Do Statins Increase the Risk of Eczema?

Like many senior citizens and patients of mine, if asked if I am healthy, I would probably answer “yes.” “Yes” ignores the fact that my blood pressure is well controlled with a blood pressure medicine, salt restriction and constant efforts to control my weight.

I exercise regularly and with great duration and modest intensity, so I think I am healthy. My allergies are controlled with a long acting non-sedating antihistamine. My normal pressure “glaucoma” requires nightly eye drops and thankfully the developing cataracts have not caused issues.

Then there is the cholesterol which is normally elevated despite eating according to expert advice and is controlled by a popular statin. Since I take the statin, I deplete my Coenzyme Q 10, so I take that as well. I guess the correct answer to the question of “are you healthy?” is I have multiple chronic medical conditions being well controlled with medication, diet and exercise.

I started the statin a few years back and was always amazed at the lack of muscle aches and pains I experienced yet so many of my friends and patients suffer greatly. What I did not expect was to see my skin slough and get irritated and itch with an atopic dermatitis called eczema. Several dermatologists prescribed soothing creams and ointments without making any attempt to determine the core cause of the problem. One suggested I go for allergy testing.

This is the background of me seeing an article in the Journal of the American Academy of Dermatology asking, “Do Statins Increase the Risk for Eczema?” The study performed in Iowa looked at patients taking statins for high cholesterol and heart disease and compared them with individuals not taking lipid lowering medications.

Almost ten thousand patient records were reviewed over a six-year period. It turns out that those taking stain medicine had a higher risk of developing eczema at almost 7% compared to the general population at less than 2%. The study by Dr. Cheung and associates called for further research to determine the exact mechanism of statins being associated with an increased risk of eczema.

In the meantime, I continue to take my rosuvastatin and CoQ10, watch my intake of forbidden foods, exercise and support the pharmaceutical industry by purchasing specials soaps , creams and ointments to mitigate the eczema and prevent me from scratching my skin until it bleeds.

What Happened to Honesty & Integrity?

A great deal of time and research was invested in developing a safe plan to resume seeing patients in our office. We prescreen everyone before scheduling an appointment. We screen again the night before the visit and, once again, at the front door. We ask extensively about their contacts and exposure. I expect the answers to be truthful. I have a professional responsibility to keep my patients safe and well cared for. I also have a responsibility to protect my staff and myself.

My first patient back had pushed his way into an expedited visit with a complaint of excessive weight loss. His request for one of the first visits after we reopened was supported by “telehealth” consults recently from two specialists – assigning the evaluation of this problem to me. Of course, they hadn’t bothered to weigh him.

When he arrived at the front door, we gave him a mask. He answered “no” to unmasked close encounters with others and to questions about behavior and visits which might raise his risk of catching COVID-19.

I treat all patients now as if they are contagious so I was masked, face shielded, wearing a gown and feeling safe. After a detailed history he told me he was flying on a commercial airline in two days to his northern home.

On Monday, his “back doctor“ was going to inject him for chronic low back pain. I asked him if his northern physician was aware that he was flying commercially and not maintaining a 14-day self- quarantine as advised. He said “no” and he had no intention of informing him. I told him that was wrong and that with diabetes, hypertension, heart disease and obesity I didn’t think flying on a crowded jet was a great idea.

His exam showed nothing of concern and when we weighed him his weight loss was minimal. He brought blood test results from his other physicians which we discussed. I wished him luck, suggested he quarantine after flying commercially and suggested he drive up instead. He chuckled, removed his facial covering and wished me a safe summer.

Two days later, as we closed up the office, my cell phone rang. The patient had flown up north and as he walked down the concourse he received a call from his friends who told him they were ill, were hospitalized and tested positive for COVID-19. He was calling to ask me what he should do.

He admitted that a few nights before his visit to my office this couple had been to his home for dinner. No masks were worn and no social distancing was practiced. I suggested he go home and self-quarantine for 14 days and seek medical attention if he felt ill.

