Neurology Solutions Movement Disorders Center (NSMDC) is a private movement disorders practice based in Austin that provides comprehensive care and treatment of movement disorders such as Parkinson’s disease, dystonia, and essential tremor. The first subspecialty movement disorders clinic in Central Texas and a leading Parkinson’s treatment center, Neurology Solutions is headed by Dr. Robert Izor, a board-certified neurologist and fellowship-trained movement disorder specialist. With many treatment options at his disposal as a movement disorder specialist including deep brain stimulation, intrathecal baclofen therapy, and more, our movement clinic is ready to help you treat and manage your problems. Learn more>>>

Neurology Solutions is located at 12345 North Lamar Blvd., Suite 260, Austin, Texas. To speak to a provider or schedule an appointment, please call 512-977-7000.

 

Covid 19 Threat: Analysis and Recommendations

Updated November 16, 2020

Many of the recommendations below are a compilation of Dr. Izor’s and NSC staff, as well as adapted from Paul Marik, MD’s MATH+ protocol. Dr. Marik is Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. His team posts more frequent updates on their EVMS website:

https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf

We are all highly concerned about the clear and present danger from Covid19. We are taking utmost precautions utilizing telemedicine as well as staff wearing masks, eye protection and disinfection of hands and commonly touched surfaces frequently throughout the day. With these efforts, we are available for in-office visits for those who cannot perform a telemedicine visit or have complaints that require direct patient examination. In those cases, we request all patients, and up to one caregiver, must wear some form of mask during the entire visit unless directed to remove for examination purposes. Upon entry to the office we will check your temperature, and please use the provided hand sanitizer, and again right before leaving the examination room. If a decent hospital mask is not available to you at your home, a homemade mask is acceptable. The mask can be a simple doubled over triangle bandana or large handkerchief tied behind the back of the head to adequately cover the nose and mouth from any spray droplets while talking with providers and staff. If you are actively sick from upper or lower respiratory symptoms, we will offer telemedicine visits only. We are doing everything we can to make ourselves available to you and the community for the long-haul while protecting other patients and ourselves. Here are is our analysis of the Covid19 threat and recommendations we encourage all of us to implement.

Most people, greater than 85%, who become infected with Covid19 will have none, mild or moderate illness and recover fully without permanent injury or need to be hospitalized. Sick people should self-quarantine for at least 2 weeks and take extra precautions wearing a mask and generally avoiding all high-risk people for at least 2-3 weeks after all symptoms have resolved. High risk people include:  elderly particularly over 65, worse above 70, and much worse over 80; those living in nursing homes; immunocompromised; pre-existing cardiovascular/pulmonary disease (COPD, emphysema,) obesity BMI >40; uncontrolled chronic disease like diabetes/kidney/liver; and smokers are all at higher risk for more severe sickness and/or hospitalization. Also, low levels of vitamin D have been associated with worse outcomes. Severe cases advance to severe acute respiratory syndrome (SARS) which kills many of these patients, often from viral sepsis induced cardiomyopathy and/or cardiac arrest. The clinical course from initial symptoms to death can take up to 6 weeks.

Since the transmission rate is 2-3 times that of the flu, and the death rate could be as much as 3-4 times worse than the flu, if we all get sick at once without taking precautions, the healthcare system will be overrun and 3-5 times more people will get very sick and/or die.  If we take reasonable precautions like good hand washing/disinfection protocols and wearing masks in public we may be able to minimize transmission risk to the high-risk minority to keep hospitals from being overrun until we have more liberal mitigation strategies available. Unfortunately, there are serious dangers to the economy which we must balance or we may find ourselves with just as much suffering and many deaths and suicides unrelated to the viral threat. Here are my best recommendations which we will update as new data emerges:

Personal Protective Protocols to Reduce Infection Transmission Risk:

  1. High risk people should avoid contact with others who may be asymptomatic viral shedders by “social distancing” as much as possible.
  2. Wash your hands for 20 seconds after touching suspect surfaces before eating or touching face/mouth.
  3. Wipe down and disinfect surfaces, door knobs and handles, twice a day, and after interactions with others.
  4. Wear a mask in public and always around high-risk individuals just in case you are a pre-symptomatic or asymptomatic carrier.
  5. Avoid being in small rooms or in transit with anyone coughing, sneezing or any other suspicious symptoms, and if unavoidable, make sure you are wearing a mask and eye protection if available.
  6. Walking and talking outside next to someone is very low risk as long as they don’t talk or breath heavily directly at your face.
  7. If you can’t avoid someone who may have been exposed, and are not wearing a mask and eye protection, maintain at least 6-8 ft distance, especially when that person is talking in front of you.
  8. For those who are asymptomatic, assume they are shedding virus and stay 6 feet away when talking directly in front of you, and preferably wear any kind of mask and glasses to catch any saliva/spray during conversation or if the person inadvertently coughs or sneezes on you.
  9. If you think you are getting sick wear a mask all the time to limit spread of virus to others as well as surfaces around your home. Make a mask using a large handkerchief if necessary.

