No Increased COVID-19 Risk With Adequately Treated Adrenal Insufficiency

COVID-19

Adults with adrenal insufficiency who are adequately treated and trained display the same incidence of COVID-19-suggestive symptoms and disease severity as controls, according to a presenter.

“Adrenal insufficiency is supposed to be associated with an increased risk for infections and complications,” Giulia Carosi, a doctoral student in the department of experimental medicine at Sapienza University of Rome, said during a presentation at the virtual European Congress of Endocrinology Annual Meeting. “Our aim was to evaluate the incidence of COVID symptoms and related complications in this group.”

In a retrospective, case-control study, Carosi and colleagues evaluated the incidence of COVID-19 symptoms and complications among 279 adults with primary or secondary adrenal insufficiency (mean age, 57 years; 49.8% women) and 112 adults with benign pituitary nonfunctioning lesions without hormonal alterations, who served as controls (mean age, 58 years; 52.7% women). All participants lived in the Lombardy region of northern Italy. Participants completed a standardized questionnaire by phone on COVID-19-suggestive symptoms, such as fever, cough, myalgia, fatigue, dyspnea, gastrointestinal symptoms, conjunctivitis, loss of smell, loss of taste, upper respiratory tract symptoms, thoracic pain, headaches and ear pain. Patients with primary or secondary adrenal insufficiency were previously trained to modify their glucocorticoid replacement therapy when appropriate.

From February through April, the prevalence of participants reporting at least one symptom of viral infection was similar between the adrenal insufficiency group and controls (24% vs. 22.3%; P = .788).

Researchers observed “highly suggestive” symptoms among 12.5% of participants in both groups.

No participant required hospitalization and no adrenal crisis was reported. Replacement therapy was correctly increased for about 30% of symptomatic participants with adrenal insufficiency.

Carosi noted that few nasopharyngeal swabs were performed (n = 12), limiting conclusions on the exact infection rate (positive result in 0.7% among participants with adrenal insufficiency and 0% of controls; P = .515).

“We can conclude that hypoadrenal patients who have regular follow-up and trained about risks for infection and sick day rules seem to present the same incidence of COVID-19 symptoms and the same disease severity as controls,” Carosi said.

As Healio previously reported, there is no evidence that COVID-19 has a more severe course among individuals with primary and secondary adrenal insufficiency; however, those with adrenal insufficiency are at increased risk for respiratory and viral infections, and patients experiencing major inflammation and fever are at risk for life-threatening adrenal crisis. In a position statement issued by the American Association of Clinical Endocrinologists in March, researchers wrote that people with adrenal insufficiency or uncontrolled Cushing’s syndrome should continue to take their medications as prescribed and ensure they have appropriate supplies for oral and injectable steroids at home, with a 90-day preparation recommended. In the event of acute illness, those with adrenal insufficiency are instructed to increase their hydrocortisone dose per instructions and call their health care provider for more details. Standard “sick day” rules for increasing oral glucocorticoids or injectables would also apply, according to the statement.

From https://www.healio.com/news/endocrinology/20200910/no-increased-covid19-risk-with-adequately-treated-adrenal-insufficiency

Bee’s Knees 7

This is a continuation of an ongoing knee issue.  It started in 2013 with Icy Days and Mondays and Bee’s Knees I’m hoping to end my knee pain in the very near future.

What’s happened since the “quick kneecap recap” below:

First of all, came this article.  I’d already decided to get only one – max 2 – injections a year, with one of them being a week before a cruise.  We currently have a cruise scheduled for August, but that may not happen.

I’d been keeping up with water aerobics and the hot tub until both of those were canceled due to COVID-19.  So, my knee pain gradually started getting worse again.  Luckily, I’m not walking around so much and we don’t have stairs at home.

I’m having lots of meetings on Zoom as well as piano teaching.  For those meetings, I’ve been using an iPad on a music stand. To be able to see well while sitting on the sofa, the stand and iPad need to be almost verticle.

After one meeting a week ago, I moved the unit out of the way, the iPad slipped off the stand and the edge whacked the top of my kneecap.  Major owee and a few bad words, Tylenol and a knee brace.

