EMERGENCY ISSUES – Page 4

SALT USE AND CARDIOVASCULAR DISEASE AND HYPERTENSION

where to buy provigil in south africa Stroke and other cardiovascular diseases are linked closely to high blood pressure. In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The Barrancas importance of salt intake (sodium chloride) with regard to high blood pressure is well linked. Most of these studies have been a type of case control showing high probable causal relationship. Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue. In the study, persons were given about 2.6 gms or 2.0 gms of salt daily. Another group of placebo was a control also. The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period. This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group.

We have long known this concern of salt and high blood pressure and other cardiovascular diseases. Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day.

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %. In many developing countries however, the personal use is the burden of salt. Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation. More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it. Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products? Dear ol' Mom probably had it right when she said, "Not so much salt!"

So next time you pick up the product, do a salt survey. Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk. The debate appears to be over. Salt can take a toll. Be a wise shopper and a wiser eater.

Salty popcorn with butter anyone? Remember, more fiber, less salt, less trans-fats….Yuk!

DVT – DEEP VEIN THROMBOSIS – POTENTIAL SILENT KILLER – planes, trains, and surgeries

YEARS AGO, MY FATHER RETURNED AFTER SEEING MY GRANDFATHER, FROM THE SMALL HOSPITAL IN THE LITTLE TOWN IN MIN-NEE-SOOO-TAH.

My grandfather had been in the hospital after a minor surgery. Remember years ago, even small procedures were done in the hospital by the general practitioners or early surgeons and patients were held in the hospital for days. Just shortly after my father returned from seeing his father, our telephone rang. I remember seeing his face change and his voice quiver slightly. But dad was a strong man. He said to all of us, a big family, and my mother, that grandpa had "some trouble" and that he needed to go to the hospital right away. Only, not just dad went, but mom went hurriedly along also. Grandpa died that few moments between my dad seeing him, and returning home, about 5-10 minutes. Grandpa died of a pulmonary embolism, a clot in the lungs that travelled from his leg, after that small procedure. Certainly a sudden and quick death, a reality that still exists these days.

Deep vein clot (thrombosis) is a relatively common, and a very serious potential disease. We see those patients in the emergency room, immediate care, and certainly worry about many more. The mortality and further injury (morbidity) from clots in the legs is not in the leg! The risk occurs from associated lung clots (pulmonary embolism) and a rare condition of post-clot syndrom (post-thrombotic syndrome).

There is not one specific symptom or sign that clinches the diagnosis. The elderly have rates of DVTs in the 200/100,000 range while younger people have rates of about 50 per 100K. The clots occur in the higher deep veins of the legs, or from extension of clots in the lower legs – even though this risk is lesser. When clots in the lower leg veins extend, the risk of lung clots goes up. The problem with DVTs creating the lung clot (PE) is that symptoms can range from sudden death to minimal at all symptoms.

In a doctor I knew, his clot formed during a long airplane ride and he lived. In my grandpa's case as told by my father, it was sudden death.

Risks for developing DVTs in the leg veins are:

conditions: cancer, pregnancy, blood disorders, kidney disorders, estrogens, and smoking

stagnant movement: surgery, immobility, paralysis, obesity, extended travel

other: previous DVT or PE increases risk, and trauma increases risk.

If patients have any two or more of these, they really become at risk. Symptoms that patients can feel or see are: swelling of the leg compared to the other side, calf swelling, localized tenderness of the calf or leg, new pain or numbness in the leg. There are other causes of these same symptoms, therefore you should see a doctor without hesitation.

Your doctor will most likely go through the above lists with you. But your doctor will be concerned. Lab tests will be drawn most likely and an ultrasound of your leg will be ordered stat. Usually if both of these are negative, the cause is not a clot. If the ultrasound is positive, you will begin treatment. If the blood test is positive and the ultrasound is negative, you will probably have a repeat ultrasound in about a week.

