ, I take quinine (which HCQ was brought on the market to replace). Both have similar effects on the human body.

https://pubmed.ncbi.nlm.nih.gov/21221847/

https://blogs.sciencemag.org/pipeline/archives/2020/03/20/chloroquine-past-and-present

Update 2024-01-05: 

• Quinine Inhibits Infection of Human Cell Lines with SARS-CoV-2  https://pubmed.ncbi.nlm.nih.gov/33918670/
• Hydroxychloroquine was found to be more potent than chloroquine to inhibit SARS-CoV-2 in vitro. https://pubmed.ncbi.nlm.nih.gov/32150618/
• chloroquine and hydroxychloroquine are effective for the treatment of COVID-19 among hospitalized adults https://pubmed.ncbi.nlm.nih.gov/37906618/
• HCQ has small but significant in vivo antiviral effects that are able to reduce SARS-CoV-2 transmissibility https://pubmed.ncbi.nlm.nih.gov/37218196/

Zinc for prophylaxis of COVID-19. It plays an important role in inflammatory response, and a deficiency could result in an increased risk of infection and disease, including pneumonia. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247509/ 

Update 2021-06-17: A new study published by medRxiv found that hydroxychloroquine, when paired with zinc, could increase the coronavirus survival rate by nearly 200% in ventilated patients who have a severe version of COVID-19.

"We found that when the cumulative doses of two drugs, HCQ and AZM, were above a certain level, patients had a survival rate 2.9 times the other patients," the study’s conclusion reads.

Source : https://www.medrxiv.org/content/10.1101/2021.05.28.21258012v1

You have to take this as a cocktail. While some individual components may help, the total is more than the sum of the parts.

I have also added vitamin D. It has been used in the prevention or treatment of acute respiratory infections since the 1930s.

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext

Having low serum vitamin D levels was an independent risk factor for having symptomatic COVID-19 with respiratory distress requiring admission to intensive care – as opposed to having mild COVID-19 – and for not surviving, in a new study from Italy.

https://www.mdedge.com/endocrinology/article/228779/coronavirus-updates/low-vitamin-d-covid-19-predicts-icu-admission-poor

Update 2020-09-24 (Vitamin D)

The first randomized controlled trial (RCT) of vitamin D in COVID-19 has just been published. The results are astounding: vitamin D nearly abolished the odds of requiring treatment in ICU. Although the number of deaths was too small to say for sure, vitamin D may actually abolish the risk of death from COVID-19.

https://chrismasterjohnphd.com/covid-19/finally-confirmed-vitamin-d-nearly-abolishes-icu-risk-in-covid-19

Update 2020-12-14 (Vitamin D)

Vitamin D deficiency on admission to hospital was associated with a 3.7-fold increase in the odds of dying from COVID-19, according to an observational study looking back at data from the first wave of the pandemic.

The recommendation to providers is to consider vitamin D to prevent COVID-19 infection.

Nearly 60% of patients with COVID-19 were vitamin D deficient upon hospitalization, with men in the advanced stages of COVID-19 pneumonia showing the greatest deficit. 

Also note in this article that men are being hit harder (see below).

Source: https://www.mdedge.com/hematology-oncology/article/233376/coronavirus-updates/vitamin-d-deficiency-covid-19-quadrupled

So why does COVID-19 respond to antifungal approaches (Zn, Vit D3, hydroxychloroquine, and others, more effective than antiviral approaches?

We need to ask what role did genetic fusion play in COVID-19? Several years ago, Wuhan Virologists entered a bat cave to collect fecal samples from bats. They would have undoubtedly stirred up the soil within the caves. 

Histoplasma capsulatum, a dimorphic fungus that causes Histoplasmosis, is found in contaminated soil in bat caves. These scientists may have (speculation) inadvertently carried Histo out on their clothing, shoes, etc. Once they entered that Virology lab, nucleic acids could have easily fused; DNA from Histo and RNA from COVID. The new hybrid organism may arguably respond to antifungal approaches. The symptoms of Histoplasmosis and COVID-19 are nearly identical and the incubation periods are identical. 

https://www.independentsciencenews.org/commentaries/a-proposed-origin-for-sars-cov-2-and-the-covid-19-pandemic/

I just recently added the flavonoid Quercetin which works in conjunction with Vitamin C. Guidance from Eastern Virginia Medical School in Norfolk, Virginia, written by Paul E. Marik, MD, chief of pulmonary and critical care medicine there. Marik included quercetin in the institution's COVID-19 management protocol for prophylaxis and mild to moderate cases.

https://www.frontiersin.org/articles/10.3389/fimmu.2020.01451/full

Update: 2020-08-12 (Quercetin)

Quercetin helps get zinc into the cells. It is a "zinc ionophore". (which is why hydroxycloroquine helped so inconsistently, perhaps when given with zinc, because it also helps get zinc into the cells). Zinc is know to interfere with the coronavirusls ability to replicate.

