Two cortisone stories involving Peekaboo and yours truly …
First, the news about Peekaboo. When I met with the vet a few days ago, he repeated that we wouldn’t be able to give her the current anti-inflammatory drug forever. Too bad, since she eagerly takes it in her wet food in the morning, and it seems to have no side effects. Oh well.
He suggested I substitute it with a drug called Contramal, which is basically Tramadol, and with another one that contains quercetin (I checked it out, it’s okay, so she’s on that now).
Tramadol is a different story. That’s the drug that Piccolo was on for some time last summer, and I am CONVINCED (although I have no proof, ...
Source: Margaret's Corner - September 7, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll cortisone Medrol Source Type: blogs
An Ischemic ECG and Bedside Echo shows diffuse dysfunction but with Apical Sparing
An approximately 40 y.o. male was in jail when he reported dyspnea. He was brought to a small local ED where a chest x-ray showed pulmonary infiltrates. He was hypotensive and hypoxic, and a provisional diagnosis of sepsis from pneumonia was made. He had CT pulmonary angiogram which was read as " no PE. " His lactate was 4.6 mEq/L and WBC count 20,000. He was given levofloxacin, thentransferred to a tertiary care center.Upon arrival, his vitals were HR 115, BP 87/53, RR 30, T 37.3, and O2 sat 91% on room air. Breathing was labored, tachypneic. He had cool extremities. ...
Source: Dr. Smith's ECG Blog - September 4, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without
Submitted by Nic Thompson, Written by Pendell Meyers, edits by Steve SmithThis is a long post, but well worth the read because it clearly delineates the difference in patient outcomes between advanced ECG interpretation and STEMI criteria!Dr. Thompson evaluated a male in his 40s with history of CAD s/p MI with PCI years ago, active smoking, HLD, HTN, who presented with chest discomfort and diaphoresis starting when the patient woke up a few hours prior to arrival. The pain waxed and waned until EMS arrived and gave him 325 mg aspirin en route, and had significant relief just prior to arrival. Here was his presentation...
Source: Dr. Smith's ECG Blog - September 2, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Primary prevention of CAD with Aspirin : Why we are asking same research question for over 50 years & still go wanting ?
Thousands of delegates* converge annually in glittering convention centers on a regular basis to present high quality research. It’s all about overflowing seminar halls, stunning speeches , Intense questions , adoring debates , cozy discussions in grand dinner nights . The meet continues further, as news breaks in global TV shows, spreads in non-stop handles of twitter after igniting the face books.
Finally , it ends over the week-end ! (It has to you know ! ) . . . Every one flies back, only to come back next year to ponder “almost the same issue” all over again. (Some times the questions are left unan...
Source: Dr.S.Venkatesan MD - August 31, 2018 Category: Cardiology Authors: dr s venkatesan Tags: Preventive cardiology Primary prevention of CAD Primary prevention studies Public Health Public health issues What is the role of aspirin for primary prevention of cad Source Type: blogs
A Bayer of a Case
A 30-year-old woman was brought in by EMS tearful and reluctant to answer questions initially. Her mother was with her and stated that the patient had been depressed and may have taken some pills in a suicide attempt. Her initial vitals on presentation were a temperature of 99.1°F, heart rate of 128 bpm, blood pressure of132/92 mm Hg, and a respiratory rate of 26 bpm. She had clear lungs and sinus tachycardia on cardiac monitoring. She admitted to having taken "a lot" of aspirin.Initial LabsCBC: WBC of 14, hemoglobin of 14 g/dL, hematocrit of 42%, platelet count of 250,000BMP: Sodium of 132 mEq/L, pot...
Source: The Tox Cave - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Total eclipse of the heart
Written by Pendell MeyersA male in his late 50s had sudden chest pain radiating to the left side and back, with nausea and diaphoresis as well as bilateral finger tingling sensation. He drove himself to the Emergency Department.Here is his ECG on arrival at 11:33 am (unclear whether pain was persistent at this time, or if it had decreased since onset):What do you think?There is a small amount of STE in II, III, and aVF, but there is not clear STD or T-wave inversion in aVL. There is STD in V2 and V3 which must be assumed to be abnormal unless proven otherwise by a baseline ECG. The T-waves in V3 and V4 are not definitively...
Source: Dr. Smith's ECG Blog - August 30, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
A strong doctor-patient relationship: why it matters
Writing in Annals of Family Medicine a few years ago, Chicago obstetrician Benjamin P. Brown vividly described his mentor’s interaction with a patient who had just emigrated from Mexico and had no family support. “When he asked earnestly how she was doing, her hard-won defenses seemed to crumple, and all of a sudden she was sitting on the exam table, sobbing,” Brown wrote. “I watched, rapt, as Dr. Gonzales — or Wilfredo, as he insisted I call him — reached out a steady hand to squeeze her shoulder and offered a tissue.”
