Monday, October 28, 2019

An Alternative Treatment for Aneurysms

                

Many aneurysms are very small, but you get the idea here.





           Some years ago, during about a break of about a week in college, one of my friends, developed a severe headache, and before the day was over, had surgery for a bleeding aneurysm, in a community hospital.  As a nursing major, I was flabbergasted that he'd left for the holiday, and almost immediately developed an almost blinding headache while driving, and chosen to go to the ER. From there, a neurosurgeon saw him and off he went for an aneurysm clipping, which is certainly brain surgery. A couple of weeks later, once back in school, he seemed fine, if perhaps a little more outgoing following his near brush with death. He continued to do well afterward.

                      The clipping of an aneurysm, using a metallic clip of some design, is the surgery with which most of us are familiar. An aneurysm is a bubble in the arterial system of the brain, that can either remain small and often undetected for many years. Most aneurysms are in fact detected when a CT or an MRI is done for some other reason entirely.  A bleeding aneurysm can be very dangerous. A bleeding aneurysm carries with it a 40% chance of death and an 80% chance of disability.  In addition to releasing blood in a closed space, a ruptured aneurysm can cause a vasospasm or narrowing of an artery of the brain, and this complication can also be devastating, and this alone may cause death.

                     At one time, the permanent clipping of an aneurysm was the only treatment for it. However, in about 1991, neurosurgeons found that they could treat some aneurysms using a "minimally invasive technique".  In a hospital suite, they found they could insert a lengthy and fairly large catheter into the arteries of the groin and thread them up toward the patient's brain.  Since many aneurysms patient to patient, occur in similar locations, techniques to access them from the inside were mastered.  Neurosurgeons who specialized in this technique found that using fluoroscopy allowed them to track the progress of floating the catheter, and that by depositing very thin platinum wires, either interrupted or continuously, inside the aneurysm itself, they could cause it to clot off, seal and become very unlikely to leak in future.  At first, this allowed a different technique to be used for patients who simply weren't well enough for brain surgery.  The technique was also only used for specially selected or aneurysms, at that time.

                   In the present day, the medical literature still considers the interior embolization of aneurysms to be a slightly less effective modality than clipping the aneurysm from the outside.  However, this may not be true for much longer.  Enough of these types of embolization, coiling or stenting of aneurysms has been done so that data can be studied.  It seems that some neurosurgeons who perform this technique have never had an aneurysm leak or rupture following their platinum wire coiling of it.  In fact, almost all aneurysms may be potentially treated using the minimally invasive method as described under present US medical standards.

                   What can you do to avoid aneurysms ?  The ones that are simply a genetic weakness and error don't give us much of a chance to avoid them. However, the aneurysms that we acquired as adults from untreated or poorly treated hypertension or high blood pressure, could potentially be avoided.

                 A patient who has an embolization may be given general anesthesia. Often though, they are medicated, but are awake and cooperative through the procedure. Please know that even if a patient has an aneurysm embolization that they will still remain in ICU for about a day after the procedure. They will still need follow up.  They should still have a follow up examination every year or more with their neurosurgeon on the timetable he/she recommends.  However, the less invasive procedure should take less time, be safer, cheaper, and should get you or your loved one back to work and functioning again more quickly that brain surgery would.

                  Yes, this is the kind of procedure most survivalists would choose !


 http://brainavm.oci.utoronto.ca/malformations/embo_treat_aneurysm_index.htm







                  

Tuesday, September 10, 2019

Looking at the Eighteenth Anniversary of 9-11

         
Ginger Ormiston


 
    Some years ago, when I was in high school, I was involved in musical groups and in singing, and gigs outside the realm of school. Even in my teens, I spent some time working for New York based record companies. For a time, most everything I did revolved around music. In school, I was in the accelerated classes for everything, including math class, which probably hadn't been the wisest placement for me. Just because I was articulate, didn't mean I was particularly mathematical or even logical at the time. I clearly remember one day when the instructor had spent too much time explaining that day's math to me, that one of the stars of that class, a lovely blonde girl named Ginger, told me that I should spend less time writing music, and more time on my math.  Of course, she was right, but I was fourteen at the time and couldn't envisage ever using the type of math we were being taught. Later that semester, I was eventually dropped to an average level math class, a placement  I sincerely deserved at the time.

