Hospitals & Asylums
Fall Equinox
Edition
Vol. 13, No. 3
By Anthony J.
Sanders
Nehum 3:18-19
18 King
of Assyria, your shepherds slumber;
your nobles lie down to rest.
Your
people are scattered on the mountains
with no one to gather them.
19
Nothing can heal you;
your wound is fatal.
All
who hear the news about you
clap their hands at your fall,
for
who has not felt
your endless cruelty?
Habakkuk
1:1-7
1 The prophecy that Habakkuk the prophet received.
Habakkuk’s
Complaint
2 How
long, Lord, must I call for help,
but you do not listen?
Or cry
out to you, “Violence!”
but you do not save?
3 Why
do you make me look at injustice?
Why do you tolerate wrongdoing?
Destruction
and violence are before me;
there is strife, and conflict abounds.
4
Therefore the law is paralyzed,
and justice never prevails.
The
wicked hem in the righteous,
so that justice is perverted
The
Lord’s Answer
5
“Look at the nations and watch—
and be utterly amazed.
For I
am going to do something in your days
that you would not believe,
even if you were told.
6 I am
raising up the Babylonians,[a]
that ruthless and impetuous people,
who
sweep across the whole earth
to seize dwellings not their own.
7 They
are a feared and dreaded people;
they are a law to themselves
and promote their own honor.
Pulmonology HA-18-7-13
The respiratory system
includes the nose, mouth, a pair of lungs, the tubes or airway to the lungs,
chest bones and muscles. Oxygen is pumped into the lungs by the
respiratory muscles and is brought into close contact with blood, into which it
passively diffuses, at the level of the pulmonary capillaries in the
alveoli. Carrier molecules in the blood, hemoglobin, bind the O2 to
make blood, pumped by the heart, as efficient as the air in transporting O2. Each
cell in the body is equipped with a specialized furnace, the mitochondria,
which burns carbohydrates with O2 to produce the high-energy
ATP molecules that fuel the cells' functions, and ultimately maintain the life
of the whole organism. O2 is transformed into water by this
process and with carbon dioxide (CO2) is returned to the external
environment where it is recycled by plants into O2 and
carbohydrate by solar energy. Humans can tolerate only 5 minutes of
oxygen (O2) deprivation without irreversible damage and death. Any change in pH, whether produced by
respiratory or metabolic changes, alters O2 affinity. Under
pathologic conditions, blood pH can deviate markedly from pH 7.4 and have
profound implications in oxygen delivery. Low pH may hamper oxygen uptake
in the lung. Addition of CO2 to blood causes pH to
fall by 0.03 to 0.05 units. Sputum has a pH of 7.0 and must be
removed through daily naso-bronchial hygiene. Ascent
to high altitudes produces both hypoxemia and respiratory alkalosis. Alkalinity
can be prevented by administration of acetazolamide. Acidosis is
often corrected by hyperventilating through pursed lips and its cure is
dependent on the excretion of acid by the kidneys. Bicarbonate
therapy is most effective when plasma bicarbonate is low and there is little be
gained when the initial (HCO3- ) is above 20 to 1 mEq/liter.
The treatment of cough
is successful in over 95% of cases. All narcotic antitussives are
effective cough suppressants. Dextromethorphan hydrobromide
is the most common nonnarcotic cough suppressant, it is slightly less
effective. Around 2010 the FDA removed some 600 different types of
flu remedies from the market. The FDA has approved Allegra
(Sanofi-Aventis) and Children's Allegra (fexofenadine) and Allegra-D
(fexofenadine and pseudoephedrine) product lines to be marketed
over-the-counter. The two prescription antivirals for the flu are Oseltamivir (Tamiflu) and Zanamivir
(Relenza), for Haemophilus influenza the
antiviral Amantadine (Symmetrel) and anbimicrobials ampicillin (Principen)
or levofloxacin (Levaquin) are also used. Winter
2012-2013 the flu vaccine was reported to be only 8% effective. Respiratory
syncytial virus (RSV) infections are treated with NSAIDS such as
acetaminophen or ibuprofen and corticosteroids may be administered if the
pneumonia worsens. Antibiotics should be administered if an ear
infection (otitis media) or pneumonia develop. For Severe Acute
Respiratory Syndrome (SARS), a coronavirus, the treatment with no fatalities
was to ventilate the patient and medicate with the antibiotic levofloxacin (Levaquin), and corticosteroids methylprednisolone IV and
then prednisone. Vaccines are the
greatest achievement of modern preventive medicine. Polio and
smallpox have been eradicated and one more generation of vaccines will
eliminate whooping cough, measles and mumps as threats to our children. Allergies
have become more common since vaccines and GM crops saturated the market. Antihistamines
are sedative and 100 immunotherapy injections is a lot. Herbal
medicine is successful in the treatment of viral and allergic illnesses. For
allergic rhinitis the best treatment is the essential oils of fresh Lavender,
Lemonbalm, and Peppermint in the nose, or as
drops on the tongue or mix the oils in a ¼ cup of juice or water, swish 10-20
seconds in the mouth and swallow, relief should be instant, use must
continue. Eucalyptus oil kill dust mites, a common household
allergen. Take Vitamin C 200-1,000 mg daily to shorten duration of
cold. Oranges, echinacea and
elderberry are high in vitamin C and very good at treating colds.
