Friday, August 28, 2020

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: 

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:

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. 






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Wednesday, June 10, 2020

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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Wednesday, January 1, 2020

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. 


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.

dig·ni·ty / ˈdiɡnədē /
noun The state or quality of being worthy of honour or respect.

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.

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:


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."



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.


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.




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.
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