On a more positive note, the anniversary of a disaster or traumatic event also can provide an opportunity for emotional healing.

inflammation of the glomeruli of the kidney; characterized by decreased production of urine and by the presence of blood and protein in the urine.

 The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical medications, particularly neuroleptics.

Work like you don’t need the money, love like you’ve never been hurt and dance like no one is watching.

- Randall G Leighton

Abnormal involuntary movements which primarily affect the extremities, trunk, or jaw that occur as a manifestation of an underlying disease process. Conditions which feature recurrent or persistent episodes of dyskinesia as a primary manifestation of disease may be referred to as dyskinesia syndromes

Suddenly

we have come to a

breathtaking,

bone shattered conclusion

that there is nothing else

yet everything

is captured

with beautiful simplicity

in the here and now.

Methemoglobin is a form of hemoglobin that does not bind oxygen. When its concentration is elevated in red blood cells, tissue hypoxia can occur.

Normally, methemoglobin levels are <1%, of total blood hemoglobins.

Etiology:

1. congenital methemoglobinemia – NADH methemoglobin reductase mutation
2. acquired methemoglobinemia -

•  exogenous oxidizing drugs and their metabolites
• benzovaine
• dapsone
• nitrates
•  may accelerate the rate of formation of methemoglobin up to one-thousandfold, overwhelming the protective enzyme systems and acutely increasing methemoglobin levels.

Transitional cell carcinoma (also called urothelial carcinoma)

• urothelial cells that line the bladder
• noninvasive flat carcinoma and noninvasive papillary carcinoma

Squamous cell carcinoma

• 1-2% of bladder cancers
• originate from cells that line the bladder
• invasive

Adenocarcinoma

• less than 1% of bladder cancers
• originating from duct or gland-like tissues
• invasive

Small cell carcinomas

• less than 1% of bladder cancers
• rare and highly aggressive

Manifestations

1. gross and microscopic hematuria
2. Urinary frequency
3. Urinary Urgency
4. Dysuria

Treatment:

1. Edoscopic resection for superficial lesions
2. Cystectomy and resection of pelvic lymph nodes
3. Electrocautery – Diathermy
4. radiation
5. chemotherapy
6. immunotherapy – instilled directly in the bladder

We go where

the light of the candle goes

after you blow it out…

The smoke lingers

intensifies

then dissipates.

What is this journey we call life?

I don’t know

A journey of the heart,

full of greetings and departures.

Death,

the end of the journey,

Birth,

the start.

Of laughter,

our sense of humor

our heart’s defense

against the misery we face.

What of sorrow?

Someone wise once said:

it opens the heart,

it softens it,

so we love more deeply than before

Of our time here,

of this I am certain:

There is no rewind,

no fast forward,

no repeat.

This is your life

your time,

what will you do with it?

Manifestations:

1. loss of balance
2. lunging forward when mobilsing
3. speed-walking
4. knocking into objects and people
5. falls.
6. personality changes
7. general slowing of movement

Later manifestations:

1. dementia – loss of inhibition and ability to organize information
2.  slurring of speech
3. dysphagia
4. difficulty moving the eyes, particularly in the vertical direction (accounts for some of the falls experienced by these patients as they are unable to look up or down)
5. poor eyelid function
6. contracture of the facial muscles
7. a backward tilt of the head with stiffening of the neck muscles
8. sleep disruption

Treatment and Management:

• symptom management
• The average age at symptoms onset is 63 and survival from onset averages 7 years with a wide variance.