Podcasts about bactrim

Desde 2013, o cientista francês Maxime Annereau adapta as doses, o sabor e a forma dos medicamentos usados por crianças e adolescentes com câncer. Ele utiliza impressoras 3D para fabricar os remédios na farmácia do Instituto Gustave Roussy, situado em Villejuif, perto de Paris.  Taíssa Stivanin, da RFI em ParisO hospital francês é uma referência na luta contra o câncer e um dos três estabelecimentos no mundo que produz medicamentos impressos em 3D para seus pacientes, em sua própria farmácia.  De acordo com o farmacêutico, há uma grande carência de moléculas no mercado para tratar crianças e idosos – a indústria utiliza principalmente dados de homens adultos saudáveis para produzir a maior parte dos remédios.Em busca de soluções, o farmacêutico então apostou, há três anos, na impressão 3D de medicamentos para melhorar a tolerância das crianças aos produtos usados nos tratamentos contra os cânceres.“São questões que foram sendo trazidas pelos médicos e as enfermeiras, que sempre estão em contato com os pais", conta Maxime. Os pediatras então perguntaram ao farmacêutico se era possível melhorar o sabor do Bactrim, um medicamento que associa dois antibióticos e é utilizado em larga escala.  “O problema é que, na maioria dos casos, esse comprimido é muito grande para os pacientes. Ele existe em forma de xarope, mas uma dose corresponde a mais ou menos 20 mililitros ou duas colheres de sopa... E o gosto é de fato muito ruim. As crianças tentam tomar uma vez e depois recusam, mas deveriam usar o remédio durante a quimioterapia, que dura entre seis meses e dois anos, três vezes por semana” explica. Sem o antibiótico, há risco de infecção, o que pode levar ao adiamento das sessões de quimioterapia, aumentando o risco de recaídas. Para resolver o problema, Maxime e sua equipe então começaram a testar outros formatos e sabores possíveis para o Bactrim com a impressão 3D. “O desenvolvimento de um remédio é mais ou menos como uma receita culinária”, conta o cientista, com “erros e acertos”. Durante o processo, a equipe tentou, por exemplo, criar comprimidos menores do antibiótico com o aroma de hortelã, mas não obtiveram a aprovação unânime dos pacientes. Antibiótico em forma de macaronO farmacêutico então aprimorou a molécula, que foi testada em 20 crianças e adolescentes internadas no hospital com diferentes tipos de câncer. Os centros de pesquisa e tratamento franceses se beneficiam de uma legislação que permite colocar em prática rapidamente novas soluções para os pacientes, com menos burocracia.  O resultado foi aprovado, mas os pediatras queriam algo "ainda melhor", conta Maxime. "O 'melhor' demorou oito meses para ficar pronto. Como somos franceses", brinca, "imaginamos um jeito para disfarçar o gosto do remédio e decidimos fazer um macaron”. O macaron é um biscoito redondo francês de cerca de 5 centímetros, de vários sabores, popular em várias regiões do país.“O gosto é uma questão física. O que não é gostoso não deve estar em contato direto com as papilas gustativas. Sem esse contato direto, você não sente um gosto ruim”, explica o farmacêutico.A equipe então separou os dois antibióticos do Bactrim vendido na forma de xarope e colocou a molécula que tinha o melhor sabor na parte externa do comprimido. A outra ficou na parte interna, o que reduziu o tempo de contato com as papilas, "enganando" o paladar.Ao separá-los, a equipe também aumentou a concentração do produto em formato 3D, que passou a ter 400 mg, o que também facilita o tratamento. A última fórmula, que tem um gosto "bem açucarado", está sendo testada em cinco pacientes desde março. Em junho, diz o farmacêutico, o estudo com a molécula será ampliado para 30 pacientes, durante seis meses.  Neste período, os dados coletados permitirão confirmar a eficácia do medicamento transformado pela impressão em 3D. A equipe busca também otimizar os parâmetros de impressão para produzir um número maior de comprimidos, mais rapidamente.  Segundo Maxime, a equipe também é encarregada da parte logística e, além de produzir os remédios, o instituto deve também desenvolver os cartuchos para as impressoras. Em breve, outras moléculas, usadas em tratamentos contra os cânceres pediátricos e adultos, também será melhorada pelos farmacêuticos do centro.As impressoras do hospital em breve serão capazes de produzir 60 antibióticos por hora, 500 por dia. Em dois anos, a produção quadruplicou e novos projetos de grande escala estão sendo estudados, como a versão pediátrica de um medicamento anticâncer usando impressão 3D. 

