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Hearsay

The Democrats have moved their impeachment inquiry fiasco to the next level with their public testimonies.  These are the same witnesses that were hand-selected by the Democrats for “closed door” sessions with the goal of presenting to the public the most incriminating evidence for impeachment.  Nancy Pelosi and Adam Schiff have actually “raised the bar” on their accusations and are now saying that the President has committed an act of extortion and/or bribery.  Like the conductor of an orchestra, Schiff is carefully conducting every minute of his symphony.  I did not waste any time watching the televised testimony knowing that the biased media would tell me what they thought I needed to know.  From what I have seen of the testimony there has been nothing of substance.  Everything in the testimony today was hearsay.  The Democrats proudly displayed their primary witness for the day, Bill Taylor.  I think the Democrats feel that the witness’s credentials somehow make him a more trustworthy observer.  Mr. Taylor is a graduate of the United States Military Academy and received a bronze star while serving in Vietnam.  Robert Mueller had a stellar record as a marine veteran and former head of the FBI.  His Russia probe was a total disaster however and made his Democratic backers look like fools.  Despite his outstanding record, Mr. Taylor did not speak with the President and therefore does not know why the military aid was temporarily withheld to the Ukraine.  He (Taylor) assumed that the aid was contingent on the launching of an investigation into the Bidens and Burissma.  Gordon Sondland, ambassador to the EU testified last week to essentially the same assumptions.  When Taylor initially texted Sondland regarding his concerns over the delay in aid, Sondland responded that there was no quid pro quo.  Sondland testified to that while under oath in his closed door sessions.  Once other witnesses contradicted Sondland’s testimony, he suddenly “remembered” the phone call in question.  Was that a simple memory lapse or was it perjury?  Perhaps the Democrats pressured him to say there was a quid pro quo.

One thing is certain, you can’t convict someone on hearsay alone.  There has been no firsthand knowledge or objective evidence to indicate that the President pressured Zelensky into investigating the Bidens.  The military aid flowed and no investigation was ever conducted (although it should have).  The Trump Administration has been a good ally of the Ukrainians, supplying military weapons, including anti-tank missiles.  Under the Obama Administration the Russians invaded the Crimea and annexed it without Obama doing anything to stop them.  Then when the Russians invaded the Ukraine, the Ukrainians bravely fought back.  Obama aid consisted of blankets and MREs (meals ready to eat).  The Obama Administration was cowardly in the face of Russian aggression in Eastern Europe but it was President Trump who provided real aid to the Ukrainians for survival.  Hopefully Republicans in the House and Senate will continue their steadfast support of this President who has been under continuous attack by the corrupt deep state.  The longer this unjust debacle continues the more the Dems are ensuring Trump’s second term.

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Trump’s Budget

More on defense & security, less on social programs.

The Trump Administration released their budget proposal. As promised our President is wanting to increase spending on defense and homeland security. They have also suggested limiting growth in many social programs. Under the previous Administration food stamps, disability payments and welfare programs increased exponentially resulting in a doubling of our national deficit to some 20 trillion dollars (even with cuts in defense). Chuck Schumer is screaming bloody murder and will no doubt depict Republicans as heartless. Our society has become one of entitlements and dependency. The Dems are relying on government dependency to remain in power and expand the Democratic base. Have we learned nothing from the events in Venezuela? How long can the burden of an entitlement society be borne by the working taxpayer? We are taking a long walk off a short pier. Many Republicans are reluctant to support such efforts fearing loss of voter support. We elected a president with courage, but we still have a Congress of cowards. Remember the parable, “Give a man a fish and you’ve fed him for a day. Teach him to fish and you’ve fed him for a lifetime.” Handouts are not helpful long term.

 

Is COVID-19 Cardiotoxic?