In cell cultures, quercetin has been shown to prevent viral entry and reduce the cytopathic effects of many viruses, including rhinovirus and poliovirus. 

Source: https://www.medpagetoday.com/infectiousdisease/covid19/87373

After the 2003 SARS-CoV-1 coronavirus [original SARS] outbreak, researchers in China found quercetin and other small molecules bound to the spike protein of the virus, interfering with its ability to infect host cells.

Source: https://pubmed.ncbi.nlm.nih.gov/15452254/

COVID-19 has been tied to acceleration of Alzheimer's pathology. Certain plasma biomarkers of neuronal damage and neuroinflammation are markedly elevated in hospitalized COVID-19 patients with neurologic symptoms compared to hospitalized COVID-19 patients without such symptoms. These results suggest COVID-19 may accelerate Alzheimer's disease (AD) symptoms and pathology.

Source: https://www.medscape.com/viewarticle/955755

Flavonoids show great potential in reducing inflammation and oxidative stress in the body. They are also vasodilators that help improve blood flow, which is important for the cardiovascular and cerebrovascular systems.

Source: https://www.mdedge.com/neurology/article/244147/alzheimers-cognition/flavonoids-dietary-powerhouses-cognitive-decline

COVID-19 has been linked to Alzheimer's disease. Flavonoids prevent cognitive decline and may be an effective defense against Alzheimer's disease. Thus, one might conclude that flavonoids would fight the same mechanisms that COVID-19 shares with Alzheimer's disease.

Here are some more prophylaxis that I am not doing (but I know others who are doing with positive results). 

A nurse friend in Harrisburg is on birth control (taking both estrogen and progesterone). She also smokes (more on that later). She had COVID patients cough in her face back in March (prior to the PPE requirements).  

I have transgender friends taking testosterone blockers, estrogen, and progesterone. None that I know, have contracted COVID-19.

Friends working the front lines of NY Presbyterian in Queens also noted that they had all men in their specific wards.

https://academic.oup.com/endo/article/161/9/bqaa127/5879027

Men are more likely to suffer from severe COVID-19 than women, scientists suspect that the hormone estrogen may have a protective effect against COVID-19.

https://covid.joinzoe.com/post/covid-estrogen-hrt

https://www.healio.com/news/endocrinology/20200501/study-investigates-estrogen-patch-use-to-lessen-covid19-complications

https://pubmed.ncbi.nlm.nih.gov/32324533/

https://www.cuimc.columbia.edu/news/lowering-testosterone-may-reduce-severity-covid-19

Update 2021-03-12: (Testosterone May Contribute to More Severe COVID-19 Disease)

Study of airway smooth muscle cells show differences in ACE2 expression in men and women. (Source: https://www.newswise.com/coronavirus/testosterone-may-contribute-to-more-severe-covid-19-disease/?article_id=742709 )

Progesterone has anti-inflammatory properties. There is a significant amount of data in clinical literature on how progesterone affects immune response. Progesterone has some of these anti-inflammatory properties, could dampen the cytokine storm (body’s overactive immune response).

https://www.healio.com/news/endocrinology/20200507/study-examines-progesterone-to-reduce-inflammation-in-covid19

https://clinicaltrials.gov/ct2/show/NCT04365127

Update 2021-03-19: (Progesterone Therapy May Improve COVID-19 Outcomes for Men)

Clinical trial at Cedars-Sinai suggests injections of progesterone may reduce disease severity in male patients.

https://www.cedars-sinai.org/newsroom/study-progesterone-therapy-might-improve-covid-19-outcomes-for-men/

Update 2021-11-10: Testosterone, estrogen, progesterone, and nicotine 

Testosterone may be linked to myocarditis in young males from the mRNA vaccines. 

One theory is that the spike protein itself could be to blame, as it has some similarities to heart muscle proteins. Neutralizing antibodies created in response to vaccination may start attacking those heart proteins.

Another theory is that since myocarditis occurs more frequently among younger males, researchers have also speculated that testosterone may also play a role, given that young men have higher levels of the hormone. It could heighten an inflammatory response. This could support the reason that the actual virus hits men harder; something about te presence of testosterone. 

https://www.wsj.com/articles/researchers-probe-link-between-covid-19-vaccines-and-myocarditis-11636290002

Nicotine may bind with the ACE2 receptor, particularly in people with COVID-19, and thus could interfere with further SARS-CoV-2-ACE2 binding. The best delivery system is the patch because smoking may damage the lungs and counter the effects of nicotine.

https://www.cebm.net/covid-19/nicotine-replacement-therapy/

https://conscienhealth.org/2020/06/the-odd-case-of-tobacco-nicotine-and-covid-19/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192087/

https://www.theguardian.com/world/2020/apr/22/french-study-suggests-smokers-at-lower-risk-of-getting-coronavirus

Note that the references are those of accepted research/academic journals, institutions, and healthcare systems. These are NOT fringe sources.

Not myself and none of my friends who are taking any of these prophylaxes have had symptoms or tested positive for COVID-19.

