Tuesday, July 7, 2009

Prognosis, Handholding and Herr Doktor (No Overlap)



17 comments:

Σφιγξ said...

"Because obesity is associated with lower circulating concentrations of testosterone, our results suggest the hypothesis that androgens may play a more direct role for early-onset or hereditary prostate cancers than for sporadic prostate cancers."

http://www.ncbi.nlm.nih.gov/pubmed/12928350

Σφιγξ said...

http://www.patienthealthinternational.com/83137?itemId=6285641

Σφιγξ said...

The man my mother married, his father, died an agonizing death of prostate cancer with bone and colon metastases. I helped her take care of him.

Σφιγξ said...

You shouldn't ask the question if I could smother you with a pillow like Haneke's Amour (2012), but could you smother me?

No one knows how one will go, but the endings in which I have participated, it did not come to that, and we could all accept the outcome. I tell people never to be a DNR because at least it gives you time to get your family at the bedside, if and when one withdraws care.

Σφιγξ said...

I will never leave the bedside of a person I love. Deciding when to end it is hubris. Usually there is an answer all can accept.

We have had several cancer patients recently; one with metastatic SCLC and one with CRC and a LVAD. One was easy to be around, and one was miserable and screaming at me because I could not give her oxy, when she was nearly obtunded after radiation and chemo that day. I could barely rouse her.

The Rambam states that most doctors go to hell because they lose their empathy, and the recognition that the treatment and recovery is not ultimately in their hands.

Σφιγξ said...

"But they don't use the word
once dropped it might break
They do not say that they have loved
for who can say
We were killed yesterday"

https://soundcloud.com/muterecords/04-youme-meyou

Σφιγξ said...

Exercise 91.

Σφιγξ said...

https://books.google.com/books?id=EtJD6qvyPyoC&pg=PA310&dq=14+iyar+pesach+sheni&hl=en&newbks=1&newbks_redir=0&source=gb_mobile_search&sa=X&ved=2ahUKEwjd39uMm6GGAxXFlYkEHYuqB4I4ChDoAXoECAkQAw#v=onepage&q=14%20iyar%20pesach%20sheni&f=false

Σφιγξ said...

I had trouble sleeping last night because I heard my mother down the corridor coughing, persistently, all night. A cardiac cough. She does not have lower limb edema; more likely central edema, but one of the symptoms of heart failure is dyspnea and persistent cough at night. Not a violent cough; like a throat-clearing cough.


https://cvrti.utah.edu/coughing-and-cardiovascular-health-understanding-the-warning-signs/#:~:text=Regarding%20cardiac%20cough%2C%20the%20body,tries%20to%20eliminate%20by%20coughing.

Due to the fulminant viral infections overlying her COPD in 2023, her symptoms are suggestive that she had chronic inflammation contributing to heart failure. I suggested a 2-D echocardiogram outpatient? This is a noninvasive snapshot of heart pumping efficiency, and it can check for valvular defects.

"For example, it has become apparent that almost 50% of HF patients may have HF with preserved left ventricular (LV) ejection fraction (HFpEF) (3), a disease that represents a diagnostic, prognostic and therapeutic challenge. Echocardiography provides a large amount of detailed information regarding cardiac structure and function in an easily accessible and cost-effective manner and is currently recommended in the diagnostic workup of patients in whom HF cannot be ruled out clinically (4)."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958420/

"The risk of post-discharge incident HF was more pronounced among patients who were young (i.e., <65 years old), White, and those with established cardiovascular disease."

https://www.nature.com/articles/s41467-022-31834-y

I am not one to diagnose a situation, but having the foresight to check issues , and then to take temporizing measures is wisdom.

It seems close to home: she is within four years of your birth cohort. The issues that concern me in my life have happened to many nurses: devastating ischemic stroke from dehydration.

My issues are blood-borne, not heart or lung-related.


*Temporizing measures in my context is almost always hyperkalemia in surgical patients with delayed or in process dialysis. Giving IV insulin, D50W, calcium glucose, and Lokelma, for good measure, prevents life-threatening arrhythmia.

Σφιγξ said...

If the Creator supplies the insight, then there remains the possibility of a treatment.

Humility in all things.

Σφιγξ said...

https://drive.google.com/file/d/1znmScSRzl9jNFmu01fWDS88DAcEFXGt4/view?usp=drivesdk

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8841953/

Σφιγξ said...

Elevendy*

One of the refrains of my generation is how a peer group can accelerate/decelerate one's potential. We were not educated in public school for high school. Keith was, one year, after being expelled.

Elevendy*

Once again, the mother got high and bent her glasses. They spent a day from their vacation plans finding am optometrist to fix her frames. It is agreed that the burden of education will not be on her family.

https://youtu.be/IHYtYE8_bzU?si=mZVnNljaRPIgVTWt

Σφιγξ said...

When I mention that Linda, Keith's de facto MIL, is heading toward long-term care, I do not say it flippantly. She has her divorced spouse's pension, but is it fair that my mother should work and provide her housing in perpetuity? Particularly, when it appears that she will be unable to work? In one week, she is transferring from bed to a wheelchair. As a gesture of good faith, she should be moving around and trying to remain independent.

The ugliness of aging without forethought applies.

The obligations to a spouse or primary relative stipulate different degrees of sacrifice.

Σφιγξ said...

I am leaving it alone. If she is bedbound or if they have fifteen children, then it is in the hands of Hashem. In my incapacity or lack of merit for it to be otherwise, I cede.


https://calicocritters.com/en-us/catalog/item_detail.php?product_id=2556

https://www.barnesandnoble.com/w/fisher-price-thomas-friends-wooden-railway-edward-engine-and-coal-car-fisher-price/1140338902

Σφιγξ said...

She is walking again.

I work a lot in December, and my goals are to finish things at my bachelor hut before I interfere there.

Σφιγξ said...

https://www.ctsnet.org/article/port-access-and-minithoracotomy-mitral-valve-surgery

I had a physician summon me to the bedside of his family member to tell my surgeon that his femoral incision looked like a seroma was forming. I politely told him, with all due respect: the incision is soft circumferentially to palpation (no hematoma); there isn't a mobile mass to suggest a fluid-filled seroma, and isn't professional discourtesy, to critique a colleague's work, uninvited? Pictures had already been taken and forwarded, and that he would be in punctually for bedside rounds 0700.

The general surgeon conceded that this surgeon is the best, that he did his mitral valve repair, sixeen years ago, and he left.

Σφιγξ said...

https://www.newyorker.com/magazine/2008/01/07/outage