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    What to do if you or a close relative is declined emergency coronavirus/pneumonia treatment? Archived Message

    Posted by walter on April 4, 2020, 5:27 pm

    The subject of these hard choices to be made by ICUs (and presumably NHS emergency departments) has come up, and made a few appearances in the media in a short space of time eg referred to here: https://members5.boardhost.com/xxxxx/msg/1585789397.html,(and probably has made more appearances since).

    I guess we all understand such decisions will need to be made - but what to do if in that situation? Well it might of course be TOO LATE at that point to do anything (little hint...), or it might not. If the NHS can not treat you (with what they see is the best option) then is it time to try something that was not previously considered? (Naturally, a related question is whether some of what you night have done too late could beneficially have been done earlier).
    Especially relevant might be treatments that have been used in other countries, like China, but haven't made it through our somewhat sluggish approval mechanisms.
    Vitamin C and melatonin

    Our Rhisiart has posted several times on the positive effects of vitamin C in coronavirus avoidance and care, and, as he puts it, intends to put his life where his mouth is, should he catch the coronavirus.

    Having looked through some of his stuff (tends to be first hand accounts from the front lines, like from people who have been to China) but also the supporting medical literature, I can say there are researchers who based on clinical evidence, wonder why it's not being used more routinely.

    In case you might think this any of this isn't really 'medical' (I'm not, BTW), read this snippet:

    "In rodent sepsis models, nitric oxide was demonstrated to inhibit NLRP3 activation [93]. Ascorbic acid, in addition to supporting the production of nitric oxide [97], can act on multiple levels, reducing oxidative stress, regulating hypoxia signaling, mitochondrial membrane potential, furin expression, and modulation of immune defenses to stem the progression of cytokine storms [94, 95, 96].
    Ascorbic acid can dose-dependently inhibit NLRP3 Inflammasomes both in vitro and in vivo, decreasing IL-1β secretion, without inducing any cytotoxic effects nor cell death [98].
    Thus, the combined use of melatonin and ascorbic acid may prove to be most effective in the treatment for COVID-19 patients, especially those with cardiovascular and hypertension comorbidities. "
    I'm not sure how much of this particular body of work is from human studies and how much if from rats (but if it works on government NHS-floggers, did I hear you say... )

    Readable medical background/explanations here (but too medical for me):
    https://www.evolutamente.it/mitochondria-the-coronavirus-the-vitamin-c-connection-part-3/

    The bit I quoted was from this:
    https://www.evolutamente.it/covid-19-pneumonia-inflammasomes-the-melatonin-connection/

    How did melatonin get into this? Well-known as the body's sleep hormone (it can be NHS-prescribed in limited amounts in the UK for this purpose), melatonin is another substance that some researchers are calling for to be used in critical respiratory-related situations.

    Eg "COVID-19: Melatonin as a potential adjuvant treatment", https://www.ncbi.nlm.nih.gov/pubmed/32217117

    Just to quote a view from a 2017 'ideas' paper (Seven unconfirmed ideas to improve future ICU practice), note the range of roles played by melatonin here:

    "Melatonin should be administered to all critically ill patients able to receive it."

    "... Less well appreciated by intensive care unit practitioners is the intriguing body of research evidence indicating that melatonin may have other important roles to play during serious illness and recovery. The spectrum of melatonin’s effects unrelated to sleep ranges from antioxidant properties to antimicrobial activity and immunomodulation [29]. Neuroprotective [30], antioxidant, infection inhibiting, and anti-neoplastic actions have been reported [29]. Given melatonin’s central importance as a regulatory hormone, restoring its normal daily influence and timing of its concentration could make a major contribution to ICU care. Melatonin plays a pivotal role in the regulation of circadian rhythm, not only for the brain, but for the activities of other vital organs as well. Virtually free of deleterious side effects, melatonin is inexpensive to administer and offers a variety of potentially beneficial actions. It should therefore be routinely used in both the acute and chronic phases of serious illness. "
    https://www.ncbi.nlm.nih.gov/pubmed/32217117

    Melatonin's role as a potent anti-oxidant (also true of Vitamin C) is well known; as an example, melatonin-treated mice survived a lethal dose of gamma radiation in Vijayalaxmi et al (1999), https://www.ncbi.nlm.nih.gov/pubmed/10082913; and in Mihandoost et al (2014) https://www.ncbi.nlm.nih.gov/pubmed/25431791).

    Finally (at the risk of being contradicted by Dan) I understand many coronavirus patients die from sepsis - melatonin has been called for in treating sepsis patients. "While clinical data is limited, we propose the adjunctive use of melatonin is patients with severe sepsis and septic shock."

    I can't judge the strength of the evidence in medical terms for myself, but if you go into Pubmed and put 'melatonin sepsis' in the search bar, you will see plenty of support for the idea, all positive that I saw. You will likely also find a study that found melatonin helped repair or prevent ventilator injury, and others that recommend it as helping the traumatised patient get some sleep has clinical benefits.

    As befits the somewhat conspiratorial-wounding web links, please note that the above 'melatonin connection' material recommends both melatonin and vitamin C, and suggests dosage etc.

    Melatonin can be freely bought online from the US, but not from UK outlets. If buying from the US a possible drawback might be unreliability or variability of the stated strength.
    I don't know what would happen if you asked for it in a hospital but as I say the NHS can provide smaller doses.

    That's two substances with high safety profiles (but do check medical advice first, eg I think melatonin shouldn't be taken along with blood thinners) that some researchers are calling for to be used more.
    Might it be worth thinking about what can be done before a dreaded refusal-to-treat comes!?

    I don't have shares in these two products, or any other....but if you have, then earlier today I may have just boosted them a little

    Best of luck to anyone who finds themselves in this situation or affected by it.
    Walter

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