Of Birds and Beauty (Covidian repose)

Of Birds and Beauty (Covidian repose)


PAST

-SACRED-1991

Mr Gali was my fifth and sixth grade teacher at Webster Hill Elementary School in West Hartford, CT.  He was a short and stocky man with a stern face and menacing, thick eyebrows.  He had a passive-aggressive way of massaging the shoulders of us misbehaving boys, which both taunted our nascent homophobia and established him as the Alpha male in the room.  As with most people – especially those that loom large in our past – he was complicated.  

He had a friend who we called Mrs Barker.  She was an elegant woman with red hair that she wore in an old-fashioned beehive doo.  At my young age, it was hard to say how young or old she was, but from this vantage point I would guess her late 50s.  She wore neatly tailored pantsuits, or a blouse and slacks, and always had light scent of a flowery perfume.  

Mrs Barker and her husband had lived in Japan for some time, and on some of the occasions that she would join our class, she brought treasures from her travels, including the most beuatiful silk kimonos and caligraphic scrolls.  Her stories stirred our imaginations with news of a peaceful people, who ate fish and rice for breakfast, while sitting on bamboo mats, lived in homes with moving rice paper walls, and who use terms such as Chan and San.   Until we grew older and could venture out ourselves, this was an engaging way to expand our understanding and awareness of the world beyond our immediate experience.

I was aware of birds as a boy, because there were many trees around our home and in the mature neighborhoods of West Hartford, CT.  But I had never touched a bird, or seen one up close, until Mrs Barker.  What would have been weird or creepy from another person, came off as eccentric from her, i.e. when a bird would fly into a window of her home and break its neck, and she would wrap it up in a plastic bag and put it in her freezer.  (I always imagined them right next to her half gallon of mint chocolate chip ice cream).  She would then bring them to our classroom, so that we could feel what light as a feather really was, and admire their bright colors and delicate features in detail.  

Our class once made field trip to Mrs Barker’s house.  It was a quite a spread, almost a museum.  There were more kimonos on the walls, as well as numerous vases and sculpture from her time in Japan.  She encouraged us to touch and smell, which was so different from don’t-touch field trips to the Hartford Atheneum.  She was always happy to entertain our many questions.   I didn’t even get in trouble, because my mind was present, and I was able to pay attention in this classroom of life.

RECENT PAST

One of the reasons we moved to Ithaca, NY nearly twenty five years ago was Cornell University.  No, we didn’t attend as students or work there as minions or Ivy League demi-gods/goddeses.  But we knew that the presence of such an old and esteemed institution of higher learning conferred many opportunities and resources to the surrounding community.  

Cornell was part of my childhood.  My great grandfather had attended the state side of the school (as compared to the private side) and studied agriculture, twice!  It was a source of friction with my great grandmother’s newspaper tycoon parents that Walter Stanley Marsland, Sr was happy as a clam to grow cash crops in New York and Florida, trucking his family back and forth according to the season.  His son, my great uncle David, studied at Cornell as an undergraduate in chemistry.  As a result, my Nana and Pop pop had a thing for Ithaca.  They came to Ithaca for their honeymoon in 1937, and later they would visit Uncle David while he was in school.  

One of my Pop pop’s quirks was that he enjoyed picnics all year round, when more delicate souls wouldn’t even consider spreading out a blanket and nibbling on fried chicken and fresh pie.  Several times during my childhood, I rode along for four hours with Nana and Pop pop from Parkerford, PA to Ithaca for a picnic.  I remember the suspension bridge, the gorges, and the vast Cornell campus.  I remember being cold, and quietly wondering that nobody else seemed to be doing what we were doing.     I remember my Pop pop and Nana laughing, and looking at each other with a surprising tenderness and twinkle in their eyes.  Perhaps remembering their honeymoon? Then we drove another four hours home.  

– SAPSUCKER WOODPECKER -2021

True to our expectations, one of the resources Cornell has provided to Ithaca is the Lab of Ornithology.  I don’t think I ever even heard the word ornithology before we came to Ithaca, and it took many years of living here before we ventured into this realm.  The birders among you are likely familiar with the Lab of O as a tremendous resource of pictures, sounds, and knowledge of all things birdy.  There is a physical building that is a seriously expensive pile of stonework and architectural extravagance.  Then there is the land and the paths around the water features, with blinds for watching the birds in any season.  On Saturday mornings, if you can get your sleepy head out of bed and show up by 7:30am, you don’t even need to bring binoculars (provided) to join a group for a walk and bird watching.  

Sapsucker Woodpecker & Scott at the Lab of O

I’ll just say birders are weirdos.  And, I’m finally old enough that I’m glad to be counted as a weirdo among weirdos.  Birds are simply amazing.  There are so many different kinds, doing so many different things, in so many different ways, and regularly performing feats of aeronautical maneuver, navigation and long distance travel that it renders me silent.  I marvel at the miracle of it all.

PRESENT

My commute is a seven minute walk up a steep hill to the clinical space I share with my colleague of twenty years, a traditional Chinese medicine (TCM) herbalist and acupuncturist.  Over the last week, I have heard the sounds of the birds returning to Ithaca, or passing through on their migration further north.  The Sapsucker greets the morning with its raspy chatter and a harsh, squealing weep.  The Robins emit their string of clear whistles.  The Black Birds lift my eyes and heart from my weary trudge with their shrill rising squee and concluding metallic click.

The deer which eat our perennials and frolic in the field outside my office window will soon be mating, and hiding their fawns in surprising places. The ground hog woke up much earlier than I can enjoy noting, and can be seen nibbling at the base of the bird feeder every morning.  Soon the family of skunks, or their most recent progeny, which has lived under our mud room for nearly a decade will show themselves.  I will have to be more cautious when I arrive home or take out the compost, so that I don’t get sprayed!

– GROWING TOGETHER -2021

Sprouts, buds, tendrils and shoots are appearing all around us as reminders that we have made it throught another Winter.  I look forward to seeing what plantings survived, what volunteers landed in the soil from the excrement of a passing bird or a resourceful squirrel.  There will also be the encroaching invasive species which will test our perserverance again this year. 

My beloved steadily conceives and brings forth creative expression into the world.  She manifests this in glass and metal which require infinite variations of light to fully appreciate.  Her labor is Olympic, Athenian even, as she moves against the currents of a collapsing society, a devaluation of art, and loss of hope.  While I’m trying to help make life bearable for hundreds of patients, she ensures that life is worth living, because there is spark, spirit and beauty.

– BLUEBIRD -2015

P.S.  It turns out that there was in fact a subscriber from Wyoming already, who was the recipient of a lifetime subscription to Lightning Bug.  The  50th state from which I am still wishing, and desiring, oh, so ardently, a reader, is the wildly beautiful and rugged West Virginia.  Please announce yourself monsieur/mademoiselle/madame.

P.S.S.  This week marks the occasion of reaching 1000 subscribers to Lightning Bug!  There are so many Substacks, and posts and papers and, and, and to read, and yet some of you spend some of your time each week reading Lightning Bug.  Thank you! 



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You look mahvelous! – by Scott Marsland, FNP-C

You look mahvelous! – by Scott Marsland, FNP-C


HISTORY

My mother’s mother was our Baba.  Baba was a first-generation American from a Slovak family in Central Pennsylvania.  Luckily for me, I spent a lot of time with her growing up, including summer visits to her home in Wyndmoor, PA, where she lived with my Grandpop until his death in 1985.  When I was adopted by my paternal grandparents in 1984, I relocated to Parkerford, PA, which put me within an hour’s distance of Baba, and once I had my driver’s license, I could—and did— go visit her.

Baba and I, high school graduation week 1987

The inside of the garage at Baba and Grandpop’s was clean and spare.  Along with their two cars, there were two golf bags, his and hers.  I think there was a lone snow shovel.  But tucked in the back corner there was a huge, black, shiny hunk of Pennsylvania Anthracite coal.  I always wondered about this, but never asked.  As an adult, it makes perfect sense.  Baba wanted to remember from whence  she came.

As the second youngest daughter, with three siblings, Baba was the first in her family to leave Coaldale, PA, go to the big city of Philadelphia, and achieve a higher education.  She went to secretarial school at the Peirce School of Business, and she boarded in a building nearby at the corner of 14th and Pine Street.  Somehow, between her studies, she made it all the way out to Pottstown, PA to Sunnybrook Ballroom for dancing.

Sunnybrook is a stone’s throw from Parkerford. In it’s day it was an elegant place, which began as a swimming club in 1926 with a circular pool that had a lively summertime crowd.  During The Great Depression, a ballroom was constructed which became one of country’s great dance floors during the Big Band era of the 1930s-1940s.  Both my maternal and paternal grandparents met at Sunnybrook and danced the night away.  My junior and senior proms were held at Sunnybrook.  For years we would take Nana and my aunts to Sunnybrook for a delicious Mother’s Day brunch.  The Eggs Benedict were unbeatable!  My Nana and Pop pop’s 50th wedding anniversary was celebrated at—you guessed it—Sunnybrook.  

