COVID Circle of Trust Breached

As an Infectious Disease specialist I am very careful following precautions against getting COVID19.

My wife and I are high risk. 
We are more than 68 years old.
She has asthma and I have Diabetes Mellitus type 2


I knew we needed to get out of Florida as soon as possible.

This is why I left Florida link






JUNE 23, 2020 below



You can see Florida went from 56,000 cases to 103,000 cases.
Kansas went from 10,000 cases to 12,500 cases.

We decided not to fly home we drove home. 

The two day drive home link

May 20 Escape from Florida part 1 link


Why we decided not to fly home link


However family had us cancel our plane tickets link

The above shows how I listened to my family because I have Alzheimers and deferred to their opinion. 

My wife and I were very careful in Florida.  We did not socialize with anyone. 

In Kansas I knew my wife would want to see her family.  

We have had them outdoors with only two people visiting at a time.  We stay 6 feet apart. 

Her daughter comes over and spends the night.  I know she is very careful living at home with her dogs. 

When she visits we keep our social distance. 

I did not anticipate a blatant breach of the circle of trust.  

My wife was invited to visit her new great grandson.
She has visited once before but did not hold the baby and it was outdoors. 
This time I don't know why but they met indoors.  
They kept social distancing. 
There were five people in the room 
I wasn't there. 
Her son (the grandfather) did not hold the baby because he was at a meeting where a man who touched him later turned out to be Covid positive. 
Her son should have quarantined himself from my wife for two weeks. 
I became angry when I found out they pressured her to hold her great grandson. 
The problem with this is her grandson had been holding his son the whole time before my wife did. 
The grandson works as a Director of a Nursing home that just opened. 
He only had nine residents but two recently died.  Cause of death not discussed. 
His touch and breathing on the clothes of the baby was to my mind an unacceptable risk to my wife when the grandson  passed off the great grandson to her. 
My wife at first said no but family encouraged her to hold the baby.
It will probably be okay but to me this was 
a breach of the circle of trust during COVID 19 pandemic. 

Two great British TV series

G.B.H. came out in summer 1991.
There are amazing parallels to President Trump.
How power can be amassed in one persons hand and then used to persecute an honest man.
Slow start.  Weak middle but overall very good.
Worth the time in these uncertain political times.
Many threads.
It all comes together in the end quite well.






Rake is one of the best and funniest TV series I have ever seen.

My Microbiologist friend thinks Covid will cool down

Hi, Chris maybe you want to update your last letter to me?

I was 13 days early on my prediction.

Hi Brian,

Yes, understand it. (my model of death predictions)

 Both are estimates of course. 

I don’t believe we will ever get to an average of 60% infection rate in the US. 

That is too many deaths.

 People will self-quarantine even more, well before we get there. 

Most areas still have less than 5% incidence rate with some states hardly infected. 

The highest published testing positivity rate I have seen was in Flatbush with 45%. 

If we don’t have a vaccine, 

the virus will become endemic and smolder for years with occasional outbreak hot spots that will need to be stamped out. 

Chris 

My response:

I never said how long it will take to get to 2 million COVID deaths.

There will be waves and surges if no vaccine, lockdown or 3 t's national plan You think people will lockdown on their own.  So far no evidence that will happen.  

If it becomes endemic it will still kill 2 million people. 

Herd immunity requires 60 to 70% of immune people. 

At that point COVID may become endemic.

Number of Covid deaths if we don't get a vaccine

If there is no lockdown or  vaccine or
National Plan of testing, tracing and treatment:

328.2 million is the population of USA.

60% of the population is:

196,920,000

(number of people that need to be infected by COVID before there is herd immunity.)

Infection Fatality Rate (IFR) = Deaths / Cases = 23,430 / 1,694,781 = 1.4% 

1.4 X 196,920,000 =  2,756,880 deaths

Which is the number of covid deaths if we don't get a vaccine

UPDATE by my son:

"using today's numbers...