A quick kneecap recap:

From https://maryomedical.com/2013/02/18/icy-days-and-mondays/ January 28, 2013:

 I checked the weather and found that school was starting late because of icy conditions.  I put on boots and took the dog out.  It seemed to be raining – if it’s raining, it must be warm, right?  So I didn’t really pay attention (and I had other things on my mind!) and completely missed seeing the black ice.  Next thing I knew, I had fallen on one knee, my cellphone in my pocket bruised my other thigh and my left arm hurt where I’d reached out to catch myself.

From https://maryomedical.com/2016/02/28/bees-knees/

January 2016.

I fell in the bathroom in the middle of the night and hit my left knee on the tub. I used a brace for a few days and it seemed better.

Around January 27-28, 2016, I was in Walmart and had to get a produce bag that was way over my head.  I had to stand on tiptoe…and my knee felt like something ripped.  Thankfully, I had a cart available to use as a temporary crutch.

Got home, used the brace, took Tylenol but the pain got worse.

Thursday, I drove home from choir at church.  My car is a manual so the act of using the clutch, extending my foot that way, made everything worse again.

Friday, we went to the Limp-In Clinic in Greenbriar.   That doctor was going to prescribe Cortef or NSAIDs but I couldn’t take either due to my history of Cushing’s (Cortef) and kidney cancer (NSAIDs).  He prescribed Vicodin and sent me for an x-ray.

January 31, 2016, I got very itchy, presumably from Vicodin so I stopped that and started taking Benadryl for the itchiness.

February 2, 2016, I went back to the clinic for the results of x-rays and  I mentioned the itchiness.  Since I have very limited meds available to me, he recommended an Orthopedist.  I called him when I got home and he didn’t take my insurance.  I tried another doctor who supposedly took my insurance but they didn’t.

February 7, 2016, I really needed the sleep so I took half a Vicodin.  No pain and no itching.  HOORAY!

February 8, 2016, I saw my regular doctor.   She thinks it’s a possible “lateral collateral ligament vs meniscus tear”.

I was surprised that she thought my knee was swollen but one of my therapists showed me later that it was.

She referred me to Physical Therapy (PT) and prescribed Ultram. As of this writing, I haven’t used that yet.

February 11, 2016, 8:30 am  My first appointment with PT.  Since my blood pressure was high, we mostly did assessments.  I had a main therapist and a student. They had to use 3 types of BP machine to do this.

I bent my knee and they took measurements with a caliper.  I lay on my front and they manipulated my knee to see what happened. They also concluded that it was a lateral collateral ligament.

A suggestion – to rest my foot on the walker without the brace and see if gravity helps my knee straighten out.

After this, there was more pain than before but I know this is the right thing to do.

February 13, 2016.  My leg feels a bit better.  I had the brace off last night and almost straightened my knee out.

Somewhere in this period, I learned how to manually move my kneecap (patella) around.  I saw my day 1 therapist again and he said my knee was angry.  Swollen, angry, whatever.  I just want a normal non-hurting knee!

One of the therapists had me doing a stretching exercise and my hip was out of kilter (everything is attached!) since I’ve been walking with my knee bent.  So she manipulated that back into alignment.

February 22, 2016, A new-to-me therapist had me do an exercise with a basketball under my knee, pointing my toe to the left.  I didn’t remember doing that before but she said I had.  Hmmm…

That hurt too much so we moved to a foam roll under my knee.  It was still uncomfortable but I did it, a bit too much, apparently.

Turns out this exercise hurt my “VMO”, which is short for Vastus Medialis Oblique.

“This is the most important quad muscle and arguably the most responsible muscle for knee stability. The VMO’s main function is to control knee extension…” 

February 25, 2016,  My VMO pain still hurt.  I told my regular therapist about it and she worked on it some.  She concurred that my knee was swollen.

February 26, 2016,  I went all day with no brace at all!!  A bit of pain but manageable.

February 28, 2016, and I haven’t worn the brace since the 27th. I still need assistance to get up from sitting but I can see huge improvement.

I still have 6 more PT sessions, finishing on March 16, but I’m really impressed with what they’ve done for me.  I still have twinges of pain and I don’t plan on stepping on tiptoe anytime soon but I can tell I’m on the right track.