 

Basic OTC URI/Viral Survival Strategy

  1. Stay home and rest, stay in limited areas of home as much as possible to protect others, and follow protective precautions as stated in Personal Protective Protocols to Reduce Infection Transmission Risk.
  2. Sleep as much as possible using stronger first-generation antihistamines (preferably chlorpheniramine every 4 hours or diphenhydramine every 6 hours) to control secretions and help with congestion. These have very strong anticholinergic effects which will control congestion/secretions better than other antihistamines, and induce sedation/sleep which is desirable when you are really sick. If not severely ill, you may use second-generation non-sedating antihistamines (Allegra, Zyrtec, Claritin) during the day.
  3. For congestion, take Mucinex DM OTC 12 hr. twice a day. If still not enough with chlorpheniramine, you should try adding decongestants like Sudafed (phenylephrine or pseudoephedrine.) Use with caution if hypertensive. Nasal sprays inhaled deeply into the lungs through the nose may be helpful and safe for short term use, like Afrin (oxymetazoline.)
  4. Maintain an adequate nutrient dense diet, avoiding processed carbohydrates and prioritizing whole food sources of protein and healthy plant-based fats.
  5. Take food grade medium chain triglyceride (MCT) oil (Premium Sports Research with C12 lauric acid, Amazon), ½ to 1 tablespoon up to 3-4 times a day. MCT has antibacterial and antiviral effects. If you can’t tolerate it use it like a lotion on your skin which will absorb systemically.
  6. If you have nausea and vomiting, simplify food intake with frequent smaller amounts of preferably high protein bone broth (or lower protein chicken broth if necessary,) and as tolerated supplement with MCT oil and/or extra virgin olive oil or avocado oil (or any cold pressed food grade oil like cod liver oil, flax oil, etc.)
  7. Supplement diet with adequate hydration preferably from electrolyte drinks (Pedialyte, similar OTC alternatives, or Dr. Izor’s Antioxilyte drink.)
  8. For severe nagging cough especially at night, you need a prescription for Tessalon (benzonatate) and if insufficient add codeine or hydrocodone from your doctor. Unfortunately, the latter are now triplicate medications and not as easily available because they require a special handwritten prescription. These are very powerful cough suppressants and also very anticholinergic to dry up secretions which can be critical at night to help induce sleep so important for a strong and effective immune response.
  9. Alternatives for cough may include cannabidiol (CBD) 10-25mg four times a day, Atrovent (ipratropium) and albuterol inhalers which require Rx. Ultram is another option (also Rx but not a triplicate, caution drug interaction risk with some antidepressants and dextromethorphan in Mucinex DM.)

Supplies:

Tylenol

Mucinex DM, or Mucinex if you can’t tolerate DM

Phenylephrine or pseudoephedrine

Oxymetazoline

Chlorpheniramine or Benadryl

Allegra or Claritin

Medium Chain Triglyceride oil

Bone broth preferably, or any broth (vegetable broth is ok too)

Extra virgin olive oil, avocado oil or high oleic sunflower oil

Pedialyte or preferably lower sugar electrolyte replacement drinks may be helpful.

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Antiviral Strategies which Support Healthy Metabolism and Immune System

Vitamin D3 5000 units at bedtime. Vitamin D3 should be taken late in the day or at bedtime to stimulate better, more restorative sleep and directly support the immune system.

Life Extension’s Two-Per-Day Formula (http://www.lifeextension.com). Take one capsule twice a day. This product contains reasonable amounts of important immune boosting supplements including: B12, MTHF, alpha lipoic acid, quercetin, selenium and vitamin D3.

Vitamin C 500-1000 mg twice a day. Higher doses can cause diarrhea.

Melatonin, usually 3-6 mg approximately 30 minutes to one hour before bedtime (start with 3 mg extended release (ER) tablets.) If you do not tolerate melatonin ER, particularly if feeling groggy next day, try reducing dose of ER by half tablets until you are no longer groggy. Then, try adding a 1 mg immediate release (IR) dose.  If groggy again, reduce melatonin IR as low as a quarter tablet or 0.25 mg. If not groggy but still not sleeping deeply enough, try increasing ER until sleep improves without grogginess up to a maximum of 20 mg total each night. Melatonin improves depth of restorative sleep, reduces insulin resistance and improves immune function. You should continue melatonin at a dose that does not worsen sleep or cause other side effects, even if it does not noticeably sleep on its own. Melatonin has many immunological, anti-inflammatory and other metabolic benefits that are not directly related to perceived sleep benefits.

Quercetin 250 mg once a day. LE multivitamin has minimal quercetin 15 mg daily. Quercetin is a zinc ionophore and immunoregulator.

Zinc Gluconate 50 mg daily is maintenance dose. If around high-risk potential exposures increase dose to 50 mg twice a day. Zinc supplements increase intracellular Zn2+, which helps block viral replication. Hydroxychloroquine and quercetin work as a zinc ionophores, helping increase Zn2+ intracellularly to help inhibit some viruses including coronavirus. Other alternatives that are relatively bioavailable include zinc picolinate and zinc carnosine.