Baba had what I would describe as presence, which I’m guessing went back to her childhood: she was a beautiful, smart, and capable.  She was ambitious in the highly motivated manner emblematic of many first-generation American immigrants.  She and my Grandpop built a successful restaurant supply business, and were original bondholders for the “new” clubhouse of Whitemarsh Valley Country Club, which was incorporated in 1908.  Her name was on every…damn…trophy in the vast display case of the WVCC lobby.  I admired her tremendously, and always enjoyed her company.  But it could sometimes, actually often, be excruciating to be in Baba’s presence in a restaurant.  She expected to be waited on, and was very vocal if the service was less than exemplary.  Every time I gather up the cutlery and plates for our waiter or waitress, I think of my Baba and the time she slapped my hand away in WVCC.  “You DO NOT clear the table.  That is the job of the servers!”  Oooh boy.  Yet in the next breath she would whisper to me in a conspiring tone, “These haughty Philadelphia blue bloods have no idea that I’m a saloon keeper’s daughter.”

Competitive doesn’t quite capture Baba’s ethos.  Yes, she was a fantastic golfer.  In her 70s, when she would take me to a little nine hole, par three course called Woody’s (I’m a terrible golfer and WVCC wouldn’t have tolerated the number of divots I produced), we would invariably get matched up with two strong young men as a foursome.  She always let them go first, then me.  Yes, their swing was strong, and the ball would travel far, as long as they didn’t shank it into the treeline.  But Baba, her swing was elegant and her aim was true.  I loved, loved, loved to watch their expressions, when my little old lady grandmother in her green pants and bug-eyed sunglasses hit that first ball.  Huzzah!!

I could write dozens of stories about my Baba and our adventures, but for today’s purposes, I wanted to wrap up this section with a reference to her skin care routine.  It fascinated me.  Baba looked…shiny.  In her bathrooms she would have enormous jars of Vaseline.  As best as I could tell, she would liberally apply this to her entire face on a daily basis.  Her bedtime ritual was a gentle wash with Dove soap and warm water, and then a coating of Pond’s facial cream.  With her quilted smoker’s jacket, white cream-covered face, and long, thin, brown More cigarettes, she reminded me of a Hollywood actress backstage in her dressing room.  Indeed, in my life, she was a star.

RECENT PAST

Between leaving my first primary care job as an FNP-C, becoming embroiled in a two year unionization campaign, and landing at SUNY Upstate, I spent some time exploring aesthetic medicine.  My friend and dentist of twenty four years happened to have a fancy-pants laser machine gathering dust in his office.  His staff at the time, and his wife/business partner, had been keen on starting an spa as a side hustle, but their enthusiasm quickly petered out.   During one of our conversations which took up a good part of a dental visit, he pitched me an offer.

Never would I have imagined that I would be interested in aesthetic medicine.  Yet the work was interesting, and turned out to be quite rewarding.  Richard, my friend/dentist, first used the laser on me so that I would understand what it felt like.  It wasn’t terribly unpleasant.  My face felt sunburned for a day.  I don’t hold it against him, but my labial folds have been uneven ever since.  Geesh!  We reviewed the protocols, I read a stack of research papers, and then I started seeking volunteers from among the many female nurses and friends in my life.  In fact, the more wrinkles, the more welcome you were.  

The most satisfying work I did was with a woman who had been attacked with a knife by an abusive boyfriend.  She had a divot and scar in the side of her face that makeup would never hide.  I wasn’t able to eliminate it, but by the time we were done, it was much less pronounced.  A close friend who told me that premature wrinkles were a curse upon the woman of her family felt that I had given her back three years of youth (I thought five).  Another woman who detested the striae (stretch marks) on her abdomen from carrying four children was also thrilled with the results.  Aside from treating joint pain, I am empathetic with why women (and some men) would be eager to use collagen if they thought it will help them look younger. During my foray into aesthetic laser work, essentially I got to make some women happy, and see the lift in their smile and self-estimation.  Not a bad way to make a living.

PRESENT

There are three main points I want to cover in this second part of my collagen case series: how our bodies have changed, a potential mechanism of action for collagen to promote pathology, and some limited observations about Vitamin K2.

Before I go there, I’ll mention that my colleague Dr JP Saleeby wrote a brief Substack on the topic of collagen a few weeks ago. I value the perspective of such a learned practitioner. Knowledgeable criticism from his clinical experience should only shed light on the topic. JP uses modified anticoagulation, avoiding Plavix, and infrequently measures micro clotting as we do, because of the logistical challenges of completing it. The synopsis is that we shouldn’t throw the baby out with the bone broth.

Is Collagen good for you?

Questions came up after that last FLCCC weekly webinar this week about collagen and taking such as a dietary supplement and worsening you LongCOVID condition. Well…. the whole Collagen thing is quite complex, and I don’t believe researchers know all there is to know about it (but claim to, such the hubris of some researchers). Just to remind everyone …

Read more

16 days ago · 10 likes · Yusuf JP Saleeby MD

I also note that a Registered Nurse writing for The Epoch Times wrote an electronic article, now printed in the most recent paper edition, which extols the virtues of collagen and enthusiastically encourages its use. I share these references with you so that you will understand that while my perspective is based in what I see with my own eyes and brain in front of me, it is a minority view.

The bodies which we inhabit today have been transformed from those we inhabited pre-pandemic.  In areas of the world with vaccination levels between 70-90%, we can expect that everyone has microclotting, from direct injection of spike promoting molecules, or receipt of spike into our bodies from shedding.  Spike has traveled to every part of our bodies.  It is the most toxic pathogen known to modern medicine, and has a very lengthy list of potential pathologies which it promotes.  See pages 9-10 of the FLCCC I-RECOVER Protocol for a list. When you speak to any physician, it is fair to ask her/him, “What is your understanding of spike protein, the pathologies it engenders, and how to treat them?”  If you are rewarded with a deer-in-the-headlights look, at least you know that the expert in front of you has an expiration date: November 2019.  Any claim to expertise in the realm of medicine which preceded that date, stops at the doorway to spikopathy.  Clinicians who aren’t curious or motivated to learn about the spike protein which has poisoned more than five billion people are less capable of accurately evaluating, testing, diagnosing and treating you.  In fact, they could be dangerous to your health.

I don’t know if collagen was harming or helping us before November 2019.  One reader shared her experience with how it healed her Doberman.  Another pointed out that she wasn’t using it simply for reasons of vanity (skin/hair/nails), but to help aching joints function better.  The question  however is not whether collagen used to help or harm us, but rather this: given what we know about how the spike protein has altered our bodies, is it possible that collagen is deepening that harm?  My clinical observations tell me that the answer is yes.

The next question is, how might collagen be harming us?  As you read in the first part of my case series from last week, and now in the second part this week, you will see that I’m focused on the amyloid fibrin microclotting which is measured in our patients at the Leading Edge Clinic.  In particular, when the microclotting score of a patient, and then another, didn’t drop after months of anticoagulation therapy, I wanted to learn why.  The common thread was collagen. 

This week however, in a visit with a patient who has had a tortuous postoperative course following major surgery, another possible explanation began to emerge, which is the impact of collagen on mast cells. Aside from microclotting, a second way in which our bodies have changed is that our mast cells have been dysregulated.  The Epoch Times had an excellent article on the subject recently.   My appreciation for the profound impact of mast cell activation syndrome (MCAS) on the clinical trajectory of patients with post-acute sequelae of COVID (PASC) and vaccine injury has only grown over time.  Dr Lawrence Afrin is the eminent expert on the subject, and I recommend his accessible book Never Bet Against Occam: Mast Cell Activation Disease. Even more accessible is the website of my beloved colleague, Dr Tina Peers in the UK. Her recommendations of NAC Augmentata and Arc Microtech microcurrent technology have made a profound impact upon our patient care.

It turns out that collagen impacts MCAS.  This isn’t a scientific reference, but it’s a good place to start digging.  From the website of an Australian collagen vendor, Nutraviva

How Does This Impact People With Sensitivities To Histamine?

Unfortunately for people sensitive to histamines, bovine collagen powder supplements,  gelatin, and  bone broths can present a challenge. Histamines can be present in certain species of fish so choosing  Marine Collagen as an alternative may not always be the best option either. The appropriateness of a  collagen supplement is also very individualised and dependent on the individual’s level of tolerance, so one product may be more suitable than another.

If you have a dietary histamine sensitivity or Mast Cell Activation Syndrome (severe, clinically diagnosed histamine intolerance) then a  collagen protein powder or  bone broth may not be appropriate due to their sourcing and long processing/cooking times and the bioaccumulation of histamine from a range of foods sources within a time frame, which may increase levels of histamine overall.

