Where the Hell Are Medical Savings Accounts?

The actual problem with our failing health care system is that consumers have no control over it. Already, too much is paid for by middlemen like insurance companies and government. If Americans only paid 5% of their food bills, a cheeseburger would cost fifty bucks, too.

Why are people handing off control of their health care to middlemen? Because government imposes massive taxes on them, and then “rewards” them, with tax breaks, for paying needless insurance companies to cover their well-care, checkups, and minor problems while charging them triple what those will cost.

If you say “screw that, boss, I’ll take the cash instead of the health insurance”, you’re forced to pay taxes on the money, when the insurance was pre-tax.

The solution? (aside from cutting the massive tax burden)

Medical Savings Accounts.

Instead of giving the money to a middleman insurance company, you get to keep it yourself, to save for any medical needs. It is not taxed, and once you accumulate enough to cover any predictable needs, you roll the rest over into a retirement account each year. Meanwhile, you by a very cheap catastrophic insurance plan, that only covers unexpected, rare disasters like cancer and falling in a wood chipper. These can cost only a fraction of a harmful full-coverage plan.

This gives you control over your own health care, the ONLY way to cut costs. It also allows you to save for your retirement, freeing you from depending on the ridiculous, doomed social security system that will NOT be there when even Gen X retires.

Why do we not have this?

As your congressman.

Swine flu in the Czech Republic: first minor epidemic this week, first confirmed victim last week

(c) Getty Images

Twenty junior high school students and some of their relatives have recently been diagnosed with the “swine flu”, which means it is the first minor epidemic in the Czech Republic, as all the cases that have been reported so far are isolated (mostly individuals returning from Canada, Mexico etc.).

According to the Blesk daily eight of the students and one of their teachers caught the flu during a trip to Bavaria, Germany last week. All of them are at home, taking antibiotics. None of them has experienced serious complications that would require hospitalization. There are six more people who are waiting for their test results…

Last week a woman died from complications because she had one of her organs transplanted and her immunity was significantly affected by her “heart condition” as well.

It's A Start, Isn't It?

Hello World!

Or at least that is how WordPress would like me to greet you. I have started this blog as a way for me to organise my thoughts while I go through the remainder of my college course, and subsequent application to Medical School. I have completed my application already, including the mandatory UKCAT (Evil BTW). If you are interested in where I have applied to and for what, info is in the side bar!

I am studying five Highers in one sitting and am aiming for 5 As. It is doable by anyone’s reckoning, I have just encountered a few problems and managed to miss the first few weeks of my course. Which sucked, frankly. I have been doing my best to catch up, and as such hope to have completed the following subjects by next year: Matsh, English, Chemistry, Physics and Biology.

Admittedly a boring start to my new blog, but I will do my best to keep this thing up to date!

Difference Between Doctors and Engineers

Doctors and Engineers especially in their student years dont share a respectful relation. Mostly Medicine being the more preferred choice of career, most of the engineers are actually “wanna be doctor but could not get into” types. Hence they now want to prove that being Engineer is actually a better thing than being a Doctor. But this blog is not about that.

I never wanted to become a doctor and pure love for mathematics and analytical think brought me into Engineering field. But now while I attend Artificial Intelligence lecture, medicine often comes in our discussion. How can we design expert systems to diagnose diseases.

The question that our professor raised today was something that I had thought about many times before. There is a fundamental difference between how people in different professions think. A Doc, said my prof., makes any hypothesis purely based on his experience and diagnosises the disease. He then continuously updates his hypothesis based on response that the patient gives to his treatment.

As long as the basis for hypothesis is not the Doctor’s immediate financial needs, I would say it is a fine approach. But Doctors need to work harder at getting their hypothesis write in the first shot, if an engineer has to trust them.

Engineers have analytical mind. Given a set of symptoms we will have to correlate those symptoms with some disease with know symptoms. Clearly a well studied and well known (though not well solved) problem in machine learning.

But then I am really worried about the cases where a wanna be doctor ends up becoming an engineer. Isnt something terribly wrong with that?

Second Life News: Midwifery and Molecules

• Midwifery, birth and Second Life

• Can Training in Second Life Teach Doctors to Save Real Lives? (Discover)

• A Virtual Science Environment in Second Life

Mary Anne Clark describes the organization and uses of Genome Island, a virtual laboratory complex constructed in Second Life. Genome Island was created for teaching genetics to university undergraduates but also provides a public space where anyone interested in genetics can spend a few minutes, or a few hours, interacting with genetic objects—from simple experiments with peas to the organization of whole genomes.

• Molecular models in SL

• Virtually Useless #fote09 #fote09vw

I’m not against virtual environments – it’s SL I have a problem with. There are many potential applications, the ones that particularly attract me being travel replacement and carbon footprint reduction. However, I don’t feel that virtual environments are good conferencing tools – I don’t need a 3D representation and the lighter touch of tools such as Eluminate and Skype are much more appropriate for this application.

• Trademarks and the SLeducation Wiki

As some readers probably already know, I received a request from Linden Lab on Wednesday in relation to the Second Life in Education Wiki requesting  ‘not to use our trademark “Second Life” in your name or website name and not to use “SLeducation” in text or in your domain name…’ and to ‘..make the changes to your website name and domain name as soon as possible and let us know when you expect to have this done…’.

Food for Thought: Healing From Within...A Positive Diet & Positive Thinking for Better Health - David Martin, Executive Director, WPA Chapter

“The Doctor of the future will give no medicine,
but will interest his patient in the care of the human frame,
in diet and the cause and prevention of disease.”
-Thomas Edison

That quote is from my recent Arthritis Radio guest’s website … Janet McKee, a board certified Holistic Health Counselor.  Here is an excerpt from my intro to that show:

I don’t know if you’ve seen the iphone commercials – where the tag line in “we have an app for that” … want to order a pizza – we have an app for that … need directions … need to book a hotel – we have an app for that – amazing technology.  It has changed society as we know it … something else that has changed are the levels of stress and anxiety … depression, obesity … overall wellness … are you stressed – we have a pill for that … depressed we have a pill for that – overweight, have pain – we have a pill for that … everything is quick – never enough time and one area that really suffers is what we eat and consume.  Drive-throughs, coffee shops, energy drinks, processed foods, vending machines, microwaves – this has changed society too… and has changed our overall wellness.

I used to think my father was a “fanatic” over what I called his “health foods” … his attention to what he ate and how much of it always resulted in some good-natured jokes as the rest of us stood around with our quarter pounders … he was right.  He was right and is now the healthiest person in my family.  A family that has Rheumatoid Arthritis, Psoriatic Arthritis, JRA, Fibromyalgia, Lupus, auto immune disease,  and more… is there a connection?  If you ask Janet Mckee … you would get an enthusiastic yes!

Considering the pills and the drinks and the processed and fast food we consume — what we should be considering what is on the end of our fork.