Treatment consists of starting the pill, warfarin, for "thinning the blood." But this takes days for the body to change. Therefore, almost all patients will need to use injections of a heparin substance that "thins" the blood quickly. Usually, patients will need to be on heparin medicine for 5 days or so, or at least until the pill warfarin reaches a therapeutic level in your bloodstream.

Patients will need to use compression stockings during this time and after the event to minimize risk of recurrence of DVT. These stockings also help prevent the post-thrombotic syndrome of pain, swelling, inflammation that can become a chronic condition.

Risk of recurrence never goes away. That is why proper treatment and post-event planning is so important. Expect to be on medicine for 3-12 months after a DVT or PE. Risk reduction knowledge goes a long way.

TALK WITH YOUR DOCTOR ABOUT CONCERNS AND PREVENTION.

DRUG ERROR – COLCHICINE – POSSIBLY LINKED TO FATALITIES

THIS IS IMPORTANT INFORMATION FOR THOSE PERSONS SEEKING MEDICAL AIDES AND MEDICAL CURES. (REFERENCE CITED.)

(generic photos from tufts.edu and generic medicines)

The Herald – Everett, Wash. – www.HeraldNet.com

Published: Saturday, April 28, 2007

Toxic drug at Portland clinic causes three deaths

Associated Press

PORTLAND, Ore. – Three people in the Pacific Northwest have died after receiving a drug that was erroneously made 10 times more potent than intended, the Oregon State Medical Examiner’s Office said Friday.

ApotheCure Inc., a drug-compounding pharmacy company in Texas, said an employee made a weighing error in the creation of the drug colchicine, which lead to the deaths. Colchicine is commonly used to treat gout, but in these cases it was being given intravenously to treat back pain.

The drug was sent to the Center for Integrative Medicine in Portland, where three people received injections of the defective batch of the drug this spring. All three people, two from Portland and one from Yakima, died between the end of March and beginning of April from the toxic levels of the drug.

The defective doses were sent only to the Portland clinic, ApotheCure said.

The Food and Drug Administration said it is investigating the case but believes the problem has been contained.

The Center for Integrative Medicine has since closed, and representatives from the organization could not be reached.

Colchicine works by stopping cells from dividing, which reduces inflammation in conditions such as gout, said Dr. Rob Hendrickson, associate medical director for the Oregon Poison Center. But in excess doses, the drug stops all cells from dividing – eventually leading to organ failure and death.

The medication is not commonly used anymore and the use as a back pain treatment is less common than for gout.

Gary Osborn, a pharmacist and certified clinical nutritionist for ApotheCure, said the situation could have been contained earlier, but the clinic did not contact ApotheCure until nearly two weeks after the first death. He said the second death occurred before the company was able to complete recalling the batch and sending them a new lot. He said this is ApotheCure’s first incident of this sort.

“We are kind of the leaders in the industry,” Osborn said. “But you know what people say, stuff happens.

Copyright Â©1996-2007.
The Daily Herald Co.
ALL RIGHTS RESERVED.

POISON CENTERS AND TOXINS AND POISONINGS METH to METHANOL to MUSHROOMS – One Call 1-800-222-1222

This is the time of year when lawn chemicals, yard cleanups, and neighborhood events start to be exposed and available to little hands. Certainly many chemicals, including pesticides, herbicides, fuels, and cleaning agents are ubiquitous in homes and garages. But beware. Many of these chemicals are poisonous and dangerous with regard to flammability, explosiveness, and chemical burns.

Each dollar invested in poison centers saves about seven dollars in expenses not needed if the patients go into their doctor, their clinics, or their hospitals. This is a great public health service.

Over the years since the early 60's, the poison centers have become an integral part of the healthcare network. Now with the terrorism issues, the poison centers have become an integral monitoring source of information, as many times calls come to the poison centers early and often, thereby making a grid of what is happening and where it is happening.

For instance, when the bad botulism toxin product that was being used by spas and clinics that were trying to save money by not buying and using the approved botulinum toxin brand, the poison centers were seeing a problem early. Patients across the country, in pockets, were being paralyzed – not just the muscles of the eyebrow, forehead, and other smaller muscles.