A few words of explanation are in order.  Among the hundreds of cytokines released by mast cells, there is the cytokine IL-6. This is a cytokine which we are targeting with low-dose Naltrexone (LDN) when treating PASC and vax injury.  Among it’s many roles, IL-6 elevation is provocative of …abnormal clotting.  And cancer.  Mast cells which have become hyperactivated are releasing IL-6 throughout the body.  People with hyperactivated mast cells who ingest collagen, according to some Aussies who make the stuff anyway, are going to have trouble. They will release more Il-6.  And, the patients will experience more coagulopathy.  Which comes first, MCAS or clotting?  If someone has both, I’m not sure how much that matters. 

Now on to Vitamin K2.  (Ooof, I can hear the experts howling to the rafters already). As with collagen, there have been signals of trouble from my patients.  When you spend an hour with a patient (as opposed to a ten minute McSick Care visit), there is time to listen and ask questions.  I like the rule of three.  By the time the third patient says, “You know doc, when I started that K2, I just felt like my blood was sludgy”, she/he has my full attention and intent curiosity.  

In the fourteen  years I spent in the Emergency Department setting, I administered IV Vitamin K2 less than twenty times.  It’s what we do for a patient who is on Warfarin/Coumadin and has a gastrointestinal bleed.  K2 is an antidote, by way of blocking one pathway in what we call the clotting cascade.  The dose is 10mg in an IV bag over at least thirty minutes.

Our patients are uniformly taking 100-200mcg of Vitamin K2 because they are also taking high dose Vitamin D3, and they have been instructed to do so.  The understanding is that K2 helps prevent deposition of calcium deposits along the walls of our blood vessels as a result of how Vitamin D3 at high doses modulates calcium metabolism and absorption.  Fair enough.  But wait, what might be different in our bodies since November 2019?  I know this doesn’t make sense, because the ratio is obscenely out of balance.   But, could 100 mcg of Vitamin K2, which is 1/1000th of the dose given to reverse a GI bleed, possibly increase clotting in a PASC or vax injured patient?  I think so.

I’m a sailor, so I’ll put it to you in sailing terms.  Sailing into a north wind, the boat will be upright, the mast straight, the sail luffing.  Sailing 28 degrees northwest or northeast of a north wind, the sails will fill and the boat will lean (heel) to the side.  Pre-pandemic, if you gave Vitamin K to someone who was bleeding, it would be like steering your boat back towards the north wind, and your ship would right itself.  Currently, with all of us microclotting, it’s as if we are moving fast and heeling hard, with one edge of our boat dipping into the water.  Then you turn away from the wind just a smidgen more, say 30 degrees, 100mcg of Vitamin K2, and in rough weather, the water may start splashing over the sides.

If a patient is taking Nattokinase, at least 6,000 fu daily, I have little concern about them accumulating calcifications along their blood vessels.  The reason the Japanese live to be eighty, don’t have dementia, are still physically active, is because the slimy, stinky, fermented soy they eat—Natto–has Nattokinase, which gently prevents and removes such plaques.  To keep the ship sailing without taking on water, I will guide patients who are on Nattokinase to stop their Vitamin K2.  I also caution them to avoid super green powders, which have concentrated Vitamin K1, as there have been signals of similar concerns with this.  Basically, get your Vitamin K from your food.  Do I have the same level of concern about Vitamin K2 and supergreen powders as collagen?  No.  But if you were my patient, we would discuss the risks versus benefits and come up with the answer which is right for your individual case.  This is the art of medicine.

What follows are six more case studies in which I think collagen is an active dynamic. They are necessarily works in progress and incomplete. I will follow up with a third Substack in the future as we recheck labs and observe for clinical responses with discontinuation of collagen.

Patient 8

61 yo male, x2 mRNA + booster, last shot 7/22, onset of symptoms 8/22, vaccine injured.  First visit 9/22.  Hx IBS, eczema, psoriasis, bilateral mediatsinal lymphadenopathy. No surgeries declared.  Reported facial flushing, sudden sense of heat, numbness/tingling of nose, mouth, fullness in ears — like underwater, insomnia, occasional dizziness with standing, myalgias, groin discomfort, chest discomfort, depression/anxierty, mild brain fog, rash on chest, post exertional malaise.  Strong signal of MCAS.  Initiated IVM and has used on/off, with LDN on/off , Nattokinase, Neprinol, NAC Augmentata, Turmeric, Garlic.  Labs 2/23 show reactivated EBV, spike ab 24,330 U/mL.  8/23 testing showed 4 of 4 microclotting.  PAI-1 5G/5G polymorphism, which should have placed him in the lowest risk category for venous  thromboembolism.  Started Aspirin 8/23, Plavix 11/23.  Long-term workup for iliac venous compression started. By 11/23, spike ab down to 11,671 U/mL.  During 1/24 visit, in response to quesitons from this provider, patient reported that he stopped collagen-protein peptides 20gm per day in November of 2022(after vaccine injury), because of concerns upon reading more medical literature on the topic.  

Patient 9

67 yo male, x2 mRNA shots. First visit 5/22, with unknown previous COVID at that time.  Hx squamous cell carcinoma, congenital slight curve of spine, arthritis of lumbar vertebrae,  s/p excision of squamous cell carcinoma.  Intake reported brain fog, two incidents with brief loss of vision in left eye, tinnitus, sleep disruption, failed root canal.  Bi-weekly use of IVM at time of first encounter, increased to daily, later with Nattokinase, then NAC Augmentata,    2/23 spike ab was >25,000 U/mL At 6/23 visit reported an incident while traveling: developed sudden onset of dyspnea, lethargy, and malaise.  Concern for iliac venous compression began around this event.  Spike ab down to 23,156 by 7/23.  7/23 added Aspirin daily, and microclotting study result was 3 of 4. Began anticoagulation with Plavix and Eliquis.  Using the Arc Microtech 3-6 hours daily and a grounding mat.  Last visit was 1/24.  At that time patient felt that he was getting worse, waking with muscle aches in his arms and legs, some increased varicosities, and ongoing dyspnea.   In response to questions  re: collagen use, patient shared that he had been adding collagen to his bullet coffee daily for months.  Collagen DC’d.  At 2/24 measurement, microclots were only down to 2.5 of 4, despite nearly seven months of therapy. 

Patient 10

65 yo male, x1 J&J shot, and five previous COVID infections (four after the shot).  First visit 10/23.  Intake reports fatigue, brain fog, memory problems, shortness of breath, fast or pounding heart rate, anxiety and depression, symptoms worsening after activity.  Reports reduced capacity during exercise, tachycardia and palpitations during higher intensity exercise, poor recovery following exercise.  Strong signal of MCAS, early concern for iliac venous compression based upon history.  10/23 measure of spike ab was 9108 U/mL.  IVM, LDN, NAC Augmentata initiated.  1/24 study of microclotting was 3.25 of 4.  Discussion at second visit, end of January 2024 revealed that patient had been supplementing with collagen for an extended period of time, although it hadn’t been on his list.  Collagen DC’d.  Plavix low dose, Aspirin, Antronex initiated.  

Batch ADRs Deaths Disabilities Life Threatening Illnesses

203A21a      1645     18                     21                     23

Patient 11

80 yo male, x2 mRNA Pfizer, last shot 2/21, onset of symptoms 2/21.  Hx neuropathy, muscle weakness and atrophy, Sjogren’s syndrome, joint pain, tinnitus, S/p gall bladder removal via open surgery, catheter ablation for A-Flutter, detached retina surgery following cataract surgery the previous year. Intake reports weight loss (30 lbs), muscle loss, weakness, neuropathy, nerve sensitivity, symmetrical sensorimotor axonal polyneuropathy by EMG and blood work, fatigue, brain fog, joint pain, worsened after activity.  D-dimer prior to our first visit 10/22 was elevated at 321ng/mL (normal <= 230ng/mL)  Eliquis had been recommended by PCP, but patient was reluctant.   Using soft-shell HBOT.  Many, many trials of therapy over time, with consistent use of Aspirin, LDN and IVM. Later adding EPA, NAC Augmentata, and Nattonkinase.  Late September 2023 study showed 3.5 of 4 microclotting.  Patient initiated low dose Eliquis and Plavix shortly thereafter.    At end of November 2023, patient reported that he had been using Dr Gundry’s Phyto Collagen Complex and had DC’d it in the last week.

Patient 12

75 yo male, PASC.  Acute COVID infections April and November 2022.  Onset of symptoms January 2023.  First vist 10/23.   Hx transient ischemic attack (TIA), HTN, depression, anxiety  S/p bowel obstruction surgery, with extensive adhesions noted in August 2023.  Intake reports fatigue, brain fog, memory problems,dizziness when standing, anxiety and depression, symptoms worsening after activity.  Anti-depressants stopped working and he developed insomnia.  Started on Aspirin prior to our first visit. Early concern for iliac venous compression, validated in review of previous CT abdomen/pelvis and during consultation with coordinating IR specialist. Patient unable to travel very far and so stent placement is not easily achieved at this time.    Already on IVM and LDN; started NIR, Flavay and Arc Microtech.  Moderate signal of MCAS.  Mid-November 2023, spike ab was 70 U/mL, reported during visit that he ran out of his collagen supplement two days prior.  Collagen DC’d.  Microclot study 2/24 revealed 2.5 of 4.  12/23 lab showed very low serum serotonin level of 34 ng/mL (range 23-230ng/mL).

