Some news

If you aren’t willing to learn, no one can help you.  If you are determined to learn, no one can stop you”. Zig Ziglar

What’s new in shoulder surgery?  In an article by Dr Moosmayer and associates, chronic rotator cuff tears that were treated surgically had better function than tears treated conservatively.  Of course, traumatic tears do much better fixed.  In another study by Dr Ranebo, acute tears did much better without progression to big tears if fixed soon after injury.  Nonetheless, 6.5% did not heal after repair.  However, 93.5% did heal.  Age and health has a lot to do with it.  Also, we have learned that double row repair, like I do, is better.  

For shoulder dislocations, a recent article by Dr Bishop and associates suggest that every patient should be assessed for bone defects and decisions regarding which technique be chosen accordingly.  This is great news, we have been doing this for decades.  So not every dislocation can be fixed with a simple scope.  There are some exciting new discoveries and new equipment which can improve outcomes.  We are on the cusp regarding these techniques.  The younger you are, the higher the re-dislocation rate without surgery.  Even then, complex high contact sports makes decisions about which technique important.  

The big controversy in Total Shoulder Replacement always gets back to how you fix the  subscapularis.  That is the muscle you take off to get in and put back at the end.  Recent studies have shown that whether you take it off the bone or cut the tendon, results are the same.  So what we do has never been shown to have a better way.  Healing that tendon back is the key to happiness.  Our results are comparable to any major medical center that trains surgeons and reports results.  More than 90% of our patients make above 90 out of a hundred on their Shoulder test at 1 and 2 year follow up.  

Reverse shoulder, or replacing the ball where the socket is and the socket where the ball is, is occasionally used for fractures and older patients with no rotator cuff that have arthritis.  What’s great and pretty new is that the component you put in the humerus can fit either the reverse or the regular, so for revision years later, so much easier than the old days.  

In elbow surgery the newest thing is arthroscopic tennis elbow treatment.  We do that and I must say, results have been impressive and quick recoveries have been the rule.  

In knee surgery the Arthrex corporation has a very cool new device to repair the meniscus tear.  It makes for a very non traumatic experience with surgery.  Everyone always is interested in PRP for knee arthritis.  We do it in the office.  

And finally, Covid.  Whether you are a believer in vaccines or not, the population is becoming more and more immune.   It looks like its going in the right direction. Finally……….If you have a lot of health issues, talk to your primary doc about boosters.  

“If you want to get medical advice, why not try asking the person you hired to take care of you instead of using facebook or twitter”.        J. F., Petroleum Engineer

      Covid is back.  No one likes it, but it’s true and it isn’t going away until we get vaccinated.  And vaccination is a bad, bad word these days for reasons of uncertainty, lack of FDA approval, fear of being magnetic, thinking that it allows us to be identified by a number, conspiracy, and a host of other ideas propagated by the media, the internet, and just plain madness of ideas.  So let’s get a few medical facts out there.  Simple facts of truth and science.

      It does not make you magnetic.  It can give you some symptoms.  A recent study just out today suggests that if you have had Covid, then you have more symptoms after the first shot but no different than previously uninfected people after the second shot.  However, 43% of people have significant symptoms after the second shot.  Moderna has more side effects than Pfizer, that’s a fact now.  I can’t recommend the Johnson and Johnson.  I got Pfizer, my wife Moderna.  Are we certain we won’t get Covid?  No.   Are we glad we got the vaccine?  Yes.  Are we magnetic?  No, but I did unplug Alexa so I am a conspiracy person too I guess.  

     A recent study demonstrates that vaccination protects you more than previous infection for the new Delta variant.  So does it work?  Yes, it works.  And FDA approval for Pfizer is real. 

     89% of the people in the hospital at BSA right now have NOT had a vaccination.  The other 11% mostly have complex medical issues.  So, the vaccine keeps you out of the hospital 99% of the time.  Does the vaccine work?  Yep.  It works.  My friend that I quoted at the top of the blog called to tell me thanks for recommending the vaccine.  He and his wife got Covid after a public gathering in New Mexico.  He said the vaccine did it’s job.  His symptoms were mild and very short lasting.  That’s opposed to the people gasping for air begging for the vaccination right before they get intubated, stay on a ventilator for 40 days and then die or suffer long term sadness and brain fog for years or who knows?  Maybe forever.  Is this always true? No.  Some still get very sick or even die.  But not many.  Most are helped immensely by the vaccine.  Doctors are calling this new Delta the pandemic of the unvaccinated.  

     It can affect your brain.  How this happens is a mystery but no Covid grows in the brain.  This is proven.  What we think happens is a big inflammatory response due to the “cytokine storm” you may have heard about.   It isn’t so important to understand about cytokines if you are an accountant or rancher.  It is important to know that some people that get it have severe mental changes that keeps them from working.  Or even doing simple home life.  Like forgetting you were cooking eggs until everything is on fire and then forgetting how to operate the fire extinguisher.  Does the vaccine prevent this?  Every scientific article so far says it does, most of the time.  

     Which is worse:  Getting the vaccine or getting Covid?  Covid is so much worse it can not be compared.  The risk of the vaccine is way way less than the risk of dying of Covid.  How many doctors have had the vaccine? 98%.  

      In Great Britain only 35 deaths all together since the beginning of the pandemic in kids under 18.  Most of those had issues like serious pulmonary compromise from a bad congenital defect.  So for now kids don’t seem to be as seriously affected as many adults.  So for now that’s lucky, I hope it remains true for the US and the new Delta variant.  Should teachers and parents get vaccinated?  Yes.  

     When did we discover the SARS virus?  2002.  How long have we been working on MRNA vacccines for SARS?  Since 2002.  So genius scientists have been trying to figure this all out for almost 2 decades.  So did we whip it together in a couple of months?  No.  Have we been working on this stuff since your first car phone had a big cord and an antenna?  YES.  So let’s get it straight.  It isn’t a government Trump conspiracy to give you an ID.  It is a vaccine that works.  Did we eradicate Smallpox with a vaccine? Yes.  Did we eradicate Polio? Yes.  Do you want smallpox?  How about polio?  I will say you do not.  All you have to do is see one person with shingles on the face into the eye to get you to go get a shingles vaccine.  So what’s different with Covid?  Nothing, it's the same process.  Get a couple of shots, develop immunity, and don’t die.  Or at least have a much much much greater chance of NOT dying or getting severe disease.

     If you have had a vaccine can you carry Delta around in your nose?  Yes.  Can you give others Delta?  Yes.  Do masks work?  Yes but remember in Sweden they didn’t mask and it made no difference.  So it isn’t as clear.  It probably has to do more with what kind of mask.  What kind of mask is best? N95.  

     If you are trying to get pregnant should you talk to your OB doc? Yes, talk to them first.  Always talk to the OB docs first about any medicine or anything medical first.  Always…

     So does it work? Yes.  In a recent New England Journal of medicine article the Pfizer vaccine was 93% effective in preventing the alpha variant and 88% against Delta.  So if 100,000 people get the vaccine and everyone is exposed then only 7000 people get Covid and it isn’t as bad as it would have been and only one percent or 70 go to the hospital for treatment.  So if half of Amarillo, about 100,000 others don’t get a vaccine and are exposed, 100,000 get Covid and many get very very very sick and some die.  Which road to take?  Death and sadness or just annoyed and the inconvenience of some symptoms.  It for now is a choice.  I am afraid the day will come you’ll have to present the card to board the airplane.  It wasn’t that bad for me.  I am going to get the booster when it is available to me.  

     I hope this little blog today helped you understand.  It’s just science.  It isn’t a government conspiracy.  

     Nancy Messonnier, MD, the Director of the National Center for Immunizations and Respiratory Diseases within the CDC was interviewed recently by the President of the JAMA.  Her absolute bottom line recommendation is for everyone to be vaccinated ASAP.  Regarding these new variants, her position is that mutations are going to happen no matter what.  The key, according to the director, is to accelerate the production and administration of the vaccine.  If we all get vaccinated, then the infection rates will drastically fall and the opportunity for the virus to replicate and sometimes mutate will be tremendously impaired.  She says that according to the plan, every American could be vaccinated by summer.  As far as the 2 dose schedule she recommends following the protocol.  So many have had the virus the question at hand is whether or not one dose of the vaccine will be effective.  So far, there isn’t solid data so just follow the protocol.  

     With regard to the mutations, another paper suggests that moderna has only 1/12th and pfizer 1/10th the antibody response that is produced to the original virus.  Once again if we all quickly get the vaccine, fewer variants will result from the continued propagation of the disease.  Many are fearful of the vaccine.  So far it would appear that the risk of the disease progressing to long term brain or heart issues is far, far greater than the minimal risk of the vaccine.  The key issue is whipping down the presence of this menace to our existence.  Go get vaccinated ASAP!

     Will we need a booster?  Maybe.  More research is ongoing to answer this and so many other questions, like will the Johnson and Johnson one shot deal be good?  Or, will the one shot deal be all you need after you get it?  Maybe.  Still so many questions that will have answers soon.  The bottom line:  Don’t be afraid to get a vaccine.  

     Everyone is tired of the pandemic and so am I.  As the weeks unfold we’ll be switching to regenerative medical ideas and current research on the topic.  This aspect of medicine is growing rapidly.  For those of us with some arthritis, lifestyle and dietary changes can make a huge difference.  

     Changing the subject, let’s talk about longevity.  There is so much that we are learning about living longer.  Something very interesting came across in my reading recently.  In the Journal of Nutrition, Christine Lacuna from the University of Barcelona correlated high intake of polyphenols with a 30% reduction in mortality in older adults.  Where do polyphenols occur?  Olive oil that has a high level is one of the best sources.  Morraco is where these super high polyphenol olive oils come from.  You want a first cold press olive oil from a place higher in altitude where the tree struggles to survive and a high concentration of natures own defense, polyphenols get concentrated into the olive.  Also, nuts, especially walnuts, pecans,  and pistachios, legumes pressure cooked, fruits, vegetables especially cruciferous, Also, coffee and tea (black and green), oregano, flax seed crushed, Moringa, cloves, 80% dark chocolate, grapefruit, and lemons.  

     Another interesting finding from a study at Mass General Hospital demonstrated high animal protein intake led to higher mortality, and high plant protein intake led to lower mortality,  So interesting.  The anti-inflammatory diet I recommend for many of my patients really follows the same basic concepts that we are finding in the diets of the “blue zone” areas where people live the longest of any place on earth.  It’s my thinking that most of the people that live in these areas that live a long time all have this one thing in common.  High polyphenols and low animal protein, mostly when eaten is wild caught fish.  Animal protein when consumed is better when grass fed like Elk or Bison or grass finished beef, or naturally occurring like pastured chickens.  In Sardinia, they don't eat much animal protein but when they do it’s little fish, like Sardines and Herring.  These little fish have the very highest levels of omega 3’s.  That is what you're looking for.  One thing is for absolutely sure.  If you have a lot of inflammatory arthritis, then cutting out grain fed animals treated with antibiotics and adding to that consuming only very limited dairy like aged cheeses and butter only from Europe where the correct type of Casein is in the milk, and really concentrating on small amounts only will lead you to feel much better and you may also find yourself losing weight.  Look for the Kerry Butter from Ireland and imported aged cheeses like parmesan  from  Italy.  What about eggs?  If you can find the omega 3 purely natural grass fed eggs that have very little omega 6 in them, then they are probably just fine in small amounts.  Just a little nippet of information in the sea of new information about our food and our health.  Keep reading.  The key is the natural food, not just the supplements.  