This issue has been politicized, without a doubt. That is most evident than with scientists and physicians opining on the pandemic and protests. (Reference: https://www.axios.com/black-lives-matter-protests-coronavirus-science-15acc619-633d-47c2-9c76-df91f826a73c.html)

This has happened before, the politicization of an outbreak. Fauci let 30,534 HIV patients die in the 1980's because he refused to issue interim guidelines urging doctors to prophylax patients deemed at high risk for pneumocystis pneumonia. (Reference: https://www.poz.com/blog/the-long-road-to-pcp)

Update 2021-06-17: (Fauci)

Again Fauci's hand has caused the needless death of Americans, this time 100,000 of them.

"This irresponsibility has further undermined the credibility of the crowd of experts we once trusted. Even worse, if this latest study is right and hydroxychloroquine can actually make a difference, their negligence may have also cost people their lives. There’s nothing silly about that."

Source: https://www.msn.com/en-us/health/medical/hydroxychloroquine-study-further-erodes-credibility-of-health-experts/ar-AAKWXYw

I will address the use of masks. The CDC should follow their own science in that masks do not work to prevent the spread of viral illnesses.

In our systematic review, we identified 10 RCTs that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks (RR 0.78, 95% CI 0.51–1.20; I2 = 30%, p = 0.25) (Figure 2). Source: https://wwwnc.cdc.gov/eid/article/26/5/19-0994_article

Plain and simple; masks do NOTHING. The implementation of the mask mandate is so that the population thinks that state and local government is doing SOMETHING to protect the citizens. They are relatively benign (no one foresaw the psychological impact), inexpensive, and easy to implement. 

According to the New England Journal of Medicine, masks  are a talisman (a rabbit's foot), and NOT scientific. Masks create confidence in something that has no scientific basis.

We know that wearing a mask outside health care facilities offers little, if any, protection from infection... It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. Source: https://www.nejm.org/doi/full/10.1056/nejmp2006372

Update: 2020-08-12 (Red blood cells)

COVID-19 attacks the red blood cells. Here is the scientific explanation:

(Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267810/)

An Italian pharmacology scholar has claimed that COVID-19 damages the hemoglobin, thus impairing the ability of red blood cells to transport oxygen throughout the body, affecting the lungs and leading to Acute Respiratory Distress Syndrome (ARDS). This research also explains why hydroxychloroquine is effective against COVID-19 (in protecting the red blood cells). (Reference: https://www.hospimedica.com/covid-19/articles/294782164/researcher-claims-covid-19-damages-hemoglobin-and-hydroxychloroquine-promises-coronavirus-immunity.html)

As stated before, COVID-19 hits men harder. A study published on May 10 reported that men men have higher concentrations of angiotensin-converting enzyme 2 (ACE2) in their blood than women. (Reference: https://www.healthline.com/health-news/men-more-susceptible-to-serious-covid-19-illnesses#Enzymes-and-immune-systems) 

COVID-19 seems to hit black men and Asian men harder. My friend on the front line of NY Presbyterian had ONLY black men and Asian men in her ward. She also noticed this in Long Island. So why black and Asian men?

Black men carry the genetic trait that causes sickle cell, a red blood cell disease that could put black men at greater risk from COVID-19. (Reference: https://www.startribune.com/unitedhealth-group-studies-covid-19-risks-with-sickle-cell/572054442/) Previous studies have shown that influenza severity and hospitalization rates are higher among persons with sickle cell than those without.  (Reference: https://wwwnc.cdc.gov/eid/article/26/10/20-2792_article) 

In sickle cell disease (SCD), the hemoglobin is abnormal, causing the red blood cells to be rigid and shaped like a "C" or sickle. Sickle cells can get stuck and block blood flow, causing pain and infections. Complications of sickle cell disease occur because the sickled cells block blood flow to specific organs.

There are milder forms that might not exhibit symptoms of SCD, where the hemoglobin is "wrinkled," but will put the person at greater risk to COVID-19  (Reference: https://www.cdc.gov/ncbddd/sicklecell/facts.html)

Thalassemia is another genetic disorder (like SCD) caused by errors in the genes for hemoglobin, a substance composed of a protein ("globin") plus an iron molecule ("heme") that is responsible for carrying oxygen within the red blood cell. (Reference: https://www.hematology.org/about/history/50-years/sickle-cell-disease-thalassemia)

(South) Asian men are especially prone to thalassemia. (Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437604/)

Further proof that COVID-19 attacks red blood cells comes from a March 2020 French warning against the use of ibuprofen in patients with COVID-19 symptoms. (Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287029/)

Among ibuprofen's rarer side effects, are some that specifically affect red blood cells, thus explaining why ibuprofen worsens COVID-19. (Reference: https://www.webmd.com/drugs/2/drug-6143-368/advil-oral/ibuprofen-chewable-oral/details/list-sideeffects)

Update: 2021-07-01 (Sickle Cell)

Sickle Cell Comorbidities Increase Risk for Worse COVID Outcomes (Reference: https://www.medpagetoday.com/hematologyoncology/hematology/93384) This furthers my findings that COVID-19 is a disease that attacks red blood cells.

