COVID-19 ongoing thread part 2

[Broomstick]

So the times I joked that it would make a surgery patient feel like they can ascend Everst without oxygen weren't the level of hyperbole I thought. Huh.

As to crash and taper... The commentary I've seen from people who've been on it has been that even with a taper there's a hell of a crash. Given how little Trump sleeps, and how difficult sleep becomes on the stuff, he's probably going to be jacked up bad as they take him off of it. Dunno what your personal experience is with corticosteroids, so my info is coming from randos on Twitter and might not be as accurate as what you've got.

I've twice been on a high dose of prednisolone after an anphylactic reaction to an allergy trigger. My information is that it is not as strong as dexamethasone, but it was still bad enough. Don't get me wrong - I absolutely did need it, it saved my life, but there were side effects. Within a day I felt like Wonder Woman, I felt bullet-proof, I had tons of energy, I needed less sleep. I had terrible mood swings, it was a real emotional roller coaster. It alarmed my spouse and he managed to talk me into staying home for a week rather than let me go out in that state. I was already on taper, so by the end of the week I was much more rational but despite feeling great at the time in retrospect I didn't really enjoy the ride. The experience does vary considerably depending on the individual, but at a high dose everyone feels effects.

When Trump says "I feel better than I have for 20 years!" I hear the dex talking.

Of course he feels good - that's what it does.

I did see that the Wikipedia article lists "death" as a possible consequence of going cold-turkey, though from what I gathered that's only really a risk after prolonged time and severe dependence. I highly doubt he'll have been on it long enough for that to be terribly likely.

True - dex, like most such steroids, suppresses the action of the adrenal glands as far as endogenous steroid production. They don't shut down completely immediately, but the purpose of a taper is to give them time to come back on-line without an interval with no cortisol and related steroids being produced. Lack of those can result low blood pressure and low heart rate which, if severe enough, can lead to shock and death. A lot depends on how long he's on it - when I was on prednisolone/prednisone for anaphylaxis I received a very high initial dose then moved immediately into a two-week taper because the immediate immune-suppressing effect was only needed for about 3-4 days until the allergen was out of my system, after which I needed to get off the steroid. So the need was for about 3 days of the drug, but the taper was two weeks after that which gives you some idea of how doctors treat coming off even a short-term dose. I'm not sure how this is managed during covid, but after the therapeutic use of the drug is no longer needed I'd expect a couple weeks to taper off as the shortest course of action. In some cases it can take months.

In somewhat related news, Stephen Miller has now tested positive.

Couldn't happen to a nicer guy.

How dangerous is it if they try to delay when he crashes until after the election ?

Well, he's a guy in his seventies - his adrenal glands are probably not going to bounce back as quickly as a 20 year old's.

If Trump is on dex that long he will certainly have acquired a dependence. If he stays on a therapeutic dose for an entire month his adrenals will be suppressed and he'll need a medically supervised taper. The problem is that this guys doesn't listen to doctors, he dictates to them, and on top of that withdrawal means you stop feeling like a superhero and I just don't see Trump submitting to fatigue, body aches, and all the rest meekly. He is exactly the sort of guy to develop a real addiction because he insists on feeling good all the time.

Meanwhile - dex suppresses the immune system. When your immune system is trying to kill you - with covid induced lung inflammation, for example - the benefits can outweigh the risks. While it might help him with covid symptoms it will leave him more vulnerable to other infections in the meanwhile. But while an infection is rampaging through your body you may not notice because, remember, steroids make you feel good and powerful. People on steroids can keep going and going until their body suffers a catastrophic collapse.

So... yes, potentially quite dangerous. MOST people treated with this drug are OK in the end, but there are real risks.

That's aside from what a whacked-out Trump might order during a mood swing that can affect the rest of us.

[Broomstick]

There's a line of succession, with Pelosi next,

I've heard some people saying that having Pelosi next would violate separation of powers because Congress is not the executive branch. So if Trump and Pence are incapacitated, I'm expecting Republicans to sue to try and block her.

>sigh<

Succession is based on legislation passed by Congress. passed in 1947 and last amended in 2006. The only reason this is being brought up is because Pelosi is a Democrat - I'm sure they'll try to argue that the successor can't be from a different party, too.