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: CYP enzymes are responsible for the metabolism of many medications, drugs, and other substances CYP3A4 is responsible for the majority Other common ones include CYP2D6 (antidepressants), CYP2E1 (alcohol), and CYP1A2 (cigarettes) CYP inducers lead to reduced concentrations of a particular medication CYP inhibitors effectively increase concentrations of certain medications in the body Examples of CYP inducers Phenobarbital Rifampin  Cigarettes St. John's Wort Examples of CYP inhibitors -azole antifungals like itraconazole and ketoconazole Bactrim (trimethoprim-sulfamethoxazole) Ritonavir (found in Paxlovid) Grapefruit juice Clinical relevance Drug-drug interactions happen frequently and often go unrecognized or underrecognized in patients with significant polypharmacy A study conducted on patients receiving Bactrim and other antibiotics found increased rates of anticoagulation in patients receiving Bactrim Currently, Paxlovid is prescribed to patients with COVID-19, many of whom have multiple comorbidities and are on multiple medications Paxlovid contains ritonavir, a powerful CYP inhibitor that can increase concentrations of many other medications A complete list of clinically relevant CYP inhibitors can be found on the FDA website: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers  References Glasheen JJ, Fugit RV, Prochazka AV. The risk of overanticoagulation with antibiotic use in outpatients on stable warfarin regimens. J Gen Intern Med. 2005;20(7):653-656. doi:10.1111/j.1525-1497.2005.0136.x Lynch T, Price A. The effect of cytochrome P450 metabolism on drug response, interactions, and adverse effects. Am Fam Physician. 2007;76(3):391-396. PAXLOVID™. Drug interactions. PAXLOVIDHCP. Accessed March 16, 2025. https://www.paxlovidhcp.com/drug-interactions Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Dr. Gary Null provides a commentary on "Universal  Healthcare"       Universal Healthcare is the Solution to a Broken Medical System Gary Null, PhD Progressive Radio Network, March 3, 2025 For over 50 years, there has been no concerted or successful effort to bring down medical costs in the American healthcare system. Nor are the federal health agencies making disease prevention a priority. Regardless whether the political left or right sponsors proposals for reform, such measures are repeatedly defeated by both parties in Congress. As a result, the nation's healthcare system remains one of the most expensive and least efficient in the developed world. For the past 30 years, medical bills contributing to personal debt regularly rank among the top three causes of personal bankruptcy. This is a reality that reflects not only the financial strain on ordinary Americans but the systemic failure of the healthcare system itself. The urgent question is: If President Trump and his administration are truly seeking to reduce the nation's $36 trillion deficit, why is there no serious effort to reform the most bloated and corrupt sector of the economy? A key obstacle is the widespread misinformation campaign that falsely claims universal health care would cost an additional $2 trillion annually and further balloon the national debt. However, a more honest assessment reveals the opposite. If the US adopted a universal single-payer system, the nation could actually save up to $20 trillion over the next 10 years rather than add to the deficit. Even with the most ambitious efforts by people like Elon Musk to rein in federal spending or optimize government efficiency, the estimated savings would only amount to $500 billion. This is only a fraction of what could be achieved through comprehensive healthcare reform alone. Healthcare is the largest single expenditure of the federal budget. A careful examination of where the $5 trillion spent annually on healthcare actually goes reveals massive systemic fraud and inefficiency. Aside from emergency medicine, which accounts for only 10-12 percent of total healthcare expenditures, the bulk of this spending does not deliver better health outcomes nor reduce trends in physical and mental illness. Applying Ockham's Razor, the principle that the simplest solution is often the best, the obvious conclusion is that America's astronomical healthcare costs are the direct result of price gouging on an unimaginable scale. For example, in most small businesses, profit margins range between 1.6 and 2.5 percent, such as in grocery retail. Yet the pharmaceutical industrial complex routinely operates on markup rates as high as 150,000 percent for many prescription drugs. The chart below highlights the astronomical gap between the retail price of some top-selling patented pharmaceutical medications and their generic equivalents. Drug Condition Patent Price (per unit) Generic Price Estimated Manufacture Cost Markup Source Insulin (Humalog) Diabetes $300 $30 $3 10,000% Rand (2021) EpiPen Allergic reactions $600 $30 $10 6,000% BMJ (2022) Daraprim Toxoplasmosis $750/pill $2 $0.50 150,000% JAMA (2019) Harvoni Hepatitis C $94,500 (12 weeks) $30,000 $200 47,000% WHO Report (2018) Lipitor Cholesterol $150 $10 $0.50 29,900% Health Affairs (2020) Xarelto Blood Thinner $450 $25 $1.50 30,000% NEJM (2020) Abilify Schizophrenia $800 (30 tablets) $15 $2 39,900% AJMC (2019) Revlimid Cancer $16,000/mo $450 $150 10,500% Kaiser Health News (2021) Humira Arthritis $2,984/dose $400 $50 5,868% Rand (2021) Sovaldi Hepatitis C $1,000/pill $10 $2 49,900% JAMA (2021) Xolair Asthma $2,400/dose $300 $50 4,800% NEJM (2020) Gleevec Leukemia $10,000/mo $350 $200 4,900% Harvard Public Health Review (2020) OxyContin Pain Relief $600 (30 tablets) $15 $0.50 119,900% BMJ (2022) Remdesivir Covid-19 $3,120 (5 doses) N/A $10 31,100% The Lancet (2020) The corruption extends far beyond price gouging. Many pharmaceutical companies convince federal health agencies to fund their basic research and drug development with taxpayer dollars. Yet when these companies bring successful products to market, the profits are kept entirely by the corporations or shared with the agencies or groups of government scientists. On the other hand, the public, who funded the research, receives no financial return. This amounts to a systemic betrayal of the public trust on a scale of hundreds of billions of dollars annually. Another significant contributor to rising healthcare costs is the widespread practice of defensive medicine that is driven by the constant threat of litigation. Over the past 40 years, defensive medicine has become a cottage industry. Physicians order excessive diagnostic tests and unnecessary treatments simply to protect themselves from lawsuits. Study after study has shown that these over-performed procedures not only inflate costs but lead to iatrogenesis or medical injury and death caused by the medical  system and practices itself. The solution is simple: adopting no-fault healthcare coverage for everyone where patients receive care without needing to sue and thereby freeing doctors from the burden of excessive malpractice insurance. A single-payer universal healthcare system could fundamentally transform the entire industry by capping profits at every level — from drug manufacturers to hospitals to medical equipment suppliers. The Department of Health and Human Services would have the authority to set profit margins for medical procedures. This would ensure that healthcare is determined by outcomes, not profits. Additionally, the growing influence of private equity firms and vulture capitalists buying up hospitals and medical clinics across America must be reined in. These equity firms prioritize profit extraction over improving the quality of care. They often slash staff, raise prices, and dictate medical procedures based on what will yield the highest returns. Another vital reform would be to provide free medical education for doctors and nurses in exchange for five years of service under the universal system. Medical professionals would earn a realistic salary cap to prevent them from being lured into equity partnerships or charging exorbitant rates. The biggest single expense in the current system, however, is the private health insurance industry, which consumes 33 percent of the $5 trillion healthcare budget. Health insurance CEOs consistently rank among the highest-paid executives in the country. Their companies, who are nothing more than bean counters, decide what procedures and drugs will be covered, partially covered, or denied altogether. This entire industry is designed to place profits above patients' lives. If the US dismantled its existing insurance-based system and replaced it with a fully reformed national healthcare model, the country could save $2.7 trillion annually while simultaneously improving health outcomes. Over the course of 10 years, those savings would amount to $27 trillion. This could wipe out nearly the entire national debt in a short time. This solution has been available for decades but has been systematically blocked by corporate lobbying and bipartisan corruption in Washington. The path forward is clear but only if American citizens demand a system where healthcare is valued as a public service and not a commodity. The national healthcare crisis is not just a fiscal issue. It is a crucial moral failure of the highest order. With the right reforms, the nation could simultaneously restore its financial health and deliver the kind of healthcare system its citizens have long deserved. American Healthcare: Corrupt, Broken and Lethal Richard Gale and Gary Null Progressive Radio Network, March 3, 2025 For a nation that prides itself on being the world's wealthiest, most innovative and technologically advanced, the US' healthcare system is nothing less than a disaster and disgrace. Not only are Americans the least healthy among the most developed nations, but the US' health system ranks dead last among high-income countries. Despite rising costs and our unshakeable faith in American medical exceptionalism, average life expectancy in the US has remained lower than other OECD nations for many years and continues to decline. The United Nations recognizes healthcare as a human right. In 2018, former UN Secretary General Ban Ki-moon denounced the American healthcare system as "politically and morally wrong." During the pandemic it is estimated that two to three years was lost on average life expectancy. On the other hand, before the Covid-19 pandemic, countries with universal healthcare coverage found their average life expectancy stable or slowly increasing. The fundamental problem in the U.S. is that politics have been far too beholden to the pharmaceutical, HMO and private insurance industries. Neither party has made any concerted effort to reign in the corruption of corporate campaign funding and do what is sensible, financially feasible and morally correct to improve Americans' quality of health and well-being.   The fact that our healthcare system is horribly broken is proof that moneyed interests have become so powerful to keep single-payer debate out of the media spotlight and censored. Poll after poll shows that the American public favors the expansion of public health coverage. Other incremental proposals, including Medicare and Medicaid buy-in plans, are also widely preferred to the Affordable Care Act or Obamacare mess we are currently stuck with.   It is not difficult to understand how the dismal state of American medicine is the result of a system that has been sold out to the free-market and the bottom line interests of drug makers and an inflated private insurance industry. How advanced and ethically sound can a healthcare system be if tens of millions of people have no access to medical care because it is financially out of their reach?  The figures speak for themselves. The U.S. is burdened with a $41 trillion Medicare liability. The number of uninsured has declined during the past several years but still lingers around 25 million. An additional 30-35 million are underinsured. There are currently 65 million Medicare enrollees and 89 million Medicaid recipients. This is an extremely unhealthy snapshot of the country's ability to provide affordable healthcare and it is certainly unsustainable. The system is a public economic failure, benefiting no one except the large and increasingly consolidated insurance and pharmaceutical firms at the top that supervise the racket.   Our political parties have wrestled with single-payer or universal healthcare for decades. Obama ran his first 2008 presidential campaign on a single-payer platform. Since 1985, his campaign health adviser, the late Dr. Quentin Young from the University of Illinois Medical School, was one of the nation's leading voices calling for universal health coverage.  During a private conversation with Dr. Young shortly before his passing in 2016, he conveyed his sense of betrayal at the hands of the Obama administration. Dr. Young was in his 80s when he joined the Obama campaign team to help lead the young Senator to victory on a promise that America would finally catch up with other nations. The doctor sounded defeated. He shared how he was manipulated, and that Obama held no sincere intention to make universal healthcare a part of his administration's agenda. During the closed-door negotiations, which spawned the weak and compromised Affordable Care Act, Dr. Young was neither consulted nor invited to participate. In fact, he told us that he never heard from Obama again after his White House victory.   Past efforts to even raise the issue have been viciously attacked. A huge army of private interests is determined to keep the public enslaved to private insurers and high medical costs. The failure of our healthcare is in no small measure due to it being a fully for-profit operation. Last year, private health insurance accounted for 65 percent of coverage. Consider that there are over 900 private insurance companies in the US. National Health Expenditures (NHE) grew to $4.5 trillion in 2022, which was 17.3 percent of GDP. Older corporate rank-and-file Democrats and Republicans argue that a single-payer or socialized medical program is unaffordable. However, not only is single-payer affordable, it will end bankruptcies due to unpayable medical debt. In addition, universal healthcare, structured on a preventative model, will reduce disease rates at the outset.    Corporate Democrats argue that Obama's Affordable Care Act (ACA) was a positive step inching the country towards complete public coverage. However, aside from providing coverage to the poorest of Americans, Obamacare turned into another financial anchor around the necks of millions more. According to the health policy research group KFF, the average annual health insurance premium for single coverage is $8,400 and almost $24,000 for a family. In addition, patient out-of-pocket costs continue to increase, a 6.6% increase to $471 billion in 2022. Rather than healthcare spending falling, it has exploded, and the Trump and Biden administrations made matters worse.    Clearly, a universal healthcare program will require flipping the script on the entire private insurance industry, which employed over half a million people last year.  Obviously, the most volatile debate concerning a national universal healthcare system concerns cost. Although there is already a socialized healthcare system in place -- every federal legislator, bureaucrat, government employee and veteran benefits from it -- fiscal Republican conservatives and groups such as the Koch Brothers network are single-mindedly dedicated to preventing the expansion of Medicare and Medicaid. A Koch-funded Mercatus analysis made the outrageous claim that a single-payer system would increase federal health spending by $32 trillion in ten years. However, analyses and reviews by the Congressional Budget Office in the early 1990s concluded that such a system would only increase spending at the start; enormous savings would quickly offset it as the years pass. In one analysis, "the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage."    Defenders of those advocating for funding a National Health Program argue this can primarily be accomplished by raising taxes to levels comparable to other developed nations. This was a platform Senator Bernie Sanders and some of the younger progressive Democrats in the House campaigned on. The strategy was to tax the highest multimillion-dollar earners 60-70 percent. Despite the outrage of its critics, including old rank-and-file multi-millionaire Democrats like Nancy Pelosi and Chuck Schumer, this is still far less than in the past. During the Korean War, the top tax rate was 91 percent; it declined to 70 percent in the late 1960s. Throughout most of the 1970s, those in the lowest income bracket were taxed at 14 percent. We are not advocating for this strategy because it ignores where the funding is going, and the corruption in the system that is contributing to exorbitant waste.    But Democratic supporters of the ACA who oppose a universal healthcare plan ignore the additional taxes Obama levied to pay for the program. These included surtaxes on investment income, Medicare taxes from those earning over $200,000, taxes on tanning services, an excise tax on medical equipment, and a 40 percent tax on health coverage for costs over the designated cap that applied to flexible savings and health savings accounts. The entire ACA was reckless, sloppy and unnecessarily complicated from the start.    The fact that Obamacare further strengthened the distinctions between two parallel systems -- federal and private -- with entirely different economic structures created a labyrinth of red tape, rules, and wasteful bureaucracy. Since the ACA went into effect, over 150 new boards, agencies and programs have had to be established to monitor its 2,700 pages of gibberish. A federal single-payer system would easily eliminate this bureaucracy and waste.    A medical New Deal to establish universal healthcare coverage is a decisive step in the correct direction. But we must look at the crisis holistically and in a systematic way. Simply shuffling private insurance into a federal Medicare-for-all or buy-in program, funded by taxing the wealthiest of citizens, would only temporarily reduce costs. It will neither curtail nor slash escalating disease rates e. Any effective healthcare reform must also tackle the underlying reasons for Americans' poor state of health. We cannot shy away from examining the social illnesses infecting our entire free-market capitalist culture and its addiction to deregulation. A viable healthcare model would have to structurally transform how the medical economy operates. Finally, a successful medical New Deal must honestly evaluate the best and most reliable scientific evidence in order to effectively redirect public health spending.    For example, Dr. Ezekiel Emanuel, a former Obama healthcare adviser, observed that AIDS-HIV measures consume the most public health spending, even though the disease "ranked 75th on the list of diseases by personal health expenditures." On the other hand, according to the American Medical Association, a large percentage of the nation's $3.4 trillion healthcare spending goes towards treating preventable diseases, notably diabetes, common forms of heart disease, and back and neck pain conditions. In 2016, these three conditions were the most costly and accounted for approximately $277 billion in spending. Last year, the CDC announced the autism rate is now 1 in 36 children compared to 1 in 44 two years ago. A retracted study by Mark Blaxill, an autism activist at the Holland Center and a friend of the authors, estimates that ASD costs will reach $589 billion annually by 2030. There are no signs that this alarming trend will reverse and decline; and yet, our entire federal health system has failed to conscientiously investigate the underlying causes of this epidemic. All explanations that might interfere with the pharmaceutical industry's unchecked growth, such as over-vaccination, are ignored and viciously discredited without any sound scientific evidence. Therefore, a proper medical New Deal will require a systemic overhaul and reform of our federal health agencies, especially the HHS, CDC and FDA. Only the Robert Kennedy Jr presidential campaign is even addressing the crisis and has an inexpensive and comprehensive plan to deal with it. For any medical revolution to succeed in advancing universal healthcare, the plan must prioritize spending in a manner that serves public health and not private interests. It will also require reshuffling private corporate interests and their lobbyists to the sidelines, away from any strategic planning, in order to break up the private interests' control over federal agencies and its revolving door policies. Aside from those who benefit from this medical corruption, the overwhelming majority of Americans would agree with this criticism. However, there is a complete lack of national trust that our legislators, including the so-called progressives, would be willing to undertake such actions.    In addition, America's healthcare system ignores the single most critical initiative to reduce costs - that is, preventative efforts and programs instead of deregulation and closing loopholes designed to protect the drug and insurance industries' bottom line. Prevention can begin with banning toxic chemicals that are proven health hazards associated with current disease epidemics, and it can begin by removing a 1,000-plus toxins already banned in Europe. This should be a no-brainer for any legislator who cares for public health. For example, Stacy Malkan, co-founder of the Campaign for Safe Cosmetics, notes that "the policy approach in the US and Europe is dramatically different" when it comes to chemical allowances in cosmetic products. Whereas the EU has banned 1,328 toxic substances from the cosmetic industry alone, the US has banned only 11. The US continues to allow carcinogenic formaldehyde, petroleum, forever chemicals, many parabens (an estrogen mimicker and endocrine hormone destroyer), the highly allergenic p-phenylenediamine or PBD, triclosan, which has been associated with the rise in antibiotic resistant bacteria, avobenzone, and many others to be used in cosmetics, sunscreens, shampoo and hair dyes.   Next, the food Americans consume can be reevaluated for its health benefits. There should be no hesitation to tax the unhealthiest foods, such as commercial junk food, sodas and candy relying on high fructose corn syrup, products that contain ingredients proven to be toxic, and meat products laden with dangerous chemicals including growth hormones and antibiotics. The scientific evidence that the average American diet is contributing to rising disease trends is indisputable. We could also implement additional taxes on the public advertising of these demonstrably unhealthy products. All such tax revenue would accrue to a national universal health program to offset medical expenditures associated with the very illnesses linked to these products. Although such tax measures would help pay for a new medical New Deal, it may be combined with programs to educate the public about healthy nutrition if it is to produce a reduction in the most common preventable diseases. In fact, comprehensive nutrition courses in medical schools should be mandatory because the average physician receives no education in this crucial subject.  In addition, preventative health education should be mandatory throughout public school systems.   Private insurers force hospitals, clinics and private physicians into financial corners, and this is contributing to prodigious waste in money and resources. Annually, healthcare spending towards medical liability insurance costs tens of billions of dollars. In particular, this economic burden has taxed small clinics and physicians. It is well past the time that physician liability insurance is replaced with no-fault options. Today's doctors are spending an inordinate amount of money to protect themselves. Legions of liability and trial lawyers seek big paydays for themselves stemming from physician error. This has created a culture of fear among doctors and hospitals, resulting in the overly cautious practice of defensive medicine, driving up costs and insurance premiums just to avoid lawsuits. Doctors are forced to order unnecessary tests and prescribe more medications and medical procedures just to cover their backsides. No-fault insurance is a common-sense plan that enables physicians to pursue their profession in a manner that will reduce iatrogenic injuries and costs. Individual cases requiring additional medical intervention and loss of income would still be compensated. This would generate huge savings.    No other nation suffers from the scourge of excessive drug price gouging like the US. After many years of haggling to lower prices and increase access to generic drugs, only a minute amount of progress has been made in recent years. A 60 Minutes feature about the Affordable Care Act reported an "orgy of lobbying and backroom deals in which just about everyone with a stake in the $3-trillion-a-year health industry came out ahead—except the taxpayers.” For example, Life Extension magazine reported that an antiviral cream (acyclovir), which had lost its patent protection, "was being sold to pharmacies for 7,500% over the active ingredient cost. The active ingredient (acyclovir) costs only 8 pennies, yet pharmacies are paying a generic maker $600 for this drug and selling it to consumers for around $700." Other examples include the antibiotic Doxycycline. The price per pill averages 7 cents to $3.36 but has a 5,300 percent markup when it reaches the consumer. The antidepressant Clomipramine is marked up 3,780 percent, and the anti-hypertensive drug Captopril's mark-up is 2,850 percent. And these are generic drugs!    Medication costs need to be dramatically cut to allow drug manufacturers a reasonable but not obscene profit margin. By capping profits approximately 100 percent above all costs, we would save our system hundreds of billions of dollars. Such a measure would also extirpate the growing corporate misdemeanors of pricing fraud, which forces patients to pay out-of-pocket in order to make up for the costs insurers are unwilling to pay.    Finally, we can acknowledge that our healthcare is fundamentally a despotic rationing system based upon high insurance costs vis-a-vis a toss of the dice to determine where a person sits on the economic ladder. For the past three decades it has contributed to inequality. The present insurance-based economic metrics cast millions of Americans out of coverage because private insurance costs are beyond their means. Uwe Reinhardt, a Princeton University political economist, has called our system "brutal" because it "rations [people] out of the system." He defined rationing as "withholding something from someone that is beneficial." Discriminatory healthcare rationing now affects upwards to 60 million people who have been either priced out of the system or under insured. They make too much to qualify for Medicare under Obamacare, yet earn far too little to afford private insurance costs and premiums. In the final analysis, the entire system is discriminatory and predatory.    However, we must be realistic. Almost every member of Congress has benefited from Big Pharma and private insurance lobbyists. The only way to begin to bring our healthcare program up to the level of a truly developed nation is to remove the drug industry's rampant and unnecessary profiteering from the equation.     How did Fauci memory-hole a cure for AIDS and get away with it?   By Helen Buyniski   Over 700,000 Americans have died of AIDS since 1981, with the disease claiming some 42.3 million victims worldwide. While an HIV diagnosis is no longer considered a certain death sentence, the disease looms large in the public imagination and in public health funding, with contemporary treatments running into thousands of dollars per patient annually.   But was there a cure for AIDS all this time - an affordable and safe treatment that was ruthlessly suppressed and attacked by the US public health bureaucracy and its agents? Could this have saved millions of lives and billions of dollars spent on AZT, ddI and failed HIV vaccine trials? What could possibly justify the decision to disappear a safe and effective approach down the memory hole?   The inventor of the cure, Gary Null, already had several decades of experience creating healing protocols for physicians to help patients not responding well to conventional treatments by the time AIDS was officially defined in 1981. Null, a registered dietitian and board-certified nutritionist with a PhD in human nutrition and public health science, was a senior research fellow and Director of Anti-Aging Medicine at the Institute of Applied Biology for 36 years and has published over 950 papers, conducting groundbreaking experiments in reversing biological aging as confirmed with DNA methylation testing. Additionally, Null is a multi-award-winning documentary filmmaker, bestselling author, and investigative journalist whose work exposing crimes against humanity over the last 50 years has highlighted abuses by Big Pharma, the military-industrial complex, the financial industry, and the permanent government stay-behind networks that have come to be known as the Deep State.   Null was contacted in 1974 by Dr. Stephen Caiazza, a physician working with a subculture of gay men in New York living the so-called “fast track” lifestyle, an extreme manifestation of the gay liberation movement that began with the Stonewall riots. Defined by rampant sexual promiscuity and copious use of illegal and prescription drugs, including heavy antibiotic use for a cornucopia of sexually-transmitted diseases, the fast-track never included more than about two percent of gay men, though these dominated many of the bathhouses and clubs that defined gay nightlife in the era. These patients had become seriously ill as a result of their indulgence, generally arriving at the clinic with multiple STDs including cytomegalovirus and several types of herpes and hepatitis, along with candida overgrowth, nutritional deficiencies, gut issues, and recurring pneumonia. Every week for the next 10 years, Null would counsel two or three of these men - a total of 800 patients - on how to detoxify their bodies and de-stress their lives, tracking their progress with Caiazza and the other providers at weekly feedback meetings that he credits with allowing the team to quickly evaluate which treatments were most effective. He observed that it only took about two years on the “fast track” for a healthy young person to begin seeing muscle loss and the recurrent, lingering opportunistic infections that would later come to be associated with AIDS - while those willing to commit to a healthier lifestyle could regain their health in about a year.    It was with this background that Null established the Tri-State Healing Center in Manhattan in 1980, staffing the facility with what would eventually run to 22 certified health professionals to offer safe, natural, and effective low- and no-cost treatments to thousands of patients with HIV and AIDS-defining conditions. Null and his staff used variations of the protocols he had perfected with Caiazza's patients, a multifactorial patient-tailored approach that included high-dose vitamin C drips, intravenous ozone therapy, juicing and nutritional improvements and supplementation, aspects of homeopathy and naturopathy with some Traditional Chinese Medicine and Ayurvedic practices. Additional services offered on-site included acupuncture and holistic dentistry, while peer support groups were also held at the facility so that patients could find community and a positive environment, healing their minds and spirits while they healed their bodies.   “Instead of trying to kill the virus with antiretroviral pharmaceuticals designed to stop viral replication before it kills patients, we focused on what benefits could be gained by building up the patients' natural immunity and restoring biochemical integrity so the body could fight for itself,” Null wrote in a 2014 article describing the philosophy behind the Center's approach, which was wholly at odds with the pharmaceutical model.1   Patients were comprehensively tested every week, with any “recovery” defined solely by the labs, which documented AIDS patient after patient - 1,200 of them - returning to good health and reversing their debilitating conditions. Null claims to have never lost an AIDS patient in the Center's care, even as the death toll for the disease - and its pharmaceutical standard of care AZT - reached an all-time high in the early 1990s. Eight patients who had opted for a more intensive course of treatment - visiting the Center six days a week rather than one - actually sero-deconverted, with repeated subsequent testing showing no trace of HIV in their bodies.   As an experienced clinical researcher himself, Null recognized that any claims made by the Center would be massively scrutinized, challenging as they did the prevailing scientific consensus that AIDS was an incurable, terminal illness. He freely gave his protocols to any medical practitioner who asked, understanding that his own work could be considered scientifically valid only if others could replicate it under the same conditions. After weeks of daily observational visits to the Center, Dr. Robert Cathcart took the protocols back to San Francisco, where he excitedly reported that patients were no longer dying in his care.    Null's own colleague at the Institute of Applied Biology, senior research fellow Elana Avram, set up IV drip rooms at the Institute and used his intensive protocols to sero-deconvert 10 patients over a two-year period. While the experiment had been conducted in secret, as the Institute had been funded by Big Pharma since its inception half a century earlier, Avram had hoped she would be able to publish a journal article to further publicize Null's protocols and potentially help AIDS patients, who were still dying at incredibly high rates thanks to Burroughs Wellcome's noxious but profitable AZT. But as she would later explain in a 2019 letter to Null, their groundbreaking research never made it into print - despite meticulous documentation of their successes - because the Institute's director and board feared their pharmaceutical benefactors would withdraw the funding on which they depended, given that Null's protocols did not involve any patentable or otherwise profitable drugs. When Avram approached them about publication, the board vetoed the idea, arguing that it would “draw negative attention because [the work] was contrary to standard drug treatments.” With no real point in continuing experiments along those lines without institutional support and no hope of obtaining funding from elsewhere, the department she had created specifically for these experiments shut down after a two-year followup with her test subjects - all of whom remained alive and healthy - was completed.2   While the Center was receiving regular visits by this time from medical professionals and, increasingly, black celebrities like Stokely Carmichael and Isaac Hayes, who would occasionally perform for the patients, the news was spreading by word of mouth alone - not a single media outlet had dared to document the clinic that was curing AIDS patients for free. Instead, they gave airtime to Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, who had for years been spreading baseless, hysteria-fueling claims about HIV and AIDS to any news outlet that would put him on. His claim that children could contract the virus from “ordinary household conduct” with an infected relative proved so outrageous he had to walk it back,3 and he never really stopped insisting the deadly plague associated with gays and drug users was about to explode like a nuclear bomb among the law-abiding heterosexual population. Fauci by this time controlled all government science funding through NIAID, and his zero-tolerance approach to dissent on the HIV/AIDS front had already seen prominent scientists like virologist Peter Duesberg stripped of the resources they needed for their work because they had dared to question his commandment: There is no cause of AIDS but HIV, and AZT is its treatment. Even the AIDS activist groups, which by then had been coopted by Big Pharma and essentially reduced to astroturfing for the toxic failed chemotherapy drug AZT backed by the institutional might of Fauci's NIAID,4 didn't seem to want to hear that there was a cure. Unconcerned with the irrationality of denouncing the man touting his free AIDS cure as an  “AIDS denier,” they warned journalists that platforming Null or anyone else rejecting the mainstream medical line would be met with organized demands for their firing.    Determined to breach the institutional iron curtain and get his message to the masses, Null and his team staged a press conference in New York, inviting scientists and doctors from around the world to share their research on alternative approaches to HIV and AIDS in 1993. To emphasize the sound scientific basis of the Center's protocols and encourage guests to adopt them into their own practices, Null printed out thousands of abstracts in support of each nutrient and treatment being used. However, despite over 7,000 invitations sent three times to major media, government figures, scientists, and activists, almost none of the intended audience members showed up. Over 100 AIDS patients and their doctors, whose charts exhaustively documented their improvements using natural and nontoxic modalities over the preceding 12 months, gave filmed testimonials, declaring that the feared disease was no longer a death sentence, but the conference had effectively been silenced. Bill Tatum, publisher of the Amsterdam News, suggested Null and his patients would find a more welcoming audience in his home neighborhood of Harlem - specifically, its iconic Apollo Theatre. For three nights, the theater was packed to capacity. Hit especially hard by the epidemic and distrustful of a medical system that had only recently stopped being openly racist (the Tuskegee syphilis experiment only ended in 1972), black Americans, at least, did not seem to care what Anthony Fauci would do if he found out they were investigating alternatives to AZT and death.    PBS journalist Tony Brown, having obtained a copy of the video of patient testimonials from the failed press conference, was among a handful of black journalists who began visiting the Center to investigate the legitimacy of Null's claims. Satisfied they had something significant to offer his audience, Brown invited eight patients - along with Null himself - onto his program over the course of several episodes to discuss the work. It was the first time these protocols had received any attention in the media, despite Null having released nearly two dozen articles and multiple documentaries on the subject by that time. A typical patient on one program, Al, a recovered IV drug user who was diagnosed with AIDS at age 32, described how he “panicked,” saw a doctor and started taking AZT despite his misgivings - only to be forced to discontinue the drug after just a few weeks due to his condition deteriorating rapidly. Researching alternatives brought him to Null, and after six months of “detoxing [his] lifestyle,” he observed his initial symptoms - swollen lymph nodes and weight loss - begin to reverse, culminating with sero-deconversion. On Bill McCreary's Channel 5 program, a married couple diagnosed with HIV described how they watched their T-cell counts increase as they cut out sugar, caffeine, smoking, and drinking and began eating a healthy diet. They also saw the virus leave their bodies.   For HIV-positive viewers surrounded by fear and negativity, watching healthy-looking, cheerful “AIDS patients” detail their recovery while Null backed up their claims with charts must have been balm for the soul. But the TV programs were also a form of outreach to the medical community, with patients' charts always on hand to convince skeptics the cure was scientifically valid. Null brought patients' charts to every program, urging them to keep an open mind: “Other physicians and public health officials should know that there's good science in the alternative perspective. It may not be a therapy that they're familiar with, because they're just not trained in it, but if the results are positive, and you can document them…” He challenged doubters to send in charts from their own sero-deconverted patients on AZT, and volunteered to debate proponents of the orthodox treatment paradigm - though the NIH and WHO both refused to participate in such a debate on Tony Brown's Journal, following Fauci's directive prohibiting engagement with forbidden ideas.    Aside from those few TV programs and Null's own films, suppression of Null's AIDS cure beyond word of mouth was total. The 2021 documentary The Cost of Denial, produced by the Society for Independent Journalists, tells the story of the Tri-State Healing Center and the medical paradigm that sought to destroy it, lamenting the loss of the lives that might have been saved in a more enlightened society. Nurse practitioner Luanne Pennesi, who treated many of the AIDS patients at the Center, speculated in the film that the refusal by the scientific establishment and AIDS activists to accept their successes was financially motivated. “It was as if they didn't want this information to get out. Understand that our healthcare system as we know it is a corporation, it's a corporate model, and it's about generating revenue. My concern was that maybe they couldn't generate enough revenue from these natural approaches.”5   Funding was certainly the main disciplinary tool Fauci's NIAID used to keep the scientific community in line. Despite the massive community interest in the work being done at the Center, no foundation or institution would defy Fauci and risk getting itself blacklisted, leaving Null to continue funding the operation out of his pocket with the profits from book sales. After 15 years, he left the Center in 1995, convinced the mainstream model had so thoroughly been institutionalized that there was no chance of overthrowing it. He has continued to counsel patients and advocate for a reappraisal of the HIV=AIDS hypothesis and its pharmaceutical treatments, highlighting the deeply flawed science underpinning the model of the disease espoused by the scientific establishment in 39 articles, six documentaries and a 700-page textbook on AIDS, but the Center's achievements have been effectively memory-holed by Fauci's multi-billion-dollar propaganda apparatus.     FRUIT OF THE POISONOUS TREE   To understand just how much of a threat Null's work was to the HIV/AIDS establishment, it is instructive to revisit the 1984 paper, published by Dr. Robert Gallo of the National Cancer Institute, that established HIV as the sole cause of AIDS. The CDC's official recognition of AIDS in 1981 had done little to quell the mounting public panic over the mysterious illness afflicting gay men in the US, as the agency had effectively admitted it had no idea what was causing them to sicken and die. As years passed with no progress determining the causative agent of the plague, activist groups like Gay Men's Health Crisis disrupted public events and threatened further mass civil disobedience as they excoriated the NIH for its sluggish allocation of government science funding to uncovering the cause of the “gay cancer.”6 When Gallo published his paper declaring that the retrovirus we now know as HIV was the sole “probable” cause of AIDS, its simple, single-factor hypothesis was the answer to the scientific establishment's prayers. This was particularly true for Fauci, as the NIAID chief was able to claim the hot new disease as his agency's own domain in what has been described as a “dramatic confrontation” with his rival Sam Broder at the National Cancer Institute. After all, Fauci pointed out, Gallo's findings - presented by Health and Human Services Secretary Margaret Heckler as if they were gospel truth before any other scientists had had a chance to inspect them, never mind conduct a full peer review - clearly classified AIDS as an infectious disease, and not a cancer like the Kaposi's sarcoma which was at the time its most visible manifestation. Money and media attention began pouring in, even as funding for the investigation of other potential causes of AIDS dried up. Having already patented a diagnostic test for “his” retrovirus before introducing it to the world, Gallo was poised for a financial windfall, while Fauci was busily leveraging the discovery into full bureaucratic empire of the US scientific apparatus.   While it would serve as the sole basis for all US government-backed AIDS research to follow - quickly turning Gallo into the most-cited scientist in the world during the 1980s,7 Gallo's “discovery” of HIV was deeply problematic. The sample that yielded the momentous discovery actually belonged to Prof. Luc Montagnier of the French Institut Pasteur, a fact Gallo finally admitted in 1991, four years after a lawsuit from the French government challenged his patent on the HIV antibody test, forcing the US government to negotiate a hasty profit-sharing agreement between Gallo's and Montagnier's labs. That lawsuit triggered a cascade of official investigations into scientific misconduct by Gallo, and evidence submitted during one of these probes, unearthed in 2008 by journalist Janine Roberts, revealed a much deeper problem with the seminal “discovery.” While Gallo's co-author, Mikulas Popovic, had concluded after numerous experiments with the French samples that the virus they contained was not the cause of AIDS, Gallo had drastically altered the paper's conclusion, scribbling his notes in the margins, and submitted it for publication to the journal Science without informing his co-author.   After Roberts shared her discovery with contacts in the scientific community, 37 scientific experts wrote to the journal demanding that Gallo's career-defining HIV paper be retracted from Science for lacking scientific integrity.8 Their call, backed by an endorsement from the 2,600-member scientific organization Rethinking AIDS, was ignored by the publication and by the rest of mainstream science despite - or perhaps because of - its profound implications.   That 2008 letter, addressed to Science editor-in-chief Bruce Alberts and copied to American Association for the Advancement of Science CEO Alan Leshner, is worth reproducing here in its entirety, as it utterly dismantles Gallo's hypothesis - and with them the entire HIV is the sole cause of AIDS dogma upon which the contemporary medical model of the disease rests:   On May 4, 1984 your journal published four papers by a group led by Dr. Robert Gallo. We are writing to express our serious concerns with regard to the integrity and veracity of the lead paper among these four of which Dr. Mikulas Popovic is the lead author.[1] The other three are also of concern because they rely upon the conclusions of the lead paper .[2][3][4]  In the early 1990s, several highly critical reports on the research underlying these papers were produced as a result of governmental inquiries working under the supervision of scientists nominated by the National Academy of Sciences and the Institute of Medicine. The Office of Research Integrity of the US Department of Health and Human Services concluded that the lead paper was “fraught with false and erroneous statements,” and that the “ORI believes that the careless and unacceptable keeping of research records...reflects irresponsible laboratory management that has permanently impaired the ability to retrace the important steps taken.”[5] Further, a Congressional Subcommittee on Oversight and Investigations led by US Representative John D. Dingell of Michigan produced a staff report on the papers which contains scathing criticisms of their integrity.[6]  Despite the publically available record of challenges to their veracity, these papers have remained uncorrected and continue to be part of the scientific record.  What prompts our communication today is the recent revelation of an astonishing number of previously unreported deletions and unjustified alterations made by Gallo to the lead paper. There are several documents originating from Gallo's laboratory that, while available for some time, have only recently been fully analyzed. These include a draft of the lead paper typewritten by Popovic which contains handwritten changes made to it by Gallo.[7] This draft was the key evidence used in the above described inquiries to establish that Gallo had concealed his laboratory's use of a cell culture sample (known as LAV) which it received from the Institut Pasteur.  These earlier inquiries verified that the typed manuscript draft was produced by Popovic who had carried out the recorded experiment while his laboratory chief, Gallo, was in Europe and that, upon his return, Gallo changed the document by hand a few days before it was submitted to Science on March 30, 1984. According to the ORI investigation, “Dr. Gallo systematically rewrote the manuscript for what would become a renowned LTCB [Gallo's laboratory at the National Cancer Institute] paper.”[5]  This document provided the important evidence that established the basis for awarding Dr. Luc Montagnier and Dr. Francoise Barré-Sinoussi the 2008 Nobel Prize in Medicine for the discovery of the AIDS virus by proving it was their samples of LAV that Popovic used in his key experiment. The draft reveals that Popovic had forthrightly admitted using the French samples of LAV renamed as Gallo's virus, HTLV-III, and that Gallo had deleted this admission, concealing their use of LAV.  However, it has not been previously reported that on page three of this same document Gallo had also deleted Popovic's unambiguous statement that, "Despite intensive research efforts, the causative agent of AIDS has not yet been identified,” replacing it in the published paper with a statement that said practically the opposite, namely, “That a retrovirus of the HTLV family might be an etiologic agent of AIDS was suggested by the findings.”  It is clear that the rest of Popovic's typed paper is entirely consistent with his statement that the cause of AIDS had not been found, despite his use of the French LAV. Popovic's final conclusion was that the culture he produced “provides the possibility” for detailed studies. He claimed to have achieved nothing more. At no point in his paper did Popovic attempt to prove that any virus caused AIDS, and it is evident that Gallo concealed these key elements in Popovic's experimental findings.  It is astonishing now to discover these unreported changes to such a seminal document. We can only assume that Gallo's alterations of Popovic's conclusions were not highlighted by earlier inquiries because the focus at the time was on establishing that the sample used by Gallo's lab came from Montagnier and was not independently collected by Gallo. In fact, the only attention paid to the deletions made by Gallo pertains to his effort to hide the identity of the sample. The questions of whether Gallo and Popovic's research proved that LAV or any other virus was the cause of AIDS were clearly not considered.  Related to these questions are other long overlooked documents that merit your attention. One of these is a letter from Dr. Matthew A. Gonda, then Head of the Electron Microscopy Laboratory at the National Cancer Institute, which is addressed to Popovic, copied to Gallo and dated just four days prior to Gallo's submission to Science.[8] In this letter, Gonda remarks on samples he had been sent for imaging because “Dr Gallo wanted these micrographs for publication because they contain HTLV.” He states, “I do not believe any of the particles photographed are of HTLV-I, II or III.” According to Gonda, one sample contained cellular debris, while another had no particles near the size of a retrovirus. Despite Gonda's clearly worded statement, Science published on May 4, 1984 papers attributed to Gallo et al with micrographs attributed to Gonda and described unequivocally as HTLV-III.  In another letter by Gallo, dated one day before he submitted his papers to Science, Gallo states, “It's extremely rare to find fresh cells [from AIDS patients] expressing the virus... cell culture seems to be necessary to induce virus,” a statement which raises the possibility he was working with a laboratory artifact. [9]  Included here are copies of these documents and links to the same. The very serious flaws they reveal in the preparation of the lead paper published in your journal in 1984 prompts our request that this paper be withdrawn. It appears that key experimental findings have been concealed. We further request that the three associated papers published on the same date also be withdrawn as they depend on the accuracy of this paper.  For the scientific record to be reliable, it is vital that papers shown to be flawed, or falsified be retracted. Because a very public record now exists showing that the Gallo papers drew unjustified conclusions, their withdrawal from Science is all the more important to maintain integrity. Future researchers must also understand they cannot rely on the 1984 Gallo papers for statements about HIV and AIDS, and all authors of papers that previously relied on this set of four papers should have the opportunity to consider whether their own conclusions are weakened by these revelations.      Gallo's handwritten revision, submitted without his colleague's knowledge despite multiple experiments that failed to support the new conclusion, was the sole foundation for the HIV=AIDS hypothesis. Had Science published the manuscript the way Popovic had typed it, there would be no AIDS “pandemic” - merely small clusters of people with AIDS. Without a viral hypothesis backing the development of expensive and deadly pharmaceuticals, would Fauci have allowed these patients to learn about the cure that existed all along?   Faced with a potential rebellion, Fauci marshaled the full resources under his control to squelch the publication of the investigations into Gallo and restrict any discussion of competing hypotheses in the scientific and mainstream press, which had been running virus-scare stories full-time since 1984. The effect was total, according to biochemist Dr. Kary Mullis, inventor of the polymerase chain reaction (PCR) procedure. In a 2009 interview, Mullis recalled his own shock when he attempted to unearth the experimental basis for the HIV=AIDS hypothesis. Despite his extensive inquiry into the literature, “there wasn't a scientific reference…[that] said ‘here's how come we know that HIV is the probable cause of AIDS.' There was nothing out there like that.”9 This yawning void at the core of HIV/AIDS “science" turned him into a strident critic of AIDS dogma - and those views made him persona non grata where the scientific press was concerned, suddenly unable to publish a single paper despite having won the Nobel Prize for his invention of the PCR test just weeks before.  10   DISSENT BECOMES “DENIAL”   While many of those who dissent from the orthodox HIV=AIDS view believe HIV plays a role in the development of AIDS, they point to lifestyle and other co-factors as being equally if not more important. Individuals who test positive for HIV can live for decades in perfect health - so long as they don't take AZT or the other toxic antivirals fast-tracked by Fauci's NIAID - but those who developed full-blown AIDS generally engaged in highly risky behaviors like extreme promiscuity and prodigious drug abuse, contracting STDs they took large quantities of antibiotics to treat, further running down their immune systems. While AIDS was largely portrayed as a “gay disease,” it was only the “fast track” gays, hooking up with dozens of partners nightly in sex marathons fueled by “poppers” (nitrate inhalants notorious for their own devastating effects on the immune system), who became sick. Kaposi's sarcoma, one of the original AIDS-defining conditions, was widespread among poppers-using gay men, but never appeared among IV drug users or hemophiliacs, the other two main risk groups during the early years of the epidemic. Even Robert Gallo himself, at a 1994 conference on poppers held by the National Institute on Drug Abuse, would admit that the previously-rare form of skin cancer surging among gay men was not primarily caused by HIV - and that it was immune stimulation, rather than suppression, that was likely responsible.11 Similarly, IV drug users are often riddled with opportunistic infections as their habit depresses the immune system and their focus on maintaining their addiction means that healthier habits - like good nutrition and even basic hygiene - fall by the wayside.    Supporting the call for revising the HIV=AIDS hypothesis to include co-factors is the fact that the mass heterosexual outbreaks long predicted by Fauci and his ilk in seemingly every country on Earth have failed to materialize, except - supposedly - in Africa, where the diagnostic standard for AIDS differs dramatically from those of the West. Given the prohibitively high cost of HIV testing for poor African nations, the WHO in 1985 crafted a diagnostic loophole that became known as the “Bangui definition,” allowing medical professionals to diagnose AIDS in the absence of a test using just clinical symptoms: high fever, persistent cough, at least 30 days of diarrhea, and the loss of 10% of one's body weight within two months. Often suffering from malnutrition and without access to clean drinking water, many of the inhabitants of sub-Saharan Africa fit the bill, especially when the WHO added tuberculosis to the list of AIDS-defining illnesses in 1993 - a move which may be responsible for as many as one half of African “AIDS” cases, according to journalist Christine Johnson. The WHO's former Chief of Global HIV Surveillance, James Chin, acknowledged their manipulation of statistics, but stressed that it was the entire AIDS industry - not just his organization - perpetrating the fraud. “There's the saying that, if you knew what sausages are made of, most people would hesitate to sort of eat them, because they wouldn't like what's in it. And if you knew how HIV/AIDS numbers are cooked, or made up, you would use them with extreme caution,” Chin told an interviewer in 2009.12   With infected numbers stubbornly remaining constant in the US despite Fauci's fearmongering projections of the looming heterosexually-transmitted plague, the CDC in 1993 broadened its definition of AIDS to include asymptomatic (that is, healthy) HIV-positive people with low T-cell counts - an absurd criteria given that an individual's T-cell count can fluctuate by hundreds within a single day. As a result, the number of “AIDS cases” in the US immediately doubled. Supervised by Fauci, the NIAID had been quietly piling on diseases into the “AIDS-related” category for years, bloating the list from just two conditions - pneumocystis carinii pneumonia and Kaposi's sarcoma - to 30 so fast it raised eyebrows among some of science's leading lights. Deeming the entire process “bizarre” and unprecedented, Kary Mullis wondered aloud why no one had called the AIDS establishment out: “There's something wrong here. And it's got to be financial.”13   Indeed, an early CDC public relations campaign was exposed by the Wall Street Journal in 1987 as having deliberately mischaracterized AIDS as a threat to the entire population so as to garner increased public and private funding for what was very much a niche issue, with the risk to average heterosexuals from a single act of sex “smaller than the risk of ever getting hit by lightning.” Ironically, the ads, which sought to humanize AIDS patients in an era when few Americans knew anyone with the disease and more than half the adult population thought infected people should be forced to carry cards warning of their status, could be seen as a reaction to the fear tactics deployed by Fauci early on.14   It's hard to tell where fraud ends and incompetence begins with Gallo's HIV antibody test. Much like Covid-19 would become a “pandemic of testing,” with murder victims and motorcycle crashes lumped into “Covid deaths” thanks to over-sensitized PCR tests that yielded as many as 90% false positives,15 HIV testing is fraught with false positives - and unlike with Covid-19, most people who hear they are HIV-positive still believe they are receiving a death sentence. Due to the difficulty of isolating HIV itself from human samples, the most common diagnostic tests, ELISA and the Western Blot, are designed to detect not the virus but antibodies to it, upending the traditional medical understanding that the presence of antibodies indicates only exposure - and often that the body has actually vanquished the pathogen. Patients are known to test positive for HIV antibodies in the absence of the virus due to at least 70 other conditions, including hepatitis, lupus, rheumatoid arthritis, syphilis, recent vaccination or even pregnancy. (https://www.chcfl.org/diseases-that-can-cause-a-false-positive-hiv-test/) Positive results are often followed up with a PCR “viral load” test, even though the inventor of the PCR technique Kary Mullis famously condemned its misuse as a tool for diagnosing infection. Packaging inserts for all three tests warn the user that they cannot be reliably used to diagnose HIV.16 The ELISA HIV antibody test explicitly states: “At present there is no recognized standard for establishing the presence and absence of HIV antibody in human blood.”17   That the public remains largely unaware of these and other massive holes in the supposedly airtight HIV=AIDS=DEATH paradigm is a testament to Fauci's multi-layered control of the press. Like the writers of the Great Barrington Declaration and other Covid-19 dissidents, scientists who question HIV/AIDS dogma have been brutally punished for their heresy, no matter how prestigious their prior standing in the field and no matter how much evidence they have for their own claims. In 1987, the year the FDA's approval of AZT made AIDS the most profitable epidemic yet (a dubious designation Covid-19 has since surpassed), Fauci made it clearer than ever that scientific inquiry and debate - the basis of the scientific method - would no longer be welcome in the American public health sector, eliminating retrovirologist Peter Duesberg, then one of the most prominent opponents of the HIV=AIDS hypothesis, from the scientific conversation with a professional disemboweling that would make a cartel hitman blush. Duesberg had just eviscerated Gallo's 1984 HIV paper with an article of his own in the journal Cancer Research, pointing out that retroviruses had never before been found to cause a single disease in humans - let alone 30 AIDS-defining diseases. Rather than allow Gallo or any of the other scientists in his camp to respond to the challenge, Fauci waged a scorched-earth campaign against Duesberg, who had until then been one of the most highly regarded researchers in his field. Every research grant he requested was denied; every media appearance was canceled or preempted. The University of California at Berkeley, unable to fully fire him due to tenure, took away his lab, his graduate students, and the rest of his funding. The few colleagues who dared speak up for him in public were also attacked, while enemies and opportunists were encouraged to slander Duesberg at the conferences he was barred from attending and in the journals that would no longer publish his replies. When Duesberg was summoned to the White House later that year by then-President Ronald Reagan to debate Fauci on the origins of AIDS, Fauci convinced the president to cancel, allegedly pulling rank on the Commander-in-Chief with an accusation that the “White House was interfering in scientific matters that belonged to the NIH and the Office of Science and Technology Assessment.” After seven years of this treatment, Duesberg was contacted by NIH official Stephen O'Brien and offered an escape from professional purgatory. He could have “everything back,” he was told, and shown a manuscript of a scientific paper - apparently commissioned by the editor of the journal Nature - “HIV Causes AIDS: Koch's Postulates Fulfilled” with his own name listed alongside O'Brien's as an author.18 His refusal to take the bribe effectively guaranteed the epithet “AIDS denier” will appear on his tombstone. The character assassination of Duesberg became a template that would be deployed to great effectiveness wherever Fauci encountered dissent - never debate, only demonize, deplatform and destroy.    Even Luc Montagnier, the real discoverer of HIV, soon found himself on the wrong side of the Fauci machine. With his 1990 declaration that “the HIV virus [by itself] is harmless and passive, a benign virus,” Montagnier began distancing himself from Gallo's fraud, effectively placing a target on his own back. In a 1995 interview, he elaborated: “four factors that have come together to account for the sudden epidemic [of AIDS]: HIV presence, immune hyper-activation, increased sexually transmitted disease incidence, sexual behavior changes and other behavioral changes” such as drug use, poor nutrition and stress - all of which he said had to occur “essentially simultaneously” for HIV to be transmitted, creating the modern epidemic. Like the professionals at the Tri-State Healing Center, Montagnier advocated for the use of antioxidants like vitamin C and N-acetyl cysteine, naming oxidative stress as a critical factor in the progression from HIV to AIDS.19 When Montagnier died in 2022, Fauci's media mouthpieces sneered that the scientist (who was awarded the Nobel Prize in 2008 for his discovery of HIV, despite his flagging faith in that discovery's significance) “started espousing views devoid of a scientific basis” in the late 2000s, leading him to be “shunned by the scientific community.”20 In a particularly egregious jab, the Washington Post's obit sings the praises of Robert Gallo, implying it was the American scientist who really should have won the Nobel for HIV, while dismissing as “

