DIARRHEA – THE NOT SO TALKED ABOUT SERIOUS ILLNESS

Diarrhea is certainly a “not so talked about” medical condition. But today, at least one kind of diarrhea is becoming quite a medical problem. It is the Clostridium Difficile colitis (colon infection and inflammation).

Physicians, nurses, clinics and hospitals as well as Public Health agencies are seeing a rise in the incidence of this C. Difficile associated diarrhea. This change in the demographics of this disease is toward a younger and healthier group of patients, and not the classic patients.

The typical patients for this “C. Diff.” diarrhea have been the elderly, those with recent antibiotic usage, and those on certain higher risk medications such as clindamycin, cephalosporins, and quinolones. Recent hospitalization and the use of gastric acid blockers, now advertised daily on television and print media are also higher risk factors.

The use of gastric acid blockers has been studied and continues to be. This arena of high use of these acid pH changing medicines in the gut may be contributing to the growth of the C. Diff. more quickly in the gut, than without the acid blocker.

The toxin in itself from the bacteria, can cause worsening symptoms such as toxic mega colon, severe sepsis, perforation of the gut, a need for colectomy (removal of the colon), and even death.

The diarrhea is many times unrelenting. It continues to be watery, sometimes mucous-like, and eventually bloody. But many patients wait to see if the diarrhea will clear. Dehydration and weight loss can be associated with such diarrhea also.

There are both blood tests for the disease and stool tests specific to the disease.

If you are on antibiotics, and develop diarrhea over 24 hours you must call your health care provider or doctor. The best treatment is to stop the antibiotic immediately with your doctor’s order if possible.

Many times two different OTHER antibiotics are used to treat the C. Diff. infection of the colon. One antibiotic for the C. Diff. is only about 80% effective now, while the backup drug is only about 90% effective. But now, resistance is starting to mount to these treatments, leaving patients in severe distress with life-threatening diarrhea and infection.

New studies are being done now using probiotics. Specifically Sacharomyces boulardii and other lactobacilli have been studied. Many are recommending the use of probiotics with the initiation of antibiotics and other antimicrobials.

There are many reasons patients get diarrhea.  But you can eliminate some high risk yourself.  So, do not use antibiotics without a reason. Do not borrow or loan antibiotics. Always talk with your doctor if you develop diarrhea while on antibiotics. When in doubt, call.

CastMD says, “You do NOT want to develop this toxic type of diarrhea.”

“SICKO” – WILL IT HELP MAKE THE DIAGNOSIS AND TREATMENT?

AFTER LISTENING THIS PAST FEW DAYS TO SOME NEWS, CASTMD FIGURED THE SYSTEM IS TOO BROKEN NOT TO COMMENT.  MIKE MOORE’S DOCUDRAMA OF THE U.S. HEALTHCARE SYSTEM IS AT LEAST A STARTING POINT…AGAIN….A NEW KIND OF DOCTOR EXPOSED

A FRIEND OF MINE SAVED A PATIENT’S LIFE.   IN SURGERY, THE PERSON ALMOST DIED. THIS ANESTHESIOLOGIST WANTS TO GET PAID BY THE PATIENT’S INSURANCE COMPANY. SOUNDS SIMPLE?

THE PATIENT HAD TO BE TRANSFERRED FROM THE SMALLER HOSPITAL TO A TERTIARY CENTER (A LARGER TEACHING TYPE HOSPITAL) AND LATER UNDERWENT ANOTHER SURGERY. NOW THE INSURANCE COMPANY WILL NOT PAY THE FIRST HOSPITAL AND THE ANESTHESIOLOGIST. THEY DEMAND MORE PAPERWORK, SAYING IT WAS THE SAME SURGERY. SO THE BATTLE OF HEALTHCARE PAYMENTS GOES ON! GENERALLY, DESPITE THE ONLINE DIRECT SUBMISSION OF BILLING TO MEDICAID, MEDICARE, AND OTHER INSURANCE COMPANIES, PAY IS SLOW.

WHAT HAPPENS THEN, IS THE PATIENT GETS BILLED, THE EXPLANATION OF BENEFITS GOES OUT AND EVERYONE INVOLVED IS SENDING DOCUMENTS AND PHONECALLS TO EVERYONE ELSE. SO IT GOES. SO MUCH LOST EFFORTS, EXPENSES, AND WORK…TO GET PAID.

ALL THAT MONEY COULD BE FOR HEALTH AND WELLNESS AND PREVENTION. INSTEAD YOU HAVE FAMILIES BEING BANKRUPTED BY MEDICAL BILLS. THIS HAS BECOME ANOTHER CREDITOR ATTACKING YOUR CREDIT RATING, YOUR PROPERTY, YOUR LIVELIHOOD, AND YOUR HARD-EARNED DOLLARS. MANY HOSPITALS HAVE LAW FIRMS NOW FILE LITIGATION AND SUE THE PATIENTS FOR PAYMENT.

