UofT researchers have used nanomaterials to develop a microchip sensitive enough to quickly determine the type and severity of a patient’s cancer so that the disease can be detected earlier for more effective treatment.
Their groundbreaking work, reported Sept. 27 in Nature Nanotechnology heralds an era when sophisticated molecular diagnostics will become commonplace.
“This remarkable innovation is an indication that the age of nanomedicine is dawning,” says Professor David Naylor, president of the University of Toronto and a professor of medicine. “Thanks to the breadth of expertise here at U of T, cross-disciplinary collaborations of this nature make such landmark advances possible.”
The researchers’ new device can easily sense the signature biomarkers that indicate the presence of cancer at the cellular level, even though these biomolecules – genes that indicate aggressive or benign forms of the disease and differentiate subtypes of the cancer – are generally present only at low levels in biological samples. Analysis can be completed in 30 minutes, a vast improvement over the existing diagnostic procedures that generally take days.
“Today, it takes a room filled with computers to evaluate a clinically relevant sample of cancer biomarkers and the results aren’t quickly available,” says Shana Kelley, a professor in the Leslie Dan Faculty of Pharmacy and the Faculty of Medicine, who was a lead investigator on the project and a co-author on the publication.
“Our team was able to measure biomolecules on an electronic chip the size of your fingertip and analyse the sample within half an hour. The instrumentation required for this analysis can be contained within a unit the size of a BlackBerry.”
Large groups of patients with cardiovascular disease can benefit from this study by Dr. Warren-Gash from the CDC:
Charlotte Warren-Gash C, Smeeth L, Hayward AC. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: A systematic review. Lancet Infect Dis 2009.
The study reported that patients with cardiovascular disease has increased likelihood of suffering a sudden coronary event with influenza. Seasonal patterns of influenza also coincides with seasonal patterns of myocardial infarction. It has been hypothesized that influenza can act as an inflammatory stimulus that can act to dislodge atherosclerotic plaques and cause arterial occlusion.
Two small randomized clinical trials assessed protection by flu vaccine against myocardial infarction. Flu Vaccination Acute Coronary Syndromes (FLUVACS) trial showed reduced risk of death from cardiovascular causes. However the effect diminishes with time. FLU Vaccination in Secondary Prevention From Coronary Ischemic Events in Coronary Artery Disease (FLUCAD) trial showed a significant protective effect against coronary ischemic events however there was no significant effect on cardiovascular deaths.
The study is a meta-analysis of various studies dealing with the association with Influenza and cardiovascular events. None of the studies reviewed dealt with the H1N1 strain.
*sigh* *cough* Well. Hello again. I hardly know how to begin, and gosh! I’m sure Inquiring Minds Want To Know…just how Boozilla is faring. SHE is fine. And waiting for breakfast.
1) I don’t know about you, Gentle Reader, but? Plaxico Burress getting two years in jail for shooting himself in the leg seems completely ridiculous. Someone can be chopping people up and storing them in their freezer undetected by their Parole Officer, but boy howdy. Shoot yourself in the foot/leg? You are in the cooler, you menace to society. Also, we’re looking at, what? $100,000 over that two year period for his incarceration for a victimless “crime”.
2) I’ve figured out the thing with health care and medicine in this country. Finally. Besides the fact that everyone is so risk averse they won’t even say if it’s day or night when they’re outside and it’s staring them in the face, there is also the fact that you, as the patient, are not presenting with a question to be answered. No, you are an item to be stuffed into the prevailing paradigm whether you fit or not. It’s just the way it is. No point getting upset about it, right? I’ve gone beyond ballistic, seeing as how I actually had to figure something out or watch someone live in total misery. And? I DID figure something out. Which given what I am attempting to do in my work, makes sense I suppose. Still, it was grueling and upsetting and infuriating. However, also a function of the fact that there appear to be just too many people to pay attention to. It’s a game of Russian Roulette, going to a doctor in these circumstances. If their favored best guess about you is in actual synch with you, you are lucky. If it isn’t, you stay sick, get worse, and…well. Good luck. The “clinical” model of having to get a huge amount of empirical (” “) evidence (” “) before arriving at a diagnosis (” “) has its’ strengths. Blood tests can be wonderful. But also, it has a lot of weaknesses. It removes the necessity of paying any real attention to the person in front of you. After all, you have to wait for the “test results”. So, the necessity of compassion, empathy, feeling what the other person is feeling, actually LOOKING at them? Not there. So medicine becomes a cut and dried process when in fact a good deal of it is STILL intuition and exploration. Not to mention perhaps a dash of common sense. Obviously, the best strategy for healing is an inclusive one. You do the tests AND you pay attention. You leave your prejudices at the door of your consulting room. Sure, people lie. Sure, people do things that are completely opposite to their best interests. But not everyone does that. There are alot of medical issues people have that are not, as the literature says, “well understood”. That doesn’t mean they are not real. It just means right now, our medicine people don’t understand them. And that’s all it means.
3) Tomatoes. Have, indeed saved my life.
Small bit of nature
You can see a few speckles on the lower right: Lovely yellow pear tomatoes. Right now, a slender thread between me and sanity, but a good one. Panzanella is quite sustaining, as it turns out. Cube up some french bread, day old is good but just moisten and warm first if it is hard. Finely chop red onion (about a half a good size onion for 1/3 loaf of french bread), chiffonade of two paws full of basil, I like some parsley too, then cut up tomatoes (three or four depending on size) (I like the watermelon shape slices in this). Mix all together, toss with red wine vinegar, olive oil, salt and pepper. Divine. Even good left over. Lead me, as it says in the Upanishads, from the Unreal to the Real.
Stress is an an inbuilt mechanism in the organism to survive.Unless stress is present, survival will be difficult.Stress stimulates organism into the mode of Face or Flee Reaction,which is essential for survival.No surprises on this affirmation .Continuous harping on Stress and repression of it leads to Psychological/Physical problems.Stress arises mainly due to , at the basic level,clash of instincts of Survival,Thirst,Hunger,Sex and gregariousness.When there is a clash among them, Stress is noticed.
Stress is managed best, when we do nothing about them, as the system knows how much it can take.
http://www.the-scientist.com/blog/display/56023/
I launched PeRSSonalized Medicine to help patients and doctors keep themselves up-to-date more easily, without any kind of IT knowledge. It is an easy-to-use, free medical information tracking tool that lets you select your favourite resources and read the latest news and articles about a medical specialty or a medical condition in one personalized place.
Now the Portuguese version launches! It does not only mean the platform is Portuguese, but the resources are also the best ones in that language. We will publish French, Polish and German versions as well soon. Please let us know if you want another national version.
Many thanks to Alexandre Gouveia (Twitter) and Tiago Villanueva (Twitter). They helped a lot with the translation and the selection of quality Portuguese resources.
Some reasons why PeRSSonalized Medicine is unique:
You can search in the database. It means you will find medical information only from a quality selected portion of the world wide web.
You can personalize any of the sections.
You can also receive the newest Pubmed articles focusing on your search term. Just insert your field of interest, a therapy, a condition, etc. and click Search. Then you can add the newly created box to your personalized medical “journal”.
It is a community-based project. Please let us know which quality resources should be added to the database.
Around 40 million doses of the swine flu vaccination will be available in the United States by mid-October, reports the International Herald Tribune. As I read the article I remembered reading something in the Egyptian daily Al Masry Al Yawm a few days back about how the first round of shots was being given to kids in China. They reported that there were no side-effects besides the regular vaccination fever that some kids get. Every front page in the Egyptian news these days seems to be concerned with nothing other than H1N1, schools closing… Swine flu this, Swine flu that….But, anyway….
This got me thinking about Egypt. What is our government going to do about these shots?
If the United States is getting 40 million doses in October, how much are we getting and when. This number doesn’t even cover half the Egyptian population. Are we going to get enough shots to give to this huge population? I think not, seeing as the problem here is more than just Swine Flu vaccination. There are things worse than Swine Flu in this country, why is the government not worried about those? Why are we Egyptians not worried about the hygienic conditions of agricultural villages all along the roads between Cairo and Alexandria, or in Upper-Egypt? The answer is simple–we are apathetic to the things that matter and we concern ourselves with the superficial things in society, like rumors and gossip. Yes, us Egyptians love gossip.
I remember being very scared about going home to Alexandria for the weekend. I’d been getting calls all week from friends telling me about several people catching Swine Flu.
“My grandmother just told me that the number of cases rose from 30 to 60 at [Alexandria Sporting Club] in just two days,” my friend told me over the phone.
Others also told me that a friend’s brother, and another’s sister also got the flu.
“Don’t go to the club,” they told us. “Don’t go to the movies, or to malls, or to restaurants.” “Don’t eat out,” my own grandmother yelled one time.
But I have been eating out, going out, spending time with people and hearing the latest rumors, and not one was about anyone catching Swine Flu. If there were really 60 cases in one of the most popular hangouts in Alex, where everybody knows everybody else, wouldn’t we have heard something about it, wouldn’t we have heard of someone close-to-home catching it, and does every feverish kid have to have Swine Flu?
