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As COVID-19 rages through the world with devastating consequences, scientists and doctors are attempting to come up with therapeutic solutions. Some of these are based on clinical experience already gathered in other countries. At this point, Hydroxychloroquine is one of the agents of great interest.  

What Is It?

The modern drug is a derivative of a constituent of the bark of the Cinchona plant, which was taken as an herbal remedy by indigenous Peruvians four centuries ago to treat fever. It is a medication that has traditionally been used against malaria but also has well-proven immunomodulatory properties. For years, this medication has been on hand for the treatment of the autoimmune arthritic type of conditions such as rheumatoid arthritis and systemic lupus erythematosus (that have nothing to do with malaria or any other infectious condition as such). 

For the past fifteen years, the premise involving Hydroxychloroquine is that it could be effective against coronavirus infections and found to have definite effectiveness. Hydroxychloroquine is remarkably well-tolerated, especially for short term use, as it would be as applied in the fight against COVID-19. It has been used successfully in both China and Australia. It is now on the drawing board for potential treatment protocols even in the U.S. Note we are referring to Hydroxychloroquine and not Chloroquine itself, a drug with considerably more side effects.

 How Does It Work?

Hydroxychloraquine appears to have several mechanisms of action. It seems to be an immunomodulator suppressing the malignant hyperactivation of the immune system resulting from certain viral infections. It also interferes with the virus’s ability to replicate, in two different ways. First, it works through channels in the cell membrane that the virus uses to enter the cell and seems to block access to those channels. The drug also prevents SARS-CoV from plugging into a receptor called angiotensin-converting enzyme 2, or ACE2. When the virus inserts its spike protein into the ACE2 receptor, it sets off a chemical process that alters the structure of the receptor and allows the virus to infect. An adequate dose of Hydroxychloroquine appears to undermine this process, and in turn, viral replication in general. 

However, Hydroxychloroquine is not an approved and tested therapeutic in humans. The U.S. Food and Drug Administration (FDA) this week stated that this drug is not on the approved list as treatments for COVID-19. The drug is approved to treat malaria, lupus, and rheumatoid arthritis, but assessment and testing in the framework of COVID-19 are still necessary.

Of course, like any medication, this drug has side effects and should be prescribed by a knowledgeable physician. The side effects are to a large extent benign with the more serious concern about damage to the retina in the eye not of concern in a short term course. Many patients with rheumatoid arthritis are readily started on a regimen of 400 mg twice a day and remain on that dosage for years. The COVID 9 protocol is a 7-day course.

Testing and Effectiveness in the United States

At present, the FDA is organizing a large clinical trial to assess the drug’s effects formally. FDA Commissioner Dr. Stephen M. Hahn (who spoke at a recent White House briefing), has noted that this trial to assess the drug’s effects was made at the request of U.S. President Donald Trump, but that caution must be utilized; that no promises can be made; and trials must be completed just like all FDA approved drugs. 

 Still, reports of successful informal trials are surfacing rapidly. For example, a medical doctor in New York state has announced that he has treated 350 people with COVID-19 with a one-week course of Hydroxychloroquine, azithromycin, and zinc, with a remarkable success rate and minimal side effects. Dr. Vladimir (Zev) Zelenko of Monroe New York has indicated in a public letter that his treatment plan has resulted in zero deaths, hospitalizations, and intubations. Adverse side effects reported in his trial are almost non-existent, other than approximately 10% of patients showing temporary nausea and diarrhea. Based on his treatment success, Zelenko is recommending initiation of treatment in an outpatient setting. He notes that in his experience, such treatment prevents acute respiratory distress syndrome (ARDS), avoids the need for hospitalization, and ultimately saves lives.

 It is interesting to note that researchers at the University of Minnesota have embarked on a study including 1,500 people to probe the drug’s effectiveness further in preventing the development of COVID-19 after people are exposed to SARS-CoV-2. The trial is open to an enrollment of healthcare workers or household contacts nationwide from across the United States, and researchers are hoping to have results within a matter of weeks.

 Global Testing and Effectiveness   

Preliminary reports from China, South Korea, and France suggest that the treatment is at least somewhat effective in treating human patients. For example, Chinese researchers report randomized trials in humans to indicate promising data. In France, results from a small study of 24 patients suggest that Hydroxychloroquine could quicken recovery. Doctors said 25% of patients who received the drug tested positive for the virus after six days, compared with 90% of those who did not receive it. 

