Public protocols

Recommendations from RTHM, available to anyone who visits this store.

RTHM Covid19 Infection Risk Reduction
** Watch this video (3min) on how to use a nasal spray correctly before using, or it may not be maximally effective!*** Nasitrol $20/bottle at https://nasitrol.com/product/nasitrol/ “So far, one study of about 400 healthcare workers suggested that iota-carrageenan may potentially lower the risk of getting COVID-19 by up to 80% ” - GoodRX Dosed 4 times per day in the study. Carageenan processed properly is used in a lot of OTC products currently (like toothpaste), but if processed with acid can be toxic . S. Salivarius BLIS K12 (OralProbio) This oral probiotic lozenge contains BLIS K12 probiotics. This has stronger evidence for use as a part of a preventative routine against SARS-CoV2 (and other respiratory infections), but could also be used during acute COVID-19. In a study in school children , BLIS K12 reduced the risk of catching COVID-19 and upper respiratory infections in general notably. Another study in healthcare workers found a notable reduction in respiratory infections (no one in the study or control group caught COVID-19 in the study though). The probiotic appears to increase anti-SARS-CoV2 antibodies in the blood (including types of antibodies that can cross into/protect the mucous membranes in the mouth/gut) in vaccinated people. In this preliminary study , BLIS K12 appeared to improve blood markers and reduce the risk of death in people hospitalized with COVID-19, but results did not reach significance. So this has stronger evidence for use as a part of a preventative routine against SARS-CoV2, but could also be used during acute infection. Enovid (SaNOtize) *not yet approved in the US. Currently approved and available for purchase in EU, Israel, India, Singapore, Thailand, Bahrain. "The new study, conducted at Srinakharinwirot University in Bangkok, Thailand, found participants who took NONS after COVID-19 exposure were 75% less likely to become infected when compared to the control group, yielding a statistically significant reduction in infection rate." ~ Source People infected with Covid19 who used Enovid had reduced viral load and turned PCR negative notably faster than those using the placebo in this study . Please note: There is the possibility that an ingredient in the Enovid spray that was not in the placebo (a type of cellulose) may inhibit PCR tests, potentially leading to false negative tests in the studies. ________________________________________________________________________________ Items below have weaker evidence (in vitro studies, human case reports), mixed efficacy in larger studies, and/or notable side effects that make them less ideal options ________________________________________________________________________________ Covixyl ~$19/bottle at https://covixyl.com/ "Covixyl™ is effective for up to six (6) hours and can be reapplied for continuous protection. Covixyl™ can safely be applied more frequently, especially in areas of high risk (crowds at a concert, traveling on public transportation, etc.). If you sneeze or blow your nose strongly, you should reapply." Study in hamsters. Study in humans? (was unable to find it) -- on their site they claim that 4 times as many people using their product didn't catch Covid19 than those using the placebo. Because we were not able to locate the publication their site was referring to, Covixyl is in the weak evidence category. If you find the human study, please send it to support@rthm.com so we can update this! Xlear There is an in vitro pre-print study looking at xylitol inactivating SARS-CoV2 virus in a lab. Case series of 3 people with active Covid19 using the nasal spray. Nasal spray: Xlear has 2 versions - regular and Max. Max has additional ingredients added to help with nasal congestion. Lozenges and mouth wash: There are also xylitol lozenges to suck on and Spry xylitol mouthwash - this wasn't studied specifically for Covid19, but the nasal spray reduced infection, so presumably adding the lozenges or gargle/spit mouthwash might help protect the mouth (as opposed to just the nose). Betadine (povidone iodine) Studies had mixed results as far as efficacy, and some concerning side effects. It's an option, but given the high rate of TSH elevations after just 5 days of use, nose burning, and mixed efficacy results, betadine spray isn't the strongest candidate nasal spray to use for Covid19 risk reduction. One study where people used the spray for 5 days, all particiapnts had burning in the nose (temporary) and elevations in TSH (thyroid stimulating hormone) that resolved after stopping. Another study found that 0.4% nasal spray showed poor anti-viral activity and was unlikely to work. Additional studies https://www.frontiersin.org/articles/10.3389/fmed.2022.863917/full#main-content https://journals.sagepub.com/doi/epub/10.1177/0145561320957237 https://pubmed.ncbi.nlm.nih.gov/34724213/
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RTHM Covid19 Infection Master Protocol
21 more items in RTHM Covid19 Infection Master Protocol
ACUTE COVID19 STACK (to try and prevent severe Covid19/reduce mortality risk, and to try and minimize risk of developing Long COVID) PLEASE READ THIS SECTION FIRST 1. This is a general guide to items that may be helpful if you catch Covid19 -- this list is based on literature, my experience, and the different theories of Long COVID derived from existing research (i.e. microclots & platelet activation, autoimmunity, viral persistence, etc.) which I discuss and link to in the Google Document in #2 so you can have a better sense of why particular things are recommended, and which have stronger vs. weaker evidence for their use: 2. PLEASE READ THIS GOOGLE DOC FOR THE STUDIES AND RATIONALE FOR EACH ITEM LISTED BELOW https://docs.google.com/document/d/15cTRYESe680lyEaSrO85WkUegJJehNgi-qulgH4SXsw/edit?usp=sharing 3. This list is intended as general information, not as specific medical advice. Every person is unique and on different medications or supplements, do not start new supplements or medications without first consulting your healthcare provider. 4. You do NOT need everything in this list! There are some items that are duplicates - they are just different options for the same item. Other items (like zinc, vitamin D, or vitamin C) may not be needed if you take a multivitamin that contains sufficient amounts of them, so make sure to actually read through the list before purchasing. 