     The office is full speed ahead.  For now we still wear the masks mostly to protect those at greatest risk to be inside near others.  We now have a one visitor per patient policy.  

Jan 29, 2021

“Science and Religion are not at odds.  Science is simply too young to understand.” 

Dan Brown

In a recent study done by Jennifer Dan, Science 06Jan21 DOI:  10.1126/science.abf4063, collaborators studied immunity to COVID-19 at 6 months and found that after infection immune response is still present and active.  This study rids us of the idea immunity only is short lived.  Many doctors now believe that one could wait up to 8 months after infection to get the vaccine because the data supports longer term immunity.  That’s good news.  

A nasal spray, Xclear, is an over the counter product that has been proven to reduce the viral load of COVID and shows promising hope that suggests effective treatment.  Apparently two components of the nasal wash are responsible.  Xylitol and grapefruit seed extract.  The seed extract apparently kills the virus and the xylitol blocks virus attachment to the cell wall of the infected person. We know from the paper that the actual viral amount in your nose is reduced 4 fold with this stuff.  We also know viral load, of the amount you get in your nose has a lot to do with how bad your experience with COVID is.  For me, if I get it in my nose I am interested in getting it beat down as much as possible.   Interesting.  Biospace, Jan 26,2021.  

The Department of Health and Environmental Control released the news on Jan 27 that the South African Variant B.1.351 has been found in South Carolina.  They also report most health experts agree that the vaccine will likely be protective in this strain.  No one really knows how protective.  

A great book I read some time ago, Lifespan by David Sinclair, predicted that in the future we would wear a device that would track our health and warn us of impending health problems.  That day has arrived.   A wearable device like an apple watch has had data analyzed in infected individuals by scientists.  They correlated heart rate, sleeping, and activity level with changes that were recognizable 4 to 5 days before the infection presented itself.  They were unable to distinguish between COVID and other viral illness; however, it is still useful and may help doctors get on the treatment wagon early once they develop a useful algorithm.  Nature Electronics, 25 Jan 2021.  By the way, you should read Dr. Sinclair’s book.  He is a professor and chairman of the Department of Aging research at Harvard and is one if the leading, if not the leading, researcher on the topic.  Fascinating.  

If you want THE reference on blood type and COVID, here it is:  

https://doi.org/10.1016/j.blre.2020.100785

O is protective but it doesn’t mean you won’t get it.  A and B are more susceptible and A has poorer outcomes.  Warning-the article is pretty heavy reading.  

In a new study, Viruses 2021, 13(1), 132 by Kumari, et al, COVID can live quiescently in the brain and come back later.  This is bad news and a good reason to get the vaccine when you can.  What’s worse about this news is it brings up the idea that brain diseases like Parkinson’s or other unfortunate conditions like Multiple Sclerosis might be easier to get if COVID lives in the brain.  To quote Dr Kumari, “the virus likes to hide in the brain”.  One thing about science, it brings us the news.  The news isn’t always good.  Kumar is the professor that headed the project is at Georgia State University in the Department of Biology.  Kumari is the lead author.  9 people worked on this project.  It might be one of the most important pieces right now.  

On another note, our colleagues at Queen Mary University of London have found that eating fish may help with asthma.  This is because of the high concentration of long chain omega-3’s.  The children with a gene type that makes them prone to lower levels of omega 3 benefitted from consuming more omega-3’s.  Add one more reason to increase your level of omega-3’s to the already large list of benefits:  higher good cholesterol (HDL), lower triglycerides, lower blood pressure, prevention of plaque, reduces abnormal heart rhythms, improve mental health, may help weight loss in a program of exercise and proper diet, may improve your vision, helps with inflammation, may help improve dermatitis and psoriasis, may improve hand eye coordination in infants that breastfeed from mothers that take fish oil, may help reduce liver fat, improve depression, help ADHD, may help prevent mental decline,  and probably improves bone health.  Wow, fish oil is a great idea.  Take two a day.  

According to the New York Times article by Sheryl Stolberg and Abby Goodnough, Biden reopened the Affordable Care act marketplace, re-established tax dollars for abortion counseling, a new ramped up enrollment period from Feb 15 to May 15, and is making efforts at protecting people with pre-existing conditions.  The supreme court hears a case about requiring all Americans to have insurance.  Republicans claim its unconstitutional.  The drama up there in Washington is wearing us all out.  One thing I think all of us can agree on is that health care is broken.  Old school doctors are becoming harder to find.  Just remember what Will Rogers said.   “When the world ends, I want to be in Amarillo, because everything happens two years later there”.  Just know that old school still lives in my office.  It’s an old friend of mine and won’t ever go away.  

     Dr Fauci says we should wear KN-95 masks because the new strain is so contagious.  According to author Robert Dillard of one of the medical news sites I read, the UK variant is in 60 countries.  Over 98 million people have had it.  The head of the WHO has been vocal about the lack of equal access to the vaccine.  Biden mandates masks on federal property, except for him apparently as he violated his own rule twice the first day.  Fauci also went on to say that 85% of the population will be vaccinated by fall.  This surprises me because I am not sure 85% of us will choose to get it.

     I got the Pfizer vaccine.  Everyone wants to know how I did.  Here is the news:  After the first dose I had a mild headache for a day, then nothing else.  After the second dose I did not do as well.  I felt rough for 3 days starting after 48 hours.  I felt like I had the flu.  So did my PA, Lisa.  I like to Peloton.  I am not really that good.  So, if there are 30,000 people in the class, I usually come in about number 15,000.  The first day I felt bad I did the Peloton and finished in the bottom 5%.  I felt like a dollar thirty-four.  I know lots of people felt really nothing at all.  A few were just like me.  From what I have seen in my patients, my symptoms were nothing like the real thing. 

     Another common question everyone is asking.  Should I get the vaccine?  Yes.  Just that simple unless you have allergy to any of the ingredients, do not meet the age criteria, have active COVID now, or have been vaccinated within the previous 14 days with any other vaccine.  Also, pregnant and breast-feeding women should ask their health care provider. 

       A famous virologist that works at the Imperial College of London and a professor at Oxford published an article on the website virological.org.  Dr. Faria did an analysis of the new variant from Brazil and concluded that the new variant may avoid the human immune response triggered by the virus that killed everyone the year before.  Virologists call this an “immune escape”.  It may mean you can get it again and it probably means we will need a new vaccine. 

     CNN reported on the Pfizer trial for younger people suggesting that 2,359 12-to-15-year-olds are enrolled.  Dr. Rochelle Walensky is the incoming Director of the CDC.  She says it will get much worse by February.  Biden wants to ramp up the delivery of the vaccine.  Incoming travelers must show a negative test.  California is getting pounded, especially in LA.  The news just keeps rolling in. 

     Go to Covidactnow.org and look.  Our leaders, our Governor, and our organized health care teams have done a great job at getting the vaccine out.  Believe it or not, Amarillo LEADS the nation in percentage of the population vaccinated.  

     The office is open and running smoothly.  Physicians Surgical Hospital is open for surgery with one visitor allowed. 

Happy New Year, Jan 2021

The first case of the coronavirus COVID-19 was in Wuhan China on December 8, 2019. Since that time there’s been a widespread pandemic as you are aware. What’s been so disappointing is that we didn’t really learn as much as we needed to from the Chinese.  I’m not sure if they really shared all the information that they really needed to. The pandemic was handled very poorly in the beginning and so it spread with reckless intent. The result of this early in effective management is what you say today all over the world. Hence 2020 has been a bust for many. And what a ride it has been.

While the pandemic was getting underway, the  opening arguments were heard by the senate of the United States of America. Nancy Pelosi and her team of bandits had impeached the president.  They charged him with abuse of power and obstruction of Congress. Apparently their claim was that he pressured the  Ukrainian government to investigate a political rival. He also allegedly directed officials to ignore subpoenas. Remember the O.J. Simpson case? Alan Dershowitz was the lawyer. Guess who worked for Mr. Trump? That’s right Alan Dershowitz. Also in the limelight was Ken Starr who’s investigations led up to provide enough evidence to impeach Clinton.  From the very beginning it was going to be a failure. But these antics were pretty regular during this crazy year. I look back at it and just think it was one of the things that made 2020 special in a pretty horrible way.

About this time during the year we were hearing a lot from Bernie Sanders and Elizabeth Warren. Instead of talking about how to deal with the pandemic they were talking about “ the most corrupt administration in history”.  Looking back, this administration is what got us a vaccine as early as we got it. But it was all just a set up. Making way for the agenda.

It was pretty clear that China lied about the virus. Communist China was setting up a series of propaganda ads making them look innocent.  None of that was probably true. Thank God for the national Institute of health, American and free country scientists many of which are women equally worked tirelessly to come up with the answers that we have so far.   

In China and in Taiwan they use cell phones to track people. Once the health authorities identified you as being infected with the virus they would track you on your cell phone. If you were out of bounds the police would come and arrest you. Oh my gosh, I wonder what happened to those people that got arrested?  

Our elective surgery schedule went to almost zero. For 6 weeks. Finally realizing that the hospital at Quail was as safe a place as can be achieved, we went back to work. It was stressful being away from work so much but conditions for all healthcare workers has been super stressful. 

In early April the effects of spring break we’re beginning to be seen and it wasn’t long after that that the effects of spring break in Florida spread all over the United States of America at a super rapid pace. Many states across the country had taken action to shut down social gathering.  We look back in history we find that this was not true in Florida. I don’t mean to say that he was the only reason for the pandemic, but one man changed the rate of spread of the virus to a new and unprecedented level. It was Ronald Dion DeSantis, the 46th and current governor of the state of Florida since 2019. Mr. DeSantis was responsible for leaving spring break open. Floridians went crazy and after a huge amount of pressure and way too late he shut the beaches for a while. But his work was done and it was cinched that the pandemic would now be totally out of control. If there’s one man to thank For the mis-handling of the pandemic, you may send your personal letters and communication to the office of the governor of Florida. 

Remember the famous Heatseeker map that you saw on social media where the thousands and thousands were gathered on the beach with their cell phone signals so strongly recorded? Well thanks to modern technology we were able to follow all those signals all across the United States of America and track the pandemic spread pretty accurately. Although no one was arrested and who knows what like in China and Taiwan, the evidence was still clear.

June brought us a different time in history. We haven’t seen anything like it in 10 years or more. George Floyd died under the knee of a police officer. Chaos broke out all across America. The national guard was deployed, cities had curfews, looting was rampant. In downtown New York shops were ransacked. All of this conveniently was brought to us in 100% living color in our living rooms by our media.  Over and over and over.  Pundits spun the news to Influence America.  A Defund the police movement was well underway.  Far left liberalism gain steam. Biden became the figurehead to take out the other side. Somehow all the rioters and demonstrators forgot it was a pandemic. Covid spread like wild fire.

