Dr. Merritt Dunlap, MDVIP

12/20/2023

I wanted to thank all of our patients who once again pitched in so generously to help us with our 7th annual Angel Tree benefiting the Northern Nevada Foster Children. With your help, we raised nearly $14,000 and filled over 200 wishes for these kids in our communities this year. We are filled with gratitude for everyone who participated. A special shout out goes to our MA, Sarah Ferris, who has spearheaded this project for the past seven years. And a special thank you to the Carson Valley Cinderella Girls and their parents who helped Sarah shop and deliver the gifts. We couldn't ask for better elves! From all of us, Dr. D, Julie, Sarah, Pam and Rita, we wish you all a very Merry Christmas and a healthy and happy New Year!

05/03/2023

I recently came across a statistic that seemed truly incredible to me. After doing some research on the topic I feel compelled to communicate with all my patients about this issue.

FENTANYL POISONING IS NOW THE #1 CAUSE OF DEATH IN THE 18-45 YEAR OLD DEMOGRAPHIC!
If you’re between the ages of 18 and 45, fentanyl is the number 1 threat to your life in this country. It’s not gun violence, it’s not an auto accident, it’s not su***de and it’s sure the heck not COVID. It’s unintentional fentanyl poisoning.

This is both staggering and terrifying. Historically, the biggest risk to life for this age group has been accidents and su***des. Now it’s fentanyl and it’s getting worse. The CDC 2021 statistics indicate the 106,699 people died of drug overdose. These are people who either think they’re taking a recreational drug or take a pill that’s been laced. These are NOT people who are trying to harm themselves. If you do the math, that means someone is dying from accidental poisoning about every 5 minutes in the United States. Almost every one of us has someone we love in this demographic and we need to be educated about this. We will all, at some point, be touched by this.

Medically, we’ve used fentanyl for pain management during procedures for many years (and still do). We typically use doses like 100 micrograms (1/10th of a milligram). What’s happening now is that the Mexican drug cartel is making their own fentanyl and getting the doses terribly wrong. They typically get the doses wrong by 10-60 times (using 1-6 milligram/pill). They make counterfeit pills (Adderall, Ambien, Xanax, Oxycodone, etc.) and they lace illicit drugs (ma*****na, co***ne, M**A, m**hamphetamine, he**in). They do this to “improve the high” and increase their market share.

The cartel is making fentanyl in a powder form in labs in Mexico. This is much cheaper than cultivating and harvesting poppy fields. Historically, the raw materials were imported from Asia but now they’re making their own ingredients. They are moving the fentanyl across the border in either a powder or pill form and then selling the pills or lacing the drugs in the U.S. Their counterfeit pills are virtually indistinguishable from what you get at the pharmacy.

In 2019, about 1.5 million pills were seized. In 2021 it was almost 10 million. The 2022 data are not yet available but will certainly be higher. It’s not clear what percentage of the incoming supply the seizures represent but it’s thought to be far less than half of what’s actually getting into the country. It’s simply overwhelming our border security.

HOW IS THIS KILLING OUR YOUNG PEOPLE?
Basically, kids (as young as middle school) and young people in our country are getting pills or recreational drugs from friends or associates, taking them thinking they’re safe, and then not waking up. Fentanyl is an extremely potent respiratory depressant (50 times stronger than He**in) and if the dosing is wrong, the person will stop breathing fairly quickly after ingestion.

A typical scenario would be someone getting a pill to help them sleep, or help them study, or help with anxiety, etc. from a trusted friend who got them somewhere else. The person takes the pill, goes to bed and is found the following morning dead. The pills that are most commonly laced are Xanax, Ambien, Percocet and Adderall. The counterfeits are readily available on the street and look exactly like the real pills. There’s no way to tell them apart. Often, the person is not taking the pill for the first time. It’s just a matter of time before they get one that has a lethal dose of fentanyl in it. It could be the first time they take it or the tenth.