 Another study in France published this week in the International Journal of Antimicrobial Agents described the treatment of 42 patients hospitalized with COVID-19, 26 of who received Hydroxychloroquine, and 16 of whom received routine care. Of the 20 patients who took the antimalarial and completed the study, six also received the antibiotic azithromycin. All six of these patients were free of SARS-CoV-2 by the fifth-day post-treatment, while seven of 14 patients who took Hydroxychloroquine alone were negative for the virus, and two of 16 control patients were no longer infected.

 Finally, Hydroxychloroquine is among the four treatments tested in an international “mega” clinical trial, announced on Wednesday by the World Health Organization (WHO), and the U.K. has added Hydroxychloroquine to its list of medicines under export controls. This study is referred to as SOLIDARITY. Overall, more extensive clinical trials will be necessary to determine how effective the drug is.    

 What About Accessibility? Good News and Bad News

Now for the bad news. According to the American Society of Health-System Pharmacists, Hydroxychloroquine has been in short supply since earlier this month. 

Fortunately, however, Israeli generic drug giant Teva has announced that it will provide ten million doses of Hydroxychloroquine to U.S. hospitals free of charge. Additionally, the pharmaceutical company Bayer donated three million tablets to the federal government, and Novartis, Mylan, and Teva are moving to follow suit.

What Happens Next?

Doctors in the U.S. have wide latitude to prescribe drugs “off-label,” meaning for conditions beyond their initial FDA approval. Doctors still have the liberty to mandate it in view for this purpose, given the fact that it has a good chance of at least improving the condition.

And this just in: The FDA is on the cusp of designating the drug for Expanded Access, or “compassionate use,” to address the novel coronavirus (COVID-19) pandemic, according to FDA Commissioner Stephen Hahn, MD, and President Donald Trump (Coronavirus Task Force. White House Press Conference. Presented: March 19, 2020. Accessed March 19, 2020.) Expanded Access allows patients with severe or life-threatening cases of the virus to have access to them as investigational medicinal products, in the framework of “compassionate use.”

 Dr. Ingendaay Weighs In

Hydroxychloroquine holds excellent potential in at least decreasing the intensity of the progression of this disease. While we don’t have all the information we need yet to consider this a 100% effective treatment, we are not taking much of a risk in allowing patients access to this course of treatment. The risk is minimal, the potential benefit now unmeasurable.

It certainly looks like the risk versus benefit ratio is rapidly tipping toward benefit. The risk of not giving this medication a chance vastly outweighs the risk of causing any side effects, especially since this drug is generally well-tolerated, especially for a short course. As a physician, I would highly recommend giving any patient with COVID 19 the chance to benefit from it. 

MenoPassage: the holistic Journey through the menopausal years

Ancient Chinese medicine reveals the menopausal years to hold the potential of a profound transformational passage. This is for one simple reason: it sheds light on the deeper currents of life and how they start moving differently within one in the course of these years. This in turn allows the lotus to arise out of the mud. Actually, the mud turns into the deeply nourishing terrain it can be and allows new flowers of creativity and vitality to arise.

Indeed, it is a time of life to nourish the “Yin Essence”, the yin being the deep, nourishing energy within. “Essence” also relates to our core energy and the gifts we have carried through life from birth. Nourishing this aspect allows a woman to better regulate her hormones and sexual energies. Yin fluids build gently for release at just the right time.

It is difficult to boil things down to a nutshell because it encompasses such a deep understanding of how we function, how as human beings, we are suspended between Heaven and Earth and need to align with the laws of both these worlds. But I am passionate about sharing this understanding so here is my humble attempt.

Most people think of Chinese medicine as the use of herbs and acupuncture, perhaps to bring about better flow and balance of vital energy. This is certainly true, but it goes much beyond that. It is really more about understanding and stimulating the internal regulatory intelligence, making sure that the right part is in charge of each of our physiological processes and that all parts work in harmony.

Chinese medicine is not so much interested in the physical body as such, but rather in the regulatory functions that make it tick and allow it to function in harmony with Nature and in integrity with one’s deeper purpose. We are suspended between Heaven and Earth and have Body, Mind and Spirit to attend to and bring into harmony with the greater cosmic forces. This is the main thing, and everything else revolves around that.