WE SPEND THE MOST ON HEALTH IN THE INDUSTRIALIZED WORLD, YET WE HAVE HIGH INFANT MORTALITY, A SHORTER LIFE EXPECTANCY, AND NEARLY 45 MILLION KNOWN ABOUT PERSONS WITHOUT ANY INSURANCE COVERAGE TO ADEQUATELY PROTECT THE FAMILY OR THEMSELVES.

THE DIRECTOR OF THE G.A.O. (GENERAL ACCOUNTING OFFICE) WAS ON TV THE OTHER DAY. HE SAID IT IS TOO LATE IF WE DO NOT CHANGE NOW. HE IS IMPORTANT. HE IS THE UNITED STATES’ CPA BASICALLY. HE IS MEETING WITH BUSINESS LEADERS, COMPANIES, AND OFFICIALS TO TRY TO GET THE MOMENTUM UP TO CHANGE HOW WE DO THINGS. HE SAID THAT WITH THE BABY-BOOMERS COMING “ON LINE” IN JANUARY 2008, THE GOVERNMENT HAS CREATED A SYSTEM OF INCOMPATIBLE EXPENSE. WITH MEDICARE, MEDICAID, AND SOCIAL SECURITY FOR THE BOOMERS, THE SYSTEM WILL BUST.  SOON!   2020 OR SOONER!   WHY?  HE HAS GIVEN UP ON CONGRESS !!!

IF YOU ADD ON THE NUMBER OF MANDATED ER CARE OF ILLEGAL IMMIGRANTS GOING TO THE EMERGENCY ROOMS, PLUS THE UNDERINSURED, AND THE UNINSURED – IT IS EASY TO APPRECIATE THE PROBLEM.  MANY HOSPITALS’ ERs HAVE CLOSED.  SOME HOSPITALS ARE BEING SOLD FROM NOT-FOR-PROFIT TO FOR-PROFIT SYSTEMS.

WHAT ARE YOU DOING TO HELP TALK IT UP ABOUT HEALTH INSURANCE RATES, HEALTH INSURANCE, AND THE COSTS.  

NO FAMILY SHOULD BE FORCED INTO BANKRUPTCY BY HEALTH ISSUES……

EMERGENCY ROOM VISITS – ILLICIT DRUG ABUSE TOP TEN

poppy.gifAccording to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.

COCAINE………………………..OVER 448,000

MARIJUANA……………………..OVER 242,000

HEROIN………………………….OVER 164,000

meth-1.pngMETHAMPHETAMINE…………..ALMOST 109,000

ECSTASY (mdma)……………..ALMOST 11,000

PCP………………………………OVER 7500

INHALANTS……………………..OVER 4300

HALLUCINOGENS……………….OVER 3700

LSD………………………………OVER 1800

GHB………………………………OVER 1800

This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.

To round out this medical commentary today, the United States still has these top ten killers. ecg_evol1.gif

This data is from the 2004 National Center for Health Statistics, the latest full database.  Prevention is the key in almost all of these killers.  With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top.  For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.

HEART DISEASE……………………………………………………………………………27.2%

CANCER…………………………………………………………………………………23.1

CEREBROVASCULAR DISEASES…………………………..6.3%

CHRONIC LOWER RESPIRATORY DISEASES…………5.1%

UNINTENTIONAL INJURY…………………………..4.7%

DIABETES MELLITUS……………………………..3.1%

ALZHEIMER’S DISEASE………………………2.8%

INFLUENZA AND PNEUMONIA……2.5%

KIDNEY DISEASES……………….1.8%

SEPTIC CONDITIONS……….1.4%

NET NEUTRALITY AT RISK- THE BIG DEAL IN YOUR e-LIFE

Sometimes this medical man must make the leap from meth, cocaine, cheese heroin, disability, west nile, herpes, and death…to a topic that is close to the heart and mind.

In the blogger world and the internet world, many brilliant minds exist in a community open source manner, while many other minds (even some the same) coexist in a competitive free market manner. They so far seem to have been a symbiotic relationship at the least.

But a reminder from www.castMD.com now, as it is important. We as bloggers must pay closer attention to this “Net Neutrality” issue. This is how I understand it. Right now, internet is paid for at all levels. About 26 of them. I pay a company to provide access to the net, that company pays the next, the next pays the next…eventually to a major backbone of internet ability. These access points are not “pipes” as one Senator stated in Congress. Everyone gets paid some money along the way…

What may be happening in the telecom companies, is access restriction! Unlike other countries, especially Korea, China, Japan, access is being looked at like your cable or cellphone.

