Sunday 31 July 2016

Don’t waste your time on jealously. The only person you’re competing against is yourself.

  1. Don’t waste your time on jealously.  The only person you’re competing against is yourself.

Write it Out Journal to problem-solve.

Write it Out

Journal to problem-solve.

annus mirabilis - wonderful year

annus mirabilis - wonderful year

Don’t sit too much. It kills you. Move, dance, run, play.


GRATITUDE

 Gratitude is one of the best ways to find contentment. We are often discontent in our lives, desire more, because we don’t realize how much we have. Instead of focusing on what you don’t have, be grateful for the amazing gifts you’ve been given: of loved ones and simple pleasures, of health and sight and the gift of music and books, of nature and beauty and the ability to create, and everything in between. Be grateful every day.

WALK

A good walk cures most problems. Want to lose weight and get fit? Walk. Want to enjoy life but spend less? Walk. Want to cure stress and clear your head? Walk. Want to meditate and live in the moment? Walk. Having trouble with a life or work problem? Walk, and your head gets clear.

AKRASIA

CANCEL

CHILD

MOOD

Interesting Psychological Facts You Probably Didn’t Know

FRNDS

Interesting Psychological Facts You Probably Didn’t Know

RMMBR

Interesting Psychological Facts You Probably Didn’t Know

I DONT LIKE THE FACT THAT MY FATHER WILL NOT HEAR TO HIS SON OR DTR BUT WILL HEAR TO EVERYBODY ELSE


“dark triad” of personality – Machiavellianism, narcissism and psychopathy


KORNFIELD

ACS

Twice as many patients now survive cancer for ten years after diagnosis


78 MIDDLE ROAD RKV MISSION BARRACKPOREASHRAM INCHARGE MRS RUMA ROY

RAMKRISHNA

PH-9051153914

SON PROSENJIT ROY -7797732449

DUM DUM ROAD AT END NAGER BAZAR SOUTH DUM DUM MUNICIPALTY ON LEFT


DAKSHINESWAR ADYA PITH AND BELGHORIA VISIT


Friday 29 July 2016

RAKSHA TPA MEDICLAIM PARENTS

SAIL Mediclaim Scheme (2016-17) SAIL Mediclaim Scheme has been renewed for a period of one year from 1st April, 2016 to 31st March, 2017 with M/s. IFFCO TOKIO General Insurance Co. Ltd. and M/s. Raksha TPA Pvt. Ltd. will be the TPA for the aforesaid period. For any treatment related enquiries or claim (cashless/ reimbursement) related enquiries, members of SAIL Mediclaim Scheme as on 31st March, 2016 may contact the following: For Written Communications: • For Cashless Request or Intimation of Claim: sailclaims@rakshatpa.com •

For any query/ information/ to check status of claim/ feedback: sailsupport@rakshatpa.com


 For Telephonic Communications: • Toll Free No. (24/7): 1800-180-1555 (Toll Free) • Customer Care : 0129-4289980 Note-The last date for completing the process of renewal of membership under SAIL Mediclaim Scheme (2016-17) has been extended till 31 st May, 2016. No further extension shall be granted. 

DM2 HYPERGLYCEMIA OZ ALGOMED

MIL DIABETIC CRSS BS 500


A HOLIDAY INTO PARNTAL FRAILTY-TALU


Thursday 28 July 2016

PRNT MEDICLAIM E-Meditek (TPA) Services Ltd. Suit No.6, 8th Floor, Shanti Niketan Building, 8, Camac Street, Kolkata ,Kolkata, West Bengal, 700017.

E-Meditek (TPA) Services Ltd. Suit No.6, 8th Floor, Shanti Niketan Building, 8, Camac StreetKolkata,Kolkata, West Bengal, 700017.

FTHR MEDICLAIM TO CAMAC STREET OFFICE


ACTIVE INVALID DTH=AID SPECTRUM PRNTS 89 PLUS


LEBOWITZ You're only as good as your last haircut."

You're only as good as your last haircut."

JEFFERSON There is not a sprig of grass that shoots uninteresting to me."

There is not a sprig of grass that shoots uninteresting to me."

MUST TRY HARDER


KAKU CONSC

thermostat has one unit of consciousness.  That is, it senses the temperature around it.  And then we have a flower.  A flower has maybe, maybe ten units of consciousness.  It has to understand the temperature, the weather, humidity, where gravity is pointing.  And then finally we go to the reptilian brain which I call level 1 consciousness and reptiles basically have a very good understanding of their position in space, especially because they have to lunge out and grab prey.  Then we have level 2 consciousness, the monkey consciousness.  The consciousness of emotions, social hierarchies, where are we in relationship to the tribe.  And then where are we as humans.
As humans we are at level 3.  We run simulations into the future.  Animals apparently don’t do this.  They don’t plan to hibernate.  They don’t plan the next day’s agenda.  They have no conception of tomorrow to the best of our ability.  But that’s what our brain does.  Our brain is a prediction machine.  And so when we look at the evolution from the reptilian brain to the mammalian brain to the prefrontal cortex, we realize that is the process of understanding our position in space with respect to others – that is emotions – and finally running simulations into the future.

