Paris – 1719
Sweden – 1749-1765
Paris – 1719
Sweden – 1749-1765
Health officials in Sierra Leone are admitting defeat in the fight against Ebola and are trying to set up self-treat kits for patients to use at home because of the lack of hospital beds to care for the ill.
This sad development started me thinking about what I would do if I was stuck in a place with Ebola and could not receive care from a physician or in a hospital.
***Please note that any one who thinks there might be even a tiny chance that they have Ebola should present immediately to a hospital for definitive care.***
***The information below is not medical advice or recommended treatment on how to treat Ebola and should not be used as such. Treatment for a suspected or known Ebola virus infection MUST be carried out under the care of the appropriate health authorities and by a licensed physician.***
The information listed below is purely an academic exercise for my personal professional growth as a critical care physician and serves solely as a template around which to organize my current reading on the Ebola infection.
Here is what I think I would do to try to self-treat Ebola at home and survive the disease if I was in Sierra Leone. The following strategies are based on a healthy, non-obese adult with moderate financial resources. I am giving myself some time to prepare my kit and to gather supplies and oral medications, etc.
Faced with Ebola, I would try remedies that have some at least theoretical rational – even if they have not been scientifically proven, are not used in conventional medicine, and that might be considered crazy or gross.
But, since treating Ebola at home would be a desperate situation, desperate measures would be warranted and I would do whatever I had to do to provide a chance at a better outcome than taking on Ebola straight up. Even the World Health Organization sponsored group of ethicists deemed “unproven interventions” acceptable in the looming Ebola healthcare catastrophe.
This is going to be a long post so I will post it as I write it to give myself some time to reflect. It should be finished in a couple of days.
Convalescent Antibody Strategy
One strategy that is being tried with perhaps some success is convalescent serum therapy. This entails giving a blood transfusion to a patient from a patient who has had Ebola and recovered. The rationale is that the plasma or whole blood transfusion will provide protective antibodies to the receiving patient.
However, since a blood transfusion would not be available on an at-home basis, I would attempt to get antibodies into me from a recovered patient another way. Probably the best stab at this would be to imbibe saliva from a recovered patient.
Saliva contains IgA antibodies for certain and might contain IgG and IgM antibodies. Since the most natural way saliva is passed between people is kissing and that would not be a good idea even if the person donating the saliva is supposed to be “immune” I would have the donor spit into a vial and then mix the collection into a gas of juice or milk.
I would shoot for at least 250 cc of saliva donation. It certainly would be somewhat off-putting and not nearly effective as a serum transfusion but faced with no Ebola antibodies and at least a chance at some antibodies I would go for it.
This treatment would be fairly high on my list. Nano silver is a commercially available product and is a similar product to the more commonly discussed and sold colloidal silver solutions.
There is no direct data on nano silver killing Ebola virus but the scientific rationale is fairly straightforward. Silver has been used for centuries as a natural anti-microbial and is incorporated into many modern day medical devices for its germ-killing benefits. Virtually all central catheters are impregnated with a silver layer as are many intubation tubes.
There are numerous published reports in Pubmed about the anti-viral effects of silver.
The main side-effect of silver per mouth is argyria, which is a permanent bluish, gray discoloration of the skin. It is unknown why some people develop this or how much silver load is needed to cause this skin reaction.
However, the general consensus is that a higher load of silver increases the risk. The effect of taking the silver in the smaller nano-sized particles as opposed to the larger particles in the colloidal solution is not known.
This is a very controversial treatment modality that is widely panned by the scientific and professional care communities but used by many tens of thousands of patients worldwide.
Rife treatment consists of generating electromagnetic frequencies that are supposedly used to kill microorganisms. Supposedly each microbe has specific frequencies that render it susceptible to killing.
It is most frequently used in the United States by patients with Lyme disease. One physician has reported in a private communication that he used it to great effect in patients with West Nile and dengue fever, two diseases caused by viruses that have few good conventional drug treatments.
For a more detailed discussion of Rife therapy, please see Can Rife Therapy Help Cure Ebola?
This is a highly controversial product used by many thousands of Lyme patients in an attempt to kill the Lyme bacteria and other co-infections. It is chlorine dioxide, a substance that is used as a water treatment chemical.
It is essentially very dilute bleach and any suggestion of its efficacy in the Lyme patient community draws immediate howls of protest from most physicians, including most typically this physician.
I would never use it to treat any patient, Lyme or not, under normal circumstances. However, what is going on in Africa is not a normal circumstance. If I was dying of Ebola, I would take my chances and take it.
My rationale for using it in myself as an Ebola patient is that the virus is readily killed by chlorine and this a chlorine solution. The supposed “non-lethal” dosing has been worked out and reported by many Lyme patients and there are patient chat groups with many hundreds of members discussing it on the internet.
