A doctor’s diary from a pandemic: All about antibodies

Lately many of us are thinking quite a bit about antibodies. When’s the antibody test going to be ready? Can I get a test? Do I have antibodies? Will we be able to give antibodies from one person to another as a treatment? Are antibodies our ticket to resuming our normal lives?

What is an antibody, anyway?

In medicine we talk about antibodies all the time, though I am far from an expert on the subject. I remember learning about them in Immunology lectures from medical school, at least when I wasn’t talking in class. I remember them as Y-shaped thingies in our blood. Yes, “Y-shaped thingies” is the correct medical term. They look like this:

Photo: CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=916435

At least they look that way in the textbook.

Antibodies are the soldiers that live in our blood that fight foreign invaders to our bodies. The really cool thing is that once our bodies have encountered an invader like a virus or a bacteria, our bodies manufacture these antibodies in huge quantities. Those antibodies live in us long into the future so that when our bodies encounter that pathogenic invader at some future point, our bodies recognize it and are able to fight it off much more readily. This is the role of antibodies. When you think of it you may marvel at the elegance of a system that can learn from the past so as to be able to be prepared for future.

But that is exactly what antibodies do. Learn from the past. We as people could learn from our own immune systems about learning from the past!

The big questions in the COVID-19 pandemic may be answered with research into antibodies. So that is why I rolled up my sleeve in the picture above to see if my blood has any antibodies to SARS-CoV-2 (the real name of the COVID-19 virus). I was participating in a research project being conducted at Hennepin Healthcare where I work. The Centers for Disease Control (CDC) is conducting this study at 16 hospital sites around the country to help us understand how the human body is responding to this virus. The study is looking at healthcare workers (nurses, doctors, respiratory therapists, among others) who have been working with patients infected with COVID-19. I guess I qualify. The idea is to see how many of us are developing antibodies.

A quick shout out to Dr. Matt Prekker of Hennepin Healthcare. Not only is he leading the research on this antibody study in healthcare workers, he also is a board-certified doctor in 4 specialties at once: Critical Care, Internal Medicine, Pulmonary Medicine, and Emergency Medicine. Not only that, he is the guy drawing my blood in the picture above and he’s a great guy. He and his team of researchers are worthy of a “thank you” from all of us.

This is really important research. We used to call this virus the “novel coronavirus” because it is indeed novel – new – to the world. Due to that one fact, there was nobody on the entire planet who had any antibodies in their system. That’s also why it is so deadly because nobody has the foot soldiers – the antibodies – yet in place in their blood.

Once we learn more about the human body response to the virus, we should be able answer many of the questions for which our knowledge is currently lacking:

  • Does getting COVID-19 protect you from future infections? We just don’t know but it will depend on the antibody response and how durable that response is over time.
  • Do people develop antibodies even if they didn’t have symptoms?
  • How quickly does the immune response develop?
  • Importantly, can we use the antibodies from one person to treat another person who is really sick?

Vaccine research is based on immune response as well. Vaccines work by exposing your body to a teeny amount of the virus and allowing your own body to develop its regiment of antibodies. So these areas of research overlap.

I’ve heard it said that science will help get us out of this pandemic. Today I got a first-hand look at how that may look and it gives me renewed hope.

Thanks for reading this blog. Subscribe by e-mail if you wish to receive periodic notifications of future posts. My Twitter account is @DrDavidHilden for occasional updates from me as well.

David

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Aspirin for people over 70? New science right here.

Photo: NIAID

I know many people who take a daily aspirin in an effort to stay healthy.  I even know many doctors who recommend it.  But you may be surprised to know about what the actual medical science says about aspirin.

Back in 2016, I wrote a post that proved to be one of the most-popular that whole year.  In that post I described the guidelines for who, and who should not, be taking a daily aspirin.  Fortunately, that post is still largely accurate and these guidelines have not changed in the past two years.  You can read that 2016 post here.

But there is now a massive new study about a group of people for which there was no medical science one way or the other.  The new study, called ASPREE (ASPirin in Reducing Events in the Elderly) was just published in September 2018 and it specifically looked at healthy people over age 70.

The one thing you need to know

There is no data to support healthy people 70 and older for taking a daily aspirin, and in fact, it likely has more risks than any potential benefit.

I will expand a bit on this new data in this post.

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No amount of alcohol is safe. Oh, c’mon now.

Hi, friends!  I’ve been gone on a bit of a hiatus but am back and ready to weigh in on the health care news of the day.  Like this eye-catching headline I recently read:

“No amount of alcohol is safe, health experts warn”

A new study was recently published that pretty much came to that conclusion.  The authors did a big retrospective look at previous medical research into alcohol use and concluded that there was no amount of alcohol consumption that could be considered safe.  This really made the news all over the place, like this sobering 30-second blurb:

Due to my unending dedication to finding sound medical advice . . . and even more because I had just enjoyed a nice glass of a dry rose wine on a hot summer evening and didn’t want a bunch of egghead researchers to spoil it for me . . .  I had to investigate further.   Read on for my take on the latest alcohol brouhaha. Continue reading “No amount of alcohol is safe. Oh, c’mon now.” Facebooktwitterredditpinterestlinkedinmail

The connection between weight and heart disease

We all know that being overweight is probably not good for our health.  It seems to make intuitive sense and there is ample scientific data that says losing weight is good for you in the long run.  But there are many uncertainties.  One of the unanswered questions is how best to measure body fat and how best to correlate being overweight with long-term disease.

