Hospitals & Asylums
July 2013
By Anthony J. Sanders
There
will be no moon eclipsing the peak of the Perseid meteor shower this August
11-13. There is supposed to be a full moon party on the 22nd. I
hitched 30 miles and spent $50 to go to a concert and eat last full moon and
I'll be damned if I'm going to spend another penny when there is a rave down
the street to make peace with the neighbors. The wildnerness has
everything I need, wild carrots (yampa), onions, berries, herbal tea,
reasonably priced two pound blocks of pepper jack cheese and friends to share
with. After dropping $250 on "rents" and a new digital
camera last month I am hoping to save enough hiking the Pacific Crest Trail
(PCT) to Crater Lake to buy some solar panels so that I can sit around my
nearly finished 2 ½ ft. wide and 10 ft. long stick table until after fire
season, and the earth oven isn't warm enough to type in a tarp shelter a half
mile from the cross-country ski trail, anymore. With the Internet
more than 10 miles away and sister's 13 miles from wifi 1,000 miles away on
vacation, I don't expect to run into any more writer's block as I cover my book
in human skin and cancer this August-September. Dapsone a treatment for leprosy
was proven effective in treating psoriasis and the skin diseases and burns of
partially gassed Jews in concentration camps by Nazi Germany's last subsidized
dermatologist, who I am loth to convict of war crimes, not to tempt physicians
to test their moral fibre in totalitarian situations better understood by
social workers, the medicine given torture victims is not always safe and
effective. Shaded from the ferocity of the 12-3 pm summer sun that
will suddenly age the skin of 45 year olds, by the hiking trails of the PCT, I
hope to walk 20 miles a day with a 65 pound pack my way from daily long
distance running to five days a week of marathon running. Having
relaced my trail running shoes two days rest a week should be enough for my
blisters to heal in the future. The nearly daily ten mile run to
charge the computer, each way, is a great routine - daybreak to 10-12 am
workout, 10-12 to 3-5 pm typing, and 5-8 pm running hitchhike until I find the
county trailhead off the Forest Service map, and run with a 10-20 pound pack,
or hike in the shade with 65 pound pack and no inside job, 20+ miles a day,
three to six days a week.
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.
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.
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.
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.
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