Ralph A. Harvey, MD

06/23/2024

Interesting story about ‘epigenetics’ just recently- In some ways this is not a new idea-about 10 years ago there was a “beautiful study” where mice who love cherries were trained to associate the smell of cherries with pain (electrical shock). Their offspring-children and grandchildren were also fearful of cherries even though they did not experience any pain. (but not a great study if you were the mouse!)
Interestingly, some of the mice were raised by "foster parents", so that parents would eat cherries, but the offspring of those who had the electrical shock avoided them. The most recent study took that same model where they trained generation 1 to avoid cherries-but then they retrained/reconditioned those mice to eat/enjoy cherries. Their offspring “unto the second and third generation” would eat cherries with no problem.
People think genetics are things that are hardwired but the body is so profoundly complex.
The experiences (good, bad or "sideways") of our grandparents affected our parents, affect us and can affect our children- and probably our children’s children.
Reference:

The science of epigenetics suggests we can pass on trauma – but trust and compassion too

08/17/2021

Covid-19 Vaccine and boosters?- YES!!

Good news! It looks like federal and state authorities will be allowing the third Covid booster shot.
Bad news: It may take some weeks and even months for the details to get worked out.
It looks like there may be 4 basic categories of people who can get a 3rd booster.
A) Folks who are ‘obviously immunocompromised (ex: transplant patients, people on chemotherapy, or advanced HIV infection).
B) Folks who are immunocompromised in a ‘lesser way’- such as patients taking some of the Rheumatoid arthritis drugs, or people who have multiple chronic illnesses, and are at higher risk for infection and hospitalization.
C) Patients who are at increased risk. ( Such as patients over age 65, or overweight, or with diabetes
D) Everyone else.

As of Friday, 8/13, the CDC stated some patients who are immunocompromised should get a 3rd shot. On Monday, 8/16, the Michigan Dept of Health and Human Services said: “Michiganders who want a third COVID booster shot should be able to get one, even without providing proof of a medical condition, health officials said Monday.” As of Tuesday 8/17, Michigan pharmacies are still receiving emails about the specifics of the new recommendations, and what pharmacies are allowed to do. Pharmacies can give patients a 3rd vaccine only if it meets state health department and CDC recommendations, and those recommendations are changing daily.
I am a strong supporter of the Covid-19 vaccines. I believe that essentially everyone, (with very few exceptions) should be fully vaccinated. Will I get a 3rd Covid vaccine? In a heartbeat! YES!!

For now- I recommend that my patients keep in touch with their local pharmacy to see what becomes available over the coming weeks and months.
And if you haven’t been vaccinated- GET IT!!!

02/21/2021

Covid-19 Vaccinations- YES!!
Last week, my wife and I got our 2nd Covid-19 vaccines, (qualifying because we are health care providers.) When the vaccine became available through our County Health Dept, we jumped at the opportunity! I recommend that all my patients, my friends, neighbors, and relatives get the COVID-19 vaccine.
However, it seems there are many people who are hesitant to get the vaccine. Recently-a study showed that one third of the military have declined vaccine.
Nationally, almost 50% of Americans said they would refuse the vaccine if it was offered.

What are the personal, practical advantages of the vaccine?
It effectively eliminated the risk of death from Covid-19.
Nearly eliminates the risk of hospitalization.
Drastically reduces a person's ability to infect someone else.

Are there side effects? Yes- my wife had ‘flu like symptoms’ for 2 days, including chills, overall achiness, and she basically stayed on the couch for 2 days. I felt a bit achy, a bit slow, and glad that I took the day off after we got the shot.
Would we do it again? In a heartbeat!

There are unanswered questions:
-Might we need a booster shot? Possible.
-Are the vaccines 100% effective? No- but it looks like they are 90-95% effective, and that is much better than not having any protection without a vaccine.
-Is one vaccine better than another? there may be slight differences, but both vaccines currently being used in the US are very similar & very effective. I would have been happy to get either.

The distribution of vaccines within the US has been chaotic, and less than optimal.
It may take some months for most of the people who want the vaccine to be able to get it.
However, some folks are refusing to get the vaccine when it is offered. I think that is one of the biggest health mistakes anyone can make.