5. Where items are not available on Fullscript, I've tried to put links to the most affordable options I could find from reputable vendors. 6. You can search for other options besides those listed below within the Fullscript catalogue. I tried to pick the options that had the least problematic fillers and were still well priced. If you don't have difficulties with magnesium stearate or silicon dioxide, there are likely cheaper options for each item within the Fullscript catalogue and at local retailers. 7. We do receive a percentage of the proceeds from any orders through Fullscript and Researched Nutritionals, but not from any of the other items linked below. Feel free to shop around for better prices from reputable vendors elsewhere, just be careful purchasing from off-brand stores on Amazon as fake/non-authentic items and poor temperature control during warehouse storage can impact the quality and effectiveness of the items you buy. If you can, try to buy cGMP certified supplements made in the USA. 8. This goes without saying, but do not take anything you are allergic or sensitive to. Do not take aspirin, nattokinase, serrapeptase, or lumbrokinase if you are on prescription blood thinners or have a bleeding disorder, stomach or intestinal ulcers, recent surgery, are pregnant or breastfeeding. 9. Again, please note that this list is intended as general information, not as specific medical advice . Every person is unique and on different medications or supplements, do not start new supplements or medications without first consulting your healthcare provider. ARRANGING COVID19 TESTING FROM HOME OR AT A NEARBY LOCATION: "Test-to-treat" site locator (get tested & get prescribed treatment ASAP for FREE): https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/ Free on-site testing locator: https://testinglocator.cdc.gov/ Labcorp Pixel home Covid19 PCR test kit for flu and Covid19 that ships to your house (covered by most insurances): https://www.ondemand.labcorp.com/at-home-test-kits/covid-19-flu-pcr-test-home-collection-kit Drip Hydration will send someone to come test you (and your household if needed) at your home for a fee: https://driphydration.com/coronavirus-testing/at-home-covid-19-testing/ **ALWAYS TAKE A PHOTO OF YOUR POSITIVE TEST RESULT AND SAVE IT!** You may need the proof of positive test to access Covid19 antivirals - or if you develop Long COVID - to become a patient of some Long COVID clinics, to join certain Long COVID studies, to access Long COVID clinical trials, or to apply for disability related to Long COVID. It is SO much harder to get care, into trials, etc. without the proof of positive test! PLEASE NOTE: Some people take a long time to test positive, or they never do, so act/treat yourself as if you have Covid19 if you had a known or suspected exposure and you have symptoms, regardless of whether your test is positive. LIMITING SPREAD OF COVID TO OTHERS IN YOUR HOME IF YOU CATCH IT: - distancing from others in your household if you can, consider using a separate bathroom or sleeping in a different bedroom as others until you are recovered - Run HEPA filters in your room with the room door closed, - wear a well fitted N95 or better mask in common/shared areas - leave windows open to the outside for better air flow (weather and allergies permitting). - allow natural sunlight in (UV helps kill Covid19 on surfaces) - wash hands often, avoid touching or kissing others' faces until you are recovered - avoid sharing utensils, cups, or food with others until you are recovered REST, REST & PACE YOURSELF #. REST & PACE your activities - do not overdo it. Even if you feel better quickly, ease back into strenuous activities gradually; if your body is telling you to sleep, do so (when safe to do so, of course). If you need time off work to recover, ask your provider for a note. #. Re-starting intense activities or exercise too soon after Covid19 infection has triggered Long COVID in many people. After you feel fully recovered, give yourself another week at least before you can do some gentle exercise (a short walk perhaps), and gradually increase intensity and duration of exercise over the next 2-3 months back to your prior baseline only as tolerated. TREATMENTS: #. Paxlovid ( possibly followed by TollovidMAX - for 2-3 weeks, as directed on the bottle) if you can get them locally. The Paxlovid can be prescribed by your primary care doctor, urgent care, or pharmacy "minute clinic," etc. Generally your PCP or urgent care is fastest. -- If you are prescribed Paxlovid, there is a risk of rebound after stopping the 5 day course. If the prescribing clinician is open to it, consider having them put 1 refill on your Paxlovid prescription so you can get another round IF you experience rebound symptoms after completing the first course of Paxlovid. If they are not willing to do that, you could take TollovidMAX instead. Follow the high dosing on the bottle for 5 days (1 bottle), it is optional to then. then lower to 2 capsules twice daily for another week or two depending on symptoms (will require a 2nd bottle of TollovidMAX) -- Where to buy TollovidMAX: https://mytollovid.com/products/tollovid%E2%84%A2-immune-support-capsules. (Use code RTHM33 to get 33% off of a purchase of 2 bottles or more) -- [Monoclonal antibodies for Covid19 are no longer available] One place to get Monoclonal Antibodies infused at home (needs a doctor's order): https://driphydration.com/covid-iv-treatment-monoclonal-antibody-iv-therapy/ #. METFORMIN - may reduce Long COVID risk by 42% according to this randomized, blinded study . This is prescription- your PCP, a local minute clinic, or your RTHM provider can usually provide it. Healthspan and AgelessRX prescribe it online (for longevity) if you are unable to get it otherwise. - Metformin dosing in the study: -- Day 1: 500 mg once daily -- Days 2-5: 500 mg twice daily -- Days 6-14: 500 mg in the morning and 1000 mg in the evening #. AB21 Probiotics (acute covid): – This blinded study in nearly 300 people with acute covid19 showed improved resolution of symptoms by the end of the study in those on the AB21 probiotic vs. those not taking it. -- I've reached out to Kaneka (who distributes AB21 in the USA) but have not heard back on how to access their probiotics. The only version directly orderable right now is from Probio7 in the UK #. Cucurmin -- A recent review found