Update: 2021-07-20 (Sickle Cell)

Given the established susceptibility to other viral infections and the ethnic “patterning” of sickle cell disorders, affected persons may have increased risks for severe COVID-19. Evidence about COVID-19 risks in sickle cell disorders mostly derives from studies of hospitalized persons or selective registries...

...analysis estimated a 4-fold increased risk for COVID-19–related hospitalization and a 2.6-fold increased risk for COVID-19–related death for sickle cell disease. Sickle cell trait was also associated with increased risks for both outcomes, albeit to a lesser extent. Several aspects of sickle cell phenotypes overlap with the pathophysiology of severe COVID-19, which could be relevant mechanisms worthy of further study, as should the directionality of infection and sickle crisis.

(Reference: https://www.acpjournals.org/doi/10.7326/M21-1375)

Update: 2021-08-12 (Blood Cancers and COVID)

I am not sure of the relevance of this yet, but there is a connection; Patients with certain blood cancers may be at risk for breakthrough COVID-19 infections.

Approximately one-quarter of patients with hematologic malignancies did not produce measurable antibodies after two doses of COVID-19 vaccines, according to a study from The Leukemia & Lymphoma Society published in Cancer Cell.

Precious research shows that the SARS-CoV-2 virus attacks red blood cells and red blood cells stricken with certain conditions (such as sickle cell) are more vulnerable to COVID. Perhaps the cancers make vaccinated people more susceptible to COVID. 

(Source: https://www.healio.com/news/hematology-oncology/20210810/patients-with-certain-blood-cancers-may-be-at-risk-for-breakthrough-covid19-infections)

Update: 2021-08-12 (Hericium erinaceus (HE) mushrooms)

I came across this academic article on the use of sulforaphane and astragalus COVID-19. What I found most interesting is that it supports many other assertions here such as Quercetin.

https://pubmed.ncbi.nlm.nih.gov/33607929/  

Update: 2022-07-29 (Lion's Mane mushroom)

A friend that is an engineer with a strong chemistry background made me aware of the following: Hericium erinaceus (HE) also called Lion's Mane mushrooms have prophylactic and therapeutic effect against SARS-CoV-2 and its pneumonic superinfection and complicating inflammation.

Source: https://pubmed.ncbi.nlm.nih.gov/32657436/

Even mild SARS-CoV-2 infection can cause multi-lineage cellular dysregulation and myelin loss in the brain. 

Source: https://pubmed.ncbi.nlm.nih.gov/35043113

With a long history of usage in Traditional Chinese Medicine, Lion’s Mane mushroom is famous for its neuroprotective properties and ability to support memory, clarity, focus, nerve health, and mood. In fact, the mushroom’s reputation for cognitive health has even earned it the nickname, the “smart” mushroom.

Lion’s Mane is rich in β-glucan polysaccharides as well as the active nootropic compounds erinacines and hericenones, are directly related to the mushroom’s ability to stimulate the growth of brain cells. Erinacines are low-molecular weight compounds that easily cross the blood–brain barrier to synthesize brain cell growth and support brain plasticity, which affects memory and new learning. Research has also shown that Lion’s Mane Mushroom may help to accelerate nerve regeneration. 

Source: https://ommushrooms.com/blogs/blog/how-does-lions-main-mushroom-help-the-brain

Additional source: https://www.healthline.com/nutrition/lions-mane-mushroom

This essentially helps the brain rewire itself. As a trauma survivor, the benefit that Lion's Mane mushroom aids in memory reconsolidation (which makes overcoming trauma possible) caught my attention.  Overcoming trauma can be accomplished by rewriting memories and rewiring the brain. 

Source: https://traumafocusedtherapy.com/memory-reconsolidation-how-rewriting-your-memories-is-a-game-changer-for-ptsd-relief

It is known that the human brain can rewire itself after a traumatic bodily injury. This is part of the brain’s (neuro) plasticity—the ability for the brain to adapt to changing conditions—such as when a traumatic bodily (brain) injury occurs.

Source: https://www.futurity.org/traumatic-injury-brains-2202932-2/

Neuroplasticity can be viewed as a general umbrella term that refers to the brain’s ability to modify, change, and adapt both structure and function throughout life and in response to experience.  This includes healing from mental trauma. 

Source: https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01657/full

I am officially adding Lion's Mane mushrooms to the cocktail.

One item not related to Lion's Mane mushrooms: I have covered how female hormones (estrogen and progesterone) protect against SARS-CoV-2 and male hormones (testosterone) increases susceptibility. I did not say the obvious, which is reducing testosterone reduce susceptibility. 

Studies conclude that antiandrogens (spironolactone, cyproterone acetate) may reduce susceptibility to SARS-CoV-2 infection. While the results are not definitive, research into the use of antiandrogens against SARS-CoV-2 are still continuing.