March 8, 2016 at 9:48 am

Physical Therapy is sapping what little energy I had 

 I can tell it’s working but I am even more exhausted all the time. I’m taking extra Cortef but it’s not enough…

From https://maryomedical.com/2016/05/05/bees-knees-continued/

May 5, 2016

My left knee is still bothering me, even after doing Physical Therapy since January. <sigh>

It seems to get better, then something happens and it’s back to pain again.  When we were on a trip to New York a month ago, we walked a lot and climbed so many stairs, I had to buy a new brace.

Today is supposed to be my final PT but I don’t think I’m ready.

When this clinical trial came to my email, I just went through the whole survey for this but there was no doctor nearby:

Osteoarthritis Research Studies. Knee and hip arthritis studies enrolling now. No-cost medication. http://curec.lk/1VL5hu9


Fast forward to September 5, 2018

My knee has been bothering me off and on for a while.  I’ve been taking water aerobics and was careful not to do anything that would hurt my knee.  The hot tub afterward was a great place to aim hot water jets at my knee – that would numb any pain for a while.

I realized that the neoprene braces were making me itch so I actually found one with no neoprene – Hooray! “All BioSkin material is hypoallergenic. Latex-free and Neoprene free.”  Hooray again!

This last week or so, the pain has been getting worse again so I decided to try a new doctor.  This one seems like maybe – just maybe – he’ll fix things.

He said: “Your previous knee injuries made sense for pain but this spontaneous onset of medial knee pain is a bit strange.  I can only do a limited examination due to the pain and difficulty bending, but it seems to be over the distal insertion of the VMO (quadriceps muscle) with possible inclusion of some joint line tenderness on that same side.

I’d like for you to use ice packs in your knee brace at least three times a day with the goal of calming down the inflammation.

My goal with getting you to sports medicine next week is to re-evaluate it, hopefully with better ability to examine and flex. It may need ultrasound evaluation and/or steroid injection. Since you cannot take NSAIDS, I suggest trying the Ultram that your previous doctor gave you so you can sleep.”

So, next Wednesday, I have an appointment with sports medicine – I might be moving forward. Or not.

 

 

September 12, 2018, I got my first cortisone shot (Kenalog 40 mg/mL suspension for injection).  I did notice some sleep issues that first night, probably since I had the cortisone so late in the day

It was wonderful and got me through a cruise to Maine and Canada.  In Bar Harbor, I overheard some women talking about their knees.  One said that the cortisone didn’t work for her at all and she was going to have surgery <uhoh> and another said that they’d have to cut the nerves around her knee.  I’ve asked a couple doctors and Dr. Google.  No one seems familiar with that idea at all.

It also got me through our son’s wedding in October, including climbing stairs! 

It also produced one of my only smiling photos, ever!

December 5, 2018, I saw my endo, Dr. Roberto Salvatori, and “confessed” that I’d had this injection.  We’d talked about this before and how it might react with my daily Cortef and Omnitrope shots.  He hadn’t thought I should get this.  But, since it was a done deal, he said to monitor how I was feeling with the additional cortisone.

By then, the knee pain had returned, anyway, so no issues.

March 27, 2019, I found a new no-neoprene, no-latex brace on amazon. “Hinged Knee Brace: Shock Doctor Maximum Support Compression Knee Brace – For ACL/PCL Injuries, Patella Support, Sprains, Hypertension and More for Men and Women”
This is very good – much stronger than the one I mentioned below on September 8, 2018.  The only real issue I have with it is that it bent, so I have to bend my knee to put it on.  The other one is completely straight and just wraps around.

The older, wrap-around does have a tendency to slip sometimes so I make it tighter than I probably should.

I do love that they’re making products for people with latex and neoprene allergies,  though!

 

April 8, 2019, I was supposed to get my second cortisone shot in time for Easter but there were car issues at the last minute.

On the way to water aerobics, I was having trouble shifting my car. I’d have to actually turn the ignition off to do so.  Not fun!

When I got home, Tom was sure he could do it…but he couldn’t either.  He drove it into Advanced Automotive.

One of the Advanced Automotive mechanics test-drove the car and then found the bolts holding the brake master cylinder to the firewall had loosened.  

Could have been even more serious!

