Quadrapill for Blood Pressure Control

At the beginning of each patient visit I make it a habit to meticulously review with each patient their list of medications, supplements, vitamins, herbs etc. I compare their list with the lists on notes sent to me from consulting specialty physicians and then I access the pharmacy prescribing data base whenever it is available.

I am always amazed by how many chemicals we put into our body for the sake of maintaining health. How patients maintain accurate medication lists and administer daily medications is something I am in awe of. In the best interest of their care, I am always looking for a way to reduce the number of medications taken and to simplify the process if possible.

Clearly researchers in Australia feel the same way. They realize that to control blood pressure, most seniors are taking low doses of 2-3 medications. In previous years we physicians prescribed one medication and pushed its dosage to the limit before adding a second medication to gain control of blood pressure. We soon realized that at the higher dosages, patients experienced adverse effects and just stopped taking their blood pressure lowering medications.

In an intriguing study, Australian researchers created a poly pill consisting of one quarter of the starting dosage of four medications. Irbesartan 37.5 mg, (angiotensin receptor blocker), amlodipine 1.25 mg (a calcium channel blocker), indapamide 0.625 mg (a thiazide diuretic) and bisoprolol 2.5 mg (a beta blocker) were put into one pill. Five hundred ninety-one patients at ten medical centers participated in the study. Their average age was 59 years with a fair mix of men and women. They were randomly selected and blinded from knowing whether they were receiving the Quadrapill or increasing dosages of one pill. If BP stayed up amlodipine was added.

At the end of three months the poly pill group had lowered their BP by 6.9mm Hg more than the single pill group. At a year the figure stools at 7.7. millimeters mercury. There were no significant adverse effects in the poly pill group. The study clearly showed that taking a pill with multiple types of blood pressure medication, at low dosage, controlled blood pressure and was convenient and tolerable. That pill is now in development and should be presented to the FDA and European Union for review in the near future. It’s release to the public will certainly make taking medication simpler and more convenient.

Walnuts Lowered LDL Cholesterol in Seniors

Emilio Ros, MD, PhD led the Walnuts and Healthy Aging Study (WAHA) looking at healthy seniors in Loma Linda, California and Barcelona, Spain. He followed 636 patients who were randomly assigned to a walnut supplemented diet or walnut free diet.

Senior Citizens who ate a diet supplemented with walnuts lowered their LDL cholesterol significantly.  The walnut supplemented group exhibited a reduction of total cholesterol of 8.5 mg/dl with an LDL cholesterol reduction of 4.3 mg/dl.  Triglycerides and HDL cholesterol were not affected. In addition to lowering cholesterol, Dr. Ros said other studies showed a positive result in lowering blood pressure. 

Christie Ballantyne MD, chief of cardiology at Baylor College of Medicine, and director of cardiovascular disease prevention at Methodist DeBakey Heart Center, said nutritional studies are difficult to complete. The number of participants is usually small and the length of the study short. This study encompassed large numbers over two years in two different locales. 

Dr. Ros commented that adults are always wondering what can they eat as a healthy snack?  Walnuts can now be added to that list.

Influenza Season 2021-2022 is Approaching

The office has ordered enough influenza vaccine for all patients including 65 and older.  Let’s start the discussion by making it very clear that you can take the influenza vaccine at the same time you take the COVID-19 vaccine or booster. Several vaccine companies are actually producing a combination vaccine of COVID-19 and influenza but that product will not be available in the USA this fall.

The next issue to examine is when does influenza A generally arrive in south Florida? In most years we see very little influenza A prior to Thanksgiving . There is a smattering of influenza B primarily in the pediatric population year-round.

The disease arrives earlier north of the Mason Dixon Line but last season due to masking, lockdowns and school closures there was very little spread of the flu. It takes about two weeks to develop immunity after you receive the vaccine so if you are planning on traveling in October and November it pays to research when influenza arrives in the area you are traveling to and get vaccinated two weeks in advance of the trip.

In South Florida the influenza season peaks the last week in January and first weeks in February most years. Think Super Bowl weekend as the most infectious time.