The patient said he said he did not mention his encounter which occurred before his exam at my office because he wanted to be seen and did not wish to wait 14 days.  What happened to honesty and integrity?

Stay Safe & Stay Home – It’s Still the Best Decision

This past week the number of new Coronavirus cases in the state of Florida has dramatically increased. The percentage of patients having positive results and the number of patients showing up at the emergency rooms locally complaining of flu like symptoms has increased as well.

Due to a continued shortage of testing supplies, patients receive a nasopharyngeal swab and the test is sent out to the reference lab with results back in 48 to 72 hours. The number of hospital admissions with COVID-19 has increased dramatically in the last two weeks. The number of individuals requiring intensive care beds has increased while the availability of ICU beds has decreased. Some hospitals in Jacksonville and Sarasota have no current availability of critical care ICU beds.

Florida’s Governor says it is due to more people being tested so there are more positives. He initially blamed it on migrant farm workers of Hispanic descent but farmers and elected officials from farm districts pointed out they had left the state after harvesting crops weeks ago.

The increase is blamed on young people who will not require hospitalization or develop very many complications from COVID-19 say the elected officials. No need to order masks in public places in Palm Beach County according to the County Commissioners despite numerous studies saying facial coverings are an effective way to slow the spread of the disease. Epidemiologists and virologists from the University of Florida School of Medicine blame the surge on opening businesses too soon and lack of facial coverings as well as social distancing by those people going to restaurants, gyms, shopping and retail stores. The Director of Nursing at the University of Miami Jackson Memorial Program feels the same way as does an infectious disease expert at Florida International University in Miami.

Over the last three weeks I have read, re-read and studied numerous protocols and guidelines designed to safely reopen my small business establishment and internal medicine practice. We spent two weeks training the staff, rearranging traffic patterns, purchasing new equipment for protective purposes. We called our patients and started to bring them in slowly and in small numbers while reviewing and critiquing what we could be doing better to make sure our patients were well protected on the trip from their cars , up the front steps or ramp with a bannister, through a revolving door, into a common lobby and up an elevator to the second floor before reaching my office. It was going very well until the surge of new cases.

This is a very transmissible virus with newly contagious and minimally symptomatic individuals felt to infect 5.7 patients before they discover they are ill. As the surge reached day five on record new cases we met as an office, two experienced physicians, one experienced nurse manager, two medical assistants and one receptionist and decided it would be safest for our patients who were doing well to just stay home and delay a routine visit until the number of new cases and hospital cases declines again.

We phoned and used email as well to contact our patients and try to reschedule them. The negative blow back was both disheartening and surprising. “We need our blood work and are overdue for checking our cholesterol and sugars.” No, you are not. We were accused of being afraid of catching COVID-19.

With the protective gear we have and training and experience I believe seeing a patient in my office is far safer for me than entering and exiting my office building or walking my dog at dinner time. The concern is for my patients’ safety and health in an environment where many have been led by our elected public officials to believe the pandemic is over and scientists, doctors, epidemiologists are blowing COVID-19 out of proportion with the help of the media.

On a personal level these comments are hurtful and simply inappropriate. If younger asymptomatic people have the disease and are roaming the community without face coverings your trip to the supermarket, retail store, hospital emergency room is far more dangerous now then it was a month ago when potential COVID-19 patients were easy to spot and separate from those with other problems.

My hair cutting shop opened up two weeks ago when the Governor gave Palm Beach County an early opening even though the county had not met any of the minimal guidelines set by the Federal agencies including President Trump’s Coronavirus task force. When a client called in sick with COVID-19 two days after a haircut; the owner closed the shop, sanitized the facility and re-examined his protocols to protect his employees and customers. That shop is still closed with no imminent plans for opening

We still have no medical treatment for COVID-19. A vaccine is months away. There is promising news about blocking monoclonal antibodies. Self-distancing, hand washing, and facial coverings is all we have.