Please let me know what you think of the interview on Arthritis Radio. Leave a comment and your personal story.  I should add – Are we suggesting you drop your meds and eat “vegan”?  No… but a better diet, a diet and lifestyle that suits our particular bodies can only lead to feeling better.

On part 3 of the interview we also touch on the power of your mind.  I recently read a book entitled “You Can Heal Your Life” by author Louise Hay.  She has a DVD of the same name and the potential that exists of how our bodies and life can change depending on our thoughts and outlook is simply astounding.  How many times have we awoken to a gray, rainy day not having received enough sleep, dreading going to work, having too much on our plate, not feeling 100% and not looking forward to the day ahead.  We plant the seeds for a miserable day – and that is what we get…  What we expected from the moment we opened our eyes.  What would have happened if we had greeted the day being grateful, thankful for the rain and our work day ahead and thoughts of how we expected to feel good.  A different outcome, I suspect.  Louise Hay has been quoted talking about “waking up and thanking the bed for a night’s sleep”!  Now that is grateful.  The idea has been around for centuries.  I first heard of it as a child and came across the book, “The Power of Positive Thinking” by Norman Vincent Peale.  It’s been most recently brought back into popular culture through books like Louise Hay’s and “The Secret”.  Organizations like Abraham Hicks and best-selling authors like Chicken Soup for the Soul’s Jack Canfield and Michael Beckwith have promoted positive thought for a better life. Our thoughts, expectations, imaginations and life-outlook can have an impacting effect on our health and how we feel.  It’s a journey worth taking.

A better diet, positive thoughts, feeling better… sound good?

Check out the interview! To listen to Arthritis Radio Episode 11: Parts I, II, and III - please visit http://arthritisradio.podbean.com or simply search Arthritis Radio in the iTunes store to download it as a free podcast!

We have recently posted another AFWPA “Rheum for Wellness” blog entry about Janet McKee and the “food for healing” aspect of this topic.

View Ashley’s entry, “Food for Thought: Healing from Within” HERE.

To learn more about Janet McKee, holistic health counselor and drugless practitioner, please visit her website at http://www.janetmckee.com

Thank you, and be well!

- David Martin

Executive Director

Western Pennsylvania Chapter

Finding Relief From Asthma With Advair

Advair a combination of bronchodilators and steroids is a twice daily for maintenance treatment of adults and children 12 years or older who suffer from asthma. Advair is prescribed to improve the functions of the lungs and prevent asthma attacks. However, it is important to understand that this is not a fast-acting inhaler, but is a maintenance treatment, which is used to control their symptoms over time overall.

Advair is also prescribed for adults suffering from chronic bronchitis and COPD (Chronic Obstructive Pulmonary Disease). Normally, if a child has to rely on their quick action, such as Albuterol for asthma medications on a regular basis, your doctor may prescribe Advair. There are 3 different ways of Advair 100/50, 250/50 and 500/50. The first number indicates the strength of steroid medication in the second indication of the strength of the bronchodilator.

As you can find any type of medication, Advair is a list of things you should know. For example, if you have an infection or have been sick, your doctor will probably wait until you are better before prescribing Advair. One of the drugs in combination, salmeterol, has been shown to increase the risks of deaths that are associated with asthma. Therefore, you need to talk to your doctor and understand the benefits versus risks.

If you have any allergies to medications or foods, have liver disease, a thyroid disorder, tuberculosis, glaucoma, diabetes, epilepsy or high blood pressure, you must let your doctor know, either not recommended Advair or carefully monitor their condition while taking the medication. If you are pregnant, you should not take Advair because research shows it can cause injury to an unborn child.

In children, Advair may have an effect on the growth rate of the child. It is therefore important to monitor this carefully and if there is any doubt, talk to your doctor.

People who smoke, have a history of bone loss, failure to exercise or not getting enough calcium or vitamin D in your diet may have an increased risk of osteoporosis due to long-term use of a steroid.

While taking Advair Diskus, is important to keep people at bay unhealthy. Advair has been shown to reduce the number of blood cells in the body, which also reduces their ability to fight infections in the body. This means that you are taking Advair, an increased risk of infections and get sick.

Many people use Advair twice a day to combat the symptoms of asthma and live a healthier life easier breathing. It is important that you talk to your doctor about all possible benefits and side effects before deciding if the asthma treatment Advair is the maintenance for you.

Key Issues Impacting Anesthesiology Programs: Understanding the History - Jerry Ippolito

Key Issues Impacting Anesthesiology Programs – Part 1: Understanding the History

Hospital administration typically recognizes that “Surgery” is the “Financial Engine Powering a Hospital”.  As reported by the Clinical Advisory Board, 65 percent of a hospital’s profit and 60 to 70 of hospital revenue originates from the OR.  While a hospital’s anesthesiology program is a paramount support service to a number of hospital programs the anesthesia service is a vital component of perioperative services. 

 

A high quality and service oriented anesthesiology program which focuses on patient and surgeon satisfaction is generally a champion of business development for hospitals and ambulatory surgery centers (ASCs).  Conversely, anesthesiology programs can restrict business growth.  High quality medicine and a service oriented culture alone are not sufficient to successfully support a hospital’s or ASCs programs. Even where anesthesiology maintains a service orientation, anesthesiology can and does frequently restrict program growth due to a shortage of anesthesiologists and CRNAs and a lack of ability to provide staffing in balance with programs’ need.  The existing shortage of anesthesia providers can restrict hospitals and ASCs in their staffing of additional anesthesia sites required to provide surgeons the OR access required by their practices.  Surgeons rely on OR access to generate a livelihood and must take cases to / perform cases at facilities maintaining OR access in balance with their practice needs.  In a Clinical Advisory Board survey of 118 hospital executives, 50 percent responded that “Our Greatest Barrier to Doing More Surgical Cases Is Limited Anesthesiology Coverage”.  Additional surveys performed by the Clinical Advisory Board reported that 47 percent of hospitals closed ORs due to insufficient anesthesia coverage.  In my own experiences as a perioperative services management consultant, review of financial data indicates that, on average, the value of an OR case to a community hospital or medical center ranges between $1,800 to $2,500 of margin per case (prior to indirect cost allocation and including all hospital revenue and expense associated with the surgical encounter).  Therefore in settings where on average four to six cases are performed per OR per day, closing an OR can result in a financial loss to a hospital of, on average, $10,000 per day or approximately $2.5 million per year.  This factor needs to be considered when an anesthesiology group requests and income guarantee to recruit additional staff.  A return on investment analysis needs to be considered (e.g. potential revenue from an additional room = $2.5 million annually; potential cost of an anesthesiologist = $450,000 annually; potential cost of a CRNA = $200,000)

Key Issues Impacting Anesthesiology Programs is a series. Please book mark our blog and check back each week for new updates. Coming soon:

Part 2: The Anesthesiology Shortage                                                                                          

Part 3: The Financial Impact

Part 4: The Hospital Dilemma

Part 5: Understanding Anesthesia Billing

Part 6: The Care Team Model

Part 7: Conclusion – Issues Every Anesthesiology Practice Must Face to Succeed

Are we still evolving?