Episode 184: Multiple Myeloma BasicsSub-Interns and future Drs. Di Tran and Jessica Avila explain the symptoms, work up and treatment of multiple myeloma. Written by Di Tran, MSIV, Ross University School of Medicine; Xiyuan Yang, MSIV, American University of the Caribbean. Comments by Jessica Avila, MSIV, American University of the Caribbean. Edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Di: Hi everyone, this is Di Tran, 4th year medical student from Ross university.  It's a pleasure to be back.  To be honest, this project is a part of teamwork of two medical students, myself and another 4th year, her name is XiYuan.  She came from the AUC. Unfortunately, due to personal matters she was unable to make it to the recording today which makes me feel really sad. Jessica: My name is Jessica Avila, MSIV, American University of the Caribbean.Di: The topic we will present today is Multiple Myeloma. Multiple myeloma is typically a rare disease and it's actually a type of blood cancer that affects plasma cells in the bone marrow.Jessica: Let's start with a case: A 66-year-old male comes to his family doctor for an annual health checkup. He is not in any acute distress but he reports that he has been feeling tired and weaker than usual for the last 3 months. He also noticed that he tends to bruise easily. He has a history of arthritis and chronic joint pain, but he thinks his back pain has gotten worse in the last couple of months. Upon checking his lab values, his family doctor found that he has a calcium level of 10.8 and a creatinine level of 1.2, which has increased from his baseline. Given all that information, what do you think his family doctor is suspecting? And what kind of tests she can order for further evaluation?Di: Those symptoms sound awfully familiar – are we talking about the CRAB? You know, the diagnostic criteria for Multiple Myeloma.Jessica: Exactly! Those are called “myeloma-defining events.” Do you remember what those are?Di: CRAB criteria comes in 4 flavors.  It's HYPERCALCEMIA with >1mg/dL, RENAL INSUFFICIENCY with serum creatinine >2mg/dL, ANEMIA with hemoglobin value 10% plasma cells, PLUS any one or more of the CRAB features, we can make the official diagnosis of multiple myeloma. Di:  Before we go deeper, let's back up a little bit and do a little background.  So, what do we know about the immunoglobulins, also known as antibodies? Back from years of studying from medical school, we know that the plasma cells are the ones that producing the antibodies that help fight infections.  There  are various kinds that come with various functions.  Each antibody is made up of 2 heavy chains and 2 light chains.  For heavy chains, we have A, D, E, G, M and for light chains we have Kappa and Lambda.Jessica: Usually, the 5 possible types of immunoglobulins for heavy chains would be written as IgG, IgA, IgD, IgE, and IgM.  And the most common type in the bloodstream is nonetheless the IgG. Di: What is multiple myeloma? In myeloma, all the abnormal plasma cells make the same type of antibody, the monoclonal antibody.  The cause of myeloma is unknown, but there are lots of studies and evidence that show a number of potential etiologies, including viral, genetic, and exposure to toxic chemicals, especially the Agent Orange, which is a chemical used as herbicide and defoliant. It was used as a chemical warfare by the U.S. military during the Vietnam War from 1961 to 1971.Jessica: We need to order some specific blood tests to see if there is elevated monoclonal proteins in the blood or urine. So, to begin with we'll need to take a very thorough history and physical exam. Next, we'll do labs, such as CBC, basic metabolic panel, calcium, serum beta-2 microglobulin, LDH, total protein, and some not so common tests: serum protein electrophoresis (SPEP), immunofixation of blood or urine (IFE), quantitative immunoglobulins (QIg), serum free light chain assay, and serum heavy/light chain ratio assay.If any of the results is abnormal, we should consider referring our patient to an oncologist.Di: Interesting! I read that Multiple Myeloma symptoms vary in different patients.  In fact, about 10-20% of patients with newly diagnosed myeloma do not have any symptoms at all.   Otherwise, classic symptomatic presentations are weakness, fatigue, increased bruising under the skin, reduced urine output, weakened bones that is likely prone to fractures, etc. And if multiple myeloma is highly suspected, a Bone Marrow biopsy should be done with testing for flow cytometry and fluorescent in situ hybridization (FISH). Actually, if any of the “Biomarkers of malignancy (SLIM)” is met we can also diagnose multiple myeloma even without the CRAB criteria. Jessica: The diagnosis is made if one or more of the following is found: >= 60% of clonal plasma cells on bone marrow biopsy, > 1 lytic bone lesion on MRI that is at least 5mm in size, or a biopsy confirmed plasmacytoma. Di: Imaging comes in at the final step especially if we able to find one or more sites of osteolytic bone destruction > 5mm on an MRI scan.Jessica: What if the bone marrow biopsy returns > 10% of monoclonal plasma cells, but our patient doesn't have either the CRAB or the Biomarker criteria? Di: That's actually a very good question, since Multiple Myeloma is part of a spectrum of plasma cell disorders. That's when smoldering myeloma comes into play. It is a precursor of active multiple myeloma. Smoldering myeloma is further categorized as high-risk or low-risk based on specific criteria.A less severe form is called Monoclonal Gammopathy of Undetermined Significance, or simply MGUS, with < 10% bone marrow involvement. Those are diagnoses we give once we rule out actual multiple myeloma, which are defined by the amount of M-protein in the serum.Jessica:  When to get started on treatment? Multiple Myeloma is on a spectrum of plasma cells proliferative disorders, starting from MGUS to Smoldering Myeloma, to Multiple Myeloma and to  Plasma Cell Leukemia.  Close supervision/active watching is enough for MGUS and low risk Smoldering Myeloma. But once it has progressed to high-risk smoldering myeloma or to active Multiple Myeloma, chemotherapy is usually required. Some situations may require emergent treatment to improve renal function, reduce hypercalcemia, and to prevent potential infections.Di: As of 2024, treatment of Multiple Myeloma comprises the Standard-of-Care approved by the FDA. In fact, the quadruple therapy is a combination of 4 different class of drugs that include a monoclonal antibody, a proteasome inhibitor, an immunomodulatory drug, and a steroid. Jessica: They are Darzalex (daratumumab), Velcade (bortezomib), Revlimid (lenalidomide) and dexamethasone.  Other treatment plans for Multiple Myeloma include chemotherapy, immunotherapy, radiation therapy (for plasmacytomas) and stem cell transplants. The patient will also be on prophylaxis acyclovir and Bactrim while on chemotherapy. Sometimes anticoagulants are also considered because the chemo increases the risk of venous thromboembolic events.Di: Although the disease is incurable, but with the advancing of novel therapies and clinical trials patients with multiple myeloma are able to live longer.  Problem is the majority of patients diagnosed with Multiple Myeloma are older adults (>65), the risk of falling is adding to multiple complications of the disease itself, such as bone density loss, pain, neurological compromises, distress and weakness.  Palliative care may come in help at any point in time throughout the course of treatment but is most often needed at the very end of the course. Jessica, can you give us a conclusion for this episode?Jessica: Multiple Myeloma may not be the most common cancer, but we have to be aware of the symptoms and keep it in our differential diagnosis for patients with bone pain, easy bruising, persistent severe headaches, unexplained renal dysfunction, and remember the CRAB: HyperCalcemia, Renal impairment, Anemia and Bone lesions.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:International Myeloma Foundation. (n.d.). International Myeloma Working Group (IMWG) criteria for the diagnosis of multiple myeloma. https://www.myeloma.org/international-myeloma-working-group-imwg-criteria-diagnosis-multiple-myeloma Laubach, J. P. (2024, August 28). Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/multiple-myeloma-symptoms-diagnosis-and-staging-beyond-the-basics.University of California San Francisco. (n.d.). About multiple myeloma. UCSF Helen Diller Family Comprehensive Cancer Center. https://cancer.ucsf.edu/research/multiple-myeloma/about Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

The treatment landscape for Lyme disease has undergone significant evolution over the years, offering a wider array of options to manage this multifaceted illness. When I first began treating Lyme disease in 1987, the primary antibiotic prescribed was doxycycline. This choice was driven by doxycycline's effectiveness not only against Lyme disease itself but also against co-infections such as Ehrlichia and Anaplasmosis. These co-infections, often transmitted by the same ticks that carry Lyme, present additional challenges in patient management. However, when patients couldn't tolerate doxycycline due to side effects or failed to respond to the treatment, rifampin emerged as a viable alternative. For pediatric patients, the treatment approach required special consideration. amoxicillin was commonly used to avoid the risk of dental staining associated with doxycycline, which can be a concern for growing children. However, the limitation of amoxicillin lies in its inability to combat co-infections like Ehrlichia or Anaplasmosis. Over time, other antibiotics related to amoxicillin, such as Pen VK, IM Bicillin, Omnicef, and Ceftin, became available. Of these, Ceftin (cefuroxime axetil) is notably the only one FDA-approved specifically for Lyme disease, reinforcing its role in the treatment regimen. When dealing with neurologic Lyme disease, which can involve the central nervous system and present with symptoms such as memory loss, cognitive difficulties, and neuropathy, the approach often necessitates more aggressive treatment. Intravenous (IV) antibiotics like ceftriaxone (Rocephin) and Claforan were preferred due to their ability to cross the blood-brain barrier, a crucial factor in effectively treating neurological manifestations. These IV antibiotics are essential for some patients, particularly those with severe or persistent symptoms, but they are not without risks. The use of PICC lines for IV administration carries potential complications, including infections and blood clots. Interestingly, in my experience, many patients with chronic neurologic Lyme have shown significant improvement with oral antibiotics, allowing them to avoid the complexities and risks associated with IV treatments. For patients who are allergic to or unable to tolerate doxycycline, or for those who are sun-sensitive—a common side effect of doxycycline—Zithromax (azithromycin) and Biaxin (clarithromycin) have emerged as effective alternatives. These antibiotics belong to the macrolide class and have shown efficacy comparable to doxycycline in the majority of clinical studies, offering additional options for patient care. In the treatment of co-infections like Bartonella, the approach becomes more nuanced. Bartonella, initially identified as the causative agent of cat scratch fever, has been a subject of ongoing debate in the context of Lyme disease. This bacterium is traditionally associated with transmission through cat scratches, where the bacteria are introduced under the skin from cat saliva or flea feces. However, there is growing evidence suggesting that Bartonella may also be transmitted via tick bites, complicating the clinical picture for Lyme disease patients. In treating suspected Bartonella co-infections, I have employed antibiotics from the doxycycline, Zithromax, and rifampin families, drawing on research related to cat scratch fever. Additionally, I have used Bactrim (trimethoprim-sulfamethoxazole) in some cases. However, I generally avoid fluoroquinolones like ciprofloxacin due to their association with severe side effects, including joint pain, tendonitis, and tendon ruptures. Babesia, another common co-infection found in Lyme disease patients, requires a different treatment approach altogether. Babesia is a parasite that infects red blood cells, causing symptoms similar to malaria. For treating Babesia, I often prescribe atovaquone, availa

Free book is here at https://www.memorizingpharm.com/books In this episode we return to turning the open educational nursing resource for nursing pharmacology into audio, we'll start with the 1st edition antimicrobials then move on to the new second edition with the next topic.  Chapter 3.3 Administration Considerations Summary Chapter 3.3 of the Nursing Pharmacology guide covers key considerations when administering antimicrobial drugs. Topics include drug half-life, the impact of patient age and organ function on dosing, dose/time dependency, administration routes (oral, intravenous, etc.), and the significance of drug interactions. It explains how liver and renal function can affect drug metabolism and excretion, emphasizing the need for tailored doses. Synergistic and antagonistic drug interactions are also explored, with examples like Bactrim for synergy and antacids reducing antibiotic effectiveness. Multiple Choice Questions What does a drug's half-life refer to? a) The time it takes for a drug to start working b) The time it takes for 50% of a drug to be eliminated c) The amount of drug absorbed in 24 hours d) The period a drug remains active in the body Why is renal function important in antimicrobial dosing? a) It affects the speed of drug absorption b) It determines the length of the treatment c) Poor renal function can lead to drug toxicity d) It impacts the immune response Which type of drug interaction is beneficial in antimicrobial therapy? a) Antagonistic b) Synergistic c) Time-dependent d) Dose-dependent What is the goal of time-dependent antimicrobials like penicillin? a) Maximizing exposure duration b) Delivering a high dose quickly c) Reducing side effects d) Minimizing drug resistance What can negatively impact the absorption of antibacterials in the stomach? a) High salt intake b) Antacids c) Fluids d) Dairy products Answer Key for Multiple Choice Questions Question 1: b) The time it takes for 50% of a drug to be eliminated Question 2: c) Poor renal function can lead to drug toxicity Question 3: b) Synergistic Question 4: a) Maximizing exposure duration Question 5: b) Antacids