It is the case that, at present, for Pelosi to take over as President would require her to resign her position in the House - if she's permanently the president until the end of this term. If she remains Acting President she may not have to as the law is currently written but of course the Republicans would lose their shit.

They want Pelosi out of the way because after her is Chuck Grassley, who is a solid Republican, and they don't give a shit about him having a seat in the Senate.

The Republithugs want to stay in power, they don't care how they have to cheat.

[bilateralrope]

Yes, I'm aware of the legislation. But if the separation or powers argument holds merit, that would make the legislation unconstitutional. I don't know if it holds merit, just that I'm expecting Republicans to sue over it.

It probably won't even make it far enough through the court process to be decided on the merits of their argument. Not before inauguration day when it becomes moot. So it's all going to come down to any preliminary injunction the courts issue.

[Napoleon the Clown]

I've twice been on a high dose of prednisolone after an anphylactic reaction to an allergy trigger. My information is that it is not as strong as dexamethasone, but it was still bad enough. Don't get me wrong - I absolutely did need it, it saved my life, but there were side effects. Within a day I felt like Wonder Woman, I felt bullet-proof, I had tons of energy, I needed less sleep. I had terrible mood swings, it was a real emotional roller coaster. It alarmed my spouse and he managed to talk me into staying home for a week rather than let me go out in that state. I was already on taper, so by the end of the week I was much more rational but despite feeling great at the time in retrospect I didn't really enjoy the ride. The experience does vary considerably depending on the individual, but at a high dose everyone feels effects.

When Trump says "I feel better than I have for 20 years!" I hear the dex talking.

Of course he feels good - that's what it does.

How high was the dose, if you don't mind sharing? The probable dose for dexo for Trump is 16 mg, which is about equivalent to 40 mg of prednisone.


In absurd news, Conley announced that they detected antibodies for COVID. Note that they dosed him with, you guessed it, COVID antibodies last week. The level of Dear Leader is a Superman that's going on is approaching parody levels.

[Raw Shark]

Something about this has been nagging at me and then my sister pointed it out:

"A wealthy ruler throws a big party in his huge mansion during an epidemic for his asymptomatic friends while the peasants die and then the virus shows up and tears through his fancy guests is note for note the plot of 'The Masque of the Red Death' by Edgar Allen Poe."

[Broomstick]

When Trump says "I feel better than I have for 20 years!" I hear the dex talking.

Of course he feels good - that's what it does.

How high was the dose, if you don't mind sharing? The probable dose for dexo for Trump is 16 mg, which is about equivalent to 40 mg of prednisone.

The initial dose for my first anaphylaxis episode was 120mg of prednisolone (or was it methylprednisolone via injection? Not entirely clear, which isn't too surprising given I was semi-conscious at the time), which was immediately tapered down over the course of 2-3 weeks (memory is a bit vague on that) back down to zero. I was bouncing off the walls. The shit worked, between that, the epinephrine, some time on a nebulizer, and the 50 mg of diphenhydramine the allergic reaction was stopped cold. I went from semi-conscious, carried into the hospital flat on my back in shock (they couldn't get a blood pressure off my limbs but as I was still responsive to questions to some degree they assumed I had some), and low oxygen saturation even on 100% oxygen via mask to walking out of the hospital under my own power six hours later feeling... fine. A little twitchy, but fine. Another six hours and I was goddamned Wonder Woman and twelve hours later than that fucking Supergirl. Then things got crazy for a few days.

The next time I had a brush with anaphylaxis I wasn't quite that bad off (I actually walked into the ER on my own two feet. Well, staggered. It's amazing the reaction you get from a triage nurse when you gasp "Bad...reaction...food... allergy...") and talked the doc into giving me just 60mg prednisolone because I didn't want to go through the full dose again. Despite the whole allergic-shock-might-kill-me thing. Which worked and I never got past "goddamned Wonder Woman" but it was still a roller coaster ride for two weeks.

I've been on 40mg and 20mg of prednisone for other allergic episodes. Frankly, do not let me get behind the wheel of a car if I'm taking 40mg. I am far too erratic in temperament to be a safe driver. If I'm alone on the road, fine, but road rage could become a real problem. Back when this was a concern I just didn't drive as I was living in Chicago and mass transit was available.