Patient 13

60 yo female, PASC unvaccinated.  Hx HTN, hypothyroid S/p partial thyroidectomy with benign nodule.  Onset January 2022 after acute COVID.  Intake reports severe fatigue, tachycardia, anxiety and depression, symptoms worsening after activity, insomnia, only able to sleep 2-3 hours at a time.  She suffers from a burning sensation throughout her body – extreme heat – mixed with itching of skin.  Had Epstein Barr Virus (EBV) reactivation reflected in labs.  Strong signal of MCAS.  Started on Aspirin, Nattokinase, IVM, NAC Augmentata, and Arc Microtech.  8/23 spike ab was 

22 U/mL.  9/23 visit had some days of feeling better, then overexerted and was back in bed for 3-4 weeks.  Burning was less intense.  Conintued to have palpitations.  Presentation consistent with iliac venous compression, but difficulty getting correct study and doesn’t want to use Gadolinium contrast.  In 11/23 started Ketotifen.  12/23 microclot study showed 3 of 4.  Visit following this report revealed patient was taking collagen daily.  Collagen DC’d.  Late 1/24 visit, started Eliquis and began having night sweats.  Went up on Flavay, started Antronex, titrating up on Ketotifen. 2/23 visit feeling stronger, walking more, finding benefit from NAD Platinum from QuickSilver.  Off Eliquis, feeling clearer when she wakes up.  Tolerating Plavix ¼ tab daily.  Mental clarity from 5-HTP.  Plan to trial Cromolyn nebulizers, and try Inositol for reactivated EBV.



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Iliac Venous Compression (May Thurner Syndrome)

Iliac Venous Compression (May Thurner Syndrome)


Notes to the reader: if the Substack is truncated in your email, click on “View entire message” and you should be able to view the entire post in your email app. Comments and the final plan of care are restricted to paid subscribers for this post. Some of the links are not active, because this post is so long.

35 year old male

Has a benign medical history, eats very healthy, and prior to injury, exercised a lot.  Eventually determined that he had overtrained and over-dieted which led to a low testosterone issue.  Was a field scientist, and went back to school for a health profession.  Most of 2022, was at his apartment for 18 hours studying and sleeping, or going to class.  

Patient initially presented 7/11/23 for telemedicine consultation re: symptoms following acute COVID-19 infection and COVID shots. Referred by his functional medicine mold specialist.

– Health status: stable chronic.  Hx CIRS, hypogonadism, exogenous testosterone S/p  Muscle biopsy and dehiscence semicircular canal

– COVID-19 vaccination status : x2 mRNA Moderna

BATCH     ADRs DEATHS DISABILITIES LIFE THREATENING ILLNESSES

013L20A    3119           62                39                  26

023M20A   1616           23                17                  31

-7/5/23 spike antibody IgG 10,090 U/mL

– Previous COVID-19 infection by testing or presumptive by symptoms, December 25, 2022.

– Onset of symptoms December 2022 and constellation of symptoms including fatigue, brain fog, memory problems, shortness of breath, dizziness when standing, fast or pounding heart rate, loss of taste or smell, anxiety and depression, symptoms worsening after activity. Also reports burning muscle pain, fiberglass skin sensations, stabbing upper and lower back pain, muscle twitches and “blood pumping in legs” sensation

– Clinical trajectory: worsening.

April 2022 was diagnosed with hypogonadism.  Had fatigue, wasn’t gaining muscle while working out, libido was low, was cold all the time.  Total testosterone below 50 ng/dL, and was started on exogenous testosterone therapy with internist.  Had researched therapy, shifted to a hormone specialist with an aromatase inhibitor (AI) and higher dose of testosterone.  June 2022 had a back injury with weightlifting.  Did physcial therapy.  Symptoms started to pile on.  Thought the AI was the issue.  Came off both testosterone and AI after a couple of months. Between insurance and appointment scheduling delays it took months for tx.  Scheduled twice for a muscle biopsy.  Looking at Multiple Sclerosis and autoimmune illness.  Did labs, nerve conduction study, muscle biopsy, brain and then spinal MRIs.  Went to Neurologist, who said this was post-viral illness, and given medication (uncertain what meds).  

Found his way to a functional medicine physician who focuses on CIRS and mold toxicity, first visit January 2023.  Had Genie testing: https://www.survivingmold.com/resources-for-patients/treatment/genie-genomic-expression-inflammation-explained-now-available.  Was living in an apartment which had high levels of mold.  Moved out, started to get better with treatment, and then got much worse.

Activity makes him worse.  He has to be careful about walking more than ten minutes at a time.  He can’t lift anything without it causing a flare of his symptoms.  His muscles burn when he uses them.  He’ll have a “fiberglass” symptoms affecting his skin systemically.  Was wearing shorts, no socks.  Typically feels cold.  He has stabbing back pain all the time.  Has sporadic muscle twitching.  He couldn’t think at all, or remember what he expect to be able to remember.  “My legs are always vascular, especially my left one all the time.”  He feels a “blood pumping sensation”, used to happen all the time, went away, and then came back.

He had drowsiness during Summer 2022, and couldn’t work even part-time.  He would be studying during summer courses, and would get up early in the morning to get a couple of hours of studying in; this lasted a few months, but recently came back some.  He was trying to start some classes in August 2023, and was struggling with self-worth, because he “isn’t doing anything.”

***He has had some anxiety, depression and suicidal thoughts, which is completely new.  When pain went away, those feelings would go away.  More recently, even without the pain, he would have those feelings and thoughts.  On a good day this typically goes away.  

June 30th, 2023 he started IVM.  Within days, the anxiety and depression disappeared.

Physical symptoms seemed to be getting better.  Started ATP360 6/23 and hadn’t noticed any difference.  One of the few things which improved was his libido.

IMPRESSION: Constellation of multi-system symptoms NOT temporally associated with vaccination for COVID-19, BUT temporally associated with episode of acute COVID and consistent with vaccine injury.  Patient received two mRNA shots from bad batches.  Symptoms reflect mitochondrial damage, endothelial inflammation, anti antibody response, and micro clotting, with a no signal of mast cell activation (initial impression).  Provocation and exacerbation of injury facilitated by testosterone use (enables spike entry into cells via TMPRSS2 pathway).

Discussion: You are taking Colsevelam/Welchol (as a binder Rx by your mold specialist).  As we discussed, cholesterol is both the constitutional basis of building hormones in your body, and is utilized in your mitochondria to make Progenolone, which is your own endogenous steroid, that helps lower systemic inflammation.  Your last testing of this level is in the 50s ng/dL, which is suboptimal.  My suggestion is to stop this medication and permit at least four days to evaluate for change in your symptom burden.  In the short term your blood lipids will increase.  Within six months, they will be better than previously.  Four days after discontinuation of Colsevalam, I would suggest initiating Nattokinase per my directions, which will modulate your blood lipids, and more importantly, help heal the lining of your blood vessels, while breaking down microclots and neutralizing spike.  Because Nattokinase heals the lining of blood vessels, your blood pressure will improve.   You should check your blood pressure daily, and expect that you will need to stop taking your Losartaan for BP control.  As your systolic BP approaches 120 mm/hg or less, it would be best to cut back or eliminate this medication.  

The Desmopressin which you are taking, for reasons which are unclear to me (mold specialist later explained conern for decreased cardiac preload secondary to disregulation of anti diuretic hormone or ADH), is most likely harming you.  Please see the attached study re: the development of autoantibodies following acute COVID which attack ADAMTS13, the enzyme which manages clotting in our body.  When ADAMST13 is driven down, it drives up vonWillebrand factor levels, and both changes increase your body’s tendency towards clotting.  It is very likely that you already have significant microclotting at baseline due to vaccination and spikopathy.  If you use the free software Epocrates to understand the pharmacology of Desmopressin,  you will learn that the mechanism of action leads to increased plasma Factor VIII and von Willebrand factor levels.  This increases the risk of clotting in the context of vaccine injury and autoimmune dysregulation.

DRAFT SCHEDULE: Spacing changes is important in order to assess for benefit, neutrality and side effects.

Day 0 Pacing is the single most important intervention in surveys of vaccine injured by REACT-19.  See the presentation about this by Dr Joel  Wallskog of REACT-19 from the FLCCC Conference in May 2023.

Day 0 DC Desmopressin

Day 0 Intermittent fasting.  Long-term goal should be at least one 72 hour fast per month.

Day 0 Continue with IVM daily.  Target at dose of 0.4mg/kg, divided into two doses daily with food and fat.  

Day 4 DC Colsevalam

Day 8 Nattokinase 2000fu (100mg) orally on an empty stomach.  Take this daily for two days, and then increase to 4,000fu daily.  As tolerated, advance by adding an additional 2,000fu later in the day at least two hours after a meal and at least thirty minutes before the next meal.  