Cardiac injury was a relatively common finding in patients sick enough to require hospitalization in Wuhan, China.  Significant elevations in high-sensitivity cardiac troponin I were seen in up to 20% of hospitalized COVID-19 patients.  Those elevations were associated with a several-fold increase in mortality.  Patients with troponin I elevations (suggesting cardiac injury) were much more likely to require mechanical ventilation than those with normal troponin I levels.  Patients found to have troponin elevations were also more likely to develop ARDS (acute respiratory distress syndrome), acute renal failure, electrolyte imbalances, coagulation disorders and hypoproteinemia.  Patients with elevated troponin I levels (cardiac injury) tended to be older and have multiple comorbidities such as hypertension and diabetes.  Other inflammatory markers were frequently elevated in infected patients including C-reactive protein, procalcitonin, CK-MB (creatinine kinase myocardial band), myohemoglobin, BNP (beta natriuretic peptide), and D-dimer.  This suggests that an intense inflammatory response (when superimposed on preexisting cardiovascular disease) may trigger myocardial injury in COVID-19 patients.  There is intense controversy as to whether ACEIs (angiotensin converting enzyme inhibitors) and ARBs (angiotensin receptor blockers) mediate or contribute to myocardial injury in COVID-19 infections.  Both classes of drugs are widely employed in the treatment of hypertension and heart failure.  The possibility that they could be contributing to or intensifying coronavirus infections is leading both patients and doctors to question their continued therapeutic use.  The COVID-19 virus utilizes the (ACE2) receptor to gain entry into human cells.  According to a published report in the “Lancet Respiratory Medicine” ACE2 expression was increased in diabetics treated with either ACEIs or ARBs.  An upregulation of ACE2 has also been seen with the use of thiazolidinediones and ibuprofen.

The logical conclusion to be drawn from these findings is that increased expression of ACE2 (the gateway by which the virus infects cells) would increase susceptibility to COVID-19 infection.  These drugs are more often used in patients at greatest risk for infection due to such co-morbidities such as diabetes, hypertension, and heart or kidney disease.  Infection from the COVID-19 virus is likely a multi-step process and not solely dependent on the number of ACE2 receptors.  Some evidence could suggest that ACEIs and ARBs may play a protective role in the lungs since they either interfere with the production of angiotensin II or “block” angiotensin receptors.  Angiotensin II increases pulmonary vascular permeability, leading to a greater potential for ARDS.  At this point there is no DIRECT evidence that any of the aforementioned classes of drugs increase the risk of infection from COVID-19.  Patients wishing to change their medication should discuss this with their provider.  It is not wise to stop taking your medicine out of fear that you could catch the coronavirus.  There are other classes of drugs that can be substituted for these medications but those substitutions should be made jointly with your provider.  We need more evidence to either confirm or disprove the assertions that have been made thus far.  Protecting high-risk individuals from exposure to the virus is the ideal solution until we have a tested vaccine ready for use.

Politics as Usual

The Senate has passed the $2 trillion relief package for workers and businesses that are in freefall from the COVID-19 pandemic.  The House has yet to vote on the measure and it is questionable whether Speaker Pelosi will play political football with the bill or get relief to those who need it most.  From her recent actions and bellicose talk I would not count on a smooth vote in the House.  Governor Cuomo is not happy with the bill since it only provides $3.8 billion for New York when the Governor says the state has suffered a $10 billion loss from the crisis.  Seems that the COVID-19 pandemic has struck “blue states” much harder than “red states.”   At least Senate Majority Leader McConnell got the Dems to abandon their demands for increased airline fuel emissions standards and solar and wind tax credits.  Now if we can just get the House to abandon their goal of “restructuring things” according to the Socialist Democrat vision as suggested by House Majority Whip James Clyburn.  Trump critics are losing their minds over the President’s statement that he is hoping to “reopen” parts of the economy around Easter.  The most significant accomplishment of the Trump presidency to date was an exploding economy.  Trump could proudly point to statistics like the lowest unemployment in at least 50 years for nearly every subgroup of the population, wage growth combined with low inflation, and expansion and growth in nearly every business sector.  The Democrats attacked him over Russia collusion, Quid pro quo with the Ukrainian president and failure to convict him on a partisan impeachment.  It took a microscopic virus to finally bring down this economy and its leader.  The Democrats could not have wished for better timing of a pandemic.  It certainly has to be very disheartening for the President to witness the dismantling of the most prosperous economy in history.

The President has no medical background and I’m sure he will ultimately rely on the advise of his close medical team before taking any action.  Some parts of the country have been heavily affected by the virus while other areas have been barely touched.  The President is looking at the China experience and how quickly they were able to reopen parts of their economy.  I hope that the President is correct in his assumption that the “shutdown” of the economy will last weeks and not months.  If this drags on for many months it will be extremely difficult to “pick up where we left off.”  The President is trying to lift everyone’s spirits by giving a timeline for an ending to the crisis.  It is always easier to face a stressful situation if there is an end in site.  Reporters and the media have never given the President any credit and instead are the incessant critics.  I sincerely doubt that Joe Biden or any other Democrat would have done a better job of managing this crisis.  God help us if we had government health care; the federal government moves slower than molasses and the death rate from COVID-19 would be astronomical.  The number of ventilators and the medications to treat the infection (chloroquine and hydroxychloroquine) would be rationed.  The private sector has already stepped up and is retooling to produce the necessary equipment to care for patients and healthcare workers.  My advice to the public is to 1) stay calm, 2) practice your social distancing, and 3) wash your hands or use hand sanitizer.  Remember the old expression: “if you’re not part of the solution, you’re part of the problem.”  Don’t be part of the problem!