Initial therapy for
acute asthma and chronic obstructive pulmonary disease (COPD) should include
supplemental oxygen and inhaled beta-adrenergic drugs. Corticosteroids
are indicated if the initial response is insufficient or if the patient has had
several recent asthma attacks. There are two chief types of
bronchodilator drugs: adrenergic agents (Ephedra aquisetina and E.
sinica and synthetics) and those
derived from theophylline (originally isolated from tea, Camellia sinensis) which act directly on the bronchial muscle to
relieve obstructions, increase coronary blood flow and stimulate respiration
centrally. Tea as an oral treatment of 100 patients for 20 days
proved effective in 93% of cases, of which 58% could be described as
excellent. During the course of treatment, sputum decreased in 91%
of the cases, cough in 85% and asthmatic symptoms in 58.1%. Streptococcus
pneumoniae is the most common bacterial
cause of pneumonia. Pneumococcus, Haemophilus
influenzae, Legionella pnemonphila, Mycoplasma and viruses
abound in the community and gram-negative bacteria and Staphylococcus species
in hospitals. Cystic fibrosis patients are frequently infected with Pseudomonas and Staphylococcus. COPD
patients are vulnerable to the typical community-acquired infections. The
bacterium Legionella pneumophila causes
both Legionnare’s disease and Pontiac fever and is an
occupational hazard contaminating air-conditioning units and water
reservoirs. Empiric therapy for the majority of immune-compromised
patients with a presumed pulmonary infection includes antibiotic coverage for
both gram-positive and gram-negative organisms (usually a semi-synthetic
penicillin or a cephalosporin plus an aminoglycoside. Penicillin by
mouth and corticosteroids by mouth or nebulizer may be effective in simple lung
abscesses. Inpatient treatment of lung abscess, especially the putrid variety,
should be 2 to 6 million U crystalline penicillin G intravenously daily; 600,000
U procaine penicillin G intramuscularly every 6 hours for 4 weeks may be
sufficient in milder cases. In the presence of serious penicillin
hypersensitivity, clindamycin 600 mg 4 times daily, lincomycin
600 mg intramuscularly every 6 hours, or erythromycin 2 gm/day
may also be used. Some observers are in favor of adding streptomycin
1 gm intramuscularly daily for at least the first 7
to 10 days, or tetracycline 2 gm daily to 3 to 5
days, then 1 gm daily. If Staphylococcus
aureus is found and believed to be a
causative agent, intravenous methicillin, or an equivalent drug such as nafcillin, 8 to 16 gm daily, if
penicillin resistant. Vancomycin, 500 mg
intravenously every 6 hours is an effective anti-staphylococcus drug but has
significant toxicity, resistance and probably should seldom be used. Antimicrobial
treatment should be continued for at least 2 to 3 months, sometimes even
longer. Oral doxycycline 100 mg the once a day antibiotic, for the
treatment of methicillin resistant S. aureus (MRSA),
seems more ideal than hospital treatment for a hospital acquired
infection. If Klebsiella organisms
are found and are the causative agent, the initial therapy should include
kanamycin, 15 mg/kg/day intramuscularly in 2 or 3 divided doses, the total dose
being decreased if renal insufficiency is present or appears. Metronidazole
(Flagyl ER) is a safer and possibly more effective
alternative but clinical trials are needed for the FDA to indicate its
effectiveness against Klebsiella and E.
