The Vaccine

[tabbibus]

Oof, that's rough.

In the frame of risk mitigation. What can we do as healthy individuals to maintain "pliable" or "not stiff" lungs so that we might have the best chance to minimize the impacts of an intubation should we get there?

In my head, that's general good cardiovascular health. General fitness and frequent "pushes" to places the require deep breathing. I'm far from a doctor though, Im just a mechanical guy.

Thoughts?

I may have lied. Thinking about it a bit more, obesity, alcohol intake (first two are big ones), active smoking, active use of other inhaled substances, are risk factors to develop ARDS and hence stiff lungs. These are modifiable.

 

[Acard7]

Healthy lungs are very compliant by default. Only certain chronic conditions make them stiff. Things like fibrosis (scarring), certain autoimmune conditions. You basically treat the cause of the fibrosis or the autoimmune disease. Not much you can really do to change this before hand. Counter to what many may think, smoker lungs tend to be veeeery pliable. Too compliant. I call them floppy lungs. This is a different problem all together.

During an acute insult, such as pneumonia (bacterial, viral), or pneumonitis (inflammation from a drug or from aspirating gastric contents) the lungs become acutely stiff. This is part of what we call ARDS, acute respiratory distress syndrome. When intubated, we do what @Robconn mentioned. Basically try and use low pressures and low volumes to minimize further insult to the lungs.

Another way to understand this, is to think about how we breath naturally and how we breath on the vent. Naturally, our diaphragm and intercostal muscles contract and expand the rib cage. Negative pressure is created inside the chest and air is basically sucked into the lungs. Stiff lungs won't expand as much but won't be damaged by this method. On the vent, we PUSH a volume of air at a certain pressure. Positive pressure breathing. This can damage an otherwise healthy lung if you are not careful, and will create big issues on stiff lungs.

Since I've gone full nerd, I always enjoy telling people that breathing out is a passive maneuver. There are no "breathing out" muscles. You can squeeze all you want but you really aren't pushing air out. You are basically removing any forces that may want to expand the lungs.

It always amazed me the settings you would have to constantly change on the vent for an ARDS patient. Prior to Covid we would transport tubed ARDS patients occasionally. My last one I transported I had the PEEP set at 10, O2 100%, tV around 200 and rate of around 30. Those were the settings I had to use to properly oxygenate/ventilate while keeping the Inspiratory pressures down as well. This was for 1.5 hour transport. Best ETCO2 I achieved was 50, crazy how you just can't win sometimes. I assume this is the same kind of settings for Covid patients as well when their lungs just aren't pliable anymore. We haven't had to tube and use the vent in the field or even in the rural hospitals yet for Covid because they usually haven't gotten to that stage yet, just ship them on to bigger hospitals if they don't get better while on the medsurg floor. Luckily, most, if not all, have gotten better after Antibody treatments and/or oxygen therapy while on Medsurg out here in the sticks, I haven't heard too many of them actually transporting to the city thankfully.

 

[msavold]

Thought this was an interesting read. The 180 degree mindset change of someone resistant to vaccines...
I Was An ‘Anti-Vaxxer.’ This Year, I Changed My Mind.

 

[2kwik4u]

I spent a year taking care of myself perfectly, mask wearing, handwashing, avoiding crowds, and never caught it.

Did you maintain these habits once you were vaccinated?

School teachers have it rough. So many kids are NOT great at hand washing/mouth covering/etc, and combined with varied storylines from home, I can see where the classroom is a breeding ground for this type of virus. With that said, we send ours every day as well, and trust he's doing what he can to stay protected.

Truly sorry to hear your wife is sick, hope she recovers quickly. Likewise, hope it's an easy passage for you. Being sick sucks.

 

[Julian]

Well, my fully vaccinated wife has contracted C19, and I’m pretty sure my fully vaccinated self is coming down with it. There are 10 fully vaccinated teachers at her school who are also out. She has 101 to 102 degree fever, and moderate bronchitis like symptoms. The “barking seal cough”, weakness, headache, etc. I know, I know… We would probably be worse had we not been vaccinated. That seems like a total line of bs, when 99% of the people who get it have a mild case anyway. I’m starting to think that my vaccine was just sugar water. I spent a year taking care of myself perfectly, mask wearing, handwashing, avoiding crowds, and never caught it. I guess we can’t really return to normal with a vaccine. This really sucks, and I hope it’s not an accelerating trend.