It is commercially available on the internet and is inexpensive and does not require refrigeration or special handling.
This prescription-only drug is used for HIV treatment and post-exposure prophylaxis. It does have side effects including liver failure, but there are anecdotal reports of its use by physicians in Africa using it in the current Ebola outbreak with good effect.
The dosing is either 300 mg once a day or 150 2X/day and I would do the twice a day dosing.
Turmeric – based on the centuries-old use and the current mega-dosing strategies used by oncology patients, I would take this in high doses. I would take 4 gms 3X/day. Turmeric has ample scientific rationale as an antiviral and has biochemical support for why it might be useful against Ebola.
For a more detailed discussion of seven additional possible herbal remedies, please see Can Gingko and Turmeric Help Cure Ebola?
Red Marine Algae
I would try these supplements early in the course of the disease with the understanding that the commercially available supplements do not contain the chemical substances or species that have been proven against Ebola. However, the commercially available formulations do have some reported activity against other viruses and the supplements are generally well-tolerated. I would hope for some luck in covering Ebola.
Red marine algae does cause anticoagulation so I would not take it in the later stages of the disease when hemorrhage is a risk.
Much of the morbidity and mortality of the Ebola virus is the result of severe dehydration that takes place because of the prolonged and nearly constant vomiting and diarrhea that occur.
When patients lose a significant amount of fluid that is not replaced, the kidneys become damaged and lose function. This is an ominous development even in a highly advanced ICU setting, where renal failure is associated with an 85% mortality. At all costs, the kidneys must be protected with sufficient fluid in the intravascular space.
In addition to the fluid that is lost to the outside of the body, some fluid is “lost” from the intravascular space into the tissues because of leaky capillaries. Functionally, in the acute period this is also damaging because it can not be used to perfuse and hydrate the internal organs, particularly the all-important kidneys
So, fluid replacement is key to surviving the disease.
I would start drinking fluids on a steady basis, the oral intake depending on what was in the fluid.
I would doctor up a solution that approximates the IV solutions used in the ICU. These are usually about 5% glucose and about 1% sodium chloride.
To get to this approximately, I would put several teaspoons of table sugar in a liter of clean water and about .5 teaspoon of salt. I would drink this at a constant rate of about 300 cc/hr to start.
One problem with this is that the salt might cause diarrhea because of the osmotic load. If this happened, I would switch to drinking soda diluted with 50/50 water and start eating pickles, which are loaded with salt but which would be less likely to cause diarrhea.
In this situation, it is more important for me to get the NaCl in than the sugar. In fact, it is beneficial for humans who are ill and being closely monitored to have their serum sodium levels bumped up to around 150 meq/L.
This is the famed “hypertonic saline solution” strategy that was pioneered at Johns Hopkins Hospital in the 1990s. The benefits of this strategy are beyond the scope of this discussion, but in summary having a slightly high level of salt in the blood stream both kills microbes and benefits all the internal organs and also shuts down the inflammatory response.
Because of the nausea and vomiting, Ebola virus disease has severe electrolyte derangements and several electrolytes must be replaced aggressively.
The most difficult to replace is magnesium. It should be taken in the glycinate or malate forms. I would not use the oxide form because that form causes abdominal pain and diarrhea.
For Ebola patients who have massive diarrhea and vomiting, the potassium ion losses are large (see below). The body has a narrow therapeutic window for potassium so the kidneys do their best to retain as much of the diminishing potassium stores as they can. They dump magnesium to try to save potassium.
But, typically this mechanism ultimately gets overwhelmed and the result is that the serum potassium and magnesium levels are low.
Once magnesium is low in the body, it takes a massive amount of repletion to make up the lost ground. Luckily, magnesium has a large therapeutic window (meaning it is hard to overdose on it if the kidneys are working OK.)
So, since I am figuring that I am going to be losing lots of potassium and hence magnesium as the gastrointestinal problems gets worse, I am going to start taking magnesium at the outset to try to get ahead of the game.
Magnesium pills are big horse pills and as patients get sicker, they get harder to take, but they can be ground and dissolved in oral fluids.
Potassium – this is a critical electrolyte to replace during vomiting and diarrhea. This gets very low very quickly and almost all IV solutions have potassium chloride in them.
I would take potassium tablets fairly aggressively. Typically the IV amount is 40 meq/L. Since over the counter supplements with potassium have about 1-2 meq of potassium in them, you have to take a lot of tablets to get close to the IV dose.
The issue is that potassium has a narrow therapeutic window meaning there are serious side effects if you get too high. If I was having GI losses I would probably take 1 tablet an hour. If no vomiting or diarrhea, I would take 1 tablet every 3-4 hours.