The poison centers across the USA now have a single number. Depending on your area code, your call will be forwarded to the center in your area, or the one contracted by your state officials. For instance, Idaho calls go to Denver's poison center. Alaska's poison calls go to Oregon. Washington's poison center gets all of Washington State's calls. This year that number will be around 150,000 calls! Poison calls are answered by an expert group of pharmacists, nurses, Pharm Ds and have backup by physicians specializing in toxicology and poisonings. It is the number that the experts in all fields, from dermatologists to kidney specialists, call when the patient has been poisoned, or is toxic from unknown sources, or when the patient doesn't act or change based upon "normal" disease states.

The goal of Poison Prevention Week is to reduce illnesses, injuries, and deaths due to poisonings; build safer communities; and reduce unnecessary health care costs for everyone.

Here are some ways to be poison cautious:

Obtain syrup of ipecac and keep it in your home – but use it ONLY if instructed to do so by a poison center or physician

Use child-resistant containers and remember, they are not childproof

Keep products in their original containers

Never call medicine candy or take it in the dark

Return products to storage areas immediately after use

Teach children about Mr. Yuk

Put Mr. Yuk stickers on all poisonous products

Call the Poison Center for a free information packet and Mr. Yuk stickers

Keep emergency numbers next to your phone:

1-800-222-1222

What is National Poison Prevention Week?

Public Law 87-319 authorizes the President to designate annually the third week in March as National Poison Prevention Week. This act of Congress was signed into law on September 16, 1961, by President Kennedy, after which the Poison Prevention Week Council was organized to coordinate this annual event. Congress intended this event as a means for local communities to raise awareness of the dangers of unintentional poisonings and to take such preventive measures as the dangers warrant.

(PC week and listing adapted from WAPC.org website with commentary from castMD.com)

STROKE – BRAIN ATTACK – MRI OR CTSCAN

When it comes to having a stroke, with a sudden loss of movement, speech, thought processes, or consciousness – the quick response to get to 911 and get the patient to the hospital is paramount. Once in the hospital, sometimes a "clot buster" drug can be used, just like in heart attacks, to restore function. There are very strict timeline and symptom criteria for use of such "clot busters" in the setting of an acute stroke – "cerebrovascular accident" or CVA.

*****

Stroke is a medical emergency. Know these warning signs of stroke and teach them to others. Every second counts:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

Call 9-1-1 immediately if you experience symptoms!
Time lost is brain lost!

*****

But how does the doctor know if a stroke has happened and where is the stroke? New modalities of computerized tomography of the brain (CT) and magnetic resonance imaging (MRI) and other imaging techniques tell the doctors more information about the stroke.

Some strokes are not the "clot or blocking artery" type – as some are bleeding types and yet others are "embolic" types, or clots that have travelled from some other area of the body.

The National Institute of Neurological Disorders and Stroke (NINDS), part of NIH has conducted the largest study of these patients to determine which imaging study might be best to see the stroke in the brain.

A non-dye MRI showed five times the sensitivity compared to and twice the accuracy of a non-dye CT scan. Both MRI and CT not using dye again, were about equal in seeing the bleeding type of stroke.

Independent neuroradiologists read the studies and both studies were conducted on each patient in the study. Of the 356 patients with suspected stroke, the MRI showed superior for diagnosis.

If you or anyone you know, develops sudden loss of speech, motor control in an arm or leg, loss of consciousness, or confusion – call 911 immediately. Time is so important in this disease. Just as in a heart attack, let your doctor know of any concerns you have with regard to stroke.