USA Case Fatality Rate = 120,686 deaths / 2,262,602 cases = 5.3% based on todays data

World Case Fatality Rate = 455,557 deaths / 8,567,280 cases = 5.3 %

Let's assume CFR is close to the 1.4% found on May 1st to calculate how many cases are "actually" out there.

USA  =  ((( 0.014 x total cases = 120,686 deaths ))) = 8,620,428 cases

World = ((( 0.014 x total cases = 455,557 deaths ))) = 32,539,785 cases

Hypothetical herd immunity at 60% of USA population is 197 million. 

This means 188.4 million cases and 2.6 million deaths to go before herd immunity. 

Let's assume CFR is close to 0.9% to calculate how many cases are "actually" out there.

USA  =  ((( 0.009 x total cases = 120,686 deaths ))) = 13,409,555 cases...still far from herd immunity."

you can inflate the numbers even more by using deaths divided by known recovered. 120,688 deaths / 930,781 recovered = 13% Infection Fatality Rate"

From Cato Library link

"This worst‐​case simulation came up with 2.2 million deaths by simply assuming that 81% of the population gets infected ­–268 million people– and that 0.9% of them die. It did not assume health systems would have to be overwhelmed to result in so many deaths, though it did make that prediction.

Neither the high infection rate nor the high fatality rate holds up under scrutiny."

My biggest fear

My biggest fear is that my wife die before me.
She already is a good caretaker of me.  Laundry, cooking and paying bills.

If she died unexpectedly (ie COVID) I made a plan hoping I could do basic living functions.

I have been watching the Australian TV series JAKE.

It is excellent.

He is an Australian lawyer who makes good money but is over his head in debt due to gambling.

He lives in a cheap apartment above a cafe.

He goes down each morning to the cafe in his bathroom to get his coffee.

I would like to move from Kansas to NOLA and live on Magazine street where I can walk to the restaurants.

Two bedrooms with kitchenette.

One bedroom for my 85" Samsung TV, books and DVD's.

I would rather do this than live on the beach in our condo.

I would be near my oldest son and two grandkids.

I know he and his wife could help me with my affairs.

Positive effect of Intermittent Fasting

 Better Bioelectrical Impedance Analysis (BIA)

with Intermittent fasting (IF).


I have not had much weight loss with IF but I have
a good response on my BIA numbers at the same weight.  
I did more walking in Florida but no weight lifting.  
 My Hgb A1c went back up 2 points due to Covid shut down and an increase in carbs while still in ketosis.


Below I document the changes at the same good weight of 211 pounds for me.






With Intermittent fasting I have lost 5.7 pounds of fat 
at the same weight 211 pounds.

I have hope but not false hope

 I have hope to slow my Alzheimer's

but I have no false hope for these nostrums to cure my AZ.





I increased my Zinc intake as it seemed to be a harmless thing to do. 

I switched from Mg maleate to Mg L-Threonate
as Threonate is touted to enter the CNS better.  
I hope my muscle cramps don't come back





I thought this bottle of wine said it well:

"Hope dies last"

I always remember the story of Pandora's box.







From New Testament.

These are the tools in the toolbox to cope with AZ

But drugs are very important.

The most intense moment of my life

The carpets were being cleaned and we had to clear the furniture.

I had picked up the large plastic mat at my desk that protected the rug which allowed my chair to roll in and out from the desk.  

It is an unruly piece to move as it bends so easily.  
The underside of the thick plastic piece has very sharp points to hold the plastic in place on carpet. 

In my usual haste I just threw it on the small utility room floor. 

As we are waiting for our carpet to dry I have on my paper slippers to not get the carpet dirty.  I go to let the dog out through the utility room and without thinking I step onto the spikes of the plastic mat. 
My world changed at that moment.  
In my panic I continued to walk forward on the spikes. 
The pain was immense and to compensate I screamed like a banshee being tortured. 
It lasted only five seconds and the pain stopped immediately once I sat down off the mat. 
 I checked my feet immediately as I am a Diabetic with some foot neuropathy.  
If my feet were totally numb as with severe neuropathy I may not have noticed the pain and caused great damage to my feet.  
The paper slippers had several holes in them but I had only one point of bleeding which stopped quickly. 