Episode 155: Diabetic Foot Infection GuidelinesFuture Dr. Perez presents the updates on lung cancer screening by the American Cancer Society. Future Dr. Danusantoso explains the classification, diagnosis, and treatment of diabetic foot infections according to the guidelines published by the International Working Group on the Diabetic Foot (IWGDF). Dr. Arreaza adds comments and anecdotes.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Intro: Lung cancer screening update.Written by Luz Perez, MSIII, Ross University School of Medicine. Editing by Hector Arreaza, MD.Hello, my name is Luz Perez and today I will talk about lung cancer screening.As a reminder, lung cancer is the top cause of cancer-related death in men and women worldwide. In the United States, lung cancer causes the death of about 154,000 people each year[4]. Smoking is the most significant risk factor for developing lung cancer, a risk that directly correlates to how much and how long a person has smoked[2]. Despite the efforts to decrease lung cancer-related deaths, which include screening of patients at risk and counseling on smoking cessation, many patients go undiagnosed in part because lung cancer can be asymptomatic but also because many people at risk did not meet the criteria for screening, according to previous guidelines… BUT On November 1, 2023, the American Cancer Society updated its guidelines for lung cancer screening to decrease mortality by lung cancer in the US. The updated lung cancer screening guidelines were published in November, which is Lung Cancer Awareness Month. This guideline aims to expand eligibility criteria for lung cancer screening. Previously, the guidelines covered people only between the ages of 55-74 who were current smokers or had quit within the past 15 years and had a 30 or more pack-year smoking history[3].The new guidelines recommend annual screening with low-dose CT (LDCT) scan for people who are 50-80 years old who are current or former smokers and who have a 20 or more pack-year of smoking history [1]. This change means that about 5 million people who would previously not qualify for screening are now eligible for this potentially lifesaving screening exam.Additionally, the American Cancer Society emphasizes the significance of shared decision-making between patients and healthcare providers on lung cancer screening and smoking cessation. This includes ways to help patients stop smoking by providing counseling and interventions including medications. For patients who are eligible for screening, having a full discussion of the lung cancer screening process including the purpose of the procedure, risks and benefits of low-dose CT, and recommendations from other organizations, is key in the shared decision-making process[1]. Perhaps, the most important step in the implementation of these new guidelines is ensuring that medical professionals talk to their patients about them and make them aware of the importance of screening for lung cancer. In this way, we can reduce mortality and other consequences of this devastating disease. Written by Maria Danusantoso, MSIV, Ross University School of Medicine. Editing by Hector Arreaza, MD.Update to Guidelines for Treatment of Diabetic Foot InfectionsIntroductionIn October 2023, the International Working Group on the Diabetic Foot (IWGDF) and the Infectious Disease Society of America (IDSA) collaborated and published an update to the 2019 guideline on the diagnosis and management of infections of the foot in persons with diabetes mellitus.The present guidelines include a list of 25 recommendations for diagnosis and management and clinically useful figures and tables including a treatment algorithm, a classification system for defining diabetic foot infections, and empirical antibiotic therapy according to clinical presentation and microbiological data.The goal of this episode is not to provide an exhaustive review of the updated guidelines and algorithms but to highlight what I believe are the most important recommendations. I hope this brief presentation is viewed as an introduction and that this encourages you, the listener, to independently read the guidelines in full and implement them into your own clinical practice.Wound Colonization Versus Wound InfectionBefore jumping into some of the recommendations, I want to take some time to discuss briefly how to classify diabetic foot infections. Most clinicians, including myself, will see a patient with diabetes with a foot ulcer or wound and want to treat it with antibiotics or admit the patient to the hospital. However, the updated guidelines propose that antibiotics and/or admission are not always indicated. For clinicians, there needs to be an awareness that wound colonization and wound infection are not the same. Wound colonization by bacteria is defined by the presence of bacteria on a wound surface without evidence of invasion of the host tissues. Colonization, then, can be considered a constant phenomenon as we live in a bacteria-filled world. Comment: If we culture our intact skin, we may find pathogens, that's why wound cultures even if they are positive, do not indicate there is infection. Tell us about infection.In contrast, wound infection is a disease state caused by the invasion and multiplication of microorganisms in host tissues that induce an inflammatory response in the host, usually followed by tissue damage. Therefore, since all wounds are colonized – often with potentially pathogenic microorganisms – we cannot define wound infection using only the results of wound cultures. Instead, diabetic foot infections are a clinical diagnosis based on the presence of manifestations of an inflammatory process involving a foot wound located below the malleoli. These signs and symptoms of inflammation may be masked in persons with diabetes especially if they have some level of baseline peripheral neuropathy, peripheral artery disease, or immune dysfunction.Classification of Diabetic Foot Infections.To assist with the classification of diabetic foot infections, the updated guidelines include a table for defining the presence and severity of an infection of the foot in a person with diabetes. Again, diabetic foot infections are a clinical diagnosis, and the clinical classification of infection can be described as: 1) uninfected, 2) mild, 3) moderate +/- O if osteomyelitis is present, 4) severe +/- O if osteomyelitis is present. Uninfected has no systemic or local symptoms or signs of infection. Mild infection is when at least two of the following are present: local swelling or induration, erythema between 0.5-2 cm around the wound in any direction, local tenderness or pain, local increased warmth, purulent discharge, and there is no other cause of an inflammatory response of the skin present (e.g., trauma, gout, acute Charcot neuro-arthropathy, fracture, thrombosis, or venous stasis).Moderate infection is without systemic manifestations and involves erythema extending 2 cm or more from the wound margin and/or involves tissue deeper than skin and subcutaneous tissues (e.g., tendon, muscle, joint, and bone) +/- the presence of osteomyelitis. The surrounding erythema and the depth of wound are key element in the classification of the wounds. Severe infection is associated with systemic manifestations and meets systemic inflammatory response syndrome (SIRS) criteria as manifested by 2 or more of the following: temperature below 36°C or above 38°C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute, white blood cell count greater than 12,000/mm3 or greater than 10% immature (band) forms +/- presence of osteomyelitis. Features of Osteomyelitis on Plain X-RayWe have mentioned osteomyelitis quite a few times in this episode, so what are some ways we can diagnose osteomyelitis? Most commonly, osteomyelitis is diagnosed via imaging either with plain X-rays  or MRI. When looking at plain X-rays, there are a few features that are characteristic of diabetes-related osteomyelitis of the foot of which we should be aware regardless of our status as radiologists. Some of these features include bone sclerosis with or without erosion, abnormal soft tissue density or gas density in the subcutaneous fat, or new or evolving radiographic features on serial images spaced several weeks apart such as loss of bone cortex, focal demineralization, periosteal reaction or elevation. Changes in x-ray may be a late finding and indicate that the osteomyelitis is established.General Treatment Recommendations for Diabetic Foot InfectionsIn the updated guidelines, recommendation 11 states to not treat clinically uninfected foot ulcers with systemic or local antibiotic therapy when the goal is to reduce the risk of new infection or to promote ulcer healing. As previously said, diabetic foot infections are a clinical diagnosis. So if clinically the wound does not meet criteria to be classified as a mild, moderate, or severe infection, this recommendation proposes that no antibiotic treatment is the best treatment so as not to expose patients to potentially unnecessary and harmful treatment and to not promote antibiotic resistance in patients, which would potentially make treating diabetic foot infections more challenging in the future. We still want to very closely monitor the wound every 2-7 days and promote wound healing with pressure offloading, keeping the wound and the surrounding skin clean and dry, and other non-antibiotic management for local wound care.What are some common bacteria?.When it is indicated to treat diabetic foot infections per the guidelines, recommendation 14 states to target aerobic gram positive pathogens only for people with a mild diabetes related foot infection. These pathogens include beta hemolytic streptococci and Staphylococcus aureus including methicillin-resistant strains if indicated. Additionally, recommendation 15 advises not to empirically target antibiotic therapy against Pseudomonas aeruginosa in cases of diabetes-related foot infection in temperate climates. However, it is appropriate to use empirical treatment of P. aeruginosa if it has been isolated from cultures of the affected site within the previous few weeks or in a person with moderate or severe infection who resides in tropical/subtropical climates.Antibiotic Treatment Duration RecommendationThe final recommendation we have time to discuss in this episode is regarding antibiotic treatment duration. For mild infections, oral antibiotics (such as cephalexin or Bactrim) for a duration of 1-2 weeks is appropriate. However, if the infection is improving but is extensive and is resolving slower than expected or if the patient has severe peripheral artery disease, it is reasonable to consider extending treatment for up to 3-4 weeks.For moderate or severe infections without osteomyelitis, a total treatment duration of 2-4 weeks is recommended starting initially with IV antibiotics before transitioning to oral antibiotics. Antibiotic selection will depend on multiple factors, such as recent antibiotic use, or MRSA risk factors. For example, if the patient took antibiotics recently, they could receive Zosyn® and ceftriaxone. If osteomyelitis is present, antibiotic treatment duration can be anywhere from 2 days to 6 weeks depending on the amount of source control achieved. Ideally, we should wait to have bone resection before giving antibiotics, but we know that antibiotics are given promptly in the ER.In the cases of a resected infected bone or joint (when complete source control is achieved), a duration of 2-5 days is recommended, starting with IV antibiotics before transitioning to oral antibiotics. If there is minor amputation of the infected foot but there remains a positive wound culture or positive margins are seen on pathology (inflammatory cells are seen at the proximal margin of the amputated section), a 3-week antibiotic treatment duration is recommended, again starting with IV before transitioning to oral antibiotics.For diabetes-related foot osteomyelitis without bone resection or amputation, a 6-week course of antibiotics is recommended, again initially with IV antibiotics before transitioning to oral. In all the situations where there is a transition from IV to oral antibiotics, this transition may only occur once there are clinical signs of improvement, for example, improving erythema surrounding the wound, resolution of tenderness or purulent drainage, or SIRS criteria is no longer met.Summary: For more details regarding the 2023 update to the guidelines on the diagnosis and treatment of foot infection in persons with diabetes, please refer to the complete guidelines which can be accessed on the IWGDF Guidelines website and via the citations listed in the References. As a reminder, this podcast episode is not an exhaustive review of the guidelines, but, instead, a brief introduction to some of the recommendations. Thank you for listening and I hope you learned something new!_____________________________Conclusion: Now we conclude episode number 155 “Diabetic foot guidelines.” Future Dr. Perez started this episode with an introduction about the new guidelines to screen for lung cancer, then future Dr. Danusantoso gave an excellent summary about the classification and treatment of diabetic foot infections. Our patients with diabetes must have foot self-awareness and report any concerns to their family physicians or podiatrists so they can get prompt treatment.This week we thank Hector Arreaza, Luz Perez, and Maria Danusantoso. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:McDowell, Sandy, New Lung Cancer Screening Guideline Increases Eligibility. American Cancer Society, published on November 1, 2023, Cancer.org. https://www.cancer.org/research/acs-research-news/new-lung-cancer-screening-guidelines-urge-more-to-get-ldct.htmlWolf AMD, Oeffinger KC, Shih TY, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society [published online ahead of print, 2023 Nov 1]. CA Cancer J Clin. 2023;10.3322/caac.21811. doi:10.3322/caac.21811. Link: https://pubmed.ncbi.nlm.nih.gov/37909877/Moniuszko, Sara. Lung cancer screening guidelines updates by American Cancer Society to include more people. CBS News, updated on November 3, 2023. https://www.cbsnews.com/news/lung-cancer-screening-guideline-american-cancer-society-update/Deffebach, M. E., & Humphrey, L. (2023). Screening for lung cancer. UpToDate. Retrieved November 6, 2023, UpToDate. https://www.uptodate.com/contents/screening-for-lung-cancerÉric Senneville, Zaina Albalawi, Suzanne A van Asten, Zulfiqarali G Abbas, Geneve Allison, Javier Aragón-Sánchez, John M Embil, Lawrence A Lavery, Majdi Alhasan, Orhan Oz, Ilker Uçkay, Vilma Urbančič-Rovan, Zhang-Rong Xu, Edgar J G Peters, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), Clinical Infectious Diseases, 2023; ciad527, https://doi.org/10.1093/cid/ciad527Senneville, Éric et al. 2023. “IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Foot Infection in Persons with Diabetes.” IWGDF Guidelines. Retrieved November 6, 2023 (https://iwgdfguidelines.org/wp-content/uploads/2023/07/IWGDF-2023-04-Infection-Guideline.pdf). Royalty-free music used for this episode: Gushito, “Gista Mista”, downloaded on November 16th, 2023, from https://www.videvo.net/ 

Episode Notes In what has been described on Twitter as the “doing your own taxes of medicine,” Drs. Emily Heil (@emilylheil) and Andrew Fratoni (@AFratty) join Dr. Jillian Hayes (@thejillianhayes) to break down the ins and outs of sulfamethoxazole/trimethoprim dosing! Tune in for a discussion on the use of this agent for methicillin-resistant Staphylococcus aureus, gram-negatives, pneumocystis, and Stenotrophomonas maltophilia. References: Twitter Thread re: Bactrim dosing: https://twitter.com/IDdocAdi/status/1661174505702674432?s=20 PJP OI Guidelines: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/pneumocystis-0 IDSA Resistant Gram Negative Guidance Document: https://www.idsociety.org/globalassets/idsa/practice-guidelines/amr-guidance/1.0/idsa-amr-guidance-v3.0.pdf (Lower doses of PJP Treatment): Butler-Laporte G, Smyth E, Amar-Zifkin A, Cheng M, McDonald E, Lee T. Low-dose TMP-SMX in the Treatment of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-Analysis. Open Forum Infectious Diseases, Volume 7, Issue 5, May 2020, ofaa112, https://doi-org.proxy-hs.researchport.umd.edu/10.1093/ofid/ofaa112 (DS Vs SS for PJP PPX): Schneider MM, Nielsen TL, Nelsing S, et al. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group. J Infect Dis. 1995;171(6):1632-1636. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7769306. General Bactrim PK/PD: Trubiano JA, Grayson ML. Trimethoprim and Trimethoprim-Sulfamethoxazole (Cotrimoxazole). Chapter 92, Kucers' The Use of Antibiotics (7th Edition). Taylor & Francis, 2017. (2014 IDSA SSTI Guidelines). PMID 24973422 Cadena J, Nair S, Henao-Martinez AF, Jorgensen JH, Patterson JE, Sreeramoju PV. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2011 Dec;55(12):5430-2. doi: 10.1128/AAC.00706-11. Epub 2011 Sep 19. PMID: 21930870; PMCID: PMC3232808. Halilovic J, Heintz BH, Brown J. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. J Infect. 2012 Aug;65(2):128-34. doi: 10.1016/j.jinf.2012.03.013. Epub 2012 Mar 21. PMID: 22445732. Paul M, Bishara J, Yahav D, Goldberg E, Neuberger A, Ghanem-Zoubi N, Dickstein Y, Nseir W, Dan M, Leibovici L. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ. 2015 May 14;350:h2219. doi: 10.1136/bmj.h2219. PMID: 25977146; PMCID: PMC4431679. Lasko MJ, Gethers ML, Tabor-Rennie JL, Nicolau DP, Kuti JL. In Vitro Time-Kill Studies of Trimethoprim/Sulfamethoxazole against Stenotrophomonas maltophilia versus Escherichia coli Using Cation-Adjusted Mueller-Hinton Broth and ISO-Sensitest Broth. Antimicrob Agents Chemother. 2022 Mar 15;66(3):e0216721. doi: 10.1128/aac.02167-21. Epub 2022 Jan 10. PMID: 35007135; PMCID: PMC8923228. Lasko MJ, Tabor-Rennie JL, Nicolau DP, Kuti JL. Trimethoprim/sulfamethoxazole pharmacodynamics against Stenotrophomonas maltophilia in the in vitro chemostat model. J Antimicrob Chemother. 2022 Oct 28;77(11):3187-3193. doi: 10.1093/jac/dkac304. PMID: 36101486. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Love Bactrim and Flagyl (Reimagined Tribute to Diamonds & Dancefloors by Ava Max) *Original written by: Amanda Ava Koci, Caroline Ailin, Henry Walter, & Michael Pollack : D **WARNING: Although this tribute is entitled “Bactrim & Flagyl,” please take these medications separately!!! Taking both medications AT THE SAME TIME can increase your risk for a serious condition called rhabdomyolysis : ( ***Thank you to God, to Dr. Tauseef Ali, to his brilliant and lovely problem-solver Bobbie, & to Dr. Paul Dautenhahn for curing my SIBO (Flagyl) & eye and ear infections (Bactrim) this year ; ) Lyrics From C. diff to SIBO They treat me right These antibiotics keep a watchful eye Today I'm here thanking Dr. Tauseef Ali cause I needed a cure To get back my mind Also, thank you, Bobbie She's such a sweet delight I'm out of order Where is here? Maybe, it's definitely a might…. Drinking my kratom Relying on my wonderful family & Howmie Keep having these pressing thoughts thoughts The obsessive kind Love Bactrim and Flagyl They wake me up Help me cope with SIBO Bacterial Overgrowth Need them to function Walgreens, that happy & healthy corner I love this Bactrim, Bactrim, Bactrim Bactrim and Flagyl Effects so deep Inside my colon Thank God for pain relief They never falter Priceless mixture on board I love this Bactrim, Bactrim, Bactrim~ Prescribing them is wise Now come; please, hear: Avoid insurance headaches Get symptom management quicker Could have thrown thousands of dollars away at that designer drug Xifaxan But I write music to entertain you Not to pay for meds Let me be clear Love Bactrim and Flagyl They wake me up Help me cope with this SIBO Intestinal Bacterial Overgrowth Need them to function Walgreens, that happiness & healthy corner I love this Bactrim, Bactrim, Bactrim Bactrim and Flagyl Effects so deep Inside my rectum Thank God for pain relief They never falter Priceless mixture on board I love this Bactrim, Bactrim, Bactrim Bactrim and Flagyl Bactrim and Flagyl Bactrim and Flagyl Flagyl, Flagyl Fla a gyl Fla a a agyl Bactrim and Flagyl End Tribute by Melissa Smith: - Melzy of Wonderland on Youtube - Mel's Music on Spreaker, Spotify, Apple Podcasts, JioSaavn, Castbox, Deezer, Podcast Addict, Google Podcasts, iHeartRadio, Podchaser, Facebook & - Melissa_Martinek_Smith on Instagram (AKA: MelsMusic)

Welcome back to the Lighthouse Podcast! Chris and Christy have the privilege of talking with Joshua Elder today. It's so great to have Josh on the podcast representing his profession as a Clinical Pharmacy Specialist. It's the first time Chris and Christy have talked with someone in this profession. He lives in Kentucky with his wife and two daughters, who are six and four years old. In his free time, he volunteers as a counselor at a pediatric oncology camp and loves to travel. In the episode today, you will hear about the role of an Oncology Pharmacist and why it's essential. You will also learn practical information about supportive care medications like Zofran, Bactrim, and more. Last but not least, you will listen to some specific side effects to look out for. In conclusion, Josh shares how his role is in a lot of larger hospitals. If you are unsure you have access to a Clinical Pharmacy Specialist, ask your medical team about it. Follow Lighthouse on Social Media: Facebook: https://www.facebook.com/lighthousefamilyretreat Instagram: http://instagram.com/lighthousefr

How do you say sulfamethoxazole and trimethoprim?  This antibiotic is also known as Bactrim or Septra and abbreviated SMZ-TMP.  It's one of the top 200 drugs in the US.   In my pronunciation episodes, I break drug names down into syllables, explain which syllable(s) have the emphasis, reveal the source of the information, and put the written pronunciations in the show notes so that you see them and use them right away. The purpose of these  pronunciation episodes is to provide the intended pronunciations of drug names from reliable sources so that you feel more confident saying them and less frustrated learning them.  I hope this episode helps! Thank you for listening to episode 202 of The Pharmacist's Voice ® Podcast! To read the full show notes, visit https://www.thepharmacistsvoice.com.  Click on the podcast tab, and search for episode 202. Highlights from this episode  Sulfamethoxazole = SUL fa meth OX a zole.  It has 6 syllables: “SUL” like sulk *secondary emphasis on this syllable “Fa” like familiar “Meth” like methanol “OX” like the animal (ox) *Primary emphasis on this syllable “A” as in the schwa vowel sound “uh” “Zole,” which rhymes with “mole” Trimethoprim = try METH oh prim.  It has 4 syllables.   “Try,” like I'm TRYING to pronounce this drug name! “Meth,” like methanol *Primary emphasis on this syllable “Oh,” like the letter “o” in the alphabet.  (When I say it fast, it sounds like an  “uh.”  “Uh,” like a schwa vowel sound: “uh.”) “Prim,” like primitive Disclaimer:  I do not work for USP, and I am not compensated in any way for mentioning the USP Dictionary Online.  It's just my favorite reference for generic drug name pronunciations.  Thank you to the USP Legal Dept for permission to use written pronunciations in my podcasts and YouTube videos!  Subscribe to or Follow The Pharmacist's Voice Podcast! Apple Podcasts Google Podcasts Spotify Amazon/Audible Links from this episode USP Dictionary Online (USAN)   USP Dictionary's (USAN) pronunciation guide (Source:  American Medical Association's  website) National Poison Prevention Month is March The Pharmacist's Voice ® Podcast episode 198, pronunciation episode 13 The Pharmacist's Voice ® Podcast episode 194, pronunciation episode 12 The Pharmacist's Voice ® Podcast episode 188, pronunciation episode 11 The Pharmacist's Voice ® Podcast episode 184, pronunciation episode 10 The Pharmacist's Voice ® Podcast episode 180, pronunciation episode 9 The Pharmacist's Voice ® Podcast episode 177, pronunciation episode 8 The Pharmacist's Voice ® Podcast episode 164, pronunciation episode 7 The Pharmacist's Voice ® Podcast episode 159, pronunciation episode 6 The Pharmacist's Voice ® Podcast episode 155, pronunciation episode 5 The Pharmacist's Voice ® Podcast episode 148, pronunciation episode 4 The Pharmacist's Voice ® Podcast episode 142, pronunciation episode 3 The Pharmacist's Voice ® Podcast episode 138, pronunciation episode 2 The Pharmacist's Voice ® Podcast episode 134, pronunciation episode 1

Generic Name trimethoprim/sulfamethoxazole Trade Name Bactrim/TMP-SMZ Indication bronchitis, UTI, diarrhea, pneumonia, multiple types of infection Action bacteriacidal by preventing metabolism of folic acid Therapeutic Class anti-infectives, antiprotozoals Pharmacologic Class folate antagonists, sulfonamides Nursing Considerations • may cause renal damage, Steven Johnsons Syndrome – rash, pseudomembranous colitis, nausea, vomiting, diarrhea, rash, agranulocytosis, aplastic anemia, phlebitis • contraindicated with sulfa allergies • monitor CBC • obtain cultures prior to initiating therapy • monitor intake and output • instruct patient to complete dose • drink 8-10 glasses of water

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Jamin Brahmbhatt discuss the evaluation, causes, and treatment of chronic testicular pain. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/Ed2uAQ --- CHECK OUT OUR SPONSOR Athletic Greens https://www.athleticgreens.com/backtableuro --- SHOW NOTES First, Dr. Brahmbhatt shares his basic algorithm for evaluating chronic testicular pain. He will take a history, perform a thorough physical examination, and obtain new CAT scans and scrotal ultrasounds. He emphasizes the importance of physician examinations in order to find hernias and encourages urologists to ask their patients to name 3 quality of life activities that are affected by their testicular pain. Later, he will use these activities to document patient progress. Dr. Brahmbhatt also notes the possibility that the testicular pain is also a result of referred pain. He makes sure to explain the mechanics of the testicular nerves within the spermatic cord to the patient. He usually does not prescribe or refill pain medications unless they are required for postoperative pain. Dr. Brahmbhatt offers various procedures to alleviate testicular pain. First, he will perform a spermatic cord anesthesia block (SCAB) if no surgery is indicated. This procedure involves sedating the patient and then injecting a mixture of anesthesia and steroids into the highest point of the spermatic cord. He usually injects 30 cc of the solution, saving 5 cc to inject in the most painful region. He follows up with his SCAB patients in 5-7 days and observes for pain reduction. He notes that this non-surgical procedure is very effective in many patients. Worsening pain after SCAB is a contraindication to surgery. The second procedure that Dr. Brahmbhatt offers is testicular neurolysis or microscopic testicular denervation, a procedure in which he cuts and divides tissue microscopically within the spermatic cord. This is a procedure that can be performed robotically and is very effective for resolving pain in patients with retractile testicles. Although he offers procedural-based treatments to testicular pain, he always tries to maximize medical treatment for at least 30 to 90 days. Medical options include: 7.5% Meloxicam, a short course of antibiotics (Bactrim), Flomax (for pain during ejaculation), or gabapentin. He will attempt SCAB first before prescribing a muscle relaxant, as muscle relaxant can be addictive. He also recommends specialized physical therapy for groin and testicular pain. Additionally, the doctors discuss the role of varicoceles in testicular pain. Although both doctors agree that varicoceles are not supposed to cause pain, grade 2 and 3 varicoceles can cause a stretching sensation that irritates the nerves. Dr. Brahmbhatt will continue with his standard evaluation algorithm, even in patients with a known varicocele. He notes that SCAB is very effective in patients with varicoceles. If he has to proceed to surgery to manage testicular pain, he usually includes an additional varicocelectomy as well. Finally, Dr. Brahmbhatt discusses his non-profit organization, Drive for Men's Health, which aims to increase male engagement with health care by organizing road trips around the US and the rest of the globe. --- RESOURCES http://myballshurt.com/

Or any other beta-lactam antibiotic? Or do we have to use a fluoroquinolone or Bactrim? Find out on this week's Pharmacy Consult episode.  Click HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 76 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show

Macron's re-election and what it portends to French-Africa relations+++Guinea risk more ECOWAS sanctions over transition delays+++Special Criminal Court in CAR restarts hearing on war crimes+++ Malawi's government accused of rationing Bactrim, essential HIV/Aids therapy drug+++ DW's Africa Link Monday sports wrap

