PhyBits: The Milwaukee Protocol

[@fireiceuk9221]

MP or not, palliative care for rabies is mostly diazepam and morphine (WHO, "Frequently asked questions about rabies for Clinicians"). So it is basically a choice between being tied to a bed in a semi-comatose state or induced coma. Assuming medical resources are available induced coma seems like a more dignified way to go. You missed one very major point IMO. There might not be a difference between bat and dog rabies strains. The difference is that in the developed world there are no rabid dogs on the streets. Dogs are responsible for 99% of 59,000 annual cases (WHO, Rabies website). In this light Milwaukee Protocol might be just a miracle of modern ICU protocols.

[@phylumchannel]

Great points! It does touch on my insecurity covering this at all- medicine is difficult! The mess of confounding variables is tough to untangle.

[@phylumchannel]

Of note is a protocol called the Starfish palliative care protocol that at the very least seems to reduce suffering (Marsden & Cabanban 2006). I don't know how common this route is. It includes chlorpromazine, haloperidol and diazepam, but not morphine.

[@fireiceuk9221]

@@phylumchannel Don't let my nitpicks discourage you. You make great longform content. 🙂

[@CruorBlossom]

Im terrified of rabies, and i guess if it was me showing symptoms in a hospital bed, I would rather try something to fight and not simply die a bit more comfortably.

[@joteas]

I remember stumbling on this channel then watching all the videos from it and wondering where were the rest. Can't believe this started 6months ago

[@spindash64]

I suppose "Milwaukee Gambit" would be a more apt description. I'm no healthcare provider either, but if it's the ONLY treatment anyone is willing to offer for rabies, then until an alternative arrives, it seems to me better than doing nothing. Even if the MW _itself_ isn't the source of the survival rate, the cases suggest there is SOMETHING that can still be done for people showing symptoms, even if we dont know what TLDR: If the only thing is offers is hope of a cure, then until we find it, i dont think we can risk throwing that hope away.

[@robincray116]

If Milwaukee itself isnt the source of the survival rate. That would imply something else is giving that 14% survival rate and given that everything else is giving 0%, that sounds doubtful. It is probably more accueate to say some part of Milwaukee Protocol PLUS something else is the source of the survival.

[@nerysghemor5781]

@@robincray116Right, so we need to figure out what that is and we will only know if we keep trying. The patient is in a deep enough coma that it should not mean prolonged suffering to make the attempt when the family consents to do so.

[@techneti_um]

Maybe the little guy could be named Squ? After squamous epithelial cells that make up the blood vessels - since neutrophils are usually found there, I could imagine Phy starting up a convo with one of the cells lining it. Also because then you can pronounce it as “screw” and this little guy is trying to screw over Phy over - ok not really, but “squamous” does stem from the Latin word for “scale,” and the little guy is balancing Phy out / the points being made Did I overthink this? Yes. Do I regret it? No.

[@epos.nephilo]

my favourite fan project no way

[@GeneralCorviknight]

@@epos.nephilo mp is an epic fan project 🔥🔥🔥

[@ElAmigoQueSubeShorts]

I was expecting a comment like this

[@WithinTheFacade]

@@ElAmigoQueSubeShorts yea same

[@hanro50]

So what I am seeing is that they basically said screw it, knowing the patient was essentially dead already and decided to forgo all normal safety protocols to kill the virus by any means necessary. Seeing as anything less then eradication would have lead to the patient's demise?

[@psydere]

Little guy said "innit" so they need a British name

[@phylumchannel]

Avery Goodcell

[@psydere]

@@phylumchannel Stemmy Cellington

[@phylumchannel]

Celly McCellFace

[@darius-m3p]

​@@phylumchannelMontgomery

[@EmmaDilemma039]

Maybe they could improve this treatment in the future? But you're right, prevention is always better than the last resort.

[@fallendeus]

People who bring up the Milwaukee protocol havent really looked into it. The general consensus is mixed as to it's efficacy, with most actually considering it ineffective and that the patient survived due to other reasons such as a weakened strain.