Source: https://www.frontiersin.org/articles/10.3389/fmed.2021.629176/full

Additional Source: https://pubmed.ncbi.nlm.nih.gov/33477294

Update: 2023-01-05 

I was against the COVID vaccines for myself because of questions that I had about safety and efficacy. Now we are finding out the truth about the vaccines, especially the mRNA vaccines:

• the more COVID vaccines (boosters), the more COVID infections one gets (ref: https://www.youtube.com/watch?app=desktop&v=Rh7I7fKmzT0&feature=youtu.be)
• The mRNA COVID vaccine was approved without proof of safety or effectiveness
• mRNA vaccines pose a danger to the organs (ref: https://www.linkedin.com/pulse/mrna-vaccines-dangers-caner-demir)

Much, much more is coming out.

Thank you, please share, and apologies...

I would like to thank you for taking the time to read what my personnel research has yielded. Please share those who are critical thinkers, have an open mind, are interested in views that may not be mainstream (today), or look at plausible theories. 

Many of the therapeutics that I examine, when taken in the traditional doses, tend to have mild side effects to most people (unless they have some susceptibility or specific condition),  and have been used for a long time (some dating back to ancient times). Some others (that are more regulated) have more profound side effects (such as cross hormonal therapy).

I apologize that the information is not in a more logical order. This post was started as a response to the abysmal failures by government, public health, healthcare providers, and the healthcare industry. As research became available and brave people spoke against the mainstream propaganda pushed by special interests. 

One day (and with the help of someone with better writing skills than I), I hope to rewrite this in a more logical and academic manner. Perhaps, my nomination for a Nobel Prize ( #nobelprize ) may force me to do this. 

I apologize for my grammar, spelling, punctuation, sentence structure, consistency of form, etc. My brain is more of the mathematical/scientific than grammatical/linguistic. 

I apologize for any links that are broken and any information that is removed, cancelled, censored, called into question, or proven wrong.

Feel free to laugh at me and my research, ignore it, etc. I am always open to a robust, well thought out debate. You can even compliment me. Please do this in a way that is respectful of the human dignity that we all have. (You can even, nominate me for a #nobelprize. Just saying...)

I hate that I have to say this (despite the fact that no one reads what I write), but...

DISCLAIMER: THIS BLOG (WEBSITE) DOES NOT PROVIDE MEDICAL ADVICE

 The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. This is not an attempt to practice medicine. The content is provided for reference and educational purposes only. The content is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website. Nothing here has been peer reviewed. In fact, I may be insane and not even know it, so do not make decisions based on what I write. 

Why Patients Dislike Rectal Exams

I came across the following article on the National Institutes of Health's PubMed website: Masculinity and the Body: How African-American and White Men Experience Cancer Screening Exams Involving the Rectum

These are the authors:

• Julie A. Winterich, Ph.D.,
• Sara A Quandt, Ph.D.
• Joseph G. Grzywacz, Ph.D.
• Peter E. Clark, M.D.
• David P. Miller, M.D.
• Joshua Acuña, B.A.
• Thomas A. Arcury, Ph.D.

The purpose was :

"Much of the research on prostate and colorectal cancer beliefs, knowledge, and screening finds that barriers to screening include African-American men’s perceptions that DREs are “embarrassing” and colonoscopies are “offensive,” but none of this literature investigates WHY men report these attitudes."

My first reaction was that that of disbelief. These are well educated people, how could they lack such common sense? But this is the paternalistic problem that medicine has; that just because someone wears a magic white coat or a magic stethoscope, the patient should readily accept what ever indulgences the provider has (no matter how invasive).

Then I looked at this scientifically. The first thing that struck me is the "why." One of my undergrad degrees is a counseling degree. We learned that you never ask "why," but you do ask what the feelings associated with the behavior, incident, object, procedure, etc. Here is a prime example for never asking "why:"

"A financial analyst was convicted Thursday of beating his wife to death with a rock and impaling her heart and lungs on a stake after she complained he had burned their ziti dinner." Source: Associated Press

In this instance, when asked why by a police officer, he said she complained he had burned the ziti again. As a counselor, I know that the complaining was the trigger. Another why is the mass suicide by the Heaven’s Gate,

"They weren’t killing themselves, they thought, but freeing their souls from their so they could ascend to a spacecraft flying in the wake of the Hale-Bopp comet – which at that point was passing by Earth – and were going to be taken to their new home in space." Source: Rolling Stone

The true underlying reasons were cult dynamics at the hands of a mentally ill leader. Why do healthcare providers not accept the reasons of "I just don't want to do that (and it is my RIGHT)" or "I don't like that (and that is just the way that I feel)?" Both are very valid answers, but when pressed, nobody can explain why they feel certain ways, they just know that the feelings are there.

One may not even know what they are feeling (let alone why). All emotions is that they don’t start out as feelings at all but as physiological sensations. So even when a person can’t comprehend their feeling experience, they’re typically aware of what’s happening to them physically. Source: Psychology Today

Emotions are an automatic process in the brain that happens behind conscious thought. We can share emotions with others but not understand what they’re feeling exactly.

