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2020 Dumpster Fire (Enter at your own risk)

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29 minutes ago, yzerman19 said:

People just don’t want to pay for it...how many people have a combined monthly car and cell phone payments of $700 but bitch about a $1000 deductible.

Dare I say people value the outward 'stuff' more than they value themselves as human persons body and soul, and as such are more willing to pay to support the outward fixtures more than their own health and well-being? 

That's a major problem we as a society face. And a most conversation ... on Easter Sunday. 

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55 minutes ago, UND1983 said:

What's insensitive about simple math?  

If you're more concerned about the people that might scam the system vs the people that need the financial support, you need to figure out your priorities. 

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5 minutes ago, southpaw said:

If you're more concerned about the people that might scam the system vs the people that need the financial support, you need to figure out your priorities. 

When did I say either of those?  Wut?

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16 hours ago, keikla said:

Sometimes it feels like there are two totally different viruses.  You have the 'good' virus that feels like a bad cold (if at all) and only requires hospitalization for those who have significant comorbidities.  And then there's the 'bad' virus that drops O2 sats in the blink of an eye, requires ventilation (if you're lucky the vent was planned and not during a code), and usually leads to extensive multi-organ failure in just a couple days.  The bad virus is unforgiving to those of all ages, even without comorbidities, and is wholly unlike anything I have ever seen.

It feels weird to talk about overall mortality, because it might not be that bad when looking at everything altogether.  I'd be interested to see data on the mortality of those who code and/or require intubation, because that looks very, very bleak.  We're several weeks in, and my hospital still has single digit numbers of those who have improved and come off a ventilator. We talk daily with dept leaders of the nearest hospital to us, and their numbers are similar.

Just curious if you are seeing any success in treating patients with any specific drugs ?

There seem to be a few drugs that may help like hydroxychloroquine, remdesivir, and leronlimab. 

Good luck and thank you for all your good work. 

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It appears that northeast North Dakota has fared better than nearly any other part of the country so far in terms of positive tests. Collectively, Grand Forks, Traill, Steele, Griggs, Nelson, Ramsey, Walsh, Cavalier and Pembina Counties have a population of about 120,000. There have been a total of 17 positive tests so far, and the rate of positive tests is just 1.23% (17/1318).

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1 hour ago, rochsioux said:

Just curious if you are seeing any success in treating patients with any specific drugs ?

There seem to be a few drugs that may help like hydroxychloroquine, remdesivir, and leronlimab. 

Good luck and thank you for all your good work. 

We can't get our hands on remdesivir or leronlimab.  Mixed results with toci.  Haven't seen a lot of benefit with hydroxychloroquine though, admittedly, I've been focusing significantly more on the course of critical patients than those in med surg.  So it's quite possible it serves a bigger role in intermediate level care.

The biggest thing we're playing with right now is using heparin drips.  We saw a noted improvement in several ICU patients after they were started on aggressive anticoag.  Still a lot to figure out there, though...what lab cut-offs to use to qualify, protocol intensity, duration, etc..

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3 hours ago, The Sicatoka said:

Dare I say people value the outward 'stuff' more than they value themselves as human persons body and soul, and as such are more willing to pay to support the outward fixtures more than their own health and well-being? 

That's a major problem we as a society face. And a most conversation ... on Easter Sunday. 

No.  Prices of diabetes supplies have exploded in 2015.  I can speak to that one first hand.  I’m not sure about any other conditions but can’t imagine they are much different.  Has nothing to do with choice.  

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4 minutes ago, homer said:

No.  Prices of diabetes supplies have exploded in 2015.  I can speak to that one first hand.  I’m not sure about any other conditions but can’t imagine they are much different.  Has nothing to do with choice.  

No doubt costs continue to go up- diabetes management has probably jumped the most (as you mention).  There are many health plans out there that greatly lower the out of pocket costs for diabetes.  Many State’s Medicaid programs also offer zero $ co-pays for drugs, insulin, and test strips.  