They describe a whole microscosm, which they refer to as an Empire. It is ruled by an Emperor and a whole set of Officials which all have their own intelligence, their own identity and their own tasks. Each of  these officials is referred to as one of the inner organ systems, such as the LIVER, the HEART and the KIDNEYS. These terms by no means are confined to the physical organs but rather refer to a particular aspect of our self regulatory intelligence, with all its internal feedback loops on the level of the BODY, the MIND and the SPIRIT. They are all meant to work in harmony with a very precise set of tasks and mutual checks and balances. When we speak about these regulatory systems, we will always keep them capitalized to minimize confusion.

By the time most of us have reached midlife, the harmony and cohesive strength of this Empire has been challenged many times and eroded at least to some extent. In addition, the hormonal changes that happen around that time tend to disturb the natural balance of things just a bit more. The magic of it all is that by rekindling the intelligence of the system, one can reestablish the vitality of the whole with remarkably simplicity.

This is one of the great secrets of MenoPassage: it is a wake-up call to heed the order in our inner kingdom. Once we have woken up to this reality, it is completely in the realm of possibilities to return greater harmony to the Empire with a few well-guided steps and a bit more intensive self-care. We can not only regain the vitality we had in our younger years, but reattune ourselves to our inner compass. In this way, we can continue building on the richness and wisdom of our past experience to keep moving towards greater creativity and continue unfolding our destiny There is something innately magical about arriving at the midlife station, reassessing everything and consolidating one’s foundation so one has strong basis to move forward from.

The main Officials involved in MenoPassage are the KIDNEYS and the LIVER, followed by the SPLEEN, of course all overseen by the HEART, who represents the Emperor. And then of course there are a wide variety of individual variabilities. The KIDNEYS and LIVER are the primary Officials that will give us the classical menopausal symptoms, such as the hot flushes, night sweats, insomnia, mood swings, anxiety etc… so we will be to a large extent focusing our discussion on these for the time being. They are in charge of most of the hormonal realities as well as the interaction of hormones with neurotransmitters, thus indeed major players in the MenoPassage years.

On the level of the physiology of the Body, the KIDNEYS actually refer primarily to the adrenal glands and the aspects of the brain that regulate it, the HPA (hypothalamus-pituitary-adrenal) axis. Estrogen is a hormone deeply linked to the KIDNEYS, and its gradual diminishment during the menopausal years can cause some imbalance in that system, particularly if it is already strained for other reasons. They are also in charge of the health of the Bones, thus menopausal issues of osteopenia and osteoporosis, as well as our hair, thus a tendency to hair loss around that time.

Beyond that, the KIDNEYS is where our Essence, the “Jing” resides, that deeper gift of our heritage that we receive at birth, from both our parents and our “Heavenly heritage”. It is what shapes our Destiny, “Ming” and allows us to be in tune with our deeper destiny, the gift that we have been born with.  The Essences are also considered the basis of growth, development, and reproduction.

The KIDNEYS also give us the ability to will things into being, take action that creates a desired result. It is clearly one of the key players in the course of MenoPassage and we will spend more time to understand it. As we focus on supporting it, we will address not only many of the physical symptoms and issues of the menopausal years but also enrich the MenoPassage journey by supporting the deeper Essences.

Now let us now look at the LIVER. Again, the LIVER Official is only marginally related to the 3 lb organ under our rib cage. One of its primary functions is to “regulate the smooth flow of Qi”, Qi being our vital energy.  It is very much related to how we are able to relate to stress in all its many varieties. When things get too intense, the energy can tend to stagnate. This, in turn, can give rise to symptoms that usually have greater intensity, migraines, burning sensation in the eyes, peptic ulcer disease and gastroesophageal reflux, intense hot flushes, especially in the afternoon.

On the Mind level, the LIVER is responsible for the smooth flow of emotions. It is also “the general of the armed forces” within the internal Empire. It will strategize to allow us to accomplish our aims, make proper use of our resources and advance and retreat at the appropriate time.