This past week there was a big study published out of Europe that tried to address these issues.  In this post I’m going to break it down for you and see if there is anything we can learn from this study.  As always,  it is important to note that this is just one observational study, which means that it simply looks at a large population of people and attempts to observe a specific medical outcome (in this case, heart disease) with a specific condition (in this case being overweight).  It can’t prove cause and effect!

Consider this post a “mini-Medical School” in which I’ll walk you through a medical research study.  It may get a bit nerdy.  Here we go.

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Opioids for back, knee, and hip pain? A chat with Dr. Erin Krebs

You have undoubtedly heard about the opioid crisis. It is a near daily part of my life since treating pain is a hefty part of what most doctors do. In addition, I am fortunate to work in an academic health setting so I am surrounded by researchers and teachers. Just this week, one of my friends and colleagues, Dr. Charlie Reznikoff was in Washington DC where he testified about opioids to members of Congress. So you might say I’m surrounded by smart people on this issue.

In this post, I want to draw your attention to some new information about treating arthritis pain.  A new study was recently published in JAMA (one of the most respected journals in existence) which concluded that for chronic back pain and arthritis pain of the hips and knees, opioids are no better than other remedies.

Let me say that startling conclusion again:  opioids are no better than non-opioid treatments at relieving low back, knee, and hip pain.  There is NO advantage, and plenty of risk, in using opioids to treat these chronic pain conditions.

This is big news.  For me, it is just a little bigger because the lead author of the study is a Minneapolis physician from my medical school class, Dr. Erin Krebs. Dr. Krebs is a leading researcher in this area and I may add, a terrific doctor and person. To her, I say, well done! To learn more about Dr. Krebs, check out her site from the VA here.  You can also learn more about her from the University of Minnesota Medical School.

I reached out to Dr. Krebs and she graciously responded to some of my questions about her research.  I offer her insights to you below.  This is a rare chance to hear from a physician-scientist, uncluttered from what you may find elsewhere on the Internet.  Often people ask me what where to get reliable information on health issues.  On this issue, this is as reliable as it gets.  I’ll include a couple links as well, including one to an audio interview with Dr. Krebs.  Read on.
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Should you trust the latest “medical advance”? And koalas too!

Hey friends!

The plaque in this photo above was a gift from a medical student and hangs on my wall right above my desk. It is a saying reportedly from Michelangelo that I use in teaching medical students and residents fairly often.

I even gave a speech to some graduating medical students called “I am still learning.”  I don’t even think Michelangelo actually said this at age 87 but the sentiment still resonates.  This post is about learning medicine.

This past week I’ve really been going back to school.  I’m now back from several days in San Diego at the American College of Physicians Internal Medicine conference.  ACP is my professional organization, and our annual conference brings many thousands of us together to learn about the latest in medical science, pick up tips for our practice from some of the country’s top experts, and re-connect with colleagues from around the world.

In the next several posts, I am going to highlight for you some of what I learned at the ACP conference in San Diego.  Look for short posts in the coming weeks about:

  • Clostridium difficile infection
  • Lyme disease
  • Zika virus
  • Menopause and depression
  • Pain control and opiates
  • Sleep disorders
  • Restless legs syndrome
  • Blood pressure in older adults
  • Antibiotic resistance
  • Weight loss and exercise
  • Iron replacement
  • Osteoporosis

I’ll try to keep these future posts really short and helpful.

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Maybe your doctor should be a woman

people_green_icon-svg

Quick, picture in your head a highly competent physician.  What does that person look like?

Does your doctor image look like this?

Photo: ABC Television [Public domain], via Wikimedia Commons
Public domain photo

Or like this?

By Ministry of Information Photo Division Photographer, Stone Richard [Public domain], via Wikimedia Commons
Public domain photo

 For the record and the recognition, that’s Dr. Gibson-Hill, a doctor in Bristol, England.  You probably know the guy in the top photo.

History has maybe ingrained in us the image of doctors as many things, but first of all they have been men.  The reality, even dating back over a hundred years (Elizabeth Blackwell, anyone), is that women have served as physicians for a great long time.

And the reality today is that women are a huge part of the physician workforce in the United States.  I remember vividly one moment during the first hour of the first day of my Medical School education at the University of Minnesota some 20 years ago.  The Dean stood up in front of the nearly 200 of us eager young medical students and announced that for the first time in that school’s history, more than half the medical students were women.  The room erupted in applause that day.

My current practice bears this out.  In my group of hospitalist physicians at HCMC, we have 17 women and 14 men.  So when you see a doctor in our hospital and I presume at all other hospitals in the country, you are likely to be cared for by a physician who happens to be a woman.