11/14/2020

COVID-19- a Personal Update:

Yesterday, my wife and I cancelled our Thanksgiving plans to travel for a small family Thanksgiving gathering. The risks far outweigh any potential benefit.
Within the past few weeks, the number of cases of Covid-19 infection are skyrocketing.
Of the people getting tested, the number who are positive is going up. Last spring, 1-1.5% of tests in the Lansing area were positive. Now, it is about 12% of people tested are positive. Hospital admissions for COVID, and the number of COVID-19 deaths are rising throughout the country. The COVID -19 epidemic is getting much worse than it was last Spring.

For Michigan, many, if not most of the major hospitals are already at capacity. For Sparrow hospital in Lansing, the ICU is already full, and the hospital is already overcapacity. Emergency contingency plans are being implemented. One of the difficult things is that in Lansing, and nationwide, hospital staff are getting exhausted, burned out, and right now 10-12% of the hospital workforce is out with Covid on any given day.
For a more frightening perspective- many cities are running out of ‘morgue’ space to store dead bodies. This happened last spring in New York City. It is now happening in El Paso, Texas.
Cities are renting refrigerated semi-trailers to store the bodies of people dying of Covid.

Good news! - More people are surviving COVID! - We are learning how to take care of hospitalized patients. But- the death rate is still increasing as the number of cases is increasing each day. We do know that there are health risk factors that influence whether the Covid virus will cause mild symptoms or result in hospitalizations and death.
Covid is ‘easier’ if you are: young, healthy, normal weight, without chronic illness, a non-smoker, and you are white, middle class with good health insurance, living in a good neighborhood.
Covid is more likely to kill those who are: Older, overweight, with multiple health problems, who are minorities, who don’t have good health insurance, and who are not financially stable.
People who live in nursing homes, and assisted living facilities are at very high risk of dying from Covid.

What can we do to prevent getting Covid, or to make the infection less fatal?
Some things are simple: Wear a mask whenever you are around other people, wash your hands and use hand sanitizer when you are around others, and practice social distancing. Throughout the nation- areas where people are less likely to wear masks get Covid more often and are more likely to die. This is not ‘rocket science’. There are simple steps that can protect our health- as individuals, as families, as a community, and as a country.

I will miss the opportunity to spend Thanksgiving with my 97 yr. old father in law, my son, my sister & brother in law. However- I feel it is my obligation and duty to do all that I can to reduce the chance for illness for myself, my family, our communities, and our country.

09/10/2020

Slowing down the aging process:
9-10-20
One of my primary goals with the HarveyHealthPerspectives blog is to highlight recent medical research that can make a difference to my patients.
A recently published European study showed that eating ‘ultra-processed foods’ was associated with an increased rate of aging. These processed foods increased ‘oxidative stress’ and inflammation, which can lead to quicker aging, cardiovascular, neurodegenerative diseases and cancer.

Examples of highly processed foods included: dairy products, including custard, ice cream and milk shakes. Processed meats included ham, sausages and hamburgers. Grains included: Pastries and breads, including muffins, doughnuts and croissants. Processed foods also include foods with added sugars, high fructose corn syrup, multiple additives and preservatives. - Think: The longer the list of ingredients, the more processed the food.

In Dr. Harvey’s opinion, other disadvantages of processed foods include: Increased risk of hypertension, obesity, diabetes, inflammatory diseases, fatigue, gut problems, depression, anxiety and dementia.

For those interested in the scientific side- the primary measurement for aging was the length of telomeres in a subject’s genetic DNA. For more information, the article can be found at:

Higher consumption of ultra-processed foods is associated with shorter telomere length — a sign of cell aging — among a cohort of adults from Spain, according to study data. “Telomere length gets shorter with every cell division, and thus, producing aging. However, this process may...

06/16/2020

COVID-19 in 2020: Thoughts from Epidemiologists & Infectious Disease specialists.
6/16/20

Recently, The New York Times did a survey of 6,000 Epidemiologists and infectious disease specialists. 510 doctors gave their thoughts about ‘when will life return to ‘normal’?
Their responses were in 4 categories: This Summer, 3-12 months, > 1 year, or “Never Again”.
These are the responses of less than 10% of the doctors. The following are the top 6 responses from my perspective.

These are not the results of a scientific study. This is a simple survey, asking physicians who specialize in infectious diseases and in public health what they are planning to do in the coming months. The response categories are this summer, in 3-12 months, more than 1 year from now, and for some activities- Never.