Day 12 Take NAC Augmentata (NAC-A) 200mg orally once daily for a week to determine your tolerance.  You may feel some minor return of previous spike related symptoms as your body begins to break down the fragments from spike denatured by the NAC-A.  Then take twice daily for up to three months, or until resolution of symptoms, and then daily indefinitely. You can take it with food, but I have found that best effect is to take on an empty stomach, or at least 15 minutes before eating.  Drink plenty of water, i.e. at least 16 ounces with each dose, when taking NAC-A.  

Day 16 LDN 0.5mg/drop, starting with one drop under tongue at night for one week, advancing as tolerated up to 4.5mg. 

Reassess after 2-3 weeks.  

***If iliac venous compression (IVC) continues untreated, it is possible (I have seen this in at least four patients) for neuropsychiatric symptoms to emerge.  Post acute sequelae of COVID (PASC) and vaccine injured patients are often misdiagnosed as having psychiatric issues and treated with a raft of antidepressants, antianxiety and antipsychotic medications which don’t address the underlying and undetected pathophysiology.   My working understanding of the pathophysiology of IVC is as follows: IVC or May Thurner Syndrome (MTS) exists in 30-40% of the population as detected on autopsy, but many people pre-pandemic were asymptomatic during their lifetime.  The origin of this condition is an anatomical vulnerability.  The left kidney sits higher than the right in most people, and as a result, the right iliac artery crosses the left iliac vein in a manner which increases compression.  The spike protein from the COVID shots enters the bloodstream and provokes both direct and indirect injury to the endothelium  (cells lining the blood vessels).  I have seen IVC in an unvaccinated individual, so that I think high spike burdens from shedding can contribute to this condition.  Spike also provokes microclotting and causes injury to the collagen which provides structure to compressible veins.  

The perfect storm which appears to provoke IVC in PASC and vaccine injury patients is a combination of  anatomical vulnerability, vascular injury, widespread coagulopathy, and resulting pelvic hypertension with venous stenosis, reflux and collateral flow that decreases the preload to the right atrium (results in POTS).  The pooling blood in the pelvis provokes ongoing systemic inflammation, irritating and impacting surrounding organs, such that we can see in the labs impaired renal and liver function, and irritation to the bladder causing cystitis, and the gut, causing dysbiosis.  MCAS flares in such patients.

Historically, IVC and MTS was associated with young woman of child-bearing age, and symptoms including left leg pain and swelling, pelvic pain, and lower back pain.  In the more than sixty patients I have worked up for IVC, there have been men and women of all ages, less than half of whom have any left leg symptoms or even pelvic pain.  Most of them have an athletic history.  Many have a history of trauma or surgeries or both affecting the abdomen and pelvis.  Men often have history of left testicular varicocele.  Woman may have had multiple pregnancies.  Development of urinary urgency, frequency and nighttime voiding is common, as well as dysbiosis (constipation, diarrhea, bloating, heartburn, abdominal pain), new hemorrhoids, painful intercourse for women, POTS and MCAS.  A minority of patients have lower extremity edema and new varicosities.  Dyspnea, chest pain and headaches are not uncommon.  Increased anxiety, depression and insomnia or poor sleep patterns are common.  Coagulopathy, with consistently elevated microclotting scores is uniform, and it is not uncommon that elevated D-dimers are found.   Patients often feel worse in the morning and get progressively better during the day.

7/28/23 Recently has experienced an increase in his symptoms. He started NAC-A about four days ago and is correlating the increase in pain for when that started. I explained to him the process of denaturing spike and how we can see patients have an increase of symptoms during the initial start of taking NAC-A. He is only taking 1 cap daily. I suggested that he go down to 1 cap every other day, but he wishes to continue taking it daily knowing his symptoms may improve after a week or so. He clarified that he is off of the Atorvastatin as well as the Colesevelam, but is still taking the Desmopressin to finish off the bottle.

7/30/23 I was able to speak with his mold doctor via phone for an hour.  He utilizes the Shoemaker Protocol in treating CIRS patients.  Notable excerpts from our conversation reflecting his clinical thought process include:

With pulmonary hypertension, patients will have elevated right-sided pressures, and so have less blood return to right side of heart.  Can only increase stroke volume or heart rate.  With POTS, the first thing he does is look at specific gravity and it is typically 1.10, indicating intravascular volume depletion.  With Desmopressin, increase ADH, which improves intravascular volume and eliminates passing out.  Try to reset hypothalamic output of ADH.  Proopiomelanocortin (sic) pathway is disrupted. 

***This is a very important part of the history, as the mold doctor was on the right track with concern for decreased preload, the volume of blood returning to the right side of the heart and this leading to POTS symptoms, but the pathologic cause was actually iliac venous compression and coagulopathy, not changes in ADH.

The physician thinks that the patient got much worse due to exposure to a water-damaged building.  He had gone to visit his mother, and staff had documented issues with her home.  Was wearing long-sleeves and shirt in June 2023, first time able to do this in a while.  Skin culture showed Propionibacterium acnes (gram positive)…. was >200,000, and should less than 10,000.

***Another  important point, because mold practitioners are inclined to blame mold as the primary souce of the patients troubles, when it is more likely that the spikopathy from COVID infection and vaccine injury has destablized mast cells, provoking MCAS and lowering the patient’s tolerance of pre-existing environmental mold.

Historically there is a relation between CIRS and increased vonWillebrand, and thus increased clotting.  He hasn’t noted previous microclotitng with CIRS, but hasn’t had a manner of testing it.

Discussion of and agreement re: use of micro current therapy going forward.

08/15/2023 Telemedicine visit

Not very much is going well.

Just finished abx, going to Peridontist, who will be removing an implanted left upper tooth.

His pain wants him to say that everything is worse.  He’s trying to be realistic about what is worse.  He struggles to go to the mailbox.  Got up yesterday to make breakfast for his girlfriend.  Getting up and walking to the kitchen feels like a big workout.  Back in January 2023 he could still move himself into his kitchen.

Wakes up with burning and stabbing pain, hyperalgesia.  Clothes hurt.  Has lost half of his hair, starting about a year ago.  He can feel every hair which falls off his head, and it is worse.

He is experiencing a lot of stress, and it has gotten into his head.  Got rid of his bed and couch, and had his apartment cleaned professionally.  Got his workout bench out of storage, and is looking at it, wondering if it has mold.

“I’m tired of fighting, and don’t want to be here.  I’m telling everybody so that doesn’t happen.  My life is trying to be a good boyfriend, because I found the woman of my dreams.  I’m doing one college class, and it’s hard.  In the past, I could do that in my sleep, but now I’m tired, in pain, and struggling.”  Would prefer to physiologically feel better before reaching out for psychological therapy and cost is a concern.

Cold all the time, but burning and stinging is mostly in legs, and going everywhere, including now in his face.  His skin is very wrinkly, which started a while back.  Unless the mold and bacteria are the issue.  He overthinks eating, his relationship, his finances.

His girlfriend ran a race this last weekend.  “Everyone’s life is going elsewhere.”

Mold doctor indicated to him that we were on the same page, but wanted him to keep taking the Cholseval and VIP (vasoactive intestinal peptide, nasally administered).   The VIP is used in CIRS  “to attack several biomarkers.”  It’s the only thing which feels like it has for sure helped him.

He ventured a theory: references Dr Jordan Vaughn’s statement that he has a large segment of patients who can identify the day that they were injured.  The only thing which changed before injury was starting to take testosterone.  Then, he was deadlifting and had a lower back injury while deadlifting.  The day his skin sensation/pain started, was the week he had a muscle biopsy, cold-turkey quit nicotine, which he understands to open the floodgates to spike in the brain.  He can wake up and his left leg is “super vascular.”  He would look at it every day, and it would upset him.

***Another key point in his history, as many IVC patients can pinpoint the day and time when their life dramatically changed for the worse.

7/11/23 Telemedicine visit

“My legs are always vascular, especially my left one all the time.”  He feels a blood pumping sensation, used to happen all the time, went away, and then came back.

No Hx of left testicluar concerns.  Has Hx of hydrocele on his right.  Mornings used to be manageable, and things would go downhill over the day.  For fourteen months, he has always slept very hard.  The last several weeks have been the hardest of his life.  He wakes up with hope and fight, pushes through his day, and by the end of the day, he doesn’t want to talk to anyone.  Mornings now suck, because he started in pain.  Hasn’t noticed any edema in his legs.

He is on day three of the Arc device.  He can perceive the micro currents.

IMPRESSION: Severe post-exertional malaise secondary to mitochondrial dysregulation and hypoxia from extensive microclotting. Left iliac venous compression: specific time of onset, following possible pelvic injury, severe lower back pain, left LE vascular prominence.   

PLAN:

-Please complete the vascular study ordered to initiate workup for left iliac venous compression.  This is the first step towards completing an MR venogram which would provide the definitive diagnosis and is needed by a vascular surgeon.

***I ordered vascular studies on the first tweny or so patients until I realized how useless they were in diagnosis.

-Please complete blue top testing with Dr Vaughn to evaluate/stage microclotting.