By August it was clear college would be different. Trust me when I tell you I still have a student at Texas A&M University. The adjustments that he has had to make and deal with have been tremendously challenging and as I look and listen to the stories, I’m not sure I would’ve had the resilience to make it work as well as he did.

America maddened by the sharp contrast in political viewpoint, bitter about having to wear or watching others refuse to wear a mask became a victim of the essential freedom of choice in the United States. Hospitals became overun. Death tolls sharply rose to unprecedented levels. At some point in August 800,000 people had died of COVID. In spite of this activists for no masks and anti-vaccinator cries of government as the bad guy lived on as strong as ever. 

During the next months we went thru the ugliest, most embarrassing time in all of history in my opinion. The manipulation of America by media to an arrogantly corrupt system so complex followed up by the most controversial election of modern times. In the midst of all of that, science boomed home run after home run flexing powerful academic muscles to bring forth in record time a vaccine. Doctors feverishly set for modern treatment protocols saving millions of lives. While politicians bickered over pork to cram another who knows million after million into a stimulus number two physicians, nurses, and brave health care workers went to work every day to save your life, even if you were an anti-masker. In the face of the year’s conclusion, Time magazine makes Joe Biden and Kamala Harris person of the year. What an insult to the massive team of Doctors, Nurses, Scientists, health care workers all over the entire Earth. A sad commentary on the state of our media and those that seek to influence us. 

A new case of a different variant that was discovered first in England has now been discovered in Colorado. Authorities believe that this strain of the virus is much more transmissible than the previous strains. The person who got this strain in Colorado apparently has no travel history so we have no idea how it got from England to Colorado. We do know however there’s not screening going on flights from UK. One thing that we think we know is that the vaccine more than likely is thought that it will work against the new strain.  Another strain that has just developed in South Africa may be much more concerning.  Some experts feel as though the vaccine might not be effective against it.  The concern here is that there will be even more strains to come.  

When in modern times is it OK to abandon your team, ie Florida, and just “opt out”?  Sure, it’s 2020-21. By all means don’t do what’s traditional and finish the season with your team. The team that got you where you are.  Nope, just leave ‘me in the dust to lose. Thanks all you 17 Florida guys that selfishly left your team to go get paid millions. You could have done that a few days later, but no.......But that’s the way it is now. And it’s why the pandemic has been so hard on us. It takes teamwork. Nancy Pelosi taught us it’s OK to not work and play well together. It’s just all about the individual. Where is our Ronald Regan of this time?  What would Vince Lombardi have said to those boys?  And thank God medical and science experts don't act like this.  

Maybe if we can look back at the worst year in history we can look forward with a rebirth of some kindness to our fellow man.  One thing’s for sure. Science and Medicine are here to stay in spite of all this political frenzy.  At my office old school rules, science and modern ideas in Orthopaedics gets tested to the limit and tried and true prevails. We are going to power thru into 2021 with some enthusiasm that hope is on the way. Happy New year Everyone. To 2020, good-bye. 

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Preamble to the United States Constitution

     We certainly have recently seen large number of discussions regarding the use of masks. Four of the five commissioners have  recently voted to mandate masks. Apparently this is to begin on December 11th. Although it's going to be very difficult to enforce reliably, it hopefully will increase the amount of mask wearing and thereby diminish the transmission of this unfortunate virus opening up room at the hospital for treatment of emergencies. I hear a lot of discussion with regard to our constitutional rights. The argument that it's against our constitutional right to be forced to wear a mask is incorrect. Lawyers and constitutional scholars have commented on this, courts have ruled in favor of imposing certain actions many times in the  defending the Constitution of United States duty to protect the public health. I found a very interesting article in “The Conversation” by John Flinn, a professor emeritus of government at Wesleyan University. I quote his article directly where he was discussing in some detail a group of people who filed a lawsuit because they didn't want to wear a mask:

       (The Florida residents were claiming) “mandatory masks violate the First Amendment right to speech, assembly, and especially association and mandatory masks violate a person’s constitutional right to liberty and to make decisions about their own health and bodily integrity.”  (then the author responded)

     “They’re not mutually exclusive claims: A lawsuit filed by four Florida residents against Palm Beach County, for example, argued that mask mandates “interfere with … personal liberty and constitutional rights,” such as freedom of speech, right to privacy, due process, and the “constitutionally protected right to enjoy and defend life and liberty.” The lawsuit asked the court to issue a permanent injunction against the county’s mask mandate.

On July 27, the Court declined to issue an injunction against the mask mandate. Citing Jacobsen v. Massachusetts, the Court found that “no constitutional right is infringed by the Mask Ordinance’s mandate … and that the requirement to wear such a covering has a clear rational basis based on the protection of public health.” More to the point, the Court continued, “constitutional rights and the ideals of limited government do not … allow (citizens) to wholly shirk their social obligation to their fellow Americans or to society as a whole…. After all, we do not have a constitutional right to infect others.””

     The case Jacobson vs. Massachucetts was in 1905. It upheld the mandate to have to receive the smallpox vaccine. As you know, smallpox was a horrific global killer and it was eventually erradicated by the vaccine. I encourage you to read his short article:  The Conversation.com under politics.  An acquaintace of mine is filing a lawsuit against the city over this issue. He clearly will be defeated unless he can change history by overturning historic landmark cases that have come before his that have supported the Constitution and what it stands for. As for me, I just don’t get what the big deal is.  It’s just a mask and it’s only for a little while.  It beats the massive shutdowns happening in California.  It also beats the heck out of more death and suffering. 

     On another note the Texas Department of State health services has said that Covid-19 vaccines will be distributed in four phases: phase 1 will be limited access to the vaccine because of the short supply. Phase 1 will mainly target healthcare emergency workers. Phase 2 is broader access allowing wider distribution to priority groups and to other parts of the public. Phase 3 allows for broad vaccination of everyone. Phase 4 is when vaccination becomes routine. The speed of distribution will depend on the national supply and it remains unclear how fast the state of Texas will reach each phase. The Texas Department of State health services has established a panel of 16 Texas lawmakers, officials, and physicians including seven Texas medical Association members to advise the Department of state health services on how the distribution will go.

     The centers for Medicare and Medicaid services has released a rule to make Covid-19 vaccines available at no cost to Medicare, Medicaid, and CHIP patients. Practitioners who administer the vaccine to the uninsured will be able to receive payment to the provider relief fund. This is good news for all of the people.

     In the world of shoulder surgery, a recent journal article in the American Journal of sports medicine predicts shoulder pain in youth competitive swimmers. The study by Dr. Feijen used a regression model that demonstrated the strongest predictors for shoulder pain were regional competitive swimming level, workload ratio, posterior shoulder muscle endurance, and hand entry error. The exercise program will use in our office is a derivative of the UCLA model emphasizing scapular muscles. Building shoulder muscle endurance through an effective kinetic chain exercise model has been effective for swimmers that we have treated. The hand entry error is new data that hopefully can be communicated to swimming coaches to improve techniques. https://doi.org/10.1177%2F0363546520969913.

     For those of you that might be interested the state of Texas is now requiring that mandatory prescription drug monitoring program check be performed on all patients being prescribed controlled substances for take-home use or when leaving an outpatient setting as of March 1, 2020. As you might be aware this is going to create frustrations for you and I.

     On the subject of diet very interesting article was just published. Dr. Turnwald studied the nutritional analysis of foods and beverages depicted in the top grossing United States movies from 1994 to 2018. I bet you can guess. The study conclusively demonstrated that popular US movies depict an unhealthy diet that fails national dietary recommendations. He concluded also that depicting unhealthy consumption in media is a social cultural problem that extends beyond advertising and branded product placements. JAMA Intern Med. Published online November 23, 2020. doi:10.1001/jamainternmed.2020.5421. If you're interested in healthier diet read Dr. Gundry's book “Plant Paradox”.

     On the subject of exercise, Dr. Ferrari studied the national cohort of 403,681 adults. They found an association of high-level physical activity that was intense decreased mortality once and for all proving without a shadow of a doubt heavy exercise is good for you. The study recommended 150 minutes a week of sweat and heavy breathing.

JAMA Intern Med. Published online November 23, 2020. doi:10.1001/jamainternmed.2020.6331. If you want a much simpler read on this, read “Younger Next Year” by Crowley.  

     For now we're still at full speed in the clinic and in the operating room. Because the pandemic some of you have cases that we postponed for a while until the hospital settles down. Hopefully it won't be too much longer. Even more hopeful is that the vaccine shows up soon.

"We need hope, or wlse we cannot endure"  Sarah Maas

     The President of the American Medical Association interviewed Dr Fauci for some insight into the pandemic.  There were some key points.  We have 6 candidates for the vaccine, 2 are almost here in our city.  Who will get it and who will take it.  There will be anti vaccine activists just like always.  Just remember, back in the days of smallpox, only the anti-vaccinators died of smallpox.  It will be the same here. 

     He commented on the use of dexamethasone which clearly diminishes the death rate.  He discussed clots and the more common uses of anti-coagulation protocols.  His thoughts on remdesivir cautioning physicians that they shouldn't expect it to do more than we know what it does, which is shorten, not lessen, the disease.  He spoke about the hope of the vaccine and how to study the many candidates once we have one that works.  If someone is in a trial with one of the other candidates, then he suggested we take the placebo group and give them the one that works, that way we can study which one works the best.  He was positive about the current efficacy. 

      Most importantly, he discussed the "long haulers", or those that are affected for months after being infected.  The concern was that the findings are real and serious in some cases.  When asked about how long you are immune if you get it he suggested that it might be longer than a few months but not forever. 

     I want to say how well our healthcare workers and doctors have handled the pandemic by putting their lives on the line to care for the people.  It's a proud day for medicine and all healthcare workers that have been the only glimpse of hope for many in this difficult time.  To the 4 commissioners that voted to try and design a healthier city with a stimulus to wear a mask, all of us in the medical community thank you very much.  To the Mayor who has pleaded with us to wear a mask, thanks Mayor.  To those of you that support the mask in crowed areas great job. 

     Happy Thanksgiving to all. 

      “Sensible people will see trouble coming and avoid it, but an unthinking person will walk right into it and regret it later.”         Proverbs 22:3

      Many of my friends currently have COVID-19. Of the people I know, most of them have gotten it from their children. It truly is unfortunate because most of our children don’t wear masks. In fact when you go to the grocery store, many people in the grocery store don’t have a mask on.  This is an unfortunate sign of our times.

      Dr. Michael Osterholm, Director of the center for infectious disease research and policy at the University of Minnesota says “the darkest part of the pandemic is approaching”.

      The intensive care units in Amarillo are full.  The overflow of ventilator patients are being treated in other areas making the capacity of the hospital reduced for any emergencies that may occur. Super spreader events occurred multiple times in the city over the weekend. People take the virus head on with reckless disregard for the safety of those with greatest risk.  The mayor has requested for us to wear masks but still there is no fine, no penalty, no way to enforce her request. The governor will most certainly take action. However, he’s not here in Amarillo. He’s not making the call based on anything but the numbers. Only our local government knows what really is happening.  I’m expecting as I write this that he will impose restrictions that would otherwise be unnecessary if everyone wore a mask.