Baby aspirin 81 mg daily unless contraindicated. Reduce to every other day if bruising easily.

Medium Chain Triglycerides (MCT) oil (Sports Research Premium, Amazon) or Coconut MCT oil, ½ to 1 tablespoon up to 4 times a day (target total of 45-60g/d (3-4 Tbs).) I prefer mixed MCT oils or coconut oil separated from the palmitic acid long chain saturated fats. MCT has antibacterial and antiviral effects. If you can’t tolerate it use it like a lotion on your skin which will absorb systemically. MCT higher in C8 and C10 with less C12 is absorbed better through the skin, and less greasy. However, lauric acid, C12 seems to have the most antiviral/antimicrobial activity of the 3 main MCT fatty acids, although the others have more specific activity against certain microbes and viruses including HIV and HSV. Unfortunately, there are only few small clinical trials testing antiviral effect in humans.

Magnesium taurate 125 mg (Cardiovascular Research, Amazon), 2 capsules (250mg) at bedtime for 1 week. If no side effects like diarrhea, increase to 2 caps twice a day. Reduce dose if diarrhea or other side effects which can develop as magnesium stores replete in bone and tissues. Nuts, seeds and other whole foods contain magnesium and therefore when consuming these foods, you may need to lower dose of supplemental magnesium, especially if stools are getting too loose. If using magnesium to help cognitive decline, depression and/or anxiety symptoms and not seeing substantial improvement, replace morning dose with Magtein (magnesium threonate 144mg).

Fish Oil (Arazo Nutrition, Amazon) 2250mg omega-3 per 3 capsules (take at least 500mg DHA/d), 2-3 capsules daily at least 3-4 times per week, on days you are not eating healthy fresh high omega-3 fatty fish. Omega-3 oil combined with vitamin E (already in Life Extension Multivitamin) activates multiple genetic and metabolic pathways including PPAR-y, which reduces insulin resistance and inflammation, enhances fatty acid oxidation and deepens nutritional ketosis for those on a striving for a Mediterranean ketogenic diet.

WARNING: Omega-3/polyunsaturated fats have important healthful effects, but at the same time anti-platelet and blood thinning effects. Other prescription blood thinners like Plavix, Coumadin and aspirin will amplify this effect and increase bleeding risks when combined. Discuss alternatives with your doctor, or limit fish oil supplements and eat leaner fish if bruising easily.

N-acetylcysteine (NAC), 500-600 mg daily (sustained release NAC, Jarrow.) N-acetylcysteine may sometimes cause gastrointestinal upset which can be reduced when taken with food. During active flu/cold symptoms you may increase to twice daily.

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Antiviral Treatment/Prescriptions

Ivermectin 3mg tablets, (200mcg/kg), take _ tablets by mouth now, and _ tablets 24 hours later (part of Covid-19, MATH+ protocol). Ivermectin may cause: dizziness, loss of appetite, nausea, vomiting, stomach pain or bloating, diarrhea, constipation, weakness, sleepiness, uncontrollable shaking of a part of the body, chest discomfort. More serious and less likely side effects may include: fever, blistering or peeling skin, rash, hives, and itching. Stop ivermectin and call office if any severe and/or progressive side effects occur.

Azithromycin (Zithromax, Z-pak) 250mg, take two tablets day one, and one tablet daily for four more days. Azithromycin is a broad spectrum macrolide antibiotic that also has antiviral effects on certain viruses. Side effects may include: nausea, vomiting, diarrhea, or abdominal pain; Cardiovascular palpitations and chest pain; Dyspepsiaflatulence, vomiting, melena, and cholestatic jaundice; Candidavaginitis, and nephritis; Dizziness, headache, vertigo, and somnolence; Fatigue; Rash, photosensitivity, and angioedema. May increase QT interval so use with caution if on drugs that also elongate QT interval.

Increase aspirin 325 mg daily. If you bruise easily, take every other day, or reduce to baby aspirin daily or every other day. Continue until symptom free and for another week after.

Increase zinc gluconate 100 mg twice a day until symptoms improving, then 50 mg twice a day until resolved.

If you have not been taking Vitamin D3 regularly, at the onset of flu/cold/Covid 19 symptoms, take 50,000 to 100,000 units Vitamin D3 at once, and then 10,000 units daily until symptoms subside. Once symptoms resolve, skip nightly Vitamin D for 7 days. Then, restart maintenance dose of 5000 units at bedtime. During the 7-day Vitamin D holiday, you should continue taking Life Extension’s Two-Per-Day multivitamin which contains 2000 units per day. Vitamin D level should be checked to determine optimal dosing needed to reach and maintain optimal levels.

Increase Vitamin C, 1000-2000 mg, three times a day. Sodium, Calcium or Magnesium Ascorbate powder mixed in a drink will have less risk for acid stomach/GI upset. Over 1000mg can often cause diarrhea, in which case reduce dose and take 4 times a day.

Increase quercetin 250 mg twice a day. LE multivitamin has minimal quercetin 15 mg daily. Quercetin is a zinc ionophore and immunoregulator.

Increase melatonin ER to at least 10 mg nightly.