Of course.

The release:

Are humans still evolving? Absolutely, says a new analysis of a long-term survey of human health

Durham, NC – Although advances in medical care have improved standards of living over time, humans aren’t entirely sheltered from the forces of natural selection, a new study shows.

“There is this idea that because medicine has been so good at reducing mortality rates, that means that natural selection is no longer operating in humans,” said Stephen Stearns of Yale University. A recent analysis by Stearns and colleagues turns this idea on its head. As part of a working group sponsored by the National Evolutionary Synthesis Center in Durham, NC, the team of researchers decided to find out if natural selection — a major driving force of evolution — is still at work in humans today. The result? Human evolution hasn’t ground to a halt. In fact, we’re likely to evolve at roughly the same rates as other living things, findings suggest.

Taking advantage of data collected as part of a 60-year study of more than 2000 North American women in the Framingham Heart Study, the researchers analyzed a handful of traits important to human health. By measuring the effects of these traits on the number of children the women had over their lifetime, the researchers were able to estimate the strength of selection and make short-term predictions about how each trait might evolve in the future. After adjusting for factors such as education and smoking, their models predict that the descendents of these women will be slightly shorter and heavier, will have lower blood pressure and cholesterol, will have their first child at a younger age, and will reach menopause later in life.

“The take-home message is that humans are currently evolving,” said Stearns. “Natural selection is still operating.”

The changes may be slow and gradual, but the predicted rates of change are no different from those observed elsewhere in nature, the researchers say. “The evolution that’s going on in the Framingham women is like average rates of evolution measured in other plants and animals,” said Stearns. “These results place humans in the medium-to-slow end of the range of rates observed for other living things,” he added. “But what that means is that humans aren’t special with respect to how fast they’re evolving. They’re kind of average.”

###

Additional authors on the study were Sean Byars of Yale University, Douglas Ewbank of the University of Pennsylvania, and Diddahally Govindaraju of Boston University.

The team’s findings were published online in the October 19th issue of Proceedings of the National Academy of Sciences.

CITATION: Byars, S., D. Ewbank, et al. (2009). “Natural selection in a contemporary human population.” Proceedings of the National Academy of Sciences 106(42). doi: 10.1073_pnas.0906199106.

The National Evolutionary Synthesis Center (NESCent) is an NSF-funded collaborative research center operated by Duke University, the University of North Carolina at Chapel Hill, and North Carolina State University.

Best Topic Suggestion Sites and Search Engines

“Google it” doesn’t mean exclusively search on Google.com these days.   As search engines and information portals evolve and continue to improve our ability to drill down results within tighter parameters, many effective ”first step” sites have been developed that deliver specific information.  We’ve put together the below list on how to find topics and then more specifically, by discipline, search engines and sites:

I NEED TO FIND:

TOPICS:   Bing Cool visuals; strong results.      Clusty Old fashioned layout but great result clusters.     Social Issues The latest hot topics and pro/con arguments.     Technorati Search for topic suggestions via “tags” resulting in related blogs.   TOPICS W/ANNOTATIONS:   InfoMine Researched critical comments and notes.      Intute Out of the U.K. but w/worldwide results.    RELATED TOPICS:   Grokker As stated, related topics (Yahoo based).      Ask.com Click “Expand Your Search”    REFINED TOPIC SEARCHES:   Ask.com Click “Narrow Your Search”.      Surfwax Click “Focus” to broaden or narrow your search results.   QUALITY SEARCHES:   Librarians’ Internet Index Extremely well defined search trees with authoritative sites chosen by topic experts.     Virtual LRC Scholarly search results based on a word or a phrase.   ADVICE FROM EXPERTS:     Sources and Experts A comprehensive listing of sources, compiled by a journalist.     Ask A Librarian The site of last-resort (but not for last minute homework help!) Library of Congress      

 

 

NOW I NEED TO FIND:

TOPICS WITHIN SPECIFIC DISCIPLINES:GOVERNMENT:   USA.gov Browse official U.S. information and services sites.     Foreign governments Search worldwide government sites.  LAW:   Law.com Legal stories, technology, firm identification and jobs in the field.     Findlaw.com Search U.S. cases, codes, news and commentary     LOUIS Amazing site, named for famed jurist Louis Brandeis, Search Congressional documents, Federal Register, GAO reports, bills and resolutions  SCIENCE & TECHNOLOGY:   SCIRUS Science-specific portals.      Nat’l Science Digital Lab Science, technology, math and engineering.  ARTS & HUMANITY:   Stanford Encyclopedia of Philosophy Browse peer-reviewed, continually-updated entries on contemporary philosophy.   HEALTH & MEDICINE:   Health & Medical Sleuth Find health information faster by searching multiple health search engines from one place.     Medical Search “Fast and productive medical searches” – The Washington Post.  NEWS & INFORMATION:   BBC Incredible source for searching worldwide issues, especially war coverage,     eHow Search and ye shall find; how to do just about anything.     FactCheck.org From the Annenberg Public Policy Center at the Univ. of Pennsylvania, research political speeches, press releases, TV ads, public statements…     FedStats.gov Useful compilation of stats and reports from 100+ official US agencies.

BNI Operatives: Street smart: Web savvy.

As always, be safe.

Looking for coffee shop & snack bar owners interested in increasing their income!

Lifestyle Food is offering a financially interesting healthy snack solution for coffee shop and snack bar owners in Bangkok. Go with the global trend and take a share on the Thai government supported initiative to support your customers in staying vital, healthy and young with an easy concept.

Lifestyle Food is offering a starter kit with all the marketing material and nutrition information you need to start a healthy snack corner in your own shop or bar. No monthly fee, no stock, no risk. We show you how and consult and update you every month with news, recipes and information.

Interested? Contact: lifestylefood@bkk-health.com

Stevie Nicks has nothing to do with this post....

But, being the major blog-geek that I am, I noticed that “Stevie Nicks” was one of the most popular search engine terms for today…so what the heck, I will blatantly use her name in the title of my post but for no other reason than to attract more wayward surfers….

Due to the little Medical Malpractice “accident” that caused me to become disabled nearly 11 years ago, I have quite a few issues with nerve pain in my legs. Those of you who have experienced nerve pain will know how miserable it can make you in a real hurry. My nerve pain involves sharp, electrical shock type pains jolting my legs at random intervals, for hours on end, usually always at night. To combat this, over the years I have been prescribed just about every type of pain reducing medication on the market. Some help the nerve pain but cause unwanted side effects..

Anything with Codeine makes me unable to sleep and unable to go #2 for about a month.