South African civil and nuclear engineer Hügo Krüger discusses the HIV/AIDS fraud and how the COVID19 fraud is carried out using essentially the same playbook. People were tested for HIV using fraudulent false-positive testing, given toxic drugs such as AZT, and then many of them ended up dying from the drug which was then mislabeled as an epidemic. During the AIDS situation in the 1980s Fauci blocked a simple, safe, and effective drug called Bactrim, just like Ivermectin today has been blocked. COVID19 is the flu re-branded. Hügo believes the capabilities of so-called biological weapons is greatly exaggerated and is greatly skeptical of bioweapons claims, including in Ukraine. The bioweapon is AZT and the COVID vaccine. He's interested in how the AIDS and COVID stories have been used for regime change and discusses the CIA-AIDS connection. As a civil engineer, he is skeptical the Social Credit Digital Passport system they are attempting to bring in through the backdoor as a Covid Pass will ultimately be workable. Watch On BitChute / Brighteon / Rokfin / Rumble Geopolitics & Empire · Hügo Krüger: COVID19 Fraud Uses the Same HIV/AIDS Fraud Playbook, The Cure is the Disease #282 *Support Geopolitics & Empire! Become a Member https://geopoliticsandempire.substack.comDonate https://geopoliticsandempire.com/donationsConsult https://geopoliticsandempire.com/consultation **Visit Our Affiliates & Sponsors! Above Phone https://abovephone.com/?above=geopoliticseasyDNS (use code GEOPOLITICS for 15% off!) https://easydns.comEscape The Technocracy course (15% discount using link) https://escapethetechnocracy.com/geopoliticsPassVult https://passvult.comSociatates Civis (CitizenHR, CitizenIT, CitizenPL) https://societates-civis.comWise Wolf Gold https://www.wolfpack.gold/?ref=geopolitics Website Website https://hkrugertjie.substack.com Twitter https://twitter.com/HgoKrger1 Odysee https://odysee.com/@hugokruger:5 Quillette https://quillette.com/author/joel-kotkin-and-hugo-kruger About Hügo Krüger Hügo Krüger is a civil and nuclear engineer. He served on the SRC at the University of Pretoria in 2011 and had the portfolio Multilingualism and Culture. He is a graduate from UP and ESTP in France. His interests include technology, human nature, politics and economics. *Podcast intro music is from the song "The Queens Jig" by "Musicke & Mirth" from their album "Music for Two Lyra Viols": http://musicke-mirth.de/en/recordings.html (available on iTunes or Amazon)

Showdate:  3/28/22 Connect your phone to your vehicle audio, by blue tooth or cord and its "Action Radio Drive Time!" ***** Action Radio Show Notes:  Greg Penglis - Creator and Host. 0:00 - Shannon Rice, Milton City Council.  Shannon had a couple of big issues.  One, why should we use tax dollars to pay for electric charging stations when we don't pay for gas stations?  And, where is missing City Coucil Member - Matt Jarrett??? 30:00 - Action Radio Classic - Supreme Court 1.  There were four hours that I devoted to the Supreme Court at WEBY before the Kavanaugh hearings.  This is the first. 1:00:00 - Lots of parallels between Dr. Fascist and AZT during AIDS, and Dr. Fascist and Remdesivir during Covid.  Both drugs were dangerous or deadly and made huge profits, and a cheap, safe and effective drug was already approved.  I think by pushing AZT instead of Bactrim, the Hydroxychloroquine of its day, Dr. Fascist killed Freddie Mercury of Queen, and tens of thousands of others. 2:00:00 - The National Security Report, with Dr. Peter Vincent Pry.  More on our unpreparadeness for nuclear war. ***** Live show 6-9 am Central time weekdays, then podcast. When the show is in podcast: Click on "The Thinker," wait 10 seconds for the show to load, when the pink Timeline appears at the top, you can use the Show Notes to find the features you want. Sponsors/Contributors:  https://www.GiveSendGo.com/ActionRadio International Skype calls online - Skype name - live:.cid.fddbac53a2909de1 Strike Force Energy Drinks - www.strikeforceenergy.com - 20% Discount Code: WYL.  Helps Action Radio! Bill writing site:  www.WriteYourLaws.com Email:  Greg@WriteYourLaws.com

It's me, back from the dead. I mean it's us, but SOMEONE mocked my style on here and I'm out for blood. So here's my revenge, Janno is on his 5th marriage. It's like, come on, commit to something, amiright? With my vengeance at hand, I'm feeling more clarity and now I can finally return to great service. Although I would like to reinforce, goo goo ga ga I have played multiple Fire Emblem games. MASSIVE shouts out to a close friend Derek for coming through and talking about Gundam! This series runs pretty damn deep, like most places have a series, one spinoff, etc. There's like, 50 spinoffs for this show. That's wild. And all of the robits are different? I'm getting so old. I can't make it up to my bedroom so I've been sleeping on the couch. There was no point to reference that, I live alone and no one cares where I sleep. Which means I can watch all 50 spinoffs of Gundam, so who's down bad now? Derek sent us a .jpeg of the entire timeline, and it was pretty much fullscreen when I opened it. And the text was small. That's just wild. It'd take a while to run out of things to watch. And isn't that the goal of TV? Exactly, I'll take 4 more spinoffs please. Speaking of Gundam, I have lots of friends who do those builds and stuff, with like 5000 pieces and such? Is that wild? I mean, I have an app on my phone where I can do jigsaw puzzles, that's kinda similar right? I could never do a build, I have like no patience at all. Jigsaw puzzles are way easier, they have clear pictures of them. These Gundam builds look like Ikea setups, and it is insane to think that people voluntarily build Ikea furniture. I thought it was more of a last resort. But that's more bitterness on my part, I'm missing that weird allen wrench from the build kit and have been leaving my clothes on the floor. It's been so hard since Veronica left. So hard. If you vibe with the boy Derek, show him some love and support on Twitter or on Twitch @Greatbigsword. Better yet, he has 3 podcasts with some awesome topics, so find them on Twitter, "the Good Friends Anime Club" @goodfriendscast, "Kicking Stones - A Dr. Stone Podcast" @Dr_Stone_pod and "Deal With The Devils - An Eyeshield 21 Podcast" @devilbatpod. Personally, I'm really into Dr. Stone, that show is pretty fuckin' tight. I know now how to make Bactrim, which Naruto never taught me. Believe that, you useless fuck. You know where to find us for more love, see y'all next time! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

In this episode, we debunk four medication myths that have persisted for decades: metronidazole and alcohol; statins and hepatotoxicity; cidal vs. static antibiotics; and "sulfa" allergies. Key concepts Metronidazole does not interact with alcohol (ethanol) and does not cause a disulfiram-like reaction. Statins can cause transient increases in liver function tests; however, these increases are not associated with hepatotoxicity. Routine LFT monitoring is not recommended unless clinically indicated signs or symptoms of liver injury exist. The distinction of bactericidal versus bacteriostatic antibiotics is irrelevant. No evidence exists showing that having a bactericidal drug has superior efficacy to a bacteriostatic drug. A “sulfa” allergy nearly always means an allergy to Bactrim (sulfamethoxazole-trimethoprim). There are many non-antibiotic sulfonamide-containing medications that do not need to be avoided in patients with a sulfa allergy; however, patients with an allergy to any medication have an increased risk of an allergic reaction to other medication classes.

Video on YouTube https://www.youtube.com/watch?v=Cb3-zmFV27I&t=605s  Schedule a 20-minute Discovery call Send me a voice message if you have a questions Website: https://dochugh.com/ Doc Hugh Check out my Facebook Page: Visit my YouTube Channel[00:00:00] Again, this is Dr. Hugh Wegwerth [00:00:10] antibiotics and autoimmune disease[00:00:20] Cipro, Levaquin, Flagyl, Bactrim cause a component of autoimmune disease in your body[00:00:40] fluoroquinolones[00:01:15]  55 percent of your blood is plasma[00:01:50] drugs attach to your proteins, will cause autoimmune immune reactions [00:02:05] fibromyalgia conditions, tendon problems, nerve problems[00:03:00] damaged with antibiotics[00:05:40] autoimmune diseases, twice as much money are spent on autoimmune diseases versus cancer[00:08:00] antibiotics cause autoimmune disease [00:08:40] amoxicillin[00:09:05] Cipro and the protein[00:10:45] sulfa drugs[00:12:10] attacks everything, brain  [00:12:15] gut tissue, thyroid, bone, lungs.[00:12:20] low-grade, whole body autoimmune disease[00:13:05] there's lab testing that you can do to see[00:13:10] do you have autoimmune disease against your tissue[00:13:20] adrenal cortex[00:13:45] phospholipid membrane[00:14:20] collagen or tendon problems[00:14:50] myelin basic protein, central nervous system[00:15:20] rheumatoid factor[00:15:30] cerebellar tissue[00:15:35] do you have an autoimmune disease against your brain[00:15:40] having brain fog [00:16:15] high homocysteine, CRP insulin, low blood pressure

Learn more about Dr. Hugh Wegwerth and his services on:SEE VIDEO ON YOUTUBE~  https://www.youtube.com/watch?v=AAzA4n6zigsSchedule a 20-minute Discovery call Send me a voice message if you have a questions Website: https://dochugh.com/ Doc Hugh Check out my Facebook Page: Visit my YouTube Channel00:00:00] Hi community, this is doctor Hugh Wegwerth[00:02:00] Floxed [00:02:15] they put me on Bactrim, which is another antibiotic[00:02:20] I was prescribed Levaquin[00:02:45] it was it was crazy[00:02:55] I had no energy to feed yourself.[00:03:15] it was just such a shocker that what just suddenly happened[00:03:50] struggle was the gut[00:04:05] And I literally I lost like 17 pounds[00:04:25] panic attack before[00:04:35] confusion[00:04:40] you probably heard this from every Floxed person went to like three different doctors.[00:05:30] know, I'm not imagining this. This is happening with other people[00:06:30]  I really loved about for me and I think it's been a major part of even my healing with you is your attitude[00:06:55] there is hope, like you say, there's hope[00:07:10] I decided to go with the program[00:08:10] But like nobody asked me to do those tests[00:08:20] you also get clarity[00:08:45] real and simple.[00:09:15] gluten thing[00:09:35] HCL Challenge[00:10:13] Ups and downs,[00:10:20] I really started seeing major changes[00:11:05] consuming my energy[00:11:25] you're so vibrant[00:11:50] I know. I remember telling you initially I had weird I had developed phobias[00:12:00] would be like, I'm scared of travel.[00:13:09] What to think about pain. Almost unthinkable pain[00:13:15] ringing in your ears and stuff like that.[00:13:45] It's like an earthquake kind of going on inside your body[00:14:05] I don't have vibrations anymore. No cloudiness. [00:14:30] no vibrations anymore[00:14:46] Yeah. Wow. That's that almost makes you want to cry. Be honest with you. I'm holding back tears [00:14:55], there's so many people that are suffering needlessly that aren't getting the advice that they need.[00:15:30] I still I just love you as a doctor[00:15:40] somebody to guide[00:16:05] I did a lot of stuff. I tried acupuncture, I tried energy healing. I mean, you don't know, like, I was going nuts and and I was like, please just help me find something that's going to help my condition.[00:16:20] I'm a spiritual being, your spiritual  person,[00:16:40] The spirit, the power is in your body, heals your body. We just got to figure out what's interfering with that body's ability to heal and function.[00:17:00] low blood, blood pressure[00:17:15] you told me something really simple, like salt water[00:17:45] this Floxed just have like so many issues[00:17:50] so weird like and sometimes, you know, you, you just feel weird sensations throughout your body like you and you have no name for it. You're just like, I don't know. [00:18:00] And that's why they think that they're crazy because you have so many weird neurological problems. They just say it's you're crazy here1[00:18:40] I think my stomach is so much better

Join hosts Shawn Hannon and Ben Hussong as they separate the latest news from the noise. EP56: Fauci Redux: Ivermectin is Bactrim, , Masking Children Unsafe, Facebook Extremist Content, Epstein Maxwell Docs to be Unsealed, Assange Setup, NYC Election Fiasco, NBA Finals RUNDOWN - NBA Finals: Milwaukee Bucks vs Phoenix Suns. Chris Paul in 16th season, age 38, Suns missed playoffs last 10 seasons, 1993 last finals appearance - NYC Mayor Election Fiasco https://www.registercitizen.com/news/article/Vote-mistake-not-the-first-flub-for-NYC-Board-of-16286281.php - Jeffrey Epstein & Ghislaine Maxwell: Judge rules to unseal dozens of documents about Ghislaine Maxwell's personal affairs, including those that reveal her and Jeffrey Epstein's relationship with the Clintons https://www.dailymail.co.uk/news/article-9747011/Judge-rules-unseal-dozens-documents-Ghislaine-Maxwells-personal-affairs.html - Facebook Extremist Content https://www.foxbusiness.com/lifestyle/facebook-asks-are-your-friends-becoming-extremists - Tucker Carlson vs NSA https://www.washingtontimes.com/news/2021/jul/1/glenn-greenwald-calls-out-liberals-who-loved-his-n/ - Julian Assange Setup: A major witness in the United States' Department of Justice case against Julian Assange has admitted to fabricating key accusations https://stundin.is/grein/13627/ - Masks and Children; A study https://jamanetwork.com/journals/jamapediatrics/fullarticle/2781743 - Fauci Redux: In 1987, pioneering AIDS activist Michael Callen begged Fauci for help in promoting the use of Bactrim as PCP prophylaxis and issuing interim guidelines urging physicians to prophylax those patients deemed at high risk for PCP. https://www.huffpost.com/entry/whitewashing-aids-history_b_4762295 ## About the Sports, Clicks & Politics Podcast SCAPP is a weekly podcast with a Livestream every Monday at 12pm eastern. Join hosts Shawn Hannon and Ben Hussong as they separate the latest news from the noise. The podcast has frequent guest interviews for additional perspectives in the worlds or sports, politics and beyond! Follow the show on social media Website: scappodcast.com Facebook: facebook.com/scappodcast Twitter: @SCAPPodcast Follow Shawn & Ben on social media Facebook: facebook.com/hannon44 Twitter: @hannon44 Facebook: facebook.com/ben.hussong.3 Twitter: @benhussong --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/scapp/support

Contributor: Cheyenne Bean, PharmD Educational Pearls: Bactrim (TMP-SMX) is a sulfa antibiotic used for a number of infections but can have untoward effects. Hypoglycemia can be induced by the sulfa component of Bactrim, which binds receptors in the pancreas causing insulin to be secreted, dropping blood sugar levels. Oral diabetic medications, specifically sulfonylureas, when taken with Bactrim most often lead to these hypoglycemic episodes. Hyperkalemia can be induced by Trimethoprim by blocking potassium excretion in the kidney, so Bactrim in combination with ACE inhibitors/ARBs/spironolactone can induce high potassium. When prescribing Bactrim, remember to check home medications and if a patient is taking an above medication, check a baseline BGL and potassium. References 1) Khorvash F, Moeinzadeh F, Saffaei A, Hakamifard A. Trimethoprim-sulfamethoxazole Induced Hyponatremia and Hyperkalemia, The Necessity of Electrolyte Follow-up in Every Patient. Iran J Kidney Dis. 2019 Jul;13(4):277-280. PMID: 31422395. 2) Kennedy KE, Teng C, Patek TM, Frei CR. Hypoglycemia Associated with Antibiotics Alone and in Combination with Sulfonylureas and Meglitinides: An Epidemiologic Surveillance Study of the FDA Adverse Event Reporting System (FAERS). Drug Saf. 2020 Apr;43(4):363-369. doi: 10.1007/s40264-019-00901-7. PMID: 31863282; PMCID: PMC7117991. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account. 

For 16-year-old Izzy McKinney, a course of treatment with the antibiotic Bactrim first led to fevers and a bad rash.But that was just the beginning.What no one realized was that Izzy was suffering from a severe case of D.R.E.S.S: Drug Reaction with Eosinophilia and Systemic Symptoms.This introductory episode tells the tragic story of how DRESS syndrome took Izzy's life, leaving behind a devastated family. It is a cautionary tale that illustrates the importance of understanding and making a prompt diagnosis of this potentially fatal condition.Interviewed: Tasha Tolliver, Izzy's Mother, (President, Executive Director the DRESS Syndrome Foundation), July,  2019 in Richmond, VA.Making Drugs Safer: Izzy's Story – In-Depth Physician Interview: https://www.ivanhoe.com/interview/making-drugs-safer-izzys-story-depth-doctor-interview/https://www.ksat.com/health/2017/07/14/making-drugs-safer-izzys-story/Medical Paper Highlighting Izzy's Case -- HHV-6 encoded small non-coding RNAs define an intermediate and early stage in viral reactivation: https://www.nature.com/articles/s41525-018-0064-5The DRESS Syndrome Foundation:https://www.dresssyndromefoundation.org

From opposite ends of the U.S., two mothers share a common bond. They both know what it's like to sit at a child's hospital bedside, desperately searching the world over for the medical information that could save their daughter's life.When the resources they needed weren't available, they took matters into their own hands to create them.While working through their grief, these mothers have bonded in their mission to create better awareness of DRESS syndrome and support others who suffer from it –beginning  with a foundation, social media, and public outreach projects.Interview: Tasha Tolliver (President/Executive Director the DRESS Syndrome Foundation),Nancy Szakacsy, (Vice President the DRESS Syndrome Foundation), August 2019, in Bethesda, MDRESOURCES:DRESS Syndrome Foundation: http://www.dresssyndromefoundation.orghttps://www.facebook.com/DRESSSyndromeFoundationFacebook Support Group: https://www.facebook.com/D.R.E.S.S.SyndromeCommunity

You've probably heard about the extremely popular antibiotic known as "Bactrim," which is used to treat all kinds of ailments from acne to urinary tract infections.  But two local physicians recently figured out - that for some teenagers - the common prescription can lead to devastating reactions, including death.  I welcome Dr. Jenna Miller and Dr. Jennifer Goldman to The RadioDana Diaries.  Their story is Diary Entry Number Eight.  

Thanks for tuning in to the Armor Men's Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.In this segment Donna Lee asks Dr. Mistry talk about Urology Specialists' holistic approach to urology and how it differs from men's health clinics. Because sexual health is often the "canary in the coal mine" that alerts a person to other health problems they might not have noticed, the providers at NAU Urology Specialists know to look at the bigger picture when it comes to patient health. Dr. Mistry and Donna Lee also answer a listener's question regarding side effects from the commonly prescribed antibiotic Bactrim. While side effects like thrombocytopenia are rare, they're not impossible. That's why having a doctor who treats the whole patient is so critical to achieving optimal health outcomes. As always, if you have a urology or health-related question that you would like to hear answered on the air, please email your questions to armormenshealth@gmail.com. Questions are answered anonymously, unless otherwise specified, and the answers will likely benefit many people with the same concerns. If you enjoyed today's episode, don't forget to like, subscribe, and share us with a friend! As always, be well!Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.We enjoy hearing from you! Email us at armormenshealth@gmail.com and we'll answer your question in an upcoming episode!Phone: (512) 238-0762Email: Armormenshealth@gmail.comWebsite: Armormenshealth.comOur Locations:Round Rock Office970 Hester's Crossing Road Suite 101 Round Rock, TX 78681South Austin Office6501 South Congress Suite 1-103 Austin, TX 78745Lakeline Office12505 Hymeadow Drive Suite 2C Austin, TX 78750Dripping Springs Office170 Benney Lane Suite 202 Dripping Springs, TX 78620