[@Drakid13Re3kt]

Have we considered she is maybe just built dif

[@nerysghemor5781]

If that is the case then so be it. At minimum the Milwaukee Protocol should be the standard of care as we work towards a solution that will help with all strains. If you don’t survive, you have received far more merciful hospice/palliative care than the prior standard, which was to put the patient in a stuporous haze where they are still semi-conscious in literally incomprehensible suffering they cannot advocate for themselves to stop. Put bluntly, under the Milwaukee Protocol you are guaranteed a path with far less suffering to a better place. Most likely that will mean death and yet the doctors are NOT committing euthanasia because there is an outside chance of survival. Even a possible weakened strain has not been survived by any other means. Let’s do what we need to do to find out the truth and not speculate, AND for the ones who are not going to make it, give them the level of sedation and lack of awareness of their end that they deserve.

[@ambatabuss]

your content is awesome bro. this might be the most underrated channel on yt rn but i’m sure it’ll blow up

[@mrslinkydragon9910]

The first person who survived went on to have a child!

[@The_Variable1]

And it happened during Mother’s Day, or very close to that.

[@ImDelphox]

They've been naturally selected

[@kalkuttadrop6371]

On the one hand, I agree. On the other hand, the fact there were no confirmed survivors prior to the Protocol indicates it's doing something. Even if it can't save a person with the odds staked against them, it might be able to save a person with a few things going for them that wouldn't otherwise. (Also I don't think Dog rabies is a different disease. The distinct is because rabies in dogs and large mammals is extremely rare in the west nowadays so rabies is almost always bats, while in the old world stray dogs are a massive massive problem. They require different solutions. Dog based rabies does usually present quicker with shorter incubation, but that's down to viral load)

[@MarianneKat]

After 30 years in adult icu, ive seen people make decisions to keep going even if no chance of survival is possible. Literally hoping for a miracle. 😢

[@liesdamnlies3372]

Hard to blame someone for wanting to go down swinging, as it were. Doubt anyone really knows what they’d choose to do in that situation either.

[@parthnagdev]

so MP is like Chemotherapy basically? I think suffering individuals should be presented with a choice and shouldn't be kept in the dark similar to how the option for chemo or palliative care is given to those diagnosed with cancer.

[@SalviaCat]

Name ideas: How about a T-Cell, who learns from the content? In the body, they learn from encounters etc. I assume the character somewhat represents us, the audience. You can come up with a lot of T-names also which is helpful if you want to name them. Basically we learn from past content [the original video]. Tess], Taylor [androgynous], Troy, etc.? We learn from you. T-Cells learn too. Seems apt. They are watching and listening for sure. It kinda keeps up the theme too ^^

[@SleepsWithDragons]

Terri T-cell

[@Nickname1978]

All your vids make my brain hurt… in a good way!!!!

[@murmurcub]

We need to be more educated about rabies and mp. I love how a group of people made an álbum trying to show how nightmarish the sickness and mp really are, sadly it's not as popular as it should be.

[@BartdeBoisblanc]

Name that little guy Celldon after Young Sheldon.

[@themysteriousface7633]

From reading an article and to quote it, it’s a red herring to researches/scientists. I think from what I saw after the procedure was successful with the first patient they did, there was an attempt to do it on a young boy, who unfortunately died 2 weeks after.

[@Alice-si8uz]

The issuse with antiviral medication is that at that scale you start risking causing damage to things the body actually needs. Kinda like a more dangerous version of how anti bacterial medications cause trouble as well

[@ThomasTheThermonuclearBomb]

You should call the little guy µ, or micro

[@unamix7729]

Rabies “All that for a drop of blood.” Scientist “A wise man once told me that if you can make God bleed people will cease to believe in him.”

[@YunxiaoChu]

?

[@yea18899]

@@unamix7729 omg survovor here

[@ChimeraX0401]

I pretty much think it is better to try and make a new protocol for rabies like injecting antivirals directly to the spine and a high dose of IV rabies immune serum. If it didnt succeed the patient is gonna die anyway so nothing is lost, if it succeed then we can just deal with the side effects later on....

[@zyxwvutsrqponmlkh]

There are villages in Peru where unvaccinated people commonly have rabies antibodies. The reservoir is almost certainly vampire bats and it's likely they just carry strains that are less fatal.

