This information could save your life.

I don’t usually start with this, but I feel it is fully warranted in this case.

This information is for your use if you “get in trouble” with Covid.

What does “get in trouble” mean? It means you are past the initial viral symptoms, you are now in the inflammatory and clotting phase (day 7/8 and beyond), you still have a fever (or have a new fever which indicates high inflammatory and clotting response), lungs feel congested, you are having breathing difficulties, or your oxygen level is unstable, bouncing around every few hours, or just plain low and in serious concerning range (covered below). Having an oximeter and a thermometer is a must. They are easily purchased on Amazon.

Because the number of days from the beginning of symptoms is very important to know correctly, please refer to recent post “Covid Symptoms”.

I have just watched a new video with Dr DeMello and Dr Mobeen Syed (he is also called “Dr. Been”, and he addresses his viewers and supporters as “The Kool Beens”).

I have added the link to the video later in this email, because I want to introduce you to the concepts first, with some definitions and also the summary of the video in Power Point which Dr DeMello has shared with me – I re-typed it below.

Please understand these definitions before watching the video.

Thrombosis occurs when blood clots block your blood vessels. There are 2 main types of thrombosis: Venous thrombosis is when the blood clot blocks a vein. Veins carry blood from the body back into the heart. Arterial thrombosis is when the blood clot blocks an artery.

Prothrombotic: Tending to favor or promote blood clotting.

The Relationship Between Thrombosis and Inflammation:

Thrombosis and inflammation have an intricate, circular relationship, where each can cause the other. In an editorial by Dr. Peter Libby and Dr. Daniel Simon, published by the American Heart Association in 2001, they wrote “Inflammation can beget local thrombosis, and thrombosis can amplify inflammation.”

Technical reference here: https://www.ahajournals.org/doi/full/10.1161/01.cir.103.13.1718

Source: https://natfonline.org/2017/07/thrombosis-inflammation-connection/

Fibrinogen: a soluble protein present in blood plasma, from which fibrin is produced by the action of the enzyme thrombin.

Fibrin: an insoluble protein formed from fibrinogen during the clotting of blood. It forms a fibrous mesh that impedes the flow of blood.

Fibrinolysis:  In fibrinolysis, a fibrin clot, the product of coagulation, is broken down. The breakdown of fibrin, usually by the enzymatic action of plasmin.

In the coagulation system two mechanisms operate that are indispensable to life and normally work in opposite directions, each counterbalancing the other. On the one hand, coagulation involves a thickening of the blood so that a plug can form and prevent excessive bleeding from damaged vessels. On the other hand, there is “fibrinolysis”, a process that keeps the blood fluid and breaks down clots.

Hemoglobin: A protein inside red blood cells that carries oxygen from the lungs to tissues and organs in the body and carries carbon dioxide back to the lungs. 

SPO2: Saturation of Hemoglobin with Oxygen as Measured by Pulse Oximetry. (It’s O2 “SATs” for saturation, not O2 “stats” for statistics.)

SPO2: also known as oxygen saturation, is a measure of the amount of oxygen-carrying hemoglobin in the blood relative to the amount of hemoglobin not carrying oxygen. The body needs there to be a certain level of oxygen in the blood or it will not function as efficiently.

Following is Dr DeMello’s Power Point transcript (with some editing – in italics – on my part)

Why do Patients clot at night?

1. There are more prothrombotic cells circulating in the blood at night compared to the fibrinolytic elements (promoting fibrinolysis) during the day. This is related to our circadian rhythm.

2. During the day we produce higher cortisol and this decreases inflammation in the body. Lower cortisol at night, following our circadian rhythm, causes general increase in inflammation. Increased inflammation causes increased thrombosis (covered above). At night less Cortisol is produced hence thrombosis can occur.

3. A drop in oxygen saturation is expected during the night, especially when we sleep. The level of drop changes with age, underlying respiratory disease and other factors. Even in normal people it is known to drop by 10% from daytime baseline. A low SPO2 can also be caused by abnormal broncho constriction. Broncho constriction increases at night. This can cause hypoxia (reduced oxygenation) and increase clotting. More constriction of the lungs can result in more thrombosis.