Type 3 diabetes is a title that has been proposed for Alzheimer's disease which results from resistance to insulin in the brain.

Type 3 diabetes is a title that has been proposed for Alzheimer's disease which results from resistance to insulin in the brain.

Consumption of meat, eggs and high-fat dairy increased risk for Alzheimer's disease, according to research published in the Journal of the American College of Nutrition.

Consumption of meat, eggs and high-fat dairy increased risk for Alzheimer's disease, according to research published in the Journal of the American College of Nutrition.

LET BE

TURKEY 2412

CAMUS

There is in me an anarchy and frightful disorder. Creating makes me die a thousand deaths, because it means making order, and my entire being rebels against order. But without it I would die, scattered to the winds." Albert Camus

1730 GOPAL BHAR CARTOON WITH FTHR


Wednesday 27 July 2016

HX

OVERPOPULN

ZEN 10 DIET

1/ EMGT-ORB =  50 C

2/ OAT MEAL CONCOCTION= 300 C

3/ EMC AND FRUIT = 50 C

4/MMC AND FRUIT =50 C

5/ LUNCH - SCY= 500 C

6/ MAC AND FRUIT= 50C

7/DINNER = ECV2 =600 C

8/ EC-OB = 50 C

9/ DARK CHOC= 150 C

10/ NUTS=100 C

TOTAL=1900 C MINUS 10 K STEPS 200 C= 1700 C


NADO RT ORDER DTHS WCS

FTHR DTH FIRST-MTHR TO BGA

MTHR DTH FIRST-FTHR TO BRRCKPR

AD MO DTH FIRST- 1/3 PENSION OF DIDI WITH 9K MO OF SIDD

DIDI DTH FIRST-9K MO OF SIDD

SIDD DTH FIRST- NEEDS SUPPORT 10 K MO-AS CARETKR

NTL

UNIV X BIOLF

TRAUMA

  • Primary survey
    • Primary goal: identify and prioritize the most life-threatening injuries
    • Includes: Airway, Breathing, Circulation, Disability, Exposure
  • Secondary Survey
    • Identify and address all other injuries
  • Diagnostic testing options
    • Bedside ultrasound (FAST examination)
      The focused assessment with sonography in trauma (FAST) examination for the evaluation of injured patients is not sensitive enough to exclude all intra-abdominal injuries. Patients with small amounts of free fluid may have false-negative FAST examination.[ii]
    • CT scan
      Should be obtained only in hemodynamically stable patients in whom there is no apparent indication for an emergent laparotomy.
    • Potential useful laboratory tests
      • CBC, CMP, lipase, UA
        • Laboratory evaluation is generally of limited value and should be considered as an adjunct to the clinical assessment.

People think the world is getting worse. … That’s the perception. What’s actually happening is our information about what’s wrong in the world is getting better. A century ago, there would be a battle that wiped out the next village, you’d never even hear about it. Now there’s an incident halfway around the globe and we not only hear about it, we experience it."

People think the world is getting worse. … That’s the perception. What’s actually happening is our information about what’s wrong in the world is getting better. A century ago, there would be a battle that wiped out the next village, you’d never even hear about it. Now there’s an incident halfway around the globe and we not only hear about it, we experience it."

The world isn't burning. We imagine to be so because access to information is getting better. As Kurzweil

The world isn't burning. We imagine to be so because access to information is getting better. As Kurzweil

FTHR 80 BITTER PHONE SKILLS


SCHOPENHAUER Sorrow is the beginning of philosophy


REALITY

debt

Seven blunders of the world that lead to violence: wealth without work, pleasure without conscience, knowledge without character, commerce without morality, science without humanity, worship without sacrifice, politics without principle. — Mahatma Gandhi

Seven blunders of the world that lead to violence: wealth without work, pleasure without conscience, knowledge without character, commerce without morality, science without humanity, worship without sacrifice, politics without principle.
— Mahatma Gandhi

If you want someone to agree with you, nod while you talk.

 If you want someone to agree with you, nod while you talk.

Open with “I need your help.”

Open with “I need your help.”

Whenever someone is angry and confrontational, stand next to them instead of in front of them.

Whenever someone is angry and confrontational, stand next to them instead of in front of them. 

GODARD "To be or not to be. That's not really a question."

"To be or not to be. That's not really a question."

Tuesday 26 July 2016

CRACK OF LIGHT

BOREDOM

no human being can exist a day without his private escape from boredom and Reality. The completely disillusionized and indifferent being has never existed, for indifference and disillusion are also escapes—retreat to the tree-top of one's own pride. - Benjamin De Casseres

DTH

LF SUCKS AND THEN U DTH


FALLEN

There are moments which mark your life. Moments when you realize nothing will ever be the same and time is divided into two parts, before this, and after this... Sometimes you can feel such a moment coming. That's the test, or so I tell myself. I tell myself that at times like that, strong people keep moving forward anyway, no matter what they're going to find.". Join Hobbes (Denzel Washington) 'Fallen'.

way to non conformity starts in steps. Introspection, coming out to those close to you, finally doing what's in your power to make you happy (supporting your egoism 100%).

way to non conformity starts in steps. Introspection, coming out to those close to you, finally doing what's in your power to make you happy (supporting your egoism 100%).