Another scenario would be a group of kids passing around a v**e pen in which the ingredients have been unknowingly laced with fentanyl and then all of them collapse in short order. This can happen in a typical high school or middle school classroom and does! These kids don’t know what’s in the v**e cartridges. It’s just a matter of luck.

I saw a story of a DEA agent in Texas who said that his kids had a friend spending the night at their house. Unknown to the hosts, the kid had a Xanax he often used to help him sleep, especially in unfamiliar environments. Turns out that on this particular night, the Xanax he had was laced with fentanyl. Fortunately, this agent recognized what was going on and had some Narcan to save the kid’s life.

The point is that this is not just happening to “drug addicts”. This is happening to regular kids and young adults. They’re taking a pill they got from a trusted source to help their anxiety or sleep or they’re va**ng with friends and get poisoned. Of course there are the he**in and m**h addicts but a growing percentage of those getting killed are our own children.

WHAT YOU CAN DO
First, be aware of what’s going on and how pervasive this is. We are being barraged by stories of shootings and gun violence which are truly awful but when you look at the actual numbers and risk, you realize that the risk from fentanyl is about 300-400 times higher. Think about that for a minute. Furthermore, it’s happening in every community in America, it’s escalating exponentially and it’s affecting all socioeconomic groups.

Next, talk to your loved ones. They absolutely should never ever, ever take a pill they did not get at a pharmacy. They should absolutely never ever, ever smoke or consume som**hing they did not get from a licensed dispensary. All it takes is one single time to kill you and you don’t get a second chance in most cases.

It’s estimated that about 6 of 10 counterfeit pills currently on the street are laced with fentanyl. This truly is a crisis and we all have to be aware in an effort to avoid becoming a victim.

Please talk to your family and friends. This is going to take a grass roots effort to reverse this calamity.

08/31/2022

Dr. Dunlap will be the guest speaker at the upcoming Carson City Chamber of Commerce luncheon on September 13. He has been very pro-active during the Covid-19 Pandemic educating his patients and the community. This will be another great opportunity for him to share his knowledge as a physician and educator to our great community.

If you’re as confused as we are about this continuing pandemic that seems to ebb and flow for reasons not quite understood even by those within the Center for Disease Control, we invite you to join the Carson City Chamber of Commerce for a special luncheon on Sept.

12/10/2021

Our office wrapped up our 5th Angel Tree benefiting the N. Nevada Foster Children this week. In total, our patients donated over $10,000 in gifts, gift cards and cash donations this year. We are amazed and humbled by the generosity of our patients over these past five years -- especially 2021! The first photo is in 2017 and the second photo was taken this past weekend. Can you say WOW!?! I'd like to give a big shout out and thank you to our medical assistant Sarah Ferris who coordinated all the shopping this past weekend to buy gifts for the remaining tags on the tree. From all of us at Dr. Dunlap's office -- Dr. Dunlap and Julie, Sarah, Pam and Rita, we wish you Happy Holidays, Merry Christmas and here's to a great New Year!

04/13/2021

Dr. Dunlap's office wrapped up its final COVID-19 Vaccine Clinic last Friday. In total, our amazing staff and volunteers were able to put about 2,500 shots in arms during our 12 vaccine clinics.
Proudly, because of our efforts that began in January and ran through April, we vaccinated nearly 1,250 members of our community! The last few months have been A LOT of extra work for our staff, and our many volunteers showed up to work in wind, cold, snow and sunshine. The Casino Fandango went above and beyond to provide us with a location for our clinics. We are happy to have completed our clinics but more than anything, we are grateful to have been a part of this worthy endeavor.

01/22/2021

We did it! Today and yesterday, our office vaccinated 272 people in our community with the Covid vaccine. We couldn't have done it without our amazing staff (Sarah, Pam, Rita and Julie) and a great group of volunteers (Gary, Lynn, Steve, Holly, Ed and Dee). The operation ran without a hitch, and it was an awesome feeling to see our patients and fellow Nevadans get their first dose of the vaccine. This was not an easy task, but all of us at Dr. Dunlap's office knew it was well worth our time and efforts to make this happen. Also, a special thank you to the Casino Fandango for offering up their parking garage and providing support for our drive-through clinic. This is the beginning of the end of this horrific pandemic. Together, we are going to keep working to get our community vaccinated!