A recent article in a peer reviewed journal pointed out that people recovered from COVID-19 only had protective IgG antibodies for sixty to 90 days calling into question whether we ever can achieve “herd immunity” by keeping everything open and allowing the young less vulnerable to get sick, recover and develop antibodies.

How many more people must die in the name of economic well-being? How many people will get so ill that even if they recover the rehabilitation process will be so long and so partial that the price is too steep to pay?

I cannot say it enough – stay home, keep your distance and wear a facial covering in public. That is not an imposition on your civil rights. It’s being caring and compassionate for others.

Testing in Pharmacies, Another “Duh” Moment for Florida’s Governor DeSantis

At his coronavirus pandemic news conference, the Governor of Florida, who last week defined professional wrestling as an essential business, announced that testing for COVID-19 will be expanded by using pharmacies as test sites. He indicated the details still need to be worked out.

In the absence of a Federal plan for testing, states like Florida, which are desperately trying to reopen for tourism and business, are attempting to figure it out themselves. I just raise these simple questions:

  1. Who will be performing the testing? Will it be the same pharmacy techs that take 30 minutes to give a vaccination that can be administered in five minutes or less elsewhere? Will they hire nurses? Medical assistants? Moonlighting EMS personnel?
  2. Which test for COVID-19 will they be using? If it requires a nasopharyngeal swab will the personnel have adequate personal protective gear? Will it be sent to a lab? Will it be a quick on site test? If 100 people with COVID-19 took the test how many would test positive? If 100 people not infected with COVID-19 took the test, how many would falsely test positive?
  3. Who will train the pharmacy personnel on how to correctly take a deep nasal sample?
  4. Who will train the pharmacy personnel on how to dress in the personal protective gear and sanitize between test subjects so that they do not expose the non-infected, or next test subject in line, to COVID-19 or expose themselves?
  5. Where in the pharmacy will this be done? Will it be a drive thru in the parking lot? If it is in the pharmacy how will you protect healthy shoppers from potentially sick patients? How often will each store need to be disinfected and how will they do it?
  6. Who will pay for the cost of testing?
  7. For those who test positive, who will be responsible for reporting it to Public Health? Who will be available and responsible for tracking down contacts of infected patients?
  8. Will the testing only be done by appointment at specified times?
  9. Will the pharmacies have the same limited test supplies that has prevented appropriate recipients from being vaccinated for shingles with the Shingrix vaccine?

The State of Florida, through decimation of its Public Health system due to inadequate funding under former Governor, now Senator Rick Scott, is reeling from an inability to respond, test and treat the poor and underinsured of Florida. They once again turn to an inexperienced and untrained private sector to assume their responsibility.

Distancing, N95 Masks and Eye Covering Protect Against Respiratory Illness

To wear a facial covering or mask, or not, has been turned into a political affiliation and machismo issue in the United States instead of a scientific, medical and public health issue. A publication in the British medical journal Lancet clearly brought the issue into a medical public health category.  The “cliff notes” summary of the study is that for each meter (2.2 meters = one foot) you distance from a contagious individual, the less likelihood you have of becoming infected with that illness.  Facial coverings diminish your risk of catching the disease by about 15% and N95 or KN95 respirator masks work better than surgical masks, bandanas or cloth masks.

The study was a systemic review and meta-analysis of 172 observational studies involving SARS, MERS and COVID-19 spanning six continents with almost 26,000 participants.  Daniel Chu, MD, PhD made it clear, “The risk for infection is highly dependent on the distance to the individual infected and the type of face mask and eye protections worn. Six feet or more away is the optimal distance to maintain. While N95 masks scored best in terms of protection for health care workers, facial coverings of any type reduced the chance of infections from 17.4% to 3.1%. Eye protection reduced the risk of infection from 16% to 5.5%.”