A few meds had me curled up in the fetal position, crying uncontrollably like a spineless jellyfish, resulting in my being repeatedly beaten to a pulp by my aggravated wife who was trying to sleep at the time.

Other pain medications give me a rash, cause night sweats, dramatically increase my blood pressure, and have caused me to have auditory hallucinations like the medication that had me hearing a voice (of Vincent Price) whisper into my ear that I needed to paint my whole body purple, then smother my sons stuffed teddy bear with a pillow while singing “I feel Pretty”. That’s some pretty sick stuff. Needless to say, after smothering multiple bears, and after going through gallons of purple paint, I stopped that medication quickly!

But now I have been prescribed yet another medication.

This one has been around a long time and after reading about it, I was shocked that I had never been prescribed it before now.

It is Neurontin.

I did some research online and was shocked at what I read. Among it’s indications for usage it read “to help patients with post-operative chronic pain (usually caused by nerves that have been severed accidentally in an operation and when grown back, have reconnected incorrectly) and nerve pain associated with spinal cord injury”

That is me!! I got disabled when the Quack Spinal Surgeon I had was digging around in my spinal cord area with a sharp instrument and then had a major “OOPSIE!”, causing two of my spinal cord nerve roots to be severed…. Just the two little old roots that control feeling in the legs, muscle control of the legs, circulation, bowel and bladder function, etc. No Biggie.

So, why the heck had I not been prescribed this medicine before? The indications for it fit my case to a “T”.

I called my Dad, another physical wreck of a human being, and told him the news.

He then told me that he had also been on Neurontin, very recently, but had to abruptly stop the medication due to a bad side effect.

According to Dad, about 3 days after starting Neurontin, he was walking across his living room normally and then “POW!!”…..

He woke up in a pool of his own drool, face down on the floor, after passing completely out for quite a period of time. (He was home alone at the time) One minute he was fine, the next he was unconscious on the floor.

I read more of the warnings about possible side effects…

Apparently this medication greatly increases the risk of suicide in many patients.

It can also cause moodiness, dizziness, drowsiness, swelling of extremities, hypersensitivity to Barry Manilow songs recorded before 1979, uncontrolled drooling, loss of memory, and sudden death.

I can live with all that. I already live with most of those symptoms on a daily basis right now.

So, last night I started taking the Neurontin. Dad made it 3 days before hugging the floor passed out cold. I have a day and a half till that landmark. Tomorrow,I will hide all the stools, ropes, guns, knives, etc….and will strap pillows to the front and rear of my body, as I stroll around in hockey pads and a football helmet, just in case I happen to kiss the floor in a fit of unconsciousness.

I will keep you updated.

Best Stevie Nicks song: “Sara” (Fleetwood Mac)

World's First Skin Graft

Walter Yeo, the first person to receive plastic surgery, before (left) and after (right) skin graft surgery performed by Sir Harold Delf Gillies in 1917. The pictures of Walter’s face before the surgery are blurry and hard to come by. In the tragic accident he was recorded as having lost both his upper and lower eyelids. The surgery was some of the first to use a skin graft from an unaffected area of the body and paved the way for a sudden rash of improvements in this field.

From telomeres to cancer vaccines: the 2009 Nobel Prize in Medicine

It’s that time of year again: leaves are falling, the days are getting shorter, and anxious researchers wait by their phones for the call of a lifetime.  That’s right–it’s Nobel Prize season!  This week, hypios takes a look at this year’s winners, who will be awarded their medals, diplomas, and grants in Stockholm and Oslo on December 10th.  We’re sure they’re too busy fielding calls from reporters and working on their Nobel lectures to solve any of our problems–and besides, they’ve already made great contributions to science!  But if you’re still waiting for your call, may we suggest that you spend the next year solving some problems on hypios. We’re starting off with medicine, the first prize to be announced.  ”Cervical cancer vaccines” like Gardasil and Cervarix have been on the market–and marketed–since 2006, with taglines like “One less!” or “We chose to protect ourselves!”  Millions of women have been vaccinated, and researchers hope to dramatically reduce rates of cervical, vulvar, and anal cancer.  These particular vaccines, however, work by creating immunity against the HPV virus, which can cause certain types of cancer, rather than attacking cancer itself. Creating a cancer vaccine is an entirely different task–and one that might be possible, thanks to research by this year’s Nobel Prize in Medicine recipients.  Elizabeth Blackburn, Carol Greider, and Jack Szostak are sharing the prize for their work on telomeres and telomerase.  Thanks to their discoveries, researchers have been able to develop and test new cancer treatments, including a cancer vaccine that targets telomerase.  Even if these don’t work or produce unwanted side effects, the possibilities are exciting and “a continued flow of new data is expected,” as this article from the Nobel organization explains. Chromosome replication is a long-standing problem in biology.  If DNA doesn’t replicate itself exactly when a cell divides, the new cell lacks the necessary information to function, and may not be viable.  In Szostak’s experiments with yeast, cells without telomeres divided poorly and eventually stopped functioning.  Telomeres protect chromosomes from degradation during replication.  They’re small segments of DNA that, positioned on the ends of chromosomes like tiny magnets, attract proteins to form protective caps.  Blackburn, an Australian-born biologist, and Szostak, an American, discovered this after meeting at a conference in 1980 and collaborating on an experiment involving two different organisms.  The fact that telomeres from one organism were effective in another, entirely different species hinted that there was a very basic biological mechanism at work. In 1984, Blackburn and her Californian then-grad student, Greider, isolated telomerase.  They discovered that this enzyme, which contains both proteins and RNA, actually extends the telomeres so the ends of chromosomes are not snipped off during replication.  The RNA in telomerase serves as a template or platform for the DNA being built.  The more telomerase activity a cell shows, the more genomic stability and viability it has. Cancer cells have lots of telomerase activity, so their genomes remain intact through multiple divisions.  This means they can divide over and over without degradation–they’ll function just as well after the fifteenth division as on the fifth or the first.  If treatments could target telomerase activity, they could stop tumor growth and treat cancers.  The research of Blackburn, Greider, and Szostak may also be used to develop treatments for inheritable diseases and to investigate stem cell behavior. Blackburn in particular credits curiosity and an open mind for her success.  As a child in Tasmania, she wallpapered her bedroom with drawings of amino acids, and as a teenager, once used her chemistry set to make explosives, according to a 2009 interview with Clinical Chemistry.  As a doctoral student at Cambridge, she became interested in the molecular side of biology.  There, she learned from biologists like Francis Crick and Max Delbruck, who were former physicists and worked by trying to ‘leap’ to ideas, placing “huge value on the elegant solution.”  This approach inspired Blackburn to move away from the strictly ‘quantitative thinking’ traditionally used to solve problems in biochemistry.  Later, she tried to give her students the same freedom to explore, allowing grad students and post-docs in her lab to work on their own projects rather than doing legwork for her own investigations.  Asked to reflect on her success as a woman in science in the same interview, she said that perhaps men and women think about things differently, but “that’s great because [it's] how you solve problems–you have different minds, different ways of thinking about problems.” Given our hope that Solvers will collaborate across fields and contribute solutions to problems beyond their specialties, we couldn’t agree more.  Obviously, this attitude has paid off for Blackburn and her colleagues in their scientific investigations.