Of course, this varies from person to person - when my mom was on a 20mg dose one time she didn't sleep for days and started drunk-dialing people at 2 am with random paranoid fantasies alternating with laughing and sobbing. It was quite disturbing for all involved. Other people seem to handle 40mg with minimal or no problems. I suspect the mental problems are more common than typically stated in the literature because it's exactly the sort of symptom that patients don't complain about - I mean, you feel good. POWERFUL! - and it's not always in-your-face obvious change from baseline.

Please note these episodes occurred 25-30 years ago and some practices may have changed for emergency treatment of severe allergic reactions.

Supposedly dexamethasone is like prednisone, but more so. It is (forgive me) a steroid on steroids. Greater therapeutic effect, but also greater side effects.

With Trump - who the hell knows how much he's getting? I could see him being pumped up with a higher than normal dose to keep him looking good and on his feet. I could see him demanding more because it makes him feel good and masks his symptoms. You can definitely stand upright and talk on 60 mg of prednisone, don't know what the equivalent dose of dex would be, you look functional even if mentally your gears are slipping. I wince every time Trump says he feels great because yes, of course he feels great. That's one of the effects. Are you feeling great because you are great, or because the dex is masking how bad you should be feeling?

[Broomstick]

Something about this has been nagging at me and then my sister pointed it out:

"A wealthy ruler throws a big party in his huge mansion during an epidemic for his asymptomatic friends while the peasants die and then the virus shows up and tears through his fancy guests is note for note the plot of 'The Masque of the Red Death' by Edgar Allen Poe."

It's rather disturbing when real life starts to follow the plot of a Poe story.

[Zaune]

Supposedly dexamethasone is like prednisone, but more so. It is (forgive me) a steroid on steroids. Greater therapeutic effect, but also greater side effects.

With Trump - who the hell knows how much he's getting? I could see him being pumped up with a higher than normal dose to keep him looking good and on his feet. I could see him demanding more because it makes him feel good and masks his symptoms. You can definitely stand upright and talk on 60 mg of prednisone, don't know what the equivalent dose of dex would be, you look functional even if mentally your gears are slipping. I wince every time Trump says he feels great because yes, of course he feels great. That's one of the effects. Are you feeling great because you are great, or because the dex is masking how bad you should be feeling?

Oh, and here's a cheerful thought: He still technically has the authority to order a nuclear attack while taking that little lot. I'm mostly confident that actually trying would result in him being tased by his own close-protection detail and sent back to hospital in a straitjacket, but let's face it, the idea of a 'roid rage-induced nuclear holocaust is only moderately absurd by the standards of the last four years.

[Gandalf]

IIRC, Nixon used to get drunk and order nuclear attacks. So the authority to do so is not absolute.

[Broomstick]

Or, more likely, the people around the president knew better than to take orders given while drunk seriously.

[Ace Pace]

IIRC, Nixon used to get drunk and order nuclear attacks. So the authority to do so is not absolute.

Wasn't it the worry he'd order nuclear attacks while drunk rather than an actual incident?

[PainRack]

When Trump says "I feel better than I have for 20 years!" I hear the dex talking.

Of course he feels good - that's what it does.

How high was the dose, if you don't mind sharing? The probable dose for dexo for Trump is 16 mg, which is about equivalent to 40 mg of prednisone.

The initial dose for my first anaphylaxis episode was 120mg of prednisolone (or was it methylprednisolone via injection? Not entirely clear, which isn't too surprising given I was semi-conscious at the time), which was immediately tapered down over the course of 2-3 weeks (memory is a bit vague on that) back down to zero. I was bouncing off the walls. The shit worked, between that, the epinephrine, some time on a nebulizer, and the 50 mg of diphenhydramine the allergic reaction was stopped cold. I went from semi-conscious, carried into the hospital flat on my back in shock (they couldn't get a blood pressure off my limbs but as I was still responsive to questions to some degree they assumed I had some), and low oxygen saturation even on 100% oxygen via mask to walking out of the hospital under my own power six hours later feeling... fine. A little twitchy, but fine. Another six hours and I was goddamned Wonder Woman and twelve hours later than that fucking Supergirl. Then things got crazy for a few days.