coli. When Pseudomonas is clearly the causative
organisms, gentamycin or tobramycin should be used. Metronidazole (Flagyl ER) is indicated for the treatment of Bacteroides spp. (e.g. B. fragilis). Doxycycline, the once a day
antibiotic, should be prescribed at hospital discharge to prevent hospital
acquired staph infections. Although azithromycin (Zmax),
the world's best-selling antibiotic, may be more a day or two more effective in
most cases, pencillin or ampicillin (Principen) are the standard treatment for pneumonia,
meningitis and upper respiratory infections, and erythromycin, a streptomycin
like Zmax, is the traditional generic alternative for
patients allergic to penicillin. Metronidazole is a uniquely
effective antibiotic at curing gastrointestinal infections without
side-effects, that is also effective against bone and joint infections lower
than the middle of the thorax. In 1989 ten drugs were used for the treatment of
tuberculosis and non-tubercular mycobacteria (NTM), the four most important are
isoniazid (INH), rifampin, pyrazinamide, and ethambutol
with 95% cure rates in a 6 to 9 month short course of multiple drug
chemotherapy.
Corticosteroids, sporanox (itraconazole) oral and
amphotericin B are the only medicines indicated for Aspergillus spp (i.e. A. niger sold
to academic laboratories) which causes invasive pulmonary aspergillosis,
and releases a most highly carcinogenic aflotoxin, as
well as the other fungi also treated by ketoconazole Coccidiodes
immitis, Cryptococcus neoformans, Candida organisms, Histoplasma capsulatum,
and Blastomyces dermatitidis.
Hypoxemia can be effectively corrected by using controlled oxygen enrichment by
double nasal cannula or Venturi masks. Expectorants and
mucolytics such as guafenesin
or the herb mullein help liquefy secretions and allow one to cough up mucus
more easily. One of the best expectorants is water. Drinking
an adequate amount of water, about one quart per day, will make clearing phlegm
easier, which may lead to improved breathing. Lung cancer has a 10-15%
five year survival rate. The probability of contracting lung cancer
is 12 times higher in smokers and 50 times higher in smokers who have been
exposed to asbestos, a fiber that only causes cancer in smokers. The
most active single antineoplastic agents are methotrexate and cisplatin. Each produces response rate of
approximately 30% (mostly partial responses) of 4 to 6 months' duration. Cisplatin responses usually occur more promptly. Cisplatin is an effective drug whose major route of
excretion is renal, and its use should be limited to patents with a creatinine clearance that is more than 50 ml/minute. The
standard dose is 100 mg/m2 every 3 weeks. Methotrexate is
generally given at 40 mg/m2 intravenously weekly. Methotrexate
2.5 mg, once a week, might be more effective with fewer side-effects, exposure
to community and hospital acquired infections and carcinogens and at 70 cents a
pill, lower cost. Don't lose weight, extra rations for physical
labor, pregnancy and respiratory disease.