I come from a family of doctors, so I’m sensible when it comes to diseases. I understand that they are real, that we have to take good care of our healths, that we shouldn’t ignore a high fever or an aching stomach. But really why is every doctor I’ve spoken to completely unconcerned and seems to think it’s more of a government ploy than a real threat. Yes, the disease is real. Not, it’s not such a huge deal as everyone’s making of it.
I don’t know why I’m so concerned with this Swine Flu thing, but all the empty propaganda it’s getting is just getting on my nerves. I just want to understand more, but all I’m getting are words of warning. Not even operators on the government’s swine flu hotline have any data on whatever question you ask them concerned with the disease, even though they are supposed to be the experts since we see their number like 1000 times a day on national and satellite television.
Aren’t there more important things going on in the world and inside this country to worry about than this disease, just check out the front page of any paper and you’ll see — there are still wars happening out there people. Men, women, and children are dying everyday all over the world, and it’s not swine flu killing them, it’s guns and bombs.
Did anyone stop for a second to wonder how people in Palestine were doing these days while we were so worried about cleaning our Gucci bags, just in case a swine-flu-infected person was around us while we sipped our delicious Caramel Frappucinos at the nearest Starbucks and discussed who broke up with whom this past week? I highly doubt it.
The Angel Gabriel and other Angels arrive to cut Muhammad’s chest open, remove his heart, and wash it in a bowl of Zamzam water.
Sahih Muslim, Book 001, Number 0314:
Anas b. Malik reported on the authority of Malik b. Sa sa’, perhaps a person of his tribe, that the Prophet of Allah (may peace be upon him) said: I was near the House (i. e. Ka’bah) in a state between sleep and wakefulness when I heard someone say: He is the third among the two persons. Then he came to me and took me with him. Then a golden basin containing the water of Zamzam was brought to me and my heart was opened up to such and such (part). Qatada said: I asked him who was with me (i e. the narrator) and what he meant by such and such (part). He replied: (It means that it was opened) up to the lower part of his abdomen (Then the hadith continues): My heart was extracted and it was washed with the water of Zamzam and then it was restored in its original position, after which it was filled with faith and wisdom. I was then brought a white beast which is called al-Buraq, bigger than a donkey and smaller than a mule. Its stride was as long as the eye could reach. I was mounted on it, and then we went forth till we reached the lowest heaven. Gabriel asked for the (gate) to be opened, and it was said: Who is he? He replied: Gabriel. It was again said: Who is with thee? He replied: Muhammad (may peace be upon him). It was said: Has he been sent for? He (Gabriel) said: Yes. He (the Prophet) said: Then (the gate) was opened for us (and it was said): Welcome unto him! His is a blessed arrival. Then we came to Adam (peace be upon him). And he (the narrator) narrated the whole account of the hadith. (The Holy Prophet) observed that he met Jesus in the second heaven, Yahya (peace be on both of them) in the third heaven, Yusuf in the third, Idris in the fourth, Harun in the fifth (peace and blessings of Allah be upon them). Then we travelled on till we reached the sixth heaven and came to Moses (peace be upon him) and I greeted him and he said: Welcome unto righteous brother and righteous prophet. And when I passed (by him) he wept, and a voice was heard saying: What makes thee weep? He said: My Lord, he is a young man whom Thou hast sent after me (as a prophet) and his followers will enter Paradise in greater numbers than my followers. Then we travelled on till we reached the seventh heaven and I came to Ibrahim. He (the narrator) narrat- ed in this hadith that the Prophet of Allah (may peace be upon him) told that he saw four rivers which flowed from (the root of the lote-tree of the farthest limits): two manifest rivers and two hidden rivers. I said: ‘ Gabriel! what are these rivers? He replied: The two hidden rivers are the rivers of Paradise, and as regards the two manifest ones, they are the Nile and the Euphrates. Then the Bait-ul-Ma’mur was raised up to me. I said: O Gabriel! what is this? He replied: It is the Bait-ul-Ma’mur. Seventy thousand angels enter into it daily and, after they come out, they never return again. Two vessels were then brought to me. The first one contained wine and the second one contained milk, and both of them were placed before me. I chose milk. It was said: You did right. Allah will guide rightly through you your Ummah on the natural course. Then fifty prayers daily were made obligatory for me. And then he narrated the rest of the hadith to the end.
- Muhammad had yet another open heart surgery prior to this as a young boy. Again, angels show up, open his chest, remove his heart, and wash it in a bowl of Zamzam water:
[Insert Relevant Hadith]
- Angels performed these surgeries on Muhammad? Why do we not see such profound contact between Angels and Humans today? Such contact simply does not exist.
- Open heart surgeries have only become possible in the last 50 years. You can’t just rip someone’s chest open, remove their heart, wash it, and stick it back in their body. What is most critical, if you are going to open up someone’s chest and remove the heart, is that some external device be used to continue circulation throughout the body. That was accomplished in medicine with the development of the heart-lung machine, about 50 years ago. In addition, reattaching the heart would require an absorbable surgical suture, another modern invention. Such things did not exist in 7th century tribal Arabia, nor do the myths about Muhammad’s heart surgeries allude to any such procedures, and that is because the people creating these myths (or Muhammad himself) knew nothing about what would be required to pull off such a surgery. In effect, these surgeries did not take place, they are stories carelessly (or more so ignorantly) created to attribute a certain degree of holiness to Muhammad. According to the superstitions of the day, the heart blackens from sin and there is a small black part in people’s heart which is a source of evil:
[Insert the Relevant Ahadith]
Thus it is logical for a Holy Prophet to have his heart washed, especially before he enters a place as holy as Heaven, which is why we see more than one surgery attributed to Muhammad. The surgeries would have rendered him “clean” prior to his receiving revelation as well as an extra “cleaning” prior to his entry into Heaven during his night of ascension.
More information about this surgery:
Orthotopic Procedure (removing the heart): http://en.wikipedia.org/wiki/Heart_transplantation#Orthotopic_procedure
Cardiopulmonary Bypass (the heart-lung machine): http://en.wikipedia.org/wiki/Cardiopulmonary_bypass
Surgical Sutures (to reattach the heart): http://en.wikipedia.org/wiki/Surgical_suture
Here’s a glimpse at an actual open heart surgery where the heart is removed, this is no joke:
The murky waters of the debate over chemical exposures and health just got murkier. And a bit nastier.
By Valerie Brown, Miller-McCune
Washington State University researcher Michael Skinner, who found that exposing rats prenatally to a widely used fungicide resulted in male reproductive malformations and malfunctions for four generations, is being challenged by industry and government scientists who say it isn’t replicable.
Skinner and his team have carried out a series of experiments exposing pregnant Sprague-Dawley rats to high doses of vinclozolin, a fungicide used on a variety of agricultural products.
The transgenerational aspect of the damage is the really staggering feature of Skinner’s research, because of its profound implications for human health, not to mention commerce. If damage to one generation carries on indefinitely into future generations, even when ensuing generations are not directly exposed, shouldn’t we make our chemicals regulations policy far more rigorous immediately?
Complete Story
This research was featured on NOVA. It was looking so promising, but now will wait and see.
A 60-year-old woman, blind for nearly a decade, can see again!
But “God” God can’t take the credit for this one. Nuh uh!
That honor goes to a team of “Doctor” gods at the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine who performed an unusual but revolutionary surgery on the Mississippi grandmother.
MAD PROPS, DOC DUDES!!!
Sharron Thornton suffers from Stevens-Johnson syndrome and was rendered blind after an allergic reaction to a medication which damaged her cornea. She had tried many medical procedures, including gene therapy, but nothing brought her sight back.
“Being blind was horrible after seeing for 51 years,” she said.
The procedure she had in Miami — get ready to be amazed and impressed but, yeah, probably also a little freaked out — involved implanting one of her teeth into her eye as a base to hold a tiny plastic lens.
No foolin’!
It’s the tooth!!
“We take sight for granted, not realizing that it can be lost at any moment,” she said after the surgery. “This truly is a miracle.”
Because a lot of patients’ bodies reject transplanted or artificial corneas, American doctors — for the first time ever — used an Italian-pioneered procedure called (don’t hurt yourself on this one) osteo-odonto-kerato-prosthesis in which the canine or “eyetooth” and surrounding bone are extracted, shaved and sculpted. Doctors then drill a hole into it to insert an optical cylinder lens.
Freakycool, right?!? But there’s more!
The tooth and the lens are then implanted under the patient’s skin in the cheek or shoulder for two months so they could bond. Once bonded, they are implanted in the center of the eye after a series of procedures to prepare the socket.
“A hole is made in the mucosa for the prosthetic lens, which protrudes slightly from the eye and enables light to re-enter the eye allowing the patient to see once again,” read an Eye Institute statement.
And just like the dude in John 9:25 … Thornton now too can say ‘whereas I was blind, now I see’.
Biblical AND Scientifical – YAY!!!