overall improvements in mortality, common symptom duration and hospitalization across 6 studies on cucurmin in mild-severe Covid19, but stated that a larger study should be done with more standardized formulations of cucurmin -- Liposomal cucurmin (Merivia), nano-cucurmin (theracurmin), or cucurmin with piperine are good forms; take with food to minimize upset stomach. High doses over time can cause mild yellowing of the skin (not due to jaundice, but likely an accumulation of the very yellow pigmented compound in the skin), and sometimes diarrhea that resolve upon stopping the supplement. #. Nasal sprays ***PLEASE WATCH THIS VIDEO ON HOW TO USE NASAL SPRAYS CORRECTLY! IT'S REALLY IMPORTANT TO USE THE RIGHT TECHNIQUE*** -- Neti pot saline nasal irrigation twice daily helped reduce risk of severe Covid19, but you need a decent volume of saline each time ( $8 - Equate 1 neti pot + 50 saline packets at Walmart.com). Please clean netti pots per the manufacturer instructions (they can start growing things if not properly cared for). -- Chlorpheniramine 1% nasal spray (an antihistamine) reduced Long COVID symptoms when used during acute infection in this study It may be hard to find in the US. Was dosed at 2 sprays each nostril 3 times per day for 10 days in the study. -- SaNOtize (Enovid) is an alternative that is formally approved in several countries [not the US yet]. This company in Israel ships Enovid globally: Enovid nasal spray (minimum $105). #. Oral rinse with CPC-containing mouthwash : placebo-controlled study showed only mild, but significant, benefits in terms of reduced viral infectivity. So this is one you can remove if trying to cut down on items or cost. -- Crest Pro-Health mouthwash ( $7 - Crest Alcohol free mint 50.7 fl.oz. ) - gargle and spit twice daily for at least 1 week, can extend to 2 weeks if still symptomatic #. ADULTS ONLY: Baby aspirin 1-2 times per day (chewable preferred - available over the counter at most pharmacies) - can continue for 1-3 months after depending on symptoms. This is to help blunt platelet activation, as has been seen in acute and Long COVID. **Children and teens should not take aspirin when they have flu-like symptoms or they can develop Reye syndrome, which can be very severe. And anyone on prescription blood thinners or a bleeding disorder shouldn't take this before asking their doctor** -- ~$5-10 at most pharmacies over the counter or iherb.com #. Nattokinase +/- Serrapeptase & Lumbrokinase -- Nattokinase degrades SARS-CoV2 spike protein in vitro (according to this study ) and all 3 enzymes help break down fibrin, which may help reduce the microclots seen by Dr. Pretorius and colleagues. **Check with your doctor if you are taking any blood thinners, soy allergy, are pregnant, or nursing.** Start at the low end of the bottle recommended dose and work up, esp if you are also on NAC and aspirin, you may notice some bruising or easy bleeding and may need to lower the dose. -- See Nattovena below for Nattokinase -- See Lumbrokinase below -- Boluoke is a very good brand of Lumbrokinase not on Fullscript, can order here with code "CURMD": https://www.researchednutritionals.com/product/boluoke-lumbrokinase-60-caps/ #. H2 blocker -- famotidine (Pepcid) 40mg twice daily while symptomatic and for 1-3 months after depending on symptoms -- ~$16 for 25 tablets of 20mg at Walgreens, CVS or Target -- Mark Cuban's Pharmacy 60 of the 40mg tablets is ~$11 (with shipping included) #. H1 blocking antihistamine : Allegra (180mg), Zyrtec (10mg), Claritin (10mg), or Xyzal (5mg) -- twice daily while symptomatic and for up to 3 months after depending on symptoms -- Costco has the best prices on bulk generic antihistamines - 365 tablets of generic for ~$14 https://www.costco.com/kirkland-signature-aller-tec%2C-365-tablets.product.11312465.html -- Mark Cuban's pharmacy has great prices too ~$15 (incl shipping) for 90 tabs of a generic antihistamine: https://costplusdrugs.com/medications/Cetirizine-10mg-Tablet/ #. H1 blocking Antihistamine nasal spray: -- Chlorpheniramine 1% nasal spray (an antihistamine) reduced Long COVID symptoms when used during acute infection in this study It may be hard to find in the US. Was dosed at 2 sprays each nostril 3 times per day for 10 days in the study. This may need to be compounded in the US. -- Azelastine is an antihistamine nasal spray that is OTC in the US, but I haven't seen a study on this specific one on how well it compares to chlorpheniramine in terms of reducing symptoms of Long COVID #. NAC (N-acetyl cysteine) -- 600mg -1200mg twice daily with food -- See below for capsules -- Bulk Nutrition also has NAC in a bag on Amazon, if you prefer to scoop it and take it with water or make your own capsules, that is the most economical option -- Studies found it didn't necessarily reduce risk of severe COVID but based on a few mechanisms, it's possibly it may help reduce long COVID risks (please see the google doc linked at the top for more details). #. CoQ10 (ubiquinol preferred, preferably Kaneka in some sort of oil, fat or limonene base for better absorption) - 100-200mg twice daily with food -- See Below for options #. Multivitamin -- daily in the morning -- See list below for the Pure ONE by Pure Encapsulations, which contains most of the B vitamins in MTHFR-friendly formulations already -- Mary Ruth's Organics Liquid morning multivitamin is vegan, food derived, no artificial colors or flavors and has trace minerals as well; MTHFR friendly: https://www.maryruthorganics.com/products/organic-liquid-morning-multivitamin?variant=46177691797 -- If you have high B6 levels, Desert Harvest has a B6-free B complex with minimal fillers; MTHFR-friendly https://www.desertharvest.com/b-complex-without-b6-90-capsules.html #. Vitamin D3 -- 2000IU - 5000IU daily, main thing is to make sure the D levels are not low, as outcomes with Covid19 are much worse in people with low vitamin D. Vitamin D is also is a mast cell stabilizer. You don't need to take really high doses of vitamin D, as benefit was not demonstrated in acute Covid19 at least, and vitamin D can be toxic at really high doses. (If you go for higher doses like 50,000IU, take it weekly for no more than a month before you check your Vitamin D levels, high vitamin D can cause problems as well as low vitamin D.) -- if you are on a multivitamin with sufficient vitamin D, you don't need a separate vitamin D supplement -- see below for options for 2000IU