Herpes simplex

Yerpe, Yerpe.

Herpe has got some command issues, it sounds like.

He had a lot of success against the Rockies today on Sunday as we recorded this.

So it's probably more that the Rockies are just bad.

It's probably mostly the Rockies are bad versus Herpe is a great bet to continue his success.

Yeah, the command is really worrisome.

Speaking of names, because, you know, herpy, what's going on with the – there's a – do you have – can you open up the Astros Diamondbacks box score? Do you have that possible? The

They will slay you, if you dare to set me free.

Let them try, said Perseus, and drawing Herpe from his thigh, he cut through the brass as if it had been flax.

Now, he said, you belong to me, and not to these sea-gods.

whosoever they may be but she only called the more on her mother why call on your mother she can be no mother to have left you here if a bird is dropped out of the nest it belongs to the man who picks it up if a jewel is cast by the wayside it is his who dare win it and wear it as i will win you and will wear you i know now why pallas athena sent me hither she sent me to gain a prize worth all my toil and more and he clasped her in his arms and cried where are these sea-gods cruel and unjust

So they made a great wedding feast, which lasted seven whole days, and who so happy as Perseus and Andromeda? But on the eighth night Perseus dreamed a dream, and he saw standing beside him Pallas Athena, as he had seen her in Seraphos seven long years before, and she stood and called him by name and said, Perseus, you have played the man, and see you have your reward.

Know now that the gods are just, and help him who helps himself.

Now give me here, Herpe, the sword, and the sandals, and the hat of darkness, that I may give them back to their owners.

But the gorgon's head you shall keep a while, for you will need it in your land of Greece.

herpes rehab.

We rehabbed a lot of herpes.

Herpes was on the verge of going

extinct.

We rehabbed all of it.

I

like how your example started with the herpes.

By the way, do either of you have puppies? Herpes is a big

one.

I'm

Correct.

With neonatal HSV, you are looking for that watery, serious discharge we discussed, along with conjunctival injection, and crucially, an eyelid vesicular rash.

Oh, the little blisters.

Yes, those tiny blisters on the skin are the giveaway.

But the treatment for neonatal HSV isn't just an eye drop.

We go straight to systemic acyclovir.

Why systemic if it just looks like an eye infection?

Because neonatal HSV is rarely just an eye infection.

That is a critical clinical blind spot to uncover.

And speaking of blind spots, the second threat in the big three is viral, specifically the Hopi Simplex virus or HSV.

The sources highlight that the sheer physical trauma of the laser can reactivate the virus in two to 7% of ablative cases, even in patients who have absolutely no history of ever having a cold sore.

The biological mechanism there is incredibly opportunistic.

The HSV virus can lie completely dormant in the nerve ganglia for decades.

Wow.

A patient might not even know they carry the virus, but the intense thermal injury of a CO2 laser triggers a massive physiological stress response in those exact facial nerves.

So at our institution, we don't routinely start anyone on a bacterial antifungal.

We do put these patients on HSV, VZV prophylaxis with acyclovir or equivalent.

And that's really it in terms of prophylaxis, because unless they have a prolonged period of neutropenia, then we would put them on a quinolone and antifungal.

But we generally don't need to do that because we can manage their cytopenias with growth factor.

You also don't need to do PJP prophylaxis, which had been done in the past when patients were getting higher doses of steroids, but we don't do that.

So really, they're just on HSV, VZV prophylaxis.

We start all of our patients on aspirin 81.

If they do have a history of DVTs, PEs, and say they're off anticoagulation, we might consider doing a low-dose DOAC as prophylaxis because of their history, but our standard is a-aspirin 81.