Life: is to be actively lived

31/08/2009

Destiny rarely follows the pattern we would choose for it and the legacy of death often shapes our lives in ways we could not imagine. Death comes to everyone in their time – to some a parting, to some a release. We who are nearest fo with them up the long golden stairs – up  – up. A trumpet shrills – a gate clangs and we are left standing without. Then down the long stairs we retrace our steps to earth – an earth that is all numb and still – so still that one hears strange sounds –  catches strange vagrant notes on one’s heightened senses. But small hands are tugging and voices are insistent.

“Will he ever come back from that other place?”

“Oh no, he doesn’t want to come back!”

“Does he like it there?”

“Oh yes, he loves it”

“Well then that’s good.” And happy laughter rings through the tall green pines and along the rocks and sandy beaches by the sea.

No one grudges him his place in the sun.

Note: the author, widowed in 1927 packed her five children onto a 25-foot boat and cruised the coastal waters of Bristish Columbia, summer after summer.

Blanchet, M, Whylie. 1968. The Curve of Time. Gray’s Publishing, British Columbia, Canada p. 161-162.

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Autoimmune Hepatitis

31/08/2009

Auto = Self

Hepa– = Refers to the liver

-itis = inflammation of

 

Etiology:

Autoimmune is caused by the body’s own immune cells attacking the liver. 

The more commonly known form of hepatitis is of pathological origin due to infection by the body with the a virus such as the Hepatitis C virus. 

  • This disorder is chronic
  • Causes cirrhosis (scarring and hardening) of the liver.
  • May lead to liver failure

Symptoms:

  • an enlarged liver
  • jaundice
  • itching
  • skin rashes
  • joint pain
  • abdominal discomfort
  • spider angiomas, or abnormal blood vessels, on the skin
  • nausea
  • vomiting
  • loss of appetite
  • dark urine
  • pale or gray-colored stools
  • Diagnosis:

    • Blood test to detect the presence of  liver enzymes in the blood
    • Blood test to detect the presence of autoantibodies

    Symptom Management/Treatment:

    • Corticosteroids
    • Immunosuppressants

    National Institue of Health. 2008. Autoimmune Hepatitis. Retrieved August 31, 2009 from http://digestive.niddk.nih.gov/ddiseases/pubs/autoimmunehep/


    Electromechanical dissociation (Pulseless Electrical Activity)

    29/08/2009

     

    Electromechanical dissociation, Non-Perfusing Rhythm or  Pulseless Electrical Activity is a cardiac condition whereby the electrocardiogram is showing a heart rhythm that should be producing a pulse, however does not.

    Etiology:

    Hypovolemia – a state of decreased blood volume.

    Electromechanical dissociation. Retrieved August 29, 2009 from http://apma-nc.com/PatientEducation/electromechanical_dissociation.htm


    Impetigo

    28/08/2009

    Etiology:

    Impetigo is a very contagious infection of the skin. Impetigo is caused by Staphylococcus or Streptococcus bacteria.

    Symptoms:

    localized redness develops into small blisters that gradually crust and erode.

    Affected Populations:

    This condition is most common in children 2-6 years of age.

    The homeless are vulnerable to bullous and non-bullous impetigo. It also occurs when breaks in the skin allow bacteria to enter. However, the skin does not have to break to develop impetigo. Complicated impetigo may result in cellulitis.


    Virtilago (leukoderma)

    27/08/2009

    Virtilago is an autoimmune disease. Smooth, white patches appear on the skin in regions where the body’s immune system has attacked and caused the loss of melanocytes, the pigment-producing cells. 


    Systemic Lupus Erythematosus (SLE)

    26/08/2009

    Lupus erythematosus is an autoimmune disorder.  It is a chronic inflammatory collagen disease. The disease affects the connective tissue, the skin and joints.

    1. Pain in the joints of the hands, arms, shoulders, feet, legs, hips or jaws which may move from joint to joint and may be accompanied by swelling, redness and heat

    2. A red rash across the upper cheeks and over the bridge of the nose

    3. An unusual and excessive reaction to sunlight

    4. A red scaly rash on the face, scalp, ears, arms or chest.

    5. Small, usually painless sores found on the moist lining of the nose or mouth.

    6. Chest pain that worsens when breathing or lying down.

    7. Weight gain and swelling of the feet and legs which is caused by decrease in kidney function

    8. Seizures or severe mental illness

    9. A decease in the number of red or white blood cells or platelets.

    10. Presence of certain factors in the blood, specifically the LE cell, anti-native DNA auto antibodies, anti-Sin auto antibodies or a positive test for syphilis. (A falsely positive syphilis test indicates an abnormality in the immune response.  There is no relationship between lupus and venereal diseases.)

    11. Presence of antinuclear antibodies (ANA) in the blood

    Treatment and Symptom management:

  • Nonsteroidal anti-inflammatory drugs. Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin, others) may be used to treat a variety of signs and symptoms associated with lupus. NSAIDs are available over-the-counter, or stronger versions can be prescribed by your doctor. Check with your doctor before taking over-the-counter NSAIDs because some have been associated with serious side effects in people with lupus. Side effects of NSAIDs include stomach bleeding and an increased risk of heart problems.
  •  

  • Antimalarial drugs. Although there’s no known relationship between lupus and malaria, these medications have proved useful in treating signs and symptoms of lupus. Antimalarials may also prevent flares of the disease. Hydroxychloroquine (Plaquenil) is the most commonly prescribed antimalarial. Side effects of antimalarial drugs include vision problems and muscle weakness.
  •  

  • Corticosteroids. These drugs counter the inflammation of lupus, but can have serious long-term side effects, including weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy. To help reduce these risks, your doctor will try to find the lowest dose that controls your symptoms and prescribe corticosteroids for the shortest possible time. Taking the drug every other day can also help reduce side effects. Corticosteroids are sometimes combined with another medication to help reduce the dose, and therefore the toxicity, of both drugs. Taking calcium and vitamin D supplements while using corticosteroids can reduce the risk of osteoporosis
  • Rogers, L, I. 2006.  Systemic Lupus Erythematosus. Retrieved August 26, 2009 from http://www.bio.davidson.edu/Courses/Immunology/Students/spring2006/Rogers/lupus.html


    Cardiac (Pericardial) Tamponade

    25/08/2009

    Cardiac tamponade results when the heart is compressed by an abnormal accumulation of fluid in the pericardium, the membranous sac enclosing the heart. Significant increase in pressure on the heart due to dramatically elevated fluid levels will impede the hearts ventricles from properly filling with blood. This will decrease cardiac output resulting in a lower volume of oxygenated blood being delivered to the body`s tissues.

    Cardiac tamponade in a newborn with respiratory distress syndrome who developed pneumopericardium associated with barotrauma from mechanical ventilation. Chest radiograph shows pneumopericardium with cardiac tamponade.

     

     

     

    Jauhar, Sandeep. 2008. Intern : a doctor’s initiation. Farrar, Straus and Giroux, New York.