Sunday, January 29, 2017

Back

No picture made it difficult to post on this forum.  I am alive, and my wife and child celebrate our birthdays on this sunny day.  my Son is 18  I am 60.  I am still seeing patients.  I care for the sick people.  I work in a hospital now.  I have a tablet computer, but i find it had to post messages.  God blw\ess

Sunday, August 28, 2016

Off Topic, Advertising

The internet is bold, old, and dripping with sarcasm, and every other human emotion.One thing I hate is advertising.  It is everywhere you look, or hear.  I am off topic but, I can stand it no longer.  Here is my list of hated ads.  Not in order, but with equal vitriol.

1  Learn More (yeah like we are really interested)
2  Save (spend)
3  Just (like.....really?)
4  Only 19.95  (Bullshit  Try 25.36)
5  Hurry!  (why?)
6  New  (aren't they all new?)
To be continued  TJW

New Small Town

I have not been online for many reasons, the first is that my wife has been ill.  She is recovering.  She had DVT and a PE.  I have changed jobs from one small hospital to another wonderful place in south Texas.  I am warming to the small community slowly as I am only part time for now.  They make great food, and make friends slowly because of the small knit community.  I have a Toshiba machine that I use to take care of my patients.  It is great with the upgrades.  (Xario)  My bitch with this machine is that it is bulky and very hard to take portable.  I prefer to go portable for in house patients, or ER patients.  I am getting cranky in my back as I approach 60 years of age.

Thank you all for following my posts  I will continue

TJW

Thursday, April 7, 2016

Ophthalmic Nerve Sonography: Update

I need to restrain myself.  I have encountered an article which may contain truths, and half truths.  I will try to explain.  The measurements of the ophthalmic nerve for non-invasive evidence of increased intracranial pressure was pioneered by NASA and the Russian Space agency because of issues with astronauts and cosmonauts returning to earth with blurring eye site, and other signs of neural impairments due to the time spent in micro gravity. This has been known for many years.  It is known that micro gravity causes an imbalance in the CSF in the brain and spinal column of astronauts, which can result in strange effects.  These effects, specifically on intracranial pressure have been studied well by many countries participating in the ISIS.  The use of non-invasive ocular ultrasound was demonstrated many years ago, by measuring the diameter of the optic nerve using and ultrasound probe sending sonic waves to image the optic nerve through the closed eye-lid.  I will cite a couple articles:

ISS Science for Everyone
Science Objectives for Everyone 
The Vision Impairment and Intracranial Pressure (VIIP) project examined the effect of long-term exposure to microgravity on the structure of the eye along with change in distance and near vision of crew members before and after they returned to Earth.
Science Results for Everyone 
I can see (less) clearly now. Many astronauts experience poorer vision after flight, some even for years after. A number of studies have looked for causes and distinct physical changes in the eye itself have been found. MRI scans suggest that pressure changes in the brain and spinal fluid caused by weightlessness may be partly to blame. Many astronauts do not show these effects, though, and more advanced imaging techniques may be needed to understand the role of changing brain pressure in microgravity. This in turn will help researchers assess vision problems and develop ways to prevent them.  

This was published 5-13-15

Thanks NASA/gov

Next is a breaking article TODAY!

Breaking News: Ocular Sonography Detects Intracranial Pressure

SoRelle, Ruth MPH

This is so interesting that science journalists lag so far behind the times.

Faced with a patient in the emergency department who might have increased intracranial pressure, Kristi Koenig, MD, reaches for one of her most valuable tools — the ultrasound machine — to rule out the possibility that forces are building inside the skull.

Thanks Live Science

http://journals.lww.com/em-news/Fulltext/2012/08000/Breaking_News__Ocular_Sonography_Detects.3.aspxhttp://journals.lww.com/em-news/Fulltext/2012/08000/Breaking_News__Ocular_Sonography_Detects.3.aspx

Monday, April 4, 2016

URIC ACID, THE ROLE OF ULTRASOUND WHEN THINGS GO WRONG

Most people consider uric acid a nasty lab value associated with gout, and arthritis.  Many people associate it with eating meat,specifically red meat.The early symptoms of gout are linked to a painful great toe, in many cases.  Uric acid build up in the blood can also cause kidney stones.  Many ultrasound examinations are ordered because of renal colic caused by a kidney stone dislodged in to the ureter causing blockage, pain, and sometimes the death of the kidney.  Ultrasound can pick up hydronephrosis, or blockage of the kidney or ureter, but is not very sensitive for finding the source of the blockage.

Here is a short essay courtesy of Live Science regarding the basics of uric acid.

A byproduct of the body's metabolism, uric acid is a human waste product that most people never think about.
But for some people, uric acid can cause painful medical problems such as gout and kidney stones.
To understand what can go wrong with uric acid, you first need to know where this chemical comes from — purines. The purines that break down to form uric acid are nitrogen-containing compounds found in the cells of all plants and animals, including humans.

Thanks Live Science