Sorry to hear your wife is sick. The data doesn't lie. The vast majority of hospitalized patients and patients who die....are unvaccinated. I hope you and your wife's experience supports this data!!!!

The wife of one of my brother's managers is currently on a ventilator.....and will likely not make it....not vaccinated. Another manager - hospitalized in ICU.....not vaccinated.

I got the J&J vaccine and can't wait for boosters to be approved as the J&J is less effective - and this delta variant ain't no joke!

 

[WREKS]

@Mesa50 Thank you for the heads up. Hope all goes well for you and your wife.

 

[fatboyroy]

Well, my fully vaccinated wife has contracted C19, and I’m pretty sure my fully vaccinated self is coming down with it. There are 10 fully vaccinated teachers at her school who are also out. She has 101 to 102 degree fever, and moderate bronchitis like symptoms. The “barking seal cough”, weakness, headache, etc. I know, I know… We would probably be worse had we not been vaccinated. That seems like a total line of bs, when 99% of the people who get it have a mild case anyway. I’m starting to think that my vaccine was just sugar water. I spent a year taking care of myself perfectly, mask wearing, handwashing, avoiding crowds, and never caught it. I guess we can’t really return to normal with a vaccine. This really sucks, and I hope it’s not an accelerating trend.

Hope she get well soon! At least you guys did your part and got vaccinated.

 

[swatski]

I guess as long as you know literally everything you hear about covid is a lie,

Do you understand the difference between a "lie" and a "risk assessment" type of a statement?

That is pretty fucking basic.

As Julian pointed out, the numbers are pretty good at this point, as there is little worry about under-sampling, sampling error, or any of the major vaccine studies suffering from being "underpowered" - which is typically one of the issues (looking at the data that has been released and/or considered by the FDA and (legitimate) professional medical associations).

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[tabbibus]

Thank you for taking it seriously. I do disagree that they are gaslighting. For example Fauci has been very clear about why the initial recommendation not to wear masks was made. First, concern for shortage of masks for HCWs, and second, we did not have full knowledge of the degree to which asymptomatic spread was an issue. We have been learning so much as we go with this completely new virus that it is understandable why our positions change. Heck, I expect things to change. To use your terms, we should not be arrogant and think that our first thought process is the correct one and not change as evidence changes. Such is science, and medicine.

But again, thank you for being vaccinated and taking it seriously. I truly hope you and your loved ones will be well soon. As others said, numbers don't lie. The bulk of people in our care in the hospital are unvaccinated. And you and your wife will likely not be one of them because you elected to be proactive. Best wishes.

 

[adrianp89]

Hopefully I can convince my son who is in his 20’s to get the vaccine. He keeps using the “We don’t know the long term problems” excuse. I haven’t told him that his vaccinated family member has it, because he would just say.. “See, it doesn’t do any good”. There really isn’t any way to convince an anti-vaccine person. I’ve tried, and tried.

Or he is a grown man and let him make decisions for him self. If he has the information and chooses not to get vaccinated, then you should respect that. There is nothing wrong with not being vaccinated.

 

[swatski]

Not sure I understand your anger, or
how I offended you. I’m sorry if I did. I’m sure our views align, when it comes to the seriousness of the virus, and necessity of doing whatever we can to eradicate it. However, I believe those in charge of disseminating information to the public, have been utter failures at best, downright liars at worst. I was wearing masks when (legitimate professional medical sources) Fauci said they wouldn’t do any good, and we were more likely to harm ourselves by wearing them. I was socially distancing when media outlets were telling us that it was racist to do so. I got the vaccine when the CDC was still telling us that we had to continue wearing masks and socially distancing, and then that was also retracted. I’ve never denied covid existed, or that it was dangerous. I’m staying away from everyone now. I am saying that the list of absolute incompetence, or downright lies from the “legitimate professional medical professionals” is extensive, and overwhelming. Flip flopping would be a generous understatement. They come across as arrogant sociopathic authoritarians, incapable of admitting they’ve made a mistake. Instead, choosing to act as though the new decision is the same as their first, while pretending everyone they’ve misled is crazy. Total gaslighting.

Not offended, just flabbergasted.

@tabbibus, who's a gentleman, puts it very nicely and cautions not to "be so arrogant and think that our first thought process is the correct one and not change as evidence changes. Such is science, and medicine. "

While I won't pretend to be a gentleman, I struggle to understand how those basic tenets of scientific, or R&D, approach to problem solving appear so foreign to so many. Boat owners nonetheless.