Frank Braun talks with Arto Bendiken about the ongoing Coronavirus pandemic (COVID-19). How did we get here and what convinced us to prep. Paranoia, case fatality rates, and vaccines. Secondary and tertiary effects. Normalcy, authority, and confirmation bias. Subscribe Pocket Casts Spotify Stitcher Apple Podcasts Overcast Google Podcasts PlayerFM YouTube Show Notes Introduction 00:01:40 What set this whole thing in motion? Both Frank and Arto are already in lockdown mode, and prepared. It’s ~6 weeks since both of them started “buying some insurance”. Arto prepared for 11 people. 00:05:25 What made you think it’s going to be a big deal? (Risk assessment) Observations from Wuhan. Lessons from Spanish Influenza 1918-1920. High infectiousness, showing no symptoms while being infectious. People suddenly dropping in the streets. 00:08:00 Book: “The Great Influenza” Few media coverage on strange cases, like the woman dropping on the vegetable market. 2020, A strange year 00:09:10 First week of February: cancelling all travel plans (Arto Bendiken). 00:10:00 “An earthquake happened in Wuhan, and the tsunami will follow. It is hard to see the tsunami until it comes close to the shore, but it will follow.” (Arto citing Steve) 00:11:05 Analytical preparation, emotional process (fear) comes later. 00:11:40 Reactions by others: accusations of panicking. 00:12:03 Convincing others to prepare? 00:12:28 People buy insurance for things that are less likely to happen. 00:14:43 NN Taleb’s Tweet on Paranoia: “When paranoid, you can be wrong 1000 times & you will survive. If non-paranoid; wrong once, and you, your genes, & the rest of your group are done.” - Not everyone takes action on something so far away. 00:15:40 Balaji S. Srinivasan’s Three categories of people: “1) Post-headline people: only believe things that are already in print 2) No filter people: forget it, they’ll believe anything :) 3) Pre-headline people: will listen to a rational argument and look at primary data”. 00:17:05 Authority bias: Credentials, degrees, other people’s opinion. 00:18:10 Talking to family and friends about situation when there was still time to prepare. 00:18:40 Cassandra Myth (Iliad) 00:19:15 Uniform set of responses: you’re panicking and making it worse, dismissal 00:19:53 Bill Gates warned about pandemics long ago, but was dismissed as a college dropout and IT guy. (Confirmation bias, ad hominem attack) 00:21:09 Bill Gates: “The most predictable disaster in the history of the human race”. 00:21:20 Albert Camus: These things have a way of reocurring out of the blue sky. 00:21:50 Increased risk factors: base risk plus big cities, international travel. 00:22:03 On average, three pandemics a century. 00:22:21 Ebola outbreak was a close call. Hongkong Flu (1 million dead), late 1960s. Economic cost 00:23:14 Many animal to human transmissions were contained early by slaughtering millions of animals at the slightest sign of sickness. (Economical cost!) 00:23:53 Vaccines and public health system. (Smallpox) 00:25:47 We are still in the beginning of the economic impact. Common thinking errors and biases 00:26:45 Bias to focus on things that are caused by humans. Helplessness when confronted with pandemics. 00:27:37 Man-made virus from Wuhan lab? 00:28:19 Illegaly sold lab test animal at wet market? (野味 yewei, bush meat; 街市 jieshi, wet market) 00:30:08 Cognitive bias: systematic error of thinking. Man is the rationalizing animal. (Example: seeing faces in clouds) 00:31:31 Examples of observed biases: authority bias, confirmation bias, combinations of these. 00:32:25 Normalcy bias (nobody wants to be bothered to change routines). The Virus: An Abstract Threat, vs. Zombies 00:33:05 Max Brooks (World War Z): Fear of pandemics is so deep, cannot be discussed rationally. Zombies = Pandemic. 00:34:50 Virus is an abstract threat, there will be 1 trillion copies of it by infection. 00:35:14 Plague: people did not even know what caused infection. (Germ theory) 00:36:45 Are Zombie enthusiasts better prepared for a virus pandemic? 00:37:55 Trying to find out what’s going on fundamentally vs. latching onto experts. 00:38:48 Engaging brain about status vs. primary data. 00:39:30 People starting with the premise that they are not smart enough to understand what’s actually going on, not making any effort of their own. 00:40:40 Trying to understand incoming data, for example the first papers coming out of Wuhan. 00:42:05 Impossible to keep up with current findings, research, and papers. 00:42:40 More data globally, in the beginning filtering was easier. Problems with “Confirmed cases” 00:42:42 Mon, March 16th: currently 170.000 confirmed cases, 5000-6000 dead. 00:42:49 Confirmed cases != infections 00:43:17 Impossible to keep up with new cases. 00:44:00 “Confirmed case count"= comes with limitations (manpower, test kits). 00:44:55 Again, not enough test kits (USA, Berlin). Wuhan could test only 3000/day in the beginning. 00:45:20 “Confirmed cases"= lag in data. 00:46:35 “When people focus on these official measures… that are limited by staffing, test kits, by political considerations, then that’s not a good way… of understanding what’s going on.” 00:46:55 “That’s why it was so good to get this leaked information, leaked videos, from Wuhan. That way we got a sense of what was actually going on.” 00:47:30 The plural of anecdote is data. 00:47:41 Investigative Reporting. 00:48:00 Actions speak louder than data: Measures against the virus were severe. 1 Mio people in lockdown, 10% of global population. Mathematical Modelling 00:48:42 Mathematical Modelling… common problems: people cannot understand exponential function. people compare to flu last year. countermeasure lag: it takes time to show effect, politics make new changes 2 days apart, makes no sense. 00:51:12 Case fatality rate. World Health Organization (WHO) 00:51:22 Role of WHO: gives recommendations for guidelines, funding by member countries (China among them), driven by political considerations. 00:52:15 Public health emergencies of international concern (PHEIC). 00:52:25 WHO got rid of the term “pandemic”. Case Fatality Rate (CFR) 00:53:25 “Naïve” Case Fatality Rate (CFR), released by WHO. First, 2.1% (mostly China); revised 3.5%, and going up. 00:55:20 SARS initial outbreak CRF ~2%, but by the end of the outbreak, it was ~6% (resolved CFR). 00:56:49 Makes no sense to compare past cases to current cases (open cases vs. resolved). 00:57:45 CFR for age groups: not taking into consideration system overload (needed care might not be provided). 00:59:22 CFR only says so much, 20% require hospitalization, many of those need ICU. 01:00:00 Hospitals in Italy are already overwhelmed, will worsen until end of the week. 01:00:40 Italy’s CFR is already higher than China’s. Secondary and Teritiary Effects 01:00:50 Cases overload the medical system, secondary effect: death rates go up. Patients with other diseases might not get medical help. Empty hospitals beds waiting for the next pandemic are unlikely. Economic impossibility, health care system already occupies significant percentage from GDP. Makeshift hospitals. 01:03:20 Investment options. Stock-market implosions. Crypto-market implosions. Flight to cash. 01:04:28 Supply chain problems. Goods coming from China. Food also comes from China. Just-in-time economy (supermarket have no more backrooms, but once or twice a day a truck delivery). Tesco is already limiting purchases like toilet paper. Respirators (EU: FFP2 & USA: N95, or FFP3 & N99): China restricted exports. Overreacting 01:08:15 “It’s always about efficieny, never about risk of failure.” 01:08:28 Pandemic response bears a similar problem like IT security. Overreaction with swine-flu might had been the reason it never got that bad, that’s why it was called an overreaction later. 01:09:23 “It’s a bit like prepping: no matter how bad it gets, you want to be overreacting in retrospect, otherwise, you didn’t prep enough. And, you’re not gonna hit exactly on target, so you wanna err on the side of overreaction.” 01:10:01 Control theory (robotics): accuracy vs. speed. Respirators and Masks 01:12:30 “You don’t have them [the respirators] until you have them in your hand” … “It’s like cash”. 01:13:10 Only stock up on masks if you intend to not avoid people. 01:14:23 Ukrainian border confiscated protective gear when trying to cross border to Poland (export is forbidden). 01:15:21 Idea that you don’t need respirators: “You don’t know how to properly use them!” “Doctors need them.” 01:15:50 Why didn’t hospitals stock up in January? True: Doctors need respirators more. 01:16:30 How can wearing a mask not help? If everyone wears a mask, that means every infected person wears a mask, and this decreases chances of transmission. (Hongkong) 01:17:25 “Wearing a respirator makes it less likely you’re getting infected yourself, … and wearing a surgical mask … helps not infecting other people, so it makes total sense that everyone wears at least surgical masks”. 01:18:40 Men’s issue: shaving gel and razors (beards and masks don’t go well together). Prepping 01:20:40 People tend to be dismissive of people with health problems, who might need medication or health care, and the elderly (“It kills only old people!"). 01:22:02 Ukrainian health care system is monopolized by state (surgeries, child birth, vaccine). “A public hospital is the last place I want to go [in the Ukraine]". 01:22:22 Contingency planning differs on country. 01:23:25 “The real carnage is going to be in third-world countries, just like it was in 1918”. (USA: 675.000 vs. India: 2 Million, Spanish Flu) 01:24:20 Lviv Infecitous Diseases Hospital messaged it would be well-prepared with 20 isolation beds (and plans to expand to 300), 4 ventilators, 0 ECMO, 10.000 surgical masks and respirators. Medical supplies 01:25:40 No difficulty to buy antibiotics in Ukraine, whereas in other countries it’s highly regulated (prescription vs. over the counter). 01:26:37 Chloroquine is promising in treatment of COVID-19 (malaria drug). 01:27:39 Paracetamol is not easy to buy in bulk. India also has restricted export (Indians source precursors from China, too). Location 01:28:40 Arto’s housing situation: countryside Western Ukraine, foothills of Carpathians. Frank: Berlin suburbs. Location cannot be changed later. Time is a constraint. Economy is going down. “If you wanna prep now, and you don’t already have a place to go… I don’t see why you should go there now”. Consider threat model: main risk for both is electricity going down. Social Distancing 01:32:51 Where do you stay put, and with whom? Acquire resources to stay put: food and drinking water, some personal protection for supply runs. Nitrile gloves Any mask will be useful, at least you won’t touch your face. Disinfectant: WHO guide how to make your own, primers might still be available. Goggles: Construction glasses or swim goggles. Scenario 01:36:30 Think about your scenario: staying inside apartment for a long time. food, water, protective gear what could go wrong- how do I deal with it? If electricty goes down: gasoline cooker, cheap carbohydrates (no freezer/ storage), pressure canning (no freezer, conserving meat). 01:40:30 Most likely scenario: you stay indoors, everything works (electricity, water, internet) first, get prepared for this scenario. 01:41:00 If electricity goes down for extended periods, water goes down. The big problem is not drinking water, but sanitation. Off-the-grid bucket loo with trash bags and wood shavings as absorbant, and wet wipes to clean. (BranQ portable toilet) 01:43:00 Water filter Micropur Forte Katadyn Filter Foodgrade Canisters for tap water and disinfect with Micropur Forte. 01:44:06 “I tried to focus on stuff that I normally eat anyway, … I just got a lot more, so it doesn’t go to waste. Other things like rice bags, I got as an insurance, but the rest I would eat anyway.” Threat model: Electricity, Water, Internet going down 01:44:50 Threat model and scenario. Social distancing might help burn the pandemic out. Viral shedding after recovery can be up to 37 days. Countries will handle situation differently. 01:47:10 “… if the situation gets particulary bad, which it might over here [in Ukraine] at least, I would expect some more outages, for the internet connectivity, there’s multiple options for that, so I expect at least one of them working.” 01:47:44 A lot of people getting sick means a lot of people not working, especially in grid systems workers might not be able to fix things in time. 01:48:24 “For the internet, we will see how well that works if everybody’s sitting at home watching netflix, or porn in full HD.” 01:48:59 Mobile internet. 01:49:17 Mitigate risk for short downtimes. 01:50:40 Wuhan pictures from people queuing for water. 01:51:11 Mitigate risk of having to go to the store a lot. not because of food shortages, but it’s a risk for virus exposure. 01:51:48 Going out for walks, just don’t meet anybody (countryside). avoid contact, don’t touch anything droplets in common areas that you pass on the way out (hallway, elevator). Prepping and timing 01:53:25 “Although I’m now pretty well prepared compared to most people, it kinda caught me cold-handed… because I was always interested in prepping, and I was always planning on prepping more for when SHTF, but I never really executed that much. But when I started six weeks ago, I realized how much harder… it was than I imagined, and also how much harder it was because… of such a short notice, and it was getting harder to get things, for example the respirators. It would have been so easy to stock up on all of this stuff. For example, the ridiculous situation that you had to ship me antibiotics from Ukraine although I was in Ukraine in January, I should have just bought all the prescription medicine a prepper needs.” 01:55:37 Early Infections in Italy, Seattle, etc. happened in January/Feburary. COVID-19 death in Spain 2 weeks before the first confirmed case there. (Lack of indicator) Food and Cans 01:56:56 Cheap carbohydrates, easy to store. (“Insurance”) Potatoes, rice, buckwheat. 01:57:10 Newly acquired freezer to stock up on meat. Canned meat as backup. Pressure Canning, if you have time, or already own a pressure canner. 01:58:15 Add variety, if you switch to carbohydrates. Canned veggies and canned fruit. Salt, Pepper, Spices. Deliveries 01:59:18 Deliveries still working. Disinfecting parcels. All delayed (surge of deliveries, momentarily overwhelmed). Fat 02:01:05 Freeze butter, or make Ghee. Olive oil might be adulterated with industry/ vegetable oils. Timescale 02:02:55 “Right now, people in the last week or two stopped laughing… and stopped repeating this mindless It’s Just The Flu, Bro… in any case, they’re still expecting this will be over soon. … And authorities are still telling them it will be over soon, prepare for a few weeks.” even emergency measures expire in about a month (bars and club are closed only until April, etc.) People stay at home close to 50 days. (Wuhan) China is looked upon as having “beaten the virus”. 02:04:57 “It’s always better if you’re dealing with a foreign virus, than with a domestic virus”. In Iran: Zionist conspiracy. “Virus doesn’t care!” 02:05:40 Once China resumes work, and life, there will be another wave. re-imports to China (from Italy for example) fully stopping virus is not so easy. virus will become endemic. multiple waves. Dystopian future vs. helpful tracking and tracing 02:07:26 Countries which deal well with it: outbreak, containment measures, a lot of testing, tracking, and contact tracing -> situation under control, problem: reintroduction from other countries. China is currently trying to automate contact tracing. Location tracking. Surveillance cameras with face recognition. Helpful scaling of tracking vs. dystopian nightmare. 02:10:10 The Virus can travel up to 4,5m, passenger infected others through a long-distance bus ride. video camera in bus. position of citizens is known at all times. re-engineering passenger’s travel was possible. 02:12:20 Controlling coming waves, keeping the country in lockdown is not a solution unless we transition to a permanentely remote economy. 02:12:30 Appeal from engineer perspective. Social Scoring system is already established. put people on specific quarantines if they were in contact with an infected person. government AI tells you if you should leave your apartment today, or get a test. scaling without the disruptions from now would be possible. 02:14:04 Germany outruled events with more than 50 people, but if you do an event with less people, you need to create a list of all attendees. (old school approach) pressure into direction of more surveillance. pushing ban on cash forward as well. China destroyed cash on basis of contamination questions. some chains in Germany went cashless because of the virus. Acceptance pipeline 02:16:39 “Acceptance pipeline”, dealing with grief: it won’t be over soon. 02:17:10 Pipe dream: Many place hope on vaccine development. vaccines are for healthy populations. vaccine is far away: more than 12 months, at least. might not be easy to develop (7 different coronaviruses, 15 years of development but currently no vaccine for either). not so effective: 20-60% for common flu vaccine. high mutation rate. 02:20:30 Accepting that there’s no easy fix. what are you going to do to plan for it? avoid infection as long as possible (6 months). look at vaccine development like a lottery win. by the time the vaccine is developed (18 months), whatever will happen has already happened. 02:23:12 It’s hard to plan to stay in apartment for 18 months. instead, plan for a world with Coronavirus, and a lot of lockdowns, and a lot of infections. Learning from past pandemics 02:23:35 Learn from past pandemics (1918 Spanish flu, 3 waves). 02:24:04 Spanish flu: passed through ships, first cases (first wave) very mild, less than influenza, less than COVID-19. Second wave, 5 months of carnage. Worse than COVID-19, at least currently. Third wave, somewhere in between. future waves might be more lethal. or become endemic, less lethal. it would be prudent to plan on a worst-case scenario where it takes a couple of years. “something worth paying attention to is going on.” Economic changes 02:27:50 Practical preparations for 6 months is difficult (economically). savings rates in Western countries are shit. people are out of jobs already (events cancelled, tourism breaks down). bankruptcy. no more fundraising tours. airlines discharge employees. 02:29:29 Good thing: remote work will be more accepted. Prepping List 02:30:00 Supply run gear for securing supplies goggles (and anti-fog spray), respirator (or surgical mask), rain poncho (or whole body protection suit), gloves (most important). 02:32:20 Surfaces: virus can be contangious on surfaces a few days (up to 9 days). Buttons, handrails, etc. (disposable gloves). 02:33:38 Coming from outside to inside. Shoes (rain boots can be easily disinfected). 02:34:10 Sourcing is already hard, will become more difficult. switching to local production. repurposing existing production facilities. 02:34:50 Power issues. solar panels, butane, propane, camping stove, space heaters on butane. fuel: gasoline, diesel, firewood. prepare for next winter. 02:36:00 Sanitation TP!!! plumber might not be available: be prepared to unplug it on your own. 02:37:05 Disinfectant Alcohol-based wet wipes since disinfectant is nearly everywhere sold out, switch to local production and DIY. 02:37:45 Medical The Prepared List/ Medical Broad-band Antibiotics: prevent secondary infections (pneumonia, 50-60% CFR). Doxycycline, Bactrim, Zithromax. India is restricting 26 medicines& pharmaceuticals, including paracetamol. China is restricting personal protective equipment (PPE) export since a month, maybe also medicine. If you take any prescription medicine, stock up for a few months at least. Stock up on painkillers (Ibuprofen and other non-steroids like aspirin, might be a risk factor for COVID-19). Prepare to treat yourself. 02:43:13 Pregnancies. Prepare for home birth. Access to healthcare resources will be restricted (Check-ups). Sourcing books. Remote consultation with midwives. Might be a common situation this year. 02:44:45 Chronic diseases and cancer patients. Might be unable to receive treatment. 02:46:34 Hygiene and Sanitary Items. Condoms. Tampons, Pads. can also be tradeables 02:47:05 Tradeables. see above, and: Alcohol. Cigarettes. Lighters. Wrap-up 02:48:05 Send us your questions! 02:48:32 Expert: Jon Stokes, ThePrepared.com. Founder of Ars Technica. 02:49:20 Book Recommendation: Barry, John M. (2004): The Great Influenza. The Story of the Deadliest Pandemic in History. Arto’s Twitter thread with quotes from the book 02:51:15 Book Recommendation: Hatfill, Steven; Coullahan, Robert; Walsh, John (2019): Three Seconds To Midnight. US-specific, but general sections are great. 02:51:50 “Bottom line here is: People underestimated this systematically. … Systemic error of thinking, they underestimated it, and they continue to underestimate it, even though they are no longer laughing, they continue to underestimate it. … This is something that has not happened in any of our lifetimes, there’s no listener who has seen anything that has been on the order of this, and it would be very good to get out of our normalcy bias.” recognizing a lethal situation as a lethal situation. go through the acceptance pipeline. err on the side of overreaction. it’s not about calculating the odds, we have no way to know which scenario will play out, so prepare for a few. it’s not just about us, it’s also about other people (keep granny around!), that also depends on your actions. Donation Report 02:55:11 Donation Report and Minimum Wage Calculation. Reading Recommendations Barry, John M. (2004): The Great Influenza. The Story of the Deadliest Pandemic in History. Goodreads Hatfill, Steven; Coullahan, Robert; Walsh, John (2019): Three Seconds To Midnight Goodreads Taleb, Nassim Nicholas (2020): Systemic Risk of Pandemic via Novel Pathogens - Coronavirus: A Note Taleb, Nassim Nicholas: How to react to Pandemics N.N. Taleb on paranoia Homer: Iliad (Cassandra Myth) Gates, Bill (2015): The most predictable disaster in the history of the human race Gates, Bill (2015): The next outbreak? We’re not ready. TED2015 Gates, Bill (2020): Responding to Covid-19 — A Once-in-a-Century Pandemic? Bill Gates on pandemics Camus, Albert (1947): La Peste. (The Plague) Arto’s Coronavirus reading list Arto’s thread of The Great Influenza quotes Max Brooks’ quote of World War Z fame B.S. Srinivasan on post-headline people “Naïve” Case Fatality Rate (CFR) The Virus can travel up to 4,5m Centers, Josh: The Prepared List/ General Rader, Tom: The Prepared List/ Medical Desinfectant antiviral Handrub: WHO Guide to Local Production Discuss We’re on bbs.anarplex.net with our own board to discuss! Hosts Smuggler (Twitter) Frank Braun (Twitter) Guest Arto (Twitter) Contact Email: bitstream@taz0.org PGP fingerprint: 1C4A EFDB 8783 6614 C54D E230 2500 7933 D85F 2119 (key) Snail mail Bitstream Scanbox #06965 Ehrenbergstr. 16a 10245 Berlin Germany Please send us feedback letters, postcards, and interesting books. You can also send us your dirty fiat by cash in the mail! We take all currencies. 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Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Nikki: My husband has had dry scalp since his teen years and continues to do so into his thirties. He has been treated by conventional doctors for this with antibiotics/steroids with little effect. For the past 11 years it’s only been him who has struggled with this. As of last year, I have started to have dry scalp as well as our children. We try to eat healthy. We do eat out every other month and consume some white flour. We live on a small farm but are surrounded by conventional fields/farmers. Where should I start in healing my family? We recently ran the big five lab tests on my daughter and hope to get the rest of the family tested as well. Thank you! Anonymous: Hello Cabral Team, I am an undergraduate student looking to pursue a naturopathic or functional medicine health career. I have always had a passion for health and wellness, but last summer, through exposure to your podcast and products, I turned my attention towards natural remedies including detoxification, nutrition, and lifestyle changes to address chronic illness rather than through the use of pharmaceuticals. I am very interested in helping others discover this lifestyle and change their lives as I did; however, I am confused about how to pursue this path as many of my professors and advisors at school are unaware of functional medicine and the jobs it includes. Could you talk a little bit about your path in pursuing your degree, how you chose a medical school, any internships, opportunities, or jobs that lead you there and solidified your decision to attend medical school? Is it better to pursue another degree such as nursing or physician's assistant studies and build a job as a holistic practitioner around that or is it recommended to go to naturopathic/functional medical school? Ingrid: Hi Dr. Cabral, We made a video version of this email that I'm including the link to here which is better to see his skin clearly: https://youtu.be/h4PeKh-O0SQ My husband and I live in Ann Arbor, Michigan. He is a very healthy man of 34 who has never had alcohol, smoked cigarettes, has eaten a vegan diet for the last 3 years, and exercises regularly. Both he and I got a lot of mosquito and bug bites in the summer last year. In October, he realized that a small bump (he figured an insect bite) on his arm had not gone away. Thinking then that it was a wart instead, we put a salicylic acid patch on it. This burned a hole in his skin, which turned into a dime-sized open sore, oozing yellow watery liquid. Dermatologists nearby weren't available until January, so we went to the PCP office instead. The nurse practitioner determined it was impetigo (no tests, just visually) and gave him a topical antibiotic (Miuprocin) to put on it for a few days.This made the spot on his arm worse. The sore widened to be a strip of bumpy, oozing skin about 2 inches wide. We went back to the PCP, saw another NP who determined that the antibiotic must not have been strong enough, and prescribed him an oral antibiotic, Bactrim. Within a few days of the treatment with Bactrim his whole body exploded in hives, bumps and rashes. The original area on his forearm did not improve at all. It was very challenging, he couldn't sleep at all due to the itch and was extremely uncomfortable for the next few weeks. Total misery. We finally met the dermatologist in Jan. She said he likely never had a bacterial infection, that the original bump was probably an ingrown hair, but now he had developed severe eczema due to his response to the antibiotics. When asked why this happened, she basically shrugged and said "sometimes a person develops eczema", and informed us that this is now something we need to just "manage" for life. She gave him a tapered dose of oral Prednisone for a few weeks, and advised the use of hydrocortizone and triamcinolone steroid creams for some of the worst areas. This took his symptoms and level of discomfort from 100% to about 20%, but he never got completely better, some areas of the skin like the nipples were still very inflamed, itchy and scaly. After being off the prednisone, some symptoms elsewere re-emerged slightly, and the derm said this was normal after coming off of steroids. For the areas like the nipples that never got better she prescribed Protopic (a non-steroidal immune suppressant). Despite her assurances, this cream has been linked to development of lymphomas and so we never used it. From mid-March to the beginning of April his skin health really took a nose-dive. The sores and rashes came back at full steam and he's as uncomfortable as he was after the antibiotic. We began seeing an Integrative doctor in our area who had him take the OAT and a blood IgE and IgG food sensitivity test. The doc said that according to those tests, he has a number of food sensitivities and an extremely high level of d-Arabinose in his urine, which indicate a Candida overgrowth. She felt this candida overgrowth is the reason for his skin reacting this way after the antibiotic. She has him on Diflucan and Nystatin, as well as Borage Oil, Vitamin C, Quercetin and Nettles, Vitamin D3, Magnesium, Zinc, L-Glutamine, and a B Complex. We have also removed all his trigger foods from the sensitivity test and are following a paired-down anti-Candida diet (basically we've removed fruits and are eating mostly vegetables, some brown rice, mung beans and lots of nuts and seeds). We are now almost at the end of week 4 of the treatment and are concerned that his itch and other symptoms have not significantly improved. He is still incredibly itchy at night and while the scabs of his sores have fallen off, the skin underneath is raw and red and doesn't seem to be healing at a normal pace. Last weekend, some of the spots that we thought were looking somewhat better began oozing clear serum again, but have now dried up again. It's hard to say if his skin is healing, it doesn't look better, it just looks different? My question is, are we pursuing the wrong course here? We really thought the integrative doc had the answer when she said he had a candida overgrowth. But even she seems surprised at the lack of progress. We are feeling like no one really has a handle on what is actually happening to him.Thank you,Ingrid Cherie: Hello. A few questions. Can you have cheat meals on the CBO protocol, and if so, when can they begin? I am asking because foods are slowly re-introduced and I did not know if a cheat meal with foods not on the Gut guide list would negate all the benefits. Also can you have CBD oil on the protocol? And lastly, when should I take vitamin c and zinc during the protocol? Can I take them with the CBO pills? Cassandra: Hi Dr Cabral  I've completed the CBO protocol and stuck to it 100% however I've ran an organic acid test and have high bacterial and yest markers. I'm confused why you approve of legumes and beans on the CBO when they are high in fructans and they feed yest and bacteria. I understand they are easy to digest foods but still all naturopaths I have spoken to say to stay clear of them. I'm really disappointed that I'm going to need to do another round. I'd love to hear your thoughts on this. Many thanks Yvonne: I am just listening to your podcast with Dr Gerry Curatola and think I probably have several issues related to what you're talking about - teeth removed, root canals and mercury fillings and have health issues.  My concern is that the detailed information about what is required to return health sounds extremely expensive and only available for the rich. I live in Canada and am on a retirement budget so I either wouldn't have the funds required or if I did I would then be destitute.  So does that mean for someone on a retirement budget good health will not be available? Ashlee: Hi Dr Cabral. My husband and I have been trying to conceive for almost a year and would love some guidance. We have completed the 21 Day detox, have both been doing the daily protocol level 2 for 5 months and I have been taking the prenatal package as well. We both just competed the Big 5 labs and are now doing the heavy metal protocol and will do the parasite cleanse and CBO by the time you read this. I am also seed cycling and we are taking vitamin d, adrenal soothe, cal-mag, zinc, DHEA, digestive enzymes and vitamin c as recommended by our health coach. Most of these were recommend for up to 12 weeks. We eat organic as best we can and follow a similar diet to the DCD with the inclusion of carbs. We have also detoxed the house from everything we have control over too. We are hoping that by the time you read this I will be pregnant but if not I am asking where can we go from here? We want to have a natural birth and feel like we have done everything possible to help the process. Is there anything else we can do? Or what do you suggest our next step be? Thank you so much in advance for your response and we appreciate you taking the time to help us. Ashlee. Judy: Help! I am breaking out in random hives for over 2 weeks. I thought maybe it was something I ate but when I eliminated certain things from my diet, it is still happening. I get tingly itchiness and anything that rubs against my body, I get welts on my skin. I am not sure if it is a delayed response to food or some other allergen.I have been highly stressed for over 6 months. I am taking 2 capsules of adrenal soothe every night and I plan to take your TAH test again next month. I have also experienced eye floaters recently and my acupuncturist says I have a chi and blood deficiency (my last cycle ran for 25 days which isn’t normal for me). Also my tongue swells and my skin is tender to touch when I have cheat meals which sadly are happening more than Once a week. What can I do to get well again? My friend recently took the MRT food sensitivity test and it has a lot more foods on it than the one you are currently using. I prefer to go with your coaches and health plan but I wonder what your thoughts are on a more comprehensive list of foods from this competitor’s test. Sorry for the long questions but I did want to say that although I am dealing with these issues, I have come so far in my health journey based on your recommendations and health coaches and look forward to continued improvement. Take care, Judy   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions!  - - - Show Notes & Resources: http://StephenCabral.com/1268 - - - Get Your Question Answered: http://StephenCabral.com/askcabral   - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -   Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox  (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake  (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend  (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil  (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements  - - -   Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test  (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. Pylori, or parasite overgrowth) - - - > Genetic Test (Use the #1 lab test to unlocking your DNA and what it means in terms of wellness, weight loss & anti-aging) - - - > Dr. Cabral’s “Big 5” Lab Tests (This package includes the 5 labs Dr. Cabral recommends all people run in his private practice) - - - > View all Functional Medicine lab tests (View all Functional Medicine lab tests you can do right at home for you and your family!)