and 5000IU capsules #. Quercetin (+/- rutin) -- 250-500mg 2-3 times daily as tolerated; antiviral and mast cell stabilizing properties -- Thorne Quercetin Phytosome is better absorbed, so 250mg 2-3 times per day should suffice -- other brands might be better to use 500mg 2-3 times per day #. Liposomal glutathione -- 250-600mg twice daily 30min away from food or other medications as tolerated -- this is somewhat redundant with the NAC and on the expensive side, so this can be dropped to keep costs down -- glutathione tastes like sulfur (rotten eggs) so patients have said the Tropical liquid in the list below tastes fairly good, or just getting it in capsules (like Body Bio brand) is best for tolerating it -- Alternately, the Researched Nutritionals gel tastes fairly good (Orange or Watermelon), is a better price per ounce, and doesn't need refrigeration like other liquid versions sometimes do (use code "CURMD" at checkout): https://www.researchednutritionals.com/product/tri-fortify-orange-liposomal-glutathione-vitamin-c-heat-stable-gmo-free/ #. Alpha lipoic acid (ALA) -- 500-1000mg up to twice daily as tolerated, usually with food -- See Below for options -- there are also plain and vanilla caramel liposomal Vitamin C + Alpha Lipoic Acid combination options from Researched Nutritionals here (use code "CURMD" at checkout): https://www.researchednutritionals.com/product/c-rla-vanilla-caramel-liposomal-vitamin-c-gmo-free/ #. PEA +/- luteolin -- individual or in combinations to lower inflammation and stabilize mast cells; -- Vitalitus.com has plain PEA in the US that is good: https://vitalitus.com/product/pea/: 2 capsules twice daily with food for 2-3 weeks, then 1 capsule twice daily with food -- Mirica has luteolin + PEA (2 mast cell stabilizers that cross the blood brain barrier): Regular mirica 2 capsules twice daily for 2-3 weeks, then 1 capsule twice daily with food: https://youngnutra.com/products/mirica-120-capsules-palmitoylethanolamide-pea-and-luteolin-free-shipping-usa -- There's a brand below with PEA + liposomal cucurmin in it (both cross blood brain barrier); see dosing in the supplement listed below #. Antivirals or supplements against EBV + NK cell function boosting: Valtrex, Famvir, or Transfer Factor or Collostrum *This is theoretical benefit - as EBV reactivation during acute covid was associated with Long COVID development. Famvir or Valtrex 500mg 3 times per day (or 1000mg twice daily) with food. OR Transfer Factor Sensitive (if you have med sensitivities), use code "CURMD" OR Transfer Factor Multimmune (if no med sensitivities) as directed on the bottle, use code "CURMD" __________________________ #. Zinc - ~ 11-30mg daily (for adults) -- There is 25mg of Zinc in the Pure Encapsulations ONE Multivitamin in the list below, so you do NOT need extra zinc if you are taking a multivitamin with at least 11mg of zinc in it -- See below for the multivitamin and for zinc options #. HYDRATE well with electrolytes , not just plain water (unless you have high blood pressure, heart or kidney failure) - TriORal : https://www.amazon.com/TRIORAL-Rehydration-Organization-Electrolyte-Replacement/dp/B00OG8G9U2 - Normalyte: https://normalyte.com/ - LiquidIV: https://www.liquid-iv.com/products/ - Nuun tabs (avoid the ones with caffeine): https://www.target.com/p/nuun-hydration-sport-drink-tabs-tri-berry-10ct/ - More options with lower sodium content are listed below __________________________ #. Lactoferrin + benadryl -- lactoferrin is an antimicrobial enzyme containing iron (also helpful if your iron is low) **not suitable for those with milk allergies or sensitivities** with pretty weak evidence for use in Covid19 alone. One study combining benadryl + lactoferrin in monkey cells inhibited viral activity by 99%, where either alone only had ~30% effect, but petri dish studies in Covid19 have frequently not shown the same results when tested in actual people. -- See below for options #. Phosphotidyl choline - 600-900mg 1-3 times per day with food as tolerated -- The items below are derived from soy, I believe CoreMedBiosciences has a version derived from sunflower if you have a soy allergy -- If you have anti-phosphotidyl choline antibodies (a very specific type of antiphospholipid antibodies), it's unclear whether supplementation could be worse for you #. Vitamin C - -500mg twice daily (buffered or liposomal is a little easier on the stomach) -- if sufficient levels are in your multivitamin or other supplements, no need to supplement with extra unless you find it helpful for you personally -- see below for buffered and liposomal vitamin C options -- there are also plain and vanilla caramel liposomal Vitamin C + Alpha Lipoic Acid combination options from Researched Nutritionals here (use code "CURMD" at checkout): https://www.researchednutritionals.com/product/c-rla-vanilla-caramel-liposomal-vitamin-c-gmo-free/
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RTHM Acute COVID Preparedness Kit ($150-200 budget)
4 more items in RTHM Acute COVID Preparedness Kit ($150-200 budget)
ACUTE COVID19 STACK (This protocol is to try and prevent severe Covid19/reduce mortality risk, and to try and minimize risk of developing Long COVID.) Walmart had the cheapest prices by a significant margin for the OTC items (linked below) not on Fullscript, and shipping is free with relatively fast delivery times. However, you can find most of these items at a local pharmacy or grocery store (Target, CVS, RiteAid, Walgreens, etc.). *For those with Celiac disease, gluten sensitivity, sensitivities to dyes/fillers, check ingredients before buying. You may be better off with the brand name or a different generic formulation than the options below. PLEASE READ THIS SECTION FIRST 1. This is a general guide to items that may be helpful if you catch Covid19 -- this list is based on literature, my experience, and the different theories of Long COVID derived from existing research (i.e. microclots & platelet activation, autoimmunity, viral persistence, etc.) which I discuss and link to in the Google Document in #2 so you can have a better sense of why particular things are recommended, and which have stronger vs. weaker evidence for their use: 2. PLEASE READ THIS GOOGLE DOC FOR THE STUDIES AND RATIONALE FOR EACH ITEM LISTED BELOW https://docs.google.com/document/d/15cTRYESe680lyEaSrO85WkUegJJehNgi-qulgH4SXsw/edit?usp=sharing 3. This list is intended as general information, not as specific medical advice. Every person is unique and on different medications or supplements, do not start new supplements or medications without first consulting your healthcare provider. 