Hemoptysis Pearls
There was a nice article over at Consultant360.com by Drs. Laren Tan and Samuel Louie on hemoptysis pearls. Learned quite a few things. 200 mls of blood (about a cupful) is enough to fill the dead space in the lungs and is therefore generally considered the minimum amount of blood to make the diagnosis of “massive” hemoptysis. Hemoptysis with chest pain – think pneumonia/pleurisy, PE with pleurisy, pulmonary edema from an MI, or lung cancer Hemoptysis with dyspnea – think either exacerbation of patient’s underlying medical problem or a precursor to respiratory failure Hemoptysis with fever ...
Source: WhiteCoat's Call Room - June 26, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs

Mystery Solved: Which Patients Are Good Candidates For Acute Inpatient Rehabilitation?
Occupational Therapy Environment, Saint Luke's Hospital, WA For most physicians who practice inpatient medicine, acute inpatient rehabilitation facilities are mysterious places with inscrutable admissions criteria. This is partly because physical medicine and rehabilitation (PM&R) has done the poorest job of public relations of any single medical specialty (Does anyone know what we do?), and also because rehab units have been in the cross hairs of federal funding cuts for decades. The restrictive CMS criteria for inpatient rehabilitation have resulted in contortionist attempts to practice our craft in an environmen...
Source: Better Health - June 16, 2014 Category: American Health Authors: Dr. Val Jones Tags: Health Policy Health Tips 60% Rule Acute Inpatient Rehabilitation Acute Rehab Admissions Coordinator Admissions Criteria Admissions Guidance ARF ARU Case Manager CMS Hospitalists Physical Medicine And Rehabilitation PM&R Rule Source Type: blogs

RA meningitis as stroke mimic
Bourgeois P et al.  Rheumatoid arthritis presenting with stroke like episodes. Neurology 2014; 82: 1564-5.    70 yo male presented with series of TIA like events over ten days consisting of right leg more than arm weakness.  He had poorly controlled RA.  MRI was negative for brain parenchyma but there was enhancement of meninges and pachymeningitis.  Meningeal biopsy was positive and patient was successfully treated by Solumedrol 1 gram per day followed by 1 mg/kg/day prednisone, tapered over months with no recurrence.    Other reported presentations of RA meningiti...
Source: neurologyminutiae - May 17, 2014 Category: Neurologists Source Type: blogs

Uveomeningeal syndromes: ABRA (Amyloid beta related angiitis )
This reported case had uveomeningeal findings clinically and on MRI.  Diagnosis by biopsy aND MAY BE AUTOIMMUNE AND RESPOND TO IMMUNOTHERAPY IN THIS CASE PREDNISONE 60/ DAY AND CELLCEPT  1500 BID RESULTED IN IMPROVEMENTSEPARATE ARTICLENeurology 2013; 81: 1596-1603ABRA characteristics of patients:  Authors from Mayo compared  78 patients, 40 with CAA (no inflammation) and 28 with granulomatous vasculitis (ABRA) , 10 with CAA related inflammation, and 118 matched patients with PCNSV with AB seen over 25 years.  ABRA patients were older, had more altered cognition, seizures and spells, gado positive l...
Source: neurologyminutiae - April 4, 2014 Category: Neurologists Source Type: blogs

Vaccine-Induced Tissue Scurvy Globally Misdiagnosed as Child Abuse
Conclusion In trying to help falsely accused parents worldwide, I am currently aware of at least seven falsely accused parents whose children became ill after they received multiple vaccinations. In four of these cases, tests revealed that, far from being abused, the children had been suffering from the autoimmune disease tissue scurvy. Why are governments around the world burying their heads in the sand and refusing point-blank to investigate this atrocity? INNOCENT parents are being locked up on a daily basis, accused of the most horrendous crimes, and it seems as if no one actually cares. The evidence speaks for itself:...
Source: vactruth.com - March 19, 2014 Category: Health Medicine and Bioethics Commentators Authors: Christina England Tags: Christina England Top Stories adverse reactions Dr. Michael Innis shaken baby syndrome the truth about vaccines tissue scurvy Source Type: blogs