     Since AMERICA, especially Amarillo, has decided that masks won’t be required, the pandemic will grow to undo proportions not seen since the day of smallPox.  Edward Jenner, in 1796 developed a vaccine that saved the world.  The new vaccine so far is hard to store, hard to transport, and only 90% effective if perfectly handled.  Not ideal.  
      For those of you that read this, and thanks to the 13,000 visitors a month that do, here is a list of what I do.  Now don’t get me wrong, I can die from this just like anyone else, but I want all of science on my side if (and probably when) I get it from someone at the grocery without a mask on.   
  
Vitamin D 10,000 units a day

Melatonin 5-10 mg at night

Pepcid 40 mg a day at night  (the study had higher doses if you got it)

Quercetin 500mg a day

Vitamin C 1000 mg a day

Zinc 30 - 100mg a day

     Get sleep, control your medical problems ASAP, see your regular doctor please don’t skip that part, eat a low inflammatory diet.  Order Gundry’s “Plant Paradox” on Kindle or Audible.  And number one for sure, wear a mask.  

     For those of you that have had it, you can get it again. If you have a burning desire to see what that’s going to be like read the following reference:  doi.org/10.1016/S1473-3099(20)30783-0.  

      I will certainly update this website the minute that anything changes for any of your scheduled cases for surgery. For those of you that are on the schedule, as of this moment it’s a go.  That could change.  Encourage your friends and family to wear a mask so we can fix your problem.  

Nov 1, All Saints Day.    

     “ Lord make me an instrument of your peace; where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light; and where there is sadness, joy.” 

Saint Francis

      Across the world today someone gets the virus every 4 minutes in some places. In Taiwan there are very few cases. Just 7 deaths.  They wear masks.  The USA is on the sharp rise. We don’t wear masks uniformly. 

      Europe has imposed  strict lockdowns as the virus has began in earnest  the massive second wave. France has been overwhelmed. France is closed. Spain is in a state of emergency.  Italy has curfews. 100,000 people get the disease every day in England according to a recent study there.  Dr. Fauci says it may be 2022 before things are back to normal. The second wave hit Russia pretty hard. Their new vaccine called Sputnik V hasn’t been adequately tested or distributed. What makes that worse is that they are only giving it to people 18 to 60 so the elderly, the most exposed, are not able to get vaccinated at this time.   In Germany they will close the country for all of November. Moderna Is getting closer to a vaccine. 

     76,000,000 have already voted. Early voting is less common in the swing states of the Midwest.  One thing is for sure. Everyone has decided who they will vote for and how they will continue to handle the pandemic. Clearly a very large number of people have decided that mask wearing is not for them. In spite of the Mayor’s recent plea for masks, some people still refuse. Some business owners, some quite prominent, continue to allow people to enter their store and receive service. Behavior has already been set in stone. This late request 8 months into the tragic Chinese laboratory virus is long overdue and packed with zero punch. What’s the penalty for infecting all your fellow grocery shoppers?  Absolutely not one thing. How does it work in Dallas, Houston, San Antonio and most of the rest of America? No shirt, no shoes, no mask-no service.

      The policy in Dallas county: ‘Businesses can be fined up to $500 for each violation of the order if they do not "develop and implement" a health and safety policy within five days of when the order went into effect. The order technically went into effect on June 19, at 11:59 p.m., so businesses will need to have their policies in place no later than Wednesday, June 24. The newest policy is as follows affecting individuals and incorporating the governors declaration:  “Following a verbal or written warning for a first-time violator of this face covering requirement, a person’s second violation is punishable by a fine not to exceed $250. Each subsequent violation is punishable by a fine not to exceed $250 per violation. Local law enforcement and other local officials, as appropriate, can and should enforce this executive order, Executive Order GA-28, and other effective executive orders, as well as local restrictions that are consistent with this executive order and other effective executive orders. But no law enforcement or other official may detain, arrest, or confine in jail any person for a violation of this executive order or for related non-violent, non-felony offenses that are predicated on a violation of this executive order; provided, however, that any official with authority to enforce this executive order may act to enforce trespassing laws and remove violators at the request of a business establishment or other property owner.” ‘

     So there you go.  Just the facts.  So what’s going to happen?  According to world famous Mathematician Tom Britton from Stockholm University, published in Science this summer, there are 3 conclusions about developing herd immunity. Now a word of caution to those of you who will look it up.  The article is deep in math. Very deep. Nevertheless and very importantly, the 3 conclusions Dr Britton has are as follows:  

      1.  At this time all regions need preventative measures (masks)

      2. Disease induced immunity gets us closer to herd immunity than vaccine induced immunity.

      3. Regions with low overall immunity need more precautions than regions with higher immunity. 

     What’s the biggest problem here?  Disease induced immunity may not last. So you can get it again.  We will likely rely on a vaccine. This is just like smallpox was. It took a vaccine. 

     What happens when a hospital gets overrun with patients that need treatment?  Ironically in my Orthopaedic training at the University of Kentucky remember the only time I ever slept when I was there. It’s called treat and release. The ICU’s fill to capacity.  The recovery room becomes the ICU/recovery room.  When it’s full, the Operating rooms become the ICU until there are no more operating rooms. Then it’s treat and release. Divert to nearest hospital all other trauma.  At some point there becomes a moment where serious life or death is now determined by available medical facilities and available doctors and nurses. So that’s where we are headed and all we have to do to avoid it is wear a mask. Since it’s pretty clear that isn’t going to happen in Amarillo without some stronger rules, I think those of you that understand try hard not to have a heart attack or brain aneurysm while those “freedom to choose” no maskers go on trucking into the newest restaurant without any preventative measure. 

     I have talked with some of you about postponing surgery at this time. I am quite sure I will have this discussion with more of you in the future. Let’s all join in so as many Orthopedic problems can be solved as possible before it’s too late. 

“Those that deny freedom to others deserve it not themselves”.      Abraham Lincoln

      Dr Fauci says the next 6 to 12 weeks will be the darkest period in the pandemic.  Experts agree that this will be a difficult time for many. Covid is on the rise and all but two states as people have grown tired and weary of the restrictions. However that seems to be somewhat geographic. I’ve traveled to Colorado, Houston, and Dallas recently. In South Fork and then Pagosa Springs everyone has a mask on. Everyone in Katy Texas has a mask on-Everyone.  Everywhere. In Dallas everyone wears a mask. Everyone. Austin also, everyone has a mask on. People visit Amarillo and are horrified and shocked to see we have no policy in place in Amarillo or compliance with masks like they have in their cities. .  In Amarillo, nope......... so what’s the difference? The attitudes of the city leadership. Let’s take Houston for instance.  Houston mayor Sylvester Turner created a mask up campaign, a grassroots public health information campaign to encourage Houstonians to continue to safeguard themselves using masks. He has posters everywhere and has famous athletes and stars like rap artist Slim Thub, Tennis champion Simone Biles, And Astro’s player Carlos Correa on posters with him with the slogan “Mask Up !” .  Houston police issue citations for no mask.  Way to go Mayor Turner!  What do our city leaders say?  Nope, we’re not doing that. The Governor says comply.  Do we......nope.  The Mayor’s office is no longer accepting opinions while Amarillo becomes a major hotspot again.  Wow...  Don’t be surprised when they turn you away for your long awaited surgery. It won’t be long if we keep this up. It’s not that hard. If the entire population of Dallas can do it, we could too.   In Amarillo last month we roughly had about 1/4th of the COVID related DEATHS that the entire country of Canada did in that same time. Just so we all understand how things are going here in Big A.  Look at the map. Canada is HUGE and Amarillo is like a spec of pepper on your dining room table to put it in perspective.   We are doing worse in one little city of 200,000 than 37.59 million people. Or to make it fair since we are 1/4th the COVID death incidence of their entire population:  let’s say we had as many deaths here compared to 9.4 million Canadians did in that time. That’s ridiculous and completely preventable. 

      A new study Https://mbio.asm.org/content/11/5/e02590-20 demonstrated that if you want donate plasma after you need to do it sooner rather than later for it to work. We all know you’ll get it more than once if you don’t take precautions. The immune response diminishes rapidly. 

      Scientist Peter Hotez, a vaccine researcher, warns that we might likely double the current world number of cases. Deaths in the world so far 1,124,519.   This is likely going to happen in the next months.  Highest state in USA;  Texas.  An article in medscape agrees. Reference is  Institute for Health Metrics and Evaluation: “COVID-19 Projection”.

      Annals of Rheumatic Disease reports increased risk to patients on chronic steroids. Previously they reported patients on Biologics showed no increased risk. So steroids chronically may be less desirable.  Humera or similar probably no problem. 

      The Department of Defense reports that risk of getting COVID on an airplane is “virtually nonexistent” if everyone wears a mask. Wow, what if we wore masks in Amarillo?  But I already went over that. Just say’n.........

     Nasa researchers know a lot about social isolationism.  Right now in America loneliness and despair has affected 40 to 50% of the population.  Health treatment experts are teaming up with NASA to study what we can do to improve this growing impact on our mental health.  Look up "Creating a new healthcare" a podcast with Dr Zeev Neuwirth.

“Your life is yours to love, no matter how you choose to live it.  When you do not think about how you intend to live it, it lives you.  When you occupy it, step into in consciously, you live it.”

Gary Zukav

      The numbers of cases are on the extraordinary rise.  Let’s revisit the Spanish Flu for just a minute.In April of 1917 the United States entered World War I. Lots of medical personnel were called to duty. Fort Riley, Kansas was an important training facility for soldiers and in March of 1918 the Spanish Flu was born in the USA at this training facility. Six months of disease spread throughout the Country.  But then what happened? In May of that year literally hundreds of thousands of military personnel traveled to Europe each month. The flu

resurged at another military camp in Boston in September. Over the three months from September to November, the second wave of the virus broke out and was responsible for the majority of the total 675,000 deaths in the United States. In November World War I was

over, and the pandemic resurged as celebrations occurred and military personnel began returning home. By the end of the war, our military had 4.7 million soldiers and they were all over Europe and were grouped together both in battle and while coming and going across the Atlantic. So let’s remember, it was the second wave that killed everyone, but don’t forget, there was also a third wave and the whole process was a year and a half.  All in all, 50 million people died in the world.  When the really cold weather sets in, I’m betting any public place will be a lot like those men and women experienced on those ships coming back across the Atlantic.  

     Advanced Science news reports this month on some great news about the flu.  Researchers at MIT and Harvard are close to designing a universal flu vaccine that could work against any strain of flu.  It’s now coming out right away but it looks promising.  What if you could take a shot or two and be immune to all flu strains?  I think a lot of people would be really helped by such a development.  And consider this:  these famous scientists aren’t even playing political gamesmanship or kneeling before the experiment.  I don’t know how that’s possible. How did we ever do it before all the madness?

     James Gallager of the BBC did a report on “long covid” where he reported on patients with COVID-19 for many many months.  He quoted the Journal of the American Medical Association which did a study on 143 people with symptoms for 2 months or more.  87% had at least one symptom, Fatigue being the most common then shortness of breath, joint and chest pain, cough, loss of smell, headache, loss of appetite, loss of taste vertigo and muscle pain.  There was no link on how severe it had to be to have the “long covid”.  It is theorized that the virus is cleared from most of the body but hangs around in pockets.  