4. You do NOT need everything in this list! You can remove items to keep costs down. 5. Where items are not available on Fullscript, I've tried to put links to the most affordable options I could find from reputable vendors. 6. You can search for other options besides those listed below within the Fullscript catalogue. I tried to pick the options that had the least problematic fillers and were still well priced. If you don't have difficulties with magnesium stearate or silicon dioxide, there are likely cheaper options for each item within the Fullscript catalogue and at local retailers. 7. We do receive a percentage of the proceeds from any orders through Fullscript and Researched Nutritionals, but not from any of the other items linked below. Feel free to shop around for better prices from reputable vendors elsewhere, just be careful purchasing from off-brand stores on Amazon as fake/non-authentic items and poor temperature control during warehouse storage can impact the quality and effectiveness of the items you buy. If you can, try to buy cGMP certified supplements made in the USA. 8. This goes without saying, but do not take anything you are allergic or sensitive to. Do not take aspirin, nattokinase, serrapeptase, or lumbrokinase if you are on prescription blood thinners or have a bleeding disorder, stomach or intestinal ulcers, recent surgery, are pregnant or breastfeeding. Cucurmin can interfere with Cytoxan and 2 other chemotherapy drugs. Alpha lipoic acid can interact with diabetes drugs (not metformin) and interfere with thyroid conditions. 9. Again, please note that this list is intended as general information, not as specific medical advice . Every person's health situation is unique -- do not start new supplements or medications without first consulting your healthcare provider. ARRANGING COVID19 TESTING FROM HOME OR AT A NEARBY LOCATION: "Test-to-treat" site locator (get Covid-tested & get prescribed treatment ASAP for FREE): https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/ Other on-site testing search: https://www.covid.gov/tests Labcorp Pixel home Covid19 PCR test kit ships to your house (covered by most insurances): https://www.ondemand.labcorp.com/at-home-test-kits/covid-19-flu-pcr-test-home-collection-kit Drip Hydration will send someone to come test you (and your household if needed) at your home for a fee: https://driphydration.com/coronavirus-testing/at-home-covid-19-testing/ **ALWAYS TAKE A PHOTO OF YOUR POSITIVE TEST RESULT AND SAVE IT!** You may need the proof of positive test to access Covid19 antivirals - or if you develop Long COVID - to become a patient of some Long COVID clinics, to join certain Long COVID studies, to access Long COVID clinical trials, or to apply for disability related to Long COVID. It is SO much harder to get care, into trials, etc. without the proof of positive test! PLEASE NOTE: Some people take a long time to test positive, or they never do, so act/treat yourself as if you have Covid19 if you had a known or suspected exposure and you have symptoms, regardless of whether your test is positive. LIMITING SPREAD OF COVID TO OTHERS IN YOUR HOME IF YOU CATCH IT: - distancing from others in your household if you can, consider using a separate bathroom or sleeping in a different bedroom as others until you are recovered - Run HEPA filters in your room with the room door closed, - wear a well fitted N95 or better mask in common/shared areas - leave windows open to the outside for better air flow (weather and allergies permitting). - allow natural sunlight in (UV helps kill Covid19 on surfaces) - wash hands often, avoid touching or kissing others' faces until you are recovered - avoid sharing utensils, cups, or food with others until you are recovered REST, SLEEP & PACE YOURSELF #. REST, SLEEP: If you need time off work to recover (highly recommended), ask your provider for a note. If your body is telling you to sleep, do so (when safe to do so, of course). If you are struggling to sleep, consider sublingual melatonin (see below). #. PACE your activities - do not overdo it. Even if you feel better quickly, ease back into strenuous activities gradually. Re-starting intense activities or exercise too soon after Covid19 infection kicked-off Long COVID symptoms in many people. After you feel fully recovered, give yourself another week at least before you can do some gentle exercise (a short walk perhaps), and gradually increase intensity and duration of exercise as tolerated over the next 2-3 weeks** back to your prior baseline only as tolerated. **If you find that your resting heart rate is notably higher than it was prior to Covid19 infection, or if you heart rate is shooting up high with minimal activity, like standing up, walking across your room, or up a flight of stairs, you will need to have an even more gradual progression back to pre-illness activity levels (months, not weeks)! And it is possible that taking 600mg of ALA (alpha lipoic acid) right away when you notice the increased heart rate could help reverse the issue (but it has to be taken right away, it's a very short window of time, so good to have this on hand ahead of time). TREATMENTS: #. Paxlovid ( possibly followed by TollovidMAX) - for 2-3 weeks, as directed on the bottle) if you can get them locally. The Paxlovid can be prescribed by your primary care doctor, urgent care, or pharmacy "minute clinic," etc. The US govt created a "Test-to-treat" program so people can get tested for Covid19 for free and prescribed treatment on the spot if positive ( find a "Test-to-treat" location near you ). -- If you are prescribed Paxlovid, there is a risk of rebound after stopping the 5 day course. If the prescribing clinician is open to it, consider having them put 1 refill on your Paxlovid prescription so you can get another round IF you experience rebound symptoms after completing the first course of Paxlovid. If they are not willing to do that, you could take TollovidMAX instead. Follow the high dosing on the bottle for 5 days (1 bottle), it is optional to then. then lower to 2 capsules twice daily for another week or two depending on symptoms (will require a 2nd bottle of TollovidMAX) -- Where to buy TollovidMAX: https://mytollovid.com/products/tollovid%E2%84%A2-immune-support-capsules. (Use