stiveooo | 19 points | Jul 15 2020 03:42:14

Ivermectin included in the treatment protocol in USA

Ivermectin is included in the treatment protocol in USA for the early stages.

But quercetin is more helpful.

https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf

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[-] stereomatch | 3 points | Jul 15 2020 06:55:09

Ivermectin has been on the MATH+ protocol by Dr Paul Marik for a while:

https://www.evms.edu/covid-19/medical_information_resources/ COVID-19 MANAGEMENT PROTOCOL Developed and updated by Paul Marik, MD Chief of Pulmonary and Critical Care Medicine Eastern Virginia Medical School, Norfolk, VA May 25th, 2020 URGENT! Please circulate as widely as possible. It is crucial that every pulmonologist, every critical care doctor and nurse, every hospital administrator, every public health official receive this information immediately.

https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

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[-] lemallette | 3 points | Jul 15 2020 23:43:39

Good protocol. I would suggest the following modifications:

  1. Increase vitamin D3 to 5000 IU daily now and continue indefinitely (still only 25% of the dosage ever associated with a case of toxicity). Do NOT use weekly or monthly mega-dosing.
  2. Increase vitamin C to 5000 mg every 8 hours for mildly symptomatic patients (limited by loose bowels) and continue. No risk, over a short term of a month or so.
  3. Inhaled steroids can be used early, for mildly symptomatic cases. Inhaler (e.g. Pulmicort) if deeply and properly inhaled, or nebulizer for better delivery (with less convenience). Once admitted, change to parenteral or oral glucocorticoid.
  4. Zinc lozenges or gummies (usually with Elderberry) have the advantage of directly knocking down the virus in the oral cavity, pharynx and esophagus. By themselves they will not deliver enough zinc, so add to regimen.
  5. Comment: I read yesterday that ivermectin can act as a zinc ionophore; apparently two molecules can pair up to act on the cell membrane. If that is so, then the quecertin isn't going to add much, but I suppose it won't hurt.
  6. Do NOT wait for a positive PCR test to return after symptoms develop. Start the protocol NOW.. Too much time will be lost.

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[-] stiveooo | 2 points | Jul 15 2020 23:51:55

Yeah the americans are very tame with their dosages it should be more proactive

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[-] WeaverMom | 1 points | Jul 16 2020 01:52:33

How widely is this protocol known among American doctors? Would I be able to easily get a prescription for ivermectin from my PCP if I have a positive test result?

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[-] lemallette | 1 points | Jul 16 2020 03:26:52

Agree. The recommended doses of C and D will prevent survey and rickets, but will probably not assure optimal health, including optimal immune function.
Since I am recently retired, I don't chat with other docs much any more, but I'd bet no more than one in five would even know why you brought up ivermectin.

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[-] WeaverMom | 1 points | Jul 16 2020 14:56:14

The doses recommended by this protocol or normal recommended daily intake? What about zinc? Is there a risk of overdose with these supplement levels?

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[-] lemallette | 1 points | Jul 20 2020 13:53:09

I was addressing the doses recommended by the Institute of Medicine and many of the "official" bodies of organized medicine. The doses in the linked protocol are fine, but see my suggestions above.

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[-] WeaverMom | 1 points | Jul 20 2020 14:10:55

Ok thanks!

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[-] lemallette | 1 points | Jul 20 2020 14:28:14

I don't recommend taking a zinc supplement long term, as it can interfere with the absorption of trace metals that one needs. I would take zinc only when symptomatic. Exception: I take a gummie or two when I return from a shopping trip, Don't know if if does any good, but can't hurt, and that's only a samll dose every week or two.

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[-] TrumpLyftAlles | 1 points | Jul 16 2020 23:21:44

Would I be able to easily get a prescription for ivermectin from my PCP if I have a positive test result?

99.999% unknown, is my guess. The /r/medicine sub (expressly for actual MD) has 300K+ subscribers, a total of 3 ivermectin posts, all 3 months old.

My American PCP refused to prescribe ivermectin. I sent him several research papers, he wasn't persuaded.

The only news source that has any ivermectin coverage is NewsMax. Not sure watch the reach of NewsMax is.

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[-] WeaverMom | 1 points | Jul 16 2020 23:24:10

Yeah, that's kinda what I thought.

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[-] TrumpLyftAlles | 1 points | Jul 16 2020 23:18:02

This sounds like solid advice.

Zinc lozenges or gummies

Can I get a link to a product that's good on Amazon, please?

Edit: Does this look like a worthy product? It contains 7.5mg of Zinc citrate. Is that form of zinc good? How many of these gummies should I take daily?

What do you think about nicotine lozenges?