     Really obese patients have to be ventilated sometimes in the prone position.  Peripheral nerve damage unfortunately is all too common.  Colin Franz, MD suggests the protocol used in surgery by surgeons be adopted to these patients.  This came out of the Journal of British Anestheseology in September.  

     Smallpox killed 350,000,000 people, yet no one dies from it today.  And why is that?  A vaccine created by Dr Edward Jenner in 1796.  So I hear a lot of talk about how many will not take the vaccine once available.  The choices we make change the future.  HIV killed millions and thousands still die.  However, if you live in a country with great healthcare and have access to antiretroviral drugs, you can lead a long and healthy life with HIV.  How will this pandemic end?  Hard to say because everyone took the smallpox vaccine.  I’m thinking with all this diversity and hard lined diametrically opposed viewpoints in out country there will be resistance to taking the vaccine.  As for me, sign me up.  

     A new test, as reported in Science Magazine, is cheap, reliable, and takes 5 minutes. Researchers used CRISPR gene-editing (identifying a small segment of the RNA virus) to identify the SARS-CoV-2.  They make a segment that will attach to 20 RNA bases to bind it in solution.  Then get this:  they introduce the “scissor gene” to cut up the virus releasing fluorescent particles you blast with a laser showing the fluorescence lighting up and in 5 minutes you know yes or no with extreme reliability.  Jennifer Doudna won the nobel prize in Chemistry recently for discovery of the CRISPER.

     Francis Collins is the director of the NIH (the National Institute of Health).  He said “I know there’s a great deal of anxiety about mischief here.  It would be pretty darn hard for mischief to derail this process.  And I hope everybody can start to get calmed down about that.”

     In the The New England Journal of Medicine, Dr Beigel, et al describe and prove that remdisivir is effective in treating the virus.    If you have a burning desire to read the article here is the reference:       DOI: 10.1056/NEJMMoa2007764

     In more news, CPAP patients have more complex cases of COVID, obstructive sleep apnea associated with greater risk, IgG antibodies still detectable 3 months later, the US has 7,607,950 cases with 650 deaths per million population.  Guess what?  We are number one in the world for number of cases.  https:..coronavirus.jhu.edu/map.html  

     Football is back. The coach of LSU, ED Orgeron said they didn’t have any COVID around the team, most of the young men just had a runny nose……………….hmmmmmm.  At least most of the young people aren’t devastated by the disease.  I think a lot of us are glad college football and school is back.  Our kids are suffering thru a lot of rules and regulations, restrictions, and for the most part are struggling on their own to survive.  It will either create a whole new generation of self sufficient hard working self taught motivated go getters, or it will be a disaster.  Educators are being tested to their maximum levels, and thank God they are up to the task.  

     I hear there’s an election coming up.  We’ve never seen anything like it before and I hope we never see anything like it again.  Just remember, your great doctors, nurses, staff, personnel are out there on the line no matter who you vote for or if you even vote.  Wear a mask in the hospital and the office, all of us are grateful for your courtesy and selfless sacrifice.  

     "When it comes to luck, you make your own."  Bruce Springsteen

      A new study in Beckett's Hospital review found that 40% of healthcare workers that were tested for Covid-19 were asymptomatic.  Researchers in Hong Kong say they've confirmed you can get it twice.  A city in Brazil that was devastated by the virus has reached herd immunity.  The Governor of Florida lifted all restrictions on business statewide.  And the list goes on.  By now everyone has an opinion, everything's political, and 50% of the people disagree with the other 50%.

     Facial masking is the single most discussed part of this.  Let me give you some evidence why it might be a good idea to wear a mask in crowded places.  Monica Gandhi MD published an article in the New England Journal of Medicine on Sept 8, 2020.  Hot off the press.  Their study demonstrated that mask wearers are exposed to much smaller doses of the virus.  So if you get a dose of Covid-19, do you want a big sneeze right into your face or a few tiny particles of RNA virus?  It's like asking if you want to quickly touch and pull away from a hot surface or hold a burning coal in your hand and squeeze it.  Of course we all want the tiny amount or none at all.  So this study compared getting a tiny dose to Variolation, a process of giving a person on purpose a tiny dose of smallpox to make them immune before we developed the actual vaccine.  Maybe this is why so many people are asymptomatic.  And what's the downside to a mask?  As a surgeon, I wear them all the time.  I'm used to it.  So no big deal.  One doctor ran a marathon in one to demonstrate the lack of effect on getting oxygen.  His performance in the marathon was impressive. 

     Let's be clear, most people do OK.  But to Hanna Lockman of Louisville, KY, it's a nightmare.  It's 5 months now and she still has it.  She's has been to 16 ER visits and been in the hospital 3 times.  Her memory has been affected.  Overall, 10% of people that get it have prolonged symptoms.  Look it up:  JAMA, doi:10.1001.2020.17709

     It's not over.  It's about to start being cold and we are going to go inside.  All the people packed into the sardine can.  No breeze, no reverse pressure ventilation.  Dr Puntmann did a study this last July that demonstrated that in 100 patients tested that had Covid-19, 60% had ongoing cardiac inflammation on their cardiac MRI that was not present prior.  So buyer beware.  It's not over people.  Stay vigilant in crowded places.  Weigh your risks carefully. 

"Ideas stand in the corner and laugh while we fight over them”.   Marty Ruben

    The pandemic has stirred up all kinds of controversy. In fact there’s something to say about almost everything that half the people will agree with and the other half will not agree with. Here’s a new topic for discussion those of you that like to have lively conversations battling out opinions with friends and acquaintances.  The governor of California, Gavin Newsom, signed assembly bill 2147 making it possible for inmates to be cleared of all charges if they’ll fight fires during their prison time. After their sentence is over they would be eligible to have all their charges dismissed completely so they can be EMTs and firefighters and work in public service. There’s something to distract your conversation away from this crazy virus. Good news though, murderers and sex offenders wouldn’t be eligible, just robbers, theives. Looters, and people like Martha Stewart.

      In a study by Dr. Christian Happi, Professor of molecular biology and genomics at Redeemer University, seven different lineage classifications of the new Sars-CoV-2 have been identified. Basically a lineage is a change in the virus that makes it easy to track. A change in the lineage does not change the virus enough to change the encoded viral proteins. This is going to help scientists track the virus around the world and help with isolation of the sources of the spread.  If you’re a scientist this is an exciting new development.  The virus does appear to be mutating and the current version seems to be the most communicable.  Scientists are getting really excellent in actually mapping out every bit of this virus and are studying every avenue to beat it.  That’s one reason that vaccine development is going faster.   So let’s give the scientists credit where it’s due. The Politicians aren’t in the lab. And the virus doesn’t care which political party is telling the world they can fix it. And frankly, I don’t think the scientists care about the political parties either. 

     There’s a great discussion in scientific American about the virus if you’re so interested. A famous virologist at the University of California discusses everything about it. Check out scientificAmerican.com.  It’s the September 9, 2020 version. The website is just fantastic it’s got all kinds of great interesting stuff on it.

     The Robert Wood Johnson foundation and Harvard’s T H Chan School of public health found that one in every five Americans in major cities nationwide say they were unable to get needed medical care for a serious problem because of this pandemic. Let’s all be glad we live in a smaller city.  Maybe Obamacare isn’t the perfect answer. 

     In the BMCMusculoskeletal Disorders volume 21 article number 561, Dr. Christopher found that female athletes use more nonsteroidal anti-inflammatory’s than male athletes.   Oddly enough, there is a new study underway suggesting that nonsteroidal anti-inflammatory medicines may actually help with coronavirus.  What we do know is that female athletes need to understand the risks of nonsteroidal anti-inflammatory use. What we don’t know is if female athletes will have less severe cases of Covid because of their use of NSAIDS.  Maybe so.

     Dr. Judith Feinberg, the vice chair woman for research in Madison at West Virginia university made the comment that there is an enormous pressure  to develop the vaccine prematurely.  The nine major drug companies have made a pledge that they will not release a coronavirus vaccine without adequate and efficacy data from large high-quality clinical trials. What this tells me is that as much as we would like the vaccine to be available really soon it may take a little longer than we thought to scientifically prove it out for safety. I know that’s exciting for me because  I will be one of the healthcare providers that has to take it as a mandate to be able to go to work at the hospital.  

     Ann Reed, the executive director of the national Center for science education, successfully sequenced the genetic make up of the 1918 influenza virus back in the early 1990s.  The flu that we have in our current world is a genetic variation of that original pandemic flu. She said “In a sense the 1918 pandemic is still with us”.  The coronavirus will be a lot like this. As it mutates, It will continue to float around the world for hundreds of years to come hopefully in a much less severe strain.  

     For those of you big Grey’s Anatomy fans, Ellen Pompeo who plays the famous Dr. Meredith Grey dedicated the new season 17 to healthcare workers working in the Covid pandemic. I love Grey’s Anatomy. Believe it or not residency was kind of like that. It’s just that we weren’t all that good looking.

     On the other side of all this discussion about viruses, the Francis crick Institute has extremely smart scientists that have grown human intestinal grafts using stem cells from patient tissue that could one day lead to personalized transplants.  We can start the big ethical dilemma conversation on this one for sure.  If you’re one of those holding up a big sign and protesting this you’ll be holding it up a long time because science is advancing at a pretty rapid pace. I think will see this happen in our lifetimes.

     On the orthopedic surgery side we’ve made a few changes to our preoperative patients. You’ll be asked to use benzoyl peroxide and chlorhexidine in your prep. Interestingly this really lowers infection rates. This is brand new and we’re on it.  However, I have only seen a few infections in my whole career. If this lowers that rate then maybe I won’t see this much more at all. Wouldn’t that be peachy?

     The CDC just finished a study on over 300 subjects. What they found was that about 70% plus or minus of both groups in the study wear their masks in public all the time. They separated the two groups into the half that got Covid and the other half that didn’t have it. After studying all the questions that they went over the only common thing  about the half that did get the virus was that they ate in restaurants and the other group did not.  This isn’t the news I was looking for.

     The journal of science just released a study that found that people with obesity who contracted this virus were 113% more likely than people of healthy weight to land in the hospital. They were 74% more likely to be admitted to an ICU and 48% more likely to die.  In addition to the fat cells infiltrating the organs that help make the white blood cells that fight infection, fat cells also increase low-grade inflammation. The fat cells themselves secrete several inflammation triggering chemical messengers called cytokines.  This combined with the actual mechanical pressure upward on the lungs causing them to collapse and collect clots and be A fertile ground for the virus to proliferate lead to a much higher complication rate in this group of patients according to Dr Messaoudi, an immunologist who studies host responses to viral infection at the University of California, Irvine.  This isn’t surprising because if you talk to rheumatologists and cardiologists all over the country they are convinced that obesity is an inflammatory disorder that leads to these inflammatory changes in the arteries that creates so much heart disease and atherosclerotic vascular disease.  Today is a good day for all of us to start our diet.