They fixed that for free since they were the last people to work on the car and maybe(???) didn’t tighten the bolts completely the first time.

Car runs like new now 🙂

So, I missed my first appointment but got a “new” car.

April 10, 2019, I broke down and bought this leg pillow.  I’d seen similar ones on TV but I got this on amazon (of course!). Aocome Knee Pillow for Side Sleepers Knee Pillow Ergonomically Designed for Back Pain, Sciatic Nerve Pain Relief, Leg Pain, Pregnancy, Hip and Joint Pain – Memory Foam Leg Pillow.

This is one of the better things I’ve gotten in my journey.  It’s very nice, soft – and blue!

I’m of 2 opinions about the little strap – it makes it easy to keep it “attached” to my knee but I have to bend my knee to put it on in the first place.

I think over time, the elastic may stretch out, making it harder to keep on.

The whole is covered with a washable velour-like fabric.  The price was reasonable enough that I could buy another one if/whey that strap expands too much.

I have a tendency to roll over in my sleep and found that I can use it as a little pillow to raise just my left leg instead of between both knees when sleeping on my side.

I also found that it’s sometimes better to sleep on the sofa.  When I roll over, the pain from my knee often wakes me up again.  Lying on the sofa makes it harder to roll over.

During this time, my pain was so bad that I was considering surgery – later.

April 22, 2019, I got my second cortisone shot (Kenalog 40 mg/mL suspension for injection).  This time it was a new doctor (same practice), so I had to explain everything (knee history, Cushing’s history, kidney cancer history) to her.

I was unsure how often I could get his shot because I knew I’d want/need one before our cruise next September.  These look like places I will want to walk!

She said that the cortisone stayed mostly in the knee area so I could get one every 3-4 months!  I could have saved myself a lot of issues in early 2019 had I known that   So, I’ll go in the early part of September for #3 and maybe go on a 4-month schedule.

For reasons known only to her, she did the injection in my inner knee-cap.  Even with the lidocaine, it was a bit more painful there than I remember the other one – or maybe I just blacked that out.

She thought that the water aerobics I do 3 times a week (plus hot tub afterward) was a good thing.

Death Dreams.  I don’t think I’ve posted about these before but I used to have them quite often.  I hadn’t had any for a long time but I had 2 within 12 hours of getting the injection.  The first was about 6:00 PM.  I’d fallen asleep for a nap and DH was talking to me (in real life).  I kept trying to ask him which Easter service (that had been the day before) was coming up next because I needed some kind of medication to get through the service.  I know my words to him were confused and garbled but I was sure I was going to die if he didn’t help me.

The next was similar about 3:00am on 4/23/19.  I dropped my Kindle on the floor, which sort of woke me up but I wasn’t sure what the noise was.  I just knew I needed to take “something” to stay alive and wasn’t sure what that was.  I looked through my phone for ideas and checked the meds by my bedside.  Nothing.  Finally, I woke up more completely and realized it had been another dream.  I also picked up my Kindle and went back to sleep for another hour.

This morning (4/23) there’s still a bit of discomfort but I can deal with that.  I also had a bit of trying to run to the bathroom a little quicker than usual.  I also don’t remember that from before but I assume it will go away soon.

I hope this shot lasts nearly 3 months, too!  That would take me to mid-July. 🙂

I also hope that my sleep gets better than my March-April records with only one 8-hour sleep (counting naps!).:

 

Starting September 2, 2019, if I get 4 shots a year they would be: September, December,  March, June, September.

Starting September 2, 2019, if I get 3 shots a year they would be: September, January, May,  September


After my April 22, 2019 injection, things were mostly better for a while.

May 12, I went to a Celebration of Life service where the chairs were so incredibly uncomfortable.  They looked really nice but… I had trouble sitting.  I’d have to bend part way, put my arms on the armrest and fall the rest of the way.  While seated, it was a weird angle, so I didn’t like to sit but standing back up was very difficult.  My knees were stiff and painful through the next week.

Things were okish for a while.

June 7, we went to NYC and did a lot of walking/stairs which always makes things a little worse.  Around this time, my right leg started having an aching (bone?) pain.  I’m hoping that it’s “just” sciatica.

