WEBVTT

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Before I say anything, 
I just want to say

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that if you are squeamish
you might not want to watch this video

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because there will be some pictures 
of lungs that have a blood clot in them

NOTE Paragraph

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and other organs of the body. 
In my opinion it's nothing that bad

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but I wanted to give you a warning,
regardless.

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This video is a follow-up
to my last video which was called,

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"What Doctors Are Learning From Autopsy 
Findings of COVID Patients. "

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Just after I published that video,
not even a day later, this study came out,

NOTE Paragraph

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published in the 
Annals of Internal Medicine

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which I'll put a link in to the description below.

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And what makes this study such a big deal
is that it's the first study that

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looked at this many autopsies of 
patients who died of COVID.

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Not only do they do complete autopsies, 
but they use CT scans

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to scan the entire body for blood clots.

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All 12 of the deceased had tested
positive for SARS Coronavirus-2

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by means of RT-PCR.

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Now, I want to say something.
Not everyone on this planet is

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going to get COVID.
For those who do get the virus,

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80% of them will either have mild
or no symptoms.

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Roughly 15%-20% of them will 
have pneumonia.

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Roughly 4% will develop ARDS, or Acute
Respiratory Distress Syndrome

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and/or shock with
multi-organ failure.

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And about 1% will die of 
the infection.

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When I'm in the ICU and 
someone dies it's obviously horrible.

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Sometimes autopsies have to be done 
irrespective of family consent

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when it's a legal matter.

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Rarely, depending on the
circumstances,

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we ask familys' permission to 
do an autopsy.

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Most families decline the option for
autopsy,

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but during this pandemic, it's especially 
important for autopsies to be done

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because they often provide
incredibly valuable information,

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especially when we still know so little
about COVID.

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Especially when it can present in so many 
different ways.

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So in this study that was
done in Germany,

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autopsies were mandated for patients 
who died of COVID.

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And to the families of those victims
of COVID, my condolences.

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And we're still trying to figure out 
why some people do so poorly

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when they get the virus,
while others do just fine

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and then there's everyone in between.

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So, the point of this video 
is not to scare people.

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The point is to learn about
the disease,

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and to ultimately benefit from that 
learning

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with the hope of developing treatment
options

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and ultimately reduce morbidity and mortality in other 
words to save lives and by making this video the

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goal is to educate myself and others about what 
we're learning and getting the medical truth out

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there to the public so in this study there were 
12 patients total nine men three women and the

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median age was 73 all patients had some type of 
pre-existing medical condition most of them had

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obesity and/or underlying heart disease such as 
coronary heart disease some had type 2 diabetes

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hypertension peripheral artery disease asthma 
COPD initial lab tests revealed elevated levels

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of d-dimer lactate dehydrogenase meaning LD H 
and C reactive protein or CRP all of these are

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nonspecific markers of inflammation there is also 
mild thrombocytopenia in some patients meaning low

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platelet counts this isn't an unusual finding in 
patients who are critically ill they also looked

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at levels of viral RNA using rt-pcr studies all 
twelve patients had the SARS-CONORA-VIRUS 2

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RNA in their lungs nine out of the twelve had it 
in their throat and six had in their bloodstream

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in five patients they had viral RNA in other 
tissues like heart liver brain and kidney not

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only did they have the virus there but the levels 
were higher in those tissues compared to the blood

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here's a picture from a different autopsy that 
was not part of this study where the virus was

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actually visualized in the kidney using electron 
microscopy so what is this telling us it tells us

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that the virus is binding to those h2 receptors 
in those organs so in some people who die of COVID

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they had the virus in other organs besides the 
lungs. But, and this is a big BUT, they did not die

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as a result of that virus being in those different 
organs they died as a result of lung complications

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also an important takeaway from this is that all 
twelve had in their lungs and nine out of the 12

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had it in their throat so when you go to do a throat 
swab with someone who has COVID the virus might