Same Old Song

Many times I have lamented that our nation had become so divided and confrontational that it would take a national emergency to unite us once again.  The coronavirus pandemic emerged and suddenly Americans seemed to have a common enemy to fight.  Pathogens are indiscriminate, they don’t care what your political or religious affiliation happens to be.  They do prefer to attack the most vulnerable of the population, usually that means the elderly and those with chronic diseases or weakened immune systems.  Recent statistics have also suggested that men are more susceptible to the infection both with respect to numbers infected and mortality from the infection.  There is an old expression that “men are the weaker sex.”  There may be some scientific validity to that statement since the Y chromosome that determines the male sex lacks certain genetic material.  That genetic “absence” makes men more susceptible to sex-linked disorders and defects than women.  The belief that women have a stronger (or more aggressive) immune system means that they are more likely to suffer from autoimmune diseases (when the body turns on itself).  The same aggressive immune system may make them less susceptible to the coronavirus.  There are certainly other factors to consider in the statistical imbalance such as:  men tend to utilize preventive health care less, smoke more and often have other co-morbidities (hypertension, diabetes, heart disease, COPD).   This was a true opportunity for the country to work together and help one another.  But what began as an opportunity to unite the country has resorted to the same old song.

With everything but essential services being shut down, our economy has nearly ground to a halt.  Many hourly workers are unable to report to work and those in the service and transportation industries have been particularly hard hit.  Small businesses could go bankrupt and everyone in both parties believe there is an urgent need to bring financial relief to workers and prevent businesses from failing.  Both the House and Senate had been working on bills to help workers and businesses.  It looked as if something would be quickly passed and money would be flowing to those most in need.  Unfortunately politics won the day and Democrats and Republicans could not come to agreement on final bills.  Schumer does not want ANY relief for big business and Pelosi wants PERMANENT changes to unemployment (and God knows what else).  Several Republican Senators have been quarantined since testing positive for COVID-19 so Schumer suddenly feels he is in control of the Senate.  Instead of concern for their constituents, Pelosi and Schumer seem to be looking to make political gains out of a crisis.  They follow the old saying, “never let a crisis go to waste.”  It is shameful to delay help for people who are without a paycheck.  The need to put food on the table and pay the mortgage or rent and other bills remains.  I feel Congressional pay should be withheld until relief is passed for everyone else who is suffering through this crisis.

Corona Therapies

Although the media may believe they are performing a service to American society, their wall-to-wall, 24/7 coverage of the COVID-19 virus pandemic is doing the opposite.  They are actually providing a disservice by generating fear and panic in a population that has been indoctrinated by the media.  It is George Orwell’s society where the media tells you what to believe and how you should react.  When you are no longer able to think for yourself, it is only a matter of time when that helplessness leads to panic.  The media has focused on the virus’ contagious nature and relative high mortality in older, vulnerable populations.  Where was this histrionic reporting during past influenza epidemics?  My own personal belief is that this has been blown out of proportion due to the media’s extreme hatred for President Trump.  It seems more than a coincidence that this crisis appeared on the scene after other attempts to remove Trump from office failed.  With an upcoming presidential election the Dems are hoping a crashing economy from a medical crisis will result in his defeat.  The Dems answer to Trump, Joe Biden, is a medical crisis in itself.  The scientific community is apolitical and has already shown progress toward a vaccine that is now in human trials.  The FDA approval process is an arduous one, and that is to protect the American public.  It will most likely be a year or more before the vaccine has cleared all the necessary steps to be widely distributed.