Calcium is also always low when a patient is sick in the ICU. Low calcium can cause muscle weakness and cardiac failure. I would start taking calcium tablets 1-2 every 4 hours.
The last important electrolyte to replace is zinc, which catalyzes a huge number of biochemical reactions in the body. I would start with 20 mg every 12 hours.
Hydromorphone as needed. I prefer this drug over Oxycontin, morphine etc. because it is potent but relatively non-sedating and does not have the rapid build up of metabolites. It is available in pill-form as well as IV form.
Battlefield acupuncture points would be stimulated and activated as soon as the diagnosis is made and before the onset of pain. I would continue this throughout the treatment course with self-retaining needles or at the very least with ear magnets placed on the points.
For a detailed discussion on how to do a home battlefield acupuncture, please see Battlefield acupuncture.
Hippocrates said 25oo years ago, “Give me a fever and I can cure any disease.”
Based on this and somewhat counter intuitively, I would not try to lower a fever if it was below 104 or so, where the energy consumption of the body due to the fever begins to be deleterious. The fever is a positive physiological reaction and it should be left undisturbed in most cases.
Supplemental oxygen – I would use a home oxygen generator that has nasal prongs and can generate up to 3L oxygen flow. I would put this on at time of diagnosis and wear it even if I was not short of breath to keep the tissues and organs as well oxygenated as possible and the Po2 as high as possible.
Salt therapy – I would sit in a salt booth and breath pharmaceutical-grade salt to decrease mucus formation in the lungs from the systemic inflammatory response.
Breathing inhaled salt also has an anti-inflammatory effect systemically, although it is not clear that it significantly increases serum sodium.
It has been known for centuries that the miners who worked in the Polish salt mines had much lower incidences of respiratory and other disease.
If this was not available, I would use the inhaled salt therapy used by patients with cystic fibrosis to clear their lungs of mucus
Liver – milk thistle 1200 milligrams 3x/day
Gastrointestinal – Konsyl fiber, aloe powder, charcoal
Kidney – N-acetyl cysteine
I would tap the prone upper forearm near the elbow crease to activate the immune system mechanically. This would be done on both arms 40 taps each side at least once an hour.
I locate the spot by placing my bent arm on a table in front of me, with the palm down. Then a centimeter below the crease, toward the outer edge is the area where the forearm tendons insert. This is the area to tap.
Energy Therapy – OK, this might sound a lot goofy, but I would do it because it couldn’t hurt and might help and remember I am stuck in Sierra Leone by myself with Ebola. Here goes…
While I was trying to kill the virus particles and buff up the immune system and replace the electrolytes, I would also try to “clear the virus energetically” from my system.
There are plenty of physicians who are quietly getting set up to do this. As it was described to me by a colleague, I would hold an vial imprinted with the Ebola virus frequency (believe it or not available on the internet but does not contain any actual virus particles) in my hand and then tap the following acupuncture points in order in clockwise fashion 50 times each
I would then continue to hold the vial for 15 minutes and repeat every hour for 6 hours per day.
Generally, light is a healing modality. In the 1918-9 Influenza epidemic, patients who got daily sunshine had much lower rates of mortality. Using this rationale, I would try to sit outside for at least 20 minutes a day.
I would also do twice daily blood irradiation with either a red-light LED or a low-level, low coherence laser.
Ebola patient Ashoka Mukpo is to receive a blood transfusion from previous Ebola patient Dr. Kent Brantly the University of Nebraska Medical Center has announced.
In an incredible stroke of luck, Brantly is of the same blood type as Mukpo and was traveling in the Omaha area when contacted about donating blood. Brantly’s serum contains antibodies against the Ebola virus that physicians think might be helpful in fighting Mukpo’s infection.
Mukpo is also receiving supportive care and receiving an experimental antiviral drug from Chimerix.
This is the second blood donation Dr. Brantly has provided. His convalescent serum was given to Ebola patient Dr. Richard Sacra.
Dr. Sacra was discharged from the hospital several weeks ago without suffering the end stage disease such as cardiac, kidney, or liver failure.
Dr. Angela Hewlett of the Biocontainment Unit at the Nebraska Medical Center expressed thanks to Dr. Brantly.
“We are incredibly grateful that Dr. Brantly would take the time to do this, no once, but twice.”
Epidemiologist David Dausey is calling for restrictions to be placed on residents of West Africa ability to travel to the United States.
Dausey, a Yale-trained disease expert, is arguing that the disparity between care levels available in West Africa and the United States will understandably encourage well-to-do Africans who suspect they have contracted Ebola virus disease to lie about their exposure history and travel to the US for world class care that will be paid for by the United States government.
He refutes the argument being promulgated by the Obama Administration that restricting commercial travel will cause a delay in getting supplies and aid to the affected African areas by suggesting the United States military is more than capable logistically to handle the task.