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not even be there and that's just another reason 
why you can get a false negative test okay so they

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also did post-mortem CT scans of these patients 
which demonstrated mixed patterns of reticular

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infiltrations in severe dense consolidations in 
both lungs this CT scan is a patient with covid

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pneumonia in ARDS not from this study 
that we're talking about now but basically

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demonstrating the exact same thing both lungs have 
extensive consolidations ground-glass opacities

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which represent an extensive inflammation these 
are also known as pulmonary infiltrates and you

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can see the difference compared to a normal 
CT scan of the chest which doesn't have any

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pulmonary infiltrates in four cases out of the 12 
massive pulmonary embolism meaning massive blood

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clots in the pulmonary arteries was the cause of 
death in another three cases out of the 12 they

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had blood clots in their large veins of their legs 
meaning DVT without having pulmonary embolism so

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in six of the nine men they had clots in the veins 
that surround the prostate gland in all 12 cases

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the cause of death was found within the lungs or 
the pulmonary vascular system meaning within the

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pulmonary arteries for the ones who didn't die of 
having a large pulmonary emboli they died of the

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extensive inflammation within the lungs meaning 
pneumonia with ARDS in these cases the lungs were

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wet and heavy much like a sponge that is saturated 
with water. The surfaces of the lung often had

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a distinct patchy pattern with pale areas 
alternating with slightly protruding and firm

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deep reddish blue hyper capitalized areas this 
is indicative of areas of intense inflammation

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with endothelial dysfunction that can be seen at 
the microscopic level. When they look at slices

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of the lungs under the microscope they found 
diffuse alveolar damage in eight cases out of 12

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specifically they saw hyaline membrane formation 
tiny clots in the capillaries and capillaries

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that were engorged with red blood cells and 
other inflammatory findings. All these findings

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represent ARDS they also found lymphocytes 
a type of a white blood cell that infiltrated

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these specific tissues this fits the picture of a 
viral pathogen ASIS. They also look at the pharynx

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of these patients meaning the throat. The lining of 
the throat where the mucosa was hyperemic meaning

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very red and irritated and at the microscopic 
level they saw lymphocytes invading there as well

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again which is consistent with a viral infection 
in one case a patient had lymphocytes invade his

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heart muscle findings that are consistent with 
what we call viral myocarditis. In other words the

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heart muscle had evidence of viral infection more 
than half the patients in this study had large

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blood clots. 1/3 of the patients had pulmonary 
embolism as the direct cause of death. All the

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others died of intense inflammation in their lungs 
related to pneumonia and ARDS. Recently there's

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been studies showing that about 1/3 of patients 
with severe COVID have blood clots. Another study

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of 191 patients with Covid 19, half of those who 
died had clots compared with 7% of the survivors

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and levels of d-dimer that were greater than 
1,000 were associated with a fatal outcome so

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it's pretty clear now that sars-covid-2 virus 
is causing a lot of clots to form and moderate

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to severe COVID disease. But how is this happening?
it's likely a combination of reasons they have

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to do with down regulation of the h2 receptor in 
the lung alveoli with a subsequent shift towards

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having more angiotensin 2 in the lungs and less 
angiotensin 1:7 and less in angiotensin 1:9 in

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the lungs and when this happens this leads to 
more cytokine storm with more inflammation more

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constriction of pulmonary arteries and more 
clots that develop. That in turn leads to more

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endothelial dysfunction in the capillaries that 
surround the alveoli. Also there's evidence that

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the virus attaches to the ACE 2 receptors of the 
endothelial cells that line those capillaries

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which further propagates inflammation in clotting 
and in the cytokine storm that develops there

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Randy's Okemo kine bind to the ccr5 receptor 
of cd4 and cd8 lymphocytes and that causes

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those lymphocytes to infiltrate those areas of 
inflammation and in doing so further contributes

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towards the inflammatory reaction. This is why 
we're seeing low levels of cd4 and cd8 lymphocytes