We know that in those 65 years of age or older the protective effects begin to fade at 90 days. For this reason, we advise our senior citizen patients to take the influenza vaccine between Halloween and Thanksgiving. For patients over 65 who already took their flu shot at their pharmacy, we recommend a booster shot in late December or early January. For younger patients, the immunity lasts much longer and, if they choose to take the shot earlier, they should be protected for most of the flu season.

THE VACCINE IS ALREADY IN OUR OFFICE. We will officially start vaccinating in October. Seniors 65 and older will receive a version of the senior high dose quadrivalent vaccine. Younger patients will receive the traditional influenza vaccine. The vaccination will be recorded on Florida Shots – the official vaccination recording site of the State of Florida.

There is Nothing Mild About “Mild COVID-19”

Medical experts divide COVID-19 infections into the categories of “mild,” “moderate to severe” and “severe”. To be defined as “mild” you must have COVID-19 but have no respiratory symptoms that necessitate the use of supplemental oxygen or hospitalization. I currently have “mild” COVID-19 and I am recovering. I am observing the appropriate quarantine procedures and let me make this clear, there is nothing mild about mild Covid-19.

I became aware something was wrong a bit over a week ago. I developed a mild irritating bronchial cough with a stuffy nose. Since I have inhaled allergies for years, I wasn’t quite sure if it was a bad allergy day or something else. As I did my exercise routine everything was a bit stiffer and harder to loosen up and a bit more tiresome but nothing dramatic. My wife made our favorite dish for dinner but I just wasn’t very hungry. I ate a minimal amount. The next morning I woke up much sorer than usual. I attributed this to getting older and pushed through my workout and daily routine. By day’s end, I noticed my nose was running occasionally. I slept sparingly that night being unable to find a comfortable position with my hip hurting out of proportion to any injury.

On Monday my aches and pains were severe. By evening I was flushed and febrile. The aches and pains that occurred in my joints and muscles required some Tylenol to take off the edge. That night the chills and shakes started, the frontal headache worsened, the muscle and joint pains exacerbated and the fatigue was overwhelming. I was exhausted but I could not sleep. I vowed to get tested the next morning. I sat upright in a chair – unable to get comfortable most of the night.

When my wife woke up, we drove over to the test site and 30-minutes later I had my notification of a positive COVID antigen test. By the next day the PCR nasal swab confirmed it. The aches and pains and difficulty of initiating and completing simple movements, like walking to the toilet, were exhausting and accompanied by drenching sweats. The simple task of walking my small dogs to the front lawn to relieve themselves felt like the end of a long hard work-out.

Later in the day I was infused with monoclonal antibodies to decrease the chances of mild COVID progressing to moderate or severe COVID. The time after the infusion was probably the most painful and uncomfortable period I have gone through in years. I was wearing a sweatsuit mid-day in Florida with temperatures that felt like the 100 degree range, sipping tea and honey and still feeling cold and hot at the same time. The aches and pains actually got worse for a few hours.

After several hours, the symptoms began to subside – likely from the RegenCov monoclonal antibodies As my symptoms diminished my sense of smell and taste disappeared and have not yet returned. Wearing a mask in my own home to protect my wife and pets from COVID is clearly a necessity but an inconvenience. Isolating to a portion of the house for quarantine is also an inconvenience but a necessity.

I did not anticipate the loss of concentration which was present for several days and made doing clinical work from home with telehealth difficult. My patience was non-existent so expressing sympathy and empathy for anything or anyone was a challenge. I have lost ten pounds in a week due to no appetite, no taste or smell.

There is nothing mild about mild COVID. It is worse than a “bad flu” and, possibly the designation as “mild” is too non-descriptive to make the unvaccinated and even the vaccinated, who are looking to rejoin life with no restrictions, understand that this disease is a beast and best avoided.