To date only one known case of a traveler who likely surmised that he was infected with subsequent travel to the States has been reported. Thomas Duncan is receiving intensive care and an experimental drug at a Dallas hospital and his family has been moved and lodged at government expense.
Philadelphia podiatrist Dr. Aileen Gong has been indicted on charges that she fraudulently billed Medicare over $480,000 for procedures that she never performed.
Gong, who practices in the Chinatown section of Philadelphia, was allegedly out of Philadelphia during the times she claimed she performed the procedures.
According to Ana Matos, a top health official in Spain, the nurse who contracted Ebola virus disease delayed seeking medical care for 5 days after she first developed symptoms.
The Spanish nurse, who is married, developed a fever on September 30 but did not seek medical care until October 5.
Fever, along with nausea and vomiting is considered an early symptom of the disease. Later symptoms include cardiac, renal, and liver failure and hemorrhage from the skin, eyes, mouth, and rectum.
A Spanish nurse has contracted Ebola virus disease from a patient she cared for after he was transferred from West Africa for care.
The nurse, whose identity was not being released, was part of the team that took care of Manuel Garcia Viejo, a 69 year old priest who contracted Ebola in Sierra Leone and was medically evacuated to Spain for treatment. The patient died on September 25.
Spanish authorities say the recent contacts of the nurse, who reportedly presented with a fever, are being traced. The nurse presented to Alcorcon Hospital in the Madrid suburbs for treatment and was immediately placed in isolation.
Viejo was the second missionary priest from Spain to contract and die of Ebola virus disease. Miguel Pajares died after being given ZMAPP in a Madrid hospital. He was 75.
Texas Health Presbyterian Hospital has apparently been caught in a lie regarding their explanation yesterday about why Ebola patient Thomas Duncan was sent home.
Officials there initially placed the responsibility on missing Duncan’s recent stay in Liberia on a faulty electronic medical records system. They maintained that the patient’s time in Liberia was recorded but that it was not in the physician notes section of the electronic health record.
The hospital then spun an untruthful tale about taking immediate steps to change the “glitch” in the electronic chart to rectify the problem
However, now the Hospital is acknowledging that the recorded information was available to both physicians and nurses and that the issue was not a poorly designed electronic medical records system.
For shame on the Hospital staff for trying to cover up really abysmal care that likely will cause innocent people to lose their lives.
The ER physician who omitted taking a travel history should be fired. The Hospital adminstrator told tried to cover up the Hospital’s culpability should be fired also.
The father of NBC cameraman Ashoka Mukpo, who has been recently stricken with Ebola virus disease, is one of the most prominent intensive care physicians in the United States.
Dr. Mitchell Levy is the director of medical intensive care unit at Rhode Island University Hospital and nationally known for his work in the patient safety area.
Dr. Levy reported today in a television interview that his son will be transferred to the University of Nebraska, one of the four most specialized treatment centers in the country for patients with Ebola and other contagious and infectious diseases.
Certainly, having a father involved who is highly skilled in taking care of critically ill patients and treating cardiac and renal failure can only increase the chances for recovery.
Make no mistake, the Dallas Emergency Department physician who examined the patient sick with Ebola and did not elicit a travel history must bear responsibility for the grievous mistake of discharging the patient home while he was infectious and likely transmitted the virus to contacts.
Tonight, officials at Texas Hospital Presbyterian tried to diffuse the growing criticism about the handling of the case by releasing details on Duncan’s stay.
Apparently, the patient admitted that he had recently been in Africa and it was noted in the nursing section of the electronic health record.
However, this information did not at the time display in the physician section and was not available for perusal. Thus the physician could not know about the recent history.
Except, he or she could have asked the patient themselves.
This is not a hard call. When a man with a heavy African accent shows up with a fever and abdominal pain, query as to recent travel just absolutely should be a part of the history. Physicians are still ultimately responsible for the care of patients.
One of the first rules taught to many medical students is to trust no one. The teaching is to always confirm the important parts of every case personally. And, in this case, the physician did not do that.
Yes, the nurse who took the history should have verbally given a report to the physician.
Yes, the electronic health record that is no doubt loathed by most of the providers in the ER that night should have shown the information on the “doctors screens.”
But, that is no excuse for what happened. It is the duty and responsibility of the physician to take care of patients and this was not done.
It will be interesting when the identity of physician comes out to learn how about the level of training and experience of the provider.
Was it a resident or a more senior provider? Was it a physician at all or perhaps a nurse practitioner or physicians assistant?
Was it someone who was recently trained under a system where there has been an over-reliance on the electronic health chart?
Whoever it was, it is a career-ending mistake and will have likely devastating consequences for patients who were likely infected with Ebola needlessly.
They need to fired if they don’t resign. And they can take the hated electronic medical record with them.