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My Baba, aesthetic medicine, collagen case studies part two

HISTORY

My mother’s mother was our Baba.  Baba was a first-generation American from a Slovak family in Central Pennsylvania.  Luckily for me, I spent a lot of time with her growing up, including summer visits to her home in Wyndmoor, PA, where she lived with my Grandpop until his death in 1985.  When I was adopted by my paternal grandparents in 1984, I relocated to Parkerford, PA, which put me within an hour’s distance of Baba, and once I had my driver’s license, I could—and did— go visit her.

Baba and I, high school graduation week 1987

The inside of the garage at Baba and Grandpop’s was clean and spare.  Along with their two cars, there were two golf bags, his and hers.  I think there was a lone snow shovel.  But tucked in the back corner there was a huge, black, shiny hunk of Pennsylvania Anthracite coal.  I always wondered about this, but never asked.  As an adult, it makes perfect sense.  Baba wanted to remember from whence  she came.

As the second youngest daughter, with three siblings, Baba was the first in her family to leave Coaldale, PA, go to the big city of Philadelphia, and achieve a higher education.  She went to secretarial school at the Peirce School of Business, and she boarded in a building nearby at the corner of 14^th and Pine Street.  Somehow, between her studies, she made it all the way out to Pottstown, PA to Sunnybrook Ballroom for dancing.

Sunnybrook is a stone’s throw from Parkerford. In it’s day it was an elegant place, which began as a swimming club in 1926 with a circular pool that had a lively summertime crowd.  During The Great Depression, a ballroom was constructed which became one of country’s great dance floors during the Big Band era of the 1930s-1940s.  Both my maternal and paternal grandparents met at Sunnybrook and danced the night away.  My junior and senior proms were held at Sunnybrook.  For years we would take Nana and my aunts to Sunnybrook for a delicious Mother’s Day brunch.  The Eggs Benedict were unbeatable!  My Nana and Pop pop’s 50^th wedding anniversary was celebrated at—you guessed it—Sunnybrook.  

Baba had what I would describe as presence, which I’m guessing went back to her childhood: she was a beautiful, smart, and capable.  She was ambitious in the highly motivated manner emblematic of many first-generation American immigrants.  She and my Grandpop built a successful restaurant supply business, and were original bondholders for the “new” clubhouse of Whitemarsh Valley Country Club, which was incorporated in 1908.  Her name was on every...damn...trophy in the vast display case of the WVCC lobby.  I admired her tremendously, and always enjoyed her company.  But it could sometimes, actually often, be excruciating to be in Baba’s presence in a restaurant.  She expected to be waited on, and was very vocal if the service was less than exemplary.  Every time I gather up the cutlery and plates for our waiter or waitress, I think of my Baba and the time she slapped my hand away in WVCC.  “You DO NOT clear the table.  That is the job of the servers!”  Oooh boy.  Yet in the next breath she would whisper to me in a conspiring tone, “These haughty Philadelphia blue bloods have no idea that I’m a saloon keeper’s daughter.”

Competitive doesn’t quite capture Baba’s ethos.  Yes, she was a fantastic golfer.  In her 70s, when she would take me to a little nine hole, par three course called Woody’s (I’m a terrible golfer and WVCC wouldn’t have tolerated the number of divots I produced), we would invariably get matched up with two strong young men as a foursome.  She always let them go first, then me.  Yes, their swing was strong, and the ball would travel far, as long as they didn’t shank it into the treeline.  But Baba, her swing was elegant and her aim was true.  I loved, loved, loved to watch their expressions, when my little old lady grandmother in her green pants and bug-eyed sunglasses hit that first ball.  Huzzah!!

I could write dozens of stories about my Baba and our adventures, but for today’s purposes, I wanted to wrap up this section with a reference to her skin care routine.  It fascinated me.  Baba looked...shiny.  In her bathrooms she would have enormous jars of Vaseline.  As best as I could tell, she would liberally apply this to her entire face on a daily basis.  Her bedtime ritual was a gentle wash with Dove soap and warm water, and then a coating of Pond’s facial cream.  With her quilted smoker’s jacket, white cream-covered face, and long, thin, brown More cigarettes, she reminded me of a Hollywood actress backstage in her dressing room.  Indeed, in my life, she was a star.