Did a tissue and a squeeze on the shoulder ensure a better outcome for that woman?...
Source: Kevin, M.D. - Medical Weblog - August 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-bartley-bryt" rel="tag" > A. Bartley Bryt, MD, MPH < /a > Tags: Physician Primary Care Source Type: blogs
Fight Aging! Newsletter, August 20th 2018
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - August 19, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
MKSAP: 77-year-old woman with frequently fluctuating INRs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.
On physical examination, vital signs are normal, as is the remainder of the examination.
Which of the following is the most appropriate next step in management?
A. Dail...
Source: Kevin, M.D. - Medical Weblog - August 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Oncology/Hematology Source Type: blogs
Evidence for Spermadine to Modestly Slow Aspects of Aging in Humans
Spermadine is one of many compounds identified to date that trigger some of the same beneficial stress response mechanisms that are upregulated by calorie restriction. For example, spermadine is known to boost the operation of autophagy, a collection of cellular maintenance processes responsible for recycling damaged structures and unwanted proteins. Keeping the level of damage lower means a lesser a chance of generating further detrimental consequences. The outcome, at least in short-lived species, is a longer healthy life span.
Unfortunately, the strategy of enhancing stress responses produces diminishing returns ...
Source: Fight Aging! - August 14, 2018 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
MKSAP: 57-year-old man with type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before implementing significant lifestyle changes and transitioning to insulin therapy from metformin therapy 2 years ago.
His medical history includes coronary artery disease, first-degree atrioventricular block, nonproliferative d...
Source: Kevin, M.D. - Medical Weblog - August 11, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Neurology Source Type: blogs
Tapering Off Buprenorphine or Suboxone pt. 1
Many patients taking buprenorphine live in fear of a dark world around the corner where they will have to taper off the medication. They see horror stories on YouTube posted by people who, for some reason, abruptly stopped the medication and kept a video log of their experiences. My own patients sometimes ask, nervously, if I plan to retire some day. Some have asked what they should do if I ever, say, drop dead.
It needn’t be all that bad. Yes, sudden discontinuation of a typical dose of buprenorphine will result in withdrawal symptoms. But if you taper correctly, your body will slowly reset your toleranc...
Source: Suboxone Talk Zone - August 8, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Buprenorphine receptor actions Suboxone Withdrawal buprenorphine treatment opioid taper stopping suboxone Suboxone withdrawal Source Type: blogs
Tapering Off Buprenorphine or Suboxone pt. 1
Many patients taking buprenorphine live in fear of a dark world around the corner where they will have to taper off the medication. They see horror stories on YouTube posted by people who, for some reason, abruptly stopped the medication and kept a video log of their experiences. My own patients sometimes ask, nervously, if I plan to retire some day. Some have asked what they should do if I ever, say, drop dead.
It needn’t be all that bad. Yes, sudden discontinuation of a typical dose of buprenorphine will result in withdrawal symptoms. But if you taper correctly, your body will slowly reset your toleranc...
Source: Suboxone Talk Zone - August 8, 2018 Category: Addiction Authors: admin Tags: Buprenorphine receptor actions Suboxone Withdrawal buprenorphine treatment opioid taper stopping suboxone Suboxone withdrawal Source Type: blogs
Tapering Off Buprenorphine or Suboxone pt. 1
Many patients taking buprenorphine live in fear of a dark world around the corner where they will have to taper off the medication. They see horror stories on YouTube posted by people who, for some reason, abruptly stopped the medication and kept a video log of their experiences. My own patients sometimes ask, nervously, if I plan to retire some day. Some have asked what they should do if I ever, say, drop dead.
It needn’t be all that bad. Yes, sudden discontinuation of a typical dose of buprenorphine will result in withdrawal symptoms. But if you taper correctly, your body will slowly reset your toleranc...
Source: Suboxone Talk Zone - August 8, 2018 Category: Addiction Authors: admin Tags: Buprenorphine receptor actions Suboxone Withdrawal buprenorphine treatment opioid taper stopping suboxone Suboxone withdrawal Source Type: blogs
Sudden Chest pain and SOB with a Wide Complex Tachycardia
This case was contributed by a medic who wishes to remain anonymous (his comments are inred).This was a 60 something male who called for sudden onset of severe chest pain and dyspnea. No medical history or medications. Upon arrival he was in extremis with altered mentation, cyanosis and diaphoresis . We were unable to get an initial ECG due to diaphoresis but the pulse ox showed a sat of 53 and a rate of 170 without palpable radial pulse. Initial ECG:There is a wide complex tachycardia at a rate of 148.What is it?Smith Interpretation:It is fast and the patient is in extremis,so electricity is ...
Source: Dr. Smith's ECG Blog - August 5, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