It’s that time of year again: leaves are falling, the days are getting shorter, and anxious researchers wait by their phones for the call of a lifetime.  That’s right–it’s Nobel Prize season!  This week, hypios takes a look at this year’s winners, who will be awarded their medals, diplomas, and grants in Stockholm and Oslo on December 10th.  We’re sure they’re too busy fielding calls from reporters and working on their Nobel lectures to solve any of our problems–and besides, they’ve already made great contributions to science!  But if you’re still waiting for your call, may we suggest that you spend the next year solving some problems on hypios.

We’re starting off with medicine, the first prize to be announced.  ”Cervical cancer vaccines” like Gardasil and Cervarix have been on the market–and marketed–since 2006, with taglines like “One less!” or “We chose to protect ourselves!”  Millions of women have been vaccinated, and researchers hope to dramatically reduce rates of cervical, vulvar, and anal cancer.  These particular vaccines, however, work by creating immunity against the HPV virus, which can cause certain types of cancer, rather than attacking cancer itself.

Creating a cancer vaccine is an entirely different task–and one that might be possible, thanks to research by this year’s Nobel Prize in Medicine recipients.  Elizabeth Blackburn, Carol Greider, and Jack Szostak are sharing the prize for their work on telomeres and telomerase.  Thanks to their discoveries, researchers have been able to develop and test new cancer treatments, including a cancer vaccine that targets telomerase.  Even if these don’t work or produce unwanted side effects, the possibilities are exciting and “a continued flow of new data is expected,” as this article from the Nobel organization explains.

Chromosome replication is a long-standing problem in biology.  If DNA doesn’t replicate itself exactly when a cell divides, the new cell lacks the necessary information to function, and may not be viable.  In Szostak’s experiments with yeast, cells without telomeres divided poorly and eventually stopped functioning.  Telomeres protect chromosomes from degradation during replication.  They’re small segments of DNA that, positioned on the ends of chromosomes like tiny magnets, attract proteins to form protective caps.  Blackburn, an Australian-born biologist, and Szostak, an American, discovered this after meeting at a conference in 1980 and collaborating on an experiment involving two different organisms.  The fact that telomeres from one organism were effective in another, entirely different species hinted that there was a very basic biological mechanism at work.

In 1984, Blackburn and her Californian then-grad student, Greider, isolated telomerase.  They discovered that this enzyme, which contains both proteins and RNA, actually extends the telomeres so the ends of chromosomes are not snipped off during replication.  The RNA in telomerase serves as a template or platform for the DNA being built.  The more telomerase activity a cell shows, the more genomic stability and viability it has.

Cancer cells have lots of telomerase activity, so their genomes remain intact through multiple divisions.  This means they can divide over and over without degradation–they’ll function just as well after the fifteenth division as on the fifth or the first.  If treatments could target telomerase activity, they could stop tumor growth and treat cancers.  The research of Blackburn, Greider, and Szostak may also be used to develop treatments for inheritable diseases and to investigate stem cell behavior.

Blackburn in particular credits curiosity and an open mind for her success.  As a child in Tasmania, she wallpapered her bedroom with drawings of amino acids, and as a teenager, once used her chemistry set to make explosives, according to a 2009 interview with Clinical Chemistry.  As a doctoral student at Cambridge, she became interested in the molecular side of biology.  There, she learned from biologists like Francis Crick and Max Delbruck, who were former physicists and worked by trying to ‘leap’ to ideas, placing “huge value on the elegant solution.”  This approach inspired Blackburn to move away from the strictly ‘quantitative thinking’ traditionally used to solve problems in biochemistry.  Later, she tried to give her students the same freedom to explore, allowing grad students and post-docs in her lab to work on their own projects rather than doing legwork for her own investigations.  Asked to reflect on her success as a woman in science in the same interview, she said that perhaps men and women think about things differently, but “that’s great because [it's] how you solve problems–you have different minds, different ways of thinking about problems.”

Given our hope that Solvers will collaborate across fields and contribute solutions to problems beyond their specialties, we couldn’t agree more.  Obviously, this attitude has paid off for Blackburn and her colleagues in their scientific investigations.

Illustration from Howdy, I’m H. Michael Karshis on flickr.

Pharmaceutical Compounding: What Is It?

Thousands of Australians benefit from pharmaceutical compounding. This process helps create customised medications for people ranging from the disabled to those who are allergic to certain inactive ingredients. As patients become more savvy, compounding is certain to increase in popularity more and more.

Making Medicine That’s Easier To Swallow

Whether it’s adding different flavours to various medicines to make them more agreeable for children, or changing a pill into liquid form to help a person with disabilities take it more easily, pharmaceutical ompounding offers many different ways to make taking medicine more pleasant – and safer. In years past, getting a child to take his or her medicine was a dreaded chore with medicine notoriously tasted quite bad, and kids avoided taking it at all costs. Flavouring is often added today via compounding methods for young patients who are particular averse to taking their medicine – making parents’ lives much easier at the same time.

People with certain disabilities, as well as many elderly patients, have a difficult time swallowing medicines that come in pill form. Some people simply have a personal preference for avoiding such medications as much as possible. Whether it’s for a medically necessary reason, or for personal reasons, pharmaceutical compounding can be used to change pills into liquid form and makes taking medicine less of an ordeal for people who have difficulty swallowing pills.

Making Medicine Safer To Take

Pharmaceutical compounding is also often used to remove certain ingredients that may cause an allergic reaction in people. For instance, some people with gluten allergies may require customized prescription medications that avoid using that substance. Many medicines use inactive ingredients that can trigger bad allergic reactions in people; at the same time, those medications are needed to treat serious conditions. Pharmaceutical compounding provides a very beneficial compromise by removing the offending – and unnecessary – ingredients.

Many people benefit from the services of a Compounding pharmacy every single day. If you ever find yourself in need of customised medication, you will be glad to know about the capabilities of this technology. Sometime in the future, it may make your life easier.

The Cannabis Conspiracy, Truth #2: The False Floor of the Harmful Gateway Theory

Continuing to believe that marijuana is rightly illegal is difficult when a person knows the whole story.