      For those of you that have a burning desire to really understand the research about the vaccine here you go:  An mRNA Vaccine against SARS-CoV-2 — Preliminary Report New England Journal Of Medicine. July 14, 2020

DOI: 10.1056/NEJMoa2022483.   Just go to NEJM.org. Lisa Jackson lead author

     Until the next blog, stay safe out there. But we all must live on.  This is the new way for a bit longer. 

     "An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it."  Mahatma Gandhi

     A Hospital in North Dakota is paying bonuses to staff taking care of Covid patients while college students gather by the thousands and carry on with social activities.  What in the world is everyone thinking?  While it might be easy to criticize the college students, they may bring us closer to herd immunity or at least not bring it home at Thanksgiving.  By the way, how good were you in college?  Me neither. 

     I think we all know the facts by now.  We've made our choices, have our beliefs, and are moving forward.  Bolder and braver, we go to the hairdresser, get the toenails done, shop everywhere.  Many still wear masks here in Amarillo.  In the big cities, almost everyone wears a mask.  That's why we are seeing some control of this problematic unusual viral illness.  It's far from over.  Cold weather threatens to bring us all closer and inside.  Experts predict the second wave. 

     Doctors are getting better and better at treatment.  New developments unfold as the vaccine gets closer to deployment.  Of course, the non-vaccinators anti-mask faction will hold their signs up.  But they won't be immune, so they will spread it around.  In Texas, it's now lawful for schools to refuse the non-vaccinators admission to class.  Political upheaval, personal choice, freedom to choose.  It's all up for discussion as the election pundits give Biden the edge.  Is this just a political scheme?  For sure they are using it as a tool, just don't get complacent and believe it doesn't exist.  It's real.  Also don't forget what the media said about this time before the last election. Hillary was a shoe in.  The media is about as factual on everything on the pandemic and election as the comic books that we all remember by Marvel. 

     The flu is here.  Go get the shot.  Recent research suggests that the mild common cold infection with rhinovirus jump starts your immune system and protects your airway from influenza.  Wow.  Now we want rhinovirus, don't want the flu, don't know if it's covid, rhino, or influenza.  Let the ER's prepare for war.  If you keep wearing a mask and washing your hands you may avoid it all.  But don't worry, we've got the "expose yourself to everything keep your immune system strong" proponents to keep it all active.  They will change their mind when they have influenza and Covid and secondary bacterial pneumonia.  That is, if they live through it. 

     The CDC has asked states to prepare a plan for distribution of the vaccine as early as late October.  So this will be the next political tool and source of social unrest.  Who gets the vaccine?  Will it be mandated by hospitals as a requirement for staff privileges?  Who will decide who gets it?  Looks like the Governor will declare the rules according to CDC director Robert Redfield.  Dr. Paul Offit, a professor at the University of Pennsylvania says the timeline for October is unrealistic.  He advises the FDA.  Fauci says it will be ready.  Professors say he's wrong.  Who's manipulating what at the FDA?  So much discussion.  I'm going to wear a mask and wash my hands, take the zinc and Vitamin D and hope when I get it I do well. 

     Just remember,  everyone can get it.  Even the super buff superstar muscled up super in shape "the Rock" Johnson got it.  He said "this was the most challenging and difficult thing we have ever had to endure as a family".  So take a moment to stay vigilant, and if you've had it go give some plasma.  Save a life.  Karma is real. 

“ Our different perspectives and priorities seem to have shaped our pandemic response styles and pitted us against each other in some way that I fear we be detrimental when it comes to this pandemic: less solidarity, Widening rift between groups of people, more infections, more lives lost.’  Evelyn Lai, pediatric nurse practitioner.

      2020 has turned out to be a great year, right? Not so much. I think most of us would give it one star not recommended. To make all the craziness seem more chaotic, NASA just released an announcement that a meteor will possibly hit the earth on the day before the election. Good news though, it’s only 6 feet wide and only has a 0.4% chance of hitting the earth,  Really? You’ve got to be kidding me.

     It seems to me we are so overloaded with media mis-information we forget we’re in a pandemic. In a recent study Jolanda Sabatino MD “magna Graecia”University, Catanzaro, Italy and colleagues analyze data from 21 published observational studies on a total of 77,317 patients hospitalized for Covid-19 in Asia, Europe, and the United States. Cardiovascular complications were noted in 14% of hospitalized patients with Covid. 

      Another study in the European heart journal demonstrated echocardiogram abnormalities and 55% of patients tested. So take note. The college students are taking it on. They are proceeding with little or no fear with parties, gatherings, and a full social life. They will probably be fine. If you are in a young college-age low risk group you might want to remember that we are in a pandemic. Not all of them will escape unscathed. 

       Dr. Zaafran, The Texas medical Association president removes banishment of hydroxychloraquine as a treatment. Alternative treatments are OK as long as the doctor tells the patient the potential side effects. So now we shall see if anyone can research this and find evidence that it can be used for prevention. It takes weeks to get into your system, so it might not work if the disease process is well underway. Who knows, lots of doctors take small doses as a prophylactic agent empirically based on the way the drug works. Most of the frontline guys are secretly doing it. The TMA also recommends reminding patients that have had Covid to give plasma. It really helps when given in the early phases when paired with the drug everyone is talking about remdisivir.  Save a life.  Go for it.

      Researchers in California discovered a nano antibody, smaller than a regular antibody that is easily reproducible and might work on all coronaviruses. Even the common cold. I hope this turns out to be great. I am tired of Covid and I am really not a fan of the common cold, another coronavirus. Here is the reference, enjoy:       https://doi.org/10.1101/2020.08.08.238469

      Studying autopsies, pathologists reveal the lung and organ damage from Covid is much worse than expected. A recent study demonstrated that it can also cause anemia, long lasting cognitive changes, even permanent or poorly recovering sense of taste and smell. Definitely it is something you would hope to avoid. Who wants to taste the pizza?  Everyone of course.  So what’s it going to be, wear a mask, give up or at least keep trying? You tell me. It’s America.

       The office is in full swing. Telemedicine is for the next pandemic or if the next wave is out of control. We apologize for the no visitor policy, it’s to protect you. The mask? It’s a mandate from the Texas medical board. 

      Chinese president Xi said we would bathe in a sea of coronavirus. It’s like he knew exactly how it would play out. There are only a few possibilities..........

      My duty is to support and protect you. My job is to address and to fix your problem. We will make it through this. Let’s just work together.

      Many of you have asked about masks. Scroll down to my blog on Wednesday, July 8. There are a couple of nice videos to explain how it works. By the way it drives me crazy too!

"Some issues are only huge if ignored"    Amy Guth, Three fallen women

    
     Baseball's Covid outbreak.  All that tells me is that there is still a lot of work to do.  Now we all know someone that's had it.  Nope, it's not going away November 5th. 

     Texas is seeing a big drop in testing.  Is this because it's going away?  No, it's because we don't have as many "tester's".  Not as many people want the test.  We're back at school.  We are back to football.  Not testing means not knowing and not knowing means we are spreading it around without keeping track.  This is just leading to a big rise as flu arrives in the city.  By the way it's here go get a flu shot.

     The CDC reports that there is a big rise in pediatric cases.  We all heard they weren't going to have a high incidence.  I'm guessing this was incorrect as they are getting it. 

     A new saliva test has arrived.  They approved it for "emergency testing".  No one really knows how accurate it is.

     So what to do?  Everyone is back to everywhere.  Our office is 100% live we haven't done telemedicine in a week or more.   Two easy things to do right now.  Really easy.  First supplement with zinc.  Zinc deficiency has been show to be associated with more severe cases.  Also, take 5000 IU of Vitamin D.  Studies are demonstrating that the lower the Vitamin D level the more severe the symptoms.  The higher the Vitamin D level is, the less severe the disease seems to be.  These two things have some real promise to be correct.  And there is enough evidence out there to support it's use. 

    Here's the evidence about Vitamin D and more stuff you need to know about why to take it:  https://youtu.be/Mdc7T2UTHBI

"Endurance is one of the most difficult disciplines, but it is to the one who endures that the final victory comes."  Buddha

     The University of Texas has successfully redesigned a key protein from the coronavirus which has made it possible to produce vaccines much faster.  Those Longhorns beat my Aggies to it, but great job guys!

     Dr. Larry Brilliant, an epidemiologist who was part of the team that helped eradicate smallpox says the world will fight coronavirus for the next 3 or 4 years.  But good news.....just like smallpox, we are going to immunize our people and the disease will fade from here as we chase it down and try and beat it into submission in some countries with less medical prowess.  

     Dr Ashfar, a high risk obstetrician at UCLA says pregnancy makes women's bodies more vulnerable to severe Covid-19.  Some good news though, fetal infections later in pregnancy appear to be rare.  

     Politicians have really gone off the deep end both ways.  Everyone has an opinion.  No one can agree on anything.  This isn't helping anyone.  I think America will tolerate this less and less.  What will it come to?  Just remember, this virus doesn't vote or affiliate with one party or another.  It doesn't have an opinion.  It's not upset or confrontational.  This is about all of us together against an emotionless virus.  It's time for the politicians to graduate from kindergarten.  

     Here is one thing for sure.  It's something we have to live with for now.  People with masks will have much lower incidence of this virus.  As the office goes back to full swing with telemedicine available to anyone who desires it,  I grow more used to the mask.  It takes time and patience to make this part of your routine.  We're still here just like always.  Stay safe out there.  

Here's a quick blip on  one of the vaccines:  https://youtu.be/Z6yZohCRm8A

"You must be the change you wish to see in the world" Mahatma Gandhi

     Louis Gohmert, the US Representative that runs around the capital without a mask has Covid.  He's the activist that wants the democrats to change their name due to their association with slavery.  It's a great example of feeling bullet proof.  We all are at risk.  Would Louis have gotten Covid if he would have complied with the mask mandate?  My money says he'd still be flapping his wings about name changes and be in Texas with Trump.  That's the thing.  Don't get this virus and then look back and wish you'd worn a mask to the store.  Be the change you wish to see in this world.  The part that's over Nov 5 is the political strife and bitter conflict of left and right.  This virus doesn't vote. 