12/16/2020

Dr. Dunlap's office is happy to report that our 4th annual Angel Tree wrapped up last Friday. Thanks to our amazing patients and friends, we all helped nearly 250 children in our community! I would say that is some very happy news -- much needed these days! Thank you again to everyone who took the time and effort to purchase a gift for one of the local foster children in the Carson City area. Together, we can all be happy knowing that we made their Christmas a little brighter. Finally, a big shout out to our medical assistant, Sarah, who took time out of her busy life to help set up this event, shopped for some of the gifts and delivered them to the agency. Be sure to give her some extra "thank you's" next time you see her in the office!

12/10/2020

I had the opportunity to review all of Pfizer’s raw data that the FDA is going to review today. If you want to get to the final comment, it’s this: Better than I thought. I don’t have reservations about getting it.

If you want the details, here they are:

INGREDIENTS
mRNA, Lipids, potassium chloride and potassium phosphate, sodium chloride and sodium phosphate, sucrose. That’s it.
No aluminum, no formaldehyde, no preservatives, no microchips, no mercury, etc. Just what’s listed above.

DEMOGRAPHICS
About 18,000 people got the vaccine series. 50/50 male/female. 16-91 years old.
63% white, 8% black, 24% Hispanic, remainder were other races.
20% had comorbidities.

EFFICACY
After 1st dose there was an 82% calculated efficacy, however, efficacy between dose 1 & 2 was only 52%. Protection looks like it starts about 14 days after the 1st dose. However, efficacy goes up to >94% after the 2nd dose in every age group. They didn’t do a study arm looking only at getting a single dose so no further information can be assumed after only getting a single dose.

Appeared very effective in preventing severe disease in those people who were vaccinated but still got COVID-19.

There was a robust T Cell response after the series of 2 shots. This was in both the helper T Cells and the killer T Cells. This is a very big deal because much or your protection against COVID-19 disease comes from the T Cells. There was very good antibody response.

Overall, the efficacy data was very good.

SIDE EFFECTS
Generally, side effects were a little worse after dose 2 and were a little less in older patients.
Most side effects were rated as mild to moderate and occurred 1-3 days after getting the shot and lasted a day or two.
Local reactions—injection site pain (70-80%), injection site redness/swelling (5-7%)
Systemic reactions—fatigue (40-50%), headache (30-50%), muscle aches (20-25%), chills (15-25%), joint aches (12-15%), fever (5-10%)

OTHER STUFF
This wasn’t tested in kids. Future studies are planned.

They did not enroll pregnant patients. However, 12 women either were early pregnant or got pregnant shortly after getting the first dose. There were no reported problems but, obviously, the outcome of those pregnancies is not known yet. There were a couple miscarriages in the placebo group only.

Appendicitis occurred 8 times in the vaccine group compared to 4 times in the placebo group. However, these were not more frequent than you would expect in the general population.

Bell’s Palsy occurred 3 times in the vaccine group but didn’t occur in the placebo group. Again, this was not more common that you would expect in the general population.

There were not enough HIV/AIDS patients to draw any conclusions about efficacy yet. Similarly, I don’t think you can make any major pronouncements about effectiveness for generally immunocompromised patients until more numbers are accumulated.

They didn’t have big enough numbers to comment on effectiveness for patients who previously had COVID-19. However, it’s anticipated that they will benefit from vaccination. More recommendations to follow.

The study was not designed to determine if the vaccine was effective against getting asymptomatic infection so we don’t know about that from this study. We also don’t know from this trial if the vaccine protects you from getting “Long COVID” because not enough time has elapsed to determine that.

The available data do not indicate a risk of vaccine induced disease enhancement. However, this is not completely off the table yet.