Monday 25 July 2016

LIGOUTTI

"No such thing as a petty reason to kill yourself. You were forced into existence without prior consultation so if anything troubles you enough to want to die, no one has the right to say "man up", "that's life", "others have it worse" or the infinitely many variations of other platitudes in circulation out there.
As Ligotti put it,
"Nonexistence never hurt anyone. Existence hurts everyone".
...

DAY

WILL TO LV

HEMMINGWAY HAPPINESS

HOLMES The young man knows the rules, but the old man knows the exceptions."

The young man knows the rules, but the old man knows the exceptions."

"Laziness is nothing more than the habit of resting before you get tired."lenard

"Laziness is nothing more than the habit of resting before you get tired."

humn

KOL HOLIDAY- PRNT ELDERLY CARE CRSS , BNK FD COMPLETION CRSS


Friday 22 July 2016

WT LOSS IN ELDERLY

Weight loss is common in older adults. It occurs in 15% to 20% of older patients. It is associated with functional decline, frailty, and increased mortality.1-3 Clinicians should review weight trends at every office visit. Although it is not abnormal for the patient’s weight to steadily decline with age, the acceptable rate of weight loss is approximately 0.1 kg to 0.2 kg per year.4Clinically, significant weight loss in the older adult is defined as a decrease of ≥5% of usual body weight over a 6- to 12-month period.4 If the healthcare provider observes such weight loss, further investigation is warranted. 

WORLD FULL OF NIGHTMARES

"But today’s society is characterized by achievement orientation, and consequently it adores people who are successful and happy and, in particular, it adores the young. It virtually ignores the value of all those who are otherwise, and in so doing blurs the decisive difference between being valuable in the sense of dignity and being valuable in the sense of usefulness

"But today’s society is characterized by achievement orientation, and consequently it adores people who are successful and happy and, in particular, it adores the young. It virtually ignores the value of all those who are otherwise, and in so doing blurs the decisive difference between being valuable in the sense of dignity and being valuable in the sense of usefulness

STALIN DTH IS THE SOLUTION OF ALL PROBLEMS


UPLOC Nihilism and no meaning, like religion and ultimate meaning, are both possibilities on the human moral spectrum.

Nihilism and no meaning, like religion and ultimate meaning, are both possibilities on the human moral spectrum. 

MAN IS THE CRUELLEST ANIMAL


BERNHARD

We are mistaken if we believe we are in possession of the truth, just as we are mistaken if we believe we are in error. Absurdity is the only way forward.

MADE IN PAIN

LONDON

You will never be happy if you continue to search for what happiness consists of. You will never live if you are looking for the meaning of life. " Albert Camus

You will never be happy if you continue to search for what happiness consists of. You will never live if you are looking for the meaning of life. " Albert Camus

SINKOS? LWP

"I have wanted to kill myself a hundred times, but somehow I am still in love with life. This ridiculous weakness is perhaps one of our more stupid melancholy propensities, for is there anything more stupid than to go on carrying a burden which one would gladly throw away, to loath one's very being yet hold to it fast, to fondle the snake that devours us until it has eaten our hearts away? ~ Voltaire, Candide: Or, Optimism

Sleep, physical exercise and gratitude improve your wellbeing and deter angry feelings.

Sleep, physical exercise and gratitude improve your wellbeing and deter angry feelings.

AMT- or example, if you’re stuck in traffic and getting annoyed, you could think about it as an opportunitY TO LISTEN TO CLASSICAL MUSIC

AMT- or example, if you’re stuck in traffic and getting annoyed, you could think about it as an opportunitY TO LISTEN TO CLASSICAL MUSIC

LOWER SALT INTAKE BETTER ARTERIAL FUNCTION


D24

C24 LQTS PT-COLLPS-APNC P/L RHYTHM-ASYSTL 16 YR ADULT DOSES
DX-CRA-ASYSTL 2/LQTS
EAP-ET BMO2/BTO2 IV/IO UIBLS
PEAAS=AC2 C2 AC2 C2 AC2….4H VOTK 4T TATETOTH SBC

U13

T-13 12YR , GSW CHEST P140 R45 CRT7 12 YR 43 KG EST
DX-4 PEN WNDS, LUNG LAC, HMPNTHX,DUO PERF, PERIT
EAP-PCS-ET VENT HFO2M IV WIDE BORE NGT
VENT 100%O2 FLUID BOLUS-10X4,BLOOD-1
INSERT RT ICD Call sgns to stop hg

ALLEN Time is nature's way of keeping everything from happening at once."

Time is nature's way of keeping everything from happening at once."

EUT GPIG IFL THEN IP IC KCL -EUT UNDER GA


Thursday 21 July 2016

LUCKY CHARM FOR PERFORMANCE IS LIKE A PLACEBO - IT MAKES PERSON FEEL MORE SECURE AND ENHANCES PERFORMANCE


DROWNING ALGOMED PED

CHR SCROTAL PAIN

BRUE ALGOPED

Longest persisting ventricular fibrillation with an excellent outcome – 6 h 45 min cardiac arrest

Longest persisting ventricular fibrillation with an excellent outcome – 6 h 45 min cardiac arrest

IBA IMPACT BRAIN APNEA

 It is characterised by the cessation of spontaneous breathing following a TBI and is commonly accompanied by a catecholamine surge witnessed as hypertension followed by cardiovascular collapse

BRUE

 BRUE is defined as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper- or hypotonia); and (4) altered level of responsiveness.