This most intense moment of my life
caused an adrenaline rush unlike any I have ever had before. 
The intensity of feeling was so strong that when it eased up so quickly I felt a wonderful relief. 
I had been to the mountain top and back in an instant. 

I am still feeling the after effects as I write. 

Relaxation. Peace. Calm

I have no pain now. 

The pain went away as soon as I stepped off the plastic points. 

A heavy weight champion was asked why he hit his head against the wall so much. 

The Champ said "it feels so good when I stop"

I have Alzheimers and I need to try to ask myself:

What could possibly go wrong with this situation?

It's like I pick up a gun with the safety off and ask 
what could possible go wrong. 

My wife and I had a good laugh about it. 

Next time put the plastic down underside on bottom.

Self esteem with Alzheimers

 I may have Alzheimers but I think I am looking good at 68 year old.

A shower and a shave make a difference. :)






As Joe Namath said, if you have it flaunt it.  link









Face changes with Alzheimers  link

My usual walk goes awry

A better title? I go awry on my usual walk.

When I was diagnosed with Alzheimers in Dec 2017
 I tried to plan ahead.
I decided to make the same 1 mile walk every day. 
 I walk around my block which requires me to only take right turns. 
It is a circle.

Today I was deep in thought and I crossed a street and
 suddenly a dog was barking at me. 
 It was a cute small dog and I was thinking it was an Australian shepherd.  
I look up and realize I am coming to the Main Street.

It took me a long time to realize my mistake.

That makes me think my AZ is getting worse despite following 
most of the advice from the books:

1- The End of Alzheimers.
 Review of Bredensen podcast link

2- Antidote to Alzheimers 
Review of Amy Bergers book link

My fourth book will probably be titled:
 AZ is inexorable. 

I got my vitamin D to 98. 
(over than 100 can be toxic)

I increased my testosterone but since I had trouble dosing the shot correctly I did get into a very high range and was told to stop. 





This week after more research I decided there was no downside to taking 50mg of Zinc a day.
However there is caution to taking more than 50 mg and my multivitamin already has 11 mg a day.

My hsCPR was elevated after my I hurt my back with muscle spasm but in a few months with physical therapy the hsCRP went back to normal. TSH continues to be normal.  Folate and homocysteine normal and I see no reason to repeat them.
I have done a Zinc/Copper ratio.
Wilson's disease is diagnosed by three 24 hour urine collections for copper.  It is a difficult dx. to make.
I like taking Zinc because it lowers my copper level.
If I take too much Zinc I can lose my sense of smell which is interesting because loss of smell can be a sign of AZ and taking Zinc can improve it.

I seemed to have improved my Hgb A1c by Intermittent Fasting.

My best weight with Intermittent fasting and no alcohol link

I have been on Low Carb High Fat diet since 2011.
I have been in ketosis since then. 

My blood pressure is well controlled with Cardiazem and Ramipril which I take for other reasons.

My lipid panel is stellar.  

I walk everyday.  My HIIT is going up and down stairs all day long.

I now hope to be in my present state for seven years. 

I am willing to take Zinc on a slim hope of slowing AZ down.

I think more weight lifting will help me more. 

Day 3 on Contrave

DAY THREE ON CONTRAVE.

Below is my food and lab diary:



I took my 3rd Contrave
 and a high diet dose of Victoza 3.0 mg this morning.  

2:30 PM 
I was hungry before I took my walk. 
Total steps 4,000

3:00 PM
After 16 hour fast I really enjoyed my
 English muffin with roasted peanut butter 
which I topped off with cut up banana. 

It was great.
I felt full and my hunger was mostly satisfied. 
I could have eaten more but I know the rule to wait 30 minutes for the stomach to send the hormonal signal to the brain that the stomach is full. 

5:08 PM
Despite the new pill Contrave I am still hungry.
However unlike prior to Contrave I don't strong cravings that caused me have snacks after lunch.  Wine, cheese, dark chocolate. 