Thornton said people should imagine what it is like “if you could keep your eyes closed just for one week … it’s amazing what you see when you open your eyes again.”
Her bandages were removed two weeks ago and she was able to recognize objects and faces a few hours later. She is now able to read a newspaper.
But what does she most want to see?
You guessed it – the fam!
“I’m looking forward to seeing my seven youngest grandchildren for the first time,” said Thornton.
People frequently ask me how they can help the homeless. There are millions of ways to help! Here are just a few…
Post in your church bulletin, on community bulletin boards, on Craigslist, etc, asking for room and board of a homeless person, house or other work in exchange for rent until the person has income.
Offer resume help. Look it over and give suggestions or help design a new one. Everyone is qualified to do this–it could be your own resume next.
If you are spiritual, offer to say prayer. Saying prayer on the spot can even do wonders for a person’s attitude!
Give clothing, shoes, and accessories needed for job interviews.
Buy the person a phone card to put minutes on their cell phone, if they have one. Offer your own cell phone to make a phone call. Tell the person about GOOG-411–a free phone directory service by Google, by simply calling 1-800-GOOG-411 (1-800-466-4411).
Help the person set up a free email account online and teach how to use it.
Help the person sign up and use job sites such as Hot Jobs.
Assure the person is warm/cool enough during the day and at night according to climate. Long underwear is always a hit in winter months in colder climates!!! Check for a hat, scarf, and gloves. Also wool and warm socks! Hand warmer packets are good, but remind people that they can burn (especially people who have nerve damage). Ask if they have a warm enough sleeping bag and blankets. In warmer months, ask if they would like shorts, or for women perhaps skirts and casual dresses.
Give camping essentials like a tarp to put on the ground to protect from dirt and moisture; a flashlight; batteries; eating utensil; 1-man tents or a large tarp with pegs to hold in the ground; a mini kerosene cooking stove (there are some that are single-use).
Give transit tickets for getting to appointments, social services, or soup kitchens.
Offer help getting laundry done. Give them supplies. Some laundromats offer their own debit card that the machines use instead of coins.
Offer non-perishable food like peanut butter (tip: Goober’s brand is peanut butter and jelly and needs no refrigeration), granola and cereal bars, canned goods, potato chips and “shoestrings”, juice and milk boxes or small bottles, water bottles, powdered drink mixes, fruit rolls, foil-packaged meat and other food products, kipper snacks, beef jerky. Ask if there is access to a microwave so you may buy microwave-ready foods, including everybody’s favorite, popcorn. Ask about food allergies or dietary restrictions before you buy!
Ask about health needs. For medication assistance, refer to programs for help and info like PatientAssistance.com, Partnership for Prescription Assistance, Rx Assist, Medicare Pharmaceutical Assistance Program, Rx Hope, National Conference of State Legislatures State Pharmaceutical Assistance Programs. Ask if the person has blood pressure and heart problems if they could use an automatic blood pressure monitor, diabetes supplies, or other health needs. Also think to ask if the person has a special diet or nutrition needs, including vitamins.
Give store gift cards and certificates. Wal-Mart, Target, Walgreens, and other retail–even mall type stores like Kohls or Penneys would make a nice treat. Grocery, restaurant and coffee shop gift cards are also very good. If the person has a car, or gets rides from someone with a car, offer a gas card.
I hope these suggestions help. I will try to add more from time to time and add these to my site. I will also try to make list of pharmaceutical companies who have prescription assistance programs, as I am also in that need right now! Please feel free to comment to this post, email me, or send me a tweet on Twitter if you have any other suggestions, questions or comments.
Patients come and go so quickly that I hardly have the time to miss them before start taking on a new patient.
I did two warfarin discharge counsellings today. One was for a pt with DVT and another was for a pt with a PE. After my first patient, I realize that I should have a more consistent patient counselling format. This will ensure that I not miss any potential issues. It is also helpful to make the discussion relevant to the patient (ie. how much alcohol do you drink? do you play hockey? what time do you have breakfast?etc.)
COPD Didactics:
environmental factors: coal plants, espasis ( old insulation), wood smoke
complicaton: right sided heart failure ( cor pulmonale)
co-morbidities related to medication therapy: glaucoma , osteoporosis ( steriods)
dx: spirometer–> used in pt with sx….post bronchodilator less than 0.7 for FEV1/FVC
asthma : not related to sputum production, reversible, episodic, allergy related, onset younger age, doe not progress
corticosteroid correlate to increase risk of pneumonia
TORCH: surrogate marker FEV1 favors steriod, 10% of COPD can be managed with inhaled corticosteriods
neb: salbutamol, budesonide, ipratropiu<— can be given together
start antibiotic if pt is showing systemic infection ( febrile, WBC increase)
severe acute COPD exacerbation is related to gram negative bacterias
acute COPD exacerbation: H. influ, M. Catarrhalis, S. pneumo
abx use:
- simple: amox, doxy, septra, 2nd or 3rd gen ceph, extended spectrum macrolid
UCLA researchers have discovered that a combination of drugs, electrical stimulation and regular exercise can enable paralyzed rats to walk and even run again while supporting their full weight on a treadmill.
Published Nov. 20 in the online edition of Nature Neuroscience, the findings suggest that the regeneration of severed nerve fibers is not required for paraplegic rats to learn to walk again. The finding may hold implications for human rehabilitation after spinal cord injuries.
“The spinal cord contains nerve circuits that can generate rhythmic activity without input from the brain to drive the hind leg muscles in a way that resembles walking called ’stepping,’” explained principal investigator Reggie Edgerton, a professor of neurobiology and physiological sciences at the David Geffen School of Medicine at UCLA.
“Previous studies have tried to tap into this circuitry to help victims of spinal cord injury,” he added. “While other researchers have elicited similar leg movements in people with complete spinal injuries, they have not achieved full weight-bearing and sustained stepping as we have in our study.”
Edgerton’s team tested rats with complete spinal injuries that left no voluntary movement in their hind legs. After setting the paralyzed rats on a moving treadmill belt, the scientists administered drugs that act on the neurotransmitter serotonin and applied low levels of electrical currents to the spinal cord below the point of injury.
The combination of stimulation and sensation derived from the rats’ limbs moving on a treadmill belt triggered the spinal rhythm-generating circuitry and prompted walking motion in the rats’ paralyzed hind legs.
Daily treadmill training over several weeks eventually enabled the rats to regain full weight-bearing walking, including backwards, sideways and at running speed. However, the injury still interrupted the brain’s connection to the spinal cord-based rhythmic walking circuitry, leaving the rats unable to walk of their own accord.
Neuro-prosthetic devices may bridge human spinal cord injuries to some extent, however, so activating the spinal cord rhythmic circuitry as the UCLA team did may help in rehabilitation after spinal cord injuries.
The study was funded by the Christopher and Dana Reeve Foundation, Craig Nielsen Foundation, National Institute of Neurological Disorders and Stroke, U.S. Civilian Research and Development Foundation, International Paraplegic Foundation, Swiss National Science Foundation and the Russian Foundation for Basic Research Grants.
I used to think that workplace bullying was a myth or at the very least something that was conducted by someone superior. Well, guess what? I really felt like I was bullied yesterday. Except instead of getting the support from my superiors, I felt like the rug was pulled from under me even though I am very sure she did not mean to do that and that she really thought that she was helping.
Yesterday, a nurse decided to give a patient some oxycodone even though it had not been written for. She also knew that all narcotics have to be signed for by a MD. So she waited until it was time for the patient’s insulin dose to ask me to write for the Humalog dose, which I did after a conversation with the endocrinology fellow (who, despite having the justification to be frustrated at me, was a complete biatch about it). And after the nurse had overheard me being lectured by the endocrinology fellow, she came up to me (and again disrupting sign out which was the reason why I did not have the regimen for the insulin dose to begin with) to ask me to write for oxycodone. I knew from my past interaction with the GI team that narcotics are a big no-no even for pain. The most they write for is tylenol. And then they escalate to toradol (but only in extreme circumstances). But narcotics is a big no no. Ever so occassionally they will allow a one time dose of oxycodone upon admission. So I asked the nurse for the chart. I flipped to the orders. On the admission orders was written a one time dose of oxycodone to be given immediately. So I asked the nurse if the dose had already been given when the patient was admitted at 2am. She said yes. So I asked her why I was writing for it again. She said there was a second dose given at 12.15ish pm. So I flipped through the charts. There was no PRN order. I pointed this out to the nurse. At which point she starts getting antsy. She says that she knows there was no PRN order but there was another dose of oxycodone in the pyxis (that’s where the medicines sent by pharmacy are kept and accessed only by the nurses) so she gave it to the patient because the patient was in pain. So I asked the nurse if anyone had given a verbal order. She said no. She said we were nowhere to be found and the patient was “writhing in pain”. 12.15ish is during the day. There are at least 2 interns and a senior running around. She has all our page numbers. After all, she has paged me for stupid reasons such as “is the patient going home today?” when she knows that the patient is still receiving IV antibiotics. *roll eyes* So I told her that I wasn’t going to write for oxycocdone after the fact. I told the nurse that if she gave a patient narcotics without a written OR verbal order, then it will have to be written up as an incident report. Then the nurse starts accusing me of giving her attitude. WTF! And you know what? If I’m questioning you about your actions because you did something WRONG, damm right I’m giving you attitude. I don’t like writing for oxycodone without clearing it with my senior first. Who the f– are you to give a patient oxycodone WITHOUT getting an order from someone and what gives you the damm nerve to ask me to put my john hancock on it? IF you think the patient needs it and needs it so bad that you can’t wait for someone to give the go-ahead and do it yourself then YOU take the damm responsibility for it. Of course GI found out about it and was pissed. They wanted to be able to do a proper GI exam but when you give a patient narcotics its hard to elicit the where the pain is located. Thankfully this particular attending was nice. But I can imagine the amount of flak I would get if it had been another attending on service. And that’s also the reason why I did not want to sign for the oxycodone because when another attending comes on service and they wanted to find out why a proper exam wasn’t done within the first 24 hours and that it was because the patient had already received narcotics, then well, guess who they are going to yell at? Yeah. Thank you very much.