Welcome back!  This is the second episode of Rheum4Debate, an oxford-style debate show for the field of rheumatology.  In this podcast we'll tackle the question of bactrim prophylaxis in patients receiving cyclophosphamide.  The motion was:  “Bactrim prophylaxis should be prescribed to all patients with SLE who are receiving cytoxan and over 20mg of prednisone daily” Dr. Pankti Reid (@panktireid) argued FOR the motion and Dr. Anisha Dua (@anisha_dua) argued AGAINST the motion.  PLEASE be sure to fill out the post debate poll and let us know what you think! You can find it on my twitter account @ebrheum!

Tess Cacciatore is CEO of Global Women's Empowerment Network, an organization dedicated advocacy and activism for human rights. Tess is an award-winning producer, director, writer and editor creating content that focuses on social impact. She covers important topics like human trafficking, early child marriage, domestic violence and clean water initiatives. Read more about Gwen Global. Read more about The Passionistas Project.   FULL TRANSCRIPT:   Amy and Nancy Harrington: Hi and welcome to the Passionistas Project Podcast. We're Amy and Nancy Harrington and today we're talking to Tess Cacciatore, co-founder of Global Women's Empowerment Network, which is dedicated to the advocacy and activism of human rights. Tess is an award winning producer, director, writer, and editor creating content that focuses on social impact. She covers important topics like human trafficking, early childhood marriage, domestic violence and clean water initiatives. So please welcome to the show Tess Cacciatore. Tess Cacciatore: Hello. Thank you so much for having me on. Amy and Nancy Harrington: Thank you so much for being here. We really appreciate it. What are you most passionate about? Tess Cacciatore: Well that's a loaded question because it varies as we talked about earlier today. You know my book ranges from A to Z. But I think the most important message that I'm trying to get out there right now is about people to have the courage to share our stories. Everyone has a story to share and I think it's really important. We have a hash tag revealed the hill which is all about how can we get vulnerable and share stories. And through that turn of events I'm hoping to be able to inspire self-love. I think once we have that self-love we're going to make better decisions about who we bring into our life and bring better awareness of what's happening around us and hopefully do better in our lives. Amy and Nancy Harrington: Talk a bit more about how you've translated that passion into what you do for a living.  Tess Cacciatore: Well Global Women's Empowerment Network started off as a 501 c3. I came back all the way up into the 90s where I had this vision of having an interactive multimedia platform of programming for social impact. But when you talked about virtual classroom and social impact inside of the entertainment industry back in the 90s people pretty much looked at me with my own like I had two heads. So I think the timing and the juncture of vision meets technology and the awareness that people have in the world is right now. So everything's been this small little building blocks these small stepping stones and some of them big leaps and some of them been drowning in water and coming back up around the cycles that we all have in life. But why I think it's really important about right now is because there is such turmoil going on in the world. National disasters what's happening in our world in many levels. And I think that it's really important to be able to be able to have that story to heal you know what is our individual stories how can we be compassionate for others how can we be compassionate towards ourselves. In the ‘90s, you were working in the tech industry so what did you learn during that time that sort of bridged the cultures through technology. Tess Cacciatore: So technology is really interesting I just moved to L.A. about five years previous to 1993 and a friend of mine Amy Simon said there there's this new industry that's happening and you're a great writer and a producer and maybe you can come and play in this wild wild west as we called it back then and there was very few women in industry. So I was really excited about seeing what was under the hood of what was going on what the worldwide web was what email was what all kinds of you know the inventions that were coming out. And one of the side stories that I love to share is that I was with a group of friends and this one guy had this great vision and we became a board of directors and I got really close to getting US funding and the investors stepped away from the table and said ma I don't know if we want to really go down that path because I don't think anybody is going to really want to do an online auction and it ended up being this company that we called Rose Coie. And then about a year later eBay jumped onto the scene so I can fill up a whole hour of these near misses of what the vision was and how excited I was about technology. But back in the ‘90s it was really cool because I thought this would be really wonderful to be able to bring good programming documentaries that could reach the corners of the world. I hadn't started really doing a lot of global traveling at that point but it was really an adventure to see where the imagination could open up and expand the horizon of where we can reach people and bridge cultures which I thought was going to be a really important thing for history because most of the time you know a lot of countries are westernized so when you go to Africa to Asia or to visit the tribes they're not they're wearing more western clothes. And I thought this is so sad because what's beautiful is what sets us apart is that beautiful folklore and the legends and the stories that the ancestors passed down kind of like around the campfire where you get to teach each other what the generations have learned and that you learn from your ancestors. And I thought technology would be really important way to be able to bridge that. So through the 90s I worked on Web sites. There were big major corporations and we were teaching people how to be able to you know build the website and set up their email and it would be like Lotus U.K. or Sun Microsystems and I worked with a group of people we traveled all over the country and helped build this beautiful bridge to the world. What I kind of love about the experience I had back then is it on my daily basis as a producer is really I have to get down and get really detailed in the backside because I had to work with the programmers on one side. I had to work with the creative team and I had to work with the customer and the client and the corporations and to be able to work in all of those worlds and be able to communicate and make a project go from A to Z and to be able to launch and to know the how to file things and how to organize things. I still find myself laughing every once in a while because the tools that I got back in those days of project managing and producing really stays true to me. So there's the technical side that I love from back in the 90s and then there's the more cultural side that technology is. We're on wireless and we're going pick up the phone and call around the world for free. And there's that deep touch connection that I think is really important. Amy and Nancy Harrington: You started as an actress and a dancer and singer songwriter. So tell us about those experiences and what you learned during that time that inform what you're doing today. Tess Cacciatore: When I was five years old I told my mom I wanted to go to New York and be a dancer. And so when I was seven she put me into a dance class and then I slowly kind of went into the theater world and if I think back about my childhood and who I was then and who I still am to a degree I have a very introverted shy side. Believe it or not even though I speak before you know thousands and millions of people on any given day on broadcast or whatever and do public speaking there's still a homebody shy side to me you know in Des Moines Iowa Midwest girl great family life and good upbringing and all that but I just felt like that core of who I was still exists today. So the theatrical side really helped me expand. Even though I went to school for a BFA for music and theater and dance I moved to New York and I was an actress. I really felt that that helped me Blossom. It helped me be able to get the confidence to be able to talk in public and then I had to merge the other side of who I was and the passions and what I felt like I could do on the societal side but it all kind of links together in a very magical way. Amy and Nancy Harrington: And so how did all of this lead into you doing video production. Tess Cacciatore: I did a lot in front of the camera. But what I really loved back in my 20s was being able to be more part of the vision part of it all being a little bit more in control of my life. Because when you go to auditions as you know you're sitting in front of people that are making a decision about your life that you might not have the right color hair you might be too tall you might be too short. It might be to do that. And so it just came down to these molecular kind of decisions that were not in my control. And I felt like I want to be a little bit more in control my life and I'm really an advocate for that when I mentor a lot of people you know men and women younger people I say you have to really take control of what your destiny is. You have to create what you want to do. And I think with the way multimedia is now we have more power of that. But that was pretty much my deciding factors that I really wanted to be able to have that creative vision I could see the whole picture. And I saw the whole vision and what the message was rather than just memorizing someone else's lines. I wanted to be able to create those lines so it gave me a broad Bactrim of how to be able to get more in control of my destiny. And then I had a lot of fun. I love directing I love producing. We're working on original scripted series right now where my producing partner and I are writing the scripts and we have complete control complete creative control of whatever we see and whatever we want to do. And that feels really good to have that. And I think we have more options at our fingertips now than we ever had before. Amy and Nancy Harrington:What types of topics are you drawn to when you're creating a project or taking a project on social impact? Tess Cacciatore: I have a slate of programs and projects right now that are going out. One's an original scripted feature film one's a foreign feature film once a music documentary once an original scripted series and the other one is the talk show that goes along with the original scripted series and that five Slate I just put the deck together in the last couple of weeks. It makes me feel so joyful because they're commercial driven. They really can make an impact within community and they have a special message that really helps lift up humanity gets people to talk about what's going on. It gets the dialogue going it gets the juices flowing and that's exciting to me to be able to get people to talk and get people to share. Amy and Nancy Harrington:Why is that so exciting why do you want to focus on the humanitarian side of things? Tess Cacciatore: I think it's just the way I've been wired. I believe that in my world that I want it to be something that has a result to give back something that has a result to inspire or to empower somebody someone that might be able to feel healed because they heard a story that I might share or one of the people that we're profiling on our series because it's all about that story sharing and healing. And I feel like there's the reality shows genres and there's the mainstream theatrical releases of beautiful films I've loved watching and experiencing it all but I felt like my niche was really about getting in there and really doing something that could make an impact or make a social message or inspire someone to go after a law for you know for instance you can get people to be inspired. The fact that there are still children in our country in their states that still allow for young girls to be married at the age of 14 and we think that early child marriages in other countries but it's really right in our own backyard in the states that still have those rules and laws are surprising. It's not the states that you would think so to be able to let people know the statistics like there are still young girls that are being forced into marriage and this isn't like Romeo and Juliet or I'm in love with my boyfriend let's go run away and get married. These are older men in their 40s and 50s that are marrying young teenagers. And it's disgusting and it needs to stop. And they're forced into marriage because of whatever reason districts are atrocious. There's also a statistic that I share which is 300,000 children are abducted on an annual basis out of the United States. People think that sex trafficking is again in another country but it's right here in our own backyard right here in California. San Bernardino is a very big trafficked place. I grew up in Des Moines Iowa. There's sex trafficking that goes through Interstate 80. A statistic that I talk about often on Super Bowl Sunday is that that's the highest domestic violence day and it's the highest sex trafficking day. Most of the sex trafficking happens when their spring training areas and a lot comes out of Vegas. But a lot of it comes you know from other states as well. So I think through the programming we can bring awareness and let's say there's a group of people and I'll be there to charge with it to Washington or to our state capitals and figure out how can we change that law. Why are there still laws that allow for a 14 year old to get married and that kind of thing needs to change. So that's what I'm passionate about. I want to see that there's social change there's implications where people are being aware of what's happening in our own neighborhoods. You know we've watched the news all the time and we see these people going oh my god I didn't know who lived right next door to me. I didn't know that he had an arsenal of weapons in his basement or that he had three girls you know trapped in there for 10 years. It's really about bringing the awareness into what's going on in our own backyard and how can we help. How can we get resolution from different things that are happening. Amy and Nancy Harrington: How do you choose which topics to focus on and how do you manage your resources and your energy to give the most to those topics? Tess Cacciatore: I've found that in the last year or two I've had to really pinpoint and narrow down and it's really about social justice and human rights. You know equal rights social rights human rights social justice wherever you want to spin that. If it if it lands in that lane I'm right there I used to do a lot of work in the environment and animal rights. And even though I'm still passionate about that I'm really trying to narrow my focus in that and also through the platform that we're launching we're going to be able to give the ability for other people that have those passions to be able to fully explore what it is to save the elephant save the tigers save the penguins environmental greenhouse warming everything that can be happening. I want to offer this platform where people can put their programming on it so they get to go fully diving deep into that issue. I don't have to necessarily take the focus off the eye off my ball but I give them a platform and I shine a light on what they're doing. And so I think that's one of my main wishes to shine a light on the people and the organizations that are making a difference whether it's in the nonprofit arena or through theatrical releases of documentaries or short stories or books or music. When are you launching that platform and getting the dates. By the time this airs it might already be out we're already on Roku but I'm really undercover right now. We're going to be launching our programming on Amazon Fire, Roku, Samsung TV and Apple TV. And that's just the start. And through those four platforms alone we have access to 450 plus million subscribers. And that's potential subscribers then that big tap dance begins where you have to market them and how do you take the audience and bring them to your area and say Here we are. Because it's like grain of sand on a big beach. You know how do you how do you have that great of sandstone up above the rest because there's so much great content out there. So it's a big undertaking but I've been dreaming about it for a long time so I have a great team of people that work with me and we're going to make it happen. Amy and Nancy Harrington: What's it called? So Gwen Global is the incorporation and that has several silos below it. So there's the Gwen Studios which is our production house. Then we have Gwen Books so my book and other books that can go under that umbrella will be there and then we have Gwen Music and we have Gwen Tech and apps which I'll tell you about our app and then we have that when children's division. So that all is one bubble of called Gwen Global and then Global Women's Empowerment Network is our umbrella and that's been in existence since 2012 and that's the one that does the advocacy the programs the workshops the community outreach which we're doing quite a bit of here in Los Angeles but we're about ready to embark on a 10 city tour and then we do work with sister organizations in Africa. Amy and Nancy Harrington: We're Amy and Nancy Harrington and you're listening to the Passionistas Project Podcast and our interview with Tess Cacciatore. Check out her inspiring memoir “Homeless to the White House,” her story of personal healing and transformation which is available on Amazon. Now here's more of our interview with Tess. Amy and Nancy Harrington:When did you first get into doing philanthropic work? Was it in 1994, when you started the world trust Foundation was that kind of a pivotal moment? Tess Cacciatore: I think that pivotal moment because I've been asked that question a lot was when I was in high school I went to Dowling high school and we had this outreach program where we were able to volunteer. So I volunteered each year for the Drake special Olympics and we did a lot of work with kids with special needs. And it really opened my eyes and my heart. And I've always had that compassion then in my 20s I did some volunteer work. I performed in a couple places that Honduras for instance was a real eye opener for me it was my first trip to a developing country and to see the little kids it was right when Nicaragua was invading and see little kids running down the street with big huge rifles in their hands and people that were homeless and starving and all kinds of things. It was my first eye-opener. I've always had that passion but I didn't know how to put it into action until 1993 when I founded World trust Foundation. Talk a little bit about that. That was an interesting time a turning point. You can read more about it in the book but it was me coming out of entertaining I was traveling with the band as a singer dancer. We did a tour through Asia and I made a bad choice and I was in a relationship that was not good for me and it took me a while to get that oxygen mask on myself which is kind of a repeated theme in my life. And I left the band and left L.A. never to return. And I went back to Des Moines it just happened to be when the floods were hitting the Midwest and there was no running water no electricity for a while. So it was God taking me down all the way to the basics where there was like I had had to begin square root all over the place and I just prayed. And I said what am I supposed to do with my life where am I going I definitely don't want to be back to L.A. and that's when you say never say never because I'm here. It was a very interesting time for me so I had these people that we did the rebuild project in South Central after the riots. And I met one other guy that was from outside of the community and we exchanged cards I didn't really think much about it. I really wanted to work with the rehabilitation of the community I worked a lot with the gangs in a workshop and just was so heartwarming to me because these kids were really in a lot of need of just love and hugs. And I just started to crack me open a little bit more but this one guy that I met left a message on my voicemail here in L.A. and I was just getting ready to it down and shut off my service and this one message kind of open the door of a whole world because he wanted me to come and help him produce a music compilation for a coalition of nonprofit organizations. And we started talking on the phone. We started faxing because they didn't have you know e-mail and all that so we fax ideas back and forth and then before I knew it I was back in L.A. and world trust began. So it was a interesting journey. Once again as I say putting the oxygen mask on surviving through a relationship that you know was really horrific one for me. And it actually created those scar tissue of things that you kind of have on your belt as you live through life and then when you get to the other side then you have a whole other world of challenges to come. But I had to take that that compilation of scars so to speak and turn it into something that meant life to me. And I had to look at see what was my purpose of being here. I just didn't want to be a bag of bones just breathing and taking up oxygen. I wanted to be somebody that was going to be able to bring meaning to someone's life. So those trials in my own life led me to be more compassionate for others. And that's where world trust started and then that turned and took when eventually you very open in your book about your experiences with relationships and domestic violence. Amy and Nancy Harrington:Why did you decide to share those incredibly personal stories in your book and what do you hope other people take away from those stories? Tess Cacciatore: Yeah, it took me eight years to write that book. So I sometimes forget about how vulnerable and open I came I really literally just cut myself wide open and it was almost my own personal journey of healing through that process and the writing. And what I wanted to inspire is that if I can bear all and all I did hopefully other people would be able to share even with a sister like you two are so close or with a close friend or with a therapist someplace to get that scar tissue out and to be able to share it. I'm not encouraging everyone to put all their laundry so to speak in a book and put it out there because it was a very hard time to do that. And I second and triple and quadruple thought oh my God I might be doing wrong a mistake. You know the day it was coming out it was too late it was already coming out on Amazon I kept thinking is there any way I can pull it back. So it was not an easy thing to do but I felt it was necessary for me to become vulnerable and exposed and cut myself wide open so that I could really complete that cycle of my own healing so that I can help reveal to heal with other people and that's what our workshops are really about is what are our blueprints what are our addictions to that chemical reaction that happens when we are in that consistent repetitive cycle of abuse. How can we change that. And that's what I hoped that the book would do. Amy and Nancy Harrington:You've spoken regularly at the United Nations and talk about that experience speaking there. Tess Cacciatore: My first time speaking at the U.N. was in 2000 and I went to Switzerland and it was with Melba Spaulding who had this youth empowerment summit and it was named as yes youth empowerment summit and I brought one of our young delegates that I met here in Los Angeles. Earth Day and that's when I was doing a lot of environmental work. I spoke back then which was really about how technology can bridge cultures and bridge peace. And so I've been talking about this topic for so long. Technology could be the virtual classroom that we can really empower one another and have a way to talk about our passions and inspire people to be able to do better in their life or to become who they want to be. So everything's always been just truncated back into that same message over and over again. The United Nations to me I'm really excited when I'm on the campus whether it's in New York or I went to Africa several times for U.N. World Conferences and I still go to Geneva. I'm supposed to go to New York and march for the Commission on the status of women which is will be my 15th year attending. Why I love it because I'm able to meet these incredible people from around the world I get to learn about each other's cultures. I film most of the time that I'm there so I have a whole body of work of film and footage that are really speaking about the stories of these women that lived much more atrocious lives than I ever could imagine. So it always gets me to get outside of my own self and be able to share that story of another woman who might have been a survivor of genocide in Rwanda or a woman who'd been raped in the eastern Congo or a woman who escaped sex trafficking out of Asia. I get to meet the most richest amazing people. And those stories inspired me to keep going on what I'm doing. Amy and Nancy Harrington:You've traveled to so many interesting incredible sometimes dangerous places. Is there one place you've gone or experienced that helped shape your mission? Tess Cacciatore: I've gone from Sri Lanka when we built homes after the tsunami to visiting the orphanages anywhere from Cambodia to Thailand to Vietnam to South America to South Africa holding these children in my arms that was always just a daily reminder i see those faces in my head and in my prayers every day. And it drives me forward. So those are always the precious moments of my life. That kind of gives me that purpose that overall purpose. But one of the most magical places that I've traveled to and I want to go back and that was more because it was a very beautiful spiritual experience with Bali and it was so beautiful to be there. It was spiritual it was magical. And I look forward to having those kind of days because then you can really that down and let go and listen. And the thing part of the prayer which is part of meditation is listening to your higher self-listen to God listen to Angels whatever you believe in is taking that quiet moment to be able to just absorb the precious moments that make all of those memories of all those kids and people in lives that I feel have touched my life all the more and much more valuable. I think it's important to have that balance to really slow down and take a deep breath and be inside of ourselves. Amy and Nancy Harrington:You mentioned a bit ago the ten city tour. Tell us a little bit about that. Tess Cacciatore: Yes, I'm so excited. I know we're on the radio but for the camera portion of it this is a lantern that is manufactured by empowered they are out of Brooklyn and I went to a play one night. Robert Galinsky I went to see him play it was a one man play about being homeless and he was selling these after the show to give the money to the women's shelter downtown. And I do a lot of work with homeless because of my own experience in being homeless. Skid row is the epicenter of the homelessness in Los Angeles and a light bulb pun intended went off and I went when lights up skid row would that be cool and I liked the title I shared it with my board is shared with some friends. I contacted the manufacturer and I said hey I want to do this. Lights up Skid Row. I called Justin Baldoni people. He's been on my radio show before he's a dear, dear, dear person and he has this thing called Carnival of Love every year. And that's where he blocks off all these streets around the union rescue mission which I do a lot of work with as well. And January 26 he does the carnival of love where he has all these boobs in there that gives out medical services haircuts clothes toys whatever you can imagine.  And I went last year as a volunteer so I called them up and I said I want to have a booth. I'm going to give out these solar powered lanterns and while we're there inside this barricaded place I want to get into the streets so I went with a couple of our volunteers and a couple of board members Christopher Mack who works down there in the skid row area. He came with me and we went up to the tents which is a very dangerous area and very dangerous thing to do. But we did it with love and respect and I had someone who was local that knew the temperature of the community down there and just asked them Would you like a solar powered lantern. And everyone received it with a lot of love.  You have a three level kind of light switch on there and then there's a blinking light you can hang it on the inside a tent you know a lot of times you see these at sporting goods stores because people buy them for camping but when empowered. Saw the results that we had in skid row they loved the idea because they do a lot of community work they do in natural disasters and disaster relief. They'll send some lanterns out for people for hurricanes or tornadoes or earthquakes but they never thought about the homeless side of it all. So we're in conversation right now and I targeted 10 cities around the country that are highest homeless outside living in tents in the streets. And we are building the campaign right now. We're raising funds to be able to bring this to these other cities and to give a gift of light and people that want to donate 10 dollars you can give a light and sponsor light that goes to one of these people because there's so many people live on the streets and it ties into the mission of what we want to do with Quine with our workshops which is really dealing with the inner turmoil the inner story. I'm going to keep coming back to that reveal the real story because if you talk to these people that live on the streets in the towns they have a huge story to tell and there's a lot of instances that is mental health and that's another thing that I think in the States we really need to tackle. You know that's a whole other conversation but I feel like just by giving a gift of light we're able to. Give some safety you know gives some comfort because inside their tent I mentioned. I mean if you just think about it you're down in an area where there's crime right outside your tent. You can't use the bathroom you can't go out and do anything because you can be raped or you can be killed you could be robbed. You could have anything happen to you and it's a very dangerous hierarchal situation. There's a whole system that goes on down there that I'm just starting to get to the depths of that we are writing about that in our original scripted story but this one might program. It's so powerful to me because it's such a simple thing and people are like wow how did you think about that. It was just a download from God that was started by Robert's play and empowered has been really incredible with us and they're giving us huge discounts and they're donating some lights and so I'm really excited to be able to share more about that. But New York will be the next city we go to. We're going to do other parts of Los Angeles but New York just superseded Los Angeles as the number one homeless city in the States. And it's crazy what's going on. You know there's so many touchy topics when you deal with homelessness. You know people don't want to have homeless shelters in their communities because they think their property value might decrease and that's not true. There's so many beautiful rehabilitation centers that are popping up everywhere in Los Angeles and we're doing a lot of work with Union Rescue Mission in Hope Gardens which is a transitional homeless center for women and children. We'll be doing our first workshop this spring. And that's really about diving into these women's lives and figuring out how they can you know they're almost on the way out there. Almost right there. And we just want to share the light and encourage them to start a business or whatever they want to do. So it all ties into this when lights up campaign. Amy and Nancy Harrington:You talk in the book about your own personal experiences with homelessness. What's something that's commonly misunderstood about the homeless community or questions that people aren't asking that should be addressed? Tess Cacciatore: It's situational. And I think that's the one thing that a lot of people don't realize that it is tied to mental health. It is tied to the situations that might happen that we don't have control over in that sense because if you're in an abusive relationship most of the time it starts off very subtly. No one's going to come up to you with a big sign on them and say guess what. I'm an abusive guy or girl you're going to discover it through the fact that almost sometimes those of us that have been in domestic violence relationships we feel like we have to sign up that says I can be abused. Because it's the very quagmired situation. But it does tie into the homeless situation especially when you're on the streets if you have kids and you have to run away from a dangerous relationship. They don't have anywhere to go. They have probably been sequestered from their families and friends because that's one of the things that you want to watch out for. If you're in a relationship that's abusive. I'm just going to take a little pen and go in this little road for a minute because I think it's really important for people to understand the signs if you are in a relationship if the person loves you they're going to want you to flourish and shine to your highest ability and they're going to encourage that. And then that gives them breathing room for you to do the same in that relationship it's that perfect circle of being. If they start to sequester you if they start to insult you they start to out of the blue start to control where you go how you dress what you do where you speak who you go with. Those are signs and a lot of times we are people pleasers like I was. We want to please our partners and the ones we love. So it's like oh OK well then I won't talk to that person. Are you all dressed more conservatively or whatever if you're not able to be truly who you are then there's something wrong. And I really want to talk more about that more often in public because I think if people understood those signs to watch out for you might be able to save yourself from going too far deep in their emotionally abusive relationship emotionally and verbal is very hard to be able to decipher because they do it so carefully and so meticulously that they don't even know that they're doing it sometimes themselves because they might be a cycle of abuse victim too. So that's where I want Gwen to be is that we understand what the underlying attributes are of someone who's abusive is because there's a cycle there somewhere that needs to be broken. So going back to the homeless situation I think the most misunderstood part of it all is that they are people that are there are situationally and they're not all drug addicts they're not all criminal they're not all anything because no one is on anything. No sector in life no example you can ever give that you can give a blanket situation to those variables in every situation. And I feel compassionate to the ones that are living on the streets because they might not be on the proper medication if they have a mental problem they might not have the right resources to know that they can go into a shelter because there are shelters here in every city. Some of the shelters might be full so that's another situation.  How do we solve the problem? Oh, I don't know. I mean that's a loaded question. It's multilayered and there's so many things that we can do to help. That's all I want to do is just help in the smallest ways and see how we can change the trajectory of being homeless. Yes I was homeless. I moved about. I would say 15 times in about 17 months timeframe. I was never addicted to drugs. I wasn't on the streets I didn't live in a tent. I never had to sleep in my car. But I had a the stigma of not having a home which is really hard for me because I love being home. And I had a little bit of a blame and shame. No one in my life knew that I was not without a home.  I went and house sat and I was a family chef and help for people that were moving from one place to another or selling their states and getting them ready for market. I did everything I could. And I was that close to seeing people that live on the street. I'm one step away and it didn't feel really safe but it gave me such a raw experience that I'll never forget because I was that close to that that I don't have any fear of going up and talking to someone on the street that's homeless because I feel like I have that believability to them and I know a fraction of where they're at. I'm curious of the human spirit of what created that place and that reality that you're here and how can we help and how can we bring a light. How can we share our stories. It's so many layers. Amy and Nancy Harrington:One of the other current projects you mentioned earlier is the app. Why don't you tell us a little bit about that? Tess Cacciatore: So that goes hand in hand I'm really excited about that with the launch of the tensity tour back in 2000 and 12 when Gwen first began. I met Brad's who taught who is the app developer and he had an app for lost pets and it had a GPS tracker on it. And we started talking and I said What about if we were to use that for being able to target someone who might be an emotionally abusive situation or a near physical attack or especially with girls on campus and for young college girls are sexually assaulted and those are the ones that actually report it. There's so many people I say people because there's a lot of men that get sexually abused as well that we don't talk about because there is even more shame and blame in not life too. But one in four young women are sexually assaulted on campuses. So we focused it pretty much back then on the college campus life and the domestic violence world you load up five people into your phone much out of your contact list so it could be your five closest family and friend members you want to choose someone that actually has their phone nearby them you know if it's on that you love but they're not really technically savvy and they don't want to have their phone nearby we don't encourage that person to be here when five you want to pick somebody that really has their phone with them at all times. And it's a silent alert. You push a button and it notifies the five people where you are in GPS latitude and longitude if you're in another country and guess if you're near Google Maps satellite. What was important back then for this whole program was to be able to have that safety app. We built it really well Brad's team built it beautifully so it lasted on Google Play On iTunes For about three years and then when it started to kind of falter because their technology was taking off we pulled it off for safety purposes and I've been wanting to get a new version out there for three years now so we're finally in the process it's in production right now and by the time this airs it should be out by the end of March. And it has new features like voice activation and video component and Nine one by one. I'm really passionate about. I'm so excited Brad and I have been talking about it for three years. So it's coming back out. So let me go on this ten city tour my goal is to be able to go into the community give the lights out go on local news talk about the lights talk about the homeless issue go to the universities have some workshops. You know do whatever we can within that community we're going to be giving out some awards to the local communities to shine a spotlight on them doing amazing work and to download it it's free. So we're really excited about that. I'm thrilled that it's back out. Version 2. Amy and Nancy Harrington:What's your definition of success? Tess Cacciatore: That can come in a lot of forms. I think just knowing that you're on your life purpose and your life plan and that you're doing what you're brought to the world to do that to me is success. I don't think it's anything about material goods because I know plenty of people that have millions and millions of dollars in the bank and they still say oh my god I'm so broken oh my god I don't have enough. It's so to me it's not the monetary thing at all. Even though I think that the money side does help them as I said I'm opening up myself to magnify the receiving end of that. But it's really about feeling good in your body and having the self-love and feeling like you're here you're doing what you're supposed to be doing and you keep on going. Amy and Nancy Harrington: Thanks for listening to the passion project podcast and our interview with Tess Cacciatore. Visit her website Gwen.global. To learn more about the Global Women's Empowerment Network and go to pop culture Passionistas dot com. To seek one solar powered lanterns and donate to the program every ten dollars raised gives the gift of light to those in need and be sure to subscribe to the Passionistas Project Podcast. So you don't miss any of our upcoming inspiring guests.