 4. Increased broncho constriction may occur at night, which shows up in patients as a drop in oxygen saturation – SPO2 levels – between 10 pm and 6 am-7am which leads to prescribing broncho dilators (such as Albuterol*) at night before sleeping. Broncho dilators reduce the risk of thrombosis. More importantly, with broncho dilators one reduces the panic, the fear in the patient, care giver and family members.

*Albuterol can be prescribed by a telemedicine doctor or your family doctor and is delivered with a nebulizer.

If clotting in the lungs occurs in Covid disease it will likely happen starting on day 8 of symptoms and last through Day 10, and it will most likely happen during the night. Clotting can occur with or without a drop in SPO2. But a drop in SPO2 is indicative of likely clotting.

Therefore, Dr. DeMello recommends keeping the patient awake at night and having the patient sleep during the day instead. This breaks the pattern of thrombosis by keeping the patient in motion (at intervals) and able to do “proning exercises” at intervals (demonstration videos below) during times of low cortisol, high inflammation, low hydration, more broncho constriction and higher possibility of thrombosis, preventing the blood from stagnating (which leads to thrombosis, as happens on long flights).

The procedure of keeping the patient awake during the night and sleeping during the day should start on the evening of Day 7 until the morning of Day 11.

How does one keep a patient awake at night?

Walking around the room or home every hour for 10 minutes, doing “proning exercises” (demonstration videos below)  for 5-10 minutes every hour, sitting, watching TV or reading.

Let the patient sleep in the morning, afternoon and evening usually on the belly/stomach or on their sides.

It is best if the patient has a buddy – family member or friend or nurse to help with this process for 4 nights.

Note: Dr. DeMello now advises ALL his patients to stay awake during nights 7-10, regardless of “being in trouble” with their symptoms (as described above). Of course, you can make your own decision on this

Monitoring of Oxygen Saturation SPO2 levels

Please take, record and track temperature and pulse oximeter readings at 8 am, 2 pm and 10 pm every day for the next 14 days after first symptoms.

Patient is advised to take a 6-minute walk in the room, then check and record the pulse oximeter reading at 8am, 2 pm, and 10 pm every day.

Any reading above 95 is normal, no damage to lungs.

95-100 is ideal

90-94 is concerning

85-89 is very concerning

84 and below requires Oxygen, best done by admission to a Covid Hospital

Electrolyte and Fluid Consumption In COVID

Patients should drink between 3.5 and 4.5 liters of fluids a day, making sure to also keep their electrolyte levels adequate.

Dehydration can lead to blood stagnation, which can lead to thrombosis.

Proning Instructions and Demonstrations:

Dr DeMello’s instructions:

Very Important to do proning for 5-10 minutes each time, at least 4-5 times a day.

It should improve healing in the lungs, especially the posterior/ back portion of the lungs..

Avoids blood standing still… and Clotting…

Proning Exercise Demonstration: https://www.youtube.com/watch?v=z2VaS-exhlg

“Happy Puppy” Proning Exercise Demonstration: https://youtu.be/FmDunxWaMjc

Full Video:

Dr. Been and Dr. DeMello full video covering the topic of staying awake at night: https://www.youtube.com/watch?app=desktop&d=n&feature=youtu.be&fbclid=IwAR2LSN08tO90C_ysO8Xz_4kGPl2tTF9nzgs_jYsgwTNy79bbHarzKKI73A0&v=vWn3K5twY5Q

Dr. DeMello is available for consultations for prevention and for suggestions regarding the treatment of Acute Covid infection.

He can be most easily reached on WhatsApp: +91-7718079507 (his preferred method of communication).

He can also be reached by email  darrelldemello@gmail.com

He also has a website https://www.darrelldemello.in/

I asked Dr. DeMello to check this email for technical errors before sending it out to you. Rest assured that all this information was verified by him before I shared it.

Be well, do well, stay well!