EM VS SJS VS TEN

D25

C25 COLLAPSED WTH MAT METHDN BTTL-APNC P/L RHYTM-ASYSTL
DX-CRA-SECY TO METHDN POISONING  6 YR 25 KG GVN
EAP=ET BMO2/BT02 IV/IO UIBLS AFTR ROSC AND OXYGN-NLXN
PEAAS=AC2 C2 AC2 C2 AC2….4H VOTK 4T TATETOTH SBC

WHITE MATTER INJURY he developing brain is especially vulnerable to white matter (WM) injury from 23 to 34 weeks gestation when blood vessels serving the periventricular WM are immature.

he developing brain is especially vulnerable to white matter (WM) injury from 23 to 34 weeks gestation when blood vessels serving the periventricular WM are immature.

PVL With advances in obstetric and perinatal management, the incidence of intraventricular hemorrhage in premature infants has declined, while periventricular leukomalacia remains a significant concern

With advances in obstetric and perinatal management, the incidence of intraventricular hemorrhage in premature infants has declined, while periventricular leukomalacia remains a significant concern

AT RISK OF FEB NEUT SEPSIS Asymptomatic C-Reactive Protein Elevation in Neutropenic Children

Asymptomatic C-Reactive Protein Elevation in Neutropenic Children

D23

C23 LYMPHOMA-TLS-COLLPSE-APNC-PLESS- RHYTHM-P/LVT
DX-CRA-P/L VT 14 YR 36 KG GVN
EAP-ET BO2/BTO2 IV/IO UILS
VFVT-DC2DC2DAAmC2DC2DAAmC2DC2ADC2.
PULSE  AFTER 3RD SHOCK 

LOVELOCK "Sadly, it's much easier to create a desert than a forest."

"Sadly, it's much easier to create a desert than a forest."

MILLER "The aim of life is to live, and to live means to be aware, joyously, drunkenly, serenely, divinely aware."

"The aim of life is to live, and to live means to be aware, joyously, drunkenly, serenely, divinely aware."

EM VS SJS VS TEN

SJS VS TEN

Wednesday 20 July 2016

Those who complain the most, accomplish the least. – It’s always better to attempt to do something great and fail than to attempt to do nothing and succeed

Those who complain the most, accomplish the least. – It’s always better to attempt to do something great and fail than to attempt to do nothing and succeed

. The way you feel about people and situations will shift, and that’s OK. – Things will seem totally different to you at some point in the future, just as you feel different now than you did in the past.

. The way you feel about people and situations will shift, and that’s OK. – Things will seem totally different to you at some point in the future, just as you feel different now than you did in the past.

Tall, lean adolescent males have an increased risk of spontaneous pneumothorax. Pneumothorax may be the first manifestation of CF or Marfan syndrome.

Tall, lean adolescent males have an increased risk of spontaneous pneumothorax.
Pneumothorax may be the first manifestation of CF or Marfan
syndrome.

Everything that happens helps you grow, even if it’s hard to see right now. – Circumstances will direct you, correct you, and perfect you over time

Everything that happens helps you grow, even if it’s hard to see right now. – Circumstances will direct you, correct you, and perfect you over time

Histories in infants dying of SIDS rarely reveal a previous history of apparent life-threatening events (ALTEs). Childhood immunizations have not been linked to SIDS.

Histories in infants dying of SIDS rarely reveal a previous history of
apparent life-threatening events (ALTEs). Childhood immunizations
have not been linked to SIDS. 

Consider the possibility of a radiolucent foreign body in a previously healthy child with a lung abscess. Bronchoscopy may be indicated.

Consider the possibility of a radiolucent foreign body in a previously
healthy child with a lung abscess. Bronchoscopy may be indicated.

112.5-million blood donations globally and half of these come from High-income countries High-income countries more often use blood for supportive care during surgery, in traumas or therapy for malignancies Low and middle-income countries more often use blood to manage pregnancy-related complications or in severe childhood anemia

  • 112.5-million blood donations globally and half of these come from High-income countries
  • High-income countries more often use blood for supportive care during surgery, in traumas or therapy for malignancies
  • Low and middle-income countries more often use blood to manage pregnancy-related complications or in severe childhood anemia

Pulmonary embolism is relatively rare in children and symptoms are less severe than in adults. It is probably underdiagnosed for these reasons.

Pulmonary embolism is relatively rare in children and symptoms are less
severe than in adults. It is probably underdiagnosed for these reasons.

WALK 10 K A DAY

You’ll need to complete 7,000 in a day to bank five points – about the equivalent of walking 5km or running 8km. According to the NHS, the average person takes between 3,000 and 4,000 steps in a day (MSE founder Martin Lewis is a fitness tracker addict and averages 23,000 a day, so somewhere in between is doable) but the target for a healthy heart is 10,000 a day 

Mild thyroid dysfunction in the newborn-reflected by an elevation of TSH that is below the clinical threshold (5-15 mIU/L)-was not associated with impaired psychomotor development at preschool age.