There was NOT a problem with severe allergic reactions in these 18,000+ patients. The 2 UK health worker reactions are currently being evaluated.

There were no symptoms in the vaccinated group consistent with autoimmune disease induction. This is a theoretical concern only.

Again, long-term issues are a theoretical possibility but there’s nothing to suggest that this will be the case.

I fully expect the FDA to approve this later today.

12/09/2020

VACCINES
Before I start about the vaccines, I need to make som**hing very clear: There are no risk-free choices for you. If you choose not to get a vaccine, you are simply choosing the risk of getting COVID-19, continuing with the status quo and everything that goes with both. If you choose to get a vaccine you are choosing the known (and theoretical) risks that go with the vaccine. I’ll talk more about how to make a choice that’s right for you in future communications.

QUICK COVID-19 REFRESHER
I want to remind you about the actual disease of COVID-19. Overall infection mortality rate appears to be about 0.3-0.5% (roughly 3-5 times higher than the flu). However, this doesn’t mean YOUR mortality rate is 0.3-0.5%. That’s the OVERALL rate (it includes all the young folks and low risk folks). If you’re over 65 or have other medical conditions, your mortality rate is definitely higher. What scares me, personally, about this infection is the chance for long-term medical issues that comes with the infection. This is being called “Long COVID” or “Long-Haulers”. This is NOT trivial. 15-20% of people who get COVID-19 end up with this, even if they only had a mild infection. Remember, this virus causes a high tendency to form blood clots and get vasculitis (inflammation of the blood vessels). These patients have persisting problems with shortness of breath, debilitating fatigue, heart problems (myocarditis or cardiomyopathy), neurologic problems and a variety of other issues. Further, we don’t know (and can’t predict) who might end up with this and I can tell you from dealing with patients and friends who have this that it’s no joke. So, when you think about making a decision for yourself, make sure you’re not just considering the overall mortality rate. Make sure you’re factoring in ALL the information. You need to think very carefully and take all these things into consideration. Also remember, we’ve known from the beginning that a vaccine was our way out of this, but it only works if people take it. One other little fun factoid I recently learned: Humans have never, in the history of mankind, eradicated a virus through natural herd immunity. Doesn’t happen. The only way we humans have been able to eradicate an infectious disease is through a vaccine.

PFIZER & MODERNA mRNA VACCINES BASICS
As I’m sure you’re all aware, the first 2 vaccines on the block are the mRNA vaccines from Pfizer and Moderna. We anticipate that these will be going into arms by the 3rd week of December. These vaccines were developed with a technology in which a small piece of messenger RNA (essentially the blueprint for a protein) is delivered via a tiny lipid particle (nanoparticle) into your shoulder muscle. This technology has been nearly 20 years in the making but this is its first real test. Once inside the cytoplasm (outside the nucleus) of the muscle cells, your body uses its own machinery to manufacture spike proteins and your immune system goes after those spike proteins and creates immunizing antibodies. This is a different way to present spike proteins to your immune system. Historically, we would have inactivated a virus and given it to you, or we would give you actual parts of a virus (like the spike proteins). This is how most vaccines have historically been made. This time, we’re not giving you any part of the virus at all—just the instructions for your own body to make a piece of the virus. Because you’re not getting any virus at all, the vaccine cannot give you COVID-19. Additionally, it’s important to understand that mRNA doesn’t interact with your own DNA (your genes) in any way (the mRNA never even gets into the nucleus of the cell where your DNA resides). mRNA is very fragile and has a short lifespan (hence the very cold storage requirements of mRNA vaccines). After your body uses the mRNA for a little while, the mRNA degrades and is digested by your cells. Incidentally, reading mRNA and disposing of it is a natural process and is happening constantly in our bodies.