But that was part of the problem. The senior saw me crying. Partially because I was so angry about the endocrinology fellow’s mean condescending attitude towards me, and partially because I felt like the nurse was bullying me and it made me very angry to think that she thought she could get away with it. Which, to be honest, she has in the past but she crossed the line when she gave a patient with abdominal pain narcotics without at the very least running it by either the GI fellow (who was sitting there the ENTIRE TIME) or any of the residents. The senior went to talk to the nurse and then wrote for the order. After that, she said next time to just write for it. The nurse was upset that I had refused to sign it and it wasn’t a big deal anyway. I told her that it had been pointed out to me in the past by an attending that it was a medical legal issue. Plus we ALL know that GI does not like their patients getting narcotics.
But I was just so disappointed by the senior’s response to the situation. Instead of backing me up, she decided to just roll it under the carpet by signing for the order herself. I understand that she was merely trying to help..but it pretty much reinforced the feeling that the seniors see themselves above us and distinct from us interns. Which they are in a way. They are suppoed to be our educators and our leaders. But separating themselves from us and not backing us up in a situation like this makes me feel like I’m pretty much set adrift on a small dinghy by myself. This isn’t a team despite all their protestations otherwise.
Still, last night wsa perhaps my calmest call night. I actually managed to snag 2 hrs of sleep! Imagine that! Phew. And this was after I sent two kids to the PICU! (Also a first!!!) Off to the NICU. Seriously, something is wrong when someone is actually looking forward to going to the NICU.
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The cost of current government interference and threat of Medicare audit is rarely articulated. When has the government actually decreased confusing regulations and costs in ANYTHING. Medicare codes, rules, and regulations rival the IRS code interference with prosperity. At least one would think a balanced assessment of cost versus benefit would have been performed before implementation. That would only be logical but, logic and the government is rarely guaranteed. Along with the practices of defensive medicine, government regulation has become ingrained in our costs of today. Many doctors don’t realize that they have been taught defensive practices over individual analysis and problem solving.
One methodology to causing the change is the so called “evidence based” practices. As if doctors just randomly recommend care or , like Washington officials, base recommendations on which pays better. With these attempts at one-size fits all medicine the quality of the evidence often is not critically evaluated. These guidelines routinely take information out of context without regard to variations.
The President takes all this to a new level based on false assumptions and demonstrated lack of knowledge, “Pediatricians take children to surgery so they can make more money”. Hey Pres, Pediatricians don’t do surgery. His publically stated (and recorded) plan to treat by statistics is an equally erronious use of statistics and confirms a true lack of concern for individuals. If he does not care about individual’s health, whose health is the Healthcare “solution” supposed to help? If individual assesment for health care is unimportant to him how important are individual rights?
Our sacred duty is to remain vigalent and outspoken. Continue to gather, send mail, and clog switchboards. Above all, VOTE as an informed citizen and remind those around you, in your networks, at the office and at the ball game, that voting has more consequences than prom queen or American Idol.
Lesson from Psych out-patient group today: patients are genuinely interested in the medications that they are taking. They are often willing to share personal experiences in a group setting.
FMI:
vivid dreams can be cause by aricept or wellbutrin
Side effect of ACEI: angioedema (apid swelling (edema) of the dermis, subcutaneous tissue,[1]mucosa and submucosal tissues) This can happen anytime during therapy
vanco c. diff dose:125-500 mg orally every 6-8 hours for 7-10 days
cogentin ( or Benztropine mesylate): sed in patients to reduce the side effects of antipsychotic treatment, such as parkinsonism and akathisia.
epival: causes hair loss
rogaine: doesn’t work in woman???????
metronidazole dosing: 0700, 1200, 2200// it is dosed with meals to avoid stomach irritation
Procedure Log Reflection:
After working-up a patient’s drug related problems, Beth and I discussed each of the patient’s medical issues. I was able to summarize a list of recommendations to the GP, who I contacted by phone this afternoon. The GP agreed to some of the recommendations and reserved others for a later time. After the discussion with the GP, I accurately transcribed the medication order onto the patient’s orders. I will follow up with the patient to tomorrow to see how she is reacting to the changes.
“Can you tell the difference between science and pseudoscience”
“What separates effective medicine from alternative medicine?”
This is an activity from the ToK and Biology section.
As you grow in Biology and ToK, you should develop your critical thinking skills and become more of a skeptic. Being able to answer these two questions is a skill that you can carry through life, helping you to make sensible decisions when faced with a range of seemingly convincing alternatives.
Medicine is a system of rigourous testing, evidence collection, statistical analysis and controls to ensure that a treatment is effective when recommended to patients. If it works and it is strongly corroborated, we call it medicine – it is available to professionally-trained medical doctors to use or prescribe for their patients.
Alternative medicine is simply that – alternative to medicine. It is not rigorously tested, double-blind controlled or statistically analysed. It is built on belief without true empirical evidence. One might believe it’s efficacy based only on anecdotal or circumstantial evidence, but this is not enough.
This activity links with unit 3.1 – Chemical Elements and Water.
Richard Dawkins’ recent series Enemies of Reason tackles these issues brilliantly, as does Dr Ben Goldacre’s Bad Science blog. Start with this short clip of Dawkins explaining the idea behind homeopathy, a bastion of alternative medicine:
Homeopathic First Aid.
So why is it that people buy into homeopathy and alt med?
Have you heard of the placebo effect or the powers of suggestion and how they affect feeling?
Watch the whole episode (below) and think of reasons why a patient might feel better after visiting a homeopath than after a consultation with the doctor.
What is the difference between complementary and alternative medicine? Which might a doctor recommend as part of a treatment? Why?
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To find out more about homeopathy and it central ideas:
Homeopathy from the Skeptics Dictionary
The End of Homeopathy? From BadScience
And lots of great information from Evidence Based Medicine First
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Video Links
Watch the full series of Enemies of Reason on GoogleVideo:
Part 1: Slaves to Superstition
Part 2: The Irrational Health Service (includes the homeopaths)
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Ogo-dear… Burrrp!
And it’s not only homeopathy that abuses our sacred water. The oxygen-water companies are it too.
More than Water? From BadScience (download reading activity here)
Unless you have gills, it’s an expensive burp! from Chem1.com
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So, when you read the magazines, watch TV or wonder about a miracle cure, anti-ageing cream, magical treatment or anything else related to unusual claims and you health, think: “Where’s the evidence?”
One of my patients was discharged today and she was happy to go home.
I started a new patient work-up today and I am seeing a pattern in the conditions that most patients have when they get admitted to the medicine ward. They are usually as a result of falls, controlled diabetes or SOB ( pneumonia related).
I shadowed Beth during her presention at the Diabetes Education Center. The audience was a younger group who showed a genuine interest in learning more about the condition. The clinic is composed of a number of individuals from a variety of health disciplines, including pharmacist, podiatrist, diabetic nurse educator, dietitian, etc. This interdisciplinary setup seems to benefit the patient greatly by providing a fuller picture about their condition.
I notice that the psych ward has a different computer system than the rest of the hospital. Beth tells me that the computer system is different because it uses the same program as those in the community. All the patient notes are typed up and the healthcare professionals are able to followup on patient notes in both the hospital and the community because of this unfied system.
It would be wonderful if this was the case all over the lowermainland or perhaps this may an opportunity for pharmanet to take part in a greater scope of practice.