     A recent pole of 20 medical experts was taken regarding sending kids back to school.  Most specifically, their kids.  6 are sending them back, 6 are leaning home school, and 8 are "wait and see", which is a way of saying "I don't have a clue what to do".  So if you're torn about the idea, join the club of experts that can't agree. This pediatrician has some advice.  She’s got a point....

                https://youtu.be/XwG5UqbePj8

      See what’s happening in Spain. When they took off the masks......

                https://youtu.be/GQNXsTFStYk

      Here’s the expert from Mayo Clinic, Dr Greg Poland, his take on vaccines for us all and the rare but serious complication of COVID that’s happening in children:

                https://youtu.be/PII7B2-D6xg

      Once again the ICUs are filling up. This is real. Some good news however, our really good doctors are figuring out better ways to treat it. See my video if you blogs ago about masks. If you haven’t seen it it’s worth taking a look at. Here’s a couple of links that I thought were particularly interesting:

https://youtu.be/H2azcn7MqOU

     This is pretty long but it’s one of the nations leading medical physicians and professors who knows a tremendous amount about pandemics and viruses. I will warn you that this video is for the truly inquisitive with an academic interest in the disease itself. These are a bunch of doctors that do research and have huge experience with the topics they are discussing.  Although you could find another physician that might have a slightly different point of View, you can probably rely on the fact that this is not overwhelming mis-information that one out of four things on Facebook has.

https://youtu.be/Cio3rh6ta3w

"We all do better when we work together.  Our differences do matter, but our common humanity matters more"  Bill Clinton

     It gives me some hope that time has passed and we are working on solutions.  This pandemic is challenging for all of us but the wearing of a mask has become more common and so now we can more safely just go back to life as it was with only the mask being different.  This is a good video by Dr.  Maria van Kerkhove.  

              https://youtu.be/677pSwGauqs

     So rumor has it blood type has something to do with how severe corona virus symptoms are.  Here's the facts:  Type O may be less likely to get it, Type A may be more susceptible to acquire it, but once you get it there is no evidence that blood type affected outcome in a recent article in the Turkish Journal of Medicine.  In contrast to that study, Dr Francis Collins, the NIH director suggests that people with Type A face a 50% greater risk of a ventilator and people with Type O have a 50% reduced risk of severe Covid-19.  I think I'm more likely to go with the USA version here.  

     Don't forget to see the videos from my last blog

You must be the change you want to see in the rest of the World"                  Mahatma Gandhi

     Representative Gohmert, the guy that wants to make the democrats change their name and runs around the capital without a mask has Covid so he can't fly with Trump to Texas.  
     Texas has most deaths in nursing homes. There is rampant Covid related decimation of Hispanic communities according to the Dean of Tropical Medicine at Baylor, especially down south.  As unemployment climbs, numbers of  uninsured patients climb.  Horseshoe bats they say.  Bats.......

     In a study by Yee and Bailey in the journal BMJ Global Health, 27% of you tube videos are misinforming the public.  There's no telling how much mis-information is blasted out on the major networks.  Opinions, pundits, freedom revolters.......    Let's see how not wearing a mask is affecting Spain:

                  https://youtu.be/GQNXsTFStYk

"Individual commitment to a group effort-that is what makes a team work, a company work, a society work, a civilization work."  Vince Lombardi

     So many opinions.  So much controversy.  The Governor has made a mandate and then got on television and scolded the local authorities for not enforcing the law.  Judges calling him wrong.  Social media gone wild.  News not trustworthy and filled with political agendas and bias.  Wow.  It's no wonder everyone's sick of it.  

     What is going on?  Why is there so much controversy.  Well, first of all it's been going on a long time and what most of us are hearing is "I'm so over corona".  I agree, we are all growing weary of the endless talk.

     So today, a video and a piece of advice.  First, the advice.  The CDC put out a warning on hand sanitizers with methanol.  Methanol is wood alcohol, toxic when absorbed.  Most hand sanitizers are either isopropyl alcohol (71% hopefully) or ethyl alcohol (like from grain alcohol, like one you get in the store for cocktails).  So check your labels.

       We need you to think about why the Governor has mandated their usage when you are deciding on whether or not you want to have an ICU bed and ventilator available when you get it.  Here's the kicker.  When you get it, you will get it from someone not wearing a mask.  Here's two great videos to help you decide.

                  https://youtu.be/zOub_oMD0cc

                  https://youtu.be/sIpHCptKZUg

"We don't know what we've got til it's gone, like it or not"  Lance's song by Zac Brown

     It's about time.  The Governor mandated masks across the state.  If we had done this in March all across the country it would be over.  The choices we make change the future.  Don't be like Lance's Song, you don't have to lose a parent or spouse over this.  Just put on the mask.  It's not that hard.  I had some business in the city at lunch and I went out.  Everywhere I went, almost no one had on a mask.  I can say this for sure.  When I visited my kid in Katy a week ago we quarantined in his house except when my son and I went to the grocery.  In Houston the hospitals are full, the ICU's are overrun, and elective surgery is shut down.  

     Everyone, every single person, has on a mask in Katy.  Why?  The business owners care enough to enforce the rules.  The incidence in Katy is low.  In Houston, very few masks. No enforcement.   In Houston the outbreak is out of control.  So which group do you think Amarillo is in?  You tell me, take a look around.  

     Here's the link: https://gov.texas.gov/uploads/files/press/EO-GA-29-use-of-face-coverings-during-COVID-19-IMAGE-07-02-2020.pdf

"It is literally true that you can succeed best and quickest by helping others to succeed."  Napolean Hill

     The map of the country is red.  Cases are on the rise all over again.  Amarillo is behind the curve just like always.  I thought you might like a video today.  These researchers studied how the virus gets around and infects others.  As the data on mask usage becomes very convincing, it's time to show you why. Don't worry, 90% in English they just interviewed directly the Japanese Doctor briefly. 

     Take a look:  https://youtu.be/H2azcn7MqOU

"Talent wins games, but teamwork and intelligence win championships"   Michael Jordan

     So the ICU's are full in Houston.  Everyone is required to wear a mask.  People go on and do their work, they just have on a mask.  The cases in Houston are out of control.  That had to have a crisis to mandate the masks.  Why masks?  Because it works.  How hard is it?  Sooooooooo simple.  

     So much political debate.   "It's my right to do what I want".  "It's a conspiracy".   "It's all Trumps fault".  You have heard it over and over.  The pundits won't leave it alone.  

     Arizona is the epicenter of the entire pandemic right now.  Case numbers are higher than any country in Europe ever.  Cases now are higher than any day in New York.  In fact, higher than the entire country of Brazil, one of the most affected countries on Earth.  Local ordinances written by council members in Arizona banning  required masks are to blame.  Now it's a crisis.  Now it's out of control.  And now, finally, Gov Doug Ducey reverses those ridiculous local laws but it's too late.  Earlier action  could have saved hundreds of thousands of people from the misery, disease, and unbelievable financial strife.  Over 1000 doctors signed a petition and sent the Governor the recommendation to mandate masks long before he intervened.  But what do doctors know?  Remember on the news, the local Scottsdale Councilman Guy Phillips shouting the words "I can't breath" and then ripping his mask off?  To the local government that decided masks were stupid, you voters in Arizona should boot them right on out of there.  

     What are you seeing in Amarillo?  Look around you'll see everyone is doing life as usual.  July 4th is coming.  Travel again will resume.  Cases that are asymptomatic will travel here and there.  Should we wait until we are Houston?  Should we wait until it's Arizona all over again?  How long do we wait?  And what are we waiting on?  Look around people.  

      The literature is clear.  There isn't any controversy.  There is only scientific fact.  People that wear masks get fewer cases, and if everyone in the US would wear a mask for a month, everywhere they go, this would all go away, just like that.  In fact, there is one researcher in Germany that says a regular mask may be just as good as an N95.  So what's it going to be?  Sounds more like the Spanish Flu every day.  See what I said about that under "Updates Spanish Flu all over?"        

      Be safe this holiday season.  Enjoy your family.  For now I'm still healthy and alive and taking care of you.  Let's try and take care of each other.  

"Life isn't about waiting for the storm to pass.  It's about learning how to dance in the rain."   Vivian Greene

     Five pro golfers have withdrawn from this weeks tournament because of the corona.  Only one has it but the others that withdrew did it because they were exposed.  One caddie has it.  Out of respect for the other golfers they withdrew.  And then there is Novak Djokovic who organized a series of exhibition matches in Serbia and Croatia with zero social distancing.  He and his wife both have it now.  Word on the street is he wouldn't take a vaccine if there was one.  Some postulate it's on purpose?  Who's to say?

     So the governor says its unacceptable now.  So here's my question for today.  Who's right- the golfers that are acting out of respect for their competitors, or tennis man that boldly goes on with the game? 

     The TMA president just sent us all a message.  Do something about this now or face the consequences.  I'm not seeing a lot of masks out there...…..

"Often when you think you are at the end of something, you're at the beginning of something else"    Fred Rogers    

     We are seeing lots of patients in the office.  If you need to be seen then just call and we will get you in.  If you can or want to do telemedicine then it really helps spread out the patients so social distancing is possible.  

     The Texas Tribune reported on June 18 that Texas had the record number of coronavirus cases ever making June 18 the 7th consecutive day in a row for this new high and rising number of hospitalized cases.  If you haven't read my blog under updates on the Spanish Flu, it may be time for you to read it.  Right now, in the State of Texas, there are twice as many people in the hospital from the pandemic as there were on memorial day.  

     I think it's far from finished.  We still wear a mask in the office and probably will for a good while to come.  

"Out of difficulties grow miracles"  Jean de la Bruyere

     The office is open.  We have a plan for your safety and it seems to be working.  New patients are all coming to the office and follow up appointments for review of tests that need a shot or patients needing in person re-evaluation are all able to come in for a visit.  It's great to be back to work; however, we still do some telemedicine.  My thinking is that lots of patients actually like telemedicine and for those of you that are far away or need to be at home now it is working great. 

     The hospital is back to business as usual and at Physicians Surgical Hospital they are allowing a visitor.  This is a huge improvement.

     Is it over?  No, but there is a low incidence right now.  The CDC has made some observations that are important. The most likely way to get it is being close to another person that has it that doesn't have a mask on. It conveys through droplets from one pulmonary system directly to another.    So, there's that to still ponder. 

• Monday, June 15

       “Sometimes there’s not a better way. Sometimes there’s only the hard way.”          Mary Pearson

•      In the June edition of Science magazine Alexis Madrigal and Robinson Meyer wrote the   article “America’s giving up on the pandemic”
•      Standing in a crowd for a long period of time raises the risk of increased transmission of the coronavirus. There’s no doubt about it. It’s obvious to all of us that there have been a large number of crowds lately.
•      People in America as well as health officials are taking into account with what the New York Times called growing consensus “that being outdoors may mitigate some of the risk of transmission”. The virus appears to survive less in the sun and outside and survive less time in heat and humidity.  Americans are growing in their belief that they are immune to the effects of the virus if they are outside.  The governor and our local leaders have opened up the state and the city for business.
•       January 20 was the first case of the coronavirus in the United States. A man in Washington state had returned from Wuhan China. We are now five months into the pandemic. America is growing tired of the restrictions and the discussion regarding the virus. People are impatient and have grown weary with the entire concept of COVID-19. I hear many of my patients and friends say the famous words that you all hear all the time these days, “I am totally over coronavirus”.  Ask anyone in Houston if it’s over.  
•       Wishing for it to be gone doesn’t make it gone. Hoping for it to be gone doesn’t make it gone. Whatever you think about the survivability, the coronavirus is a very inconvenient thing to get. It affects some of us severely. I can think of one particular patient that experienced the infection. All of the members of his family got the virus when he brought it home from work. His wife was very very sick with the pulmonary symptoms. She got a terrible case of pneumonia and it one point in time told her husband that if she was going to die, she would just die at home.  She was sick for five or six weeks and in bed most of that time. At one point her oxygen saturation was below 80. The husband was less sick but his case lasted many weeks and he had more of the G.I. symptoms. The children all got it as well. However the oldest was the one that was the most ill and she was only sick for a few days and had a mild case. The middle child never had any symptoms but tested positive and the baby only had pinkeye. So it’s true what you hear, some people won’t be very sick but some will.  I have had the opportunity to discuss what the experience has been like for some other patients as well.  A few of them have been to the hospital and describe the illness as the worst they have ever experienced.  Some have had mental confusion, some have had moments when the symptoms went away and they thought is was over only to come back for another week or more. All of the patients that had severe symptoms had those symptoms for many weeks.  I know a doctor or two that has had it.  They would recommend you try and avoid getting it.  
•      A few things are true. Social distancing does work. Masks do work. Taking some precautions increases your chances of avoiding it.
•      In our office I believe it’s important for us to continue to space things out so the waiting room will be sparsely populated.  We will wear masks and those of you that can do telemedicine will continue to do that. We shall press on for now...

