Joe Reilly is a friend, and he's been on a couple of our videos. Joe is one of
these guys that has shared with us as a group that he's got not only world class
Lp(a) levels but also appears to have FH (familial hypercholesterolemia). So
he and I have done a lot of work in that space, and he's one of those examples of
how you know what you can have some major risk factors but if you know what
you're doing, you can prevent heart attack and stroke and remain comfortable
that you can remain healthy. You just need to know hints. Some of these
webinars about people finding out you know what I had the major risk for heart
attack and stroke, I had prediabetes. In fact, I had full-blown diabetes but my
doc didn't tell me I didn't know. Now I know what to do. Anyhow, Joe
keeps up with a lot of stuff, and he sent me a couple of texts and emails, and he
got excited about this article. And I'm so glad he did. I know Joe's watching.
Thank you so much Joe for your contribution, the financial contribution
you made a few minutes ago but especially for this information. I've
known that pulse ox was a big deal, especially for this issue but just
totally forgot to cover it. It came out in a New York Times article, "The
Infection That's Silently Killing Coronavirus Patients." Now why is it
silently killing coronavirus patients? Well it gets back to that comment that I
made earlier. What's happening is that we're losing our oxygenation, folks that
get the SARS-CoV-2 infection and are going into the COVID-19 serious
disease lose, their oxygenation, but they don't lose their CO2. So what does that
mean? Again, hopefully, we can bring some more light onto that. Here's a quote from
Richard Levitan, an ER doctor and the guy that wrote the article in the New York
Times. "We are not detecting the deadly
pneumonia that the virus causes early enough and that we could be doing more
to keep patients off ventilators and alive." In other words, if we detect this a
little bit earlier, maybe we can prevent
the death that's been going on and the visits to the ICU and the visits to the
ventilator. And we all know once you start getting to that state where you
have to go to the ICU and ventilated, your probability of surviving has
dropped dramatically, so limiting. And Dr. Levitan, in the ER, observed this. Almost
all the ER patients had COVID pneumonia, even patients without respiratory
complaints had COVID pneumonia. So no complaints but still infected with
pneumonia infection in the lung. As we reported earlier and the folks have
reported all the way back to China in the early days of this pandemic, they
were seeing what's called ground-glass findings on the chest X-ray even in kids,
and the kids were not dying from this. They're still not... this is not something
that's a virus that's attacking kids, but still a huge number of kids are showing
ground-glass. What that means is whether we're aware
of it or not, this virus does attack our lungs. It's just very silent and stealth
in terms of its attack. It's like a ninja so these patients didn't report any
breathing problems. Chest X-rays showed that diffuse pneumonia, that ground-glass
appearance that's what we were referring to in that earlier article, their oxygen
was below normal. So pulse ox and the silent infection that's killing it's the
normal pneumonia. We've got a comparison here on these two pneumonias. A
normal pneumonia on the left versus COVID pneumonia on the right. Regular
pneumonia or "normal pneumonia" is an infection of the lungs in which the
air sacs fill with fluid or pus. It happens from some bacteria. It can
happen from viruses as well. You get discomfort in your chest. You get pain
with breathing. You get other breathing problems too.
You're coughing. You keep coughing up stuff, and it feels like you just can't
get all that stuff up. And typically, you'll get a significant fever,
especially if it's bacterial pneumonia. If you look back at some of the
significant problems in the history of men,
when you talk about the discovery of penicillin, that was the big life-saving
component because prior to that, Streptococcus pneumoniae was killing a
lot of people. It was one of the major causes of death. After the development of
those antibiotics, that became a thing of the past. So back to the script
and the bullets here, most patients requiring emergency intubation are in
shock. They have altered mental status or are grunting to breathe. It's like this:
you're pushing against your glottis and then you push, and that helps
increase the pressure inside your lungs. So you can inflate those lungs again. Now
let's talk about COVID pneumonia. COVID pneumonia causes a form of oxygen
deprivation called "silent hypoxia." And it's silent because again, they're not
detecting it. We typically detect "hypoxia" not
because it's hypoxia or low oxygen. We typically detect it because our CO2
(carbon dioxide) is increasing. The brain driver, the nucleus in the brain that
tells us to breathe, tends to be more driven by elevating CO2 than decreasing
oxygen. So again, something to think about as we think about this mechanism for
this disease. So patients don't feel short of breath for days or even as the
oxygen levels are falling. They'll talk about in the ER, patients
have incredibly bad oxygen levels, but they're sitting there waiting for a
room, and they're working on their cell phone as if nothing's going on. By the
time they begin to understand it, they already have alarmingly low oxygen
levels and moderate to severe pneumonia based on the X-rays that we discussed,
that ground glass appearance. Patients requiring intubation or even using their
cellphone. So they have low oxygen level as low as 50%. And the normal range for
oxygen level is 94 to 100%. We start getting worried in the
low 90s. So now you're beginning to get an
understanding when you compare that to 50% oxygen levels, helping you
understand how this is a very serious issue but it's sneaking up on people. How
does this happen? Well, the coronavirus attacks lung cells
that makes surfactant. What is surfactant? It's sort of like an oily substance. It
helps the air sacs or alveoli in the lungs stay open in between breaths. It
creates... it uses what we call surface tension. You know, when you drop a drop of
water on the table and it'll ball up. That's surface tension. Surfactant
decreases surface tension within our lungs, so even though we exhale, the
alveoli or the air sacs still remain open. COVID inflammation causes air sacs to
collapse, and oxygen levels begin to fall. The lungs
initially remain compliant. Now, what does that mean? It means that you just saw me
sigh, I can move my rib cage easily, and when they become non-compliant, it can be
more scarring. That's more of a chronic issue, but on an acute basis, it's usually
due to lungs filling up with fluid. So early on, you get this drop of
oxygenation, but the lungs are not full of fluid yet.