AFib Didactics:
irregularly irregular–> no pattern
aka suprventricular tach
HR=VR
Define as HR greater than 120 ( critically ill) ; HR greater than 100 in normal pt
aflutter: high rate, not irregular// rate control only
atrial kick: accounts for 20% of cardiac output// contribution from atrium pressure
AFFIRM: 7401 patients x 3.5 years ( not many CHF pt): 25% mortality, 8% stroke// no difference in efficacy/mortality/stroke between rate and rhythm control; however, rate control was better in secondary outcomes (ie. decrease hospitalization, decrease SE, decrease qt)–>SS
Verapamil causes diarrhea and causes more hypotension then diltizam
digoxin is not effective in controlling exercise induced tachycardia// not used in young, active pt
rhythm control use in severe sx, hemodynamically compromised pt ( decrease BP)
Yesterday my patient said to me, “I got fucked by the snake tip. It was waving a flag.” He then shifted his head toward me, looked directly into my eyes, and while grinning said, “Yeah that’s right, you know what I mean. We got fucked by the snake tip. You know what I’m talking about, I know you do. Right?” Still staring into my eyes, but now raising his voice and becoming agitated he continues, “Jesus came and I was going to gangsta parties. Like real gangsta. And I came out alive and I know it’s because I am Jesus. I wasn’t treated like Mary did, but I got fucked by the snake tip.”
In psychiatry there is something known as a defense mechanism. Defense mechanisms can be mature, neurotic, or immature, they are ways that people deal with feelings of anxiety, pain, and internal conflict. One of my personal favorites is suppression. It’s classified as a mature defense mechanism, and is defined as conscious burrying of troubling thoughts so that you can continue to function. Just push it out of your head an keep on truckin’. Acting out is an immature defense mechanism. Projection is transferrence of anger to a more acceptable recipient. Intellectualization is when one can’t wrap his head around a painful thought or uncomfortable experience so he finds a rational way to process the info. A classic example always given the text books is that of a man who finds out he has cancer. This causes him to learn everything he can about the pathophysiology of the disease and instead of telling his son he has cancer he teaches his son about the aberrant cell cycle, P53, and the Rb gene.
So, what do you do when your patient is searching your eyes, talking about being f-ed by a snake tip, and making no sense whatsoever? Well, you nod your head, return the stare, remain expressionless, and intellectualize:
Psychosis has many, many causes. In general the etiology can be considered primary (functional) or secondary (organic). Schizophrenia, for example, is a primary/functional reason for the development of psychosis. A secondary cause can be due to things like a general medical condition or drug intoxication. When psychosis is primary (like in schizophrenia) the neurochemical abnormalities have to do with an altered dopamine/acetylcholine ratio. There is a relative increase in the neurotransmitter dopamine, and antipsychotics work because they lower dopamine levels (usually by antagonizing the D2 receptor). Organic (secondary) psychosis, on the other hand, is often treated by anti-convulsants rather than anti-psychotics. This is because this type of psychosis is thought to be ictal, that is, it is thought to be induced by seizure activity (ie. increased neuronal firing) within the brain. Not only are anti-convulsants used alone, they can be used to augment the anti-psychotics because they are also thought to act on dopamine indirectly (through neurotransmitters like glutamate and GABA) which in turn enhances the antagonistic dopaminergic effects…. la la la.
Sorry but if you’re gonna raise your voice and get all crazy on me my brain is going to move into science mode. Intellectualization at it’s best.
I received a call, today, from my brother, telling me that Alice, my sister-in-law, wife of my brother in Halifax is in the palliative care unit.
She has lung cancer. They give her “a few weeks” – less if the cancer moves aggressively.
Alice and Mom last November
Alice is the sweetest woman you will ever meet. She has suffered from a number of medical problems, including asthma, environmental allergies, and Fibromyalgia. Despite her pain and chronic conditions which have limited her mobility, she has always been cheerful and warm to everyone she meets.
John and Mom
John and Alice met later in life, and they were “made for each other”. I have never seen two people so comfortable and caring towards each other.
John took a job up on Iqaluit and then to Chesterfield Inlet (I think it was) for a couple of years and the time they spent up there was freeing for Alice because she suffered less from her allergies.
Iqaluit
They had to come back down to Halifax, though, but we saw Alice and John a number of times when Alice was in town for appointments with specialists. One memorable time was once when I took Mom in for an appointment for X-rays at a clinic up the road from us. I sat down in the lobby and the man sitting next to me looked familiar… It was John! Alice was having tests done at the same clinic.
We all went for lunch and had a lovely visit.
John isn’t a “blood brother” of mine but he’s the next best thing. John is my step-brother’s half-brother. In our family, that is still “family” and I love them both as much as (and in some ways more than!) some of the family closer to me.
I cannot imagine John’s feelings as he sits with his soul-mate, watching her die. For me, this is the second major loss this year to cancer, to lung cancer in fact. And it is… I am trying to count… the 5th person I know battling cancer… No… sixth.
Bloomberg News (9/15, Jensen, Litvan) reports Senate Finance Committee Chairman Max Baucus (D-MT) “is making one last attempt this week to win Republican support before he joins Democrats in a party-line effort to overhaul the US healthcare system.” While Baucus “said President Barack Obama’s Sept. 9 speech to Congress ‘breathed new life’ into negotiations for a bipartisan compromise, the Montana Democrat vowed to present draft legislation with or without Republican votes after struggling for months to reach a deal.” Baucus said “he probably will introduce a bill on Sept. 16 and that he expects bipartisan talks to continue after that.”
The Washington Post (9/15, Montgomery, Murray) reports that Baucus “said Monday that he will propose an overhaul of the nation’s healthcare system that addresses a host of GOP concerns, including blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits, and banning federal subsidies for abortion.” But even after Baucus “spoke optimistically of gaining bipartisan backing, lawmakers continued to haggle over a question at the heart of the debate: How can the government force people to buy insurance without imposing a huge new financial burden on millions of middle-class Americans?” Even “within his own party, Baucus confronted a fresh wave of concern about affordability.”
The New York Times (9/15, A23, Pear, Herszenhorn) reports that two of the three Republicans in the “Gang of Six” have “requested numerous major changes in a proposal drafted” by Chairman Baucus, “reducing the chances that he can win their support.” Republican Sens. Michael Enzi (WY) and Charles Grassley (IA) “have catalogued their concerns in documents sent to” Baucus. Many governors “in both parties still have deep concerns about a provision that would require states to pay some of the cost of covering millions of additional low-income people under Medicaid. And Mr. Enzi indicated that he shared their concerns.” Enzi and Grassley “also told Mr. Baucus that health legislation must include language affirmatively prohibiting the use of federal money to pay for abortion.”
The Wall Street Journal (9/15, A5, Hitt, Weisman, subscription required), The Hill (9/15, Young), and the Washington Times (9/15, Haberkorn) also cover the story.
Obama sees progress in Senate on healthcare bill. Bloomberg News (9/15, Goldman, Jensen) reports President Obama “said he sees progress in the Senate Finance Committee for his bid to overhaul the US healthcare system and will work with Congress to get it done.” In an interview, Obama said, “There are going to be times where we need to walk Congress through some difficult areas. I will be happy to use my office and my own time and energy anywhere that’s appropriate in order to get this thing done.”
Beth is sick today. I hope that she is feeling better soon. It must be uncomfortable to have one’s throat swollen shut and it’s probably not good for the baby to be sick. Poor Beth…..
I continued to follow up with 2 of my patients today and I took on an additional patient as well. Berny and I had a discussion about the different types of dementia, which I felt helpful. ( see FMI below for details) There is still quite a bit of work to be done in terms of learning to prioritize everything; nevertheless, I believe that hardwork can persevere through anything. I wrote a few notes to the GP last week regarding a few of the patient’s medications. Some of the changes were accepted and some of them were not. I guess that there is a disadvantage to note writing because I don’t usually hear back on the rationale behind accepting/refusing a recommendation. I might try and talk to the GP by phone next time. Because most of the pt I worked up have GPs with special hospital privileges, I usually don’t get to see them face to face.
We submitted our ethics submission for our project over the weekend. The statistic portion is still alittle be vague, but at least we have most of the protocol done. Ivy and I will be meeting with the statistician some time soon to discussion how we can analysis the collected data.
FMI: types of Dementia from didactic discussion
Alzheimer’s disease – Alzheimer’s dementia is the most common type of dementia, and is caused by a loss of brain cells. It is at least partly a hereditary disease, in that it tends to run in families. (Just because a relative has Alzheimer disease, however, does not mean that another family member will have the disease.) In this disease, cells in the areas of the brain that control memory and mental functions are destroyed by abnormal protein deposits in the brain. People with Alzheimer disease also have lower-than-normal levels of brain chemicals called neurotransmitters that control important brain functions. Alzheimer disease is not reversible, and there is no known cure. There are, however, medications that can slow its progress.
Vascular dementias, including multi-infarct dementia – Vascular dementias is the next most common type of dementia, and is caused by poor circulation of blood to the brain. In multi-infarct dementia, lots of tiny strokes (or infarcts) occur which cut off the blood supply to part of the brain. The progression of vascular dementia can happen in recognised steps. With this type of dementia, good control of blood pressure, good diabetic control and avoiding cigarettes may help to slow the progress.
Parkinson disease – People with this disease typically have limb stiffness (which causes them to shuffle when they walk), speech problems, and tremor (shaking at rest). Dementia may develop late in the disease, but not everyone with Parkinson disease has dementia. Reasoning, memory, speech, and judgment are most likely to be affected.