The next time I had a brush with anaphylaxis I wasn't quite that bad off (I actually walked into the ER on my own two feet. Well, staggered. It's amazing the reaction you get from a triage nurse when you gasp "Bad...reaction...food... allergy...") and talked the doc into giving me just 60mg prednisolone because I didn't want to go through the full dose again. Despite the whole allergic-shock-might-kill-me thing. Which worked and I never got past "goddamned Wonder Woman" but it was still a roller coaster ride for two weeks.

I've been on 40mg and 20mg of prednisone for other allergic episodes. Frankly, do not let me get behind the wheel of a car if I'm taking 40mg. I am far too erratic in temperament to be a safe driver. If I'm alone on the road, fine, but road rage could become a real problem. Back when this was a concern I just didn't drive as I was living in Chicago and mass transit was available.

Of course, this varies from person to person - when my mom was on a 20mg dose one time she didn't sleep for days and started drunk-dialing people at 2 am with random paranoid fantasies alternating with laughing and sobbing. It was quite disturbing for all involved. Other people seem to handle 40mg with minimal or no problems. I suspect the mental problems are more common than typically stated in the literature because it's exactly the sort of symptom that patients don't complain about - I mean, you feel good. POWERFUL! - and it's not always in-your-face obvious change from baseline.

Please note these episodes occurred 25-30 years ago and some practices may have changed for emergency treatment of severe allergic reactions.

Supposedly dexamethasone is like prednisone, but more so. It is (forgive me) a steroid on steroids. Greater therapeutic effect, but also greater side effects.

With Trump - who the hell knows how much he's getting? I could see him being pumped up with a higher than normal dose to keep him looking good and on his feet. I could see him demanding more because it makes him feel good and masks his symptoms. You can definitely stand upright and talk on 60 mg of prednisone, don't know what the equivalent dose of dex would be, you look functional even if mentally your gears are slipping. I wince every time Trump says he feels great because yes, of course he feels great. That's one of the effects. Are you feeling great because you are great, or because the dex is masking how bad you should be feeling?

The effects aren't generally that powerful. I been giving dexa, pred and etc for years for chemo purposes and then for preventing shock. There actually ..contributing factors from age to obesity and etc. And lastly, stress. What steroids do is affect your hypothalamic pituary gland axis, the stress factor. Corticosteroid will suppress the axis, meaning once the steroid is stopped, your body is producing fight/flight with adrenaline but the stress part is suppressed. Tapering down the dose helps to prevent that from happening.

There's definitely a Speedy Gonzalez type of rush.... A speed and etc. The problem is that with Trump. Who can tell? His tweets if anything are more coherent than his norm without the run on sentences. His speech is disordered and lots of run on sentences, but again, how do you tell the difference from his past.

In terms of conversion.
https://www.mdcalc.com/steroid-conversion-calculator

Dexa stays in the body longer than prednisone but there's Covid guidelines for dexa now.

https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

6mg IV dexa would be roughly equivalent to 40mg prednisone.

I'm not sure if Recovery would had needed tapering ,a consideration since Trump would also have received steroids for his monoclonal antibody treatment ... But meds wise.... It's certainly a contributing factor when you consider the stress of him losing and etcetcetc.

The problem is again, how do you tell the difference from his previous self ????

[PainRack]

Just to add some more points.

1. Trump adminstration attacked stem cell research. Said stem cell research is part of the biological revolution that gave him Regeneron.

2. Contrary to Twitter and the slightly misleading tweets of Dr Eugene Gu, Twitter is claiming that Regeneron comes from fetal stem cell research. It doesn't. Dr Gu was referring to how said research made available Regeneron. (Presumably) the source of the antibodies actually came from humanized mice, patients who recovered from Covid in Singapore and was grown in chinese hamster cells.


3. Trump appears to have been lucky. He seems to have a mild case. His simply irresponsible tweet however is maddening, given how many tweets, rightwing claims and etc of Covid is nothing and Trump is the Messiah.

Lastly for fun and giggles.

https://www.benjaminlcorey.com/could-am ... edictions/

You can twist the Bible to say it predicted all this and how it shows Trump is the antichrist.