On the Spirit level, the LIVER gives us a deep sense of DIRECTION in life. In the menopausal years, this is often very much something that a woman wishes and needs to recalibrate. If the LIVER official is functioning healthily, this will unfold on its own. If there is an issue, there may be a sense of lack of direction and motivation, dark outlook, maybe even the dark night of the soul. And of course, an imbalance in the health of that official will usually manifest on all levels, the body, the mind and the Spirit, so physical symptoms such as intense migraines and a history of intense PMS and pelvic pain may well accompany this mental state.

We are now getting a bigger picture of why the health of these OFFICIALS is so important to tend to, as they regulate our entire lives on all levels. The menopausal years act as a wake up call to attend to their balance and well being. As the endogenous hormones wane, so does some of the support for the KIDNEYS and the LIVER, and any imbalance will show itself more acutely. This in turn is an invitation to take a holistic journey through the menopausal years – MENOPASSAGE.

We should also briefly touch upon the SPLEEN, which is one of the Officials responsible for our deep inner nourishment. The STOMACH Official allows us to ingest… any type of nourishment, be it food, information, experiences or whatever else., and breaks these down into their constituents, the SPLEEN then takes these building blocks and makes them useful to us as an individual. In health, they allow us to receive deep nourishment and satisfaction from what we ingest, the constituents become transformed into the essence of who we are and enrich that. When these officials do not function properly, one will often have a sense of heaviness and fatigue, some digestive issues, perhaps excessive vaginal bleeding, issues with the clarity of the mind such as brain fog and forgetfulness. These are the Officials most readily responsive to proper self care, attentiveness to diet and backing up from excessive work or other activity etc…

Lastly, the HEART can also be involved, though more rarely. As mentioned before, the HEART Official is the great Emperor and holds the reins of the Empire in his hands. He also allows “the SPIRITs to circulate”, which allows us to live with a deeper sense of purpose and aliveness, a sense that Spirit is guiding our path and enlivening us. Dysfunction results in anxiety, palpitations, loss of control etc…

We will go into greater detail about the wonderful structure of this Empire of ours and how it relates to our inner well being and growth in a future blog. Suffice it for now to understand that it is about a regulatory intelligence that can be supported in a variety of ways to allow us to have a vastly fruitful MenoPassage.

Wisdom of MenoPassage: your own deep feminine knowing…to make a shift

MenoPassage: a holistic Journey through the menopausal years.

Menopause can be very tough, a time when women seem to lose their bearing to some extent and need to work their way through increased anxiety, instability, perhaps depression and reestablish their sense of direction and identity. Even though nowadays there are many solutions readily at hand, a little guidance through the maze of options may well be warranted, especially if it can address more than just the basic health issues of the menopausal years.

I would like to introduce you to the MenoGuide. She is personified by an OWL! She represents your own inner wisdom that has already led you through so many stages of developing as a woman and is ready to accompany you through yet another journey. Indeed, MenoPassage is about a journey and encompasses body, mind and Spirit, and we need to honor the wisdom of Spirit in lending us guidance in managing our body and our mind. The OWL’s wisdom is given voice by many great experts in the field, but the reason she is able to guide you is that she is actually within you, a deep inner knowing that guides you in transforming the many challenges of the menopausal years into new opportunities for growth and creativity.

The MenoGuide – the OWL – is highly experienced in leading you through the thick, the dark and the magic of MenoPassage and allowing you to see the new potential unfolding for you. Her sight is sharp in the dark of the night and in her wisdom, she loves exploring all the recesses where the obstacles to your well-being may be hidden. Her world encompasses magic, mystery and ancient knowledge, and this is exactly what she wants to share with you. The OWL is known to be in perfect synchrony with the moon’s cycles of renewal. Deeply connected to femininity and fertility, she loves to guide women into a cycle of renewal after reproductive fertility has come to an end.

We will explore a variety of experts that seem to reflect her wisdom, such as gynecologist Christiane Northrup, author of “The wisdom of menopause”,  “The secret pleasures of menopause” and “Goddesses never age”, and neurologist Daniel Amen, author of “Unleash the power of the female barin”. We will also look at the ancient Chinese as they encourage self tending during this challenging time of life and shed a different light on the physiology of menopause. They ancient Chinese are experts at ushering in the “second springtime” of a woman’s life. And we will use compassionate inquiry to unravel the personal pitfalls that women may be encountering. All this is part of the exploratory wisdom of the OWL.