RECENT PAST

Between leaving my first primary care job as an FNP-C, becoming embroiled in a two year unionization campaign, and landing at SUNY Upstate, I spent some time exploring aesthetic medicine.  My friend and dentist of twenty four years happened to have a fancy-pants laser machine gathering dust in his office.  His staff at the time, and his wife/business partner, had been keen on starting an spa as a side hustle, but their enthusiasm quickly petered out.   During one of our conversations which took up a good part of a dental visit, he pitched me an offer.

Never would I have imagined that I would be interested in aesthetic medicine.  Yet the work was interesting, and turned out to be quite rewarding.  Richard, my friend/dentist, first used the laser on me so that I would understand what it felt like.  It wasn’t terribly unpleasant.  My face felt sunburned for a day.  I don’t hold it against him, but my labial folds have been uneven ever since.  Geesh!  We reviewed the protocols, I read a stack of research papers, and then I started seeking volunteers from among the many female nurses and friends in my life.  In fact, the more wrinkles, the more welcome you were.  

The most satisfying work I did was with a woman who had been attacked with a knife by an abusive boyfriend.  She had a divot and scar in the side of her face that makeup would never hide.  I wasn’t able to eliminate it, but by the time we were done, it was much less pronounced.  A close friend who told me that premature wrinkles were a curse upon the woman of her family felt that I had given her back three years of youth (I thought five).  Another woman who detested the striae (stretch marks) on her abdomen from carrying four children was also thrilled with the results.  Aside from treating joint pain, I am empathetic with why women (and some men) would be eager to use collagen if they thought it will help them look younger. During my foray into aesthetic laser work, essentially I got to make some women happy, and see the lift in their smile and self-estimation.  Not a bad way to make a living.

PRESENT

There are three main points I want to cover in this second part of my collagen case series: how our bodies have changed, a potential mechanism of action for collagen to promote pathology, and some limited observations about Vitamin K2.

Before I go there, I’ll mention that my colleague Dr JP Saleeby wrote a brief Substack on the topic of collagen a few weeks ago. I value the perspective of such a learned practitioner. Knowledgeable criticism from his clinical experience should only shed light on the topic. JP uses modified anticoagulation, avoiding Plavix, and infrequently measures micro clotting as we do, because of the logistical challenges of completing it. The synopsis is that we shouldn’t throw the baby out with the bone broth.

Is Collagen good for you?

I also note that a Registered Nurse writing for The Epoch Times wrote an electronic article, now printed in the most recent paper edition, which extols the virtues of collagen and enthusiastically encourages its use. I share these references with you so that you will understand that while my perspective is based in what I see with my own eyes and brain in front of me, it is a minority view.

The bodies which we inhabit today have been transformed from those we inhabited pre-pandemic.  In areas of the world with vaccination levels between 70-90%, we can expect that everyone has microclotting, from direct injection of spike promoting molecules, or receipt of spike into our bodies from shedding.  Spike has traveled to every part of our bodies.  It is the most toxic pathogen known to modern medicine, and has a very lengthy list of potential pathologies which it promotes.  See pages 9-10 of the FLCCC I-RECOVER Protocol for a list. When you speak to any physician, it is fair to ask her/him, “What is your understanding of spike protein, the pathologies it engenders, and how to treat them?”  If you are rewarded with a deer-in-the-headlights look, at least you know that the expert in front of you has an expiration date: November 2019.  Any claim to expertise in the realm of medicine which preceded that date, stops at the doorway to spikopathy.  Clinicians who aren’t curious or motivated to learn about the spike protein which has poisoned more than five billion people are less capable of accurately evaluating, testing, diagnosing and treating you.  In fact, they could be dangerous to your health.

I don’t know if collagen was harming or helping us before November 2019.  One reader shared her experience with how it healed her Doberman.  Another pointed out that she wasn’t using it simply for reasons of vanity (skin/hair/nails), but to help aching joints function better.  The question  however is not whether collagen used to help or harm us, but rather this: given what we know about how the spike protein has altered our bodies, is it possible that collagen is deepening that harm?  My clinical observations tell me that the answer is yes.

The next question is, how might collagen be harming us?  As you read in the first part of my case series from last week, and now in the second part this week, you will see that I’m focused on the amyloid fibrin microclotting which is measured in our patients at the Leading Edge Clinic.  In particular, when the microclotting score of a patient, and then another, didn’t drop after months of anticoagulation therapy, I wanted to learn why.  The common thread was collagen. 