Lewy body dementia – This is caused by abnormal microscopic deposits of protein in nerve cells, called Lewy bodies, which destroy the cells over time. These deposits can cause symptoms typical of Parkinson disease, such as tremor and muscle rigidity, as well as dementia similar to that of Alzheimer disease. Lewy body dementia is more likely, however, to affect thinking, attention, and concentration than memory and language. Like Alzheimer disease, Lewy body dementia is not reversible and has no known cure. The drugs used to treat Alzheimer disease also benefit some people with Lewy body disease.
Alcohol-related dementia – Brain damage can be caused by drinking too much alcohol. It is important that people with this type of dementia give up drinking alcohol completely to stop the disease progressing.
Pick disease (frontotemporal dementia) – Pick disease is another rare disorder that damages cells in the front part of the brain. Behavior and personality changes usually precede memory loss and language problems.
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Do not “freak out” when researching something on the Internet!!!
Crap.
Nonetheless, we’ve upped the ante on how emergent it is that I speak to Non-Arsey Neuro tomorrow. Or possibly see him?
I read some information when I came home after my first tonic-clonic seizure, but I was too sick look at it. Therefore, I didn’t want to make mention of it on my blog until I could do so. I made a note, and have checked it out today. It all makes sense. Or it certainly could? Although, there is a big “freak out,” regarding it all. So, dig your heels in! *rolls eyes*
I’ll even give Arsey Neuro some credit here, as he always did question if something was going on with my limbic system. Because you see, there are a lot of other bits of my brain that are near it, surround it, are a part of it, that make me do some habitual things–like my hypothalamus that makes me drool like a rabid dog when I seize a lot of the time.
And speaking of animals, I found a rat study where all of this business…well… *PA crosses eyes* Okay, to get the rats out of the way, remember these words about the rat study: “hypothalamus,” “Circadian Rhythm Temperatures,” “Mesial Temporal Lobe Epilepsy.” You got that?
This may get a bit complicated but I’ll try to keep it simple–for everyone out there–and myself? *PA shakes head* It’s kind of messy, though. It runs off into certain territories of the unknown and unanswerable, but I need to get it sorted for Non-Arsey Neuro. Plus everything else that has happened.
NOTE: I am still also cognitively impaired, nauseous and having some problems with headaches. I no longer feel these are stress related. In fact, in thinking and reading about all of this, I feel like throwing up right now. *wry grin* Okay, that may be stress related…
So. What is looking like “sense?” My Circadian Rhythms are completely blown to hell. My Circadian Rhythms, in part, are responsible for controlling my body temperatures. Epilepsy and seizures can blow them all to hell! What is happening, is that my body temperatures are bouncing all around, within the 24 hour period of my Circadian Rhythm.
I am experiencing an “Ultradian Rhythm.” Ironically, this is how I have cycled with Bipolar in the past–within a 24 hour period. However, this irony is not very funny right now. This is rather serious, as it has been going on for a week and a half. I have never experienced such a thing with my seizures. I am so debilitated and sick, I can not leave my house, as I do not feel safe unless someone is with me–and preferably has a vehicle.
Now, what on earth could this mean? How can it be stopped? Well, I’m not quite sure. Let’s link some things together.
Recall the rats? They were aiming to indicate that the hypothalamus (that also plays a role in temperature regulation), could be monkeyed with (monkeys…rats…) The experiment showed changes with Circadian Rhythm Temperatures regarding seizures. The seizure activity occurred within the limbic region (well, this was kind of a finer point–the hypothalamus is basically a part of it–also, they were trying to re-create Mesial Temporal Lobe Epilepsy in the rats.) The only drag? Bummer? Don’t “freak out!!!”
Structural changes in the hypothalamus. However…they were going for status epilepticus of MTLE (Mesial Temporal Lobe Epilepsy.) That’s a prolonged seizure period. A dangerous period. A seriously “get-the-person’s-ass-to-the-hospital-period.”
Okay, if you’ve got that down, let’s continue. Circadian Rhythms and my temperatures? Looking good. Well, bad but it seems likely. My hypothalamus? Always looks like it’s been a bugger. Circadian Rhythms and MTLE? I can’t make a direct correlation but they both have one word in common: lesion!!!
Don’t “freak out!!!” *rolls eyes again* It’s alright, I’m not going off on a serious tangent, and thinking that I have some sort of “brain lesion,” or a “tumour.” Although, it has been a long time since I have had a MRI Scan! I’ve only had one, as well. And it was way before all of these things have happened. The increase of my seizures, the changes in type, this tonic-clonic.
The Circadian Rhythm stuff doesn’t specifically identify any other parts of the brain that I can find, except for the rats’ hypothalamic areas. MTLE? Different story. As I have written about before, very common regarding brain damage in Epilepsy: hippocampal sclerosis. It’s tough, though, as there is great debate as to just exactly how it happens! I see.
I also read some other very interesting things about MTLE, but I won’t bore you with statistics. I think I’ve gone on long enough here. This is of personal significance, however. I seem to fit a bit of a pattern in terms of how it may develop throughout one’s life. I see, again.
Still, “interesting” how this is all connected neurologically? Don’t “freak out!!!”
Though, on a very positive “don’t freak out” note: I also read that this, Circadian Rhythm Temperature craziness, that I am dealing with, may also be of a temporary nature. But for how long? Get your darts out and start tossing them! It’s already been 11 days!
I guess that’s it, then? As above, I could tell you much, much more. Regardless, all of this (and the more), is enough to warrant the emergent call to Non-Arsey Neuro first thing tomorrow. I have prepared my “script” for the Receptionist to hopefully get through to him, at least to talk. If I can see him in person, Grocery Man will take me to his office as I don’t think I can make it alone. Grocery Man had to take me out to run some simple errands today, no matter how much I wanted to do them by myself!
I was even thinking of going to the ER, but they won’t understand if I try to explain all of this. Hell! They wouldn’t even see me in that one hospital after I had the seizure! I need Non-Arsey Neuro, and I need him fast! Not to “freak out,” but this is serious!
September 11, 2009 (LifeSiteNews.com) – A British policewoman and born-again Christian says it was a sudden and unexpected “rush of love” that in her mind transformed her unborn child, conceived in a date-rape, from “an alien” to a beloved daughter on the day of her scheduled abortion. Miriam Virgo credits God with stepping in to save her daughter’s life.
Now 27, Virgo told her story in an autobiographical piece in Britain’s Daily Mail yesterday, saying that, having come from a devout Christian family, she had never expected to find herself a single mother at 19. In 2001, she had attended a party with co-workers at which she believes her single glass of wine was spiked with a date-rape drug. After the attack and with no memory of that night, Virgo was shocked to find herself pregnant and considered obtaining an abortion.
“Coming from such a Christian family,” she said, “I’ve never believed in abortion, but suddenly finding myself pregnant with a rapist’s baby, I looked at it differently.” She continued, “I just couldn’t face the thought of the baby being born and looking like Rob [her alleged rapist] – it would be a constant reminder of what had happened.”
After “counselling,” Virgo said, she was ready for an abortion; but when the moment came, and she was already dressed in the hospital gown, she changed her mind after what she describes as a moment of help from God.
Ultimately, after she gave birth to Kayleigh, now seven, she found that the child did look like her attacker, and she experienced some difficulty bonding. But ultimately she overcame this, saying, “After all, none of this was her fault.” A year after her daughter’s birth, Virgo applied to and was accepted by the police force.
She said that when Kayleigh is old enough, she will tell her of the circumstances of her conception, and “I’ll also tell her about the moment I decided to keep her, and how I felt all this love for her, love that is even stronger now.”
In another interview, Virgo said, “God knew what my life would be without the girl and he knew what it would be with the girl. I prayed to God and asked for his will to be done in my life.”
The so-called “rape exception” is commonly accepted, even by many who are inclined to the pro-life position, as a “compassionate” act for a rape victim. But pro-life apologists refute this, saying that it is neither just for the innocent child who is killed, nor beneficial for the mother.
Stephanie Gray, the head and founder of the Canadian Centre for Bioethical Reform, told LifeSiteNews.com that Miriam Virgo’s story should be one that inspires others to make the same choice in favor of life.
It illustrates, she said, the basic principle of the entire pro-life cause, that an unborn child has dignity and value, no matter what the circumstances of her conception. “If the unborn are valuable because they’re human,” Gray said, “then how they come into existence does not change the fact that they are persons with inherent dignity.”
Gray illustrated the principle with a hypothetical: had Virgo been married and “had consensual sex with her husband the night prior to her date rape, upon discovering her pregnancy she would not have known the identity of the child’s father.”
“Imagine if she hoped it was her husband’s child and carried on with the pregnancy, and only after birth, with paternity test results, discovered the child’s father was a rapist. Would she be permitted to kill the infant then because of the father’s crime? Obviously not. Likewise, we may not kill an unborn child because of her father’s crime.”