[Broomstick]

The effects aren't generally that powerful.

True. I have the (mis)fortune to, apparently, be very sensitive to steroids. Fortunate, because I get a lot of good out of a dose, and often need less of a dose than many people to get the same effect. Bad, because I also seem equally prone to the side effects. When I have a doctor suggesting a course of them I usually ask if I can start out with half the normal dose and, if not sufficient, go up only if necessary. So far that has worked well for me - like I said, different people have different reactions.

With Trump - who knows? What I've been told (and to some extent experienced) is that steroids don't make you anything you aren't already, you just become yourself more intensely. If you're prone to depression it can intensify depression. If you're an extrovert it can make you more so. With Trump.... well, read his tweets. I wouldn't look for something new, just an intensification of what's gone before.

[PainRack]

The effects aren't generally that powerful.

True. I have the (mis)fortune to, apparently, be very sensitive to steroids. Fortunate, because I get a lot of good out of a dose, and often need less of a dose than many people to get the same effect. Bad, because I also seem equally prone to the side effects. When I have a doctor suggesting a course of them I usually ask if I can start out with half the normal dose and, if not sufficient, go up only if necessary. So far that has worked well for me - like I said, different people have different reactions.

With Trump - who knows? What I've been told (and to some extent experienced) is that steroids don't make you anything you aren't already, you just become yourself more intensely. If you're prone to depression it can intensify depression. If you're an extrovert it can make you more so. With Trump.... well, read his tweets. I wouldn't look for something new, just an intensification of what's gone before.

Yah. Now. Having said all that, I'm just going to say Trump probably received higher doses than you. While 6mg dexa would only be equivalent to 40mg pred, he would had needed pred too for the Regeneron.

Similarly, while you being female trips one potential risk factor, Trump trips multiple simply by being older and obese (let's face it, the last doctor lied about his weight).


So. Trump did experience a rush. The problem is whether he's mentally impaired, be it delirious, in full on mania and etc and it's so very hard to tell from his tweets. For a normal person, it would be sure, he's deranged but for Trump?????

This is more a condemnation of Trump mental fitness.

[Darth Yan]

Herman Cain felt fine and he died soon after. That could easily happen with Trump.

[PainRack]

The effects aren't generally that powerful.

True. I have the (mis)fortune to, apparently, be very sensitive to steroids. Fortunate, because I get a lot of good out of a dose, and often need less of a dose than many people to get the same effect. Bad, because I also seem equally prone to the side effects. When I have a doctor suggesting a course of them I usually ask if I can start out with half the normal dose and, if not sufficient, go up only if necessary. So far that has worked well for me - like I said, different people have different reactions.

With Trump - who knows? What I've been told (and to some extent experienced) is that steroids don't make you anything you aren't already, you just become yourself more intensely. If you're prone to depression it can intensify depression. If you're an extrovert it can make you more so. With Trump.... well, read his tweets. I wouldn't look for something new, just an intensification of what's gone before.

Wait. Can I apologize? I meant to say this in my first post but it apparently skipped my mind. And my second reply to you continued the error.

Broomstick here received HIGH doses of steroid based off her account. Very high. 120mg methylprednisolone is a very high dose given for patients in respiratory distress and along with other steroids, explains her symptoms . She probably needed it given the severity and emergency of her situation.

I meant to educate in that her dose of 40mg prednisone for just allergies shouldn't be that powerful or inflict that kind of mental disturbances but as she indicated, it still has a mental impact on her. That dose does have a bit of impact, but it's usually not powerful enough to change your behaviour significantly and sadly, Broomstick has the misfortune of being sensitive.

I apologize for not clarifying this properly because it made me seem that I dismissed her first episode as being abnormal or only something sensitive people will undergo. It's not.

She is sadly sensitive as exhibited by her behaviour under 40mg but the experiences of her first time ? Yah. That's sadly a routine adverse reaction to the drug.

I used to hide the vials from facing my patient because it had a poison symbol visible on it. It's that powerful.

[Broomstick]

Thanks, PainRack - clarification is always appreciated.

