First, I want to share some definitions about the disease we are all dealing with. COVID-19 is short for Coronavirus Disease 2019. It is caused by a virus from the Corona family and the virus has been named SARS-CoV-2. As I had stated in an earlier blog, a corona type virus has shown up twice in this century. SARS in China in 2003 and MERS in Saudi Arabia in 2012 were both corona viruses. There have been no confirmed cases of death in children under 9. It is not a severe disease at that age. It affects older people more partly due to the decreased ability of the lung tissue to regenerate after injury. COPD, emphysema, other lung injury or disease, hypertension, diabetes. The virus causes a collapse of the alveoli, the small sacks deep in the lung where CO2 is removed from the blood and oxygen is put into the blood. When they collapse, this transfer is diminished. People develop hypoxia which is low levels of blood oxygen. So, when people reach the Hospital, even on oxygen their blood oxygen level remains low. The standard incubation period, the period of time the virus is in the body before symptoms develop, is from 4-6 days for Corona Virus. On day 7-9 people will begin to spike a fever and start a cough. Around day 12-16 from date of infection, the symptoms will peak. If someone is going to die, this is the time it will most likely occur. From Day 17 to day 23, those that will survive begin to get better. They continue to shed the virus in their cough and sputum though from day 23 to day 30 after date of infection. So overall, from the time of infection, people can spread it to others is up to 30 days. Symptomatically 60% of the people with the infection get a cough. 44% of people who get it have a fever. All other symptoms occur in only 20-30% of patients. This disease can not be diagnosed by symptoms. So, to think because you do not have a fever, you do not have it, is wrong. You have heard people speaking of flattening the curve. What they are talking about is slowing down the number of people who get infected at the same time. The reason is we do not have the medical capacity to treat all the severe manifestations of the disease, if everyone gets it at once. If everyone gets the disease at the same time, there will be more vulnerable people with severe presentations than we have beds and ventilators to keep them alive, in which case many will die. And if we all get it at the same time, up to 80% of the vulnerable population, those who will only survive with intensive medical intervention, will die due to lack of medical resources. If everyone gets it at the same time, in about 3 weeks, those who will survive will be better and those who will not will have died. The downside however to flattening the curve instead of a 3-week ordeal is it will last for several months and by some estimates, several years. The same number of people will ultimately get this virus, but with social distancing and quarantining, it will take longer, but the hospitals will be better able to keep up and far fewer people will die. I am aware though, that social distancing and quarantining will be economically devastating to many people. Hopefully the government will change their recent behavior, come together and pass legislation to help people affected by the steps being taken to handle COVID-19. Everyone needs to make up their own mind on how to handle this. But because many are not taking this pandemic seriously or choose to protect their family by continuing to work, it becomes critical for those in high risk categories to self-quarantine. Those with COPD, emphysema, prior lung cancer, other lung diseases, immune deficient patients, HIV, those taking biologics for autoimmune disease, high steroid use, diabetes, heart disease, those taking regular anti-inflammatory medication, and everyone over the age of 65, with risk increasing significantly every 5 years after. If I had my way, everyone in the vulnerable group would be taking my recommended supplements of Vit. D, A, C, zinc, NAC, selenium and quercetin. They should also be drinking green tea every day. Dosages for these supplements are available on earlier blogs. We have these medications in stock and are able to ship them to you.  If you have any questions, please do not hesitate to contact the office. Functional Chiropractic 506 Union Street Milton, DE 19968 302 684-1995

A lot of attention in the press right now regarding the Corona Virus has to do with an anti-malarial drug called hydroxychloroquine.  It is also known under the name Plaquenil.  It is not a new drug and in fact has been around for about 75 years in the form of hydroxychloroquine.  It also has enjoyed a lot of success in the treatment of various autoimmune diseases.  Most recently, it has come under discussion as a drug for the treatment of COVID-19 or Corona Virus. First let me state emphatically, that no double-blind placebo-controlled study, the gold standard to determine if a drug is effective against a certain problem or disease, has yet been done on anything involving the Corona virus.  It is too new.  These will not be completed for at least a year, and probably longer than that.  Of course, people are dying of this virus and everyone is now aware of the problems it is causing and the fear it is engendering. Recently, President Trump has talked about findings coming out of China, South Korea and other countries that have been dealing with the virus the last 3 months, of the use of hydroxychloroquine for treatment of COVID-19.  It appears that it has been successful in getting people over the acute stage of the virus much quicker than in people not taking the drug.  (1) Hydroxychloroquine does not actually kill the virus itself but acts as an ionophore.  An ionophore is a substance that carries an ion across a cellular membrane. In other words, it functions by carrying the mineral zinc inside the cell where the virus replicates.  Viruses do not have the ability to reproduce on their own but must hijack the machinery inside the hosts cells to make more viruses.  Zinc when it is inside the cell blocks this action. (2) What is exciting and the reason for me writing this article, is there are other natural products that also help carry zinc inside cells so that it can block and hinder viral replication of Corona viruses.  These substances are Epigallocatechin-gallate or EGCG which is the active ingredient in green tea and the bioflavonoid quercetin. These are supplements that have found great use in the treatment of allergies for years with people and are widely available. (3) For my patients who I have communicated with, I had been suggesting the following preventative course from a supplement standpoint:

1. Vitamin D – 10,000 IU’s per day.
2. Vitamin A – 10,000 IU’s per day.
3. Zinc 15-30 mg, twice per day.
4. Selenium – 200mcg per day.
5. Vitamin C – up to 5000mg per day. Some people will develop loose stools on high doses of Vitamin C.  So, start at 1000mg per day and add a 1000mg per day to your dose until you reach 5000mg.  If you develop loose stools before you get there, drop back to the previous dose you could handle.  I prefer Vitamin C with bioflavonoids in them, or a combination of one with bioflavonoids and one with higher doses of C.

To this I am now adding:

6. Quercetin – 500mg twice per day between meals as a preventative. 1-3 grams per day if exposed or mildly sick.
7. Drink lots of green tea every day. If green tea bothers you due to caffeine content, get EGCG – double the bottle recommendations.

These suggestions are meant as an approach you can take before getting the virus, to help prevent it from becoming a severe case. At the onset of symptoms, you think maybe related to Corona Virus, please contact your doctor.  When symptoms begin to get moderate or worse, you may need to be hospitalized. For those who are interested in the science, here are links to papers on the above points.

1. https://www.mediterranee-infection.com/hydroxychloroquine-and-azithromycin-as-a-treatment-of-covid-19/
2. https://www.ncbi.nlm.nih.gov/pubmed/21079686
3. https://pubs.acs.org/doi/abs/10.1021/jf5014633