It means a person must overlook the fact that the ones who actually do make a profit from the #1 produced crop in state of California are criminals. It means a person would not see it as a good idea to tax the #1 produced crop in California. http://www.youtube.com/watch?v=J-QOgRiGnmQ It means that we have to turn a blind eye to the fact that keeping marijuana illegal ensures criminals can have steady work and make a good living. But it least it gives something for the government and police something to chase around.

http://www.youtube.com/watch?v=deyeb0Ewtvk

Both alcohol and tobacco are legal to sell, buy, and use. Yet it’s well known to the general public that thousands of people die in our country each year from the use of these products. Everybody knows it’s possible to overdose from alcohol and that it can cause not only dependency but all kinds of diseases. And obviously we know all the deadly effects of using tobacco. But how many deaths occur every year in America from the use (or abuse) of cannabis? A thousand? A hundred? Five? One? Nope.

Zero.

It’s amazing to see how many die from legal drugs, aspirin, and caffeine.

No one has ever overdosed from cannabis. In fact, there has yet to proven link between lung cancer and cannabis. Strangely, what studies that have been done on the subject show, if anything, cannabis actually HELPS patients with lung cancer. http://www.youtube.com/watch?v=EW6TU2vZe_Y

One of it’s nicknames is “weed”, giving us this idea that it’s a toxic plant. It’s just simply not toxic. It’s a medicine.

But it’s addictive, right? Yes, studies show it’s addictive as coffee, but not as addictive as tobacco or alcohol. So a person may get a headache if they’re used to having it and then they go without using it. http://www.youtube.com/watch?v=KLUmpGOLdgo

Yes, it’s illegal, yet the current President of the United States and the 2 before him have admitted to using it. In fact, one out of four American adults has admitted using it in their lifetime.  The fact that it’s illegal has pretty much become a joke since the 1970’s. We don’t take it seriously anymore. Actors and musicians openly admit to using it and cops don’t check their pockets and arrest them. We just don’t care, as a society, about cannabis like we pretend to.

One of the main reasons cannabis has remained illegal since 1937 is because people believe the hype. “It’s a “gateway drug”. Well sure- it’s illegal. A lost soul with no aspirations for his life goes to a drug dealer to get illegal cannabis who is then introduced to harder drugs. In that case, it’s a gateway drug. But if it’s not illegal, it’s not necessarily a gateway.

It’s that circular reasoning popping up again. Darn it.  http://www.youtube.com/watch?v=I9-xOTsIhZk

Some of the most eye-opening information I’ve been exposed to is comedian Doug Benson’s documentary Super High Me.  For 30 days, he doesn’t smoke marijuana, taking several tests to document his health.  Then, for the next 30 days, all he does is smoke marijuana.  The only time he is not actually smoking is while he is asleep.  Of course, he goes back and gets the same medical test done while under the influence of marijuana.  Here is a comparison of both scenarios:

Without marijuana, then with marijuana:

SAT: 980/1600; 1030/1600

Sperm Count: 21 Million/mL; 33 Million/mL

Lung Capacity: 92%; 89%

Weight: -2 lbs.; +8 lbs.

Short Term Memory: 27/29; 2/3 words; 24/29; 3/3 words

http://en.wikipedia.org/wiki/Super_High_Me

“Table of Contents”

Introduction  http://wp.me/pxqBU-5k

Truth #1: The Profit from Illegalization http://wp.me/pxqBU-4W

Truth #2: The False Floor of the Harmful Gateway Theory http://wp.me/pxqBU-4Z

Truth #3: The Stigma of a Pot Head http://wp.me/pxqBU-52

Truth #4: God was the First Cannabis Grower http://wp.me/pxqBU-55

Truth #5: Society Itself is a Hypocrite http://wp.me/pxqBU-59

Truth #6: Man is Taking Credit for God’s Free Gift http://wp.me/pxqBU-5c

Truth #7: Common Sense and Justice Eventually Prevail http://wp.me/pxqBU-5

Truth #8: Banning Cannabis Keeps Us from Utilizing Hemp http://wp.me/pxqBU-7b

Adam Yauch, Beastie Boys: "I feel healthy, strong and confident!"

The star announced his fans that he feels “healthy, strong and confident” after leading a hard fight against cancer.
Adam, 44, made the statement after he returned from the trip to Dharamsala, India, where he consulted a number of Tibetan doctors after he suffered an operation to remove the tumor from his salivary glands.
“I take Tibetan pills and under a physician’s supervision I follow an organic vegetable diet,” he added.
The launching of their new album, “Hot Sauce Committee Part 1″, was postponed when Adam announced that he has cancer, on July 20.

Pretty medical imaging

From Brainbows to dyed cells, all the prettiest images created with the aid of the human body (or someone’s body).

different brainbows

Follow the link to see the slideshow from Discover Magazine

If you’re interested in these images from a more scientific standpoint, go check out some different Journals that specialize in biomedical imaging:

Journal of Biomedical Optics
BMC Medical Imaging
Journal of Radiology

What else? Leave more in the comments, and I’ll insert them into this post.

To our health

Sujoy’s view

How do Canadians perceive their quality of health care? Some would say it’s the best in the world, but I’m usually not a fan of such celebratory claims; it implies that having the best care means we don’t have to improve on it, and that’s certainly not the case in Canada. In fact, a recent survey by the Conference Board of Canada ranked our health care system as tenth out of sixteen developed nations, the same ranking as last year. When you think of the problems of Canadian health care, issues such as wait times, availability of doctors (family physicians in particular) and cost are commonly discussed as things we need to work on as a society. I agree that there is always room for improvement in health care. Certainly there are regions, particularly in northern and Aboriginal communities where doctors are unwilling to settle compared to large urban centres. How then are these regions meant to be served equitably with quality care? Part of the answer may come from the culture of curative medicine which is such a large part of health care today, rather than preventative medicine. Campaigns for preventing teenagers from smoking or encouraging a balanced diet, and active living are so important to health care over all – and they do work well as we have seen that smoking has become more and more taboo; but there is still a huge need for awareness about these problems.

Costs are driven up by health problems associated with these lifestyle choices, and if we want a higher level of care we need to encourage preventative medicine practices. Furthermore, on the topic of educating the public, they need to be made aware of what constitutes a visit to the doctor. Too often emergency rooms are crowded with people who have a cold, or something completely trivial – it’s an asymmetry of knowledge and a hypochondriac-creating-media which makes you think that any symptom of any illness is a life threatening one. Admittedly, this is a hard thing to gauge and is one of the questions I struggle with when I think about health care.

Ziad’s view
Since the early days of public health care in Saskatchewan, there has been a constant debate surrounding the feasibility of a public health care system and its future within an expanding Canadian society. Nevertheless, whether we like it or not, public health care has become a part of our social fabric and while we may have a ‘B’ health care system, according to the latest report released by the Conference Board of Canada, it is still something I think we all take pride in and view as our fundamental right. Even more than that, it is what sets us apart from such countries as the United States of America, with their privately run, for-profit driven system.