Today, we will begin with the Owl’s wisdom as reflected in the writings of Christiane Northrup MD, a visionary pioneer and a leading authority in the field of women’s health and wellness, addressing the unity of mind, body, emotions, and spirit.

Because in essence, the menopausal years rock the boat, they are such a powerful wake up call to be in touch with our vital force, bring deep nourishment to ourselves and learn to bring our kingdom into new balance. As the hormones recede, you may now become aware of underlying levels of fatigue, anxiety, lack of motivation or direction, it may feel like a breakdown, but in essence it is a breakthrough. It is a bit of a cleansing fire.

Indeed, according to Christiane Northrup MD

In the course of menopause and thereafter, we can be” more in touch with what really matters to us, and our bodies act as incredibly accurate barometers that indicate how closely we live our lives in-line with our true heart’s desires… The menopausal transition is a wake-up call that’s urging you to make changes that will keep you in touch with your vital life force (sometimes called chi or prana). “

It is time to bring in more self-tending, be cognizant of the need for rest, touch, acknowledgement, intimacy and find a connection to inner guidance. As long as there is disconnect and denial, pain will ensue, which takes a lot of energy to uphold. It is time to do deep physical and emotional housecleaning to rid your self of all the old baggage that might be holding you back from unfolding into… such as the relationships and undertakings in our lives that deplete us because we fail to take charge and make sure we draw some benefit. With the shift may come a much greater ability to create the life we love.

Christiane Northrup MD

“The truth about this time of life is that when you have the courage to change your beliefs and behaviors so that you speak your truth and dare to cultivate pleasure instead of stress, you have the power to create a life of unbridled joy, unlimited abundance, and vibrant health.”

 The OWL is sending out an invitation to wholeheartedly cultivate a deep current of pleasure in our lives. This may not imply veering towards a hedonistic life… far from it, perhaps it is more of an invitation to move into deeper self-acceptance and self-embracing, tending to the deeper pleasures of the moment, the rich ness of friendship, beauty and sensuality that we are so much more able to open to as we mature. In many ways, this simply implies giving ourselves permission and delving deeper into what truly matters for us.

Christiane Northrup MD:

You have a chance of having “a much stronger creative drive now since your life energy isn’t being used in order to have periods and create babies. Instead, it gets rerouted into powerful urges to create other things—anything from a personal journal of poetry and sketches to a thriving new business… This is a time in life when your creative juices are ready and willing to flow like never before, even if you haven’t previously thought of yourself as very creative.”

As we start tending more towards our own need for deep nourishment, our creative juices may start flowing like never before. It is a bit like a flower opening in the sunshine of the new love and nourishment we bring to it. Many perceptions come together in a new way, we are able to synthesize a new understanding that will lead us to new ventures. And a new guidance will emerge as we become more open to a deeper current within our lives.

Christiane Northrup MD:

“Whatever doesn’t feed our soul and doesn’t make us feel vibrantly alive needs to fall by the wayside now. Our lives have no room for such things anymore. Everything we think, say, and do from this point on will either keep us actively engaged in living passionately and joyfully, or it will hasten degeneration and increase our chances of poor health and disease. It’s our choice to make.”

Be cause of the profound internal shifts and changes, it becomes so much more necessary to take a strong stance and make the changes that now suit us in a whole new way.

Again, from Christiane Northrup:

“Women who make a point of maintaining a strong, passionate life force become magnetically attractive to uplifting people and circumstances. So while you’re having a great time with all of the wonderful things you’re bringing into your life, you’ll also be sending out signals that say to the universe, I’m loving life and loving that I love life, so bring on more of the good stuff! The universe always responds, because whatever you give your attention to grows. And when you give your attention to bringing life-affirming, fun things into your life, you open up a channel for more of the same to come in. It’s as simple as that. In fact, this feeling of being in love with life itself is absolutely vital if you want to have a passionate, fulfilling relationship with a partner.”

This work in turn leads to the springtime of a whole new chapter of life, and we have so much more maturity to bring to it. The more we understand it is OUR CHOICE and that we get to embrace OUR OWN FREEDOM, the better this will go.

Bibliography:

Northrup, Christiane:  “The Wisdom of Menopause.” New York: Bantam Books, 2012