When forced to explain something that they cannot, they feel like they are wrong and acquiesce to the provider. This is just one means of forcing compliance from patients. The definitive treatise on coercing patients into compliance with uncomfortable, invasive, or intimate procedures is Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations by Joan P Emerson.

This summarizes the reasons of asking "why" are futile and fruitless.

It is well established that rectal exams are a barrier to many health screenings, even the annual physical. See: Digital rectal examination is barrier to population-based prostate cancer screening

The results of our study have demonstrated that DRE is a significant barrier to participation in PCa screening.

The invasive, uncomfortable nature of a digital rectal exam (DRE) is well known in healthcare. It is one of the main reasons that men avoid healthcare, especially the annual physical exam. (Reference: ) The DRE increases and reenforces the power differential between the patient and provider and increases the vulnerability of the patient.

Digital rectal exams (DREs) typify much of what’s wrong with our health care system. Men dread going to go get them, they’re unpleasant, they vividly illustrate the physician-patient hierarchy, and — oh, by the way — they apparently don’t actually provide much value. (Source: I Really Wish You Wouldn’t Do That)

The intimate exams are viewed as sexual by many patients despite what medical providers tell them. This again is our feelings and we can NOT tell our minds to simply not feel this way. Our feelings are what they are. See: Rectal exam mistaken for sodomy, a patients personal experience!

When forced upon patients, they see these things as a sexual assault or a rape. See: Rectal exam tried as assault One area that repeated intimate exams have risen to the level of abuse is with intersexed children:

Intersex activist Emi Koyama explains that various routine medical practices and procedures enacted on intersex infants, children, and adolescents constitute “ritualistic sexual abuse of children.” Two examples are the unnecessarily displaying of intersex children’s genitals to numerous other doctors and students, as if their bodies were side-shows to gawk at... Source:

Even the world health Organization (WHO) has deemed this behavior as torture, cruel, inhumane, and degrading. So if repeatedly, these constitute torture, why would they not de disliked?

This statement suggests that he doesn’t seem to fully recognize that the sexual abuse he committed was sexual abuse because it occurred in a medical context. Source: Sexual Assault in Medical Contexts

Indeed saying that this is a medical procedure does not change the feelings of the patient. If the exam is so benign and it is expected that patients willingly accept it, why do medical students no longer practice digital rectal exams on each other?

Policies of medical training institutions state:

"No examination of the breasts, genitals, or anorectal region are permitted between peers. Human patient models will be utilized for training in these aspects of the physical examination."

Concerns that physical exams are not just physically harmful, but also emotionally harmful through embarrassment, coercion or harassment. These concerns do NOT specifically apply to intimate examinations, but to all aspects of physical exams. Intimate exams carry their own additional concerns which medical students strongly oppose. 

All the studies and institutions conclude: "There is no role for peer genital, rectal, or female breast exams in the curriculum."

What about harming real patients? If these exams are so traumatic that medical professionals are unable to conduct on each other to further their education, why are they not traumatic for patients. Even the teachers do not use their bodies to train the students. (This demonstrates there is no existence of medical professionalism.)

The solution has been standardized patients: simulated patients are recruited from the general public to be examined by supervised medical students for teaching purposes in a clinical setting. Not every person can perform the task of enduring intimate exams.

A robotic rectum has been developed to help doctors and nurses detect cancer after only one man registered to allow medical students to examine his prostate. Source: Robotic rectum developed to help doctors get to bottom of prostate cancer

I came up with a modest proposal that would help these researchers find the answer to this question (that to everyone who has ever been a patient, the answer is obvious)...

First, the researchers should procure prostate exam trainer mannequins. The test subjects are instructed by qualified instructors on the proper technique for conducting a digital rectal exam and allowed to practice on the props until they have satisfactorily acquired the skill to properly perform the exam (not necessarily diagnose).

Each study participant will then perform a rectal exam on each of the researchers. Upon completion, the researchers will have gained the knowledge why patients dislike rectal exams.

But that is not going to happen anytime soon. (Maybe it should!)

Perhaps a better question to study is why the profession of medicine believes that patients would happily and readily accept rectal exams? 

Is it the magic white coat or the magic stethoscope?

The profession of medicine believes that patients should accept what ever whims the provider has. It just "ought to be..."

It helps us in determining what we are going to suggest you for treatment. So we can't do away with the physical exam. It's not a painful test, doesn't take a long time and really ought not to be a barrier to screening Source: Shunning Prostate Probe - Fear Of Anal Examination Puts Jamaican Men At Risk

This is paternalism. Traditionally, medical practice has been a paternalistic system, with the health care provider telling the patient what to do and making the final decisions regarding screening or treatment. This has been ingrained in the profession of medicine since it began.

There is the fact that the profession of medicine has exempted itself from the norm, expectations, and rules of society and does what it believes what is in the profession's best interest. This was done through the "Social Contract."