Mild thyroid dysfunction in the newborn-reflected by an elevation of TSH that is below the clinical threshold (5-15 mIU/L)-was not associated with impaired psychomotor development at preschool age.

SILENT AND SATISFIED

show, dont tell


ALL TESTICULAR RELAPSE

  • Testicular relapse remains an important cause of the failure to cure boys with ALL
  • Isolated testicular relapse after treatment carries an 82% six year survival with adequate retrieval treatment
  • Patients developing a testicular relapse during treatment fare badly
  • Endocrine sequelae in this group of patients are significant, but treatable; long term follow up is essential

AUTOMATICITY DEVELOPS IF HABIT CONTINUES MORE THAN 60 DAYS

IMPLEMENTATION INTENTION

Statins to Reduce Acute Kidney Injury After Cardiac Surgery.

Statins to Reduce Acute Kidney Injury After Cardiac Surgery.

COPD GOLD STAGES

CLASSIFICATION OF SEVERITY OF COPD

GOLD Stages
Symptoms
FEV1 (% predicted)
*FEV1/FVC (%)
I: Mild
+/- Symptoms
+/- Cough/sputum
> 80
< 70
II: Moderate
+/- Symptoms
+/- Cough/sputum/dyspnea
50 - 80
< 70
III: Severe
+/- Symptoms
+/- Cough/sputum/dyspnea
30 - 50
< 70
IV: Very Severe
Cough/sputum/dyspnea
+/- Respiratory failure
+/- Right heart failure
< 30
Or respiratory failure
Or Right heart failure
< 70
*Note: FVC -- Forced vital capacity: the maximum volume of air that can be forcibly expelled from the lungs. FEV1 -- Forced expiratory volume in one second: the amount of air you can exhale during the first second after you take your deepest breath.

UTIs can cause sudden confusion (also known as delirium) in older people and people with dementia. If the person has a sudden and unexplained change in their behaviour, such as increased confusion, agitation, or withdrawal, this may be because of a UTI

UTIs can cause sudden confusion (also known as delirium) in older people and people with dementia. If the person has a sudden and unexplained change in their behaviour, such as increased confusion, agitation, or withdrawal, this may be because of a UTI

CHILLI X MILK

hot chile pepper, your best bet is to drink some milk. That's according to research conducted by New Mexico State University's Chile Pepper Institute.
"Capsaicin is the chemical compound found in chile peppers that makes them taste hot," said Paul Bosland, an NMSU Regents Professor and director of the Chile Pepper Institute. "It turns out that milk has a protein in it that replaces the capsaicin on the receptors on your tongue. It's really the quickest way to alleviate the burning feeling."

The very first chile peppers evolved around Bolivia in South America. The early wild peppers were very small and round and were probably spread by birds because they do not have the same heat receptors in their mouths as humans do

Experts believe that when the first humans arrived in the Western Hemisphere, probably around 15,000 years ago, they began to cultivate chile peppers and select them for various traits. The plants naturally cross-pollinate well, so new varieties are easily developed and constantly being made. Today, there are thousands of chile pepper varieties, from the super-hot Trinidad Moruga Scorpion to the standard bell pepper, which doesn't have any heat at all.


red or green chile peppers," Bosland said. "It depends on the variety, but generally, red won't be as hot because red chile peppers will have more sugars in them, which helps to counter the heat."

An interesting situation happens when astronauts put hot sauce on their food in space, because it doesn't taste as hot as it does on earth. Bosland said researchers are still trying to figure out why that is.

HUMN EVOLN

Chimpanzees who travel are more frequent tool users


A low quantity of ripe fruit also increases chimpanzees' motivation to acquire new foraging skills, but the effect is less pronounced than travel.

 travel created an extra need for high-energy food while the challenge of inaccessible honey created an opportunity for innovation. 

Higher education associated with reduced heart failure risk after myocardial infarction

OCD X SUICD

MOL PSYCH The serotonin transporter gene (SLC6A4) with the 5-HTTLPR is located on chromosome 17.HAPPY X SAD

Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author


an x poor insight

The brains of people with anorexia nervosa who have poor insight may not generate an ‘error message’ when told, for example, that they are putting themselves at serious risk for death by severe restricting,” said Dr. Alex Leow

being in a car can impact distance judgements

SINGULARITY

AGE UNIV

BBTBR

PLANCK TIME

BBTBR The "prime mover" would be electromagnetism, and gravity. Hardly worth deification.

The "prime mover" would be electromagnetism, and gravity. Hardly worth deification.