Gray said that Virgo’s “witness is a powerful example to all people, and that is that we should be other-focused, not self-focused.”
“Even amidst her own victimization and deep pain, Miriam chose not to victimize an innocent child.”
Brush up on the pro-life answers to pro-abortion slogans here.
Read related LifeSiteNews.com coverage:
Rape Victim: My Child “No Different Than a Child Not Conceived in Rape”
Rape and Incest Victims Don’t Want Abortion, Say It Doesn’t Help Women
The blog “Exposing Obama” has posted information about the march today including pictures of the crowds. There are several different versions on the count going around. NBC’s “own people” say at least hundreds of thousands”, and the Daily Mail in the UK are reporting up to 2 million were there.
They had to close down Pennsylvania Avenue to accomodate protestors who were trying to get to the mall.
This was a great day for our country, for so many to take time out and come tell our government “in person” that we are TIRED of the lies, and the out of control slide into a Communist or Fascist country.
Be sure to check out the coverage – print, video & pictures!
@ ExposingObama.wordpress.com :
A ‘Sea of people from the Capitol to the White House” for the March on Washington against Obama
Thursday was the last day for Lacey to take her meds for her giardia.We need to bring her stool sample to VCA in two weeks.On Friday she got a new bone (Redbarn)http://www.redbarninc.com/images/product/medium/15.jpg
and she also had her teeth brushed.She usually gets her teeth brushed on Fridays.Lacey thought we were still giving her medicine so when we picked her up she hid her face in my mom’s arms but once we got her to open her mouth so we could brush her teeth she let us brush her teeth.Hopefully the Giardia will be negative in a few weeks.
I am sure most people reading this know that Obama gave a key speech regarding the state of the health care reform legislation on September 9, 2009. (Obama’s Health Care Speech Text) This speech has been long awaited because it would provide details of the reform bill for those of us unable to understand the legal language in the actual bill (Obama’s Health Care Bill – Actual Text) Obama’s health care speech was both informative and empowering. It is wonderful to see the President lead the country on resolving an issue that has been stalled for many years now. The goals of the proposed health care reform include:
to increase stability to the insured
to provide coverage to the uninsured
to slow down the rising rate of health care costs
to demand responsibility on the part of the government, insurance companies, employers and individuals.
Obama addressed the qualms that arose about his reform plan, while addressing the presumed political tactics that have been employed to sway the public. Furthermore, he left room for compromise and bipartisan approach to solving a national crisis. Through his speech, Obama challenged the Congress to put aside the political views, the political enmities, and most importantly put aside personal gain. Rather he wants to approach health care as a united front (more on the hackling incident below). I think this particular point will be his winning ticket because the average US citizen just wants better health coverage, and sooner the better!
Just as hind sight is 20/20, I felt that his speech should have further addressed certain aspects of the reform bill. As a future physician, I would like to know more about the effect of the new health care bill on “defensive medicine.” From the looks of it, the new reform will focus heavily on making sure that coverage is provided at a competitive price. Nevertheless, it is equally important to maintain a national standard of care. I would have liked to learn more about how the reform will ensure the price for insurance coverage is not being paid by a decrease in the quality of care provided nationally. Lastly, the American College of Physicians has alerted us of the approaching shortage of primary care physicians. I want to know how and if this reform bill will address the shortage and encourage future medical graduates to pursue primary care.
All-in-all, the speech was a commendable beginning to this process of health care reform. I am looking forward to the coming weeks of debate on this topic. It will make us think critically, as a nation, about where we stand now versus where we would like our health care to be for our future.
On a side note, Re: hackling the President.
Representative Wilson of SC, I have a few words for you. South Carolina is considered a gem of the US because of its hospitality. What will your constituency think of your lack of hospitality for the Commander-in-Chief? I thought the army was respected in the South? You should know that – since all your sons are in the army. As per your website, you serve as “a Ranking Member on the Subcommittee on Military Personnel, the Committee on Education and Labor, and the Committee on Foreign Affairs.” Foreign Affairs??? I am sorry, but I thought you hackled at the point when President Obama stated that reform legislation would not mandate health care for illegal immigrants. And you are responsible for Foreign Affairs? I am sorry, but I do not want you to represent this country on matters pertaining to foreign affairs, especially not in front of other people. Since you are unable to abide by the code of a Congressman, maybe it would be best that you leave the representation of your state and the US to someone with more dignity, decorum, and grace. In parting I would only like to say: No hackling the President…ever! Thank you.
You may have noticed that my posts have not been as in-depth or as recently. It’s not because I don’t love you all and reading the great dialogue that you are always having
I’ve been suffering from a bout of headaches for the past 3 1/2 weeks that have been constant 24/7 (mild, not severe) and a state of being tired all the time. I finally went into the doctor last week and they ordered an MRI. When the results came back, they found an anonamly in the Sella region of the brain, specifically the pituatary gland.
I went in this morning for a 2nd MRI to determine the issue. I’m currently awaiting the results. As you can imagine, the thought of an “anomaly” is pretty scary so I’m just waiting to find out what the MRI shows and will move forward from there. It could be as simple as a hormone imbalance or some swelling, but of course could be worse. They mentioned the possibility of a tumor/cancer but they don’t seem too concerned that this is what it is. I’m leaning toward the good side since I’m always optimistic and, frankly, I don’t think it’s anything too serious.
With this being the case, I just haven’t felt much like reading and writing as much as I usually do, but I’ll keep trying to post some stories that I find interesting, when I can Thanks again for everyone who stops by every day to participate in the ongoing discussion on all the articles that I post. I know I enjoy reading what you all have to say and I hope you feel the same way!
Talk to you all soon!
First full patient workup today. I learned that gathering information is easier if I know what I’m looking for . There are many sources of information, so it’s a good idea to prioritize my needs so that I don’t run out of time looking through different sources. It became a much more fulfilling experience as I gathered more information and was able to form a bigger picture of the patient.
Discussion topic: Pneumonia ( extra info)
PSI is validated, CURB-65 is not
blood cultures are more useful when: pt is alocholic, increase risk of non std bug suspected, low WBC
atypicals and anaerobic bacterias don’t grow in cultures
Atypical: Legionnella, K pneumoniae, C. pneumoniae, RSV (virus)
pneum vaccine repeat needed after age 65, or a 2nd dose may be required at least 5 years afterewards if first vaccination after 65 years of age
Bacterias that cause pneumonia: S. pneumo, M. Pneumo, C. pneumo, staph aureus, pseudomonas, viral, H. influenza, Legionnella
Atypicals that cause pneumonia: Legionnella, M. pneumo, C. pneumo, RSV
Bacterias that cause pneumonia in ICU patients: gram negatives, pseudomonas, MRSA,
Useful Pneumonia references:
IDSA/ American Thoracic Society Consensus Guidelines on the Management of Community Acquired Pneumonia in Adults. CID 2007;44 (Suppl 2).
Respiratory Tract Infections. In: Koda-Kimble MA, editor. 8th ed. Applied Therapeutics: Baltimore, Maryland: Lippincott, Williams & Wilkins; 2005. Pp. 60-4 to 60-15.
Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. CID 2000;31:383-421.
Halm EA, Teirstein AS. Management of Community-Acquired Pneumonia. N Engl J Med 2002;347:2039-44.
Gin AS, Tailor SAN. Community Acquired Pneumonia. Can J Hosp Pharm 2001;54(Suppl 1): CE Insert. Pp.1-16.
LGH CAP Pre-printed order
FMI:
gastroparesis: delayed gastric emptying// can be caused by anticholingergic, narcotics, anorexia nervosa, blemia or gerd// S/S: increase or decrease in blood glucose, nausea, early feeling of fullness, lack of appetite// treatment: metoclopramide, erythromycin, domperidone
Pharmacogenomics, the science of individualizing drug therapy based on the genetic makeup of individual patients, offers an unusual opportunity for future market growth. Applying pharmacogenomics would allow doctors to treat specific segments of the population based on their particular responses to a drug. The knowledge of the likely effectiveness of a drug in a patient makes the drug more reliable, and fewer drugs would have to be taken off the market due to adverse reactions in some, but not all, of the patients to whom they were administered. Additionally, reducing the occurrence of adverse effects to a drug effectually reduces the cost of patient care overall. This Publications study examines the market for diagnostic tests based on this science and the clinical measurement methods, the reagents and supplies being utilized in clinical medicine and the pharmaceutical industry. This report presents an overview of the latest information regarding emerging new products and industry trends and will not only quantify, but also, qualify the pharmacogenomic market segments as an area of research, product development and investment opportunity. Forecasts of the pharmacogenomic market and an analysis of products in the worldwide diagnostics market will provide a basis for understanding the significance of past developments and the immense possibilities of the future.
For More Information, Kindly Visit : http://www.aarkstore.com/reports/Pharmacogenomics-for-Clinical-Use-and-in-Drug-Development-13789.html
“You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time. “
~Abraham Lincoln
SC Congressman Joe Wilson Calls Obama A Liar During Speech
During the last week more and more Americans calling into to various talk radio shows and their hosts have called President Obama a liar.
