About me: Forest-dwelling father, Finnish sauna fanatic, emergency physician, ED and EMS Medical Director, ultrasonographer, professor, student, photographer, filmmaker, author, localism entrepreneur. Co-host Conscious Bro Podcast

Selected Projects:

Defiance Springs Lodge - artists' salon. A charming micro pioneer hotel in the forests just outside Viroqua, WI. Our goal was to create a space where one might not be sure of the time period they were in. Is it now, is it 3000 years from now or 3000 years ago? A combination of Little House on the Prairie, Westworld, and The Real World. The Prancing Pony meets Harry Potter meets Star Wars galactic café. Like a 100 acre movie set. As if you were on an Oregon Trail-type adventure, and requiring some respite, ventured upon a lively timber hotel. A literal healing sanctuary along the headwaters of the South Fork of the Bad Axe River. Surounded by artesian springs, rocky ravines, and effigy mounds. An ideal setting to rebalance, heal, and revive. A community of likeminded resident and visiting filmakers, creators, artists, physicans, healers and entreprenuers. Sharing ideas and content around loving regeneration, in-all-ways. From self to soul to soil. Colletive manifestation of a more verdent valley on the other side of the portal divide.
Viroqua Public Market, an award-winning adaptive reuse of a historic Viroqua, Wisconsin.
The National Transfer Registry app (aka theNTR). This is a directory of every acute care hospital, nursing home and EMS agency in America, a free tool to use during critical transfer challenges.
Regenven, Regenerative Adventures: We seek to leave a lasting positive effect. Optimizing resiliency, through investments focused on a regenerative mindset, from self to society, habitation to habitats to habits. Regenerative adventures.
Cobalt Cottage AirBNB Viroqua. On the grounds of the Viroqua Public Market. Super charming entire home that sleeps 10. Haunted speakeasy vibe. Right in the thick of things. Experience Viroqua as a local!
Serenity Cabin AirBNB Viroqua. Cozy, rustic cabin on forested hillside overlooking trout stream. Miles of private groomed trails. Friendly goats. Middle Earth vibe. Just five minutes to Downtown Viroqua.

I am infatuated with this "Driftless Area", a unique and mysterious zone in SW Wisconsin never bulldozed by glaciers - resulting in an ancient, undisturbed lands of artisan spring-fed streams, foggy valleys and magestic rocky bluffs covered in prehistoric oak savannas. A real-world Middle Earth. A destination sanctuary bioregion with an abundance of water, sustenance, energy, connectivity and cooperation. Arguably the richest soil on the planet and notably, mostly controlled by interconnected families. A geographic locale with an optimal balance of wet and dry, warm and cold, individual and collective, allowing us to not only survive but thrive as the Earth inevitably churns into its next version.

I have playful recurrent dream: This enchanting zone of land, is like an Arc! And we, the people of this Driftless Nation, venture together upon the waters of a world-wide calamitous flood, on 20,000 year mission to foster collective bliss and leave a lasting positive effect.

And thus healing is not a destination, but daily practice.

F E A T U R E D P H O T O G R A P H Y

An assortment of my photography our beloved Driftless Area and beyond....

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F E A T U R E D F I L M S

Mindflow Radio Podcast: Inspiration, Motivation and Values. 12 Feb 21

VISION QUESTS

Driftless Thrive Podcast, ep. 1 April 2020

Entries in covid-19 (1)

Tuesday

Apr282020

COVID & the Cellular Signal Corps.

Tuesday, April 28, 2020 at 9:57AM

COVID & the Cellular Signal Corps.