code RTHM33 to get 33% off of a purchase of 2 bottles or more) -- [Monoclonal antibodies for Covid19 are no longer available] One place to get Monoclonal Antibodies infused at home (needs a doctor's order): https://driphydration.com/covid-iv-treatment-monoclonal-antibody-iv-therapy/ #. METFORMIN - may reduce Long COVID risk by 42% when started within 3 days of Covid19 symptoms/diagnosis according to this randomized, blinded study . This is prescription- your PCP, a local minute clinic, or your RTHM provider can usually provide it. Healthspan and AgelessRX prescribe it online (for longevity) if you are unable to get it otherwise. - Metformin dosing in the study: -- Day 1: 500 mg once daily -- Days 2-5: 500 mg twice daily -- Days 6-14: 500 mg in the morning and 1000 mg in the evening #. Cucurmin -- A recent review found overall improvements in mortality, common symptom duration and hospitalization across 6 studies on cucurmin in mild-severe Covid19, but stated that a larger study should be done with more standardized formulations of cucurmin -- Liposomal cucurmin (Merivia), nano-cucurmin (theracurmin), or cucurmin with piperine are good forms; take with food to minimize upset stomach. High doses over time can cause mild yellowing of the skin (not due to jaundice, but likely an accumulation of the very yellow pigmented compound in the skin), and sometimes diarrhea that resolve upon stopping the supplement. #. Nasal sprays ***PLEASE WATCH THIS VIDEO ON HOW TO USE NASAL SPRAYS CORRECTLY! IT'S REALLY IMPORTANT TO USE THE RIGHT TECHNIQUE*** -- Neti pot saline nasal irrigation twice daily helped reduce risk of severe Covid19, but you need a decent volume of saline each time ( $8 - Equate 1 neti pot + 50 saline packets at Walmart.com). Please clean netti pots per the manufacturer instructions (they can start growing things if not properly cared for). -- Chlorpheniramine 1% nasal spray (an antihistamine) reduced Long COVID symptoms when used during acute infection in this study It may be hard to find in the US. Was dosed at 2 sprays each nostril 3 times per day for 10 days in the study. -- SaNOtize (Enovid) is an alternative that is formally approved in several countries [not the US yet]. This company in Israel ships Enovid globally: Enovid nasal spray (minimum $105). #. Oral rinse with CPC-containing mouthwash : placebo-controlled study showed only mild, but significant, benefits in terms of reduced viral infectivity. So this is one you can remove if trying to cut down on items or cost. -- Crest Pro-Health mouthwash ( $7 - Crest Alcohol free mint 50.7 fl.oz. ) - gargle and spit twice daily for at least 1 week, can extend to 2 weeks if still symptomatic #. ADULTS ONLY: Baby aspirin 1-2 times per day (chewable preferred - available over the counter at most pharmacies) - can continue for 1-3 months after depending on symptoms. This is to help blunt platelet activation, as has been seen in acute and Long COVID. **Children and teens should not take aspirin when they have flu-like symptoms or they can develop Reye syndrome, which can be very severe. And anyone on prescription blood thinners or a bleeding disorder shouldn't take this before asking their doctor** -- ~$5-10 at most pharmacies over the counter or iherb.com #. Nattokinase +/- Serrapeptase & Lumbrokinase -- Nattokinase degrades SARS-CoV2 spike protein in vitro (according to this study ) and all 3 enzymes help break down fibrin, which may help reduce the microclots seen by Dr. Pretorius and colleagues. **Check with your doctor if you are taking any blood thinners, soy allergy, are pregnant, or nursing.** Start at the low end of the bottle recommended dose and work up, esp if you are also on NAC and aspirin, you may notice some bruising or easy bleeding and may need to lower the dose. -- See Nattovena below for Nattokinase -- See Lumbrokinase below -- Boluoke is a very good brand of Lumbrokinase not on Fullscript, can order here with code "CURMD": https://www.researchednutritionals.com/product/boluoke-lumbrokinase-60-caps/ #. H2 blocker -- famotidine (Pepcid) 40mg twice daily while symptomatic and for 1-3 months after depending on symptoms -- $5.50 - Equate famotidine 20mg tabs #50 at Walmart.com -- ~$16 for 25 tablets of 20mg at Walgreens, CVS or Target -- Mark Cuban's Pharmacy 60 of the 40mg tablets is ~$11 (with shipping included) #. H1 blocking antihistamine : Allegra (180mg), Zyrtec (10mg), Claritin (10mg), or Xyzal (5mg) -- twice daily while symptomatic and for up to 3 months after depending on symptoms -- Costco has the best prices on bulk generic antihistamines - 365 tablets of generic for ~$14 https://www.costco.com/kirkland-signature-aller-tec%2C-365-tablets.product.11312465.html -- $19 - Welmate fexofenadine 180mg tabs #100 at Walmart.com -- Mark Cuban's pharmacy has great prices too ~$15 (incl shipping) for 90 tabs of a generic antihistamine: https://costplusdrugs.com/medications/Cetirizine-10mg-Tablet/ #. NAC (N-acetyl cysteine) -- 600mg -1200mg twice daily with food -- See below for capsules -- Bulk Nutrition also has NAC in a bag on Amazon, if you prefer to scoop it and take it with water or make your own capsules, that is the most economical option Optional items (can remove these to reduce cost): #. Multivitamin -- daily in the morning for a month Multiple nutrient deficiencies (zinc, vitamin D, etc.) have been found to worsen COVID-19 infection outcomes, so taking a multivitamin to make sure you are not deficient may be wise, especially if you have a restricted or classic western diet (i.e. vegan, carnivore, low histamine, lots of fast food, etc.). About 40% of the US population has at least 1 MTHFR mutation that makes it harder for them to process folic acid and cyanocobalamin in vitamins - so I use "MTHFR-friendly" versions of vitamins (particularly folate and B12) by default. -- See list below for the Pure Encapsulations O.N.E., which contains most of the B vitamins in MTHFR-friendly formulations already, contains 2000IU of vitamin D3, 25mg of zinc, and 50mg of CoQ10 -- Mary Ruth's Organics Liquid morning multivitamin is vegan, food derived, no artificial colors or flavors and has trace minerals as well, MTHFR friendly ($30 for a bottle, not including the 20% off coupon): https://www.maryruthorganics.com/products/organic-liquid-morning-multivitamin?variant=46177691797 -- If you have high B6 levels, Desert Harvest has a B6-free B complex with minimal