So the patient doesn't understand. The person doesn't understand. I'm not having
trouble breathing, but I'm not aware that my oxygen levels going down. They can
still expel CO2. They don't feel short of breath, and that was what I referred to a
few minutes ago. You don't get this increase in carbon dioxide so you don't
feel it. Patients compensate for the low oxygen
by breathing a little bit faster and deeper and then faster and then deeper,
and that's this silent hypoxia. If that breathing fast and deep causes
inflammation and it causes air sacs irritation, inflammation of the air sacs,
it causes the body to start we get hypercapnia. You ever hear that term
again, just a fancy medical term. What it means is
increase in CO2 levels. So as you get increase in CO2 levels, that's when you
start getting a little bit nervous and jumpy.
So in effect, what's going on is the patients are injuring their lungs by
breathing harder and harder. Now 20% of COVID pneumonia patients go on to
develop a second deadlier phase of this lung injury. The fluid begins to build up,
lungs become stiff, the carbon dioxide now begins to rise because you can't
ventilate any more. Then they develop acute respiratory failure. So that's
what's going on. There was a JAMA article recently on what the top five of the
first 5,000 patients, consecutive patients. They were admitted to New York,
and out of that group, they talked about 20% of them I think what's going on into
ICU and a high level of those right. So again, what you're beginning to see is
some parallels of what we've already discussed here in what's called
pathophysiology. "Patho" meaning disease; physiology, how it works. So how does the
disease work for this? First of all, you get an infection. Most people don't get a
significant problem with it, but some people, as in maybe up to 20%, we don't
know yet because we don't know the denominator, but some people start losing
their ability to oxygenate. As they do, they get into a cycle portion of those
folks get into a destructive cycle that ends up injuring the lungs. Now, by the
time the patient gets fluid buildup, the lungs become stiff, the CO2 rises, and
they develop this respiratory failure. Oxygen levels are now dangerously low.
That's when you start seeing those oxygen levels. 50%, 60% patients will
require a ventilator. And again, you're typically ventilated patient has
significantly higher levels than that. Many patients are now going to the
hospital and took home it. Pneumonia is already well advanced. So as we discussed
before, it's because they're not noticing that hypoxia, that decreased oxygen,
may delay, causing shortages of machines. And once
on the ventilator, many died. So that brings up another point. It's a recurring
theme that you've heard from many people, and that is that ventilators are killing
people. That may be the case. Here's what I'm thinking. Currently I'm thinking it's
what's always been the case. By the time somebody needs a thinner later, they're
in very very serious condition already. So what is pulse ox and how can that
help? It helps to identify patients with COVID pneumonia earlier and then
treat them more effectively. One way is through pulse oximetry. What is pulse
oximetry? It's a way of monitoring the blood oxygen level, and you see pictures
of it here on the right. So this is a way to know whether somebody's developing
silent hypoxia, provide early warning of COVID pneumonia. It displays both oxygen
saturation, and you get a pulse rate with most of these. So who should have this?
Well, all patients tested positive for coronavirus should be monitored, and all
persons right now with a cough fatigue and fever even if they have not been
tested or even if they had negative results I think right now. It's a good
idea to keep an eye on your pulse ox. Now we had some discussion when Joe
originally brought this up last week, and I made again an offhanded comment that
Janice had told me these things were no longer available. I have been meaning to
get one for awhile. It's just that we don't use them. We're mostly focused on
prevention. But when the coronavirus came up, I thought guys should be nice to have
one of these, and I just never got around to setting it up. Janice told me when I
started to look, they're not available. Then we had some back and forth with the
comments. I looked and sure enough, you can get them out. You can't get the $20
ones I think. They're out but I found several of them on Amazon for like 50
bucks.
There's nothing like a community. We saw that in the Louisville event. People got
together and started talking about how they've had challenges and successes in
preventing their own heart attack, stroke, or chronic disease. It became very clear
that you don't have to be a doc with a full time, 30-year career in preventive
medicine to understand this and successfully prevent heart attack, stroke -
the number one killer and disablers of people. You don't have to be a physician
to prevent eye disease, kidney disease. All you have to do is think, listen, and
become part of the community. Now, how do you do that? Go to the membership login
on our web page. And as you can see, you can get right in. You have to
sign up if you haven't signed up already. And I've already signed up, I've already
gone in. It's very simple, very easy to understand. In order to help encourage
this after the success and the positive emotion, the positive impact that we're
seeing with these events, we're saying look we need to offer more of these
services for free in order to help grow this community. So you'll see us starting
to do drawings for the webinar event, the courses We've got a book coming out in
about a month. We'll be offering that even full-blown evaluations, providing
those for free for folks that again helped us grow the community. So if you'd
like to find out what the most recent rules are for the most recent drawing,
just come to the membership page. Thank you for your interest.