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[-] lemallette | 1 points | Jul 20 2020 14:01:52

That's one of the ones I took and keep on hand.
Nobody knows how much zinc is optimal. If you take a zinc ionophore and the blood level goes down because zinc has entered the cells, a zinc supplement can lessen the decline. But nobody knows how much. The reason I favor the gummies or lozenges as opposed to a tablet is that it will inactivate any virus that is "brewing" in the oropharynx, and maybe be a little more effective for any that get past the stomach acid. The gummies I took when I was ill had 7.5 mg zinc and some elderberry (which is probably not worth much, but also not harmful).
Nicotine lozenges? I hate nicotine.

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[-] TrumpLyftAlles | 1 points | Jul 20 2020 16:33:24

The reason I favor the gummies or lozenges as opposed to a tablet is that it will inactivate any virus that is "brewing" in the oropharynx

I like the rationale.

Nicotine lozenges? I hate nicotine.

That's why I suck on nicotine lozenges, hoping that makes the oropharynx inhospitable.

Thanks for the advice!

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[-] TrumpLyftAlles | 1 points | Jul 16 2020 23:34:15

Pulmicort

Is there an OTC product that you would recommend? I'm confident my PCP won't prescribe this for me.

I checked your post history. Welcome to reddit, doctor! I hope you enjoy your retirement. I'm enjoying mine.

Who was President when you were born? When I want to kind of brag about my age, I mention that I was born during the Truman Administration - barely. No need to answer, really just joking.

I saw this post of yours:

There is no reason to think that optimal vitamin D nutrition for blacks is any different.. Please see the late Dr. Robert Heaney's talk on estimating optimal D intake at <https://www.youtube.com/watch?v=B9SNfrE7P1s&t=2482s

But could not find it in context so I could reply there. Was it deleted?

I watched a bit of the video, will watch more later. Thanks for the link!

My D3 is 2000IU per capsule and I'm taking 6000IU every day, hoping for prophylaxis against the virus.

Increase vitamin C to 5000 mg every 8 hours... No risk, over a short term of a month or so.

I'm taking 3000mg every night, again hoping for prophylaxis, and for an easier course of disease if I catch the virus. I'm high-risk about 6 ways. Any advice about that, please?

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[-] lemallette | 2 points | Jul 20 2020 14:20:27

There are no inhaled glucocorticoids OTC in the USA. Nasal sprays, but not inhalers
FDR.
For Bob Heaney's talk on vitamin D go to YouTube and search for "Vitamin D Sunshine Optimal Health: Putting it all Together"
I think vitamin C 1000 mg twice a day is fine while healthy. With onset of covid symptoms, I'd increase to every 8 hour dosing, and increase as tolerated to 7000 mg per dose. This is what I did when sick - at that point I got loose bowels and backed off a little bit.

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[-] TrumpLyftAlles | 1 points | Jul 20 2020 16:35:54

This is what I did when sick

Did you catch the coronavirus? Congrats on coming through unscathed -- I hope.

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[-] lemallette | 2 points | Jul 20 2020 14:24:46

PS

I do not think vitamins (or much of anything one takes orally) will prevent acquiring the virus. The object with vitamin D and melatonin is to rev up the immune system to be ready for the virus when it does hit you. The zinc gummies, may serve to a small extent to lessen the ultimate viral load a little bit, and might decrease the severity of the illness that way as well. I take two or three in succession when I return for my (as rare as possible) shopping trips.

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[-] TrumpLyftAlles | 1 points | Jul 20 2020 16:35:06

I take two or three in succession when I return for my (as rare as possible) shopping trips.

Prophylaxis! Sounds like a plan, thanks.

I get groceries about every 3 weeks. I buy a cubic foot or so of blueberries when I do my Costco grocery run and they hold up that long.

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[-] TrumpLyftAlles | 1 points | Jul 20 2020 16:41:02

I do not think vitamins (or much of anything one takes orally) will prevent acquiring the virus.

There is (apparently) widespread belief among MDs in some regions of Latin America that ivermectin offers protection against the virus. In those places there seems to be a consensus that weekly or every-other-week dosing is sufficient. Dr. Aram who made the first splash for ivermectin in Bangladesh also believes that ivermectin + AZT prevents catching the virus; health workers at his hospital and their families took the combo with 100% success -- he alleged. True? Who knows? There is at least one trial looking at prophylaxis.

What dose of melatonin do you recommend, to prepare my body for the optimal response if I catch the virus?

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[-] SARSSUCKS | 1 points | Jul 17 2020 00:00:28

Disagree with pulmicort. Ciclesonide has shown some antiviral activity in vitro where budesonide did not. I think it would be superior to Budesonide.