Due to a shortage of personal protective equipment (PPE), the CDC downgraded its requirements for health care workers treating sick infected individuals  to surgical masks, cloth masks or bandanas.  Professor Raina MacIntyre, MBBS, PhD at the Kirby Institute University of New South Wales in Sydney went on to say that recommending anything less than an N95 mask for health care workers is like sending troops into battle “ unarmed or with bows and arrows against a fully armed enemy.”

Many wonder what the difference is between an N95 respirator mask and a KN95 respirator mask. They both are supposed to prevent 95% of the particles of a certain size from penetrating. If the masks are reviewed and approved and certified by USA agencies such as OSHA or the CDC, they are labeled N95.  If they are reviewed by similar agencies in China, they are labeled KN95. In most cases the product is made outside the USA even if the company is an American firm.

Key points to remember are:

  • Distancing works with over six feet best for preventing person to person transmission of respiratory illnesses like Covid-19.
  • Facial coverings reduce the risk of infection.
  • N95 and KN95 are the gold standard for health care workers.
  • Eye covering reduces infections even further. 

This is not a macho or political issue. It’s an infectious disease public health issue.  Be smart and considerate of others. Cover your mouth, cover your eyes and keep six feet or more apart.

Sacrificing Citizens to COVID-19. Where is the True Grit?

My dad fought through the Pacific Theater in WWII with the 11th Airborne Division.  He returned to the USA and started a manufacturing business with his brother, also a veteran of WWII, that was in a ghetto in Brooklyn, NY.

The business took off until a suspicious nighttime fire burned the plant to the ground.  You could not get property insurance for a business located in the ghetto, so he lost everything.  The two brothers reorganized, got financing and reopened nearby – building a manufacturing business again.  Nighttime burglars set fire to this plant five years into operation. Being uninsured, they lost everything once again.

They started over again and built a new successful business that lasted for years.  I was aware of the differences at home after the loss of the second business but always had a safe home, food on the table and clothes on my back. They were different times with few living paycheck to paycheck but mom going back to work and grandma watching us when we got home from school until my parents got home. My college fund was used to live on so when I became a junior in high school I was told I was going to a state school if I could get a scholarship or to a city university living at home if not. I started working part time at age 15 to help at home. I never felt scarred or deprived by these changes. My parents and aunt and uncle showed true grit and resolve rebuilding their firms, raising four children and providing an education and home for us all.

I say that with the utmost respect and awe while I read about all of the small business men and women complaining about the possibility of losing their small businesses if the state and county governments do not open up businesses in the midst of the Covid-19 epidemic.

We still have no treatment other than supportive care. A vaccine to prevent Covid-19  is months off as well. Personal protective gear for health care workers is still in short supply and much of the advertised products are either inferior or being sold by scam artists.  Testing for asymptomatic but contagious COVID-19 patients is still inaccurate at best and takes days to get results.  Antibody tests to see who had the disease and has some level of immunity are still full of statistical and procedural problems. 

Despite this, the Palm Beach County Commission is voting on June 5th to move ahead and relax restrictions in restaurants and stores and open bars and lounges and theaters.  They have not adequately addressed the staffing and equipment shortages at senior independent, assisted and skilled nursing facilities. 

The number of new reported Covid-19 cases has increased each day last week. First this was rationalized away by claiming several days data was included in Wednesday’s numbers. When Thursday’s numbers were even higher, they said it was due to more testing access, but all was well because only 7% of those tested were positive.  Well 7% of more cases will mean more sickness, more potential complications and more potential hospitalizations and deaths. I guess seniors, the young and the disabled and infirm are expendable in the eyes of the Governor and Palm Beach County Commissioners if the rate of new hospitalizations doesn’t overwhelm the system. They caved to the business interests before and continue to do it again now.           I keep wondering how my dad and my Uncle Harry and their generation would have handled this situation.  I bet they would have pulled together, protected their loved ones and friends first and lost their businesses only to rebuild again when it is safe. Where is the true grit that greatest generation proudly earned?