One of the most glaring examples of the profession exempting itself from the rules of society was the concept of self-regulation (which was a dismal failure by the profession). Medicine has granted itself absolute power over the patient.

The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them. Source: American Medical Association's (AMA) initial Code of Medical Ethics (1847), under "patient obligations"

Another example of the profession doing what it wants to do and what is in its own best interest is the fact that teaching medical students pelvic examinations on patients under anesthesia without consent still occurs to this day. How can any rational person think that this is acceptable?

But the profession falls back on professionalism and science. But when the science is looked at, it finds that these procedures do very little in diagnosis of disease or to change the management of conditions. (See: Digital Rectal Exams: Worth the Trouble?) These, as other intimate exams that patients dislike, are found to be "more of a ritual than an evidence-based practice" when the data is examined.

Much of medical guidelines and what is recommended for patients is (so called) expert opinions and NOT evidence-based content. Then there is a question of comfort. If we can put a man on the moon (and soon Mars), why can't we find an alternative to digital rectal exams or make them less unpleasant.

We should do everything we can to make unpleasant things, well, less unpleasant: Physicians can’t just focus on reducing patients’ medical complaints but also should seek to reduce other complaints about their care. When patients dread having something done, and often use that as an excuse not to get services, that should be a tip-off that something needs to change. Source: I Really Wish You Wouldn’t Do That

What about teaching patients to do a self examination? (That takes the fun away from the provider to subjugate and humiliate patients.) It is possible, providers are not the only people with a magical power to perform rectal exams. See: Digital Anal Rectal Examination Performed by Patient (International Anal Neoplasia Society Guidelines for the Practice of Digital Anal Rectal Examination
)

Again, this question shows the lack of common sense that medical professionals have both in not knowing why patients dislike rectal exams and why they expect that patients just accept them. What is even more disturbing is why unnecessary voyeurs are brought in to the exam room to oogle and further humiliate the patient. If a provider can not be trusted to perform such an exam, then they should not be practicing.

(The thought) of having another person inserting their finger inside their anus can be very stressing for some men and makes them uncomfortable. Source: Shunning Prostate Probe - Fear Of Anal Examination Puts Jamaican Men At Risk


If one really needs a "why," then read: Reasons Why Patients Reject Digital Rectal Examination When Screening for Prostate Cancer.



Thank you for taking the time to read.

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A Disgusting Article

I am writing regarding the article, How Patient Modesty Affects Medical Care. This article is an affront to human dignity (patient dignity being a subset of this). 

I will make my argument why this is an affront to patient (human) dignity. 

Many patients avoid healthcare due to dignity (modesty) issues.

Today patients view themselves as customers and expect that their needs will be met. Yet, the paternalism that still infects medicine fights back against the concept that patients are customers and meeting the patients' needs.

Patient dignity is the correct term to use (as opposed to patient modesty). "Modesty" is no longer the correct term to use (in the same way that non-adherence" replaces non-compliant).

First let us establish some definitions.

mod·es·ty / ˈmädəstē /

noun Behaviour, manner, or appearance intended to avoid impropriety or indecency.

Source: Oxford Dictionaries

dig·ni·ty / ˈdiɡnədē /

noun The state or quality of being worthy of honour or respect.

Source: Oxford Dictionaries

The mercurial concept of human dignity features in ethical, legal, and political discourse as a foundational commitment to human value or human status. The source of that value, or the nature of that status, are contested. The normative implications of the concept are also contested, and there are two partially, or even wholly, different deontic conceptions of human dignity implying virtue-based obligations on the one hand, and justice-based rights and principles on the other.

Source: The Internet Encyclopedia of Philosophy (IEP) (ISSN 2161-0002) (peer reviewed)

My argument  is that referring to the human condition of not wanted to have one's (the patient) body exposed (being naked) as modesty can be construed as the patient is asking for something that they are not entitled to. The phrase that most demonstrates this is "You are being too modest."

Dignity on the other hand takes into account the intrinsic value of a human being that makes the person deserving of being treated in an absolute, respectful, and dignified manner that is not open to interpretation or negotiation. To treat one in this manner is often not the easiest option and can be inconvenient.

The basis for human dignity (by non-atheists) is that we are endowed with it by our Creator (God). For Judeo-Christians (such as myself) the concept is furthered in that we believe that we were "created in the image of God."

This was rejected because the thread has been titled "Patient Modesty" and a change would some how create a disconnect. This is nothing more than marketing fluff. I will expand on this.

As an online resource for "reliable, understandable, and up-to-date health information," you use correct terminology, especially in regards to medical terminology as well as human anatomy. Not only does this keep the procedure medical in nature (as opposed to being sexual), but it also denotes the professionalism of the physician (provider) by showing that they are (properly) educated in the correct terminology.

By using the term modesty instead of dignity, it is making one look less professional and less educated.

The term "modesty" blames the victim. The patient can be accused of being too modest.