The Cost of Cremated Ashes: Dad Nose Best A New Cocaine Substitute – Keith Richard’s Marketing Expertise’ – a parody of abuse

THE ROLLING STONE'S KEITH RICHARDS MAYBE SNORTED HIS DAD THE TABLOIDS HAVE COMMENTED AND THERE SEEMS TO BE CONTROVERSY REGARDING WHETHER IT WAS TRUE OR NOT. CastMD CONTINUES TO DIG INTO THIS ISSUE WITH CLARITY AND REASON. BUT INQUIRING BRAINIACS WANT TO KNOW THE NUMBERS……..SO HERE THEY ARE !

Theory:

Average cremation remains = 3700 grams

Crackdowns on producers and smugglers of cocaine in Colombia and the United States have caused the wholesale price of the drug to rise sharply, according to officials of the Federal Drug Enforcement Agency. A kilogram, 2.2 pounds, of cocaine that cost a dealer $15,000 six months ago now costs $25,000 to $30,000, Frank Chellino, a spokesman for the agency's Miami office, said. (NYT 4-5-07)

The common street selling price of cocaine hydrochloride powder is $80-$100 per gram. The purity of the drug is TYPICALLY diluted by dealers wanting to increase the volume of the cocaine to multiply profits. Popular "cutting" agents include lactose, inositol, mannitol, lidocaine, and even cornstarch, talcum powder, or sugar. NOW YOU CAN CUT WITH DAD'S ASHES !!!

Freebase cocaine is cocaine without its water-soluble component, or "base." It is prepared by prepping cocaine hcl with an alkali, and separating the cocaine from its impurities. The preparation of freebase cocaine involves the use of highly flammable solvents such as ether. "Crack" or "rock" cocaine is the street name given to freebase cocaine processed from cocaine hydrochloride to a base, then using a base and heating it to remove the hydrochloride. The resulting mixture is allowed to harden, then broken into small pieces or rocks, which can be easily smoked in a pipe. The term "crack" refers to the crackling sound made when the mixture is smoked.

Therefore:

30,000 dollars divided by 1000 grams is 30 dollars a gm wholesale. Yet the retail prices vary, but about the 100 dollars a gram retail street value.

3700 grams of cremation remains is 370,000 dollars of cocaine equivalency in weight.

The most popular method of use is to separate the powder into fine "lines" of approximately 1/4 gram, 4-6 inches long. A small straw is then used to "snort" the cocaine into the nose.

3700 divided by 1/4 gm per line is:

14,800 lines of cremation-dad cocaine-substitute !

Now, a direct cremation cost noted on the web was:

Direct Cremation Service : $625.00*

Therefore:

Cost of cremation divided by 3700 grams of cocaine substitute is 625 / 3700 = 0.1689 dollar/gram

SUMMARY:

IF YOU BUY COCAINE YOU WILL BE PAYING 80-100 DOLLARS RETAIL FOR ONE GRAM

USE CREMATION-DAD COCAINE-SUBSTITUTE AND YOU WILL PAY ONLY 17 CENTS PER GRAM

IF YOU DO DRUGS, YOU DO THE MATH…BUT DON'T SNORT DAD-SNOW.

CHEST PAIN: HEART ATTACK “IS IT THE BIG ONE” OR NON-CARDIAC CAUSE ?

Chest pain is generally considered the second most common cause patients show up at the Emergency Room (ER) doorstep. Yet only about 20% or less of patients admitted with chest pain to the hospital actually have significant coronary artery disease. There is a wide spread of how many patients that actually have coronary artery disease which also had other complaints already diagnosed – ranging from about one percent to almost thirty percent. That’s what makes diagnosing cardiac disease difficult. Some authors say ER’s discharge 5 % of the chest pain patients that will have a heart attack and another five percent or so that will have a chest pain (or equivalent) unstable episode soon after the discharge. This problem in diagnosing chest pain, and trying to pick the patients with the “real chest pain” from the heart or cardiac in origin is paramount in the ER.

Even with a normal ECG (electrocardiogram) and normal blood tests a condition of serious heart disease can co-exist with the patient. Many strategy techniques are used to try to capture the potential patient with significant heart disease. Recently the new CT scanners that can look directly at the heart blood vessels to see potential blockages or narrowings are being used, however not all insurance companies will pay for such studies.