Public health care is an indispensable feature of Canadian society and should continue to receive government funding. Health care should be and remain a fundamental service for all members of the Canadian polity and any undermining of the Canadian public system should be monitored closely and largely limited. It is important to realize that improving the health care system is necessary to build a stronger Canadian polity. Marginalized peoples access to health care needs to be improved, in particular Aboriginals. Just take a look at the recent Globe and Mail article that reveals health officials sent body bags up to Northern Manitoba Aboriginal communities as ‘flu-fighting supplies’ (See link at bottom of post).

Educating the public on how to prevent an illness is also a key facet of any health care system. With a stress on educating the public on health care, doctors and hospitals would be relieved of more minor concerns and the population in general could avoid patterns of poor health.

Ultimately, as the debate rages south of the border around health care and the public-vs.-private option, we can take consolation in the fact that we have a system, if supported and protected, can continue to move in the right direction and remain a central facet of our social services.

(Globe and mail Link- http://www.theglobeandmail.com/news/national/native-leaders-reject-apology-for-body-bag-blunder/article1292295/)

Critical Condition

What, exactly, does it mean to be “in critical condition”?

According to the infallible Wikipedia, it’s used to describe patients in whom “[v]ital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.”

This, as well as the alliterative qualities of the phrase, mean it’s as good a term as any to describe the current state of health care in America.

Of course, Wikipedia also notes that the term is “most commonly used by the news media and [is] rarely used by [doctors], who in their daily business prefer to deal with medical problems in greater detail,” – which might explain why it’s also a good a term as any to describe the current state of the health care debate.

Another good word might be “nebulous” – what seems like months into the process, and even after what even critics concede was a rather good effort by the president, we still lack a single definitive bill (not that that’s ever stopped its protesters from claiming it will throw us into poverty, despair, and creeping socialism, or fascism, or something).

Various news sources have made credible attempts at explaining it – Meet the Press gave the debate a full hour – but even these efforts too often seem to get bogged down in a morass of questionable numbers and debatable facts.

That’s why it’s refreshing to see a new television documentary – also called Critical Condition – on PBS’s POV series, which does an unusually good job of humanizing the debate.

Roger Weisberg’s hour-long documentary, which is available free on the Web site for the rest of the month, is unapologetically pro-reform, and at time, due to the tinklingly ominous music and lists of pathos-inducing facts, borders on the cheesy.  But for the most part, it’s excellent.

The film follows several uninsured Americans and their families as they struggle through the physical and financial consequences of their illnesses.  Their story are  clearly carefully handpicked from among the tens of millions of uninsured to avoid the usual right-wing strawmen – all are legal citizens, all hold jobs and many, before their illnesses strike, count themselves as tenuously among the middle class.

Their stories don’t need any of the film-making tricks Weisberg employs to be heartbreaking.  They are rich with painful dramatic irony: the Mexican-born man, so proud of his adopted country, who must return south of the border to seek cheaper medical treatment; or the the high-school sweethearts, now grandparents, who lose their golden years to debilitating, preventable illness.  In an extra video, a couple watches the American Dream fly by in reverse – small-business owners, they lose their store and home when their insurance refuses to cover their developmentally disabled children.   Their children, they worry, will have a worse life than they did.

Perhaps the most startling is the account of Hector, a hard-working warehouse manager who describes himself as the first to arrive at work and the last to leave.  When his foot is infected, doctors tell him it can be saved – as long as he stays off of it.  But with his remaining sick days ticking down, and afraid to lose his job – and the insurance that goes with it – he opts to have the foot amputated, hoping he can get back to work.  Instead, delays in the making of his prosthetic limb means he loses the work anyhow, and the insurance company retroactively declines to pay for the leg.  Out of a job and deeply in debt, he is reduced to attempting to fix the leg itself when it breaks, and eventually is forced out of his home.
The series is full of such preventable tragedies and Hobson’s choices:  Joe, who has diabetes and liver conditions who can’t afford the medications to control his disease ends up in the emergency room, sicker – two days before his death, he becomes eligible for Medicare.  Karen, who is battling Stage 3 cancer, recounts knowing for a long time that something was wrong, but being unable to find a doctor who will see her without insurance.  Many seem more stressed by their mounting medical bills than their illnesses.

The videos are often uncomfortably intimate – tracking the patients through the inner workings of their checkbooks as they bargain with collections departments and their bodies as they undergo surgeries.  Perhaps most privately, it chronicles the moments when each finally breaks down – Hector admits that for the first time in his life, he’s lost hope, while Karen, bald from chemo, admits that “the stress is getting to her,” before stoically adding that it “could be worse.”  We see the moment where Joe, paralyzed from a fall, tells his shell-shocked wife that he’s “finished.”

What makes these stories so gripping, however, is that they are not particularly uncommon -  I suspect it’s the rare person who hasn’t known someone touched by illness in a similar fashion, or seen the devastating effects, or the desperation, sickness can bring.

Is it the be-all-and-end-all to the  health care debate?  Clearly not – it’s designed as advocacy, not policy or objective coverage.  But by representing the faces of those actually touched by the overblown rhetoric, it provides a stark contrast to the screaming mobs and scheming politicians.

It’s a reminder of a promise made long ago to Americans, that we are a “city on a hill,” an example for the world; and a refuge for the tired, the poor, and the wretched.  If those people are walking, invisible, among us, in the richest nation on earth, then we are failing them.

Universal Arts Inc. Sponsored Medical-Freedom.com's Raffle Drawing

Raffle Drawing Independence Brew Pub Philadelphia, PA

Up for raffle December 15, 2006  is a framed autographed tee-shirt by Tommy Chong along with other souvenirs from his tour at the Keswick Theater on May 6, 2006.

Tommy Chong was originally scheduled to perform the Marijuana-Logues at the Keswick Theater on March 18th, 2005, but the tour was cancelled due to violations of Tommy’s parole because of reported incidents of audience members throwing joints on stage.

Tommy returned to the tour circuit when his parole ended in 2006 and was finally able to finish his 2005 tour. When he came to the Philadelphia area on May 6th 2006 for two shows at the Keswick Theater, William Haney graciously requested Tommy Chong to sign this tee-shirt in support of medical freedom.
This one of a kind autographed shirt has been preserved with a black marble shaded matte, high quality wooden frame with acrylic sheet. The frame measures 34″ by 25″ and has an acid free back.
The autographed tee-shirt is accompanied with several related historical souvenir items including the original Keswick Theater ticket stub for the Marijuana-Logues, a theater program for the show, a custom black bronze name plate honoring Tommy’s comeback tour, and a newspaper interview with Tommy from the Philadelphia Daily News dated May 2, 2006.

Ironic enough, when Mr. Haney contacted reporter Stu Bykofsy for a copy of the interview, Mr. Bykofsky sent Mr. Haney the actual newspaper, and the postmark on the envelope was May 24th, the Birthday of Tommy Chong! These two items will be sent along with the framed items. There is a spot on the back of the frame to house these two items.
Mr. William Haney plans to donate a part of the proceeds to four non-profit organizations that benefit medical marijuana reform groups and they are: Cheryl L. Miller Memorial, The Philadelphia Chapter of Norml, Women’s Organization for National Prohibition Reform, The San Francisco Patients’ Cooperative. Thank You Tommy Chong

Medicine- Day 19

Last day at LGH today for the medicine rotation. I am sad to see it end. The staff at the LGH have all been extremely friendly and supportively towards my learning. I will miss them alot.