THAT WAS FAST!
Yes, it was (kind of). This technology has been in the works for nearly 20 years, starting with SARS-CoV (the original) in 2002 and then with MERS in 2012. Those vaccines never made it to fruition, primarily because the virus died out, interest died out and then the money died out. However, we had the platform and the knowledge about the virus so that when SARS-CoV-2 showed up we were ready to roll with this technology. Then, along came the US Government which completely took the financial risk out of development allowing the science & trials to proceed unfettered. Put it all together and we’re witnessing one of the greatest scientific achievements in human history. This is not an exaggeration. Vaccines typically take 15-20 years and $1Billion+ to get to market (much of that money and time is spent trying to get to a Phase 3 trial). This one made it from concept to market in 11 months! Amazing.

Doing a Phase 3 trial is the critical piece in developing a working vaccine. The years and money to get to a phase 3 trial is what usually slows the process. With these vaccines, no corners have been cut. In fact, FDA Commissioner Stephen Hahn, despite tremendous political pressure to release data before the November 3 elections, stood firm that nothing would be done or announced until the trials had proceeded as designed and the data had been properly reviewed. In other words, no one has been permitted to interfere with the proper processes & procedures.

EFFICACY
Does it work? So far, when you put both Phase 3 trials together, over 35,000 people have received the actual vaccines starting in late July of this year. The efficacy results have been nothing short of remarkable. Fewer than 6% of all those in the trials who got infected were vaccinated. And those who did get COVID-19 despite vaccination only had mild illness. Thus far in human history, of the myriad of vaccines that have been developed over the past century, there have only been 3 that reached a 90% efficacy level—the new shingles vaccine, the smallpox vaccine and the measles vaccine. If this efficacy holds up, this will put these vaccines among the most elite ever developed. There are certainly still questions to be answered, but the preliminary data are very encouraging. There are lots of questions I, personally, have about efficacy in various populations of people but the data will not be out for public consumption until December 8th. I’ll certainly keep you posted.

SAFETY (DOES THE BENEFIT OUTWEIGH THE RISK?)
Biggest question on people’s minds. Is it safe? Have we studied it long enough? I think the answer to both is yes and here’s why I say that: In the history of vaccine development there has never been a serious side effect that has not been recognized within 6 weeks of using the vaccine. We have not seen any serious side effect from these vaccines, and we’ve been watching 35,000 people for almost 5 months now. With that said, 35,000 is not 35 million. There may be a rare serious adverse event post approval and I think we need to stay humble about the initial amazing data on these vaccines. There are systems in place (as with any vaccine) that will pick these up and will continue to monitor patients for years to come. In addition, by the time most folks are getting a vaccine there will probably be an additional 20 million people (likely their doctors) vaccinated so they can see what happened to them as well. There is certainly no “Absolute Safety” and there never can be. Again, the question you face is which risk are you more willing to accept given the situation & information you have? I have no doubt that at some point in the next year there will be a situation where a person develops some type of horrible medical condition at some point after they’ve been vaccinated, and you can bet your bottom dollar that the media will be all over it. However, the vaccine will only prevent what happens from SARS-CoV-2, not everything else in life.

HOW LONG WILL IMMUNITY LAST?
I don’t know. No one knows. Only time will tell. However, we can make some educated guesses. Typically, the shorter the incubation period of a virus, the shorter the immunity from a vaccine for it lasts. SARS-CoV-2 is a medium incubation time virus (about 6 days on average). Flu is about 1-2 days and measles are about 10-14 days. We need a flu shot annually and we often get lifelong immunity from a measles vaccine. Therefore, it would be reasonable to guess that the immunity from a SARS-CoV-2 vaccine would last in the range of years rather than the range of decades. Again, only time will tell. By the way, it’s common (normal really) to require booster doses of most vaccines so even if we found it only lasted a few years, that would be considered normal.