[@marppram2006]

If I never listened to the album about it I would’ve never knew stuff about how rabies can have a chance to be treated in the symptomatic stage even for the failure rate

[@Annie497-f5x]

Studies done on the MP, following the survival of Jeanna Giese, were not successful in the way it seemed to help her. It's not considered a recommended treatment any longer. But I suppose if a person contracts rabies, any hope of treatment would be better than nothing. Thankfully, it is very rare in the US and in most developed countries, and the rabies vaccine is 100% effective if given prior to symptoms appearing. The most common theory of Jeanna's survival with this treatment is that is kept her alive long enough for her own immune system to develop antibodies to fight off her infection on her own. It accomplished that, and it saved her life. Once the virus has taken hold, there is nothing that can be done.

[@shadowhackerguy3574]

Yo phy will you ever talk about autoimmune disorders?

[@phylumchannel]

only when i'm confident i can cover them respectfully, but within my style.

[@mateuszcielas3362]

well i think 14, but still its statistically almost 100%

[@hgbugalou]

I think the protocol discovered an important part of treating rabies that needs to be considered for future treatments. It likely combined with other factors, particularly the genetics of the person or previous vacination, which is why it doesn't work in others most of the time. That said, I do not think its completely irrelevant as some have speculated. As common as rabies is world wide, factors like genetics, a weak virus, and other treatments would have hit upon a win or two prior to this attempt.

[@Wolf-oc6tx]

While we don't if the mp is best option we do know that there is something about it that helps.

[@positivity3311]

maybe the name is Leuk from leukocyte

[@searchiemusic]

3:36 unfortunately, rabies deaths are still very common in poorer countries, i think ~70k a year

[@ArtieIsAlone]

@@searchiemusic I live in Thailand and I am currently sitting in the waiting room awaiting my post-exposure rabies vaccine. It is incredibly expensive and my family can barely afford it, but it’s free in government hospitals, where disease spreads rampantly and people lay in stretchers in the halls. What a world, eh?

[@ajdean2974]

In the video you state that "maybe they just survived because they had a team of doctors keeping their organs working long enough for their system to fight back". That is the entire point of the MP. Like.. thats what the MP IS. Its an attempt to put the brain in stasis long enough for the immune system to do its thing. Additonally, post-vaccine survival was already a known factor before the MP was created, so imo that should not be considered in the statistics, at least not unweighted. But for non-vaccinated exposures the survival rate was... 0. So any percentage above that is worthh pursung.

[@brianlavalley3983]

You genuinely believe that being awake longer in much more pain is a better option than being put under with an extremely low chance of actually surviving? The scientists studying rabies know its not a miracle cure so how is it doing any actual harm towards finding an actual cure like you stated???

[@tacticalidiots2340]

They're talking about public perception: what a family wants, what funding researchers get, people making misinformed decisions and dying in agony

[@Account13283]

I’m now expert but I think the MP is a good way to deal with rabies because at least the first step is to put you in a induced coma if it doesn’t work at least you don’t have to go through the pain of the symptoms

[@catboy_official]

Quality of life is infinitely more important than lifespan. Advocates of the MP should be aware that almost all survivors have severe life-altering brain damage, ie they're a vegetable. Imagine being told you're lucky to survive rabies, only to find out you can't move, talk, or even feed yourself. A prisoner in your own body because your family were too desperate to save your life that they condemned you to this hell.

[@liesdamnlies3372]

Well, at least in Canada you could probably stipulate that if that’s how you end-up you’d rather not remain so. To put it euphemistically.

[@yomomz3921]

Personal choice.

[@StephenMcGregor1986]

Only the 1 initial out of 26 attempts worked. Any other claims were rebuked.

[@CynicalCopycat]

Honestly, MP seems like a very last-ditch effort at fighting rabies, and I think it should be treated as such, not as a viable cure. Personally, I would prefer to be put in a coma and try my chances. Worst case scenario, I'll pass away in a coma and won't be in hell for the last moments of my life. Even with supportive care, rabies is a nightmare to die from, and in countries without legal euthanasia I think MP might be more humane than supportive care (though that is just plmy personal opinion, I can see if ssomebody would prefer to be conscious and alive for as long as possible, going under knowing you might never wake up again is horrifying on it's own). Let's also not forget that even when successful, it's not like MP is a miraculous cure that you can just get up from and live a normal life, people thay survived rabies were left severely disabled. From what I remember hearing about the first case, the girl had to re-learn basic skills like talking and reading and underwent months of intensive physiotherapy. Even in the miraculous successful cases, rabies is HELL.