Blood Test Biomarkers for Alzheimer’s Disease

Adam Boxer, MD, PhD of the University of California San Francisco and associates published in Lancet Neurology a study which discussed their identifying two chemical biomarkers that distinguish normal patients from those with Alzheimer’s disease or other types of dementia. The two blood markers, phosphorylated tau 217 (p-tau217) and phosphorylated tau 181(p-tau181) showed “exquisite sensitivity and specificity” for discriminating Alzheimer disease from normal and other entities.

These biomarkers are currently only being used for research purposes and are not available to be used by doctors and patients through commercial labs yet. The researchers believe a commercially available lab test will be developed within the next few years

Walking Helps Stave Off Dementia

A paper presented at the Alzheimer’s Association 2021 International Conference by Natan Feter, PhD of Pelotas, Brazil suggested that even low levels of exercise as you age reduces your chances of developing Alzheimer’s type dementia. Their study looked at the English Longitudinal Study of Aging that included 8,270 individuals 50 years or older between the years 2002-2019. Fifty-six percent were female with a mean age of participants of 64 years. Over the 17-year course of the study, 8% of the participants developed dementia. T

They found the risk of dementia increased by 7.8% for each year increase in age. The risk of developing dementia was reduced by individuals who were physically active – more so for moderate to vigorous exercisers than for low level exercisers. Eighty-year old’s who were vigorous exercisers turned out to have a lower risk of dementia than inactive 50 -69-year-olds.

The message from the study was simple if you exercise even one time a week you reduce your risk of developing dementia. Walking certainly counts favorably. A reviewer simply said that regular walking is good for the heart and what is good for the heart is good for the head.

Why Have Guidelines, Rules & Regulations If No One Adheres to Them & There are NO Consequences?

I live and practice internal medicine and geriatrics in South Florida. We have a substantial elderly population living both independently and in senior facilities. The Sars2 Coronavirus Pandemic has been devastating to this patient population. There are many who became ill and passed away under the loneliest circumstances of in-hospital isolation. There are those who became ill and recovered but have lingering long-term effects. There are those who have avoided infection but are just beaten down by the daily monotony of staying safe, avoiding crowded public places and subsequently forsaking the company of friends and family.

The vaccine rollout in Florida was Helter Skelter and disorganized. It was every man and woman for themselves trying to obtain an appointment to be vaccinated. For the most, part the senior community managed to get the shots.

We were all grateful and buoyed as the summer of 2021 began by the news that we could venture out without masks and start resuming our pre-pandemic lives. The Delta variant and the recent surge in infectious cases, hospitalizations and now mortality put a quick and moribund end to that for most. The disparity between the message coming out of Washington and the CDC and the message delivered by our Governor and State Legislature has made decision making for individuals far more difficult than it should be. The latest conundrum is about the need for booster COVID vaccines or not.

The State of Israel, which exclusively used the Pfizer Vaccine, announced a third shot for those over 50 beginning a few weeks ago. Germany announced it would start such a program in September.

The CDC hinted at a booster program but until a NY Times article appeared on the evening of August 16th there was no official news on the subject beyond the recommendation that immunosuppressed individuals, especially organ transplant patients and cancer patients, under therapy get a third shot. Days before this announcement my patients had begun calling me, texting me, emailing me to tell me that their friends had walked into a Walgreens Pharmacy or Publix Pharmacy, showed them their Medicare ID card and their vaccine card and had been administered a third COVID vaccine shot with no questions asked. This was substantiated by multiple other patients including one couple spending the summer in the mountains of North Carolina.

Is there one set of rules for large chain pharmacies and another set for the rest of the world? What is the point of data and evidence-based recommendations if anyone can just do what they want when they want to?

At this point I will wait to hear the CDC’s recommendations on when to take a third shot and the data they used to explain why. I am thrilled that Pfizer has shown that a third shot is safe with few adverse effects. I am also buoyed by a research paper that showed that those groups who spaced their second shot at longer than the three- or four-week recommendations had a more robust immunologic response.

When my friends call me and ask me to join them on a trip to Publix or Walgreens to get the third shot now, I will hear my late mother’s voice in my brain asking that irritating question, “If all your friends decided to jump off the Empire State Building would you jump too?”