Lessons learned from experience with COVID-19 in China and South Korea have made several discoveries.  1) Corticosteroids should be avoided as they may prolong viral shedding.  2) Bronchodilators are best administered by metered dose inhalers rather than nebulizers which may spread the virus.  3)  Antibiotics are best avoided unless there is a clear indication for them.  4)  Co-infection with influenza is unlikely, but co-infection with SARS-CoV-2 may contribute to pneumonia.  5)  People who die from COVID-19 are those who require ventilator support and die from ARDS (acute respiratory distress syndrome).  6)  Infection can occur in children but is generally not as severe as that seen in adults.  A case of neonatal COVID-19 infection was reported in China but is probably not transmitted from mother to fetus.  7)  Several combinations of anti-virals have been tried with mixed results and toxicity.  8) Chloroquine, used in preventing and treating malaria, has shown anti-viral activity to the coronavirus.  It does have a risk for hepatic damage and could be problematic in patients with CHF, recent MI, G6PD deficiency, epilepsy, or porphyria.  The recommended treatment of mild, moderate or severe disease is a dose of 500 mg PO twice daily for 10 days.  A combination of chloroquine and remdesivir was shown to be effective against the newly emerged novel coronavirus (2019-nCoV).  9)  Hydroxychloroquine inhibits the virus in much the same way as chloroquine and is better tolerated in most cases.  It is also 3X  more potent therefore the course of treatment is shorter.  The dosage studied was 400 mg twice a day on day 1 then 200 mg twice a day for 4 more days.

Tocilizumab is an interleukin-6 (IL-6) inhibitor that could be beneficial in patients with extensive lung involvement and those with elevated IL-6 levels.  Tocilizumab suppresses the immune system and should be avoided in patients known to have other serious infections such as tuberculosis.  Some have suggested that ACE-inhibitors(ACEIs)  and angiotensin-receptor blockers (ARBs) could increase the severity and transmissibility of COVID-19 infection as a result of greater expression of ACE2 receptors.  French researchers have suggested that NSAIDS such as ibuprofen be avoided for potentially making infections worse and for impairing renal function.  Both ACEIs/ARBs & NSAIDs are known to impair renal function at times when patients may become volume depleted and hypotensive.  It would not be unusual for an individual to become both volume depleted and hypotensive in severe COVID-19 infections.  Fluids are often administered judiciously in the sickest patients due to the increased likelihood of ARDS and fluid accumulation in the lungs.  The virus results in lymphopenia and experience has shown that COVID-19 diagnosis and treatment may be guided by the surveillance of neutrophil-lymphocyte-ratio and lymphocyte subsets over the course of the disease.

Never Ending Story

I have become increasingly disgusted with the blatant media bias.  Every news story and every headline is highly derogatory of the President.  Even when I access the Yahoo website all the stories have defamatory titles and introductions. Every “objective” journalist seems to be trying to sway public opinion against Trump.  Never in my lifetime has there been such vitriol against the leader of our nation.  The 60 Minutes program on Sunday night was a prime example of what was previously considered newsworthy programing.   Lesley Stahl gave leading questions to Fiona Hill, former official at the National Security Council who specialized in Russian affairs.  She was called as a witness by the House Intelligence Committee in the Trump Impeachment hearings for her knowledge in Russian and Ukraine intelligence.  The Democrats wanted her to refute the Trump assertion that he (Trump) wanted the Ukraine President to investigate that country’s interference in the 2016 American Presidential elections.  Although Hill testified that the Ukrainians did not interfere with our elections, Dan Bongino, a Fox News contributor (and former Secret Service agent), refuted her claims. Ukrainian officials previously testified to the fact that they did interfere with the 2016 elections.  The President has a responsibility to protect our elections and if the Ukraine attempted to alter the results of the election in any manner, it should be investigated.  Lesley Stahl was inviting Ms Hill to criticize the President and his actions.  To her credit, Fiona Hill was evasive in criticizing any officials.

Fiona Hill is considered an “expert” on Vladimir Putin and his behavior.  According to the 60 Minutes interview, Putin looks for vulnerabilities in world leaders and attempts to capitalize on them.  Every leader looks for weaknesses in his/her opposition.  Only the strong survive is true throughout the animal kingdom.  Ms Hill believes that Trump’s business-style approach of not being critical of someone with whom you are negotiating with has been manipulated by Putin (and others).  No previous president has been as successful with foreign leaders as has President Trump.  If we elect Joe Biden or Bernie Sanders we would be in much worse position throughout the world than we currently see ourselves.  I know the media wishes to destroy this president, but the Democratic alternatives are 1000 times worse.  I fear for our nation if the media is successful in bringing down President Trump.