           Of course, I moved on. Life went so quickly. Before you knew it, I was in college, then graduating, then in a first and second job. Then, getting married, then having children. Then, I worked in a number of careers, and I have worked hard to explore a number of things which interest me.  Although I have kept in touch with a few people from high school, and a few from college, I haven't spent much time looking back. The present has always been busy enough.  

          There are certain days where most of us remember where we were when they occurred.  I remember 9-11 quite clearly, as do many people. I was assembling documents for a trip to Russia and I had paperwork all over our bedroom, when I saw the first plane hit the first building on television that morning.  My husband called me just after from work in Virginia, just after it happened. The news just got worse and worse that day. I listened to everything on the news. I had grown up forty miles from The World Trade Center, in a rural area where a fair number of people commuted to New York City for their jobs. It was likely that I knew some of the people who'd died.  I prayed for them, and I listened, but I never heard names I thought I recognized. 

          In the days that have passed, we raised our kids, sent them to college, built two farms, lost both sets of our parents, and have both enjoyed and endured the challenges life brings to most of us. Many changes, positive and negative ones have since taken place in our country.

           It has only been in the last few weeks that I realized that a number of classmates from high school have died.  While googling a picture of one of those high school classmates, I saw a perfect picture of Ginger, the young girl whose sage advice regarding her favorite topic,mathematics, I had not heeded until later in my life.

             I looked for additional information, and I found that another former classmate of mine, now a writer, Bonnie Brewer Cavanaugh, had written a lovely article on Ginger.   Known to me as "Ginger O", Ginger was truly a gifted student in mathematics. In high school she was a stellar student and was also in band. She was an exchange student to Puerto Rico, I believe. After high school, she attended Rutgers University and got a B.S. in Electrical Engineering. Afterward, she attained a Master's degree in the same, at Cornell. She had a number of great jobs before marrying her husband Jim Kenworthy. They had a son and a daughter, and settled in a loft they bought in New York City. Jim was still taking one of the kids to school that day while Ginger went to her fairly new job on time. Jim wrote that he saw the first plane hit the building while he was walking to work.  Had he been on time, their children could have lost both of their parents that day.

               When terrorists attacked that day, they took Ginger from her husband Jim, from her son and daughter, from her parents, from her two sisters, and from countless people who's gone to school, worked with her, or knew her from her other activities. She became an exceptional woman, and her life was cut too short.

 
The Kenworthy Family


 

               Tomorrow, when we talk, once again, about 9-11, and grieve it once again, please think of Virginia Ann Ormiston Kenworthy, and pray for her and her family. I read that last year, Ginger's mom died, and so now she is with both of her parents.

               I wish blessings and especially comfort to all who are missing  friends or family as a result of the happenings of 9-11, that day and afterward.
           



     This is Bonnie Brewer Cavanaugh's article on Ginger Ormiston-Kenworthy.      




Wednesday, July 31, 2019

Iosat Updates from the FDA






               Some years ago I posted indications for use on Iosat, in the event of a radiologic emergency. The concern with Iosat is that some people may think that if you have Iosat, that you are protected from radiation, and this is simply not true. Iosat aid you in the protection of your thyroid in the event of a radiologic emergency of some kind. It does not protect anything else at all. It concerns me that some people may think that simply owning the Iosat in some way protects them from needing to evacuate in such emergencies.

               The FDA has released new guidelines for Iosat.   I am including the link here.   The reality is, that if you need to use Iosat, or your family members do, then you need to evacuate as soon as is reasonably possible.

 https://www.fda.gov/drugs/bioterrorism-and-drug-preparedness/frequently-asked-questions-potassium-iodide-ki




Thursday, July 4, 2019

Happy Independence Day to All



  Sending wishes to the readers of our blogs and our books, and their families, for a safe, peaceful, and memorable Independence Day.  Please stay safe and vigilant.





Sunday, March 31, 2019

Information on the Asian Longhorned Tick

             Since 2017, the Asian longhorned tick has been found within the United States. This is concerning information. Ten U.S. states are presently impacted. New York, New Jersey, Virginia, and Tennessee and East Coast states are impacted.  This tick is known to carry a number of diseases including a thrombocytopenic fever that is normally seen in Asia.  Because this tick is new here, it is suspected that it may carry, in time, the diseases the other ticks carry such as Lyme Disease, Erlichiosis, and others. It also represents significant risk to deer, dogs, cats and other animals, except perhaps mice.  This is authoritative information


https://www.youtube.com/watch?v=1myb4fNLUO4




Thursday, March 14, 2019

What is Tranexamic Acid ?