YOUNG CHILD FACIAL WEKNESS MRI BRAIN FBC LYME SEROLOGY


TACTILE FEVER NOT DOCUMENTED

TACTILE FEVER  NOT DOCUMENTED

PED ABDO TRAUMA

NN PULM HGE RX SURFACTANT HFOV IT ADRENALINE FFP CLOSE PDA WITH IV PARACETAMOL INCR PEEP

NN PULM HGE RX SURFACTANT HFOV IT ADRENALINE FFP CLOSE PDA WITH IV PARACETAMOL INCR PEEP

NN PULM HGE RX SURFACTANT HFOV IT ADRENALINE FFP


ANML GRF

Gonzalvo expected the mother to stay with the corpse. Instead, it was allowed to sink and the group immediately left the area. “My hypothesis is that the sick animal was kept company and given support, and when it died the group had done their job. In this case they had already assumed death would eventually come – they were prepared.” Gonzalvo accepts that his interpretation is speculative and based on limited data. He is gathering examples from other researchers before publishing his observations

Interpreting animal behaviour after the death of a companion is fraught with difficulty”

Interpreting animal behaviour after the death of a companion is fraught with difficulty”

DOES NOT ELIMINATE CT ABDO

USE SBC IF NN PH LESS THAN 7.25 GCR


KNOWING IS HALF THE BATTLE

KNOWING IS HALF THE BATTLE

REFEEDING SYNDROME Phosphorous is classically the most-affected Often reaching life threateningly low levels, but potassium, magnesium, calcium and thiamine can also be deranged

  • Phosphorous is classically the most-affected
    • Often reaching life threateningly low levels, but potassium, magnesium, calcium and thiamine can also be deranged

POLYTRAUMA CT HEAD ABDO PELVIS, XRAY NECK, LIMBS


"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward." -- C.S. Lewis

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward." 

-- C.S. Lewis 

DAPTOMYCIN -RESISTANT GRAM POSITIVE ORGANISMS


NN HYPOGLYCEMIA Failure to find large ketones with hypoglycemia suggests that fat is not being metabolized from adipose tissue (hyperinsulinism) or that fat cannot be used for ketone body formation (enzymatic defects in fatty acid oxidation)

NN HYOPOGLYCEMIAFailure to find large ketones with hypoglycemia suggests that fat is not being metabolized from adipose tissue (hyperinsulinism) or that fat cannot be used for ketone body formation (enzymatic defects in fatty acid oxidation)

The happiness of your life depends on the quality of your thoughts. – The mind is your battleground

The happiness of your life depends on the quality of your thoughts. – The mind is your battleground

UVC Positioning newborn infants on their right side did not result in more correctly placed umbilical venous catheters. The procedure was well-tolerated and reduced the rate of tip insertion into the portal venous circulation.

UVC Positioning newborn infants on their right side did not result in more correctly placed umbilical venous catheters. The procedure was well-tolerated and reduced the rate of tip insertion into the portal venous circulation.

children without fever, and children with Grade 3-4 VUR were more likely to have a UTI caused by organisms other than E. coli.

 children without fever, and children with Grade 3-4 VUR were more likely to have a UTI caused by organisms other than E. coli.