Hello everyone. To those I have not seen in a while, I hope you are well. I am writing to give you my thoughts on the current pandemic. As of the date of this letter, 03/19/2020, people are extraordinarily concerned about the Corona virus, otherwise known as SARS CoV-2. The disease it causes is called COVID-19 which is short for Corona Virus Disease 2019. In some parts of the country especially on the West Coast in Seattle, many people have contracted the virus and it is starting to put a strain on their medical systems. Relatively few people have been confirmed to have it in Delaware at this time, but many are starting to be tested. The virus itself is from the family of corona viruses, thus the name. It has made 2 other appearances. The first in 2003 that resulted in SARS (severe acute respiratory syndrome) in China and MERS (Middle Eastern Respiratory Syndrome) in 2012 in Saudi Arabia. In both cases about 800 people died from the viruses. Evidence does not support the theory that this Corona virus is a man-made virus, but the product of evolution. It jumped from its present form from an animal to a human host. The most likely source for this is bats as it is very close in structure to the Corona virus found in bats. The other theory is it jumped from an animal host to human in a less virulent form, and then mutated to the dangerous form we are dealing with today. So far, there have been a reported 9310 deaths so far from COVID-19. This number though is probably far smaller than the actual numbers for this is only the numbers of confirmed COVID-19 deaths. There is also great suspicion that we are not getting accurate information from China, North Korea, Iran and other countries who at least initially did not handle the outbreak well. In the US so far, there are 157 confirmed deaths from Corona Virus and confirmed cases of 9486. Again, as is the case in the worldwide numbers, these numbers are far smaller than they actually are because widespread testing has not yet been done. Now to put this in perspective, the CDC, Centers for Disease Control, estimate 34,200 people died in the US during the 2018-2019 flu season from the typical seasonal flu’s we experience every year. So, it is not yet time to panic. But we still need to be very concerned and here is why. The reason this bug is different is it’s highly contagious but only mildly symptomatic to asymptomatic in the young and healthy. The vulnerable population are those over the age of 65, those immuno-compromised (auto-immune disease, those taking medications for auto-immune disease, HIV patients, cancer patients and those who have undergone cancer therapy) and those with pre-existing pulmonary conditions. People in these groups are far more likely to develop the severe form of Corona virus which includes massive inflammatory responses in their respiratory tracts, with cytokine storm, leading to pneumonia and unfortunately death. There are also multiple reports of people in the supposed safe categories getting the severe form of the virus and even dying. Frankly, we do not yet completely understand this virus. Unfortunately, we have set ourselves up to ignore this threat. Social media, including those who should know better in the Functional Medicine and Alternative Medicine Communities have created an atmosphere where many thinks this is just one more false alarm. People and groups with political affiliations have also exaggerated the severity of the crisis or have minimized it depending on what they are trying to accomplish. Those who minimize should be reviewing the reports from northern Italy which is in real crisis with hospitals overflowing and people dying because of it. Those who exaggerate it should review the fairy tale about the boy who cried wolf. So, what to do about it? First, from a preventative standpoint, social distancing must be utilized. This is especially important for people in the vulnerable populations. Significant research is already proving that social distancing works and greatly slows the spread of the disease. South Korea, Singapore, Hong Kong have all been very successful at this. The symptoms of COVID-19 are much the same as the flu. Fever, cough and shortness of breath are the main 3. Some people have also experienced digestive issues with COVID-19. These would include loss of appetite, vomiting, diarrhea and abdominal pain. But the respiratory symptoms are more common. If you experience the following emergency symptoms, please go to the ER or call 911. These include difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse or wake up and bluish lips or face. If you see someone with these conditions, call 911. But if you have symptoms that do not fall in the emergency category, should you go to the doctor? Not necessarily. You do need to call your primary care doctor and report your symptoms. They will evaluate if it is better for you to just ride it out as you would with the flu, or if there is a need for you to come into their office. In the next few days, tests for the virus will become more available. Beebe Hospital last weekend had a drive thru testing site. Stay tuned to local TV and radio for that information. These tests are only for those who have symptoms at this point in time. That may change. From a preventative treatment perspective, these are my suggestions. These recommendations are based on case studies and case reports coming from Doctors who have been treating very ill patients for the last two months in other countries and from my own immunological understandings on viral illness in general and Corona Viruses in particular. These are not just my own conclusions but are consistent with many Functional Medicine providers I am in contact with. Finally, they are not based on double blinded controlled trials because this is a novel (new) virus and it has not yet been possible to do that. Here are my recommendations. Zinc Picolinate or zinc gluconate 30mg/ twice per day. Vitamin A – 10000 IU’s per day for the first month and then 5000 IU’s per day for the second month on. Vitamin D – 10000 IU’s per day. NAC (n-acetylcysteine) 500 mg/day. Selenium 200 mcg/day. C 4-5 grams/day to bowel tolerance. Ramp up slowly and back off 1 gram on tablet, capsule or powder if bowels become loose. For those that contract the virus and are significantly symptomatic, from a Functional Medicine perspective, I am hearing IV Vitamin C at high doses 12 grams in 50ml sterile water at 12ml/hr., twice per day for 7 days. IV Glutathione is also being used in places with reported good results. Anti-malarial medications like Plaquenil, at 400 mg twice per day the first day, then 200mg twice per day for 4 days, have all been effective and are saving lives. Plaquenil acts as an ionophore to get zinc inside the cells where it stops viral replication. Of course, medical management of the acute respiratory symptoms if they develop is paramount. There are trials being done on pre-existing anti-viral medications and some off label anti-viral use, but I have not heard of any firm conclusions. They are rushing thru vaccines, but it will be most likely a year before one is available for use in the general population. I am advising my current patients with symptoms of the Corona Virus to stay home. For my patients who are symptom free, but are part of a vulnerable group, I am cancelling maintenance appointments and will only handle acute painful conditions.  I will schedule them at a time where no one else is in the office but me. I am dis-infecting and cleaning my office multiple times during the day. In my office, I have a sign posted at my front door and front desk, that if someone has a fever, is coughing, sneezing or has any signs of a cold or flu, to please go back to the car and call us for further instructions. Once there, I will ascertain the need for the visit, reschedule at a time without other patients present and if necessary, refer to medical facilities or simply have you go home. Obviously if you are in distress, call 911 and be taken to the hospital. My paramount concern is that you my patients, your friends and family, all come thru this safe and sound. As always, I am available to answer questions are talk with you on the phone. Good luck to us all and be smart and safe.

By Dr. John Rees, D.C., C.F.M.P.

In the first blog, we covered the tremendous financial cost of American health care and in many respects the poor results obtained. We also covered how Functional Medicine has sprung up from the frustration of not only patients, but of Traditional Medical practitioners unsatisfied with results. In the second blog, we talked about some of the basic differences between traditional and functional medicine. We discussed two main points.

• The emphasis Functional Medicine places on finding out why a person gets sick.
• A significantly different definition of health that goes beyond lack of disease into the need for optimal functioning and vitality.

I also gave you my own thoughts that disease begins in human beings from a combination of two reasons:

• Something in the patient’s environment is poisoning them.
• Something that is vital to optimal functioning is missing.