WHEN WILL IT BE HERE AND WHEN/HOW CAN I GET IT?
The FDA is meeting on December 10. The states are gearing up to start administering the vaccines to Tier 1 recipients in the 3rd week of December. The CDC’s Advisory Committee on Immunization Practices (ACIP) put out guidance for states on who should be in Tier 1 on December 1st. It will be front line health care workers and the staff and residents of Long-Term Care Facilities. Nevada has adopted this recommendation. It’s anticipated that Nevada will get about 165,000 doses of Pfizer vaccine this month but there are about 175,000 Nevadans in Tier 1. You can do the math. As production is ramped up further and distribution is optimized, we will continue moving through the various tiers getting people immunized in that order.

If you want to see how the State put together the 4 tiers, go to this link: https://nvhealthresponse.nv.gov/wp-content/uploads/2020/12/NEVADA-COVID-19-VACCINE-PLAYBOOK-VERSION-2.0.pdf and look at pages 21-24. We anticipate that between Pfizer and Moderna, millions of doses will be rolling out as soon as they get the go ahead from the FDA and will continue for as long as it takes. The nice thing about mRNA vaccines is that they don’t have to be grown in cells or culture media which takes a lot of time. They can be mass manufactured by machines so I’m optimistic that supplies will stay strong. There were some recent media headlines (take any corporate media information with a big grain of salt – they have agendas) about Pfizer having problems getting raw materials but that wasn’t for the mRNA, it was for the lipid delivery particle and I’ve been told that the delay has been resolved. Moderna has not had this issue to date.

Both mRNA vaccines are two shot series. The Pfizer vaccine is given 21 days apart. The Moderna vaccine is given 28 days apart. Excellent antibody responses are typically observed about 7 days after the 2nd dose. Additionally, you can’t mix them. If you start with Pfizer your 2nd dose must be Pfizer and vice versa.

The Pfizer vaccine presents some unique challenges with regard to storage and transport. It needs to be kept at -70 Celsius (-94F). Therefore, anyone who gets a Pfizer vaccine will be required to go to a specific site (a hub) that has super-cold freezing capacity. There’s only one in Carson City and a couple in Reno. This will limit how much and how quickly we can administer that vaccine. It creates a bottle neck. The Moderna vaccine can be stored in a normal freezer so I anticipate this will be the one being given more commonly once it’s released. No word yet on when that will be or when those doses will be coming to my office, but I’ll keep you informed. It’s anticipated that on a national level we’ll be vaccinating about 5 million people weekly once this gets rolling (barring any major hiccups in the process, obviously).

FINAL COMMENTS
I know this doesn’t answer nearly all your questions (nor did I expect it would) but I’m getting tired of writing and I’m sure you’re getting tired of reading. I will address the other vaccines as we get more information

As I mentioned, the FDA is meeting on December 10 regarding the Pfizer vaccine and again on December 17 regarding the Moderna vaccine. I anticipate both of these vaccines will receive an EUA. Despite all of the nonsense perpetrated by our states and the federal government through this pandemic I have absolute faith in the integrity of the people & process for testing and evaluating these vaccines. Not only do I know that the people reviewing this are among the very best vaccine experts in the world, but I know that if they get this wrong the entire future of vaccines and the credibility of the FDA with be irreparably damaged. They know it to.

Finally, I have been asked several times if I’m going to take the vaccine. Barring any major surprises after I review the raw data on December 8th, the answer is an emphatic YES. Without hesitation.

12/01/2020

For the fourth year in a row, Dr. Dunlap's office is sponsoring an Angel Tree to benefit the local Carson City foster children. Our staff and patients have been busy little elves, but there are still plenty of names left on the tree! Please call the office if you would like us to choose a tag for you or feel free to come by the office to choose one for yourself (please call before you come up and wear your mask!). All unwrapped gifts need to be brought back to the office by Friday, December 11 at noon. This year, more than any other year, it's so important to bring some joy to others. We truly have the most generous and thoughtful patients in all of Northern Nevada, and we thank you for helping others during the holiday season!

09/03/2020

This short video discusses the most important thing we're NOT doing to control coronavirus right now.

We've received requests for a short explainer video of how inexpensive, at-home, COVID-19 screening tests (results in 15 minutes) could be utilized to dramat...