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I have been type 2 diabetic for about 4 years.  Just taking pills metformin and Now Jardiance for about a year.  On Medicare, blue cross and another plan for the drugs.  So on a plan to reverse the type 2 since Thanksgiving.  I started exercising just walking once and sometimes twice a day.  Reduced my carbs big time.  Lost 17 pounds in 3 months.  Dropped my A1C from 7.0 to 6.4. In that timeframe.  I was due for refills and the Jardiance was $550 for the next 3 months.  I told the pharmacy. To keep them.  Now just metformin until I drop another 15 to 20 with the exercise and killing the carbs.   wonderful that the gov't food pyramid promoted bread, pasta, rice.  Loved those carbs for years.  But then the gov't knows best.  Follow the money.

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7 minutes ago, Nodak78 said:

I have been type 2 diabetic for about 4 years.  Just taking pills metformin and Now Jardiance for about a year.  On Medicare, blue cross and another plan for the drugs.  So on a plan to reverse the type 2 since Thanksgiving.  I started exercising just walking once and sometimes twice a day.  Reduced my carbs big time.  Lost 17 pounds in 3 months.  Dropped my A1C from 7.0 to 6.4. In that timeframe.  I was due for refills and the Jardiance was $550 for the next 3 months.  I told the pharmacy. To keep them.  Now just metformin until I drop another 15 to 20 with the exercise and killing the carbs.   wonderful that the gov't food pyramid promoted bread, pasta, rice.  Loved those carbs for years.  But then the gov't knows best.  Follow the money.

Way to go!!!!

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16 minutes ago, Nodak78 said:

I have been type 2 diabetic for about 4 years.  Just taking pills metformin and Now Jardiance for about a year.  On Medicare, blue cross and another plan for the drugs.  So on a plan to reverse the type 2 since Thanksgiving.  I started exercising just walking once and sometimes twice a day.  Reduced my carbs big time.  Lost 17 pounds in 3 months.  Dropped my A1C from 7.0 to 6.4. In that timeframe.  I was due for refills and the Jardiance was $550 for the next 3 months.  I told the pharmacy. To keep them.  Now just metformin until I drop another 15 to 20 with the exercise and killing the carbs.   wonderful that the gov't food pyramid promoted bread, pasta, rice.  Loved those carbs for years.  But then the gov't knows best.  Follow the money.

Let's just take any personal accountability out of everything and blame it on the government??  Come on now!

BTW your current A1C is better than a vast majority of T2s out there. Good work.

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There are over 2.8M people in US that tested for this virus of which over 559,000 tested positive.
I would imagine some tested negative and later on were tested again as positive.


22,000 confirmed virus tested deaths in the US, that's close to a 4% death rate of the positive tests.

There is talk about #'s not all being reported correctly.
People may have died at home form this virus and have not counted in these deaths, because they were not confirmed with the virus.
People that never felt any symptoms or minimal symptoms may have not even been tested.
People may have had other health problems and report of cause of death may be debatable.

This brings me to the guy that died when the 5G tower fell over and killed him.
And, people are over dosing on drugs and etc.
People are losing jobs and jumping on message boards in a rage.
Mental break downs and etc. and etc.
May there be riots, and therefore more deaths.

Less people dying of car accidents.
Less smog for time being.
Some people may even be eating healthier foods.
Some people quit smoking and etc. and etc.

Economy taking a big hit.

Then back to the 4%, after everything else considered?
Going to take some time to get things back to the way they were.

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2 hours ago, keikla said:

We can't get our hands on remdesivir or leronlimab.  Mixed results with toci.  Haven't seen a lot of benefit with hydroxychloroquine though, admittedly, I've been focusing significantly more on the course of critical patients than those in med surg.  So it's quite possible it serves a bigger role in intermediate level care.

The biggest thing we're playing with right now is using heparin drips.  We saw a noted improvement in several ICU patients after they were started on aggressive anticoag.  Still a lot to figure out there, though...what lab cut-offs to use to qualify, protocol intensity, duration, etc..

From your experience is hydroxychloroquine frequently used in intermediate care?   I was under the impression, due to side effects, it's primarily used as a last resort after the kitchen sink has been thrown at the patient.  