-Please consider completing the labs which were ordered during our first visit.  

Day 0 Initiate Plavix 75mg orally daily.

Day 4 Initiate Aspirin 325mg orally twice daily with food.

Day 8 Initiate Eliquis 5mg orally twice daily

8/23/23

Day 8 of the anticoagulationt reatment plan.  

Some increased numbness in right arm.  “My muscle burning (predominantly legs), back pain, and energy have without a doubt noticeably improved.  My fiberglass skin pain has improved maybe slightly. “

9/6/23

A couple of bruises here and there but no negative side effects of anticoagulation other than the numbing in right arm.   Can walk more and exert himself a little more with less pain and less repercussions.  His three main symptoms are stabbing back pain, burning muscle pain, and hyperalgesia that he refers to as fiberglass pain where it hurts just to wear clothes. All are exacerbated by activity (walking, lifting, exercising).  Two of the three were improving last week, back pain was not getting better.

9/18/23 

Microclot results are back: stage/grade 4 of 4 amyloid fibrin microclot formation, significant and widespread.

09/28/2023

Having some improvement.  Waking up each day with a better attitude, because he has some answers re: what is causing his symptoms, i.e. microclotting.

Week two of triple therapy he was able to walk across campus.  He overdid it during that second week; went on a long walk with his girlfriend, walked across campus twice, and helped new neighbors move into their home.  His brother’s truck needed a new battery.  It is elevated, and for 1 1/2 hours he was picking up the battery and moving it around.  His upper back was excruciating for the following two weeks.  He also had an acute episode of presumed viral illness.

He also had his dental implant removed, and started feeling better last week.

The fiberglass sensation affecting his skin is up and down.  If he does too much, everything will get worse.

Before MRI of his spine in 12/22, he could feel the blood pumping through his legs and the twitching. Discussion of whether or not to repeat MRI, or wait until his previous MRI has a second read by Interventional Radiology specialist Dr Brooke Spencer in Denver, CO.

Discussion of Aspirin 81mg daily vs 325mg twice daily.  Mold doctor has concerns re: large doses harming him. 

***Worth noting that higher doses of Aspirin could have helped mitigate his MCAS symptoms, but may have led to earlier incident of rectal bleeding, which occurred three months later when the patient increased Aspirin dosing to 81mg BID and was straining to have bowel movements.  Ongoing use of the Arc Microtech has minimized concerns re: bleeding and bruising in our patients on anticoagulation therapy.

IMPRESSION: Stage/grade 4 of 4 fibrin amyloid microclotting, experiencing clinical benefit with triple anticoagulation therapy.  Suffering increased symptom burden following overexertion, recent acute viral illness, dental surgery, and ongoing shedding exposure from increased social contacts with school and medical/dental office visits.  Concern for iliac venous compression (IVC).  We identified a previous non-contrast MRI thoracic/lumbar spine, and with some small chance it could provide clinically useful information.  If not, we can order an MR Venogram.

PLAN:

-Send CD of MRI Lumbar and Thoracic spine from 12/22 to Dr Spencer’s office Colorado for an overread (medical term for second opinion radiology review)

-Rotate sites with Arc device.  Order more self-adhesive pads from the UK.

-Order for Nattokinase from Allergy Research Group sent to FullScript.  This formulation may have a special advantage for you, because it has low or no histamine and may be less provocative to your system with mast cell instability, and histamine release from breakdown of platelets.

-Feel free to take (mold doctor’s) direction to use only Aspirin 81mg daily instead of Aspirin 325mg twice daily, if upon reflection of our discussion you have lingering concerns.

-Sip Baobab 1 Tbsp in 16oz water over at least eight hours daily.

10/12/2023 RN followup call:

He is doing okay, having some days of feeling good mentally and physically. Not having the fiberglass pain when putting on clothes and being able to move around more. He will then have days that follow that he doesn’t feel well, low energy, clothes cause pain and can’t tolerate moving around much.  He continues on the anticoagulant therapy and is tolerating it well, without concerns of bruising and bleeding. He is scheduled to have telemedicine consult with Dr. Spencer’s office on 11/1/23. They are talking about doing the MR Venogram and he is wanting to get that completed. It sounds like they will order it for him to complete locally. 

10/27/2023 RN followup call:

He will have days that are considered good days. His clothes will feel okay and not cause pain, he is able to walk longer distance and mentally has more energy and clarity. Other days that are not so good, he is in a lot of pain and exhausted. During these days he feels mentally down and questions wanting to live. This was more frequent in the past. He states he is very vocal about this to his family and does not have a plan. 

11/17/2023 Telemedicine visit

Repeat MR Venogram didn’t occur.  The night before the study was supposed to happened the imaging center called and said that they don’t do MR Venograms.  Now he is communicating with staff at Dr Spencer’s office, and they advocating for him.  They have patients on the East Coast who they have sent to a local academic medical center which is about an hour away from him.

***Arranging for local MR Venogram is an uphill and time-consuming battle for our staff and the patient, and we have had to start charging for the hours spent on it.  Insurance doesn’t want to pay for it.  At least a 3T magnet MRI is needed.  Technicians, schedulers, radiology nurses and physicians are often unhelpful and do not distinguish between the venous study we want and the study they perform.  Local radiologists almost uniformly do not correctly read the MR Venogram and do not identify venous compression, but it can be identified by Dr Spencer and her expert Interventional Radiology (IR) team.  We have to arrange for a CD copy of the study to be sent to Colorado for a second opinion.  Vascular studies including locally performed ultrasounds are almost completely useless in identifying IVC.  I have spoken with more than twenty (!) vascular surgeons and IR physicians across the United States, and only three have been capable of having a reasonable conversation.  The rest have been condescending in their “expert” lectures to me about May Thurner Syndrome (MTS) or IVC, and how a patient who doesn’t fit into the box they are familiar with, could not possibly have the condition, let alone could it be caused by spike protein, let alone have it lead to neuropsychiatric symptoms.

“I want it to be something, but I’m not doing any better.”  The short walk to class is now fine with the triple anticoagulation.  Walking more than that brings negative repercussions.  He has been hopeful between now and then.  If he overexerts a little bit, the next week he has a lot of pain. 

He ran into something a few weeks back and had bruising.  The initial numbness in his arm and increased bruising with initiation of anticoagulation has resolved.  

Discussion of Flavay and Sulodexide, and potential benefit for collagen repair.  A few months into his health issues is when his skin started looking old and then exfoliating.  He is also losing muscle mass.  Recently, inside his right ear, the skin is exfoliating.  Anytime he overdoes it, his hair will start to be less soft and fall out faster.

Two weeks ago he had a very bad week.  He thinks it’s because he overexerted the week before, and then started struggling with dark thoughts, and his hair started falling out more.

He is cold on a regular basis, despite wearing extra clothes.  Compression underwear with polyester and cotton helps the pain from wearing clothes.  If he walks too much, the fiberglass pain returns.  It’s 73F in his apartment, and he has a heater on, with compression underwear.

He stopped the Arc, because it was leaving marks on his arm.  Discussion of how to rotate sites, avoid constriction, and use it on his ankle with medical tape.

If the MR Venogram comes back clear and it isn’t that, then what will we do next?  

Traditional Chinese medicine (TCM) drops, Sulodexide, Flavay.

IMPRESSION: Plateau in clinical progress.  Ongoing exposure to shedding from class attendance.  Delicate balance with post exertional malaise, extreme temperature dysregulation, hypersensitivity of skin, hair loss, decreased skin turgor, muscle atrophy.  Baseline elevated spike ab dilution and stage/grade 4 of 4 amyloid fibrin microclotting.  Concern for iliac venous compression.

*** Improvement in clinical symptom burden with initiation of anticoagulation, followed by plateau and/or regression is a common feature for patients with IVC.

PLAN:

-Use a styptic pencil from a local drug store to stop facial bleeding when you cut yourself.

-TCM eye drops and nasal spray to protect against spike shedding.

-Over-the-counter therapy to inhibit platelet adhesion to blood vessel walls, which is an over-the-counter equivalent of Plavix: Flavay 100mg (1 cap) twice daily. Advance to 200mg (2 caps) twice daily as tolerated.  Flavay is available online at: https://www.healthysource.com/flavay.html

-Pentoxifylline (PTX ER), 400mg three times daily. It is third-line therapy in patients with severe microcirculatory disturbances. PTX is a non-selective phosphodiesterase drug that has anti-inflammatory and antioxidant effects. It improves RBC deformability and reduces blood viscosity, so can mitigate the hyper-viscosity and RBC hyper aggregation, which is linked with the development of coagulopathy in the vaccine injured. It is also an PAI-1 inhibitor, which enables the body to break down the microclots more easily.  Cost isn’t prohibitive, $15 for 60 tabs with Good Rx coupon.

-Restart the Arc in two weeks on program 3, then a week on program 4, then rotate a week each on program 1, 2, 3 and 4.

-See attached reports re: Sulodexide https://pubmed.ncbi.nlm.nih.gov/36769668/ and  https://pubmed.ncbi.nlm.nih.gov/35647070/.