With those snacks we have been able to put off dinner till 7 PM.
Today I think I will ask my wife for us to eat at 6 PM. 

7 PM 
I figured out a strategy to make to a latter dinner time.
I forget I have ProteiN2O with 60 calories of protein.
I also had a cup of Tea and a can of diet soda while watching a great Australian TV series call Jake. 


Good dinner 
Pork 5 oz with bacon wrapped around it. 
Stir fried veggies.

I feel full but I do have a hankering for something more. 
This is on one pill of Contrave each morning.
After 4 weeks I will be on two tablets twice a day. 

Started Contrave

Two remarkable days on Contrave.




I first blogged about Contrave in March 2016 link

I first took Qsymia but had Atrial fibrillation and I was taken off of it.

Then I took Belviq but a couple of months ago they took it off the market. 

I took my first Contrave yesterday and soon felt bad  
after  I drank a glass of wine.
 I read later alcohol can cause side effects?
 I never new that before. 
 I knew I was not to take opioids with naltrexone.
However I also had my 2nd shingles shot 
which today has left me with a sore left arm and tiredness.
 I was not able to walk as fast as I did yesterday. 
 I have felt tired. 

Last night I skipped dinner.  
I never do that but I had no desire to eat. 
I also had no desire to drink anymore wine.
I guess Contrave really does reduce cravings and appetite. 
The lack of wanting alcohol continued all day on this second day of taking Contrave.  
I haven't done my usual routine of snacks after my 14 hour fast as I usually am very hungry or rather even though I am full after lunch the cravings to continue to eat before dinner continued but not today.

I miss wine and cocktails and I was tempted to stop the Contrave so I  could drink.  It is interesting my Obesity specialist didn't warn me not to drink. 
I put this in the category that no patient had told her of a alcohol reaction with Contrave. 
It is similar to my Endocrinologist not telling to avoid alcohol with metformin. 
The PDR will list virtually all side effects ever mentioned in the trials.  
I went home and looked up the side effects and was surprised to see the warning not to drink alcohol but also that Contrave will raise my citalopram level. 
Thus I decreased my antidepressant from 40 to 20 mg. 

Citalopram decision making link

DAY THREE on Contrave

I went from 216 lbs to 213 lbs. 
I'm sure it is mostly water. 
I did my usual mile walk but not my dumbbells.
No alcohol yesterday.  I didn't miss it at all.

I had avoided intermittent fasting in the past because I found if I missed a miss I was get so hungry that I would overeat at the next meal. 

After years of making three eggs and 3 slices of bacon I decided to skip breakfast and then hold off lunch till 2 PM.  

It was not difficult but I found even though I ate a satisfying lunch which made me full I still craved more satisfying snacks.

So I would have wine with cheese. Then some dark chocolate.  That would do the trick of satisfying my cravings. 

During the Covid 19 lock in I found it easier to stay on my diet and exercise program.

I got down to a very low weight of 202 pounds.  I had also been off alcohol for 20 days with intermittent fasting and walking. 

In the lowest right corner of this page I write:
No ETOH so I ate ice cream to overcome strong cravings after 21.5 hour fast.




This was my best weight.
No doubt 20 days of abstinence from ETOH helped me break through my plateau. 
Also no restaurant eating helped and a nice beach to walk on.





  Under the stress of COVID 19 lock down I finally decided to have some wine.  Wine does prevent me from eating desert.  






WHAT IS THE POINT?

I am 68 years old.  I was diagnosed with Alzheimer's in Dec 2017.

Why do such a regimented life? 

Intermittent fasting does involve hunger (suffering).
I deal with it by spacing out 2 cups of coffee, 2 diet sodas and 2 diet Snapple teas.
Then I go for a walk. 

I come home after a 14 hour fast and check my glucose and ketones. 
The astonishing thing is sometimes my glucose has not gone down!
I asked my Endocrinologist about this and he explained that with Diabetics the body figures out what is happening and will release glycogen from the liver even though I am in fat metabolism mode as 
demonstrated by my ketone levels. 