This week however, in a visit with a patient who has had a tortuous postoperative course following major surgery, another possible explanation began to emerge, which is the impact of collagen on mast cells. Aside from microclotting, a second way in which our bodies have changed is that our mast cells have been dysregulated.  The Epoch Times had an excellent article on the subject recently.   My appreciation for the profound impact of mast cell activation syndrome (MCAS) on the clinical trajectory of patients with post-acute sequelae of COVID (PASC) and vaccine injury has only grown over time.  Dr Lawrence Afrin is the eminent expert on the subject, and I recommend his accessible book Never Bet Against Occam: Mast Cell Activation Disease. Even more accessible is the website of my beloved colleague, Dr Tina Peers in the UK. Her recommendations of NAC Augmentata and Arc Microtech microcurrent technology have made a profound impact upon our patient care.

It turns out that collagen impacts MCAS.  This isn’t a scientific reference, but it’s a good place to start digging.  From the website of an Australian collagen vendor, Nutraviva: 

How Does This Impact People With Sensitivities To Histamine?

Unfortunately for people sensitive to histamines, bovine collagen powder supplements,  gelatin, and  bone broths can present a challenge. Histamines can be present in certain species of fish so choosing  Marine Collagen as an alternative may not always be the best option either. The appropriateness of a  collagen supplement is also very individualised and dependent on the individual's level of tolerance, so one product may be more suitable than another.

If you have a dietary histamine sensitivity or Mast Cell Activation Syndrome (severe, clinically diagnosed histamine intolerance) then a  collagen protein powder or  bone broth may not be appropriate due to their sourcing and long processing/cooking times and the bioaccumulation of histamine from a range of foods sources within a time frame, which may increase levels of histamine overall.

A few words of explanation are in order.  Among the hundreds of cytokines released by mast cells, there is the cytokine IL-6. This is a cytokine which we are targeting with low-dose Naltrexone (LDN) when treating PASC and vax injury.  Among it’s many roles, IL-6 elevation is provocative of ...abnormal clotting.  And cancer.  Mast cells which have become hyperactivated are releasing IL-6 throughout the body.  People with hyperactivated mast cells who ingest collagen, according to some Aussies who make the stuff anyway, are going to have trouble. They will release more Il-6.  And, the patients will experience more coagulopathy.  Which comes first, MCAS or clotting?  If someone has both, I’m not sure how much that matters. 

Now on to Vitamin K2.  (Ooof, I can hear the experts howling to the rafters already). As with collagen, there have been signals of trouble from my patients.  When you spend an hour with a patient (as opposed to a ten minute McSick Care visit), there is time to listen and ask questions.  I like the rule of three.  By the time the third patient says, “You know doc, when I started that K2, I just felt like my blood was sludgy”, she/he has my full attention and intent curiosity.  

In the fourteen  years I spent in the Emergency Department setting, I administered IV Vitamin K1 less than twenty times.  It’s what we do for a patient who is on Warfarin/Coumadin and has a gastrointestinal bleed.  K1 is an antidote, by way of blocking one pathway in what we call the clotting cascade.  The dose is 10mg in an IV bag over at least thirty minutes.

Vitamin K1 is naturally occurring, has limited bioavailability of about 15%, and a short half-life in the body. Vitamin K2 comes in several formulations which are syntheic, have greater bioavailability of about 85% and a much longer half-life.

Our patients are uniformly taking 100-200mcg of Vitamin K2 because they are also taking high dose Vitamin D3, and they have been instructed to do so.  The understanding is that K2 helps prevent deposition of calcium deposits along the walls of our blood vessels as a result of how Vitamin D3 at high doses modulates calcium metabolism and absorption.  Fair enough.  But wait, what might be different in our bodies since November 2019?  I know this doesn’t make sense, because the ratio is obscenely out of balance.   But, could 100 mcg of Vitamin K2, which is 1/1000th of the Vitamin K1 dose given to reverse a GI bleed, possibly increase clotting in a PASC or vax injured patient?  Knowing that K2 has greater bioavailability and a longer half-life, I think so.

I’m a sailor, so I’ll put it to you in sailing terms.  Sailing into a north wind, the boat will be upright, the mast straight, the sail luffing.  Sailing 28 degrees northwest or northeast of a north wind, the sails will fill and the boat will lean (heel) to the side.  Pre-pandemic, if you gave Vitamin K to someone who was bleeding, it would be like steering your boat back towards the north wind, and your ship would right itself.  Currently, with all of us microclotting, it’s as if we are moving fast and heeling hard, with one edge of our boat dipping into the water.  Then you turn away from the wind just a smidgen more, say 30 degrees, 100mcg of Vitamin K2, and in rough weather, the water may start splashing over the sides.