Modesty is taught to girls at some of the youngest stages of their lives. Modesty as projected by the person (patient) is t different levels. (Read about how New Jersey 'Mormon Prom' Draws Hundreds Of Teens For Celebration Of Modesty.) Modesty is about one choosing to be modest.

Teens were required to sign a pact agreeing to dress and behave modestly, to dance “appropriately” and to abstain from using alcohol or drugs...

The nearly 300 students abandoned several conventional prom practices — including arriving in limousines and wearing expensive outfits. (Organizers encourage attendees to be modest in their spending as well.) Most were dropped off by their parents, and some of the girls swapped or borrowed dresses to keep down the cost...

The problem in healthcare is that providers are taught to respect patient modesty and NOT patient (human) dignity. Let me expand...

An anesthetized patient (technically) has no modesty. [Everybody line up to practice rectal exams on the anesthetized patient.] An anesthetized patient DOES HAVE dignity. The lack of consciousness negates the presence of modesty being practiced, requested, or displayed.

I bet you know where I am going next...

A cadaver has no modesty. A cadaver DOES HAVE dignity. Increasingly, medical schools are having ceremonies honoring the sacrifice that people made leaving their body to science. This is to humanize the cadavers where traditionally (and still today) the cadavers were de-humanized. This is what happens when medical providers are taught to respect modesty and NOT taught to respect dignity:

...Last month, Stony Brook University Medical Center in Long Island announced it was developing a revised ethics policy after a student posted a photo on Facebook of a classmate posing with a thumbs up next to a cadaver. The State University of New York Upstate Medical University in Syracuse also is updating its ethics curriculum after a former resident posted a snapshot of an exposed brain on Facebook...

Let us also NOT forget the Denver 5...

By using the term modesty instead of dignity, nullifies and disregards the basic intrinsic value that human beings have and deserve being sentient beings and as endowed by our Creator. This is akin to calling a black man "boy."

...One, it's the ultimate sign of disrespect, and is often more offensive than calling them the N-word. For years black men were summarily dismissed and treated with disregard. It was as if their stature was diminished when someone white called them a boy...

Do you remember the images from the sanitation strike that the Rev. Dr. Martin Luther King Jr. was leading in Memphis in 1968? The most striking visual was that of the male protestors wearing signs saying, "I Am A Man!"

This mirrors the profession of medicine. Just as the hidden curriculum, the use of the patient gown, and teaching the term "modesty," helps retain and the paternalistic power that physicians are desperately trying to hold on to. It makes the doctor-patient relationship resemble the parent-child relationship.

For at least 2,500 years, the doctor-patient relationship has resembled the parent-child relationship. The norms of medical ethics, codified in historic documents or perpetuated as informal traditions, encouraged doctors to shield patients from bad news and from general medical knowledge. While Western medical tradition has always included some patient protections, such as informed consent (and its antecedents), doctors have possessed broad powers to withhold treatments that patients desired and, at times, to mislead patients for what they perceived to be the patients’ own good...

Even the term "doctor-patient relationship" attempts to consolidate and preserve physician power br putting the doctor first. I prefer the term "patient-physician relationship" because it puts the patient first, and recognizes the difference between a doctor (PhD) and a physician (medical doctor).

In the evolution of the doctor-patient relationship, such outdated terms are replaced with the correct term. The new terms show a respect for patient (human) dignity. One such example is noncompliance vs. nonadherence. Noncompliance as a term is a slur against patients. Nonadherence has become the preferred term to use.

The British have what I believe to be a much more acceptable term: “concordance.” This term recognizes that health care providers serve as consultants to their patients (or “clients,” as our psychology colleagues call them). Concordance implies a more equal relationship, in which the health care provider offers input, the patient offers input, and together they discuss, negotiate, and reach agreement on the most appropriate management plan for the patient.

Noncompliance painted a picture of a paternalistic provider mandating the rules of play, while the patient cowered below as a disobedient subordinate. It also implied that the patient did something wrong by breaking the rules and that the actions of the patient ought to be modified to fit the rules, rather than the other way around. On the other hand, non-adherence signified that the patient was a contributing partner in the development of the treatment plan and, further, that he may be justified for not abiding by the terms of his plan.

Many facilities have ordered the term noncompliance with nonadherence. There is a current movement to do away with the term nonadherence (along with noncompliance), because they can interfere with treatment.

Non-adherence used to be called noncompliance, which sounded too paternalistic. Now some experts are shifting to an even less judgmental language of "medication abandonment."

Now let me show how this practical application of the term "dignity" benefits providers.

There is no question that providers' modesty is respected in the healthcare setting (they wear white coats OVER their clothes, where patients remain half-naked wearing only a gown). Now if the profession of medicine was set up to respect patient dignity (human dignity), it would notice and correct the affronts to provider dignity (physician burnout, mental illness, EHR, etc.).

Trisha Torrey tells patients to "get over it" despite their reasons. This is very unprofessional and borders on malpractice for providers for not taking history of past abuse into account. 

This article also is contradictory to trauma informed care, especially trauma from healthcare providers.