fillers, MTHFR-friendly: https://www.desertharvest.com/b-complex-without-b6-90-capsules.html #. Melatonin -- melatonin helps with sleep, immunity, and inflammation! Take the melatonin sublingually (under the tongue) 30-60min before bed. If you feel excessively groggy the next morning, reduce your dose to 1/2 a lozenge (break it in half). If 1 lozenge is not enough to help you sleep, you can take a 2nd one. #. Alpha Lipoic Acid [optional] -- for Covid19 related high heart rate (tachycardia) that persists. If you find that your resting heart rate is notably higher than it was prior to Covid19 infection, or if you heart rate is shooting up high with minimal activity, like standing up, walking across your room, or up a flight of stairs, you will need to have an even more gradual progression back to pre-illness activity levels (months, not weeks)! And it is possible that taking 600mg of ALA (alpha lipoic acid) 3 times per day right away when you notice the increased heart rate could help reverse the issue (but it has to be taken right away, it's a very short window of time for it to help, so good to have this on hand ahead of time). ______________________ Links to Walmart.com versions of the OTC meds, mouth wash, and neti pot (~$42): Famotidine (Pepcid) ( $5.50 - Equate 20mg tabs #50 ) - 20mg twice daily for 2 weeks, can continue daily for another 2 weeks Fexofenadine (Allegra) ( $19 - Welmate 180mg tabs #100 ) - 180mg twice daily for 2 weeks, can continue daily for another 2 weeks Baby aspirin (Bayer) ( $2.50 - Equate 81mg chew tabs #108 ) - 81mg daily for 30-60 days Neti Pot w/ saline packets ( $8 - Equate 1 neti pot + 50 saline packets ) - irrigate nasal passages twice daily for at least 1 week, can extend to 2 weeks if still symptomatic Crest Pro-Health mouthwash ( $7 - Crest Alcohol free mint 50.7 fl.oz. ) - gargle and spit twice daily for at least 1 week, can extend to 2 weeks if still symptomatic In addition to the items above (~$42 on Walmart.com), the supplements below could be helpful as well in potentially reducing acute COVID-19 severity and Long COVID risk
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RTHM Mito Support Starter Pack (Helps with: Fatigue, Brain Fog, Immune Function, Oxidative Stress)
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Dosing Instructions & Starting Order (Please read!): This is the RTHM supplement starter pack. These supplements are being recommended based on their mechanism of action, studies done on illnesses with similar symptoms to yours, collected data and experience from RTHM and other clinics. These supplements below have been shown to produce improvements in fatigue, brain fog, immune cell function, coagulation, and oxidative stress. Think of these supplements like the building materials for a foundation of a house. You want to make sure the foundation is solid, level and well built so that all the other construction that is build upon it will have the best chance of working and lasting. 0. Multivitamin -- multiple B vitamins, vitamin C, vitamin E, magnesium, selenium are all required for mitochondria to function properly (please see the handout attached for more information. Multivitamins vary in quality, the forms of vitamins they include (i.e. MTHFR friendly) and absorption efficiency and the amount of fillers. Pure encapsulations is a brand with minimal fillers that uses good forms of vitamins and is the one we recommend. Neuroneeds Energy Needs is another that is good as well, available here: https://www.neuroneeds.com/product/energyneeds/ 1. NAC (N-Acetyl Cysteine) is a building block to make glutathione (one of the body's strongest anti-oxidants). A small group of patients at Yale's Long COVID clinic experienced improvements in brain fog on 600mg taken twice daily, but the dose can go as high as 1200mg twice daily. NAC may also help with excessive fibrin clumping - so it has quite a few benefits! 2. Liposomal glutathione is one of the body's strongest anti-oxidants, it also boosts natural killer cell function (cells that help clear virally infected cells, cancerous cells, and cells that are malfunctioning). Glutathione packs a bit more of a "punch" than NAC because it is an anti-oxidant out of the package, it doesn't need the body to convert it. NAC and Glutathione are synergistic. The Seeking Health Tropical flavor listed below was the most preferred flavor by our patients, but there is a mint flavor option instead (just search in the Fullscript Catalog). 3. D-ribose is a 5 carbon sugar (whereas glucose is a 6 carbon sugar) that uses a special pathway in your cells to help generate more ATP (the energy currency of the cell) when your TCA/Krebs cycle and mitochondria (power generators of your cells) might be struggling a bit to generate ATP on their own. Think of it like an all natural turbo boost of energy. Some have found it particularly helpful to take when they have sensory sensitivity flares, or before exertion. 4. Ubiquinol is the reduced form of CoQ10, a key energy carrier in the mitochondria (power generators of your cells) and a potent anti-oxidant. It has been studied in ME/CFS and mitochondrial disorders and showed improvements in fatigue. This is best absorbed when taken with food, so we generally recommend dosing with breakfast and lunch, or with a snack of some kind. 5. L-carnitine is a molecule that helps shuttle energy into the mitochondria from other parts of your cells, supporting energy metabolism. L-carnitine 1 gram 3 times per day for 6 weeks showed improvements in fatigue in ME/CFS patients in a study. 