Thus when he continues to lie about what he wants for health care, I was not surprised that at least one of our elected Representative called him a liar.
The majority of the American people no longer trust him or believe him.
President Obama hectoring tone is revealing.
I believe he knows it, does not like it and thinks he can fool the American yet again.
President Obama and the progressive radical socialist Democratic Party may not believe it, but they are done for.
You do not scold and lie to the American people and expect to be re-elected.
The American people do not want compulsory health insurance with mandatory coverages that will lead slowly and surely to a single payer system.
Without very specific language in the bill that specifically excludes abortions and illegal aliens, the President is lying about both abortions and illegal aliens being excluded from coverage.
The President proposed health insurance reform bill would destroy even more jobs, wreck the economy and kill the American dream.
The American people simply do not want what the President is selling.
The American people are fed up with both political parties and their arrogance.
The American people want political leaders with humility.
Humility is the acknowledgement of truth.
“You can discover what your enemy fears most by observing the means he uses to frighten you.”
~Eric Hoffer
“Humility is the foundation of all the other virtues hence, in the soul in which this virtue does not exist there cannot be any other virtue except in mere appearance.”
ok, le notizie non possono sempre lievi e leggere. di tanto in tanto capita di trovare un titolo che non si vorrebbe leggere, o un articolo che non si vorrebbe sfogliare. eppure, sapete, nella comunicazione della scienza, qualcuno dice che sono proprio le informazioni di medicina e genetica a doverla far da padrone. sarà, ma a me sembrano interessanti tutte allo stesso modo… cmq, tornando a noi, la notizia su cui mi sono imbattuto sembra un tantinello interessante. prima di tutto perchè si parla di un signore che fino a poco tempo fa si pensava neanche esistesse. secondo perchè investe una sua funzione di cui, udite udite, non si pensava fosse dotato. partiamo dal principio. 13,5 miliardi di anni fa… no troppo principio…
un tempo si pensava che il nostro dna fosse diviso in compartimenti stagni. alcune sezioni erano adibite a fare proteine, altre sezioni erano semplicemente adibite a fare niente (n.d.r gli esoni, gli estroversi che comunicano; gli introni, quelli introversi che non comunicano). sembrerà strano, ma questo era proprio quello che si studiava sui banchi di università. poi nel 2001 sono stati scoperti i micro-rna che invece investono proprio quella parte che nel dna sembra proprio non fare niente (n.d.r il junk dna). sono formati da 20-22 nucleotidi, sono importantissimi per la trascrizione genica e per la creazione delle proteine, e per ora ne sono stati scoperti ben 500. ecco, non la vorrei fare complicata, ma potrebbero essere anche rna ripiegati su stessi. vi ho confuso le idee? giuro non volevo…
ce ne sono quattro in particolare che ci interessano: miR-21, miR-210, miR-155 e miR-196a. subrata sen, del dipartimento di molecular pathology, sul numero di settembre di “cancer prevention research”, pubblica un paper molto interessante sull’insorgenza del tumore al pancreas. il nodo è questo: visto che gli mi-rna trascrivono informazione, e che sono responsabili di quello che avviene, in ultima analisi, nella creazione di “robe” nel nostro corpo, alcuni di essi potrebbero essere responsabili anche dell’insorgenza di alcune malattie. i quattro mi-rna di cui sopra, secondo sen, sono responsabili dell’insorgenza del tumore pancreatico, e trovarli tutti insieme nel sange potrebbe essere utile per una futura prevenzione di questa malattia (n.d.r per altro fino ad ora poco curabile).
How many people’s parents used to say something equivalent to this:
“As long as you live under my roof, you will obey my rules!”
For those whose parents supported them while they studied in another city, this might be a more familiar version of the expression:
“As long as I pay your bills, you will do as I say!”
It is a rather reasonable expression of the parents’ role: as long as their son or daughter lives under the parents’ roof or as long as the parents are financially responsible (even partially) for the offspring, that offspring (whether chronologically an adult or not) is not truly emancipated. As long as one is a dependent, one cannot expect to have their independence!
OK – so what if the adult child’s medical costs (say a University or College student) are covered by the parent: would that parent would be within their rights to insist that their son or daughter (adult or not) not indulge in, say, ultimate fighting?
After all, we know that some activities are, statistically speaking, much more likely to result in higher medical bills than others. So, if someone else is paying a person’s medical bill, that someone else would be justified in putting in some limits on dangerous behaviour.
Right?
So, what about a situation where a group of friends get together to purchase a medical insurance in order to get a ‘group rate’? It is inevitable that not every member of the group will necessarily have a slightly different ‘benefit’ at any given point in time – and most will accept that going into the deal. But…
What if one of these people – let’s call him ‘Bill’ (pun intended) – takes up the hobby of getting a little tipsy and, on a dare, nailing his hand to ‘stuff’. Whenever he does it, Bill gets rushed to a hospital, his hand has to be surgically separated from whatever he had nailed it to this time, Bill then has to get shots… You get the picture. Bill incurs a sizeable bill.
And he does it again. And again. And everyone’s group-insurance costs go up!
In this situation, do Bill’s friends have the right to tell him to stop nailing his hand to stuff?
Do they have the right to force him to stop?
The next time he does it, do they have the right to tell him that he is not allowed to use their group insurance to cover the cost of the medical treatment?
Perhaps we can agree that this particular Bill is an idiot. But – where exactly does his right to be an idiot stop and the rights of his friends not to have Bill’s idiocy ruin them financially begin?
Obviously, I picked an extreme example. So, let’s pick another one…
What if, instead of nailing his hand to stuff, Bill chose to get piercings? It’s sort of similar – just a bit more socially acceptable. And, what if Bill’s piercings got infected, he needed to be hospitalized, and all that.
And then he got another piercing.
And another.
And they kept on getting infected or having other complications, and Bill’s friend’s medical insurance rates kept rising and rising… Would they have the right to tell him to stop getting any more piercings? Or do they have the right to tell him that any future piercing-related costs will not be covered by the common insurance plan?
All right – what if Bill did stop getting piercings… but one of his existing rings gets caught on something, tears the skin, and Bill has to go to the hospital again. It’s the piercings which are causing the cost to go up – again! Should the group insurance cover it?
And what about if Bill were not an idiot – but his friends were. What if they thought that regular exercise and a good diet was bad for you, because they heard about a lot of athletes getting arthritis? What if these friends believed (truly and honestly) that regular exercise was an unreasonably high-risk behaviour, much like nailing one’s hand to stuff would be. And, what if Bill liked to do yoga – and he pulled something that required medical help…a few times?
Who gets to decide who is ‘the idiot’ and who is ‘reasonable’?
Or what if Bill were a Billie – and she had 16 kids, while nobody else in the group had more than 2: should her choices in fertility affect her friends’ medical rates?
Should only her first 2 births be covered by the group’s insurance?
Or should the whole group be responsible for paying for Billie’s hospital bills if she got into an accident because she was speeding? What about the bills of her 16 kids, who were in the vehicle, too?
Who gets to decide?
Before, or after the treatment?
Would any of your answers change if, instead of choosing to enter into this group insurance arrangement, all the friends were forced into it by law, with no means of opting out? You know, like all Canadians are?
These are not easy answers: I certainly don’t know where the balance lies. All I am trying to do is to make sure that people understand that the ‘benefits’ of being ‘one of a group’ come with the cost of allowing the group some control over one’s behaviour. There is no such thing as a ‘free lunch’ – or a free ‘medical care’!
Someone always has to bear the costs: and the one who bears the costs will want to have a say in how you behave (and incur the cost)!
In the UK, this is the reality: people ARE being denied medical treatment because they are deemed to have too high a body-mass-index (which actually penalizes muscular people, as muscle is heavier than fat), as are smokers or dare to get old. Their treatment them just does not seem cost-effective or fair to the rest of society that has to pay for it….
And, with my own eyes, the last time I went to renew one of my kids’ health cards at the Ontario Ministry of Health office (it is downtown – nearest public parking is about a 10-minute walk from the office), I actually saw a guy there, with a broken leg….trying to get some problem with his health-card straightened out, because the people at the hospital’s emergency room refused to treat him until the problem was straightened out. He offered to pay – but the law forbids the hospital to let him pay first and get reimbursed later…as it forbids the hospital to set one’s broken leg (or provide any treatment – even a triage assessment) until one has a working health card.
Wired had an article a couple weeks ago* on studies showing that the placebo effect is more effective now than it used to be. It seems that while the big US drug companies thought they were just fleecing customers with massive ad campaigns ever since the FDA allowed direct advertising in 1997, they were actually healing them! That’s the theory being advanced in the article, at least. Interestingly enough, it points in the direction of drugs being assisted by holistic care–not in the odd pseudo-sciencey way the term is often used, but using the real definition and viewing the entire human body as an interdependent system rather than relying only on precisely targeted drugs and therapies.
*In unrelated news, Slashdot appears to have missed the 60-second news cycle memo.