12/4 Telemedicine visit

Patient reports 12/1/23  appt with NP in Dr Spencer’s practice, and review of lumbar spine MRI from 2022.  Overread revealed severe left iliac vein compression. His dad is flying him to CO and has appt 12/11/23 for MR Venogram. Dr Spencer’s office is going to update this week but trying to arrange for stent placement while he is out there. 

Patient reports NOT feeling any better at all. Admits now that he has had blood in stool on/off since starting blood thinners but didn’t think much concern of this and therefore did not relay this information until now. Reports since changing to Flavay he has now had significant amount of bright red blood daily in stool, splatter in toilet and when wiping. Denies SOB, dizziness, lightheadedness, nausea or vomiting.  Is currently on 81mg Aspirin, Flavay 2 capsules BID, Pentoxifylline TID but has discontinued Plavix when he started Flavay. Using ARC on program 4. Has not required styptic pen as trying to shave more frequently and thus noticed less issues with knicks/bleeding. 

Advised we will follow closely regarding the concern of bleeding above and the importance of informing us of this type of issue. Verbalizes understanding.   Later acknowedged to nursing that he had bumped up Aspirin to 81mg twice daily.

Plan to get a CBC, CMP and guaiac of stool to assess for blood loss. Back off Aspirin to twice weekly.  Rotate Arc each week through programs 1, 2, 3, 4.  Ship TCM eye wash and nasal spray to him before his flight, as the shedding in the airport and on the plan could be very harmful for him.  He can/should also order Enovid nasal spray from Israel.

-Utilize ENOVID Sanotize nasal spray from Israel up to six squirts total daily during your travels.  You can use this spray before departing for the airport.  This can be ordered online at this address: https://buyenov.com

12/4/23 Telemedicine consult read of 12/14/22: MRI Lumbar performed at OPI. 

There is severe left MIV compression with a moderate length stenosis. The internal iliac on the left is dilated suspicious for presacral plexus collaterals. There is no signfiacnt disc disease. Venography and intravacular US with left renal venogram can be considered with possible iliac vein stenting.

12/5/23 RN follow up call

No further rectal bleeding since drop of Aspirin to 81mg twice weekly.  CBC, CMP normal.  Stool test negative for blood.  Likely blood was from a hemorrhoid secondary to IVC and straining to have BM with constipation.

12/7/23 Labs, note from provider

Thanks for getting these labs done. Overall, I find good trends in these values. I don’t think the low WBC or RDW is clinically significant. Decrease in MCHS tells me that you’re freeing up movement in your capillaries for the RBCs to deliver O2 and remove C02, so that your body isn’t loading as much hemoglobin on the RBCs. BUN and BUN/Creatinine ratio improved a notch, while Creatinine increased slightly, a good sign for renal function. Platelets improved, meaning less are getting chewed up in microclots, and your bone marrow is functioning well. Albumin (protein in blood) has normalized. Liver enzymes have improved, and your stool was negative for blood. 

WBC 2.9, RDW 11.3, MCHC from 34.3 to 33.5, Plts from 240 to 255, Albumin normalized, BUN 22 to 22 mg/dL, AST 32 to 19, ALT 43 to 17.  

12/19/23 Procedure note

The Inferior Vena Cava measures 431.8 mm square in cross- sectional area. The left Common Iliac Vein measures 284. 9 mm square in cross-sectional area where normal with a 56.% stenosis in the tightest area. The left External Iliac Vein measures 165.9 mm square in cross-sectional area. Additional measurements were performed including diameter of the narrowest portion of the common iliac vein which was 4-5 mm compared with approximately 18 mm diameter of the normal common iliac vein which would represent a 73% stenosis in diameter. Although his degree of compression was somewhat equivocal, his venogram does demonstrate severe reflux, therefore the decision was made to proceed with stenting.

12/22/23 No further rectal bleeding and in response to report of constipation s/p stent placement, OxyPowder ozonated Mg recommended to help with BM regulation.

01/08/2024 After completed the stent placement, reports no real significant changes in symptoms. Fiberglass sensation is still present, maybe slightly improved. Energy is still low. 

01/19/2024 Telemedicine visit

“I’ve had huge improvement.”  He was sick, tired and the three weeks after surgery were not fun.  He noticed after surgery that he had a huge release in the fiberglass pain which lasted for a while, but all the other pain was terrible.  It was hard for that to be appreciated amidst the other discomfort.  He was however wearing more clothes.  Three weeks post-surgery his post-op back pain was terrible.  In the last two weeks he feels like he has improved every day.  His fiberglass pain is better, holding steady.  He is wearing more clothes, touching more things.  Post-op and chronic back pain form the last 1 1/2 years is better.  Burning muscle pain is better.  Activity level has doubled, but mental capacity feels like it has gone through the roof.  “Right now I’m handling all kinds of stuff.  I got a part-time job teaching at the university, and am taking two instead of one class.  My truck needs repair, but I’m looking into fixing that myself, and I’m taking on more things.”  He caught himself going on walks just to go on walks, after being terrified of walking across campus.  Now with two classes, that means walking to two different locations.

Previously it would take him a week of doing nothing to recover if he walked to two different locations.  Now he is walking more, intentionally, with a big backpack with a lot of weight.  The only people who knew before yesterday how well he was doing were his mom, girlfriend and a close friend.  “I feel scared to say it, but starting yesterday, I’m just going to say that I’m doing great and keep moving in that direction.”  There have been a lot of family and friends praying for him.  

No symptom has completely resolved.  He is not yet at his normal mental capacity, to take on a part-time job and full course load.  He still has some back pain and fiberglass pain. 

He went on a fifty minute walk before our meeting and feels fine.  He can still feel increased blood pumping in his legs, which has been present from the very beginning.  “Something is going on there.”

Money has become a big issue.  He wants to discuss how to trim medicines from the list.   

He came off LDN for surgery, and hasn’t restarted it.  He has a good supply of NAC-A, Nattokinase, Eliquis.  He had a big reserve of IVM from India, but is about to run out in two weeks.  He needs Flavay, about to run out.  He did the Arc and Baobab consistently, but the Arc is a hassle.  He did the Arc for two weeks after surgery.  The Arc hurts him during a three hour cycle.  He only ever used the thick carbon pads, because it only came with two of the self-adhesive pads.   Using TCM one drop of eye drop in each eye, and one spray in each nose.  The eye drops stained his contacts.  He hasn’t noticed any negative effect, but stopped putting them in when he wears his contacts.

IMPRESSION: Significant clinical improvement following iliac venous stent placement with increased cognitive function, exercise capacity, decreased fiberglass pain.  Decreased chronic back pain.  Intense concern re: financial constraints and need to trim therapeutics in order to maintain benefit, but stay within budget.

PLAN:

-Invite to support group Thursday 8-10pm.

-Shift to normal Nattokinase from NK-SD for cost concerns.

-DC Pentoxifylline, due to lack of demonstrable benefit.

-DC fish oil for cost.

-Pause Flavay for cost.

-Change Aspirin to 81mg daily

-Continue IVM 12mg daily (reduced dose for cost)

-Restart LDN to stabilize mast cells, tighten cellular junctions of gut for leaky gut

-Use Arc for three hours a day rotate each week through program 1, 2 and 3.  You can use saliva instead of gel to make contact with the carbon pads.  

02/06/2024 RN followup call

The Monday after our last visit, he experienced a return in all of his symptoms.  The day of his visit he had made the adjustments of stopping some meds and supplements and decreasing others. He was wondering if he can go down to 1 cap daily of NAC-A augmentata instead of 2 BID to save on cost. He has been taking 1 cap daily recently and hasn’t noticed a difference in symptoms. ***He made all of these adjustments right before he experienced the crash***, but it has been 2 weeks now and he is starting to feel better. He believes he overdid it with how much he has pushed himself the weeks prior. He is not back to feeling as good as he did before, but it is improving. He is tolerating walking to campus and his pain is decreasing. We discussed nutrition habits and he feels fasting puts a stress on his body. I encouraged him to just focus on waiting to eat 1-2 hours after waking up and avoid eating at least 3 hours before going to bed, but then during the day eat low-inflammatory foods. He discussed having the habit of eating right before falling asleep after a long day of working and studying. I encouraged him to schedule breaks throughout the day from studying and dedicate an hour for dinner to enjoy a sit down meal with his girlfriend. This will help him metabolize his food before sleeping, but also manage his stress during the day. He agreed and plans on implementing this. He has decreased the amount of physical activity he is doing to not over do it and is tolerating it well.

02/16/2024 Telemedicine visit

Two weeks of severe downturn with physical and mental pain after two weeks of tremendous physical relief at third week s/p stent placement.  His mindset changed completely from being rock bottom to thinking about marriage, graduate school in a health profession, and moving forward in the near future.  