You want what, when, and how fast?

Right now, the IPhone is with AT&T I believe, after Verizon company turned it down due to strict competitive requirements. So, my contract will not allow me to get an IPhone. I cannot get a different phone with ALL the features, because some aspects of cellphones are turned off…or blocked…so the company can RESELL the access to you – EVEN though your cellphone is set for it.

My examples are real but may not be exact for the internet neutrality issue. BUT, what if my SkyNet said you can have only the internet sites that are not commerce related? What about no .com, or .biz sites? But for 100 dollars per month, I can have the .com sites? Or what if a block on all .edu sites was placed for the colleges and universities, unless a million dollars per month is paid by the college or university? Another example is whether or not your access speed would be limited? So, the telecoms give access to the “slow speeds” of uploads and downloads, yet more money for the “real” speeds.

UTube is extremely bandwidth intensive. In the beginning, without the principle of internet neutrality, the telecom ISPs most likely would have restricted bandwidth speed available to their users for viewing the site. Video traffic would slow to a crawl unless the startup business was ready to pay enormous fees to the “gatekeepers” in order to access “their subscribers.” Obviously, a startup in its infancy would not have been able to pay these fees, or would have had to grow slower or die on the vine.   The gatekeepers want to absolute control to all the access to every data pak through the internet network.  Everyone is already paying!

The meeting review on the issue might stimulate your awareness.

FTC ON BROADBAND ACCESS

A review of this issue and faqs is at: SAVE THE INTERNET

THE PRICE AND THE ACCESS RESTRICTION ARE GOING UP !

CHEESE – MARKETING HEROIN FOR YOUR KIDS “SAY CHEESE”

cheese-drug.jpgAs part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.

The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.

As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”

Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.

Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.

paremsan
(grated parmesan)

Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”

Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.

“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.

cheese-drug.jpgSAY “CHEESE” MAY BE THE LAST PICTURE TAKEN……..

HUG YOUR KIDS TODAY!

SQUIRREL ATTACK DURING HIDE N’ GO SEEK FATHER-DAUGHTER’S BONDING STORY

All my daughter’s friends were over for their little party.
These eight or so girls, all about 7 years old were playing crazily. You see wintertime had broken in Minnesota, and the summer was near.  But it was one of those days you live for there, vibrant blue sky, gentle breeze, and life’s passions greening up.
Well, the little girls had played on the playground equipment for quite awhile, and in the sand making “things.”   They were drawing chalk style hopscotch boards on the sidewalks, and had jumped rope without any bruises.   Such a great day, such harmony in family and friends with nature watching.
My daughter and her little friends decided it was time to play “hide n’ go seek."   No one better to hide than dad.   Their collective eyes leaked with sincerity of request.   How could any father turn such princesses and angels down for this next fun event, on such a great day, in such prime weather, in Minnesota ?
The "search and rescue" group of small girls began to count.  
ONE. TWO.
Meanwhile, my scurrying about reminded me to tell them to, “Count Loud” and “NO peeking."    They, in unison, guaranteed this with giggles and laughter.
THREE.   FOUR.
My eye scanned the topography.   Where to hide?   How long would it be to hide quickly, yet stealth like?   Scanning the local yard’s horizon, a brilliant idea now could become reality.   Ha ha ha.   Those little ones will never see me there.
FIVE.
Quickly, quietly, and with ease my legs jumped up into the tree.   This tree was strong.   It could hold an adult, even a hidden stealthy adult.   Lots of those huge Minnesota leaves that would cover all the color of the “hide n’ go seek” secret agent.   So covert.
SIX, SEVEN, EIGHT.
Hurriedly my arms pulled my body into location, in the tree.   Knowing how to quickly judge and climb a tree was like riding a bicycle or swimming to me.   All those hours building huge tree houses in the skies of tall ash or elm trees now would pay off.   All those limb evaluations of size versus strength and caliber were emblazoned in this climber.   This was a confident spot.
NINE.
As my arms lifted me into position, with my sitting spot almost prepared, the little girls were starting to rustle.   Shifting my seat gently as not to be heard by doing a pull-up on the branch above, suddenly my stealthy world changed.
TEN.
As my pull-up ended, my line of sight was slightly diagonally upward.   A loud noise, a squeal.   Then heard of buffalo, a covey of quail, and a wild horse stampede came right at me! My ears were frozen on the word, “TEN” that the little princesses had yelled.   My eyes were beyond frozen to see eye to eye with it.

Squirrel attack !!!   