In my practice, the basis of our treatment is removing the poisons and restoring essential nutrients to a patient’s life. The results are truly dynamic when this is accomplished.

One of the hallmarks of Traditional Medicine has been the organizational structure of specialization. In his book, “The Disease Delusion”, Dr. Jeffrey Bland includes a quote about specialists. “They know more and more, about less and less, until they know everything about nothing.” I love that quote. This artificial way of dividing up the human condition into a specialty were an incredibly brilliant doctor who knows absolutely everything there is to know about the heart, for an example, but largely ignores the rest of the person and more importantly the affect his heart treatment may have on the person as a whole is a major problem in Traditional Medicine.

According to Wikipedia, iatrogenic disease is defined as “induced in a patient by a physician’s activity, manner, or therapy. Used especially to pertain to a complication of treatment”. Surprisingly and critically important, iatrogenic disease is generally thought to be the third leading cause of death in our country following only heart disease and cancer.(1) The majority of these deaths come from the interaction of a drug. The scenario goes something like this. A doctor will give a prescription for a drug for a condition. Many of these conditions have other treatments available which do not include the side effects of the drug they prescribe. But instead of instituting another treatment, they will prescribe another drug to handle the side effect. The drug that is prescribed to handle the side effect though, has a side effect of its own, that requires another drug. Before long, a patient who is now on 4 to 5 medications, all but one of them given to handle the side effects of the other drugs, is not doing so well. Then it gets really scary. The chemical soup of all the combined drugs begins to take on a life of its own and can have a combined effect completely different than the sum total of all the individual drug side effects. Far too often in this country, the combined effect is fatal.

This is especially a problem in the elderly. As we get older, the ability of our liver and kidneys to clear drugs from our systems decrease. Because of this the dosage of prescriptions should be less in older Americans than it is in younger ones. But far too often, this physiological fact is lost on the average doctor. Due to this fact and others, a disproportionate amount of iatrogenic injury and death falls on older Americans.

A major difference in Functional Medicine is the Holistic View of the human body. Holistic or whole, is the view that the body works in concert like an orchestra, and not a combination of individual soloists. In order for a person to be truly healthy, all of the individual parts must be functioning well. In addition, treatment aimed at one body part can have a potentially devastating effect on other body parts. Functional Medicine places far greater importance on this fact then Traditional Medicine does. One of the goals of the Functional Medicine movement is to decrease the problem of iatrogenic injury and death in the country.

In my next blog, I will begin to explain what a Functional Medicine evaluation looks like. If you have concerns about the current care you are receiving and would like a Holistic based Functional Medicine look at your overall care, please call us a 302 684-1995 to schedule an appointment.

Citation

1. http://www.whale.to/a/null9.html

By Dr. John Rees, DC, CFMP

Functional Medicine is the latest version of alternative medicine approaches. It is breaking away from traditional medical care in a variety of ways, but unlike other alternative approaches, it still has its basis in scientific research. It strives to constantly improve its delivery of health care so as to achieve the best and fastest results towards restoring health.

Traditional Medicine (TM) asks one basic question when evaluating a patient. That question is “WHAT”. What is wrong with the patient? The “what” Traditional Medicine is trying to classify is disease. TM uses a tremendous amount of resources in determining if the patient has one or more diseases. Expensive diagnostic imaging studies, laboratory procedures and diagnostic skills are utilized to determine if the patient has a disease. Once the disease is classified, and a diagnosis is made, the TM model then applies a remedy or a prescription (Rx). This prescription predominantly consists of drugs and surgery. The flow looks something like this.

Functional Medicine (FM) asks an additional question that is central to the essence of FM. Functional Medicine also starts out with the question of what is wrong. It seeks to understand, like Traditional Medicine, the diseases a given patient may or may not have. But, it then asks a different question that tragically is unique in its emphasis and often in its frequency in traditional medical care. That question is “WHY?” Why did the particular disease or condition show up in a given patient in the first place? Why is the patient’s body not recovering? Why has a machine that is designed to be self-replicating and self-healing lost the ability to do so? For you see, if the environment in which the person lives contains the source of their disease, treatment that doesn’t include removing or remedying the source can only manage a person’s disease or condition. It can never truly be cured.

Functional Medicine then directs its treatment (Rx) at not only helping the body fight the disease, but also at removing the why, the source of the disease from the patient’s environment. The FM flow would look like this.