We all know the names, penicillin, Z-pack, Amoxicillin, and Bactrim and we have been taking them for as long as we have been breathing, but do we really know what antibiotics are, how they work, and what they do to our bodies? Antibiotics, in a nutshell, kill bacteria, the bad ones and the good ones and if you have a viral infection no amount of antibiotic treatment will be any help and ultimately can be detrimental to your overall health. In this episode, Dr. Swain teaches Stacy all about antibiotics, how he prescribes the right one for a diagnosis, and why prescribing a patient an antibiotic (or not) is one of the hardest things he has to do every day. Plus, Dr. Swain explains common, and severe antibiotic side effects, allergies, resistance, and why there is not a one size fits all approach to prescribing these life-saving drugs. Big Questions? What is an antibiotic, and how do they work? How many types of antibiotics are available? What is an antibiotic allergy and what are typical reactions? What are the common and severe side effects for antibiotics Why it’s beneficial not to take an antibiotic on an empty stomach? How does a doctor know which specific antibiotic to prescribe What are the three most common type of bacteria? Are doctors prescribing too many antibiotics and why is this dangerous? What is antibiotic resistance?   Need an Appointment or Sinus Consultation? Call Dr. Swain’s nursing staff at 251-470-8823 or schedule an appointment here. Quotables & Tweetables? I would name the show to antibiotic or not to antibiotic because that is the question that doctor's face all day long. - Dr. Swain If I'm going to err, I'm going to err on giving this person an antibiotic because I don't want my patients to get sicker. - Dr. Swain Viral illnesses will not respond to antibiotic treatment. - Dr. Swain An antibiotic is a chemical that we use to kill bacteria. We use some antibiotics, they have different properties, obviously for killing different types of bacteria for different kinds of infections and some antibiotics actually have anti-inflammatory properties. - Dr. Swain Sometimes we use antibiotics because they have a specific biochemical pathway that we use to decrease inflammation. - Dr. Swain The easiest way to think about antibiotics is in terms of different categories. There are penicillin-based antibiotics. Then there are cephalosporin antibiotics, there are lots of those. And then there are fluoroquinolone antibiotics, and there are lots of those. And so we have antibiotics that are classified into what they do, and then in terms of those families. - Dr. Swain The Food and Drug Administration is really vigilant about making sure that there's not an antibiotic that has side effects that need to be monitored or observed and they just need to make sure the drug is safe. - Dr. Swain Sometimes people can get severe reactions where they even have their skin started peeling off or have trouble breathing or have the swelling of their throat or their mouth or their tongue. And so those are obviously the more severe reactions, but it can vary. - Dr. Swain One of the common side effects of just taking antibiotics is to have your stomach upset sometimes, or you get a little bit of nauseated. That's just a side effect of taking the medication. - Dr. Swain We tell people don't take an antibiotic on an empty stomach. You always want to take it with food to kind of buffer the GI side effects with it. - Dr. Swain Basically, this chemical that you're taking goes and attacks the bacteria, and it does so in different ways. It can kill the bacteria. There are bacteriocidal antibiotics, where it kills the bacteria, and there are bacteriostatic antibiotics that kind of prevent the bacteria from growing. Depending on the situation, you would use a different kind of drug. - Dr. Swain The three most common types of bacteria for those is usually strep pneumonia, Moraxella catarrhalis, and Haemophilus influenza. - Dr. Swain Sometimes when people are really sick, you're not going to wait four or five days until you get a lab report back before you initiate antibiotic treatment. - Dr. Swain If you have a viral illness like mononucleosis, you can use all the antibiotics and the world, it's not going to affect the mononucleosis. It's a viral illness, The hard part about all this is usually when you have a sinus infection, it doesn't start with bacteria just jumping in your sinus. It starts with a cold, it starts with a viral illness, and then you get swelling and mucosal thickening and stasis of the secretions, and the little sinus cavity in there closes off, and then you start getting the yellow discharge, and the pain in your teeth and you know, the purulent drainage and that's when you know you've got a sinus infection and that's when you need an antibiotic. - Dr. Swain It's hard sometimes to look at somebody and go, okay. I know you feel terrible, but this is a cold. This is a viral illness. Take some Motrin and Tylenol and oh, by the way in a week, your either going to get over this or you're not, and then we're going to start antibiotics then. - Dr. Swain A patient doesn’t want to get worse, and they think they want an antibiotic now. That's reasonable thinking, but sometimes that is not necessarily the best thing to do in terms of trying to use antibiotics appropriately and ultimately keep that person safe. You don't want to be on so many antibiotics that they don't work when you need them. - Dr. Swain Generally, you do not want to start any antibiotics if you don't need them. - Dr. Swain Communicating your medical and illness history is one of the most effective ways of getting the right diagnosis and proper treatments. - Dr. Swain There are some situations where you would start an antibiotic early, but for the majority of people, if you've got a run of the mill upper respiratory tract infection we try to get those people to use the over the counter medicines initially for the first 24, 48, 72 hours and see what's going on with them. - Dr. Swain Every patient situation is different, and there's nothing like examining someone and getting their history. There's is not a one size fits all approach for antibiotic treatment. - Dr. Swain When suffering from a cold and you start to feel the pain in your teeth, and they're starting to feel swollen, that's when they need to give your doctor a call and get an appointment. - Dr. Swain   Need an Appointment or Sinus Consultation? Call Dr. Swain’s nursing staff at 251-470-8823 or schedule an appointment here. Subscribe to The Swain Sinus Show Never miss a new episode of our show. Please subscribe to our show on iTunes, Overcast, Stitcher, and any other place you find your favorite podcasts.

March 2018 - NS vs balanced crystalloids for resuscitation, inhaled isopropyl alcohol vs zofran for nausea, ED central line CLABSI, CT for abdominal injury, PROPER trial, Bactrim for UTI, Suboxone vs Naltrexone for opioid relapse, clearing the c-spine in an intoxicated patient, trauma teams and undertriage, steroids for septic shock, DEFUSE 3 - thrombectomy in stroke, MI after influenza, Abdominal injuries in kids, Palliative care symptom management, Treating hyperglycemia in the ED, Interruptions in the ED, Ectopic pregnancy - myths and tips, Bactrim for skin abscesses after I&D, MRI for c-spine clearance, Steroids for urticaria, Stroke alerts in the ED

Recorded at Essentials of Emergency Medicine 2017, Greg Moran, MD reviews current thinking on cellulitis diagnosis and management. Greg is a professor of emergency medicine at Olive View-UCLA medical center who, in addition to emergency medicine, is fellowship trained in infectious disease and has over 100 publications in journals including: New England Journal of Medicine, British Medical journal, JAMA, Lancet, and Annals of Emergency Medicine. Greg is a thought leader in the field of emergency infectious disease and a super nice guy. In this segment, Greg covers: a common cellulitis mimic; admit vs discharge of patients with cellulitis; what bugs cause cellulitis and, taking that into account, what antibiotic should I use- double coverage, single coverage?   The great cellulitis mimic: Stasis Dermatitis Similar in appearance to cellulitis Often bilateral (where cellulitis is usually unilateral) Risk factors include venous stasis, lymphedema Fluid goes into the interstitial space -> into the dermis -> and then causes superficial redness and irritation Treatment Many recommendations out there, many of them consensus, opinion or based on weak data Elevation Compression if the patient can tolerate it Wet dressings if there is crusting and exudative eczema Topical steroids (medium to high potency) such as triamcinolone, fluocinonide, fluticasone ointments If you think there could be infection at play, consider a short course of oral antibiotics (also consider topical if there’s a break in the skin or part of the leg is looking particularly red and angry)   Admit or go home? Inpatient mortality for cellulite is low (somewhere in the low single digits percent) No validated decision instruments regarding admission or discharge 2014 study Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients With Uncomplicated Cellulitis  found that fever, chronic leg ulcers, edema, lymphedema, cellulitis at a wound site or recurrent in the same area were risk factors for outpatient treatment failure Does this mean that patients with these risk factors need mandatory admission? It doesn’t, but it gives an inkling of who might do poorly or at least fail outpatient antibiotics Bottom line: no clear consensus on who can be discharged but low inpatient mortality suggests we may be over-admitting A nice review of the admit or discharge cellulitis question can be found here   Single or double antibiotic coverage Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis. JAMA May 2017 PMID:28535235 500 patients with cellulitis Treated cephalexin alone or cephalexin plus TMP/Sulfa No significant difference in outcome Comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clinical infectious diseases 2013 PMID:23457080 150 patients with cellulitis Treated cephalexin alone or cephalexin plus TMP/Sulfa No significant difference in outcome Bottom line: In uncomplicated cellulitis without abscess or significant co-morbidities, current evidence suggests no advantage of adding TMP/Sulfa to cephalexin   Check out Essentials of Emergency Medicine. Well, I guess if you're against fun education and hate puppies, then disregard that recommendation.   References Weng, Qing Yu, et al. "Costs and consequences associated with misdiagnosed lower extremity cellulitis." Jama dermatology 153.2 (2017): 141-146. PMID:27806170 Weiss, Stefan C., et al. "A randomized controlled clinical trial assessing the effect of betamethasone valerate 0.12% foam on the short-term treatment of stasis dermatitis." Journal of drugs in dermatology: JDD 4.3 (2005): 339-345. PMID:15898290 Talan, David A., et al. "Factors associated with decision to hospitalize emergency department patients with skin and soft tissue infection." Western Journal of Emergency Medicine 16.1 (2015): 89. PMID:25671016 Peterson, Daniel, et al. "Predictors of failure of empiric outpatient antibiotic therapy in emergency department patients with uncomplicated cellulitis." Academic Emergency Medicine21.5 (2014): 526-531. PMID:24842503 Khachatryan, Alexandra, et al. "Skin and Skin Structure Infections in the Emergency Department: Who Gets Admitted?." Academic Emergency Medicine 21 (2014): S50. Abstract from 2014 SAEM Carratala, J., et al. "Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis." European Journal of Clinical Microbiology and Infectious Diseases 22.3 (2003): 151-157. PMID:12649712 Pallin, Daniel J., et al. "Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial." Clinical infectious diseases 56.12 (2013): 1754-1762. PMID:23457080 Moran, Gregory J., et al. "Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial." Jama 317.20 (2017): 2088-2096. PMID:28535235 Original Kings of County Analysis of Admit or Discharge Cellulitis

When should you commit to getting urine? When can you wait? When should you forgo testing altogether? When do I get urine? Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a well appearing child. Fever – but first look for an obvious alternative source, especially viral signs or symptoms. No obvious source? Risk stratify before “just getting a urine”. In a low risk child, with obviously very vigilant parents, who is well appearing, you may choose not to test now, and ensure close follow up. Bag or cath? The short answer is: always cath, never bag. (Pros and cons in audio) What is the definition of a UTI? According to the current clinical practice guideline by the AAP, the standard definition of a urinary tract infection is the presence of BOTH pyuria AND at least 50 000 colonies per mL of a single uropathogen. Making the diagnosis in the ED: The presence of WBCs with a threshold of 5 or greater WBCs per HPF is required. What else goes into the urinalysis that may be helpful? Pearl: nitrites are poorly sensitive in children.  It takes 4 hours for nitrites to form, and most children this age do no hold their urine. Pearl: the enhanced urinalysis is the addition of a gram stain.  A positive gram stain has a LR+ of 87 in infants less than 60 days, according to a study by Dayan et al. in Pediatric Emergency Care. When can I just call it pyelonephritis? In an adult, we look for UTI plus evidence of focal upper tract involvement, like CVA tenderness to percussion or systemic signs like nausea, vomiting, or fever.  It is usually straightforward. It’s for this reason that the literature uses the term “febrile UTI” for children.  Fever is very sensitive, but not specific in children. The ill-appearing child has pyelonephritis.   The well-appearing child likely has a “febrile UTI”, without upper involvement.  However, undetected upper tract involvement may be made in retrospect via imaging, if done. How should I treat UTIs? For simple lower tract disease, treat for at least 7 days.  There is no evidence to support 7 versus 10 versus 14 days.  My advice: use 7-10 days as your range for simple febrile UTI in children. Pyelonephritis should be treated for a longer duration.  Treat pyelonephritis for 10-14 days. What should we give them? Sulfamethoxazole and trimethoprim (Bactrim) is falling out of favor, mostly because isolates in many communities are resistant.  There is an association of Stevens-Johnson Syndrome (SJS) with Bactrim use.  This may be confounded by its prior popularity; any antibiotic can cause SJS, but there are more case reports with Bactrim. Cephalexin (Keflex): 25 mg/kg dose, either BID or TID.  It is easy on the stomach, rarely interacts with other meds, has high efficacy against E. coli, and most importantly, cephalexin has good parenchymal penetration. Nitrofurantoin is often used in pregnant women, because the drug tends to concentrate locally in the urine.  However, blood and tissue concentrations are weak.  It may be ineffective if there is some sub-clinical upper tract involvement. Cefdinir is a 3rd generation cephalosporin available by mouth, given at 14 mg/kg in either one dose daily or divided BID, up to max of 600 mg.  This may be an option for an older child who has pyelonephritis, but is well enough to go home. Whom should we admit? The first thing to consider is age.  Any infant younger than 2 months should be admitted for a febrile UTI.  Their immune systems and physiologic reserve are just not sufficient to localize and fight off infections reliably. The truth is, for serious bacterial illness like pneumonia, UTI, or severe soft tissue infections, be careful with any infant less than 4-6 months of age. Of course, the unwell child – whatever his age – he should be admitted.  Think about poor feeding, irritability, dehydration – in that case, just go with your gut and call it pyelonephritis, and admit. What is the age cut-off for a urine culture? In adults, we think of urine culture only for high-risk populations, such as pregnant women, the immunocompromised, those with renal abnormalities, the neurologically impaired, or the critically ill, to name a few. In children, it’s a little simpler.  Do it for everyone. Who is everyone? Think of the urine rule of 10s: 10% of young febrile children will have a UTI 10% of UAs will show no evidence of pyuria Routine urine culture in all children with suspected or confirmed UTI up to about age 10 What do I do then with urine culture results? From a quality improvement and safety perspective, consider making this a regular assignment to a qualified clinician. Check once in 24-48 hours to find possible growth of a single uropathogen with at least 50 000 CFU/mL.  Look at the record to see that the child is one some antibiotic, or the reason why he may not.  Call the family if needed. A second check at 48-72 hours may be needed to verify speciation and sensitivities. The culture check, although tedious, is important to catch those small children who did not present with pyuria and who may need antibiotics, or to verify that the right agent is given. Ok, so your UA is negative…now what? The culture is cooking, but you are not convinced.  Below is the differential diagnosis for common causes of pyuria in children:   What kind of follow-up should the child get? The younger the child, the more we worry about missing a decompensation.  Encourage the parents to call the child's primary care clinician for a re-check in a few days, and to discuss whether or not further work-up such as imaging is indicated.  As always, strict return to ED precautions are helpful. Who needs imaging? A more accurate question is: what is an important anomaly to detect? Vesiculo-ureteral reflux – a loose ureteropelvic junction causes upstream reflux when the bladder constricts. Uretero-pelvic junction obstruction – in older children or young adults with hematuria, UTI, abdominal mass, or pain.  Infants born with UPJ obstruction have congenital hydronephrosis. Ureterocoele – a cystic mass in the bladder.  It is not malignant, but can cause ureteral dilation, and hydronephrosis.  Treatment is surgical. Ectopic ureter – either a duplication of the draining system, or an abnormal connection, such as the epidydimis or cervix. Posterior urethral valves – occur only in boys, and they are a bit of a misnomer.  The most common type of congenital bladder outlet obstruction, posterior urethral valves are just extra folds of membrane in the lumen of the prostatic urethra.  Usually ablation by cystoscopy does the trick. Urachal remnant – a leftover from fetal development, and an abnormal connection between the bladder and the umbilicus.  Look for an “always wet” belly button in an infant, or an umbilical mass with pain and fever in an older child. Imaging of choice as an outpatient? Renal and bladder ultrasound (RBUS) after the first UTI is recommended (although incompletely followed in practice). If the RBUS is positive, or with the second UTI, DMSA scan to evaluate possible renal scarring. So, with all of this testing – are we over doing it? Like anything, it’s a balance.  A few tips to avoid iatrogenia by way of a summary. If a child over 3 months of age is well, has no comorbidities, has a low grade fever "in the 38s" (38-38.9 °C) without a source, especially if less than 24 hours, you are very safe to do watchful waiting at home. More to the point, an otherwise well child with an obvious upper respiratory tract infection has a source of his fever. If your little patient has risk factors for UTI, or you are otherwise concerned, send the UA and send the culture.  You can opt out of the culture by middle school in the otherwise healthy child. And finally, deputize parents to carry the ball from here – the child needs ongoing primary care and his pediatrician may elect to do some screening.  Don’t promise or prime them for it – rather, encourage the conversation. BONUS: Suprapubic aspiration (details in podcast audio; video below) BONUS BONUS: Infant Clean Catch Technique Step One: feed the baby, wait twenty minutes.     Step Two: clean the genitals with soap and warm water and dry with gauze.  Have your sterile urine container open and at the ready.     Step Three: one person holds the baby under his armpits with his legs dangling.  The other person gently taps the bladder (100 taps/min), then massages the lower back for 30 seconds.     Step Four: Clean Catch! (can also repeat process)   References Bonsu BK, Shuler L, Sawicki L, Dorst P, Cohen DM. Susceptibility of recent bacterial isolates to cefdinir and selected antibiotics among children with urinary tract infections. Acad Emerg Med. 2006 Jan;13(1):76-81. Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child. 2014 Apr;99(4):342-7. Dayan PS et al.  Test characteristics of the urine Gram stain in infants

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Adventures of a Pus Whisperer.