                A recent article intended for civilian and military physicians in the journal of the British Royal Army Medical Corps discussed the use of something called TXA in  major trauma cases. I have never administered TXA or Tranexamic Acid, so I was interested as to what this was, and the mechanism of why it works in improving patient outcomes.

               Tranexamic Acid is a synthetic analog of the amino acid lycine. It was discovered in 1962 by Utako Okomoto, a female medical doctor who died in 2016 when she was 98 years old. This drug, which comes in a glass vial, when administered correctly can help to prevent post-partum hemorrhage, deadly episodes of bleeding in those with hemophilia who are having dental procedures, and prevent a fatality due to simple hemorrhage on the battle field or in civilian sourced trauma. It also can be helpful for epistaxis, that severe dripping nosebleed that prior to this needed to be treated by tightly packing the nose and sinus area behind it, by an ER physician or an ENT.  There are also some cases of hemorrhagic menses that can be treated with TXA.

              Those with acquired bleeding disorders which have occurred as a result of ingestion of an anticoagulant of some type may also benefit from this drug. (Heparin or coumadin overdosage patients, for example.)

                There are some side effects, and a potential for seizures, but since 2009, this drug has been on the listing of the World Health Organization's listing of Essential Medicines.  It is also available in oral form.


This is additional information for physicians, nurses, EMTs or anyone who would like to read more about this interesting and exciting drug.

              https://jramc.bmj.com/content/164/3/170?fbclid=IwAR2WMivWOXHyNcLDHwlGApw5BMowx_Mb_U3CdjAkzoyHpd56jAOKGgMPBXg

https://en.wikipedia.org/wiki/Tranexamic_acid

Thursday, January 3, 2019

What is Blastomycosis ?

This patient has ARDS, and is waiting for a diagnosis.



               Not everything you get that causes a respiratory infection is a virus or a bacteria.  Today, I have chosen to pass along some information about Blastomycosis.

               Blastomycosis, also known as Gilchrist's Disease, is a fungal disease, that is found in dirt and wet decaying organic matter. It is also known as "North American Blastomycosis".  It can infect the skin, and can affect the skin of dogs and cats also, but most often, we hear about Blastomycosis after it is inhaled, and then within a number of days it creates a pneumonia.  I worry about this kind of thing rather a lot because I am allergic to molds, and when I provide hay to alpacas, horses, sheep or others, I worry that there are varietal molds in the hay, and sometimes, there are.

              In North America, it is most often found in :

      Southern Canada, Upstate, New York, The Ohio and Mississippi River Valleys, the US Mid-Atlantic and Southeast, and the Northern Mid-west.  There is also a version which afflicts Africa and the Middle East.

              The subject inhales the buds of this fungus, and then it grows and may spread.  It is an opportunistic infection, which means that most often we expect the patient to have something else going on that allowed them to become infected with this fungus.  It is possible for this infection to spread throughout the body including the spine, the brain,  and the bone marrow.  It can cause a brain abscess and meningitis.  It is diagnosed through chest x-ray and then lab confirmation of the fungus through samples. There are some very specific hospital lab tests for it now also. It can also create some rather impressive and frightening looking skin lesions.

               A systemic infection with blastomycosis can be treated by an inpatient hospitalization, and with a number of treatments with a drug called Amphotericin-B.   This can become a life threatening disease, leading to adult respiratory distress syndrome (ARDS) especially by virtue of the fact that it can become quite advanced before the diagnosis is made, and because this may not be the first thing your physician was considering.

             It is wise to own facial masks which one should use when working with hay, dirt, near rivers, or anywhere where you are likely to inhale spores of any kind.  Change your disposable mask fairly often and wash and dry your cloth masks regularly.  I wear one whenever I am cleaning or sweeping in the barn or any enclosed space.

             It is possible to get a milder version of this illness which can be treated on an outpatient basis with oral anti-fungals.

              I wanted to make my readership aware of this, because although this does not occur frequently, it does occur, and certainly treatment with antibiotics will not improve it, in fact, it may well worsen it.

This is additional information for those who wish to read more:


https://www.cdc.gov/fungal/diseases/blastomycosis/health-professionals.html

https://www.cdc.gov/fungal/diseases/blastomycosis/index.html

https://www.merckmanuals.com/professional/infectious-diseases/fungi/blastomycosis

https://rarediseases.org/rare-diseases/blastomycosis/