If a patient is taking Nattokinase, at least 6,000 fu daily, I have little concern about them accumulating calcifications along their blood vessels.  The reason the Japanese live to be eighty, don’t have dementia, are still physically active, is because the slimy, stinky, fermented soy they eat—Natto--has Nattokinase, which gently prevents and removes such plaques.  To keep the ship sailing without taking on water, I will guide patients who are on Nattokinase to stop their Vitamin K2.  I also caution them to avoid super green powders, which have concentrated Vitamin K1, as there have been signals of similar concerns with this.  Basically, get your Vitamin K from your food.  Do I have the same level of concern about Vitamin K2 and supergreen powders as collagen?  No.  But if you were my patient, we would discuss the risks versus benefits and come up with the answer which is right for your individual case.  This is the art of medicine.

What follows are six more case studies in which I think collagen is an active dynamic. They are necessarily works in progress and incomplete. I will follow up with a third Substack in the future as we recheck labs and observe for clinical responses with discontinuation of collagen.

Patient 8

61 yo male, x2 mRNA + booster, last shot 7/22, onset of symptoms 8/22, vaccine injured.  First visit 9/22.  Hx IBS, eczema, psoriasis, bilateral mediatsinal lymphadenopathy. No surgeries declared.  Reported facial flushing, sudden sense of heat, numbness/tingling of nose, mouth, fullness in ears — like underwater, insomnia, occasional dizziness with standing, myalgias, groin discomfort, chest discomfort, depression/anxierty, mild brain fog, rash on chest, post exertional malaise.  Strong signal of MCAS.  Initiated IVM and has used on/off, with LDN on/off , Nattokinase, Neprinol, NAC Augmentata, Turmeric, Garlic.  Labs 2/23 show reactivated EBV, spike ab 24,330 U/mL.  8/23 testing showed 4 of 4 microclotting.  PAI-1 5G/5G polymorphism, which should have placed him in the lowest risk category for venous  thromboembolism.  Started Aspirin 8/23, Plavix 11/23.  Long-term workup for iliac venous compression started. By 11/23, spike ab down to 11,671 U/mL.  During 1/24 visit, in response to quesitons from this provider, patient reported that he stopped collagen-protein peptides 20gm per day in November of 2022(after vaccine injury), because of concerns upon reading more medical literature on the topic.  

Patient 9

67 yo male, x2 mRNA shots. First visit 5/22, with unknown previous COVID at that time.  Hx squamous cell carcinoma, congenital slight curve of spine, arthritis of lumbar vertebrae,  s/p excision of squamous cell carcinoma.  Intake reported brain fog, two incidents with brief loss of vision in left eye, tinnitus, sleep disruption, failed root canal.  Bi-weekly use of IVM at time of first encounter, increased to daily, later with Nattokinase, then NAC Augmentata,    2/23 spike ab was >25,000 U/mL At 6/23 visit reported an incident while traveling: developed sudden onset of dyspnea, lethargy, and malaise.  Concern for iliac venous compression began around this event.  Spike ab down to 23,156 by 7/23.  7/23 added Aspirin daily, and microclotting study result was 3 of 4. Began anticoagulation with Plavix and Eliquis.  Using the Arc Microtech 3-6 hours daily and a grounding mat.  Last visit was 1/24.  At that time patient felt that he was getting worse, waking with muscle aches in his arms and legs, some increased varicosities, and ongoing dyspnea.   In response to questions  re: collagen use, patient shared that he had been adding collagen to his bullet coffee daily for months.  Collagen DC’d.  At 2/24 measurement, microclots were only down to 2.5 of 4, despite nearly seven months of therapy. 