I have been on IM since Nov. 19, 2019.
I weighed 214 pounds and my fasting glucose was 134.
I have continued IM not because of weight loss but because my
 Hgb A1c dropped by 2 points and control of glucose is important for my Alzheimer's

Now I can't enjoy my bar anymore.  Why do it?
With Contrave, I don't enjoy ETOH. 
Why take that pleasure away from me?

I stopped Cialis for a week but I still have a headache. 
I am thinking the headache is not from Cialis but
 Post Concussion link may be causing the mild headaches.

I would like to know as I get beyond the half life of Cialis.

However my new diet pills can also cause headaches. 

It's called polypharmacy problems.

If the two new drugs allow me to lose weight I am willing to try it. 

I have a goal of getting below 200 pounds. 
I did it for my wedding with traditional low calorie diet in June 2007  I quickly gained 10 pounds due to Sponge syndrome with shrunken fat cells that never go away and the subsequent low leptin causes the brain to think the body is starving.  Thus the Rest Metabolism Rate is reduced as well as the exercise metabolism rate.  I am always cold. 
The only way to maintain weight loss is to stay on a sub-starvation diet of 1200 to 1700 calories.  I have maintained my weight to 220 from apogee of 280.  
That is with alcohol on low carb high fat diet on ketosis. 
Ketosis does not help with hunger once you become one of the reduced obese. 

This is a struggle. 
Low down with COVID 19 is a struggle. 
Having Alzheimers is a struggle. 

Why keep trying?
Getting back up to 250 pounds would make me very depressed. 

My main goal now is to slow the progression of Alzheimers.
Lowering my Hgb A1c is very important. 

Alcohol consumption does not affect my Hgb A1c.

Contrave prevents me from drinking alcohol. 

The author Cornwall wrote about a overweight British officer during the Napoleanic wars who was given an award.  In his acceptance speech he said he was "blessed to have a good appetite"

I never forgot that. 
Many sick patients lose their appetites and don't enjoy it. 
Here I am taking expensive medicine to lose my appetite?

I am switching from Victoza to Ozempic soon. 
I usually take only the DM dose of Victoza 1.8 mg unless my wife does not take her her Victoza, then I take the Obesity dose of 3.0.
Our supplemental will not cover the code for Obesity to pay for Victoza. 
Ozempic is covered for the highest dose for DM and it is for Obesity as well.
Retail price of Ozempic is $875 at Walgreens
My wife paid $56 with our supplement. 
I paid $320 as I was in the donut hole with Medicare. 

Important fact:
Loss of appetite is just before nausea and vomiting.

This is what many people on Victoza experience. 
It's amazing most work through it with lowering the dose. 
I also once stopped my Victoza because I thought it was making me feel sick.
Once I was in New Orleans and Victoza suddenly kicked and I could not finish my wonderful meals as I felt could not eat anymore.  My son said I was the only one who visits NOLA and loses weight. 

The people in National Weight Control Registry maintain the discipline over 5 to 10 years.  They are committed (compulsive/obsessive?) to do this. 

It's early days with Contrave. In 3 weeks I will be on maximum dose.

Next week I will switch from Victoza to Ozempic.

I hope the new diet medicines will help me stay on 1,000 to 1,500 calories a day so I can reach my goal of 200 pounds.  

Lab update after 4 months of COVID shut down.

It has been easy to high very low lipid levels on Low Carb High Fat Diet.
I think it is good for my  Alzheimers as it makes strokes and heart attacks less likely.
Reduced ejection fraction after myocardial infarction would decrease blood flow to brain.


I weighed 217 when I left for Florida.
I weighed 217 when I got back to Kansas.

I had been down to 202 lbs but I gained it back.
I cut down my exercise after I had a concussion.
Post concussion syndrome. link.
We ate more carbs than usual but I remained in ketosis.
I also kept to intermittent fasting for 14-16 hours since I first started IM November 9, 2019.

