Help Me Now Doc, LLC

04/08/2022

04/01/2022

Narcolepsy can be a tricky diagnosis to make and even trickier to effectively treat. 100% of narcoleptics have excessive daytime sleepiness and a large % have cataplexy, sleep paralysis, sleep attacks and even hallucinations. I have seen some misdiagnosed with mental illness, when in fact they have narcolepsy. Cataplexy is the loss of muscle tone with laughter or other emotions. Most clinicians miss this symptom or sign when they treat. Most are not trained to catch this diagnosis. Treatment is highly effective if prescribed correctly. The first step is recognition of the disorder with a Multiple Sleep Latency Test (MSLT). Genetic testing and checking hypocretin levels in spinal fluid can also help, but is usually not needed. Some will go decades not meeting their full mental and physical potential simply because the diagnosis was never thought of.

02/23/2022

Does your significant other or loved one snore loud and is always tired? They may have Obstructive Sleep Apnea. Home Sleep Studies are available and can accurately diagnose OSA. Treatment for OSA may include weight loss, CPAP, oral devices, INSPIRE or other procedures, iNAP device and more.
Moderate to Severe OSA is a risk for heart disease, amongst other things.
Don't wait to be diagnosed or treated.
Now is the time to find out and help yourself and bed partner get a better night of sleep.

02/10/2022

Alpha-1 Antitrypsin Deficiency (AATD) is a "rare" genetic disorder, or should I say rarely thought of. I have enjoyed caring for many Alphas over the years and being part of a Clinical Resource Center (CRC) through the Alpha-1 Foundation.
Guidelines support testing all people with emphysema or respiratory symptoms that are not 100% explained by another diagnosis. Tests are free and can be done as a cheek swab. If a diagnosis is made, FDA treatment or plasma replacement therapy is available and may help. AATD can present with cough, shortness of breath, wheezing, emphysema, liver disease, and a misdiagnosis or codiagnosis of asthma.

02/08/2022

Long-Haul Covid or "Long-COVID" is also known as post-acute sequelae of COVID or PASC.
Symptoms typically occur within 3 months of diagnosis and may include brain fog, shortness of breath, memory loss, insomnia, joint and muscle pain, anxiety and more.
Several theories exist as to why this is occurring.
Treatment is supportive, and time is needed. Ruling out other underlying illnesses is important.
Keep a look out for new therapies and tests in the future as studies are performed.

02/05/2022

Asthmatics can do worse post COVID-19.
I have seen recurrent exacerbations in some requiring steroids.
Some may have high Eosinophils and IgE levels and benefit from biologics that block inflammatory pathways.
Checking basic labs is the first step to seeing if someone is an appropriate candidate.
A FeNO or Fraction of Exhaled Nitric Oxide test may help determine if an inhaled steroid may be of benefit and may help determine if an asthmatic is controlled or not. Levels above 25 ppb are abnormal in adults and above 50 ppb is concerning.

01/28/2022

We are seeing prolonged dry cough post COVID-19, similar to other post-viral cough syndromes. In some cases, this can last several months and rarely even 6 months.
Most improve with time, but sometimes, we need to give cough medicine and microdose steroids. Immune support is also important, and I may recommend infusions or immune boosters. Labs or imaging are often warranted if symptoms persist post the acute phase of 4 to 8 weeks.

01/28/2022

Fluvoxamine (Luvox):
Another refurbished medication that may add some benefit.

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial – The Lancet Global Health

Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital.

01/28/2022

COVID PEARLS OF THE DAY:
Having good success with Paxlovid or molnupirivir plus
Sotrovimab.
Who said you can't give both?
Need to work the core and the spikes.
Pill works the replication and core and monoclonal works the spikes needed for entry.
Clean up the storm with prednisone or steroids. I like microdosing outpatients after antiviral and mab given.
Look for pulse oximetry readings of less than 95% or significant cough or respiratory symptoms before starting steroids.
Patients need day to day management to get this right.

01/20/2022

https://www.youtube.com/watch?v=hWxvtE7vZVU&ab_channel=AConcernedDoctor