Yesterday, I received news from Beth that one of my patients had passed away after been transferred to SPH. He had a history of alcoholic cirrhosis and was awaiting a liver transplant. Unfortunately, his kidney made a turn for the worse on Wednesday and he passed away later that evening. I feel very sad for the patient and his wife.

Didatic on alcohol withdrawal:

• DMS IV: dependence: ( 3 of following): tolerance, withdrawal, use more or longer than intended….
• Abuse: example being social problems–> essentially, it is anything that affects functionality
• mild withdrawal: sx in 0-48 hr, peak 24-48 hr, resolve: 48-72 hr
• 40% pt die if not treated: mostly from CV reasons or metabolic disturbances or infections
• DT: delirium tremens: delirium, horors, fears, disorientation, tremors, hallunciations, diarrhea anxiety
• CAGE: cut down, annoyed, guilty, eye opener
• agitation is the most common side effect
• CIWA: clinical institute withdrawal assessment for alcohol
• disadvantage of CIWA: need to communicate ( sedated patient or language barrier)
• advantage of CIWA: prn
• evidence for CIWA: decrease treatment duration, decrease BDZ dose, decrease sx
• reason for thiamine: (1) thiamine deficiency (2) wernicke’s encephalopathy: ataxia, confusion, memory problems, eye paralysis
• thiamine is found in grains and eggs, some patients are put on multivit ( help with other nutritional deficiency- ex. B12)
• CIWA protocol : option A: diazepam, option B: lorazepam
• lorazepam is more easily broken down compared to diazepam in renal/hepatic impairment
• lorazepam has less risk of respiratory depression on diazepam
• MOA of alcohol withdrawaL: alcohol bind gaba, gaba is an inhibitor, increase stimulation from SNS –> seizure, gaba is up regulator b/c of alcohol ; therefore, more gaba receptors; bdz bind gaba receptor
• watch for decrease opioid or pt will be over sedated
• overadherence of CIWA: agitated for other reasons
• CIWA protocol : duration of 5 days usually

Case presentation today

The presenation went well today. The pharmacists asked lots of thought provoking question about the case, which led me to think of other alternatives and also to question my own recommendation. The case was a discussion about the use of clopidogrel and ASA combination for a post MI patient. I discussed a few trials, including the MATCH, CHARISMA and CAPRIE trial. I think that I will spend more time looking into the recent landmark trials discussion the interaction between clopidogrel and PPI. These studies will play a significant role in the interpretation of the case. It would also be more helpful if I can remember specific population inclusion criterias and the absolute event rates for the trials included. One of the pharmacist also explained to me that the CAPRIE trial was not an ITT trial. When he recalculated the numbers, the data was not ss. The absolute risk is likely very miniscule, or less than 1%.

Procedure Log:

I was able to order a pre and post level for a new gent dosing for a patient. The patient has renal impairment and we were not sure how the medication was going to be cleared. In addition, the patient is also a very big, tall man, so conventional dosing may not be appropriate.
Secondly, I was able to interpret a digoxin level for the same patient. The level came back as 2.1 and it was taken 19 hours post dose, which is within the ideal 12 to 25 hour range. The target for our elderly patient is less than 1 to 1.5 because he is experiencing sx of weakness and anorexia when he was first admitted. Digoxin experiences linear pharmacokinetics. His current dose is 250mcg daily. Our patient weights 170 lbs, IBW: 86.8. It was suggested that the patient’s dose be decreased to 185.7 mcg daily to achieve a trough digoxin dose of approx 1.5. We would then monitor the patient for sx improvement and heart rate control. Bisoprolol was also added to the patients’s current therapy for better rate control.

Areas of improvement for the future:

1. Pay attention to the small details when doing a work up… they can make a big difference! 
2. Try to go the next level with your formal topics… memorization or better understanding will help you apply the knowledge to your patients.

Can stress cause cancer?

These are some excerpts from an article by Carly Weeks in the Globe and Mail paper today:
“Can stress cause cancer, or even hasten a patient’s death? It’s a daunting, emotionally charged question with no simple answers, but it represents a growing field of research that scientists hope could eventually lead to breakthroughs in cancer treatment.
The premise driving the theory is that stress has been found to weaken the body’s immune response and cause some physiological changes, such as the secretion of certain hormones, that could contribute to the development of cancer.
Traditionally, much of the study in this field has focused on the effects of stress on the immune system.
But now, attention is shifting to the relationship between stress and gene function, an area many scientists believe is the key to unravelling this mystery.”
… “led by Suzanne Conzen, associate professor of medicine in the Ben May Department for Cancer Research at the University of Chicago” , the researchers studied the stress levels of mice living in groups as they normally do, or alone which creates a stressful situation for them.
“The study provides some of the strongest evidence to date that an individual’s stress level may be linked to the progression of cancer. But the quest to understand why – and, perhaps more importantly, how those factors might be used to help prevent or treat cancer – is still in its infancy.”
“This is an area that has a long way to go in terms of understanding how these factors play out in humans,” said Caryn Lerman, a professor of psychiatry and scientific director of the Abramson Cancer Center at the University of Pennsylvania.”
“Stress doesn’t give you cancer, but it is a risk factor like genetic differences, like environmental carcinogens,” said David Spiegel, associate chair of the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. “There are a whole bunch of risk factors. Not everybody that smokes tobacco gets lung cancer.”

This is a comment about my personal experience which I posted after the article on the Globe and Mail website:
I’m convinced that stress increases the growth of cancer cells, so I’m very pleased to see research being done in this area. What this theory allows people to do is to manage their stress levels so they give the body a fighting chance to overcome cancer. If stress is using up much of the resources in the body, then the normal process which controls the growth of cancer is compromised, and the cancer takes over.
I learned about the link between stress and cancer from books and some health professionals when I was going through chemo in 1987.
At first I blamed myself for having cancer, which didn’t feel very good at all. Then after a course in Cognitive Behavioural Therapy, I had an Aha moment. I thought that if my high stress levels had fuelled my cancer to grow, I could possibly reduce the growth of cancer by lowering my stress level.
I figured I had nothing to lose and everything to gain. By managing my stress, I hoped to live long enough to see my children grow up, and I’ve managed to be cancer free since 1987.
It’s a simple idea but not an easy one and required much work on my part to change my stress levels, as well as building in a healthy diet, exercise, and good sleep patterns.
I have to say that every day is a blessing and my appreciation of life is so much greater than before my cancer diagnosis when I took my health for granted.