I personally believe that disease starts in a human being from a combination of two reasons. There is something in a person’s environment that is poisoning them, or something vital for the human body to run correctly is missing. Of course, there are exceptions which are outside of the patient’s control. For example, trauma, injuries and/or a few genetic disorders that are not dependent on the environment to trigger their activation. But for the most part, this is what sets Functional Medicine apart from Traditional Medicine. We seek to know why. When you remove the poison from a person’s environment and restore essential elements that may be missing, the human body has truly amazing abilities to heal and return its state to one of optimal functioning.

Another vital difference is our definition of disease. Traditional Medicine’s operating definition of health is absence of disease or at times even well managed diseases. Functional Medicine’s definition is made using terms such as creativity, joy, energy, purpose, absence of pain, proper weight control, balance and resistance to disease. It is a definition of vitality and realized potential. It is a striving for living the life each of us is designed and created to live, not accepting anything less. It is the goal of a Functional Medicine practitioner, to help patient’s realize their personal potential and experience a sense of vitality, which they thought was long lost.

For further reading on this topic, I recommend the book, “The Disease Delusion” by Dr. Jeffrey Bland, one of the fathers of Functional Medicine.

In my next blog, we will take you inside a typical patient’s experience with Functional Medicine.

If you are struggling with your health, and feel frustrated with the care and support you are currently receiving, please contact us at Functional Chiropractic. (302) 684-1995.

By Dr. John Rees

This is my inaugural post for my new website blog. I am a Chiropractor and a certified Functional Medicine Provider. I have been in the health care field since 1983 and believe that experience has given me a unique perspective. Functional Medicine (FM) is uniquely different from Traditional Medicine (TM), but is not meant as a replacement. It has a different focus and both approaches are absolutely vital to modern health care.

Traditional Medicine in the last century has made great advancements. It has been responsible for increasing human life expectancy over 25 years for men and almost 30 years for women. In 1916, in the US, men lived to approximately 49.6 years and women 54.3 years. (1) In 2015, in the US, men are expected to live to 76.2 years and women 82.19 years. (2) This is an incredible leap. We still lead the world in cutting edge technology and people still come to our country from all over the globe for care of critical life threatening conditions.

But all is not well with American health care. American health care is significantly more expensive then healthcare anywhere else in the world. In 2010, we spent $8233.00 per person on healthcare. The next highest developed country was Norway which spent $5388.00 per person. The average of developed countries was $3268.00 per person, which was 2.5 times less than the United States. (3)

The old argument that you get what you pay for comes to mind. But let’s take a closer look. We have less doctors per patient, less consultations per patient, less hospital beds per patient and shorter hospital stays per patient. We do more MRI’s, CT scans, tonsillectomies, coronary bypass surgeries, knee replacements and caesarean sections than other countries. (3)

We do some things very well. The 5-year survival rate for breast cancer is the highest in the world at almost 90% and we have the second highest 5-year survival rate for colorectal cancer at 64.5% trailing only Japan. (3)

Primary care is where our system breaks down. We lead the world in hospital admissions for asthma and COPD. (3) In one study we are number 11 out of 17 in overall ranking of developed countries. We had the highest rate of death by violence, death by car accident, highest percentage of children dying before the age of 5, highest teen pregnancy rate, highest chance of women dying from complications of child birth, and the second highest chance of death from coronary heart disease and lung disease. (4)

It is numbers like these, and the dissatisfaction of the American Public and HealthCare Community, that has given rise to the Functional Medicine Movement. Healthcare workers are frustrated with the overall decline in traditional health markers.

• Obesity is on the rise like never before.
• Autoimmune disease incidence has been dramatically increasing since the mid 1990’s.
• Physical activity is down and reliance on technology is up.
• The work force in the US is shrinking and the work that is left is increasingly of a sedentary nature.
• There are significant questions about the quality of our food supply. Our current first lady has been especially vocal about the quality of school lunches and food available in stores in inner city areas.

In 2007, Americans spent 33.9 Billion out of pocket dollars on alternative and complimentary approaches to traditional medical care. This is 11.2% of total health dollars spent. I believe those numbers today are even greater. (5)

In my next blog, I will speak on what is Functional Medicine and what makes it different and unique as compared to Traditional Medicine. If you or someone you love is struggling with health issues that are not resolving, or you continue to feel bad in spite of medical care you are undergoing, call us at Functional Chiropractic, 302-684-1995. Today is the easiest day of the rest of your life, to regain your health. Tomorrow it will be more difficult.

Citations

1. http://demog.berkeley.edu/~andrew/1918/figure2.html
2. http://www.data360.org/dsg.aspx?Data_Set_Group_Id=195
3. http://www.oecd.org/unitedstates/HealthSpendingInUSA_HealthData2012.pdf
4. http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
5. https://nccih.nih.gov/news/2009/073009.htm