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[Tgen2013]

People are all the same, they think their opinion is truth no matter what the facts are. They see things through rose colored or red or green glasses and you cant sway them. Today politics has replaced religion, (especially to the left). If there are facts available , they cherry pick or arrange them to suit their narratives.

THAT IS THE UNBIASED TRUTH....................................

Screw the China loving WHO, and hmmm let me change my mind again CDC. Guys just listen to your family doc. Their opinions are just as varied, but they do care for you directly.

****In the end you are responsible for your health. Thats all.

 

[AZMark]

Boat owners nonetheless.

Don’t give us too much credit. @Julian just had to put together a how-to thread on not sinking or blowing up your new boat for people that probably just made the largest non-house purchase of their lives.

 

[Robconn]

Or he is a grown man and let him make decisions for him self. If he has the information and chooses not to get vaccinated, then you should respect that. There is nothing wrong with not being vaccinated.
[/QUOTE]
or he is a parent truely concerned for the health and well-being of his child, no matter how old they are. There nothing wrong with that too. I once had an 80 year old patient who was visited by her 100 year old wheel chair bound mother who was a nursing home patient herself. I have never forgot that moment.

 

[Jim_in_Delaware]

Hopefully I can convince my son who is in his 20’s to get the vaccine. He keeps using the “We don’t know the long term problems” excuse. I haven’t told him that his vaccinated family member has it, because he would just say.. “See, it doesn’t do any good”. There really isn’t any way to convince an anti-vaccine person. I’ve tried, and tried.

You do what you can do as a parent. My baby girl is in her mid-20's. She was also the first in our household to get vaccinated, when she was offered the opportunity last March. She did it probably more so, for the people around her, like myself, my wife, and her aunt.

If you look at the numbers for younger people, they clearly show that getting the vaccine still makes sense, even more so with possible exposure to the Delta variant. While younger people are at lower risk of serious outcomes from getting the virus, including death, both unfortunately still happen to younger people. The covid-19 mRNA vaccines are probably the most efficacious vaccines in history. Looking at the number of doses given and the relatively small number of reported side effects, they may also be among the safest.

I am sorry to hear that your wife, and maybe yourself, have had breakthrough cases of the virus. Most likely, contracting the virus without being vaccinated, would have led to an even more severe case of covid, as y'all would have developed some resistance before your exposure.

Jim

 

[Jim_in_Delaware]

Don’t give us too much credit. @Julian just had to put together a how-to thread on not sinking or blowing up your new boat for people that probably just made the largest non-house purchase of their lives.

Perhaps, though, the difference is the folks who read the thread on boating may actually be open to learning a thing or two. ?

Now, please excuse me, as a new, wannabe powerboat owner (who comes from a sailing background and never had an enclosed gasoline engine in a boat) I go look for Julian's thread!

Jim

 

[the MfM]

Not offended, just flabbergasted.

@tabbibus, who's a gentleman, puts it very nicely and cautions not to "be so arrogant and think that our first thought process is the correct one and not change as evidence changes. Such is science, and medicine. "

While I won't pretend to be a gentleman, I struggle to understand how those basic tenets of scientific, or R&D, approach to problem solving appear so foreign to so many. Boat owners nonetheless.

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The messaging from .gov has been poor at best. Across both administrations there has at times been contradicting and confusing information. Which has been compounded by state mandates and emergency orders.

In may two high level cdc employees resigned unexpectedly. Today two high level fda employees resigned in protest of the booster shot plan. In part because they felt the CDC was overstepping into FDA decision making. And because the Biden admin announcement came before the FDA had signed off on boosters.

Obviously everyone thinks they are making the best decisions but credibility has suffered from the political infighting.

 

[the MfM]

Meanwhile in Maine today 7 nursing homes filed 60 day notices that they will be closing.

The two emergency rooms in the states biggest city are on diversion because they have no where to move patients.

 

[Bruce]

@the MfM, do you benefit from constantly posting negative comments?

Why not look for solutions instead?

 

[the MfM]

@the MfM, do you benefit from constantly posting negative comments?

Why not look for solutions instead?

The solution is not to have a vaccine mandate for healthcare workers. Otherwise people will not get the care they are used to receiving. At least in the short term and likely longer.

And part of the reason people aren’t getting vaccinated is they don’t know who to believe.

I am sorry if that doesn’t fit with your feelings and you find it negative.