Oncology HA-19-9-13
The skin is the largest
organ. No one calls insect bites or chickenpox tumors, but by strict
medical definition they are. The skin is about one millimeter
thick. There are about 100,000 hairs on the scalp of which about 70
are shed each day. Hairs on the scalp grow up to 0.015 inch every
day, a half an inch a month. Fingernails grow continuously and
average between 0.02 and 0.05 inch per week. Toenails grow about a
third more slowly.Histology is the study of the microscopic
anatomy of four basic tissue types: 1) epithelia, 2) connective, 3)
muscle, and 4) nervous tissues. Eczema is an
inflammation of the skin that causes the sensation of itch and makes the
sufferer want to scratch. An alternative name for eczema is
dermatitis – the two terms mean exactly the same thing and it is not uncommon
for some doctors to use the term eczema to describe the problem in babies and
dermatitis in older children and adults. The most common reason for
a dermatologic doctor visit is the overtreatment of contact dermatitis;
hydrocortisone ointment, available for $1, has the broadest spectrum of activity
without the side-effects of more powerful corticosteroids. Acne is
most common in teens but can strike at any age. Almost 100 percent
of people between 12 and 17 years old have at least an occasional
blemish. More than 40 percent of cases are severe enough to require
treatment by a doctor. About 15 million people in the United States
have some form of eczema, including 10 to 20 percent of babies. In
about half of these babies, the condition will largely clear up between the
ages of 5 and 15. This condition usually appearas during
infancy. About 5 percent of the U.S. population has foot infections
,including athlete's foot, other fungal infections and warts every year. Psoriasis
affects more than 7 million Americans, about 2.6 percent of the population. More
than 150,000 new cases are reported every year, 20,0000 of them in children
under 10. It is most commonly diagnosed between ages 15 and
35. About 1 to 2 percent of the world's population, 40 to 50 million
people, suffer from vitiligo, 2 to 5 million in
the U.S. It generally develops before age 40 and affects all races
and genders equally. Most skin cancer is non-melanoma cancer, such as basal or
squamous cell carcinoma. More than 1 million of these cases are
diagnosed every year. About 54,000 melanomas are diagnosed every
year, causing 7,500 deaths. About 2,000 die from non-melanoma skin
cancer. Skin cancer is the most common cancer. About 1.5
million Americans have a form of lupus. Lupus is much more prevalent
among people of color, and 90 percent of cases occur in women. Systemic
lupus usually develops between ages 15 and 45.
Acne vulgaris is a very
common skin condition of adolescents and young adults; characterized by any
combination of comedones (blackheads),
pustules, cysts, and scarring of varying severity; it is treated by washing
with water and Dial soap, Benzoyl peroxide, resorcinol, Retin-A or Accutane for severely scarring cases, for
infection topical clindamycin or erythromycin ointment or oral doxycycline, the
once a day antibiotic, is cheap and highly effective for the treatment of the
skin and greatly accelerates wound healing when the powder is applied to
topically. Keratosis are pre-cancerous skin lesions mostly found in
people over 40 when the skin begins to dry out and becomes sun sensitive,
requiring moisturizer, sunscreen, avoidance of the sun between noon and 3 pm,
best treated with the topical antineoplastic exfoliator 5-fluourouracil
(5-FU). The three kinds of malignant skin cancer are squamous cell
carcinoma, basal cell carcinoma and malignant melanoma, which has lethal
metastatic potential, are best treated by avoiding sunlight and wide surgical
excision. Aside from general anesthesia, no pain medication will
completely remove a severe burn patient's pain until they have completely
healed; surgical skin grafting and reconstructive techniques have become highly
developed. Bacterial skin infections such as impetigo are best
treated with doxycycline, that is effective against hospital acquired
methicillin resistant staphylococcus aureus (MRSA). Mycobacterial
diseases such as leprosy and tuberculosis require special treatment with Dapsone (diaminodiphenyl sulfone, DDS), rifampin, and isoniazid. Herpes
simplex virus cold sores of mouth and genitalia are treated with Acyclovir (Zovirax). Zovirax ointment
(5%), Neo-Synalar or other
antibiotic-corticosteroid ointment and Burow's solution
wet compress for 20 minutes three times a day to relieve much of the pain and
irritation. Warts, or verrucae, are very common small tumors of the
skin caused by the human papilloma virus (HPV. There are 30 to 40
types of HPV that will affect an estimated 75% of 80% of males and females in
their lifetime. For most, HPV clears on its own, but, for others HPV
could cause cervical cancer in females and other types of HPV could cause
genital warts and oropharyngeal cancer in
both males and females. Common warts of the skin are best removed
with electrosurgery. Warts around the
nails tend to recur and are treated with Salicylic acid and trimmed with a
scissors. Plantar warts of the foot are treated with trichloroacetic acid solution, fluorinated corticosteroid-occlusive
dressing, or cantharidin tincture and the
wart is removed curettage. Filliform warts,
flat warts, are snipped off with a small scissors. Moist warts (condylomata acuminate) appearing in the anogenital areas are treated with podophyllum resin in alcohol. Gardasil
helps protect against 4 types of HPV. In girls and young women ages
9 to 26 Gardasil helps protect against 2 types of HPV that cause about 75% of
cervical cancer cases, and 2 more types that cause 90% of genital warts in both
boys and girls. Topical fungal infections, usually Tinea (pedis, versicolor etc.) are treated with athlete's foot crème
(clotimazole) that can be purchased for $1. Cutaneous
candida and sporotrichosis are treated with
oral ketoconazole. Male pattern hair loss must be differentiated from patchy
hair loss from alopecia areata or
trichotillomania. Treatment for lice, pediculosis capitis and pubis, is lindane shampoo
(Kwell or Scabene). Scabies
from mites is treated with lindane lotion (Kwell or Scabene). There
are a number of treatments for psoriasis for which fluorinated corticosteroid
cream is the mainstay. Discoid and systemic lupus erythomatosus are characterize by a butterfly rash on
the cheeks and both are sensitive to sunlight and are treated with
corticosteroids but the systemic form affects all organs and dramatically
shortens life-expectancy.