He had a busy week with exams and work.  School and work keep him busy 24/7.  He and his girlfriend decided to pick up a babysitting job for four days in the middle of his exams.  During that time he started to feel better, after going into that feeling pretty crumby.  He got very little sleep, then got sick Thursday a week ago.  He couldn’t sleep and was getting behind on school and work.  ***In the middle of being sick, despite not sleeping, he didn’t decompensate.***  Normally he needs at least nine hours of sleep.

“I want to get better, heal, and go back to my normal life.”

A thought a few days ago was that he felt better the next day after starting anticoagulation medication.  With Aspirin, he went from not wanting to move to being happy to go down the steps.  This raised questions in his mind about dependence upon medications.  “I want to feel better because I’m truly healing, not because of some pill.”

All of his pain is decreased.  Last night slept eight hours.  This week he walked around campus with his backpack for the purpose of walking.  He added in the extra paces because he was feeling good.  Going non-stop from 6:30am to 10:30pm.  Back pain made it hard to drive to school, but he can now drive with less pain.  

He reflects that it’s easier for him to make decisions which are on behalf of others than himself.  In the shape he is in right now, he can’t be a father or go to school, and if someone tells him that he can’t do those things, it is hurtful.  His teaching commitment ends beginning of May, and he has been asked to teach another class from August to the end of November 2024.  

He has certain clothes which he has set aside, because it isn’t tolerable to wear them due to the fiberglass pain.  Sometimes he will try them on to test them.  Cotton has been his favorite fabric, and today for instance he is able to wear a cotton sweatshirt, which doesn’t feel great, but can bear wearing.

IMPRESSION:  ~ Two months s/p stent placement for iliac venous compression.  Global improvement in the last two weeks with decreased lower back pain, improved cognitive function and stamina.  Fiberglass sensations/pain remain at a decreased level, which may yield to treatments focused on neurological improvement.

PLAN:

-Live02

-Titrate Aspirin for benefit, e.g. up to 81mg twice daily with Arc to limit bruising and bleeding.

LITHIUM MICRO-DOSING 

-Lithium is a trace mineral which may help prevent and treat neurological conditions secondary to spikopathy.  Dosing is ~130mg orally daily.  That dosing is many times below any level of potential toxicity.  It can be purchased online for about $15 for six months worth from this source.  

 https://horbaach.com/products/lithium-orotate-130mg-180-capsules

Below is a link to the Substack by Dr Michale Nehls on the topic of Lithium.

 L-ARGININE 

-Trial L-Arginine 1500mg together with Vitamin C 500mg orally twice daily for four weeks to support energy and endothelial function.  See this study:  “https://pubmed.ncbi.nlm.nih.gov/36501014/”.

03/04/2024 RN followup call

He was justting getting over his recent acute infection and has now come down with another acute infection. He had never started the NTZ and HCQ due to receiving meds after inection was resolving. He had ordered them anyway to have on hand. Last week he would feel fine during the week, but then at night would cough and didn’t sleep much. Saturday he felt tired, but thought it was from overdoing. Sunday he woke up with body aches, fever of 99F, sinus congestion and continues to cough. He started NTZ and HCQ right away. He is also going to pick up the Azelastine spray for nasal congestion. He states his cough is productive and coughing up green sputum. Last week, despite being sleep deprived he was able to function better than he normally would.  Post exertion malaise has improved and fiberglass pain has slightly improved. 

03/11/2024 Telemedicine visit 

“I’m doing great.”  “It’s been a rough month, but I’ve been very happy.”  

Five weeks of getting sick three times was challenging.  The problems he was being treated for were getting better during that time.  He went through a month of not sleeping well due to stress, illness, life reasons.  “I could barely function off nine hours of sleep for two years, and during the last five weeks’ time I was functioning on far less sleep!”  Right now he feels so good, and is so happy, that he is scared to say it.

Adding more with zero repercussions, feeling better.  He is inching his way back to the last good day in January 2024, when he went on two 45 min walks and ran for 60 seconds with his girlfriend. Yesterday went on two 45 min walks.  Saturday night he went out to eat and was chasing his nephew around, which he did several times, picking him up, and not having negative repercussions.

The fiberglass pain is getting better.  When that goes away he feels like a normal person.  

“Finally all of the stuff I’ve been taking has been able to help in a way that I can feel.”

He is having future thoughts again of working out, and envisioning more work and more school.  If his health is better, he will propose to his girlfriend.  

He DC’d LDN because of the surgery, and didn’t go back on it because of money, but since we last talked he started it again.  

Fiberglass pain is resolving.  

“I’m type A, very disciplined.”  He still eats whole food and veggies, avoids alcohol, and when he is healthy, once a month would like to have a drink of alcohol.  He had two drinks in the last few weeks, including on his girlfriend’s birthday two weekends ago and enjoyed it.  He realized in the beginning that alcohol made him feel better from a medicinal point of view, and so stayed away from it.  He was in a social setting with friends and family and enjoying every minute of it.  Once he feels the alcohol, he sets it down.

Next week is his Spring Break.  He scheduled an ultrasound, and an eye appointment.  He feels like he could run right now and handle it.  

Discussion of Rapamycin for more rapid decrease of microclotting by promoting increased autophagy.

IMPRESSION: Recovered from most recent acute illness, with three in the last month.  Functioning well despite decreased sleep.  Credits the stent placement with the increased energy and the Lithium Orotate for increased resolution of the fiberglass pain.  

PLAN: For paid subcribers only, sent via separate email.



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Mother's Day

Mother's Day


PAST

Ocean City 1973

Most summers I spend a week at the shore in Ocean City, New Jersey. My Aunt Sue and Uncle Bruce generously host. From the time that I was a baby — in fact, when I was still in my mother’s womb — my family would go to Ocean City in the summertime. Bruce and Sue had one, and then two, rental properties there as their working investment towards retirement. There was the huge pain-in-the-ass (PITA) factor of driving down to OC and back through weekend traffic to clean them between renters. Once the PITA grew too large, and the market was looking good, they sold both properties.

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Nana and I, after baptism 1970

Spending time with this branch of the Marsland clan in OC has been a touchstone; seeing my aunt, uncle, cousins, nieces and nephews, catching up on the past year and retelling tales of Marsland lore. When my Nana was still alive, she would be there too, turning a lovely shade of brown while I was working on my sunburn the first few days of sunbathing.

Mom and I, 1972

One of the stories my Aunt Sue consistently retells is that of my mom being pregnant at her wedding to Uncle Bruce. My mother wore a bright orange dress with a short hem, showing off her lovely legs. Beneath the dress, her pregnant belly protruded like a little pumpkin. What I like about that story is that I feel included in the Marsland family history, even before consciousness; I was part of the action, and Sue enjoys reminding me of that.

MORE RECENT PAST

Mom, Sharon and I on Mackinac Island, MI

When I was fourteen, before I ran away to live with my paternal grandparents, my mom and I agreed to take a confirmation class together. My stepfather Em had been a member of the congregation and choir at Christ Church Cathedral, an Episcopal church in downtown Hartford, CT. If there was a church to which we belonged, that was it, but my mom had never been confirmed, and neither had I. For non-Episcopalians in the crowd: confirmation is the opportunity for teenagers and adults to sacramentally and publicly say “yes” to Jesus and His church as expressed through the Episcopal Church. To be confirmed is to be strengthened for ministry by the Holy Spirit and laying on of apostolic (i.e. a Bishop’s) hands. For everyone in the crowd, my favorite saying about being Episcopalian is that we are Catholic light; we have all the pomp and circumstance, but half the guilt.

Mom and I would commute from our rural abode in Amston, CT into Hartford once a week for months. Ironically, one of the other members of the class was a girl named Karen, an old neighbor from West Hartford days, who I used to tear around the neighborhood with on our Big Wheels. On the actual day of confirmation, there was a service during which the Bishop, who would have been William Bradford Turner Hastings, laid his holy hands on our heads. Aside from Karen and the bishop, I have the gestalt of sharing an experience with my mother in which we were almost equals. It was new, different — and welcome. It was a rare opportunity to see her in another light, as a fellow student and traveler.

PRESENT

Mom in Ithaca, summer 2023

Last summer my mom came for a visit in Ithaca while my wife was away, and we had a lovely time. One of the highlights for me was going on a sailboat cruise up Cayuga Lake with Captain Dave. He grew up in Ithaca, and has been sailing since he was a wee lad. He knows a lot about the history of not only the various structures on the lake, but also the geography surrounding it. The conversation was wide ranging, so of course we got into the topic of the COVID shots and spike protein. Fortunately, that was a side note to the afternoon, as the weather was too glorious, the skies too beautiful, the sails too full, to dwell on such things as we turned southwest to glide back into Ithaca.

Mother’s Day is too easily subjugated by crass commercialism and jostling for position at a crowded Sunday brunch. What I’d like to celebrate today is the imperfection, humanity, and long-term influence of the mothers in my life. Aunt Sue, Aunt Julie, Nana, Baba, Grandma Jones, Grandma Chavez, Betty Ann, my wife (the consummate mama cat), and the woman who gave me life, my mom. Thank you. I love you.

Happy Mother’s Day.

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