June 18, it was time for another stupid accident.  I got home from work, put my car in gear and the emergency brake on.  I stepped out of my car with my left foot planted on the driveway.  Somehow, the car rolled backward, twisting my knee.  Three Tylenol and a brace.  Of course, it was one of the braces I’m allergic to so I then had to take a Benadryl.  I’ll find one of my non-allergenic braces a little later.

June 22 – back to “normal” knee pain. Rest, keeping my knee up, a non-allergenic brace and Tylenol all helped.

In mid-August, 2019 my knee started getting really uncomfortable again.  The brace I’d bought for latex and neoprene allergies on March 27 was too hard to put on because I had to bend my knee to pull it up.  so I bought a wraparound one from the same company.

This one, which I hope is the last, is a mouthful of a name  “BIOSKIN Wrap Around Compression Supportive Knee Brace for Patellofemoral Pain and Patella Tracking Disorders – Q Brace“. That being said, it’s way easier to put on but I really don’t like wearing it all the time.

September 2. I was sitting on the sofa and went to straighten out my leg to put on a footstool.  Major owee.  On went the brace and three Tylenol.  I may be saving my one kidney by not taking other pain meds but I’m not sure what is going to happen to my liver  😊

September 4.  Hooray!  The next injection with yet another doctor.  This one, I know, though.  She’s my mother’s doctor and the reason I go to this practice in the first place.  When my mom was in the nursing home last year, this is the doctor they sent. She saved my mother’s life.  I had been complaining about my mom bleeding internally and the nursing home basically said “someone will check”.  I got Dr. Vo in there and my mom immediately left for the hospital where they took care of the bleeding.  Who knows, if I’d let her stay in the rehab/nursing.

I have no idea how she’ll do with knee injections, though

Actually, she did wonderfully well.  We started with the traditional PA, Jack,  who asked the traditional questions, did the weighing, blood pressure, temperature.  He asked if I could have a medical student come in and I said oh yes.  I’d definitely used to helping out with med students thanks to my many weeks at NIH.

David, the student, came in and asked similar traditional questions.  Then, Dr. Vo did the same.

Then, all 3 of them were there along with DH and my knee.  A little cramped but it worked.  She did a really good workup, Apparently, my patella isn’t moving as well as it should.  As always, they say my left knee is swollen but I can’t see that.  According to my pain when she pressed various places, she thinks I have a small tear (Patellar tendon rupture)  She was the first person to ever mention this possibility.  Years ago, another doctor thought it was a possible “lateral collateral ligament vs meniscus tear”.

Injury to the patellar tendon generally requires a significant force such as falling directly on the knee or jumping from a height. (I had most definitely fallen on my knee in 2013) – from https://maryomedical.com/2013/02/18/icy-days-and-mondays/

Ice

January 28, 2013, I checked the weather and found that school was starting late because of icy conditions.  I put on boots and took the dog out.  It seemed to be raining – if it’s raining, it must be warm, right?  So I didn’t really pay attention (and I had other things on my mind!) and completely missed seeing the black ice.

I had fallen on black ice and had been wearing flannel-lined jeans. Still got banged up a bit!

Next thing I knew, I had fallen on one knee, my cellphone in my pocket bruised my other thigh and my left arm hurt where I’d reached out to catch myself.  Luckily, I hadn’t let go of the dog’s leash.

I ended up sitting in a puddle of icy water for a long time, figuring out how to get up.  I finally sort of crawled up the trash can that was sitting in the driveway.

The dog had an abbreviated walk, I changed my wet, cold clothes and headed to the hospital.  I was showing DH my knee and one of the staff bandaged it up for me.  I told him I hadn’t fallen at the hospital and wouldn’t sue but I guess he wanted to be sure.

(February 18, 2013, my knee still had a huge lump under the skin and hurts when I touch it, although I’m no longer limping,  The bruise/pain from cellphone finally went away)

~~

Back to 2019: Risk factors for Patellar tendon rupture include patellar tendinitis, kidney failure (DUH!), diabetes, and steroid or fluoroquinolone use (DUH, again – taking daily steroids, Growth Hormone and 2 previous Kanalog 40 shots). There are two main types of ruptures partial and complete. In most cases, the patellar tendon tears at the point where it attaches to the knee cap.