Patient 10

65 yo male, x1 J&J shot, and five previous COVID infections (four after the shot).  First visit 10/23.  Intake reports fatigue, brain fog, memory problems, shortness of breath, fast or pounding heart rate, anxiety and depression, symptoms worsening after activity.  Reports reduced capacity during exercise, tachycardia and palpitations during higher intensity exercise, poor recovery following exercise.  Strong signal of MCAS, early concern for iliac venous compression based upon history.  10/23 measure of spike ab was 9108 U/mL.  IVM, LDN, NAC Augmentata initiated.  1/24 study of microclotting was 3.25 of 4.  Discussion at second visit, end of January 2024 revealed that patient had been supplementing with collagen for an extended period of time, although it hadn’t been on his list.  Collagen DC’d.  Plavix low dose, Aspirin, Antronex initiated.  

Batch ADRs Deaths Disabilities Life Threatening Illnesses

203A21a      1645     18                     21                     23

Patient 11

80 yo male, x2 mRNA Pfizer, last shot 2/21, onset of symptoms 2/21.  Hx neuropathy, muscle weakness and atrophy, Sjogren's syndrome, joint pain, tinnitus, S/p gall bladder removal via open surgery, catheter ablation for A-Flutter, detached retina surgery following cataract surgery the previous year. Intake reports weight loss (30 lbs), muscle loss, weakness, neuropathy, nerve sensitivity, symmetrical sensorimotor axonal polyneuropathy by EMG and blood work, fatigue, brain fog, joint pain, worsened after activity.  D-dimer prior to our first visit 10/22 was elevated at 321ng/mL (normal <= 230ng/mL)  Eliquis had been recommended by PCP, but patient was reluctant.   Using soft-shell HBOT.  Many, many trials of therapy over time, with consistent use of Aspirin, LDN and IVM. Later adding EPA, NAC Augmentata, and Nattonkinase.  Late September 2023 study showed 3.5 of 4 microclotting.  Patient initiated low dose Eliquis and Plavix shortly thereafter.    At end of November 2023, patient reported that he had been using Dr Gundry’s Phyto Collagen Complex and had DC’d it in the last week.

Patient 12

75 yo male, PASC.  Acute COVID infections April and November 2022.  Onset of symptoms January 2023.  First vist 10/23.   Hx transient ischemic attack (TIA), HTN, depression, anxiety  S/p bowel obstruction surgery, with extensive adhesions noted in August 2023.  Intake reports fatigue, brain fog, memory problems,dizziness when standing, anxiety and depression, symptoms worsening after activity.  Anti-depressants stopped working and he developed insomnia.  Started on Aspirin prior to our first visit. Early concern for iliac venous compression, validated in review of previous CT abdomen/pelvis and during consultation with coordinating IR specialist. Patient unable to travel very far and so stent placement is not easily achieved at this time.    Already on IVM and LDN; started NIR, Flavay and Arc Microtech.  Moderate signal of MCAS.  Mid-November 2023, spike ab was 70 U/mL, reported during visit that he ran out of his collagen supplement two days prior.  Collagen DC’d.  Microclot study 2/24 revealed 2.5 of 4.  12/23 lab showed very low serum serotonin level of 34 ng/mL (range 23-230ng/mL).

Patient 13

60 yo female, PASC unvaccinated.  Hx HTN, hypothyroid S/p partial thyroidectomy with benign nodule.  Onset January 2022 after acute COVID.  Intake reports severe fatigue, tachycardia, anxiety and depression, symptoms worsening after activity, insomnia, only able to sleep 2-3 hours at a time.  She suffers from a burning sensation throughout her body - extreme heat - mixed with itching of skin.  Had Epstein Barr Virus (EBV) reactivation reflected in labs.  Strong signal of MCAS.  Started on Aspirin, Nattokinase, IVM, NAC Augmentata, and Arc Microtech.  8/23 spike ab was 

22 U/mL.  9/23 visit had some days of feeling better, then overexerted and was back in bed for 3-4 weeks.  Burning was less intense.  Conintued to have palpitations.  Presentation consistent with iliac venous compression, but difficulty getting correct study and doesn’t want to use Gadolinium contrast.  In 11/23 started Ketotifen.  12/23 microclot study showed 3 of 4.  Visit following this report revealed patient was taking collagen daily.  Collagen DC’d.  Late 1/24 visit, started Eliquis and began having night sweats.  Went up on Flavay, started Antronex, titrating up on Ketotifen. 2/23 visit feeling stronger, walking more, finding benefit from NAD Platinum from QuickSilver.  Off Eliquis, feeling clearer when she wakes up.  Tolerating Plavix ¼ tab daily.  Mental clarity from 5-HTP.  Plan to trial Cromolyn nebulizers, and try Inositol for reactivated EBV.