Mountain Building

There seems to be an ongoing battle between the media and the Trump Administration over the coronavirus.  This should come as no surprise since the media has been at odds with the President since he first announced his candidacy.  Regardless of what the President or his representatives have done, the media have been critical of the action taken.  My mother was famous for saying, “Let’s not make a mountain out of a molehill.”  The media seems to delight in building mountains from every story to fill air time.  In this case they are creating hysteria at the same time the President and his team are trying to maintain an atmosphere of calm.  The media continue to emphasize the number of “new” cases of infection and the number of deaths related to the virus.  What the media fail to emphasize is that the virus possess little risk to the average American.  It is only a danger to the elderly and those with impaired immune systems or multiple chronic medical illnesses.  The influenza virus is a much greater threat and has resulted in more deaths, but the media don’t focus on those facts.  The Trump Administration is trying to reassure the public with a knowledge that we have the best infectious disease experts working on the disease and will soon have medicines and a vaccine to combat COVID -19.  The media should also be serving a more prominent role in preventive medicine by teaching the public what they can do to remain healthy.  Such information would help to prevent widespread panic.  World travel makes it is nearly impossible to prevent novel infections from spreading.  The media could be performing a better public service if they were to be supportive of the government’s efforts to control this latest outbreak without spreading unnecessary fear and panic.  They seem to want this crisis to undermine the economy and the Trump presidency.

Health experts agree on the best actions for the public if they wish to avoid being infected.  If you have not received a flu shot this year, it is not too late to get one.  Wash your hands with soap and water frequently, avoid handshakes and touching your face.  If you don’t have access to soap & water, hand sanitizer is a suitable alternative.  Wipe surfaces often with antiseptic wipes.  Get plenty of rest and eat a balanced diet.  Control your diabetes and blood pressure if you are being treated for those conditions.  If you do feel ill, stay home and do not expose others.  If you feel that you need to see your provider for a severe cough or high fever, do so.  Otherwise treat your symptoms with OTC remedies at home.  By the time a vaccine is available the worst of this disease will likely have subsided.  For most people this is no worse than the common cold or the flu virus.  The human body is resilient and all we need to do is give it a little help and let it do the rest.

Gone Too Far

Democrat Senate Minority Leader Chuck Schumer issued a blatant threat to President Trump’s two SCOTUS appointments over a case being argued before the Court.  Schumer was speaking to a Pro-Choice rally held outside the Court while an abortion case was being argued inside.  There could be little doubt that this was a clear threat to the President’s two conservative appointments to the Court, Neil Gorsuch and Brett Kavanaugh whom Schumer named specifically.  The threats were meant to influence the Court’s decision on an abortion case and in particular the votes of the Court’s most recent appointees.  Schumer’s comments were blunt, he said, “You have released the whirlwind, and you will pay the price. You will not know what hit you if you go forward with these awful decisions.”  Çhief Justice John Roberts responded to this attack on the Court by saying, “Justices know that criticism comes with the territory, but threatening statements of this sort from the highest levels of government are not only inappropriate, they are dangerous.”   In an attempt to defend the Senator a spokesman for him said the comments “were a reference to the political price Senate Republicans will pay for putting these justices on the court, and a warning that the justices will unleash a major grassroots movement on the issue of reproductive rights against the decision.”  The spokesperson also pointed out that the President had previously questioned the impartiality of Justices Ruth Bader Ginsburg and Sonia Sotomayor.  The President’s comments however were never threatening in any fashion whereas Schumer’s comments were irresponsible and inexcusable.

Abortion is a topic that elicits strong emotions on both sides of the issue.  The Pro-Choice “rally” was more reminiscent of a mob that could easily be agitated into violenct actions.  Apparently the Senator has forgotten what happened on a softball field when a Bernie Sanders follower tried to kill Republican House members over healthcare concerns.   Senator Schumer knows better but apparently he believes this is an opportunity to win Senate seats and possibly the White House in November.  Since the Senate approves appointments to the Court, Schumer knows that the ultimate fate of Roe v Wade lies in controlling the Senate.  Schumer’s behavior is disgusting and not up to the standards we should expect from the Senate Minority Leader.  The state of American politics has become increasingly polarized and Schumer does not need to add fuel to the fires.  The Dems can no longer use the election of Donald Trump as an excuse for their own incivility and poor manners.  As Justice Roberts added, “All members of the court will continue to do their job, without fear or favor, from whatever quarter.”