Shake hands with a friend: this summer 14%, 3-12 months 42%, > 1 yr. 42%, never-6%.
Attend a church or religious service: this summer 13%, 3-12 months 40%, > 1 yr. 52%.
Travel by airplane this summer 20%, 3-12 months: 44%, > 1 year 37%.
Visit an elderly friend or relative: this summer: 20%, in 3-12 months 41% .
Sends kids to camp or day care: this summer 30%, 3-12 months 55%, > 1 year 15%.
Eat at a dine-in restaurant: this summer 16%, 3-12 months 56%, > 1 yr. 28%.
Exercise at a gym: this summer 14%, in 3-12 months 42%, > 1 yr. 40%, never 4%.

They mostly agreed that outdoor activities and small groups were safer than being indoors or in a crowd, and that masks would be necessary ‘for a long time’.

They all agreed that available information is changing rapidly, and that for almost every question- the core answer is: “Well- it depends!”.

For the full story, go to: https://www.nytimes.com/interactive/2020/06/08/upshot/when-epidemiologists-will-do-everyday-things-coronavirus.html

Many of my patients cannot wait until “things are back to normal”. However- “back to normal” may be a long way away.
A few days ago, the CDC issued revised recommendations. My summary includes:
1) Our personal goal should be to reduce our risks.
2) Distance helps! Staying at least 6 feet away from others helps!
3) Wear a Mask when you are in groups or crowded areas!
4) The less exposure the better- (someone talking or singing can be releasing a lot more Covid-19 virus particles than someone breathing quietly, wearing a mask.)

Even experts need to make personal decisions about what risks are worth it in the age of coronavirus. For some, life will never be the same again.

05/28/2020

COVID-19 Testing, Staying Safer, and ‘What Does the Doctor Think?”
5/28/20
Lately, I have been getting more questions about COVID-19 testing, what my thoughts are about ‘staying safe’, and what the Summer may be like?

I have been working on a “Harvey Health Perspective” COVID-19 update for the past week, and it seems that every day, new information appears that changes what I want to share with my patients. Personally, I have been a physician for 30 years, and I have never seen a situation or disease where the information was changing and updating so fast!

As a physician, I try to keep my focus on ‘evidence-based medicine’. What does the data show us? (The information I am sharing is focusing on what is going on in the United States).
In any crisis, one of the key things that we need is reliable and useful information. However, that is difficult to find. Cities, regions, states, and the US government all report ‘information’.
However, the information we are receiving is ‘variable’, and sometimes unreliable.

Background- There are 2 types of COVID-19 tests: Antigen (swab up the nose)- which indicates an active infection, and Antibody testing (blood test) which indicates that the patient has had a COVID-19 infection in the past few weeks or months.

1st Problem- Within the US, there are over 150 different Antigen tests, and at least 150 different Antibody tests- and they are often not reliable. For some tests, the likelihood that the test is accurate is 50% or worse. Having a positive, or negative test is not always highly accurate. It could be falsely positive, or falsely positive. Can testing be useful? Yes… but the details are ‘complicated’ and confusing.

2nd Problem- Some groups around the country report the # of Antigen tests and the # of Antibody tests as separate numbers. Some groups report the total # of tests performed- combining the # of Antigen and Antibody tests. When we try to ask the questions:
How many Americans have been tested to see if they have active COVID-19? We don’t really know.
Likewise, when we try to ask the question: How many Americans have already had COVID-19? we don’t really know. We just do not have enough information.

3rd Problem: As of the end of May, the availability of COVID testing, both Antigen and Antibody remains low. For the Lansing, MI area, widespread COVID testing has only become available in the past 1 week. There are many areas of the country that still have very limited testing available. Often, it is only the people who are ‘very sick’ or very high risk who have been tested.

4th Problem: If you get Antibody testing done, and it is positive, it means that you MAY have COVID-19 antibodies. It means that you ‘probably’ had a COVID-19 infection, but we don’t know when, and it is possible that it is falsely positive, or falsely negative.

We also do not know if that antibody will protect you from a future infection.
Antibody testing can be very useful to epidemiologist or people who study disease progression. It helps the community and the country, but it does not always provide useful information to the individual patient.