       "Ignorance might be bliss, but it also has teeth"  Craig Lounsbrough

     Some countries are opening up and not seeing a rise in cases.  That's really great news.  In Europe the average cases are down 80%.  In Europe they are practicing social distancing and wearing masks. In New Zealand they have effectively eliminated the virus from their country.  Their borders are locked.  

     However, some countries are opening back up and seeing a massive rise in cases.  That is terrible news.  In Iran no one is following any social distancing rules, no one is wearing a mask, no one is following any recommendations in spite of the constant warnings to the people.  In Iran cases are surging to the highest levels since it all started.  

     So which model would you say Amarillo is more like?  I'll let you decide the answer to that.  

     We are open.  Telemedicine still is helping all of us stay socially distanced.  Thanks for your understanding.  

                "Reality is that which, when you stop believing in it, doesn't go away"                                                   Philip K Dick

     NIH director, Dr Francis Collins, says we have about 10 vaccine candidates globally and that testing may begin on a larger scale as soon as July.  He hopes there is an actual vaccine by the end of the year.  This brings up a lot of questions about availability and efficacy.  

     With all the distractions on the news we seem to be forgetting we are in a pandemic.  However, the cases are down for now and the risks seem smaller.  Friends gather with other friends that have been socially distancing with relative success so far.  It helps that it is summer and we are outside.  In 1918, it was the second wave that was highly fatal and responsible for the majority of the deaths during the Spanish Flu epidemic.  It's not over.  See my blog on Spanish Flu from today under "Updates".

     The office is open and we are seeing new patients.  Telemedicine continues for follow ups and discussion of tests mostly very smoothly.  Surgery continues on a completely normal schedule.  For the moment, the sea is calming.  

     "Yea, all things live forever, though at times they sleep and are forgotten" HR Haggard

     While the cases continue to drop, life returns to the community and medicine gets back underway.

     Summer is almost here.  Seems like it already is summer.  We are outside.  Golf carts are rolling, boats are out, stuff is growing.  But the coronavirus isn't gone.  Ignoring it doesn't make it disappear.  The Texas Medical Board hasn't forgotten either and we are still following all the protocols in the office and at the hospital.  

     We appreciate your understanding and patience with the telemedicine visits and the protocol in the office.  I think we will all be glad when it gets cold again and we see the incidence go back up again when we all go back inside.  If we stay vigilant now, that next peak could be a small one.  Stay positive........

     "A man on a thousand mile walk has to forget his goal and say to himself every morning, 'Today I'm going to cover 25 miles and then rest up and sleep' "

          Leo Tolstoy, War and Peace

     The Governor was here.  His plans have been announced.  The numbers are down. Is it safe to come outside yet?

     In a very recent article in the New England Journal of Medicine Dr Marc Larochelle suggests an idea worthy of your consideration.  He describes 3 groups of people: Low risk younger healthy patients, Medium risk Middle Aged or younger with high risk conditions, and Older age or middle aged with high risk conditions.  He suggests the younger group just go back out there.  If you have a high risk condition or are older, still take precautions, and if you are older or have a high risk condition, just do everything you can to avoid any possibility of contact with persons who may have coronavirus. 

     We appreciate your patience with telemedicine.  It really works pretty well.  It makes room for those of you that need to come in. 

     We press on...….

"Be patient, everything is coming together"  Anonymous

     Clinic seems to be working just fine with new patients coming in while follow up patients and test results can do telemedicine.  This makes it possible to keep the waiting room empty for the most part.  We still have the no visitor policy in place and will take your temperature in the entry.  If you pull up keep your air conditioner on, if your temp is over 100 you can't have a visit. 

     Surgery is back on track.  The hospitals are both open.  Now let's just see what memorial day weekend did to us over the next couple of weeks. 

“ To lose patience is to lose the battle“

                                   Mahatma Gandhi

     It appears as though telemedicine and traditional medicine in combination are our new normal for now. I believe this will go on for quite some lengthy period of time. Most patients are handling telemedicine very well. I think the convenience of discussing things on the phone for test results and quick follow ups to make sure things are going well is the way medicine will be practiced for a long period of time.  

     Thinking about your mental health right now is more than likely a wise choice. Being isolated and at home constantly leads to a whole different set of stressors. Take some time to go for a walk and be outside.

     Although it would appear as though the numbers are going way up remember that we’re doing a whole lot more testing. It does appear that the curve is flattening in spite of the increased number of cases that are being reported. Moving on to a more regular schedule at the hospital hopefully will occur in the next couple of weeks.  Thanks for your patience.

‘ Thought is the only thing that can cause humans to deviate from their inevitable path”.     
                        Modified from Christophe Finipolscie’s original quote

     As we embark into the seventh week of this crisis in the Amarillo and Panhandle region, I encourage you to remain vigilant. I’m getting used to wearing a mask although I must say it’s not near as much fun as it was without a mask. Clinic seems to be working very well with the telemedicine visits allowing for the spacing out in office visits.

     One thing that will help us so much to stay on better time is to fill out the forms on the Internet prior to your arrival in the office. If this is all done we have a much better chance to stay on time. In order to be fair to everyone and space our patients appropriately all of us are trying to be much more conscious of the timing of your visit to the office. We are trying our very hardest to stay as close to on time as possible. We appreciate your help regarding this issue.

     It is hard to know the exact date but it looks like June 1 maybe the date for business as usual. That of course is subject to change. Looking at the news nationally, it would appear as though countries that are opening up aggressively or having a higher recurrence rate and new spikes. Will just have to see. Nevertheless we are trying to make your office visit and your hospital visit as safe as possible. Thanks for your patience.

“ We need not so much to be taught as to be reminded“.   CS Lewis

The office is running smoothly using telemedicine and a combination of seeing patients in the office. It is making it possible to keep people separated and socially distanced. Surgery begins this week and may return to a more normal schedule next week and the week thereafter. All of these things depend on the number of cases and whether or not we see a resurgence of the outbreak. My quote from CS Lewis today is to remind you that we are still in a pandemic. It is advisable to continue to socially distance, wash your hands frequently, and continue with all precautions that we have come to learn to live with. This virus will be with us for a long time. It will be easy for us to forget and to lose our patience.

     I posted a new video today that I think will be helpful for you to understand our current situation, what’s happening at the hospital, and what’s happening at the office. As always we appreciate your patience during this unusual time in history.

• Our medical and civic leaders have spoken with the governor of the state of Texas. Governor Abbot has spoken personally with the vice president United States of America. The centers for disease control is taking over Covid operations for Moore county and for Amarillo. They are bringing supplies and strategies to get the beef packing plants under control. Their strategies will encompass all of Amarillo to address our community spread issues. The centers for disease control will arrive today or tomorrow and implement the strategies they developed in addressing the Colorado packing plants. The governor has stressed that the vice President of the United States of America is actively involved in the management and that all our key state of Texas emergency management personnel are also engaged.
• with an increased number of tests there will be more positive tests as a result of the increased testing. Don’t panic when you see the numbers rise. Will have to let a new curve develop.
• we will have more tests more equipment and more things that we need very soon
• The governor has personally stated that for our area people should stay indoors. What this means is that business is not back to usual. The law of the governor is for the rest of the state not here. He has personally suggested this is a different situation. You should strongly take that into consideration.
• with regard to elective surgery outpatient’s that have followed the rules, have self Quarantined and can pass the screening test can have surgery if they are of a low risk group. Higher risk patients are going to be delayed because there’s no ICU transfer capabilities from Quail Creek hospital if there are no ICU beds. This is a very rare occurrence but it cannot happen.
• Any patient that has had symptoms will be tested for Covid before they go to the hospital. This takes 3 to 5 days. If the test result is negative the patient may have surgery.
• any patient that will be in the hospital on an admission must be tested 3 to 5 days before surgery.
• The ASA classification system will be utilized to determine low risk patients
• what do I think about all this? I think 70% of us are going to get the virus. I think half of us that get it will not even know that we have it. Of the half that gets sick only half of those will be really really sick.  So about 18.75% of us overall are going to be really sick.  18.75% will think they have a common cold. I think the mortality rate will be less than 2% and maybe even less than 1%.  We won’t know for years what this number is.  Probably similar to the flu.
• However this is not like the flu at all. This is completely different. For those of you that believe that this is exactly like the flu please understand this is much more INFECTIVE THEREFORE IT IS MUCH EASIER TO SPREAD
• If we all just go out and do whatever we want then we’ll all get it at once and hundreds if not thousands will not have an ICU bed and will die. Please understand the facts and accept that it is much easier to spread. 
• The governor of the state of Texas has personally stated that the people of Amarillo should stay inside. What that means is it’s not back to business as usual.
• The Texas state medical board has mandated the use of N 95 masks  for all physicians and healthcare workers that come within 6 feet of a patient whether they are symptomatic or not when they are seen in the office. The patient must wear a mask as well. This is not optional. This is the law for now
• So we are going to be seeing some patients in the office and we will all be wearing masks.
• we are all going to get through this together one way or another.

The Governor said: "We strongly suggest you wear a mask". Then he said, "if you don’t want to go out yet, stay at home". Dr Smith said: “we aren’t ready to open, if you go out wear a mask. Stay calm and wash your hands”.

We are going to see you in the office for a shot or for a new visit. Many precautions will be taken to help us all stay as safe as possible. There will be screening the day before and the day of your visit. We will take your temperature in the parking lot. Many of you are hurting and need some relief. Our goal is to make sure you are as safe as possible here. That's why all the precautions. 

April 30, Thursday, I’m hoping my hospital doesn’t turn into a Covid unit and you should too:  They ordered mandatory masks in Houston risking a fine, but the Governor said his authority overrules and there will be no fine.  He said "We strongly suggest you wear a mask". Then he said, "if you don’t want to go out yet, stay at home".  

     We are going to see  you in the office for a shot or for a new visit.  Many precautions will be taken to help us all stay as safe as possible.  There will be screening the day before and the day of  your visit.  We will take your temperature in the parking lot.  Many of you are hurting and need some relief.  Our goal is to make sure you are as safe as possible here.  That's why all the precautions. 

Texas Medical Association Urges Governor to ease restrictions on Surgery, City extends to April 30, Abbott extends to April 30, Surgeries still Scheduled for April 23 for us but that could change, our office gearing up for safely getting you in for a visit.

Tip for the day:  coronavirus lives on cardboard about 24 hours.  On plastic almost 72 hours...and 50% of health workers that are in the hotspot centers working around these patients have it on their shoes.  We need less plastic anyway.