Tony Macasaet, MD, FACEP

Hypothesis: inspired by the heroic, frontline efforts of emergency physicians like Dr. Caleb Hernandez, COVID-19 may, in part, be a leukotriene/bradykinin mediated angioedema-like state, especially affecting the most distal parts of the airways and alveoli. Net effect of viral infection leading to increased vascular permeability, upper and lower airway and tissue edema, bronchospasm, excess mucin production, dysregulated inflammation, thrombosis and eventually epithelial hyperplasia and fibrosis. Fortunately like angioedema, it may be rapidly reversible if treated early with epinephrine, antimuscarinics and leukotriene blockade. Dramatic anecdotal results are consistent with a positive response, suggesting these concepts are worthy of further study.

Discussion

Medications that MIGHT have benefit and my commentary on mechanisms:

Montelukast po. See review below. Use may lead to less bronchoconstriction, mucus, airway edema, inflammation, and fibrosis
Epinephrine Intramuscular (if inadequate infusion pumps). Vasoconstriction in increased contractility of course. Increases respiratory rate, bronchodilation, decreased vascular permeability and improved tissue and airway edema. This includes improved upper airway edema if present. Shifts Oxygen–hemoglobin dissociation curve, promoting better tissue oxygenation
ADH / Vasopressin IM. Arteriolar vasoconstriction and free water reabsorption.
Atropine IM. Muscarinic antagonist - causing decreased respiratory secretions.
Systemic anticoagulation

This cocktail in severe, failing COVID-19 MAY provide:

Decreased upper AND lower airway edema/bronchoconstriction, improving WOB and oxygenation
Decreased alveolar edema/flooding, loss of surfactant, failure of oxygen absorption etc etc
Decreased respiratory secretions
Improved overall perfusion and tissue oxygenation.

Strictly my own summary and discussion.

Montelukast - high affinity leukotriene receptor blocker. Evidence it blocks bradykinin too.

I had to recall that leukotrienes are signaling molecules produced in immune cells. Made from Arachidonic acid (AA). AA is of course the building block of our beloved phospholipid bilayer and part of numerous signaling molecules. AA itself may have a role in the inflammatory cascade.

Leukotrienes released from white cells bind to leukotrienes receptors on the cell wall of respiratory epithelial cells, airway smooth muscle cells, airway macrophages and other pro-inflammatory cells.

With binding, leukotrienes trigger cellular signaling, leading to effects such as:

Increased release of histamine and prostaglandins.

Heightened bronchiolar smooth muscle tone, with small airway bronchoconstriction.
Copious mucus production, increased vascular permeability, edema
Hyper-responsiveness to bronchoconstriction (some resistance to B-agonists??)
further pro-inflammatory cell recruitment.
Not to mention smooth muscle proliferation, collagen deposition, and fibrosis.
Increased mucin secretion by goblet cells and respiratory epithelial cell hypertrophy. So, snot cells on steroids!!
Increased permeability of the blood brain barrier. Dysregulation of blood-brain barrier.

Thus, there is at least biological plausibility the above cocktail of somewhat every day medications, in many a crashcart and medicine cabinet has a net benefit. Hypothesis generating.

Taking it just a little further, SARS-Cov-2 infects respiratory epithelial cells, gaining access via the ACE2 receptor on the cell wall. The receptor and the virus are involuted into the cell. Because of decreased ACE2 receptor activity, bradykinin increases (normally metabolized by ACE2). This then may lead to increased vascular permeability, bronchospasm, edema etc. etc. Again, there is research suggesting montelukast blocks bradykinin receptor activity similar to leukotrienes.

So, perhaps in the end the key will be blocking the effects of bradykinin and or leukotrienes, which may be released as part of COVID-19. That is Montelukast, and good old epinephrine, atropine, and vasopressin.

Along these lines, other medications to ponder might include: Icatibant, TXA, H1 and H2 blockers, aminophylline, and Cromolyn among others.

Bottom Line Speculation

Mechanistically COVID-19 may be behaving in part somewhat akin to an angioedema-like process + micro pulmonary/systemic thromboembolism. Leading to catastrophic end-organ hypoxia. Antagonizing these effects may reverse the seemingly unstoppable death spiral of COVID-19.