A Doctor’s thoughts about Summer, 2020.
We cannot prevent getting COVID-19- but we can reduce our risks. For myself, that means:

1) -Social distancing: I will wear a mask whenever I am within 6 feet of people outside of my immediate family. 6 feet from others is a minimum!

2) -I will continue to wear a mask in my office, in any store, or in a mall, or if I am walking somewhere where there are people close to me.

3) -I will continue to wash my hands with soap and water whenever I can, and I will use hand sanitizer when I cannot wash. I carry a couple of bottles of hand sanitizer in my car, and it is easily available in my office.

4) - Air circulation matters! I will avoid in-door gatherings whenever I can. A concert outside is much less risky than a concert inside a building.

5)- I don’t plan on flying anywhere in 2020. I might fly on an airplane if I had a critical family emergency, but I don’t plan on attending any family gatherings, or conferences that require me to go to an airport.

6) If I were to fly on an airplane because of a family emergency-
-I would be wearing a mask from the time I entered the terminal until I was out of the building.
-I would be using hand sanitizer frequently!
-I would Self quarantine and stay away from my immediate family,
- I would get a COVID-19 Antigen testing 5-6 days after I came home.
-If it was negative, I would repeat it at 10 days from exposure.

7) Personally, I will continue to do hypertonic salt-water nasal irrigation multiple times a day. It may sound weird, but there is some good science behind it. Please look at my previous health blogs.

B) What the summer looks like in terms of COVID-19
Overall- as a country we are now at > 100,000 people dead from COVID-19. In some states, the # of new cases has decreased, and in some states, the # of new cases has increased.
As I look at the ‘lack of social distancing’ over the Memorial Day weekend, it will not be a surprise if the # of new cases increases over the next 1-2 weeks.
Because our country does not yet have adequate COVID-19 testing, the # of new cases is likely to underestimate the spread of the disease.

C) Statistics:
The information is still very “preliminary” for the United States but overall it looks like:

1) 0.4% of people who feel sick from COVID-19 will die.
For people over 65, the CDC estimates that 1.3% who get COVID-19 symptoms will die.
It is possible that up to 50% of people who get COVID-19 will have no significant symptoms.

2) In general-the older you are, and the more chronic health problems you have, the more likely you are to end up in the hospital, and a more likely you are to die.

05/08/2020

Is it OK to take Anti-inflammatory drugs with the risk of COVID-19??
Harvey Health Perspectives: 5-8-20

This is a frequent question my patients are asking, and like many scientific questions- the answer gets complicated! 1st a definition: “NSAIDs (Nonsteroidal anti-inflammatories), include OTC Motrin/Advil/Ibuprofen, Aleve/Naproxen, or prescription NSAID’s such as Celebrex or meloxicam and others). There are valid concerns about using NSAID drugs if someone has a severe COVID-19 infection.

SHORT ANSWERS:
1) NSAID- OK: Used correctly, NSAIDS are OK for people with musculoskeletal pain. People taking NSAIDS for ‘musculoskeletal pain, or arthritis should not stop taking their medication for fear of increasing their COVID-19 risk.

2) NSAID NOT OK: If you are hospitalized with COVID-19, then NSAID’s may not be helpful, and for some patients can make things worse.

BACKGROUND:
In mid-March, the French Health Minister tweeted that people with suspected COVID-19 should avoid NSAIDS. He stated that if people had a fever, they should take acetaminophen (Tylenol).
This was not a new idea. In 2019 French health workers were told to avoid treating fevers or infections with NSAID because an anti-inflammatory could reduce the immune system and slow one’s recovery. NSAID’s affect the body’s handling of inflammation. It seems that most patients with severe COVID-19 infections are hospitalized due to the body’s handling of inflammation.
However, it appears that most people who get COVID-19 do not become severely ill. Fortunately, only a small percentage of people who are COVID-19 positive end up in the hospital.

If you want more information, an article I found helpful is from Science, March 27, 2020
[ https://science.sciencemag.org/content/367/6485/1434.1 ]

As pandemic coronavirus disease 2019 (COVID-19) continues to accelerate, the French Health Minister, Olivier Véran, has confused matters by claiming on Twitter that anti-inflammatory drugs like ibuprofen or cortisone could aggravate the infection ([ 1 ][1]). However, scientific evidence does not in...