LAST DAYS OF MOCA

ON SCREEN SCIENTIST

Last Days of Chestnut, Guinea Pig

May 22
Our guinea pig, Chestnut, is dying. He will probably be dead before I finish writing this, but I am going to leave the beginning as it is. I had hopes that the antibiotics he started yesterday would do their saving work; and his eating one of his favorite delicacies—cucumber peelings—last night with a final, feeble amount of gusto gave me hope that he was bouncing back, perking up. But he has retreated inside his little plastic “igloo” inside his cage, with his back to its opening, minimizing sensory input; the equivalent of turning over to face the wall. He makes no sound, but turns away from proffered food or water as from an annoyance that belongs to the past. He has decided it is time to die. I know that he hasn’t decided anything, really; he is just too sick to stand the sight of food or drink. Yet it seems he has decided it is time to die, and he knows the right way to do it. He has decided it is time to die, and the house is heavy with his decision.
To whom shall I pose silly rhetorical questions with Chestnut gone? How long will it be before I stop adding, “Right, Chestnut?” to the end of statements. Chestnut, Chesty, Chesterfield, Lord Chesterfield, C-Field—he answered to them all the same way: with the inexpressive face of a rodent looking in your direction. “Did you mention food?” he perhaps was thinking. He loved to eat. He lived to eat. And now he turns away from food, but seems to have a certain quiet wisdom about him.
That reminds me of something our friend Carmi said when she was visiting. Being a poet with a mystical bent, Carmi often says things that stick in your mind just in her ordinary talking. She and her daughter had had a guinea pig named Oreo. Carmi was impressed that when I went out the back door, scissors in hand, to harvest some fresh grass for Chestnut, he had been so excited that he’d jumped out the open door of his cage in clear anticipation of the upcoming treat. Oreo, Carmi said, had had “ancient wisdom,” but had not been as “street smart” as Chestnut. Now Chestnut’s ancient wisdom has come to the fore.
The antibiotics and painkiller the vet gave us yesterday were just to make us all feel better that we were trying what we could think of. But Chestnut has something called bumble foot, a foot rot—maybe it’s the equivalent of gangrene, I don’t know. Anyway, for it to have affected him so severely means almost certainly that it is too late. The vet wanted to be sure that we knew it was serious, not to be surprised if he was “much worse” this morning.
Yes, there’s some guilt here. We should have noticed how bad the foot was and taken him to the vet earlier. We didn’t take him in for the foot, just for the severe overall decline, lethargy, loss of appetite, etc. Chestnut lived the life of a king from the food standpoint, but I’m afraid his long claws bear witness to a certain lack of care in other regards, including regular inspection for things such as infected feet. He had a known problem, common in older “boars,” of stool agglomeration. Instead of numerous small dry pellets, he would also produce large masses of soft fused pellets. Sometimes it would be a great effort to pass the mass of guinea pig poop. We assumed that one too big to expel was the problem that was causing his loss of appetite, which would not have been as serious.
Chestnut is my daughter’s first and only pet. Well, mammalian pet; she had some African dwarf frogs. He was a birthday present a few years ago, a reward for her agreeing to attend a summer chamber music day camp. We had taken care of a few guinea pigs for days and weeks at a time in the past, and she had been wanting one for quite some time. My wife remembered how she had lost interest in her own guinea pig as a child in a fairly short period and didn’t look forward to becoming the real guinea pig care provider. Looking farther into the future, she dreaded years more of such duty after our daughter had gone away to college. But little Chestnut, just weaned, was purchased at a local pet store, and amused us greatly with his antics, especially the “popcorning”—spastic leaps which guinea pigs engage in when they are feeling good (I guess).
We left the door of his cage open when we were home, and he would roam around the house, even follow people from room to room sometimes. He seemed to like company and play. I would put newspaper (to absorb pee) under the wicker coffee table near the chair in which I would sit reading, and Chestnut would stay under the table. Except he would venture out on a quick foray to nibble away a corner from a paper or a paperback book cover. We turned it into a game with me putting paper out for him and then gently swatting at him with a sheet of paper when he came to get it. I will think of you, Chestnut, when I see those books with the neat bites taken out of their covers. He was quick! And their teeth are so sharp.
This was all when he was young. As he matured, he stopped venturing out of his cage, even though the door was still left open. We found he had chewed on a lamp cord. Had he gotten a traumatizing shock? We couldn’t know of course, but the exposed copper made us think he was lucky to be alive. For a while I was able to lure him out by putting a newspaper near the cage door, which he couldn’t resist coming out to nibble on, but eventually he got to where he almost never came out except when it was forced on him during cage cleanings. Then, he would usually take a few laps around the cage.
My daughter cried for Chestnut last night, as is only right. Sad as it makes me to see her feel bad, I would rather have that than see her heartless and unconcerned.
We have given Chestnut his pain killer and antibiotics for the day, and then used the antibiotics mouth syringe to get some water into him. Dehydration will kill you far more quickly than starvation. He’s fat enough to miss a few meals, I imagine. The only encouraging sign is that he is now facing the entrance to his igloo so he can see out to the world.
May 23
OK, it’s now the morning of the next day. We forced some more water down him, and it must have done him good. He still wouldn’t eat until I brought him some fresh, green grass. That he munched on for quite a while, a very big improvement. Don’t know whether we should get our hopes up.
12:30 pm. Now he’s whimpering in the most pathetic way. It’s really unbearable to hear. Catatonic was better. We will have to euthanize if that doesn’t get better. When my wife gets back from the store, we’ll give him another dose of painkiller. One little rodent in agony here has more of an effect on me than the somewhat abstract knowledge of mass human suffering now occurring. I have not been watching television coverage of tragedies; perhaps I should be.
11:30 pm. My wife said that he had been whimpering that way for days, though I hadn’t heard it before. So it doesn’t signal a new stage of decline and pain, but it is still painful to hear and makes his earlier suffering seem all the worse. She went back to the vet’s because the test-tube-like container the antibiotics was in was too long for the syringe we need to use for giving Chestnut his dose. I doubt the vet thought he’d still be alive, for only now did he mention the importance of food and water. He suggested pulverizing the hay pellets he eats and mixing them with baby food carrots and water and using another bigger syringe to feed it to Chestnut. We thought we got a little into him in the afternoon.
