From the Desk of Robin Ellen Leder, M.D.
Hi everyone:
Yesterday I wrote to you and shared a Covid 19 protocol that, to me, appears to be well thought out, comprehensive, and makes sense. I would like each of you to have a printed copy, and after I print it here, I will tell you why. (Note: One of my wonderful patients copied the frame straight from the video, but unfortunately, the download couldn't be loaded here. I still want to thank her for what she did. I am more easily able to print it from here download, so it helped me.) Here is the protocol in its entirety:
Front Line Covid-19 Critical Care Consortium
Protocol to Control Inflammation and Excess Clotting
1 - Intravenous Methylprednisolone, 60 mg/day X 5 days, followed by a switch to oral prednisone, to be tapered over an additional 6 days
2 - Full Dose Low Molecular Weight Heparin
1 mg/kg subcutaneous injection every 12 hours, until discharge
3 - High Dose Intravenous Ascorbic Acid (Vitamin C)
3 grams every 6 hours for 7 days until discharge
4 - Oral Hydroxychloraquine, 400 mg 2X daily on day 1 and 200 mg twice daily on day 2 through 5
Treatment of Low Oxygen
1 - If patient has low oxygen saturation on nasal cannula, switch to heated high flow nasal cannula
2 - Do not hesitate to increase flow limits as needed
3 - Avoid quick intubation that is based solely on oxygen requirements
4 - Intubate only if patient's breathing continues to be labored
5 - Utilize "prone positioning" to help improve oxygen saturation.
And that's it.
Yesterday, upon receipt of my email, this same patient had asked me the following question:
"Just wondering, if one were to go to the hospital for treatment of Covid 19 could we have the hospital contact you and would you, as our doctor, be able to request this specific protocol/treatment for us? If not, how would we go about obtaining this treatment?"
It was such an important question, and honestly, I don't have a perfect answer, but yes, what good is knowledge if those who could implement this protocol in a time of need are unaware or unwilling to use it?
Although my answer is quite imperfect, I wanted to share it with you. As always, I would like to hear your thoughts on the subject. Maybe there is more to it that I haven't thought of, in fact, I am sure there is, but it is certainly worth thinking about, Here was my answer:
"thank you so much
that's a really great question
i certainly would be very aggressive about getting this protocol
for myself and as i wrote
would literally be walking into the hospital with my bottle of vitamin c
and have a friend inject it into my iv if they had to
not kidding
i mean business!
as to heparin and methylprednisolone,
i think i could talk them into it
if i could talk!
i could certainly share the video or info,
the precise protocol with anyone who would listen
i suggest you actually stop the video at the frame where the protocol is written down, and write it yourself
i may do that for everyone tomorrow,
but i would present it as "this is what has worked"
and i want it!”
Sadly I just spoke with an NYU neurosurgeon I barely know
and asked him what he would do if a patient presented to him suffering from Covid-19
he said he would give them "warm fluids" and make them comfortable. I told him about the protocol I sent to you and he said he would never give it because it is not proven
and would need to be proven by clinical trials in order to protect him from getting sued for using and unproven treatment which was at once remarkable and scary as hell
but it's true! So I do believe that we need to advocate strongly for ourselves when it comes to dealing with the medical system especially if we are fighting for our lives or the lives of a loved one. You know I think tomorrow I will share this exchange with the rest of my patients! (which I am doing now!)
The guy is a researcher for NYU so he should be thinking out of the box, on the cutting edge
but .... his edge was not so cutting, not at all...
We must be our own best physicians in this rigid world. You, (and I mean all of you) I know, are up to the task. You never just say "ok" without thinking something through carefully.
You're on the right track, ..keep thinking, do not be suppressed!
This was my response note, and do admit, my experience with this traditional doctor "freaked me out" quite a bit. Fortunately, he is not on the front lines treating this disease. And so, I hope that those who are are ready to take concrete, more practical action to improve outcomes in any way that does not appear risky (none of the elements in the protocol outlined are in the risky category with the exception of the hydrochloraquine, which, as I have discussed here before, does have potentially serious side effects.)
As to the specifics of the protocol, I would add that I would likely include the use of the high dose zinc and probably the azithromycin as well, as these are also relatively benign additions, and, until a definitive cure or vaccine is established, i would not hesitate to use pieces of any and all protocols that have proven effective in a physician's experience. In fact, I don't think I would use the hydrochoraquine without the addition of the zinc, which, BTW, can also be added to an IV easily enough.
BTW, we will be ordering a second round of injectable Vitamin C for those who want it, either to take in an immune enhancing IV or to reserve for "emergency use".
Always more to add, more to come. Everything can be a little crazy-making and overwhelming, at so many levels. One "great" thing is that, at least while isolation continues, the pace of life is relatively slow, and there is no need to handle every aspect or issue in a given day. Of course, with respect to the financial, there may a time limit for some, for many. But almost always, one more day to wait or to think - or to do very little in isolation - is possible.
Call me if you need anything, to think something through, to talk. Above all, stay safe, stay healthy, stay sane.
Best regards -
Dr. Robin Ellen Leder
P.S. Please make sure that you are SLEEPING adequately at night (7-8 hours). Not uncommonly, during the days, we are able to handle the scary, anxiety-provoking realities we face fairly well, but during the night, the anxiety upsets our sleep or causes disturbing dreams or nightmares. Again, LMK if you need help. It is "normal" to be kind of tired these days, but "night sleep" is a must to maintain all aspects of your health.