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20 minutes ago, UNDlaw80 said:

From your experience is hydroxychloroquine frequently used in intermediate care?   I was under the impression, due to side effects, it's primarily used as a last resort after the kitchen sink has been thrown at the patient.  

I will let Keikla answer for herself, but I believe across the country most providers use it early in the disease. We still are getting mixed reports as to the efficacy, but from what I have gathered if used it should be used early. 
 

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1.5% of all hospital beds in MN are currently COVID patients.

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1 hour ago, iramurphy said:

Thanks for your updates. I tried to address the issue with our clinic administrators and I doubt they had a clue why I was asking. It was clear they didn’t like questions and the answer was a brisk “it’s in the protocol”. Of course I can’t find the protocol but the information you have shared is invaluable. Thanks and thanks for your heroic and exhausting work. You and your colleagues are saving lives and giving comfort to so many whose families can’t be there. God bless and God speed. 

Throughout this entire thing, we have needed to revamp our protocol every two to three days.  That's how quickly new information is coming out, or we're noticing new trends.  Thus far, roughly 80% of intubated covid patients in the NYC area have died.  I think that percentage will actually increase before it decreases, as a number of families haven't yet decided to terminally extubate a loved one.  For reference, the average death rate for patients vented for a respiratory illness is usually closer to 40%. 

It all just goes to show how little we know about covid itself and how to treat it.  I hope they are constantly reviewing their protocol and analyzing the literature (truly analyzing...you'd be surprised how much crap NEJM puts out), so that they are prepared if need be.

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5 minutes ago, BarnWinterSportsEngelstad said:

Only? That would be a good thing, right?

Yah....but what else is going on at those hospitals right now?

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3 minutes ago, UND1983 said:

Yah....but what else is going on at those hospitals right now?

60-80% less of what was going on pre-COVID.

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8 minutes ago, keikla said:

Throughout this entire thing, we have needed to revamp our protocol every two to three days.  That's how quickly new information is coming out, or we're noticing new trends.  Thus far, roughly 80% of intubated covid patients in the NYC area have died.  I think that percentage will actually increase before it decreases, as a number of families haven't yet decided to terminally extubate a loved one.  For reference, the average death rate for patients vented for a respiratory illness is usually closer to 40%. 

It all just goes to show how little we know about covid itself and how to treat it.  I hope they are constantly reviewing their protocol and analyzing the literature (truly analyzing...you'd be surprised how much crap NEJM puts out), so that they are prepared if need be.

I read that stat somewhere........wow. 

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11 minutes ago, BarnWinterSportsEngelstad said:

Only? That would be a good thing, right?

Only.......definitely.

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38 minutes ago, UNDlaw80 said:

From your experience is hydroxychloroquine frequently used in intermediate care?   I was under the impression, due to its high propensity for renal damage, it's primarily used as a last resort after the kitchen sink has been thrown at the patient.  

I'm more concerned about the use leading to heart arrhythmias than renal damage.  That being said, I'm fortunate that we can monitor for both and pump a patient full of fluids to minimize any renal damage.  We've used it quite a bit for our med surg level patients, though we require an infectious disease doctor or intensivist (ICU doctor) to approve each order.  The CMO doesn't want to loosen that restriction.  Once patients reach critical care, I don't see much, if any, benefit. 

We changed our hydroxychloroquine dosing protocol this past week.  The initial study used 400mg twice daily x 1 day, followed by 200mg twice daily x 4 days.  But hydroxychloroquine follows linear kinetics with an incredibly long half-life.  So if you do a more bolus focused regimen, you can get the same AUC.  And, you have the added benefit of being able to turn med surg beds over faster (much needed right now), because you aren't keeping improved patients just so they can finish a 5 day treatment course.  Now we use 800mg x1 dose, 400mg @ 6 hours after the loading dose, 400mg @ 24 hrs after the load, and 400mg @ 48 hrs after the load.  I don't know that I would be comfortable using that dosing outpatient, but we require daily EKGs for anyone with it ordered.

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