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Archive for March, 2020

Covid-19 is quite contagious.  Patients coming into a clinic or hospital could put themselves at risk from other patients.  Patients who are not yet symptomatic can put other patients and health-care workers at risk.  How can we get essential medications, yet limit risk?  Drive-Thru.

I am on several medications which cannot be stopped because I am controlling chronic diseases (that cannot be cured).  I no longer enter my pharmacy.  Drive-Thru window.

Osteoporosis is a chronic disease we cannot cure, but can control.  We now call every Prolia and Evenity patient offering the option of being met in the parking lot.

Roll down the car window.  Roll up your sleeve and put your arm out the window.  Get your shot.  Roll up your sleeve and window.  Done with minimal exposure to another person.

Remember that skipping a Prolia shot is a very bad idea.  Recently evidence has surfaced that missing a Prolia shot by more than 2 months can increase the risk of vertebral fracture to higher than it was before starting treatment.

Most of the time we can delay the DXA/VFA or lab tests by a month or 2 or even 6.  Prolia and Evenity should not be delayed.  Forteo and Tymlos usually arrive by mail for self injection.  Changing to a different medication could be another option.  Call your doc.

Jay Ginther, MD

Could Vitamin D Help Against COVID-19?

March 23, 2020 @ 6:49 pm
posted by Dr Ginther

Today I ran across mention of an old observational study of seasonal colds and flu in northern (temperate zone) and southern (tropics) India.  Colds and flu had no seasonality in southern India where vitamin D from sunshine is equally available all year.

Colds and flu were seasonal in northern India closely following the months when vitamin D is not readily available from the sun which is too low on the horizon to produce vitamin D.  There is not direct evidence that  lower vitamin D levels allow more colds and flu, but it seems reasonable.

We have long known that vitamin D is involved in human immune system function as well as bone health.  e.g. A National Institute of Health study found that persons with monohydroxy-vitamin D levels over 33ng/ml have half the risk of colorectal cancer as those with less than 12 ng/ml.

Vitamin D toxicity is possible but very rare according to the Mayo Clinic, requiring doses of 50,000 IU (1250 mcg) daily for months.

My experience in Iowa is that most persons not taking at least 1000-2000 IU (25-50 mcg) daily have vitamin D levels below 20ng/ml  December through April.  That is also cold and flu season.

I take 5000 IU (125 mcg) daily to keep my level at 50-60 ng/ml.  That can’t hurt and it might help prevent viral infections.  Over age 65, I have started working from home and am setting up TeleMedicine capabilities because of COVID-19 guidelines.

Follow your state’s health department guidelines.  And extra vitamin D could help.  If you have not taken any in the past, up to 5000 IU (125 mcg) daily should be safe until you have a chance to check your level.

Jay Ginther, MD

Iowa Bone Club 2020 Postponed

March 13, 2020 @ 9:43 am
posted by Dr Ginther

We are cancelling Iowa Bone Club for 24 April

We plan to reschedule for September, assuming that COVID-19 will have receded by then

Jay Ginther, MD

Iowa Bone Club 2020 – Friday 24 April

March 2, 2020 @ 1:09 pm
posted by Dr Ginther

Iowa Bone Club 2020 will meet at Allen College in Waterloo, IA on Friday 24 April.  This is the only meeting in Iowa each year which is dedicated solely to optimizing Bone Health.  We prefer to prevent unnecessary fractures.

We aim primarily at teaching healthcare professionals of all types about the latest advances in caring for bone health.  NPs, PAs, DNPs, RNs, LPNs, CMAs, Meds, DOs are all included.  Often the lecturers learn as much as the students.  CME and CEU credits will be available.

This year’s meeting will include a presentation about using anabolic medications to grow bones first, then preserve the gains.  We will discuss how optimizing bone quality before total joint replacement or spinal fusion results in faster healing and better results.  We will learn how to minimize the ill effects of common diseases like diabetes on bone health.

As always, we will have a roundtable for staff dealing with insurance companies about medication pre-authorizations.  Also our roundtable among providers sharing thoughts about difficult cases.

Full details will follow

Jay Ginther, MD