Dogs And Cows And Toxic Vials, That’s What Vaccines Are Made Of!
Conclusion It is apparent that our vaccinations include some very strange and unsavoury ingredients. The three single vaccines were certainly not the only vaccines I came across containing parts of animals, humans and insects. In fact, I found a huge list of them on a PDF which I have included as extra research. For some reason, many parents are perfectly happy to have their tiny babies vaccinated with everything from insect cells to pigs’ gelatin, without a moment’s hesitation, arguing that the vaccines are to protect their children and keep them strong and healthy. Others remain totally unaware of the vaccine...
Source: vactruth.com - December 18, 2013 Category: Health Medicine and Bioethics Commentators Authors: Christina England Tags: Christina England Top Stories Adverse Events adverse reactions Measles Vaccine Medi-Mumps MMR mumps vaccine Pavivac rubella vaccine truth about vaccines Source Type: blogs

It's never a good sign when. . . .
It was shaping up to be a pretty good day. I got up a little early, packed my lunch, put the dog outside, left for work on time, and made it to work without incident.Where I walked in to find a patient, destined to be my project for the day, sitting on the floor of his room, screaming. And kicking and tantruming. Like a three-year-old. Refusing to get off the floor. Floods of tears. Demands that we call varied and sundry people.I've got such a hangover from that day that I still can't form complete sentences.Here's all you need to know: functional exam, drug-seeking, requesting Dilaudid (of course). Fourteen chart notes by...
Source: Head Nurse - November 7, 2013 Category: Nurses Authors: Jo Source Type: blogs

NYC Mayor is Calling a Meeting to Force Vaccinate Under 5′s With Two Dangerous Vaccines
Conclusion Surely, unless the mayor of New York City is a qualified doctor or scientist, he should not be recommending the force-vaccination of children as young as six months, no matter how good his intentions are, especially since the two vaccinations he is recommending are possibly completely incompatible with one another and could possibly lead to multiple child deaths in New York City and across America. This is absolutely unforgivable, and in my opinion, he should be severely reprimanded for his actions. I suggest that the public of America join forces and either attend this meeting in person to voice an opinion or s...
Source: vactruth.com - October 21, 2013 Category: Health Medicine and Bioethics Commentators Authors: Christina England Tags: Christina England Top Stories Flumist Fluzone force vaccination Mandatory Vaccination Michael Bloomberg Pneumococcal vaccine mandate Source Type: blogs

Gliadin: The Universal Human Poison
Autoimmunity is the process describing an immune response waged against our own organs. The complex collection of mechanisms consisting of T and B lymphocytes, antibodies, and others, meant to provide protection against viruses, bacteria, and other body invaders, is misdirected against proteins of the body’s organs, such as liver, pancreas, thyroid, or brain. Autoimmune conditions now affect 8% of the American population–it is increasingly looking like diseases of autoimmunity are out of control. Dr Alessio Fasano was recently awarded the Linus Pauling Award, the highest award from the Institute for Functional...
Source: Wheat Belly Blog - October 7, 2013 Category: Cardiology Authors: Dr. Davis Tags: Autoimmunity Gliadin Source Type: blogs

MKSAP: 56-year-old woman with Sjögren syndrome
A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids. On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid gland enlargement without tenderness or warmth, reported by the patient to be progressive over several months, with asymmetry of the parotid glands. Laboratory stu...
Source: Kevin, M.D. - Medical Weblog - October 5, 2013 Category: Family Physicians Tags: Conditions Cancer Rheumatology Source Type: blogs

Marijuana and Strokes: Medical Reality or Scare Story?
Heavy tokers may be at higher risk, but alcohol is the hidden confounder. Young people don’t suffer from strokes, as a rule. And when they do, at least half the time there is no obvious cardiovascular explanation. So it’s not surprising that drugs are often invoked as the culprit. A New Zealand study earlier this year once again raised the specter of a possible link between stroke and marijuana smoking. As reported by Maia Szalavitz at Time Healthland, the confounding issue, as is typical of such studies, is the coexisting use of other drugs, like alcohol and cigarettes. As Szalavitz writes: The stroke study, whi...
Source: Addiction Inbox - April 7, 2013 Category: Addiction Authors: Dirk Hanson Source Type: blogs