Just before bed, all three of us—my wife, daughter, and I—tried again to get some more water and food into him. He had trouble keeping his eyes open, nothing I’d ever seen before. He didn’t drink water that was squeezed into his mouth this time, as though reflexes aren’t even working. He wasn’t interested in food and didn’t get much if any. Would not be surprised to find him dead in the morning. Glad he ate grass one last time anyway. We’ve gone from hoping for recovery to hoping for a quick end.
May 24
Chestnut greeted me with what might be described as loud whimpers when I came downstairs to start breakfast. Maybe he is doing some things automatically, like greeting, but can only make certain sounds. Hard not to take it as a plea to put him out of his misery. He turned away from his water bottle spout as from something noxious.
10:30 am. We’re now waiting for our daughter to wake up (it’s Saturday morning), so she can be in on the decision to take him to the vet to put an end to his suffering. The waiting is getting to me, since it is starting to seem urgent to put him out his misery, as I think of what he must be enduring with so many bodily systems having broken down. Hopefully the vet is open today.
11:00 am. He’s not, but the phone message gave another place to call for an emergency. My daughter is up, and she agrees it’s time.
1:30 pm. She took him out of his cage and carried him, wrapped in a towel like a baby, upstairs to her room for a long while.
My wife has been felled by the same cold I have presumably, but harder and with fever. She got the news yesterday that an old friend she hadn’t seen in years had just died. The friend’s husband called.
The only place I have found that will euthanize a guinea pig today is quite a distance away, and my wife is too sick to be left alone. She is weak, dizzy, and nauseated in addition to having a sore throat.
I go in to check on Chestnut and he is lying flat, rhythmically whimpering. When he becomes aware of my presence, his whimpers get louder, definitely an acknowledgment of some kind. Maybe a plea. The guilt I feel is heavier, the sadness more acute.
A friend is coming over. Maybe I’ll take Chestnut to the place that will end his life for a fee while she stays with my wife. We haven’t attempted forced feeding today.
5:30 pm. I’m not changing anything I wrote before. Chestnut has been buried in the back yard. My son arrived back from his ultimate frisbee tournament just in time to help his sister and me dig and cover.
I drove to Jamaica Plain to have Chestnut put to sleep. On the way there, I and drivers in the other lanes of a very busy road had to stop for some Canada geese and a passel of goslings to cross. Very slowly. First one bunch, and then another. Especially given the nature of my journey, it was a heartening sight to me, animal life and new animal life. And everyone seemed glad to stop. The geese were lucky, and I hope they don’t try it too often, for their luck must run out.
I talked to Chestnut on the way. I told him what a good pig he had been. He was in the back of the minivan in his cage, so we couldn’t see each other. I wanted to pray, but didn’t know what to pray for. I decided to pray for whatever was the best thing a guinea pig in Chestnut’s condition, about to die, could have. I put in a word for him, knowing it was superfluous, but I asked that he might have the very best the Creator still had to offer.
We arrive at the animal hospital, and I take Chestnut out of his cage and put him in a small cardboard box, just his size, along with an old teeshirt of mine. Judging by the movements of his body and head, as we enter the building, he seems to be more alert than I’ve seen him in days. What is going on? Is this a miracle starting to happen? He actually starts trying to climb out of the box!
At the intake desk, where I’ve already told them my purpose, I’m talking to him: “What are you doing, Chestnut? Are you trying to get me to take you back home?” His body feels surprisingly strong in my hands. I look at him closely, trying to discern what the change means. I say to the intake woman, who is looking at me quizzically, “He hasn’t eaten anything in days. He hasn’t moved like this in I don’t know how long.” Chestnut moves about again. And then a small popcorn! Tired out, I suppose, he relents.
I take Chestnut and the registration form that I need to fill out over to the empty “cat area.” If Chestnut’s activity resumes, I’ll have to think harder about what I’m about to do. I’ve gotten through name and address when I look in at Chestnut, who is still. I wonder. His visible eye is now wide open and clear. His body is soft and warm, but feels totally relaxed in my hand. Is he? Yes—dead.
I’m stunned, as though a lightning bolt of mystery had struck me, electrifying me with hidden meaning I can feel but not decipher. I feel a sort of joyful sadness and great relief. I stroke his beautiful white and light-chestnut coat a few times, then carry him over to the intake desk. I know he’s dead, but I say “I think he’s dead.”
A technician takes the little box with the body away to verify he has no heartbeat, free of charge and with genuine sympathy. The young woman at the desk tries to reassure me about having let his foot infection get so bad. Small animals are very fragile, so the least thing can kill them. She has canaries. Yes, I will take him home, and we will bury him in the back yard.
What was the urgency that drove Chestnut to use every last atom of his remaining strength and life in that seeming attempt to escape? As far as I know he’d never acted that way at the vet’s before, even in that same box, which came from his last trip there. He had always been quite docile the few times he’d been to the vet. But maybe he had some memory of the recent painful foot treatment associated with being in the box. Could he have had a vague premonition, which awakened a powerful desire to live, when he hadn’t been able to summon up the strength or desire to eat or drink for days? Was he trying to escape a sudden pain or fear that came with death’s arrival and which had nothing to do with the external situation? Was it something like a chicken running around with it’s head cut off? It seemed more natural than that.
I don’t know enough about physiology, guinea pig or otherwise, to venture an educated guess. None of these speculations keep me from feeling proud of Chestnut for dying such a death. The burst of activity was brief and strangely inspiring; and, for whatever reason, the timing was just right. If we hadn’t had to wait for the geese to cross… I don’t know.
Did I cry over his death? Well, rodents have never been my favorite kind of animal. They are not the most intelligent beasts. They don’t have to be, the way predators do. They eat whatever suits them with those wonderfully efficient teeth, and they survive by reproducing bountifully, so that an individual is not so precious to the species. Do you think a rational grown man would cry over the death of a mere rodent? Even over a beautiful death that spared us from having Chestnut die at the hands of a stranger and spared me from the possibility of lingering doubt about the decision? Yes, I did cry. When out in the parking lot, I even said “Thank you, Lord” out loud more than once. Superstitious, irrational, childish: call it whatever you like. I felt and feel that Chestnut’s death at just that time—and with a flashback to his former vigorous self!—was a gift, and gifts require a giver. Amen. And, Chesterfield, I have faith that you are getting or have already gotten whatever is the best a guinea pig can get.