[@Mar_Ten]

4) Seems like a very big thing to be. Like you should probably remove those cases if you attempt to study this. As you said, this seems very unclear and good on you for not including this in the original video. The protocol is a way to sensitive topic to be simply accepted as facts.

[@gustavgnoettgen]

Anne Milwaukee, Milwaukee, Milwaukee Anne.

[@StephenMcGregor1986]

I would like a swimming pool filled with G-CSF

[@TungstenCarbideProjectile]

it's cool learning about new things on the internet and youtube in general but we must remember these presenters are mostly not experts in the field meaning there inadvertently causing misinformation no matter how well researched or spoken they are. these are the opinions of a non expert. if you want to learn use youtube to find new topics then go do your own research, methodical research, from verifiable scientific journals which are trusted. there are numerous channels i find bring up fascinating topics to stir intelligent research but the very inexperience of there professional background leads to there videos lacking quite significantly in substance. this is one of those cases and asianometry channel is another similar case.

[@TungstenCarbideProjectile]

another is William spaniel

[@alchemist9905]

what are we losing by keeping the MP around? How about what are we potentially not losing by keeping the MP around? a life. And at that point you have to ask yourself what the worth of a life is.

[@dimaboiko3124]

Why some vaccines last longer than others? (⁠・⁠-⁠・⁠;⁠)

[@superlexaan_]

Depends on the mutation rate of the virus, some viruses become unrecognizable for the immune system in a semi-short time, and "recognizing" viruses is how vaccines work

[@blacklight683]

@@superlexaan_ yea i think this is true, after the immune system makes antibodies for a virus/bacteria(i am not a professional and i might be miss remembering) i heard that these antibodies never die or atleast get replaced regularly so the body will forever have a record on that thing, but as soon as it mutates enough it might aswell be a new virus/bacteria and the body has to do the antibodies routine again

[@b.a.erlebacher1139]

This is a good question. Some vaccines AFAIK really do last for life, e.g. smallpox, but others don't and it's not just necessary due to mutated pathogens, like flu viruses. For example, it's recommended that adults have a tetanus booster every ten years. This booster usually includes a vaccine for diphtheria, too. Middle aged adults sometimes get really bad coughs that are actually pertussis, despite being fully vaccinated as children.

[@parthnagdev]

@@blacklight683 it's not the antibodies that don't die but the actual cells that produce them (B lymphocytes, specifically Memory B cell) and the memory is not permanent and how long the immune system remembers a specific antigen depends on various factors, but generally the memory starts to fade away after a decade.

[@waltersobchak7275]

Ketamine for the win. I should be immune for life then

[@ketsuekikumori9145]

I think the mistake here is not addressing it at all in your original video. Rather than sweeping it under the rug, you should've just said what you said in this video. That you're not 100% comfortable talking about it since you're not as knowledgeable about medicine. Adding to that, you could've also said "If you're interested in a more detailed explanation, I can make a separate video." You ended up doing so anyways.

[@vann20]

7:33 Rabies is no more evil or cruel than your kitchen stove. It just is. Attributing malice to it is stretch, or any disease for that matter.

[@spindash64]

I'm still gonna call it evil, because that's what we refer to things that exclusively harm and maim as being Yes, it has no mind, but it is still "evil" in the sense that we'd all be much happier without it around

[@jaggerbushOG]

OMG - The Milwaukee protocol was a fluke.

[@HalfgojoLol]

Nah nah its 100% fatal if you get it, it's guaranteed your dead that girl was just a special case.

[@simplystxr7]

more than just one person has survived it

[@user-zs9ux1ru8u]

Around 30 people survived after the implementation of the Milwaukee protocol, with sequelae. I'm not a scientist or medical professional, but there are different procedures underway involving the use of an f11 antibody that has proven to show better results of survival in mice post exposure to rabies.

[@TheActualErgo]

Last

[@secretsanny]

Bigotry bigotry! Scared now 😂😅?

[@polygontower]

biology?