Yes, man to female animal, face to face, and eye to eye there it was.  No time for a counterattack.   It was cold.   It was heartless.   The attack of the mother squirrel was like no other.   Brutally shown teeth, larger than a shark – claws drawn, sharper than the griz.   Lightening speed, out of no where.   An ICBM loaded and launched at the intruder.   No early warning system for the unprepared “hide n’ go seeker.”   BAM.   The war was on.   Knowing my face had been hit, a cover was needed.  No where to hide now.   Too far up to jump, as a youth might attempt.   Age and wisdom prevented that action quickly.   Swiping away the blood, my fight was limitless but so ill directed.   Not once was there a hit on the enemy despite readjusting my coordinates while in the leaves.   Retreat was the only option.   Cut the losses.   Sooner, not later.   This mother wasn’t retreating from the nest she had so preciously prepared for the family.

The gaggle of girls was coming down the sidewalk.   They too had heard the noisy breach of the stealthy sacred safe place.   It was over…almost.

The “hide n’ go seeker” now did what all attacked, retreating, and severely mentally and physically injured “hide n’ go seekers” do.   Swing out of the tree.   With two great leaps of caliber-calculating swings, my feet hit terra firma.   Solid.   Looking around quickly, the attack was over.  

All the faithful players of the “hide n’ go seek” family game came running. My position was still of a prepared martial arts stance, ready to counter strike as if a secondary push might occur.

“We see you,” they all yelled.   The girls approached quickly to prove they had seen me.   But as they received their victory in game, they realized what was different.   Suddenly, they all began screaming at the top of their choral lungs, high pitched in fear, yelling and running away faster and faster.  My daughter said, "Daddy, you have blood,” and she ran away too, to the safety of the flock.   Reaching up to my face, it was warm, and slippery.   Looking at my hand, realizing my sweat from the environmental battle was not red – it was blood.   Wiping away the blood from my hand to my pants, the flow of blood continued.   A painted warrior of sorts.

My wife came outside to see how things were going with the “hide n’ go seek” game.   She had come around a corner just as the girls were approaching. “My goodness,” she said, “Why did you fly out of that tree…to scare the girls…They were yelling so loud…And YOU looked like a gorilla flying out of the tree… AND you are bleeding!”   “What happened?”  
Re-living it…worse….
 

As my eyes close yet to this day, that mother squirrel is in my view forever.   Everyone survived. A family moment. A father-daughter memory forever.  And now you know why my 20 something daughter sends reminders once in a while, and why she sent me a shirt with a squirrel on it that states the rules:  “ADVICE FROM A SQUIRREL.”  

WEST NILE VIRUS UPDATE – IDAHO LEADS NATION DISCUSSION CONCERNING PANHANDLE DISTRICT

IDAHO LED THE NATION IN 2006 AND WAS THE HARDEST HIT AREA IN THE USA FOR WEST NILE VIRUS.  996 cases of WNV were diagnosed in 2006 with 171 neuroinvasive type and 825 fever – and 23 deaths.  (neuroinvasive = meningitis, encephalitis, neuro complications during and after diagnosis)

As of June 2007, GEM COUNTY has identified the first positive mosquito pool in Idaho.

Hospitals, physicians, health professionals, and labs must report probable and confirmed cases.

PROTECT YOURSELF AND PROTECT YOUR KIDS THIS SUMMER. 

The biggest problem in the Northern Idaho region that I talked with Panhandle representatives about is the standing water drainage systems.

It appears that the Planning and Zoning, government maintainence such as roadways, and the health departments are NOT talking to each other.  The ground water grassy swales that are imposed are now the breeding grounds for such mosquito populations.  This water is stagnant until it filters down through the ground to protect our ground water.  The drains typically are set 8 inches above the level of the ground to allow overflow in heavy rains or runoffs, but this is the rub.  The swales stay wet.  Hopefully all parties will begin to plan for such health disasters at the early stages of future developments.  Revising the swales may need to become a priority.

Review WNV and WNV-birdflu-hunting at the these sites:

http://www.castmd.com/?p=35

http://www.castmd.com/?p=45

OR

www.cdc.gov

www.westnile.idaho.gov

 

Mature Older 55+ Crowd and the Internet

Saw a recent article in a magazine on the over 55 crowd.  Besides still listening to crooners, rock n' roll, and elvis (sightings often), the crowd is internet savvy.  In the game category, over 55 in the slotsites are 2/3 of the internet seekers.  Surprisingly, obituaries at one site are logged onto by the over 55 about the same amount of time.  Puzzles, investments, genealogy all run about half of the logged on are in the over 55 crowd. 

This is opposed to the 25-35 crowd that find the parenting sites, over 55 %, while family issues, shopping are frequented in the mid forty percents.  News, sports, and other items run in the 30s percent on those type of websites.

So, if you are in the over 50 crowd, now you know where your colleagues are and your kids!   Wink

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.  Bye