Other causes of chest pain that are not cardiac (heart) in origin are:

gallbladder disease

pneumonia

musculoskeletal disorders

herpes zoster (“shingles”)

anxiety states

peptic ulcer disease

gastroesophageal reflux disease (GERD).

Other more serious diagnoses are:

aortic dissection (a tearing of the aorta itself)

pulmonary embolism (blood clot in lungs)

pneumothorax (popped lung – usually from trauma).

Chest pain can occur in many manners with many masks. Under the breastbone pain, aching, stabbing, with exercise especially is suspicious. However, not all cardiac pain has true pain. Many times pressure, a sense of fullness, shortness of breath can be equivalent to pain in seriousness. Some patients experience profuse sweating, nausea, light-headedness, and arm, jaw, neck, or back pain.

With the advancing of age groups, the lack of exercise in children, the growing obesity problem, and the ongoing lack of universal prevention techniques, especially in the United States – chest pain will continue to create diagnostic challenges for patients and their physicians.

Many patients do not live to tell what happened when they started having chest pain.

In 90 percent of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed by fatty buildups. Scarring from a prior heart attack is found in two-thirds of victims. When sudden death occurs in young adults, other heart abnormalities are more likely causes.

About 325,000 people a year die of coronary heart disease without being hospitalized or admitted to an emergency room. That’s about half of all deaths from CHD (coronary heart disease) â€” more than 890 Americans each day. Most of these are sudden deaths caused by cardiac arrest.

IN DOUBT TALK WITH YOUR DOCTOR IMMEDIATELY OR GO TO AN IMMEDIATE CARE CENTER OR EMERGENCY ROOM ! CALL 911 IF YOU ARE IN DISTRESS OR UNSURE !

FOR MORE INFO CLICK ON THE LINK TO THE AMERICAN HEART ASSOCIATION’S WARNING SIGNS.

http://www.americanheart.org/presenter.jhtml?identifier=3016999

(adapted: emergmed-aha with castMD commentary)

SUICIDE AND THE ELDERLY – A “MATURE MATTERS” ESSAY

Our “mature matters” group of the boomers increasing into their late 60’s, 70’s, and onward into their 80’s and 90’s represent a new volume of potential depressed individuals and suicidal risk candidates.

It is fairly simple for depression in the elderly to go unrecognized or missed. Many times the depressed mood is masked by drugs such as anti-parkinson meds, narcotics, pain relievers, and heart and blood pressure meds. Many co-morbid conditions of parkinson’s, early dementia, diabetes, mini-strokes, heart disease, neurological disorders can also mask symptoms of elderly depression and potential suicidal risk. Depression in the elderly can suddenly change, manifesting itself as agitation, confusion, new dreams or hallucinations, but even can be a change toward new apathy or diminished or unusual caring. Certainly, with any of these, the constant is a change from the baseline of the elderly person.

Males suicides rates are alarming. Rates continue to rise as men age, with a peak in the mid-80’s of age. Meanwhile, females suicide rates peak in middle age, then decrease again in older years.

Elderly men in their 80’s have greater success in suicide attempts when compared to their younger male counterparts. Younger men generally have more attempts, but generally are less apt to completion. Many times planning specifics are detailed and even some have been to their doctor recently.

Elderly men typically will have a diagnosis of depression, while younger individuals will have a history of affective disorders (mood) or substance abuse disorders. Additional risk to the elderly potential suicide victim is a group of problems including loss of spouse, loss of home, previous suicidal discussion, alcoholism, or new diagnosis of a chronic condition.

Families and caregivers must be alert for any change in attitude, mood, eating habits, sleeping habits, or conversation or discussions of suicide – or discussion of would be better, less burdensome to their family, or hopelessness.

Elderly patients need a close eye and open ear to their concerns, wishes, demands, and needs. A hopeful and loving family with caring friends, with professional consultation, can be literally elderly life saving…and that shows that “Mature Matters.”