Virtually every cell
type in the body can become cancerous. Carcinomas, leukemia,
lymphomas and the various sarcomas account for more than 95 percent of all
human cancers. Malignant tumors of the epithelial cells are known as
carcinomas, benign tumors adenomas. White blood cell cancer of the
bone marrow is known as leukemia. Cancer of the lymphatic system
lymphoma. Cancer of the connective tissues are known as
sarcomas. For example, cancer of the colon could be a cancer of the
epithelial cells of the colon (carcinoma of the colon), or of connective tissue
cells of the colon (fibrosarcoma of the colon),
or even of the muscle cells in the colon (leiomyosarcoma of
the colon). General symptoms caused by many different types of
cancer are (1) persistent tiredness for no obvious reason, (2) progressive loss
of weight for no obvious reason, (3) progressive paleness of the tongue or
fingernail beds, especially if accompanying fatigue, can signify anemia from
blood loss, (4) persistent loss of appetite, (5) fracture of a bone without any
obvious trauma. According to the American Cancer Society,
approximately 1.4 million Americans will be diagnosed with cancer in 2006, and
altogether some 10.5 million Americans alive today have had a cancer diagnosis
at some time in their lives. In 2006 nearly 550,000 people will die
of cancer, which is second only to heart disease as the leading cause of death
in the United States. One out of every five people in the United
States and many other countries in the world is expected to die of
cancer. Any child born in the United States in 1985 has a more than
one in three chance of eventually developing some form of invasive
cancer. An exhaustive epidemiologic study in 1981 estimated
that tobacco was responsible for about 30 percent of all American cancers, diet
was responsible for another 35 percent, infection perhaps 10 percent,
reproductive and sexual behavior about 7 percent, occupational hazards about 5
percent, geophysical factors such as sunlight 3 percent, alcohol 3 percent,
pollution 2 percent, medicine and medical practices 1 percent and food
additives and industrial products less than 1 percent each. A no
protein diet of mostly vegetables and fruit is highly curative for many but
sufficient caloric intake must be maintained, including the 5% minimum of
dietary calories from protein, usually satisfied with the accidental or
intentional mixing of vegetable amino acids. Standard cancer
treatment involves surgery, radiation therapy and chemotherapy and the low
survival rates are not only depressing but indicative that more research is
needed. Most patients with early stage cancer are exclusively
treated with surgery and/or radiation and chemotherapy is reserved for advanced
metastatic cancers. Radiation treatment is very expensive and
administered at ten time the lethal whole body doses precisely to the cancerous
area, but may be lethal to patients whose cancer was caused by radiation
poisoning such as the laser from a CD-ROM drive. Major surgery
involving general anesthetic and endotracheal tube is inherently dangerous and
expensive and many patients complain that they are denied chemotherapy. Intravenous
chemotherapy in high doses is very toxic and expensive. A new
protocol must be developed to provide cancer patients with low dose oral
chemotherapy, namely methotrexate 2.5 mg costing about 70 cents, once a week,
for the FDA approved purpose of treating rheumatism, while they research
curative treatment at the biohazard dumpster, doctor and oncologist's office,
college and public library, athletic exercise program, organic kitchen and herb
garden.