After all that, she showed the PA and med student how to find a good “line” for the needle to go into.  The injection includes lidocaine so it doesn’t hurt so much going in and kills pain fairly quickly in the knee.

She made a little circle with a marker (the others did this, too),  the PA really went to town with the spay antiseptic, including my sandaled feel.  She did quite well with the injection.  Tom said she hit the circle exactly.  There was a bit of discomfort when she hit/nudged something in there but it was fast.

As the first injection, this was on the lateral, outside, part of my kneecap.  The second was on the inner part.  I mentioned this to everyone, commenting that the second (medial) didn’t seem to work as well as the first.  I’d told the second doctor my pain was more on the inner side, so maybe she was going by that.  It’s my theory that the needle went right by the pain but what do I know?

More spray and a bandage.  They told me to move my knee around a lot before I could leave.  This was a first.  I used my time to go to the ladies room.  LOL

She gave me some exercises to do at home, some similar to what I do in Water Aerobics (Hooray!) which I have done for several years.  Both she and past doctors have said that’s one of the best things I can do for this.  However, I have to stay out of the water for a few days to be sure nothing gets into the injection site.

Dr. Vo also prescribed a tube of Voltaren 1 % topical gel to use as needed on our upcoming cruise.  This cruise is one reason I wanted to get the injection now.

She’s recommending 3 times a year group for this injection – the last doctor said 3 to 4 times a year.  I don’t want to get into the steroid-induced Cushing’s group so I’m trying for 3 (or less) times.  Starting September 4, 2019, if I get 3 shots a year the next Could be January, May,  September.

  • So far, the last 2 were September 12, 2018 (If it were not for the cruise, I could have held out a bit longer to make it more than a year since shot 1!)
  • Shot #2 was April 22, 2019.
  • Current #3 was September 5, 2019

The following list includes any diagnoses that were discussed at your visit.

1. Osteoarthritis
• arthritis: care instructions
• osteoarthritis: care instructions
• Voltaren 1 % topical gel
• Kenalog 40 mg/mL suspension for injection
• injection/aspiration large joint/bursa (PROC)
2. Tendonitis of left patellar tendon

 

Patient Instructions

Knee osteoarthritis – Discussed treatment with exercises. Continue water aerobics.
Knee injection done today.
Exercises given to strengthen patella tendon at home after pain improves.

 

Like 4/23/19, I also had an issue trying to run to the bathroom a little quicker than usual.  Actually, twice.

September 5, 2019.  I was sorry that I fell asleep quickly and didn’t get my watch off the charger but I know that I slept until 4:35am

Often, i’m tossing and turning to get my knee comfortable, even with the knee pillow from April 10, 2019.  I broke down and bought this leg pillow.  I’d seen similar ones on TV but I got this on amazon (of course!).

This is one of the better things I’ve gotten in my journey.  It’s very nice, soft – and blue!

I have a tendency to roll over in my sleep and found that I can use it as a little pillow to raise just my left leg instead of between both knees when sleeping on my side.

I also found that it’s sometimes better to sleep on the sofa.  When I roll over, the pain from my knee often wakes me up again.  Lying on the sofa makes it harder to roll over.

When I woke up at 4:35, I did have to get to the bathroom quickly but it was ok. Later, about 6:00 it wasn’t so good 😊

Later in the day, I was still limping a bit, perhaps more from habit than anything else.

A bit of pain on the inside of my knee but nothing that required a brace OR Tylenol.

I ordered a new travel container for my growth hormone.  The last “system” was kind of clunky.  It worked fine but required too many components.  This one looks like it will fit in the water bottle compartment of my backpack.  I definitely don’t want another failure.

I’ll be posting a review of the Dison Care Insulin Cooler Travel Case Medication Cooling Bag when we get back  I find it amazing that I ordered the black for $59.00 with a 10% coupon.  The same thing in white is $65.00 with no coupon.

I fell asleep almost immediately, but woke up about 12:30 and never really got back to sleep.  I think I’m obsessing about what to pack for the trip and getting all my work done that should be done before I go.  Also, an ear work of a handbell piece we’re working on.

September 8

I got 6 hours sleep last night!  7. 37 with a nap.  WooHoo!