This is a good thing. Continue reading “Maybe your doctor should be a woman” Facebooktwitterredditpinterestlinkedinmail

Apple cider vinegar: a Healthy Matters investigative report!

On a recent “Open Lines” radio broadcast (in which we have no topic and I simply answer the sundry questions from listeners) somebody asked about the health benefits of apple cider vinegar.  Fair enough.

Well as a highly educated medical professional I am here to firmly and unequivocally state after my extensive exposure to the best in medical science that I know nothing about apple cider vinegar, whether it be the health benefits or culinary benefits or counter top cleaning benefits.

abby-and-acvBut happily, I’m not 100% ignorant about apple cider vinegar any longer.  Just about 90% ignorant. That’s since my daughter introduced me to the stuff while I was visiting her far from home at college.  Here’s how it all went down.  I was having some queasiness in my belly or some such thing and she goes to the cupboard and pulls down a giant bottle of ACV (apple cider vinegar = ACV).  Then she starts telling me all about how ACV improves everything from colds to upset tummy to sunburn and cancer and everything in between.  But she does live in Los Angeles so I naturally wondered what the crazy Californians are teaching my level-headed Midwest-raised daughter.

But I was game to give it a try.  So  we poured some ACV into a glass of water, I held my nose, and drank it all down.  It wasn’t too horrible to drink so that was a plus.  And dang if my stomach queasiness didn’t get a little better!

So I chalk up my rapid improvement to one of two possibilities:

Placebo effect – I convinced myself that it helped because I wanted it to help.

OR

Apple cider vinegar really does help upset tummies.

Which is it?

So in the spirit of hard-hitting investigative journalism and to be true to my medical credentials and only stick to the best science, I’ve done some looking into ACV as a health option.  Here’s what I found: Continue reading “Apple cider vinegar: a Healthy Matters investigative report!”

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November is Alzheimer’s Awareness Month

grandma-h-alexMy grandfather, Heizel “Bill” Hilden, before he died used to say the goofiest things.  One doozy that I remember was when he flatly reported that the cane he carried came from the moon. It was a lovely gnarly wooden cane with white indentations if I recall.  But I doubt its provenance was the moon.   At least I’m pretty sure.

At the same time as Grandpa was talking about the moon and canes and such, he could also sing songs from his boyhood.  In Norwegian.  I doubt he had sung those songs in seven or eight decades, but apparently he nailed them – words and tune and all – in a language that he no longer spoke with any frequency.  That’s Grandpa with our son, Alex, in about 1994.  That kid is now 6’4″ tall.

I guess that is dementia in a nutshell.  My 90-something year old gramps had amazingly accurate long-term memory but couldn’t be dissuaded about the lunar origins of his wooden cane.

I bet many of you could tell a similar story of someone in your life with waning cognitive functioning.

In recognition of November Alzheimer’s Awareness Month, I hosted Dr. Anne Murray, a nationally-recognized researcher in dementia (and a colleague of mine) at the WCCO studios in downtown Minneapolis.  We talked about dementia, both Alzheimer’s and other types, and about the latest in research for this disease which is the 6th leading cause of death in the United States.  To hear the podcast of the radio broadcast about Alzheimer’s click the logo here:HM logo

Last July I discussed dementia in a previous post featuring another colleague of mine (Dr. Abigail Holley), so if you missed that post (the 6th most-popular post of the past year!), you may want to read it by clicking “Dementia is not normal aging.  It’s a Disease.”

So this post will not be information so much as a few stories.  The first was about my grandfather.  Let’s look at a couple more . . .  Continue reading “November is Alzheimer’s Awareness Month” Facebooktwitterredditpinterestlinkedinmail

Our 400th radio show!

DRH 400This Sunday morning, September 4, at 7:30, Denny Long and I will take to the veranda at the WCCO Radio booth at the Minnesota State Fair.  It will be our 16th time doing a show live from beneath the shadow of the Giant Slide and sandwiched between Sweet Martha’s cookies and the Ye Olde Mill.  But more significantly, it will be the 400th Healthy Matters radio broadcast.

That’s right.  Since our first broadcast in January 2009, we have done 399 one-hour shows and I tell you what – we’re going to keep doing it until we get the hang of it!  The 400th attempt will be on Sunday which just so happens to be one of our popular State Fair shows.

So consider this your invitation to join Denny and me on Sunday morning!  Last week we had a pretty good crowd at the radio booth around the corner of Underwood and Carnes, and that was only for the 399th show, small potatoes compared to the awesome-ness of the 400th show.

Love this Tweet from my awesome friends at HCMC (hint – hit the play button on the picture):

 

So come to the fair on Sunday, Minnesota (and Wisconsin, and Iowa, and North Dakota, and South Dakota, or where ever you are from . . . last week we had a wonderful woman from San Diego . . .).  If you ask a medical question live on the air, I just may have a special gift for you, one never knows . . . !  

As life-changing and memorable as it will be to be in the audience for the 400th show on Sunday, there is LOTS more to do at the Fair.  Here’s a recap of some cool activities related to medicine. Continue reading “Our 400th radio show!” Facebooktwitterredditpinterestlinkedinmail