6. EPA and DHEA from Krill vs. Fish oil: are helpful antioxidants and mitochondrial supports, and have some blood thinning effects as well. See the attached handout for more information. Krill oil vs. fish oil: Krill oil is in a phospholipid form that crosses into the brain a lot more easily than the non-phospholipid form that makes up fish oil. Your body will convert some of the fish oil into the phospholipid forms (found in krill oil) that will cross into the brain, but you need higher doses of fish oil to get it into your brain than you would for krill oil. a. Fish Plus Krill Oil Option: Neuroneeds Omega Needs (https://www.neuroneeds.com/product/omeganeeds/) is a blend of fish AND krill oil designed by a Geneticist for his own child -- it has low oxidation levels, is screened for metals and chemicals, combo of krill and fish oil together. We highly recommend this brand: https://www.neuroneeds.com/product/omeganeeds/ b. Fish Oil Only Option: Carlson Brand Fish oil (no krill oil) in the list below is another reputable brand of fish oil with generally lower oxidation levels, screened for purity that comes highly recommended. (There are liquid and capsules and different flavors of the Carlson brand that you can search for in the Fullscript catalog if you don't like the orange/lemon linked below.) c. Vegan option: Nordic Naturals algae oil in the list below is a vegan source of Omega 3 EPA and DHA screened for impurities from a reputable brand. Vegan sources of Omega3s tend to have a lower ratio of EPA:DHA in general than the non vegan sources. HOW & WHEN TO TAKE THESE SUPPLEMENTS *Please start 1 of the treatments below at a time 5-7 days apart, so that if you have a bad reaction to one of them, you will know which to stop and if you notice a significant improvement, you'll know which of the supplements was most likely helping! 1. Week 1: Start ubiquinol 100mg twice daily with food (to help prevent nausea), if you have insomnia, take it with breakfast and lunch. 2. Week 2: add NAC 600mg with food twice daily in the morning and evening, 3. Week 3: Start 1tsp of liposomal glutathione 30min away from food and meds/supplements twice daily (generally people dose these mid morning - between breakfast and lunch time, and mid afternoon - between lunch and dinner time, though other timing can work as well), 4. Week 4: start D-ribose 1 scoop three times daily (morning, mid-day, early afternoon) in 8-10oz water, 5. Week 5: start L-carnitine 1000mg 3 times per day (ok to take with meals). 6. Week 6: start omega 3 - 1 capsule once daily with a meal for 3 days, then increase to 2 capsules with meals if tolerated. If you need to, you can take 1 capsule twice daily with a meal instead. * IF you are typically sensitive/reactive to supplements or medications, lower the doses above by half (either dump out half of the capsule or start with only one dose per day for 3-4 days before increasing gradually to the recommended dose above only as tolerated). **If you find that you are reacting poorly to a particular treatment, please: 1) stop that treatment, 2) message your CMA to let them know what your reaction was (so they can add it to your intolerances/allergies list), 3) wait until your symptoms resolve before starting the next treatment in the series. ***If your symptoms are particularly severe or not resolving in 1-2 days after stopping the treatment you started just prior to those symptoms starting/worsening, please go to your local urgent care to make sure there isn’t another acute issue going on (like a new Covid infection, or influenza, etc.). None of the supplements above generally cause severe reactions - so if you have a severe reaction, another cause needs to be looked for. Side effects of the supplements above are typically mild (possibly some nausea if not taken with food/or if the dose is a bit high for you to start, or a mild detoxification reaction after glutathione, and resolve pretty quickly upon stopping the supplement.)
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MCAS & Histamine Intolerance Protocol
3 more items in MCAS & Histamine Intolerance Protocol
EXPAND AND READ THIS PART FIRST Always discuss changes in your treatments with your clinician before making them. Less treatment reactive/sensitive people: You can start with the recommended dose listed on the supplements below. Highly treatment sensitive/reactive people: If you are highly reactive to medications, supplements, etc. please consult with your clinician and double check the inactive ingredients of each supplement to make sure there's nothing you react to in it. You can search for other versions of the supplements below made by Pure Encapsulations or another brand you know you tolerate using the Fullscript Catalog. It may be better to start with a lower dose/frequency and taper up gradually as tolerated. -- Start with just one capsule of something daily initially to test tolerance before taking a full dose. If you don't tolerate it, then you can consider trying a brand with less fillers, or avoid the supplement all together. -- If you don't react badly to the test dose, you can try taking 1/2 or 1/4 of the recommended dose and gradually increasing the dose by 1/4-1/2 of the recommended dose every 1-2 weeks ONLY if you are tolerating it well. -- You may never reach the full recommended dose, that's ok. If you are feeling benefits at a lower dose, and higher doses trigger reactions/side effects, then just stay at the dose that is working for you. -- If you increase your dose and react badly, then you can either stop the supplement until the reaction is over, and then re-start on the prior lower dose that you tolerated well. Or you can just take the lower dose the following day and stay at that lower dose. Some people will try to raise the dose again after a month, but that really depends on how you are feeling, what you have going on in your life (don't change a dose right before a big life event), and your risk tolerance. Supplements not on Fullscript that can also be very helpful: Mirica (US) or Glialia (EU)-- contains PEA + luteolin, two synergistic mast cell stabilizers. It can also help with pain in some people. This can take a month to really see the benefits, through many see benefits sooner. Generally dosing is 2 capsules twice daily for 1 month, then 1 capsule twice daily ongoing. Some stay on the higher dose longer if helpful. Sensitive patients start with 1/4-1/2 of that dose and taper up slowly. PEA alone (without Luteolin): try Vitalitus PEA or any of the brands using OptiPEA Luteolin alone : try PureLut Neuroprotek low phenol (Algonot.com) -- contains luteolin, rutin, quercetin in olive oil pomace. It's dosed by weight and can get pretty expensive. Please see the instructions for dosing. Some like this brand if they are phenol sensitive. (Algonot.com has a lot of good supplements for mast cell stabilization in general.) Arizona Cactus Ranch Prickly Pear Extract - add to water to make a delicious drink, or just drink it straight 1-2 times per day as tolerated References: DAO enzyme Bifidobacterium infantis and longum Quercetin Perilla seed extract Vitamin C Pyridoxine (only take if your levels are not high already) Vitamin D PEA+Luteolin synergize PEA (palmatoilethanolamide) Luteolin Prickly Pear
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