Book 2 Attorney General Ethics (AGE)
To amend Chapter 2
Soldier’s and Airmen’s Home §41-70. The American Legal System
has failed, lawyers are either behind bars or drunk on power. In 2001, the
majority of the 93 million judicial cases filed, were processed by 15,555 state
trial courts operating under the supervision of the county; 13,515 of limited
jurisdiction and 2,040 of general jurisdiction, operated by 29,266
judges. There were 55.7 million traffic cases filed, 15.8
million cases were filed with the civil division, 14.1 million Criminal
cases, Domestic Relations processed 5.3 million cases, 2 million criminal
cases were filed in Juvenile Courts and 276,408 cases were filed with the
Appellate Courts. A civil law system must be instituted by lowering
law school entrance to high school graduates and the bar exam to BA and
terminate the licenses of all lawyers who are elected or appointed to public,
commercial or social office, a Civil-law Amendment III to the Annotated
United States Constitution calls for 4 year terms for elected
federal judges, with a two term limit for justices, and one year term for chief
justice, to repeal the constitutional right to bear arms and quartering of
troops in people’s homes, to change the name of prosecutor to district
attorney, elect licensed social workers to adjudicate traffic, divorce, mental
illness, substance abuse, tenant-landlord and small claims, and funeral
directors to avoid Probate, to abolish the death penalty, to change the name of
the Drug Enforcement Agency (DEA) to Drug Evaluation Agency (DEA) and transfer
to the Food and Drug Administration (FDA), to change the name of the Court of
International Trade of the United States (CoITUS) to
Customs Court (CC), to change the name of the Office of Violence Against Women
to Office of Women’s Rights and transfer to Social Work Administration (SWA)
when established, to ratify Optional Human Rights Protocols, to appoint a new
Attorney General, to transfer the Justice Assistance Grant (JAG) and other
extra-jurisdictional finance entirely to halfway house programs, primarily
financed by up to 7.7% of the Supplemental Security Income (SSI) program for
poor people on probation and parole, to safely reduce the jail and prison
population to less than 250 per 100,000 residents legal limit within a decade,
to separate the lawyers who are behind bards from those who are drunk on power; Quiz…218
Book 5 Customs (CC)
To amend Chapter 5
Columbia Institution for the Deaf §231-250. The
Millennium Development, MDGs for 1990-2015, cut in half the number of hungry
people to 622 million people and percent of people in poverty to 22.75% by 2015
from 45.5% in 1990. In 2005 843 million people, 12.5% of the
population, were hungry and over a billion lived on less than $1.25 a day, in
2009 after the economic crisis the number of hungry people rose to 18%, 1.2
billion people, and the number of people living on less than $1.25 a day rose
from 21.5% in 2007 to 22.9% in 2009. The other goals, education,
gender equality, and water and sanitation are on track and the spread of the
HIV/AIDS pandemic has been reversed. Official Development Assistance
(ODA) growth must be sustained to achieve the intermediate target of 0.7% of
GDP on the way to a 1% social security style payroll tax for international
development. Change voting at the Bretton Woods institutions from
contribution based to population based, a one person one vote system. To
end dependency upon the U.S. dollar as the international reserve currency IMF
Special Drawing Rights (SDR) shall be the international reserve currency. To
improve global public health, diplomacy and reputation the U.S. shall change
the name of Title 6 of the US Code and CFR from Domestic Security and Homeland
Security to Customs, amend Title 22 Foreign Relations and Intercourse (a-FRaI-d) to Foreign Relations (FR-ee),
change the name of the Court of International of the United States (COITUS) to
Customs Court (CC). To terminate financing the Israeli/Egyptian US
military finance race, to cease obstructing Palestinian statehood, to purchase
a quota from an Afghan Opium Agency, to terminate all international offices of
the DEA, to hold NATO and UN peacekeeping mission war profiteers accountable
for their crimes, to terminate the UN Peacekeeping Mission in Haiti, to expel
the prosecutors from the Hague, under Monroe doctrine non-entanglement in
European colonial affairs. Furthermore, it is resolved to set down the General
of the United Nations (GUN), elect a Secretary of the UN (SUN), abolish the
Permanent Membership to the Security Council, change ECOSOC to Socio-Economic
Administration, General Assembly to Assembly, Trusteeship to Human Rights
Council and establish an International Tax Administration by ratifying the
Charter of the States of the United Nations (SUN);
to perfect the law and Customs; Quiz…671