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and severe COVID. Endothelial damage can also lead 
to the development of antiphospholipid antibodies

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and these antibodies are bad because they trigger 
the formation of blood clots and that's why

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patients who have clots with the diagnosis 
of antiphospholipid antibody syndrome they

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need to be on blood thinners also 11 out of the 12 
patients in the study had underlying heart disease

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and were obese these are known risk factors not 
just for cardiovascular disease but also known

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risk factors for endothelial dysfunction, and are
known risk factors for COVID the endothelium is

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more susceptible to damage based on cardiovascular 
risk factors such as men aged 45 or older, women

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age 55 or older, smoking, high blood pressure, high 
cholesterol, diabetes, obesity, and lack of physical

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activity. So the big takeaways from the findings 
in this study is that most people who die of Covid

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it's primarily a lung problem either related to 
inflammation with ARDS and/or blood clots even

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though blood thinners are not a cure for Covid per 
se they do have the potential to save lives. The

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hard part is figuring out who is likely to develop 
clots and who should we give blood thinners to and

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which blood thinners should we give and should 
we give high doses of blood thinners or just the

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low-dose prophylactic doses? To further complicate 
matters it's often hard to diagnose blood clots in

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hospitalized patients even before COVID came along 
usually it's easy to diagnose large blood clots in

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the veins of the legs, meaning DVT by doing an 
ultrasound of the legs even though ultrasound

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isn't a hundred percent accurate. The way we 
typically diagnose pulmonary emboli is by getting

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a CT scan of the chest while at the same time 
giving IV contrast and this is called a CT angio

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or CT A of the chest the downsides of doing this,
well there's several. One, you have to transport a

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patient to the CT scanner and sometimes patients 
aren't stable enough to do that. Two, you risk

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spreading the virus to others in the hospital by 
transporting that patient. And this will also require

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more PPE use. Three, CT scans require larger doses of 
radiation. Four giving someone IV contrast has some

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risks such as the risk of serious allergic 
reaction and the risk of causing some kidney

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damage. On top of that the CTA of the chest can 
only visualize bigger clots so you might not see

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the small clots that are there. Right now more and 
more hospitals are giving high-dose blood thinners

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to COVID patients who have severe disease even 
if they haven't been diagnosed as having blood

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clots. But what about patients without moderate or 
severe Covid, should they take a blood thinner or

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maybe a low dose blood thinner, or should they take 
an antiplatelet medication like aspirin either 81

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milligrams of aspirin or 162 milligram dose or 325 
milligrams dose, or should the general public take

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a low dose aspirin like 81 milligrams in order to 
help prevent blood clots from forming if they do

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get COVID or should it just be certain people in 
the population who are at higher risk of getting

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severe COVID should they take aspirin? These are 
the questions we don't know the answers to at

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this point. It's going to take a lot of studies 
to answer these questions because not only do

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we need to know that there's a benefit in doing so, 
we have to know that these benefits will outweigh

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the risks such as the risk of bleeding and then 
there's all the other drugs that are being looked

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at right now and randomized control trials we 
should start seeing some of these results pretty

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soon. What we do know is that in order to improve 
the capillary endothelium and also to minimize

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your chances of having severe disease if you 
were to get COVID you want to do several things.

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This includes exercise, eating healthy, getting 
good sleep, minimizing stress, not smoking, what

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about vaping? generally not good either but not as 
bad as smoking. too much alcohol not good either

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have your medical conditions under control 
whether that's diabetes, high blood pressure,

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COPD, asthma, allergies, whatever the case may be. 
Now what about vitamin D? probably a good thing

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but that's a whole another topic which I should 
make my next video on because there's a lot to

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say about that and possibly other vitamins too 
if you're deficient in certain vitamins. Anyway

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to catch that video subscribe to this channel and 
hit that bell notification so you know when I post

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here on YouTube so many topics I want to cover in 
so little time but I will see you in the next one