We really don't know how much dex Trump got. I hear there is a protocol for its use in covid, but with that patient who the hell knows? They already gave him a unique "cocktail" of medications, did they up the amount of dex in order to make him look and feel good? Is Trump more or less sensitive to the side effects of this medication than average?

The official statement is that Trump has "completed" treatment. OK.... wonder how he's going to do going forward? He didn't sound real great during the Hannity interview. He strikes me as the sort of person who is going to keep saying he's "fine" until he falls over.

[PainRack]

Thanks, PainRack - clarification is always appreciated.

We really don't know how much dex Trump got. I hear there is a protocol for its use in covid, but with that patient who the hell knows? They already gave him a unique "cocktail" of medications, did they up the amount of dex in order to make him look and feel good? Is Trump more or less sensitive to the side effects of this medication than average?

The official statement is that Trump has "completed" treatment. OK.... wonder how he's going to do going forward? He didn't sound real great during the Hannity interview. He strikes me as the sort of person who is going to keep saying he's "fine" until he falls over.

https://www.sciencemag.org/news/2020/10 ... -treatment
He received a higher dose of Regeneron. The latest experiments suggest a lower dose of 2g is enough to reduce Covid virus but the higher dose as first tested may has better clearance.

[Eulogy]

Any actual good Trump does for humanity is entirely unintentional. Exhibit A, being a glorified guinea pig for experimental treatments.

[bilateralrope]

Donald Trump's doctor says he's no longer at risk of transmitting COVID-19

US President Donald Trump appeared back to his old self on Saturday (US time) as he addressed supporters at the White House in his first public event since being diagnosed with COVID-19 and his doctor said he was no longer a transmission risk.

Trump took a test on Saturday which showed that he was no longer a "transmission risk to others," his physician Sean Conley said in a statement, adding that an assortment of tests taken by the president showed there was no longer evidence "of actively replicating virus".

The White House had no immediate comment on whether Conley's statement indicated that the president had tested negative for the coronavirus.

Standing alone and not wearing a mask, the Republican president spoke from a White House balcony on Saturday afternoon - his first public event since being diagnosed with the highly contagious disease. Trump was hospitalized on October 2 for treatment of COVID-19, and returned to the White House on Monday.

Trump urged a packed crowd of hundreds of largely Black and Latino supporters, most wearing masks but not respecting social distancing guidelines, to help get out the vote in the November 3 presidential election.

Trump plans to travel to Florida, Pennsylvania, and Iowa, on Monday, Tuesday, and Wednesday, respectively.

"I'm feeling great," he told the crowd.

Speaking firmly and without hesitation, Trump delivered a shorter-than-usual campaign speech, hailing his record in fighting crime and boosting the US economy, while slamming Democrats as his supporters cheered. A flesh-coloured bandage was visible on his right hand.

Reuters

The White House had no immediate comment on whether Conley's statement indicated that the president had tested negative for the coronavirus.
So, it wasn't a negative test for Covid19. Just some other test that shows Trump's no longer a transmission risk. I wasn't aware that such a test existed.

Though this assumes that Trump's doctor is honest, but limited to only sharing what Trump has authorized him to share. Honesty is a hard assumption to make when it comes to anyone around Trump.

[Raw Shark]

Any actual good Trump does for humanity is entirely unintentional. Exhibit A, being a glorified guinea pig for experimental treatments.

Well hey, he's normalizing cosmetics for men!

[FireNexus]

Any actual good Trump does for humanity is entirely unintentional. Exhibit A, being a glorified guinea pig for experimental treatments.

Well hey, he's normalizing cosmetics for men!

If you ask me, his Mimi Bobeck shtick is really hurting that movement.

[Elfdart]

IIRC, Nixon used to get drunk and order nuclear attacks. So the authority to do so is not absolute.

That's because Defense Secretary James Schlessinger told the staff at the White House to send every order through him. I doubt there's anyone in this regime with that kind of character.

[Gandalf]

IIRC, Nixon used to get drunk and order nuclear attacks. So the authority to do so is not absolute.

That's because Defense Secretary James Schlessinger told the staff at the White House to send every order through him. I doubt there's anyone in this regime with that kind of character.

From what I recall, it was also Kissinger who acted as intermediary.