Trousseau sign of malignancy

a medical sign found in certain cancers that is associated with venous thrombosis and hypercoagulopathy.

related to factors secreted by the tumors.

malignancy-associated hypercoagulable states, the blood may spontaneously form clots in the portal vessels, the deep veins of the extremities (such as the leg), or the superficial veins anywhere on the body.

These clots present as visibly swollen blood vessels, vasculitis.

Too many times I’ve seen those ghosts before

No darling, I can’t take your thirst away
but I can show you to the sea.
While you’re walking on your path unknown, say, will you think of me.

Well time will tell,
I wish you well.

Too many times I’ve seen those ghosts before:
I’ve watched them dance around your bed.
I would give you all of my sleep filled nights,
just to see you get some rest.

It’s not my place to try to fill that place,
but I can wish you well.
Oh, I wish you well.

In times like this
I start to ponder all the thing we’ll miss.
We can always reminisce.

When you come back from the great beyond,
with moonlight in your hair,
I will meet you where that dark road ends,
and it won’t be long until we’re there.

Once, once again,
we’ll talk about way back when.
Oh but until then, I wish you well.
Oh, I wish you well.

Justin Hines – I wish you well

Tinel’s sign

 a tingling or pins and needles sensation in the distal end of a limb when percussion is made over the site of a divided nerve.

It indicates a partial lesion or the beginning regeneration of the nerve.

Ototoxicity

Having a toxic effect on the structures of the ear, especially on its nerve supply.

Resulting in damage to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, by a toxin.

Infusion of certain medications (eg. Lasix) by IV push at rates higher than recommended may result in ototoxicity.

A line already written

 

Above the mountains
the geese turn into
the light again

Painting their
black silhouettes
on an open sky.

Sometimes everything
has to be
inscribed across
the heavens

so you can find
the one line
already written
inside you.

Sometimes it takes
a great sky
to find that

small, bright
and indescribable
wedge of freedom
in your own heart.

Sometimes with
the bones of the black
sticks left when the fire
has gone out

someone has written
something new
in the ashes of your life.

David Whyte – The Journey

Tabes dorsalis

a slow degeneration of the sensory neurons that carry information due to demyelination. The degenerating nerves are in the dorsal columns.

Etiology:

untreated Treponema pallidum, syphilis, infection

Vasovagal syncope (Vasovagal reaction, episode or attack)

Condition related to stimulation of the vagus nerve.

Vagus nerve:

• a mixed nerve that innervates the pharynx and larynx and lungs and heart and esophagus and stomach and most of the abdominal viscera.
• it is the tenth cranial nerve.
• originates at brainstem

Many vasovagal syncope conditions fall under this condition – they are differ in their mechanism.

Some common mechanisms:

Standing up very quickly

Stress

Any painful or unpleasant stimuli, such as:

• Having blood drawn
• Experiencing intense pain
• Experiencing medical procedures with local anesthesia
•  Venipuncture
• Giving or receiving a needle immunization.
• Watching someone give blood
• Watching someone experience pain
• Watching or experiencing medical procedures
• Sight of blood
• Occasions of slight discomfort, such as dental and eye examinations
• Hyperthermia, a prolonged exposure to heat
• High temperature, either in the environment or due to exercise

Arousal or stimulants e.g. sex

Sudden onset of extreme emotions

Hunger

Nausea or vomiting

dehydration

Micourination syncope or defecation syncope

Abdominal straining or ‘bearing down’

Swallowing (‘swallowing syncope’) or coughing (‘cough syncope’)

Pressing upon certain places on the throat, sinuses, and eyes, also known as vagal reflex stimulation when performed clinically.

Water colder than 10 Celsius (50° F), or ice that comes in contact with the face, that stimulates the mammalian diving reflex

High altitude

Use of certain drugs that affect blood pressure, such as amphetamines 

Intense laughter

Pathophysiology:

In people with vasovagal episodes, the episodes are typically recurrent, usually happening when the person is exposed to a specific trigger.

The initial episode often occurs when the person is a teenager, then recurs in clusters throughout his or her life.

Prior to losing consciousness, the individual frequently experiences a prodrome of symptoms such as lightheadedness, nausea, sweating, ringing in the ears (tinnitus), uncomfortable feeling in the heart, weakness and visual disturbances such as lights seeming too bright, fuzzy or tunnel vision.

These symptoms last for at least a few seconds before consciousness is lost (if it is lost), which typically happens when the person is sitting up or standing.

When sufferers pass out, they fall down (unless this is impeded); and when in this position, effective blood flow to the brain is immediately restored, allowing the person to wake up.

The autonomic nervous system’s physiologic state  leading to loss of consciousness may persist for several minutes, so:

1. If sufferers try to sit or stand when they wake up, they may pass out again;
2. The person may be nauseated, pale, and sweaty for several minutes.

resulting in simultaneous enhancement of parasympathetic nervous system (vagal) tone and withdrawal of sympathetic nervous system tone.

This results in a spectrum of hemodynamic responses:

1. On one end of the spectrum is the cardioinhibitory response, characterized by a drop in heart rate (negative chronotropic effect) and in contractility (negative inotropic effect) leading to a decrease in cardiac output that is significant enough to result in a loss of consciousness. It is thought that this response results primarily from enhancement in parasympathetic tone.
2. On the other end of the spectrum is the vasodepressor response, caused by a drop in blood pressure without much change in heart rate. This phenomenon occurs due to vasodilation, probably as a result of withdrawal of sympathetic nervous system tone.
3. The majority of people with vasovagal syncope have a mixed response somewhere between these two ends of the spectrum

Don’t we all?

 

We all have our targets

in life

things we want to accomplish

at times the targets blur

clouded from our sights

by indecision

fears

doubts

or more pressing priorities

that hem us in

but sooner or later

they reappear

and we re-awaken

once again

to something stirring

inside

inspired

like the child to reach out

for what is just beyond

and not quite yet

in our grasp

then we remember to breath again

and our sight clears

rejuvenated from such

a stagnant apneaic pause

and we begin shooting

slow and steady

breathing as we fire

with each round spent

we are freeing ourselves

from the doubt,

the stagnating indecision

the inaction

calm and firing

all that came before

merely practice

until that bullet

hits it target

and day light shines

back at us

through the bull’s eye mark

Musset’s sign

Musset’s sign rhythmical jerking of the head in aortic aneurysm (abnormal dilation of a section of the aorta) and aortic insufficiency.

McMurray sign

  occurrence of a cartilage click on manipulation of the knee; indicative of meniscal injury.