Intermittent Fasting link 


Update now is my lab this past week relevant to my Alzheimers.


These are advanced lipid results after 12 hour fast:



NonHDLc 135 minus 72 = 63
This is a better marker than LDLc which was 51

Triglycerides 62 fasting.  
This is a result of:
 high dose fish oil 4000mg/d
 nicotinic acid low dose 1,000 mg

Total Cholesterol 135
Minus HDLc         72
                               63
Minus LDLc.         51
Remnants equal     12

Quest Lab in Florida Feb 5, 2020 

apo B was 50





                      

Smell

I remember years before my Uncle was diagnosed with Alzheimers that he complained of loss of smell.
I suggested he try some Vitamin A.
He said it worked.

I have Alzheimer's and today in my brain I am smelling strong marijuana.
It is not transient. It has persisted so far for several minutes.
No pot ever in this house. :)

I looked it up and found these two items.


 

This I knew.  I also learned recently poor hearing can be an early sign of dementia.







I was not aware of this either.

I was not trying to remember the small of pot, it just popped into my head. 

Paliative care A peaceful death

I took care of my Mom in her last years. 
My wife owned a nice nursing home in Topeka and when Mom could not longer take care of herself we moved her from Florida to Kansas. 
It was an assisted living home. 

She was not one to join into all the social activities. 
She always said when we became old she just wanted a room to herself. 
I worked in Topeka and my wife was the administrator of the Assisted Living Home so we kept a close eye on her. 
Like many elderly, Mom would always be cold, hence she did not like to take baths or showers. 
The nursing assistant would go to my wife and say my Mom refused her bath. 
My wife said to go tell her that she said she must have a bath. My Mom loved my wife but still refused. 
For some reason when I would ask or tell her to do something she would do it.  
She is the only person in the world that when I walked in the room, she would light up and say delightedly, "Oh Brian!"

She had diabetes and lifelong smoking history. 
In assisted living she had to stop smoking. 
She had a living will and was DNR.
Do not resuscitate. 
The nurses would fuss about her sugars and I had to continue to tell them not to worry about it and not to send her to the ER (emergency room)
Finally she was having severe leg problems from poor circulation. I couldn't believe she was sent to the ER and the surgeon advised surgery. We deferred surgery.
Mom had a sudden deterioration and was admitted. 
I had my brothers come as she did not seem much time left. 
She hung in there till they arrived and she could say goodbye. 
She stroked my oldest brother's beard when he arrived at her bedside in a loving and affectionate way.  
More physical affection than me or may other brother ever remember receiving. 
He was her first born and was born with a birth defect that required leg correction as a toddler.  
He had the wear casts on his legs while in a baby crib. 
I think once he climbed out. 
My Mom always wanted to be a nurse and the care and love she devoted to him was the bond that was the strongest among all three sons. 

She was ready to let go. 

The next morning I am called that she had a stroke. 
I go to the hospital and see she is moribund. 
I call my brothers and say if they want to see her while she is still alive they need to hurry to the hospital. 

We are all there as she is still struggling to breath with Stokes Adams  breathing.  She was unconscious.

We are waiting for the Palliative specialist physicians to arrive. 

She had a low dose morphine every hour but it was not enough to relieve her suffering.

My older brother and I are both physicians and we are getting impatient waiting for the arrival of the specialist. 

We ask our middle brother what his thinks of us pushing the morphine earlier at a higher dose? He defers to us as physicians. 

I had privileges in the hospital and thought the nurses might let me write the order. 

Fortunately, the Doctor arrives.  
He orders a higher dose of morphine to be given right away.

My Mom passes away peacefully five minutes later. 

We were brought up not to show emotions in a military family.

To my surprise for the first time in my life I cried uncontrollably like a baby.  My middle brother did the same.
My oldest brother was stoic but.  My kids looked at me surprised.  They had never been close to their grandmother. 

My Mom died with her three sons at her bedside as well as two of her grandchildren. 
I should be so lucky at my end.