Vitamin C should also be spread out to as often as possible. Oral dosage tracked and decreased if experiencing osmotic diarrhea. IV would be superior, but difficulty of getting and using obviously limits this.

100% agree with PCR test taking too long.

Also something I would change with the protocol is once hospitalized: I would not give my patients enoxaparin. UFH only and early, unless contraindicated. Unfractionated Heparin may bind with SARS CoV-2 and act as a viral sink. Improving clearance and abating viremia. Also fully AC to prevent virchow's triad.

Everything else looks solid. Nice work.

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[-] lemallette | 1 points | Jul 20 2020 14:23:52

I was surprised when a well respected and busy west Texas doctor touted budesonide by nebulizer. He has used it with alleged total success in over a hundred patients. This despite its lack of antiviral activity in tissue culture studies.
I suspect ANY inhaled glucocorticoid would do as well, if properly used so that the drug does reach the lungs.
The use of good old fashioned unfractionated heparin may be superior for the reason you cite, and it is likely what I would use.
The objective is to attack the virus that is attacking you, and attack hard and early. But get the immune system ready for it (with good vitamin D nutrition and maybe melatonin) ahead of time.

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[-] TotesMessenger | 1 points | Aug 27 2020 07:57:25

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[-] lemallette | 2 points | Jul 20 2020 14:44:37

Another thing that should be on all treatment protocols:
AVOID dextromethorphan (the "DM" cough suppressant in many OTC products for "colds and flu").
WHY?
Because in cell culture studies of the SARS-CoV-2, it was observed markedly to speed up viral replication. You want to avoid anything that helps the virus replicate!

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[-] luisvel | 1 points | Jul 15 2020 04:38:35

Where does it say quercetin is a replacement?

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[-] stiveooo | 2 points | Jul 15 2020 04:47:40

Is not. But they work in similar ways. Both inhibit the virus replication. And both work better with zinc

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[-] pezo1919 | 2 points | Jul 15 2020 13:52:09

Quercetin also acts as a blood thinner & antioxidant!

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[-] voss____ | 1 points | Jul 15 2020 19:50:37

source for blood thinner properties? thnx

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[-] foggynotion | 1 points | Jul 15 2020 05:04:01

nice find!

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[-] Qoti | 1 points | Jul 15 2020 05:34:46

Thats so great!

Sorry if I missed it, but where does it say quercetin is more helpful?

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[-] covid-19_throwaway | 2 points | Jul 15 2020 06:41:49

It doesn't say that exactly, but it makes quercetin part of the protocol, and ivermectin is just optional so far. I've been following that protocol for months, and quercetin's been on it almost from the beginning, i.e. has a lot of seniority by now.

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[-] pezo1919 | 1 points | Jul 15 2020 13:50:14

Yeah it was mentioned here on other subs as well 3-4 months ago, but many protocols are still ignoring it. So yes, both are true: it is knows for a while for a lot, but not for others.

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[-] nakedrickjames | 1 points | Jul 15 2020 21:57:27

I've been following that protocol for months

I'm assuming you mean the non-IV stuff? Ivermectin or no?

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[-] covid-19_throwaway | 2 points | Jul 16 2020 02:26:51

I didn't so much mean personally using it, though I do take 2000 IU of vitamin D and 600 mg NAC a day, and temporarily include most of the EVMS protocol any time I've experienced exposure risk. I just meant that I've been watching it evolve since April, when I started saving copies of the PDFs. I thought it was pretty good then, but like it better now.

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[-] stiveooo | 1 points | Jul 15 2020 12:10:49

https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

F3 for source

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[-] nabarkau | 1 points | Jul 15 2020 17:04:59

Yay! Fantastic.

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[-] TrumpLyftAlles | 1 points | Jul 15 2020 23:16:58

Ivermectin is included in the treatment protocol in USA for the early stages.

I noticed that the recent updates of this protocol cite the ICON study which found that ivermectin reduced fatalities 52% among patients were were severely sick, esp. they needed 02 supplementation -- but the protocol didn't change to reflect the later-stage effectiveness of ivermectin. I texted Dr. Marik (the author) asking him why he was ignoring the ICON study. Didn't get a response.

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[-] stiveooo | 2 points | Jul 15 2020 23:40:34

thats why its only optional in the protocol, cause quercetin has far better results

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[-] TrumpLyftAlles | 2 points | Jul 15 2020 23:52:51

quercetin has far better results

Really? Can you give me a few links showing that, please?

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[-] smorgasmic | 1 points | Jul 17 2020 05:40:05

It is interesting that they make Ivermectin optional only for mildly symptomatic patients at home. Anyone with more severe symptoms in the hospital never gets Ivermectin. That seems like a big mistake.

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