September 9

The big pains are mostly gone.  Every now and then will be a little twinge.  Yesterday, I felt a little unstable on my knee but nothing major.

I think I’m ready knee-wise for this cruise.

September 12

I had a new type Death Dream last night but I doubt that it’s related to the injection. In this one someone was coming at me with a knife.  Hopefully, this was a one and done!

So, I’ll post this just before the cruise, then, the next update will be…later.

Stay tuned for…

Facing-Off with Prostate Cancer During the Coronavirus Pandemic

From my email today:

At PCF, we realize that many of you who have been affected by prostate cancer, or whose loved ones have been affected by prostate cancer, might be wondering if special precautions need to be taken with the coronavirus pandemic unfolding. We have always believed that evidence out of science and research are the best tools for solving patients’ problems, whether that’s cancer or public health emergencies. As such, we will do our best to use science to provide information and a steady hand in this tumultuous situation. 

Scientists know that the coronavirus (aka COVID-19 COrona VIrus Disease 2019) can affect your immune system, although we are still learning more. Based on recent data as reported in the journal The Lancet, it appears that the virus hits the immune system early and knocks down the white blood cells that fight infections. This translates to respiratory disease for most patients who become sick with COVID-19.

The most important thing to remember, whether you have been affected by prostate cancer or not, is that if you are having symptoms as described here, such as a fever (99.1°F [37.3°C] or higher), persistent cough, or shortness of breath, you need to call your doctor.

If you are not having symptoms, it is important that you follow the guidelines to stay safe and avoid spreading the disease. It is critical that all citizens, not just those with prostate cancer, adhere to CDC and local public health guidelines (here’s an example of one source of local guidelines from the County of Los Angeles). You can view the full, trusted list of prevention tactics here, but our top three are: 1) wash your hands for 20 seconds with soap, especially after blowing your nose and before eating, 2) stay 6 feet away from people if you are out in public, and 3) keep your hands away from your face, where the virus can readily enter through your eyes, nose, and mouth.

That said, here are a few extra details for those of you in the prostate cancer journey:

  1. If you have been diagnosed with early-stage prostate cancer for example, you’re on active surveillance, are receiving radiation treatment, or are scheduled for surgery you are not at increased risk of severe disease with COVID-19. This is because early prostate cancer has not been shown to significantly affect your immune system and your ability to fight infection. Unlike some blood cancers, early prostate cancer does not affect your T cells’ and B cells’ (i.e., the cells that rule your immune system) ability to fight viral and bacterial infections normally.
  2. If you’re on a form of hormone therapy, there is no increased risk of severity. Extensive research in tens of thousands of patients on medications such as Lupron® or Zytiga® shows there is no evidence that these treatments put a prostate cancer patient at higher risk of viral infections like influenza.
  3. The situation is different for patients receiving chemotherapy (such as taxotere, carboplatin, or cabazitaxel) for advanced prostate cancer. Because chemotherapy affects rapidly-dividing cells in the body both cancerous and normal cells your bone marrow makes fewer infection-fighting cells, leaving you at higher risk for all types of infection. If your white blood cell count is being monitored, talk to your doctor before coming in for a clinic visit. You want to be assured that from getting out of your car to getting back into your car to go home, you are in a healthcare environment that is maximally prepared to reduce the spread of COVID-19 to cancer patients.
  4. Regarding the impact of COVID-19 on prostate cancer survivors, there is no data yet from China (the country where the disease has impacted the most people, and therefore where information is “leading”), but as we get it, we will share it with our community.
  5. Other co-existing medical conditions can increase your risk of severe disease if you are exposed to COVID-19, regardless of prostate cancer diagnosis. These include high blood pressure, diabetes, and heart disease. Respiratory conditions (e.g., asthma, emphysema, or former heavy smoking) and conditions that affect your immune system (e.g., inflammatory bowel disease or a history of transplant) may also increase your risk.

At PCF we are tracking any real-time data on COVID-19 in cancer patients that’s credible and peer-reviewed. PCF.org/COVID-19 lists a number of resources for patients and families, including the ones mentioned here. We will continue to update this page as more information becomes available.

With kind regards for the health of you and your family,
Jonathan W. Simons, MD
President and CEO
Prostate Cancer Foundation